|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$590.70
|
|
|
Service Code
|
NDC 50742050524
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.14 |
| Max. Negotiated Rate |
$531.63 |
| Rate for Payer: Aetna Commercial |
$502.10
|
| Rate for Payer: Aetna Medicare |
$153.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$184.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$184.59
|
| Rate for Payer: BCBS Complete |
$109.34
|
| Rate for Payer: BCBS MAPPO |
$147.68
|
| Rate for Payer: BCBS Trust/PPO |
$485.61
|
| Rate for Payer: BCN Commercial |
$485.61
|
| Rate for Payer: BCN Medicare Advantage |
$147.68
|
| 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: Health Alliance Plan Medicare Advantage |
$147.68
|
| Rate for Payer: Healthscope Commercial |
$531.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$443.02
|
| Rate for Payer: Mclaren Medicaid |
$104.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.06
|
| Rate for Payer: Meridian Medicaid |
$109.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$162.44
|
| 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: PACE Senior Care Partners |
$140.29
|
| Rate for Payer: PACE SWMI |
$147.68
|
| Rate for Payer: PHP Commercial |
$502.10
|
| Rate for Payer: PHP Medicare Advantage |
$147.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$513.91
|
| Rate for Payer: Priority Health Medicare |
$149.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.13
|
| Rate for Payer: Railroad Medicare Medicare |
$147.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.82
|
| Rate for Payer: UHC Core |
$493.23
|
| Rate for Payer: UHC Exchange |
$147.68
|
| Rate for Payer: UHC Medicaid |
$104.14
|
| Rate for Payer: UHC Medicare Advantage |
$147.68
|
| Rate for Payer: UHCCP Medicaid |
$104.14
|
| Rate for Payer: VA VA |
$147.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$443.02
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$245.68
|
|
|
Service Code
|
NDC 50742050510
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.99 |
| Max. Negotiated Rate |
$221.11 |
| Rate for Payer: Aetna Commercial |
$208.83
|
| Rate for Payer: BCBS Trust/PPO |
$202.91
|
| Rate for Payer: BCN Commercial |
$202.91
|
| 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: Healthscope Commercial |
$221.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.26
|
| 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: PHP Commercial |
$208.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$213.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.20
|
| Rate for Payer: UHC Core |
$205.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.26
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$43.81
|
|
|
Service Code
|
NDC 10019055390
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$39.43 |
| Rate for Payer: Aetna Commercial |
$37.24
|
| Rate for Payer: Aetna Medicare |
$11.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.69
|
| Rate for Payer: BCBS Complete |
$8.11
|
| Rate for Payer: BCBS MAPPO |
$10.95
|
| Rate for Payer: BCBS Trust/PPO |
$36.02
|
| Rate for Payer: BCN Commercial |
$36.02
|
| Rate for Payer: BCN Medicare Advantage |
$10.95
|
| 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: Health Alliance Plan Medicare Advantage |
$10.95
|
| Rate for Payer: Healthscope Commercial |
$39.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.86
|
| Rate for Payer: Mclaren Medicaid |
$7.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.50
|
| Rate for Payer: Meridian Medicaid |
$8.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.05
|
| 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: PACE Senior Care Partners |
$10.40
|
| Rate for Payer: PACE SWMI |
$10.95
|
| Rate for Payer: PHP Commercial |
$37.24
|
| Rate for Payer: PHP Medicare Advantage |
$10.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$38.11
|
| Rate for Payer: Priority Health Medicare |
$11.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.49
|
| Rate for Payer: Railroad Medicare Medicare |
$10.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.55
|
| Rate for Payer: UHC Core |
$36.58
|
| Rate for Payer: UHC Exchange |
$10.95
|
| Rate for Payer: UHC Medicaid |
$7.72
|
| Rate for Payer: UHC Medicare Advantage |
$10.95
|
| Rate for Payer: UHCCP Medicaid |
$7.72
|
| Rate for Payer: VA VA |
$10.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.86
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$63.25
|
|
|
Service Code
|
NDC 00378647016
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.76
|
| Rate for Payer: Aetna Medicare |
$16.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.77
|
| Rate for Payer: BCBS Complete |
$11.71
|
| Rate for Payer: BCBS MAPPO |
$15.81
|
| Rate for Payer: BCBS Trust/PPO |
$52.00
|
| Rate for Payer: BCN Commercial |
$52.00
|
| Rate for Payer: BCN Medicare Advantage |
$15.81
|
| 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: Health Alliance Plan Medicare Advantage |
$15.81
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.44
|
| Rate for Payer: Mclaren Medicaid |
$11.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.60
|
| Rate for Payer: Meridian Medicaid |
$11.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.39
|
| 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: PACE Senior Care Partners |
$15.02
|
| Rate for Payer: PACE SWMI |
$15.81
|
| Rate for Payer: PHP Commercial |
$53.76
|
| Rate for Payer: PHP Medicare Advantage |
$15.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.03
|
| Rate for Payer: Priority Health Medicare |
$15.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.02
|
| Rate for Payer: Railroad Medicare Medicare |
$15.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.66
|
| Rate for Payer: UHC Core |
$52.81
|
| Rate for Payer: UHC Exchange |
$15.81
|
| Rate for Payer: UHC Medicaid |
$11.15
|
| Rate for Payer: UHC Medicare Advantage |
$15.81
|
| Rate for Payer: UHCCP Medicaid |
$11.15
|
| Rate for Payer: VA VA |
$15.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.44
|
|
|
SCREENING OF A PATIENT
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS D0190
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$20.16 |
| Rate for Payer: Aetna Commercial |
$13.35
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Mclaren Medicaid |
$19.20
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.20
|
| Rate for Payer: UHC Medicaid |
$19.20
|
| Rate for Payer: UHCCP Medicaid |
$19.20
|
|
|
SEIZURE
|
Facility
|
IP
|
$6,296.41
|
|
|
Service Code
|
APR-DRG 0533
|
| Min. Negotiated Rate |
$5,996.58 |
| Max. Negotiated Rate |
$6,296.41 |
| Rate for Payer: BCBS Complete |
$6,296.41
|
| Rate for Payer: Mclaren Medicaid |
$5,996.58
|
| Rate for Payer: Meridian Medicaid |
$6,296.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,996.58
|
| Rate for Payer: UHC Medicaid |
$5,996.58
|
| Rate for Payer: UHCCP Medicaid |
$5,996.58
|
|
|
SEIZURE
|
Facility
|
IP
|
$3,310.69
|
|
|
Service Code
|
APR-DRG 0531
|
| Min. Negotiated Rate |
$3,153.04 |
| Max. Negotiated Rate |
$3,310.69 |
| Rate for Payer: BCBS Complete |
$3,310.69
|
| Rate for Payer: Mclaren Medicaid |
$3,153.04
|
| Rate for Payer: Meridian Medicaid |
$3,310.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,153.04
|
| Rate for Payer: UHC Medicaid |
$3,153.04
|
| Rate for Payer: UHCCP Medicaid |
$3,153.04
|
|
|
SEIZURE
|
Facility
|
IP
|
$4,233.01
|
|
|
Service Code
|
APR-DRG 0532
|
| Min. Negotiated Rate |
$4,031.44 |
| Max. Negotiated Rate |
$4,233.01 |
| Rate for Payer: BCBS Complete |
$4,233.01
|
| Rate for Payer: Mclaren Medicaid |
$4,031.44
|
| Rate for Payer: Meridian Medicaid |
$4,233.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,031.44
|
| Rate for Payer: UHC Medicaid |
$4,031.44
|
| Rate for Payer: UHCCP Medicaid |
$4,031.44
|
|
|
SEIZURE
|
Facility
|
IP
|
$12,939.34
|
|
|
Service Code
|
APR-DRG 0534
|
| Min. Negotiated Rate |
$12,323.19 |
| Max. Negotiated Rate |
$12,939.34 |
| Rate for Payer: BCBS Complete |
$12,939.34
|
| Rate for Payer: Mclaren Medicaid |
$12,323.19
|
| Rate for Payer: Meridian Medicaid |
$12,939.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,323.19
|
| Rate for Payer: UHC Medicaid |
$12,323.19
|
| Rate for Payer: UHCCP Medicaid |
$12,323.19
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$88.20
|
|
|
Service Code
|
NDC 09629513881
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: Aetna Commercial |
$74.97
|
| Rate for Payer: Aetna Medicare |
$22.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.56
|
| Rate for Payer: BCBS Complete |
$16.33
|
| Rate for Payer: BCBS MAPPO |
$22.05
|
| Rate for Payer: BCBS Trust/PPO |
$72.51
|
| Rate for Payer: BCN Commercial |
$72.51
|
| Rate for Payer: BCN Medicare Advantage |
$22.05
|
| Rate for Payer: Cash Price |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$75.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.05
|
| Rate for Payer: Healthscope Commercial |
$79.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.15
|
| Rate for Payer: Mclaren Medicaid |
$15.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.15
|
| Rate for Payer: Meridian Medicaid |
$16.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.97
|
| Rate for Payer: Nomi Health Commercial |
$72.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.15
|
| Rate for Payer: PACE Senior Care Partners |
$20.95
|
| Rate for Payer: PACE SWMI |
$22.05
|
| Rate for Payer: PHP Commercial |
$74.97
|
| Rate for Payer: PHP Medicare Advantage |
$22.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.73
|
| Rate for Payer: Priority Health Medicare |
$22.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.39
|
| Rate for Payer: Railroad Medicare Medicare |
$22.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.62
|
| Rate for Payer: UHC Core |
$73.65
|
| Rate for Payer: UHC Exchange |
$22.05
|
| Rate for Payer: UHC Medicaid |
$15.55
|
| Rate for Payer: UHC Medicare Advantage |
$22.05
|
| Rate for Payer: UHCCP Medicaid |
$15.55
|
| Rate for Payer: VA VA |
$22.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.15
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$88.20
|
|
|
Service Code
|
NDC 09629513881
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.39 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: Aetna Commercial |
$74.97
|
| Rate for Payer: BCBS Trust/PPO |
$72.84
|
| Rate for Payer: BCN Commercial |
$72.84
|
| Rate for Payer: Cash Price |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$75.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.56
|
| Rate for Payer: Healthscope Commercial |
$79.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.97
|
| Rate for Payer: Nomi Health Commercial |
$72.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.15
|
| Rate for Payer: PHP Commercial |
$74.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.62
|
| Rate for Payer: UHC Core |
$73.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.15
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
NDC 60687062211
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna Commercial |
$1.36
|
| Rate for Payer: Aetna Medicare |
$0.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.50
|
| Rate for Payer: BCBS Complete |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.32
|
| Rate for Payer: BCN Commercial |
$1.32
|
| Rate for Payer: BCN Medicare Advantage |
$0.40
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cofinity Commercial |
$1.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.40
|
| Rate for Payer: Healthscope Commercial |
$1.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.20
|
| Rate for Payer: Mclaren Medicaid |
$0.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.42
|
| Rate for Payer: Meridian Medicaid |
$0.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.36
|
| Rate for Payer: Nomi Health Commercial |
$1.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.20
|
| Rate for Payer: PACE Senior Care Partners |
$0.38
|
| Rate for Payer: PACE SWMI |
$0.40
|
| Rate for Payer: PHP Commercial |
$1.36
|
| Rate for Payer: PHP Medicare Advantage |
$0.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.39
|
| Rate for Payer: Priority Health Medicare |
$0.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.11
|
| Rate for Payer: Railroad Medicare Medicare |
$0.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.41
|
| Rate for Payer: UHC Core |
$1.34
|
| Rate for Payer: UHC Exchange |
$0.40
|
| Rate for Payer: UHC Medicaid |
$0.28
|
| Rate for Payer: UHC Medicare Advantage |
$0.40
|
| Rate for Payer: UHCCP Medicaid |
$0.28
|
| Rate for Payer: VA VA |
$0.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.20
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
NDC 60687062211
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna Commercial |
$1.36
|
| Rate for Payer: BCBS Trust/PPO |
$1.32
|
| Rate for Payer: BCN Commercial |
$1.32
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cofinity Commercial |
$1.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.28
|
| Rate for Payer: Healthscope Commercial |
$1.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.36
|
| Rate for Payer: Nomi Health Commercial |
$1.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.20
|
| Rate for Payer: PHP Commercial |
$1.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.41
|
| Rate for Payer: UHC Core |
$1.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.20
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$157.50
|
|
|
Service Code
|
NDC 00536124801
|
| Hospital Charge Code |
24216
|
|
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
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$157.50
|
|
|
Service Code
|
NDC 00536124801
|
| Hospital Charge Code |
24216
|
|
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
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$103.62
|
|
|
Service Code
|
NDC 60258095106
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.27 |
| Max. Negotiated Rate |
$93.26 |
| Rate for Payer: Aetna Commercial |
$88.08
|
| Rate for Payer: Aetna Medicare |
$26.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.38
|
| Rate for Payer: BCBS Complete |
$19.18
|
| Rate for Payer: BCBS MAPPO |
$25.91
|
| Rate for Payer: BCBS Trust/PPO |
$85.19
|
| Rate for Payer: BCN Commercial |
$85.19
|
| Rate for Payer: BCN Medicare Advantage |
$25.91
|
| Rate for Payer: Cash Price |
$82.90
|
| Rate for Payer: Cofinity Commercial |
$89.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.91
|
| Rate for Payer: Healthscope Commercial |
$93.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.72
|
| Rate for Payer: Mclaren Medicaid |
$18.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.20
|
| Rate for Payer: Meridian Medicaid |
$19.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.08
|
| Rate for Payer: Nomi Health Commercial |
$84.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.72
|
| Rate for Payer: PACE Senior Care Partners |
$24.61
|
| Rate for Payer: PACE SWMI |
$25.91
|
| Rate for Payer: PHP Commercial |
$88.08
|
| Rate for Payer: PHP Medicare Advantage |
$25.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$90.15
|
| Rate for Payer: Priority Health Medicare |
$26.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.12
|
| Rate for Payer: Railroad Medicare Medicare |
$25.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.19
|
| Rate for Payer: UHC Core |
$86.52
|
| Rate for Payer: UHC Exchange |
$25.91
|
| Rate for Payer: UHC Medicaid |
$18.27
|
| Rate for Payer: UHC Medicare Advantage |
$25.91
|
| Rate for Payer: UHCCP Medicaid |
$18.27
|
| Rate for Payer: VA VA |
$25.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.72
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$159.50
|
|
|
Service Code
|
NDC 60687062201
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$143.55 |
| Rate for Payer: Aetna Commercial |
$135.57
|
| Rate for Payer: Aetna Medicare |
$41.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.84
|
| Rate for Payer: BCBS Complete |
$29.52
|
| Rate for Payer: BCBS MAPPO |
$39.88
|
| Rate for Payer: BCBS Trust/PPO |
$131.12
|
| Rate for Payer: BCN Commercial |
$131.12
|
| Rate for Payer: BCN Medicare Advantage |
$39.88
|
| Rate for Payer: Cash Price |
$127.60
|
| Rate for Payer: Cofinity Commercial |
$137.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.88
|
| Rate for Payer: Healthscope Commercial |
$143.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.62
|
| Rate for Payer: Mclaren Medicaid |
$28.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.87
|
| Rate for Payer: Meridian Medicaid |
$29.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.57
|
| Rate for Payer: Nomi Health Commercial |
$130.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.62
|
| Rate for Payer: PACE Senior Care Partners |
$37.88
|
| Rate for Payer: PACE SWMI |
$39.88
|
| Rate for Payer: PHP Commercial |
$135.57
|
| Rate for Payer: PHP Medicare Advantage |
$39.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$138.76
|
| Rate for Payer: Priority Health Medicare |
$40.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.01
|
| Rate for Payer: Railroad Medicare Medicare |
$39.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.36
|
| Rate for Payer: UHC Core |
$133.18
|
| Rate for Payer: UHC Exchange |
$39.88
|
| Rate for Payer: UHC Medicaid |
$28.12
|
| Rate for Payer: UHC Medicare Advantage |
$39.88
|
| Rate for Payer: UHCCP Medicaid |
$28.12
|
| Rate for Payer: VA VA |
$39.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.62
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$103.62
|
|
|
Service Code
|
NDC 60258095106
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$93.26 |
| Rate for Payer: Aetna Commercial |
$88.08
|
| Rate for Payer: BCBS Trust/PPO |
$85.58
|
| Rate for Payer: BCN Commercial |
$85.58
|
| Rate for Payer: Cash Price |
$82.90
|
| Rate for Payer: Cofinity Commercial |
$89.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.90
|
| Rate for Payer: Healthscope Commercial |
$93.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.08
|
| Rate for Payer: Nomi Health Commercial |
$84.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.72
|
| Rate for Payer: PHP Commercial |
$88.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$90.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.19
|
| Rate for Payer: UHC Core |
$86.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.72
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$159.50
|
|
|
Service Code
|
NDC 60687062201
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.01 |
| Max. Negotiated Rate |
$143.55 |
| Rate for Payer: Aetna Commercial |
$135.57
|
| Rate for Payer: BCBS Trust/PPO |
$131.73
|
| Rate for Payer: BCN Commercial |
$131.73
|
| Rate for Payer: Cash Price |
$127.60
|
| Rate for Payer: Cofinity Commercial |
$137.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.60
|
| Rate for Payer: Healthscope Commercial |
$143.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.57
|
| Rate for Payer: Nomi Health Commercial |
$130.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.62
|
| Rate for Payer: PHP Commercial |
$135.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$138.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.36
|
| Rate for Payer: UHC Core |
$133.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.62
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$145.20
|
|
|
Service Code
|
NDC 00904744061
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$130.68 |
| Rate for Payer: Aetna Commercial |
$123.42
|
| Rate for Payer: Aetna Medicare |
$37.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.38
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS MAPPO |
$36.30
|
| Rate for Payer: BCBS Trust/PPO |
$119.37
|
| Rate for Payer: BCN Commercial |
$119.37
|
| Rate for Payer: BCN Medicare Advantage |
$36.30
|
| Rate for Payer: Cash Price |
$116.16
|
| Rate for Payer: Cofinity Commercial |
$124.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.30
|
| Rate for Payer: Healthscope Commercial |
$130.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.90
|
| Rate for Payer: Mclaren Medicaid |
$25.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.12
|
| Rate for Payer: Meridian Medicaid |
$26.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.42
|
| Rate for Payer: Nomi Health Commercial |
$119.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.90
|
| Rate for Payer: PACE Senior Care Partners |
$34.48
|
| Rate for Payer: PACE SWMI |
$36.30
|
| Rate for Payer: PHP Commercial |
$123.42
|
| Rate for Payer: PHP Medicare Advantage |
$36.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.32
|
| Rate for Payer: Priority Health Medicare |
$36.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.06
|
| Rate for Payer: Railroad Medicare Medicare |
$36.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.78
|
| Rate for Payer: UHC Core |
$121.24
|
| Rate for Payer: UHC Exchange |
$36.30
|
| Rate for Payer: UHC Medicaid |
$25.60
|
| Rate for Payer: UHC Medicare Advantage |
$36.30
|
| Rate for Payer: UHCCP Medicaid |
$25.60
|
| Rate for Payer: VA VA |
$36.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.90
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$145.20
|
|
|
Service Code
|
NDC 00904744061
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.06 |
| Max. Negotiated Rate |
$130.68 |
| Rate for Payer: Aetna Commercial |
$123.42
|
| Rate for Payer: BCBS Trust/PPO |
$119.92
|
| Rate for Payer: BCN Commercial |
$119.92
|
| Rate for Payer: Cash Price |
$116.16
|
| Rate for Payer: Cofinity Commercial |
$124.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.16
|
| Rate for Payer: Healthscope Commercial |
$130.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.42
|
| Rate for Payer: Nomi Health Commercial |
$119.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.90
|
| Rate for Payer: PHP Commercial |
$123.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.78
|
| Rate for Payer: UHC Core |
$121.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.90
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$163.80
|
|
|
Service Code
|
NDC 51645085101
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$147.42 |
| Rate for Payer: Aetna Commercial |
$139.23
|
| Rate for Payer: BCBS Trust/PPO |
$135.28
|
| Rate for Payer: BCN Commercial |
$135.28
|
| Rate for Payer: Cash Price |
$131.04
|
| Rate for Payer: Cofinity Commercial |
$140.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.04
|
| Rate for Payer: Healthscope Commercial |
$147.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.23
|
| Rate for Payer: Nomi Health Commercial |
$134.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.85
|
| Rate for Payer: PHP Commercial |
$139.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$142.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.14
|
| Rate for Payer: UHC Core |
$136.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.85
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
NDC 00904652261
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: Aetna Medicare |
$34.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.25
|
| Rate for Payer: BCBS Complete |
$24.43
|
| Rate for Payer: BCBS MAPPO |
$33.00
|
| Rate for Payer: BCBS Trust/PPO |
$108.52
|
| Rate for Payer: BCN Commercial |
$108.52
|
| Rate for Payer: BCN Medicare Advantage |
$33.00
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.00
|
| Rate for Payer: Healthscope Commercial |
$118.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
| Rate for Payer: Mclaren Medicaid |
$23.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.65
|
| Rate for Payer: Meridian Medicaid |
$24.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.20
|
| Rate for Payer: Nomi Health Commercial |
$108.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.00
|
| Rate for Payer: PACE Senior Care Partners |
$31.35
|
| Rate for Payer: PACE SWMI |
$33.00
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: PHP Medicare Advantage |
$33.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$114.84
|
| Rate for Payer: Priority Health Medicare |
$33.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.87
|
| Rate for Payer: Railroad Medicare Medicare |
$33.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.16
|
| Rate for Payer: UHC Core |
$110.22
|
| Rate for Payer: UHC Exchange |
$33.00
|
| Rate for Payer: UHC Medicaid |
$23.27
|
| Rate for Payer: UHC Medicare Advantage |
$33.00
|
| Rate for Payer: UHCCP Medicaid |
$23.27
|
| Rate for Payer: VA VA |
$33.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$132.30
|
|
|
Service Code
|
NDC 00904672559
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.08 |
| Max. Negotiated Rate |
$119.07 |
| Rate for Payer: Aetna Commercial |
$112.45
|
| Rate for Payer: BCBS Trust/PPO |
$109.27
|
| Rate for Payer: BCN Commercial |
$109.27
|
| Rate for Payer: Cash Price |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$113.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.84
|
| Rate for Payer: Healthscope Commercial |
$119.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.45
|
| Rate for Payer: Nomi Health Commercial |
$108.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.22
|
| Rate for Payer: PHP Commercial |
$112.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$115.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.42
|
| Rate for Payer: UHC Core |
$110.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.22
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$163.80
|
|
|
Service Code
|
NDC 37864000033
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.88 |
| Max. Negotiated Rate |
$147.42 |
| Rate for Payer: Aetna Commercial |
$139.23
|
| Rate for Payer: Aetna Medicare |
$42.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.19
|
| Rate for Payer: BCBS Complete |
$30.32
|
| Rate for Payer: BCBS MAPPO |
$40.95
|
| Rate for Payer: BCBS Trust/PPO |
$134.66
|
| Rate for Payer: BCN Commercial |
$134.66
|
| Rate for Payer: BCN Medicare Advantage |
$40.95
|
| Rate for Payer: Cash Price |
$131.04
|
| Rate for Payer: Cofinity Commercial |
$140.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.95
|
| Rate for Payer: Healthscope Commercial |
$147.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.85
|
| Rate for Payer: Mclaren Medicaid |
$28.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.00
|
| Rate for Payer: Meridian Medicaid |
$30.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.23
|
| Rate for Payer: Nomi Health Commercial |
$134.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.85
|
| Rate for Payer: PACE Senior Care Partners |
$38.90
|
| Rate for Payer: PACE SWMI |
$40.95
|
| Rate for Payer: PHP Commercial |
$139.23
|
| Rate for Payer: PHP Medicare Advantage |
$40.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$142.51
|
| Rate for Payer: Priority Health Medicare |
$41.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.00
|
| Rate for Payer: Railroad Medicare Medicare |
$40.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.14
|
| Rate for Payer: UHC Core |
$136.77
|
| Rate for Payer: UHC Exchange |
$40.95
|
| Rate for Payer: UHC Medicaid |
$28.88
|
| Rate for Payer: UHC Medicare Advantage |
$40.95
|
| Rate for Payer: UHCCP Medicaid |
$28.88
|
| Rate for Payer: VA VA |
$40.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.85
|
|
