|
ROSUVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$5.48
|
|
|
Service Code
|
NDC 60687025611
|
| Hospital Charge Code |
35135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Aetna Commercial |
$4.66
|
| Rate for Payer: BCBS Trust/PPO |
$4.53
|
| Rate for Payer: BCN Commercial |
$4.53
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cofinity Commercial |
$4.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$4.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.66
|
| Rate for Payer: Nomi Health Commercial |
$4.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.11
|
| Rate for Payer: PHP Commercial |
$4.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.82
|
| Rate for Payer: UHC Core |
$4.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.11
|
|
|
ROSUVASTATIN 5 MG TABLET
|
Facility
|
OP
|
$93.06
|
|
|
Service Code
|
NDC 68462026190
|
| Hospital Charge Code |
36612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$83.75 |
| Rate for Payer: Aetna Commercial |
$79.10
|
| Rate for Payer: Aetna Medicare |
$24.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.08
|
| Rate for Payer: BCBS Complete |
$17.23
|
| Rate for Payer: BCBS MAPPO |
$23.27
|
| Rate for Payer: BCBS Trust/PPO |
$76.50
|
| Rate for Payer: BCN Commercial |
$76.50
|
| Rate for Payer: BCN Medicare Advantage |
$23.27
|
| Rate for Payer: Cash Price |
$74.45
|
| Rate for Payer: Cofinity Commercial |
$80.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.27
|
| Rate for Payer: Healthscope Commercial |
$83.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.80
|
| Rate for Payer: Mclaren Medicaid |
$16.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.43
|
| Rate for Payer: Meridian Medicaid |
$17.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.10
|
| Rate for Payer: Nomi Health Commercial |
$76.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.80
|
| Rate for Payer: PACE Senior Care Partners |
$22.10
|
| Rate for Payer: PACE SWMI |
$23.27
|
| Rate for Payer: PHP Commercial |
$79.10
|
| Rate for Payer: PHP Medicare Advantage |
$23.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$80.96
|
| Rate for Payer: Priority Health Medicare |
$23.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.77
|
| Rate for Payer: Railroad Medicare Medicare |
$23.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.89
|
| Rate for Payer: UHC Core |
$77.71
|
| Rate for Payer: UHC Exchange |
$23.27
|
| Rate for Payer: UHC Medicaid |
$16.41
|
| Rate for Payer: UHC Medicare Advantage |
$23.27
|
| Rate for Payer: UHCCP Medicaid |
$16.41
|
| Rate for Payer: VA VA |
$23.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.80
|
|
|
ROSUVASTATIN 5 MG TABLET
|
Facility
|
IP
|
$93.06
|
|
|
Service Code
|
NDC 68462026190
|
| Hospital Charge Code |
36612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.77 |
| Max. Negotiated Rate |
$83.75 |
| Rate for Payer: Aetna Commercial |
$79.10
|
| Rate for Payer: BCBS Trust/PPO |
$76.86
|
| Rate for Payer: BCN Commercial |
$76.86
|
| Rate for Payer: Cash Price |
$74.45
|
| Rate for Payer: Cofinity Commercial |
$80.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.45
|
| Rate for Payer: Healthscope Commercial |
$83.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.10
|
| Rate for Payer: Nomi Health Commercial |
$76.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.80
|
| Rate for Payer: PHP Commercial |
$79.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$80.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.89
|
| Rate for Payer: UHC Core |
$77.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.80
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
IP
|
$2,499.50
|
|
|
Service Code
|
NDC 00078065920
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,739.65 |
| Max. Negotiated Rate |
$2,249.55 |
| Rate for Payer: Aetna Commercial |
$2,124.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,064.34
|
| Rate for Payer: BCN Commercial |
$2,064.34
|
| Rate for Payer: Cash Price |
$1,999.60
|
| Rate for Payer: Cofinity Commercial |
$2,149.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,999.60
|
| Rate for Payer: Healthscope Commercial |
$2,249.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,874.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,124.57
|
| Rate for Payer: Nomi Health Commercial |
$2,049.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,874.62
|
| Rate for Payer: PHP Commercial |
$2,124.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,174.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,739.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,199.56
|
| Rate for Payer: UHC Core |
$2,087.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,874.62
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
OP
|
$2,499.50
|
|
|
Service Code
|
NDC 00078065920
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$440.66 |
| Max. Negotiated Rate |
$2,249.55 |
| Rate for Payer: Aetna Commercial |
$2,124.57
|
| Rate for Payer: Aetna Medicare |
$649.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.09
|
| Rate for Payer: BCBS Complete |
$462.66
|
| Rate for Payer: BCBS MAPPO |
$624.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,054.84
|
| Rate for Payer: BCN Commercial |
$2,054.84
|
| Rate for Payer: BCN Medicare Advantage |
$624.88
|
| Rate for Payer: Cash Price |
$1,999.60
|
| Rate for Payer: Cofinity Commercial |
$2,149.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,999.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.88
|
| Rate for Payer: Healthscope Commercial |
$2,249.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,874.62
|
| Rate for Payer: Mclaren Medicaid |
$440.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.12
|
| Rate for Payer: Meridian Medicaid |
$462.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$718.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,124.57
|
| Rate for Payer: Nomi Health Commercial |
$2,049.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,874.62
|
| Rate for Payer: PACE Senior Care Partners |
$593.63
|
| Rate for Payer: PACE SWMI |
$624.88
|
| Rate for Payer: PHP Commercial |
$2,124.57
|
| Rate for Payer: PHP Medicare Advantage |
$624.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,174.57
|
| Rate for Payer: Priority Health Medicare |
$631.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,739.65
|
| Rate for Payer: Railroad Medicare Medicare |
$624.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,199.56
|
| Rate for Payer: UHC Core |
$2,087.08
|
| Rate for Payer: UHC Exchange |
$624.88
|
| Rate for Payer: UHC Medicaid |
$440.66
|
| Rate for Payer: UHC Medicare Advantage |
$624.88
|
| Rate for Payer: UHCCP Medicaid |
$440.66
|
| Rate for Payer: VA VA |
$624.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,874.62
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET
|
Facility
|
IP
|
$2,499.50
|
|
|
Service Code
|
NDC 00078077720
|
| Hospital Charge Code |
174640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,739.65 |
| Max. Negotiated Rate |
$2,249.55 |
| Rate for Payer: Aetna Commercial |
$2,124.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,064.34
|
| Rate for Payer: BCN Commercial |
$2,064.34
|
| Rate for Payer: Cash Price |
$1,999.60
|
| Rate for Payer: Cofinity Commercial |
$2,149.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,999.60
|
| Rate for Payer: Healthscope Commercial |
$2,249.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,874.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,124.57
|
| Rate for Payer: Nomi Health Commercial |
$2,049.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,874.62
|
| Rate for Payer: PHP Commercial |
$2,124.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,174.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,739.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,199.56
|
| Rate for Payer: UHC Core |
$2,087.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,874.62
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET
|
Facility
|
OP
|
$2,499.50
|
|
|
Service Code
|
NDC 00078077720
|
| Hospital Charge Code |
174640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$440.66 |
| Max. Negotiated Rate |
$2,249.55 |
| Rate for Payer: Aetna Commercial |
$2,124.57
|
| Rate for Payer: Aetna Medicare |
$649.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.09
|
| Rate for Payer: BCBS Complete |
$462.66
|
| Rate for Payer: BCBS MAPPO |
$624.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,054.84
|
| Rate for Payer: BCN Commercial |
$2,054.84
|
| Rate for Payer: BCN Medicare Advantage |
$624.88
|
| Rate for Payer: Cash Price |
$1,999.60
|
| Rate for Payer: Cofinity Commercial |
$2,149.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,999.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.88
|
| Rate for Payer: Healthscope Commercial |
$2,249.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,874.62
|
| Rate for Payer: Mclaren Medicaid |
$440.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.12
|
| Rate for Payer: Meridian Medicaid |
$462.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$718.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,124.57
|
| Rate for Payer: Nomi Health Commercial |
$2,049.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,874.62
|
| Rate for Payer: PACE Senior Care Partners |
$593.63
|
| Rate for Payer: PACE SWMI |
$624.88
|
| Rate for Payer: PHP Commercial |
$2,124.57
|
| Rate for Payer: PHP Medicare Advantage |
$624.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,174.57
|
| Rate for Payer: Priority Health Medicare |
$631.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,739.65
|
| Rate for Payer: Railroad Medicare Medicare |
$624.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,199.56
|
| Rate for Payer: UHC Core |
$2,087.08
|
| Rate for Payer: UHC Exchange |
$624.88
|
| Rate for Payer: UHC Medicaid |
$440.66
|
| Rate for Payer: UHC Medicare Advantage |
$624.88
|
| Rate for Payer: UHCCP Medicaid |
$440.66
|
| Rate for Payer: VA VA |
$624.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,874.62
|
|
|
SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
NDC 48582000155
|
| Hospital Charge Code |
118454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Medicare |
$6.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.80
|
| Rate for Payer: BCBS Complete |
$4.62
|
| Rate for Payer: BCBS MAPPO |
$6.24
|
| Rate for Payer: BCBS Trust/PPO |
$20.53
|
| Rate for Payer: BCN Commercial |
$20.53
|
| Rate for Payer: BCN Medicare Advantage |
$6.24
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.24
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$4.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.55
|
| Rate for Payer: Meridian Medicaid |
$4.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.73
|
| Rate for Payer: PACE Senior Care Partners |
$5.93
|
| Rate for Payer: PACE SWMI |
$6.24
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: PHP Medicare Advantage |
$6.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.72
|
| Rate for Payer: Priority Health Medicare |
$6.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.38
|
| Rate for Payer: Railroad Medicare Medicare |
$6.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.97
|
| Rate for Payer: UHC Core |
$20.85
|
| Rate for Payer: UHC Exchange |
$6.24
|
| Rate for Payer: UHC Medicaid |
$4.40
|
| Rate for Payer: UHC Medicare Advantage |
$6.24
|
| Rate for Payer: UHCCP Medicaid |
$4.40
|
| Rate for Payer: VA VA |
$6.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
NDC 48582000155
|
| Hospital Charge Code |
118454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.62
|
| Rate for Payer: BCN Commercial |
$20.62
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.73
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.97
|
| Rate for Payer: UHC Core |
$20.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$3,436.36
|
|
|
Service Code
|
APR-DRG 7611
|
| Min. Negotiated Rate |
$3,272.73 |
| Max. Negotiated Rate |
$3,436.36 |
| Rate for Payer: BCBS Complete |
$3,436.36
|
| Rate for Payer: Mclaren Medicaid |
$3,272.73
|
| Rate for Payer: Meridian Medicaid |
$3,436.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,272.73
|
| Rate for Payer: UHC Medicaid |
$3,272.73
|
| Rate for Payer: UHCCP Medicaid |
$3,272.73
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$3,737.14
|
|
|
Service Code
|
APR-DRG 7612
|
| Min. Negotiated Rate |
$3,559.19 |
| Max. Negotiated Rate |
$3,737.14 |
| Rate for Payer: BCBS Complete |
$3,737.14
|
| Rate for Payer: Mclaren Medicaid |
$3,559.19
|
| Rate for Payer: Meridian Medicaid |
$3,737.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,559.19
|
| Rate for Payer: UHC Medicaid |
$3,559.19
|
| Rate for Payer: UHCCP Medicaid |
$3,559.19
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$11,656.30
|
|
|
Service Code
|
APR-DRG 7614
|
| Min. Negotiated Rate |
$11,101.23 |
| Max. Negotiated Rate |
$11,656.30 |
| Rate for Payer: BCBS Complete |
$11,656.30
|
| Rate for Payer: Mclaren Medicaid |
$11,101.23
|
| Rate for Payer: Meridian Medicaid |
$11,656.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,101.23
|
| Rate for Payer: UHC Medicaid |
$11,101.23
|
| Rate for Payer: UHCCP Medicaid |
$11,101.23
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$6,795.96
|
|
|
Service Code
|
APR-DRG 7613
|
| Min. Negotiated Rate |
$6,472.34 |
| Max. Negotiated Rate |
$6,795.96 |
| Rate for Payer: BCBS Complete |
$6,795.96
|
| Rate for Payer: Mclaren Medicaid |
$6,472.34
|
| Rate for Payer: Meridian Medicaid |
$6,795.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,472.34
|
| Rate for Payer: UHC Medicaid |
$6,472.34
|
| Rate for Payer: UHCCP Medicaid |
$6,472.34
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$6,056.63
|
|
|
Service Code
|
APR-DRG 7503
|
| Min. Negotiated Rate |
$5,768.21 |
| Max. Negotiated Rate |
$6,056.63 |
| Rate for Payer: BCBS Complete |
$6,056.63
|
| Rate for Payer: Mclaren Medicaid |
$5,768.21
|
| Rate for Payer: Meridian Medicaid |
$6,056.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,768.21
|
| Rate for Payer: UHC Medicaid |
$5,768.21
|
| Rate for Payer: UHCCP Medicaid |
$5,768.21
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$12,078.02
|
|
|
Service Code
|
APR-DRG 7504
|
| Min. Negotiated Rate |
$11,502.88 |
| Max. Negotiated Rate |
$12,078.02 |
| Rate for Payer: BCBS Complete |
$12,078.02
|
| Rate for Payer: Mclaren Medicaid |
$11,502.88
|
| Rate for Payer: Meridian Medicaid |
$12,078.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,502.88
|
| Rate for Payer: UHC Medicaid |
$11,502.88
|
| Rate for Payer: UHCCP Medicaid |
$11,502.88
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$3,773.43
|
|
|
Service Code
|
APR-DRG 7501
|
| Min. Negotiated Rate |
$3,593.74 |
| Max. Negotiated Rate |
$3,773.43 |
| Rate for Payer: BCBS Complete |
$3,773.43
|
| Rate for Payer: Mclaren Medicaid |
$3,593.74
|
| Rate for Payer: Meridian Medicaid |
$3,773.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,593.74
|
| Rate for Payer: UHC Medicaid |
$3,593.74
|
| Rate for Payer: UHCCP Medicaid |
$3,593.74
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$4,787.25
|
|
|
Service Code
|
APR-DRG 7502
|
| Min. Negotiated Rate |
$4,559.28 |
| Max. Negotiated Rate |
$4,787.25 |
| Rate for Payer: BCBS Complete |
$4,787.25
|
| Rate for Payer: Mclaren Medicaid |
$4,559.28
|
| Rate for Payer: Meridian Medicaid |
$4,787.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,559.28
|
| Rate for Payer: UHC Medicaid |
$4,559.28
|
| Rate for Payer: UHCCP Medicaid |
$4,559.28
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$43.81
|
|
|
Service Code
|
NDC 10019055390
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.49 |
| Max. Negotiated Rate |
$39.43 |
| Rate for Payer: Aetna Commercial |
$37.24
|
| Rate for Payer: BCBS Trust/PPO |
$36.18
|
| Rate for Payer: BCN Commercial |
$36.18
|
| Rate for Payer: Cash Price |
$35.05
|
| Rate for Payer: Cofinity Commercial |
$37.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.05
|
| Rate for Payer: Healthscope Commercial |
$39.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.24
|
| Rate for Payer: Nomi Health Commercial |
$35.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.86
|
| Rate for Payer: PHP Commercial |
$37.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$38.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.55
|
| Rate for Payer: UHC Core |
$36.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.86
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$590.70
|
|
|
Service Code
|
NDC 50742050524
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$411.13 |
| Max. Negotiated Rate |
$531.63 |
| Rate for Payer: Aetna Commercial |
$502.10
|
| Rate for Payer: BCBS Trust/PPO |
$487.86
|
| Rate for Payer: BCN Commercial |
$487.86
|
| Rate for Payer: Cash Price |
$472.56
|
| Rate for Payer: Cofinity Commercial |
$508.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.56
|
| Rate for Payer: Healthscope Commercial |
$531.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$443.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$502.10
|
| Rate for Payer: Nomi Health Commercial |
$484.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$443.02
|
| Rate for Payer: PHP Commercial |
$502.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$513.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.82
|
| Rate for Payer: UHC Core |
$493.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$443.02
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$24.68
|
|
|
Service Code
|
NDC 50742050501
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$22.21 |
| Rate for Payer: Aetna Commercial |
$20.98
|
| Rate for Payer: Aetna Medicare |
$6.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.71
|
| Rate for Payer: BCBS Complete |
$4.57
|
| Rate for Payer: BCBS MAPPO |
$6.17
|
| Rate for Payer: BCBS Trust/PPO |
$20.29
|
| Rate for Payer: BCN Commercial |
$20.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.17
|
| Rate for Payer: Cash Price |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$21.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.17
|
| Rate for Payer: Healthscope Commercial |
$22.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.51
|
| Rate for Payer: Mclaren Medicaid |
$4.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.48
|
| Rate for Payer: Meridian Medicaid |
$4.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.98
|
| Rate for Payer: Nomi Health Commercial |
$20.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.51
|
| Rate for Payer: PACE Senior Care Partners |
$5.86
|
| Rate for Payer: PACE SWMI |
$6.17
|
| Rate for Payer: PHP Commercial |
$20.98
|
| Rate for Payer: PHP Medicare Advantage |
$6.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.47
|
| Rate for Payer: Priority Health Medicare |
$6.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.72
|
| Rate for Payer: UHC Core |
$20.61
|
| Rate for Payer: UHC Exchange |
$6.17
|
| Rate for Payer: UHC Medicaid |
$4.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.17
|
| Rate for Payer: UHCCP Medicaid |
$4.35
|
| Rate for Payer: VA VA |
$6.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.51
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$222.45
|
|
|
Service Code
|
NDC 00378647099
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.22 |
| Max. Negotiated Rate |
$200.21 |
| Rate for Payer: Aetna Commercial |
$189.08
|
| Rate for Payer: Aetna Medicare |
$57.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.52
|
| Rate for Payer: BCBS Complete |
$41.18
|
| Rate for Payer: BCBS MAPPO |
$55.61
|
| Rate for Payer: BCBS Trust/PPO |
$182.88
|
| Rate for Payer: BCN Commercial |
$182.88
|
| Rate for Payer: BCN Medicare Advantage |
$55.61
|
| Rate for Payer: Cash Price |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$191.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.61
|
| Rate for Payer: Healthscope Commercial |
$200.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.84
|
| Rate for Payer: Mclaren Medicaid |
$39.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.39
|
| Rate for Payer: Meridian Medicaid |
$41.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.08
|
| Rate for Payer: Nomi Health Commercial |
$182.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.84
|
| Rate for Payer: PACE Senior Care Partners |
$52.83
|
| Rate for Payer: PACE SWMI |
$55.61
|
| Rate for Payer: PHP Commercial |
$189.08
|
| Rate for Payer: PHP Medicare Advantage |
$55.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$193.53
|
| Rate for Payer: Priority Health Medicare |
$56.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.83
|
| Rate for Payer: Railroad Medicare Medicare |
$55.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.76
|
| Rate for Payer: UHC Core |
$185.75
|
| Rate for Payer: UHC Exchange |
$55.61
|
| Rate for Payer: UHC Medicaid |
$39.22
|
| Rate for Payer: UHC Medicare Advantage |
$55.61
|
| Rate for Payer: UHCCP Medicaid |
$39.22
|
| Rate for Payer: VA VA |
$55.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.84
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$222.45
|
|
|
Service Code
|
NDC 00378647099
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.83 |
| Max. Negotiated Rate |
$200.21 |
| Rate for Payer: Aetna Commercial |
$189.08
|
| Rate for Payer: BCBS Trust/PPO |
$183.72
|
| Rate for Payer: BCN Commercial |
$183.72
|
| Rate for Payer: Cash Price |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$191.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.96
|
| Rate for Payer: Healthscope Commercial |
$200.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.08
|
| Rate for Payer: Nomi Health Commercial |
$182.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.84
|
| Rate for Payer: PHP Commercial |
$189.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$193.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.76
|
| Rate for Payer: UHC Core |
$185.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.84
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$245.68
|
|
|
Service Code
|
NDC 50742050510
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.31 |
| Max. Negotiated Rate |
$221.11 |
| Rate for Payer: Aetna Commercial |
$208.83
|
| Rate for Payer: Aetna Medicare |
$63.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.78
|
| Rate for Payer: BCBS Complete |
$45.48
|
| Rate for Payer: BCBS MAPPO |
$61.42
|
| Rate for Payer: BCBS Trust/PPO |
$201.97
|
| Rate for Payer: BCN Commercial |
$201.97
|
| Rate for Payer: BCN Medicare Advantage |
$61.42
|
| Rate for Payer: Cash Price |
$196.54
|
| Rate for Payer: Cofinity Commercial |
$211.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.42
|
| Rate for Payer: Healthscope Commercial |
$221.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.26
|
| Rate for Payer: Mclaren Medicaid |
$43.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.49
|
| Rate for Payer: Meridian Medicaid |
$45.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.83
|
| Rate for Payer: Nomi Health Commercial |
$201.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.26
|
| Rate for Payer: PACE Senior Care Partners |
$58.35
|
| Rate for Payer: PACE SWMI |
$61.42
|
| Rate for Payer: PHP Commercial |
$208.83
|
| Rate for Payer: PHP Medicare Advantage |
$61.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$213.74
|
| Rate for Payer: Priority Health Medicare |
$62.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.99
|
| Rate for Payer: Railroad Medicare Medicare |
$61.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.20
|
| Rate for Payer: UHC Core |
$205.14
|
| Rate for Payer: UHC Exchange |
$61.42
|
| Rate for Payer: UHC Medicaid |
$43.31
|
| Rate for Payer: UHC Medicare Advantage |
$61.42
|
| Rate for Payer: UHCCP Medicaid |
$43.31
|
| Rate for Payer: VA VA |
$61.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.26
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$63.25
|
|
|
Service Code
|
NDC 00378647016
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.02 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.76
|
| Rate for Payer: BCBS Trust/PPO |
$52.24
|
| Rate for Payer: BCN Commercial |
$52.24
|
| Rate for Payer: Cash Price |
$50.60
|
| Rate for Payer: Cofinity Commercial |
$54.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.60
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.76
|
| Rate for Payer: Nomi Health Commercial |
$51.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.44
|
| Rate for Payer: PHP Commercial |
$53.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.66
|
| Rate for Payer: UHC Core |
$52.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.44
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$24.68
|
|
|
Service Code
|
NDC 50742050501
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$22.21 |
| Rate for Payer: Aetna Commercial |
$20.98
|
| Rate for Payer: BCBS Trust/PPO |
$20.38
|
| Rate for Payer: BCN Commercial |
$20.38
|
| Rate for Payer: Cash Price |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$21.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.74
|
| Rate for Payer: Healthscope Commercial |
$22.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.98
|
| Rate for Payer: Nomi Health Commercial |
$20.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.51
|
| Rate for Payer: PHP Commercial |
$20.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.72
|
| Rate for Payer: UHC Core |
$20.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.51
|
|
