|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$149.10
|
|
|
Service Code
|
NDC 67618030010
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.77 |
| Max. Negotiated Rate |
$134.19 |
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: BCBS Trust/PPO |
$123.14
|
| Rate for Payer: BCN Commercial |
$123.14
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cofinity Commercial |
$128.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.28
|
| Rate for Payer: Healthscope Commercial |
$134.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.73
|
| Rate for Payer: Nomi Health Commercial |
$122.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.83
|
| Rate for Payer: PHP Commercial |
$126.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$129.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.21
|
| Rate for Payer: UHC Core |
$124.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.83
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$132.30
|
|
|
Service Code
|
NDC 00904672559
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$119.07 |
| Rate for Payer: Aetna Commercial |
$112.45
|
| Rate for Payer: Aetna Medicare |
$34.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.34
|
| Rate for Payer: BCBS Complete |
$24.49
|
| Rate for Payer: BCBS MAPPO |
$33.08
|
| Rate for Payer: BCBS Trust/PPO |
$108.76
|
| Rate for Payer: BCN Commercial |
$108.76
|
| Rate for Payer: BCN Medicare Advantage |
$33.08
|
| 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: Health Alliance Plan Medicare Advantage |
$33.08
|
| Rate for Payer: Healthscope Commercial |
$119.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.22
|
| Rate for Payer: Mclaren Medicaid |
$23.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.73
|
| Rate for Payer: Meridian Medicaid |
$24.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.38
|
| 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: PACE Senior Care Partners |
$31.42
|
| Rate for Payer: PACE SWMI |
$33.08
|
| Rate for Payer: PHP Commercial |
$112.45
|
| Rate for Payer: PHP Medicare Advantage |
$33.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$115.10
|
| Rate for Payer: Priority Health Medicare |
$33.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.08
|
| Rate for Payer: Railroad Medicare Medicare |
$33.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.42
|
| Rate for Payer: UHC Core |
$110.47
|
| Rate for Payer: UHC Exchange |
$33.08
|
| Rate for Payer: UHC Medicaid |
$23.32
|
| Rate for Payer: UHC Medicare Advantage |
$33.08
|
| Rate for Payer: UHCCP Medicaid |
$23.32
|
| Rate for Payer: VA VA |
$33.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.22
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$163.80
|
|
|
Service Code
|
NDC 37864000033
|
| 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
|
$163.80
|
|
|
Service Code
|
NDC 51645085101
|
| 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
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
NDC 00904652261
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.87 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: BCBS Trust/PPO |
$109.02
|
| Rate for Payer: BCN Commercial |
$109.02
|
| 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: Healthscope Commercial |
$118.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
| 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: PHP Commercial |
$112.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$114.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.16
|
| Rate for Payer: UHC Core |
$110.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
NDC 70000044702
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.18 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: BCBS Trust/PPO |
$127.19
|
| Rate for Payer: BCN Commercial |
$127.19
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cofinity Commercial |
$132.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.20
|
| Rate for Payer: Healthscope Commercial |
$138.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.90
|
| Rate for Payer: Nomi Health Commercial |
$126.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.50
|
| Rate for Payer: PHP Commercial |
$130.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.52
|
| Rate for Payer: UHC Core |
$128.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.50
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$149.10
|
|
|
Service Code
|
NDC 67618030010
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$134.19 |
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: Aetna Medicare |
$38.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.59
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCBS MAPPO |
$37.27
|
| Rate for Payer: BCBS Trust/PPO |
$122.58
|
| Rate for Payer: BCN Commercial |
$122.58
|
| Rate for Payer: BCN Medicare Advantage |
$37.27
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cofinity Commercial |
$128.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.27
|
| Rate for Payer: Healthscope Commercial |
$134.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.83
|
| Rate for Payer: Mclaren Medicaid |
$26.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.14
|
| Rate for Payer: Meridian Medicaid |
$27.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.73
|
| Rate for Payer: Nomi Health Commercial |
$122.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.83
|
| Rate for Payer: PACE Senior Care Partners |
$35.41
|
| Rate for Payer: PACE SWMI |
$37.27
|
| Rate for Payer: PHP Commercial |
$126.73
|
| Rate for Payer: PHP Medicare Advantage |
$37.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$129.72
|
| Rate for Payer: Priority Health Medicare |
$37.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.77
|
| Rate for Payer: Railroad Medicare Medicare |
$37.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.21
|
| Rate for Payer: UHC Core |
$124.50
|
| Rate for Payer: UHC Exchange |
$37.27
|
| Rate for Payer: UHC Medicaid |
$26.29
|
| Rate for Payer: UHC Medicare Advantage |
$37.27
|
| Rate for Payer: UHCCP Medicaid |
$26.29
|
| Rate for Payer: VA VA |
$37.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.83
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
NDC 70000044702
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: Aetna Medicare |
$40.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.12
|
| Rate for Payer: BCBS Complete |
$28.51
|
| Rate for Payer: BCBS MAPPO |
$38.50
|
| Rate for Payer: BCBS Trust/PPO |
$126.60
|
| Rate for Payer: BCN Commercial |
$126.60
|
| Rate for Payer: BCN Medicare Advantage |
$38.50
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cofinity Commercial |
$132.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.50
|
| Rate for Payer: Healthscope Commercial |
$138.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.50
|
| Rate for Payer: Mclaren Medicaid |
$27.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.42
|
| Rate for Payer: Meridian Medicaid |
$28.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.90
|
| Rate for Payer: Nomi Health Commercial |
$126.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.50
|
| Rate for Payer: PACE Senior Care Partners |
$36.58
|
| Rate for Payer: PACE SWMI |
$38.50
|
| Rate for Payer: PHP Commercial |
$130.90
|
| Rate for Payer: PHP Medicare Advantage |
$38.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.98
|
| Rate for Payer: Priority Health Medicare |
$38.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.18
|
| Rate for Payer: Railroad Medicare Medicare |
$38.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.52
|
| Rate for Payer: UHC Core |
$128.59
|
| Rate for Payer: UHC Exchange |
$38.50
|
| Rate for Payer: UHC Medicaid |
$27.15
|
| Rate for Payer: UHC Medicare Advantage |
$38.50
|
| Rate for Payer: UHCCP Medicaid |
$27.15
|
| Rate for Payer: VA VA |
$38.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.50
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
NDC 00904725261
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna Medicare |
$38.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.25
|
| Rate for Payer: BCBS Complete |
$27.39
|
| Rate for Payer: BCBS MAPPO |
$37.00
|
| Rate for Payer: BCBS Trust/PPO |
$121.67
|
| Rate for Payer: BCN Commercial |
$121.67
|
| Rate for Payer: BCN Medicare Advantage |
$37.00
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.00
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Mclaren Medicaid |
$26.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.85
|
| Rate for Payer: Meridian Medicaid |
$27.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Nomi Health Commercial |
$121.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PACE Senior Care Partners |
$35.15
|
| Rate for Payer: PACE SWMI |
$37.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: PHP Medicare Advantage |
$37.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.76
|
| Rate for Payer: Priority Health Medicare |
$37.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.01
|
| Rate for Payer: Railroad Medicare Medicare |
$37.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.24
|
| Rate for Payer: UHC Core |
$123.58
|
| Rate for Payer: UHC Exchange |
$37.00
|
| Rate for Payer: UHC Medicaid |
$26.09
|
| Rate for Payer: UHC Medicare Advantage |
$37.00
|
| Rate for Payer: UHCCP Medicaid |
$26.09
|
| Rate for Payer: VA VA |
$37.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
NDC 00904725261
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.01 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: BCBS Trust/PPO |
$122.23
|
| Rate for Payer: BCN Commercial |
$122.23
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Nomi Health Commercial |
$121.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.24
|
| Rate for Payer: UHC Core |
$123.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
IP
|
$3,627.24
|
|
|
Service Code
|
APR-DRG 7201
|
| Min. Negotiated Rate |
$3,454.52 |
| Max. Negotiated Rate |
$3,627.24 |
| Rate for Payer: BCBS Complete |
$3,627.24
|
| Rate for Payer: Mclaren Medicaid |
$3,454.52
|
| Rate for Payer: Meridian Medicaid |
$3,627.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,454.52
|
| Rate for Payer: UHC Medicaid |
$3,454.52
|
| Rate for Payer: UHCCP Medicaid |
$3,454.52
|
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
IP
|
$6,235.41
|
|
|
Service Code
|
APR-DRG 7203
|
| Min. Negotiated Rate |
$5,938.49 |
| Max. Negotiated Rate |
$6,235.41 |
| Rate for Payer: BCBS Complete |
$6,235.41
|
| Rate for Payer: Mclaren Medicaid |
$5,938.49
|
| Rate for Payer: Meridian Medicaid |
$6,235.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,938.49
|
| Rate for Payer: UHC Medicaid |
$5,938.49
|
| Rate for Payer: UHCCP Medicaid |
$5,938.49
|
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
IP
|
$4,105.23
|
|
|
Service Code
|
APR-DRG 7202
|
| Min. Negotiated Rate |
$3,909.75 |
| Max. Negotiated Rate |
$4,105.23 |
| Rate for Payer: BCBS Complete |
$4,105.23
|
| Rate for Payer: Mclaren Medicaid |
$3,909.75
|
| Rate for Payer: Meridian Medicaid |
$4,105.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,909.75
|
| Rate for Payer: UHC Medicaid |
$3,909.75
|
| Rate for Payer: UHCCP Medicaid |
$3,909.75
|
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
IP
|
$12,273.63
|
|
|
Service Code
|
APR-DRG 7204
|
| Min. Negotiated Rate |
$11,689.17 |
| Max. Negotiated Rate |
$12,273.63 |
| Rate for Payer: BCBS Complete |
$12,273.63
|
| Rate for Payer: Mclaren Medicaid |
$11,689.17
|
| Rate for Payer: Meridian Medicaid |
$12,273.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,689.17
|
| Rate for Payer: UHC Medicaid |
$11,689.17
|
| Rate for Payer: UHCCP Medicaid |
$11,689.17
|
|
|
SERTRALINE 100 MG TABLET
|
Facility
|
OP
|
$3.52
|
|
|
Service Code
|
NDC 60687025311
|
| Hospital Charge Code |
11350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Aetna Commercial |
$2.99
|
| Rate for Payer: Aetna Medicare |
$0.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.10
|
| Rate for Payer: BCBS Complete |
$0.65
|
| Rate for Payer: BCBS MAPPO |
$0.88
|
| Rate for Payer: BCBS Trust/PPO |
$2.89
|
| Rate for Payer: BCN Commercial |
$2.89
|
| Rate for Payer: BCN Medicare Advantage |
$0.88
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cofinity Commercial |
$3.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.88
|
| Rate for Payer: Healthscope Commercial |
$3.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.64
|
| Rate for Payer: Mclaren Medicaid |
$0.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.92
|
| Rate for Payer: Meridian Medicaid |
$0.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.99
|
| Rate for Payer: Nomi Health Commercial |
$2.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.64
|
| Rate for Payer: PACE Senior Care Partners |
$0.84
|
| Rate for Payer: PACE SWMI |
$0.88
|
| Rate for Payer: PHP Commercial |
$2.99
|
| Rate for Payer: PHP Medicare Advantage |
$0.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.06
|
| Rate for Payer: Priority Health Medicare |
$0.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.45
|
| Rate for Payer: Railroad Medicare Medicare |
$0.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.10
|
| Rate for Payer: UHC Core |
$2.94
|
| Rate for Payer: UHC Exchange |
$0.88
|
| Rate for Payer: UHC Medicaid |
$0.62
|
| Rate for Payer: UHC Medicare Advantage |
$0.88
|
| Rate for Payer: UHCCP Medicaid |
$0.62
|
| Rate for Payer: VA VA |
$0.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.64
|
|
|
SERTRALINE 100 MG TABLET
|
Facility
|
OP
|
$319.20
|
|
|
Service Code
|
NDC 00904692661
|
| Hospital Charge Code |
11350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.27 |
| Max. Negotiated Rate |
$287.28 |
| Rate for Payer: Aetna Commercial |
$271.32
|
| Rate for Payer: Aetna Medicare |
$82.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.75
|
| Rate for Payer: BCBS Complete |
$59.08
|
| Rate for Payer: BCBS MAPPO |
$79.80
|
| Rate for Payer: BCBS Trust/PPO |
$262.41
|
| Rate for Payer: BCN Commercial |
$262.41
|
| Rate for Payer: BCN Medicare Advantage |
$79.80
|
| Rate for Payer: Cash Price |
$255.36
|
| Rate for Payer: Cofinity Commercial |
$274.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.80
|
| Rate for Payer: Healthscope Commercial |
$287.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.40
|
| Rate for Payer: Mclaren Medicaid |
$56.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.79
|
| Rate for Payer: Meridian Medicaid |
$59.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$87.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.32
|
| Rate for Payer: Nomi Health Commercial |
$261.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$239.40
|
| Rate for Payer: PACE Senior Care Partners |
$75.81
|
| Rate for Payer: PACE SWMI |
$79.80
|
| Rate for Payer: PHP Commercial |
$271.32
|
| Rate for Payer: PHP Medicare Advantage |
$79.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$277.70
|
| Rate for Payer: Priority Health Medicare |
$80.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$222.16
|
| Rate for Payer: Railroad Medicare Medicare |
$79.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.90
|
| Rate for Payer: UHC Core |
$266.53
|
| Rate for Payer: UHC Exchange |
$79.80
|
| Rate for Payer: UHC Medicaid |
$56.27
|
| Rate for Payer: UHC Medicare Advantage |
$79.80
|
| Rate for Payer: UHCCP Medicaid |
$56.27
|
| Rate for Payer: VA VA |
$79.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.40
|
|
|
SERTRALINE 100 MG TABLET
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
NDC 59762491003
|
| Hospital Charge Code |
11350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: BCBS Trust/PPO |
$161.09
|
| Rate for Payer: BCN Commercial |
$161.09
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Nomi Health Commercial |
$159.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$169.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.64
|
| Rate for Payer: UHC Core |
$162.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
SERTRALINE 100 MG TABLET
|
Facility
|
IP
|
$351.50
|
|
|
Service Code
|
NDC 60687025301
|
| Hospital Charge Code |
11350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.64 |
| Max. Negotiated Rate |
$316.35 |
| Rate for Payer: Aetna Commercial |
$298.77
|
| Rate for Payer: BCBS Trust/PPO |
$290.30
|
| Rate for Payer: BCN Commercial |
$290.30
|
| Rate for Payer: Cash Price |
$281.20
|
| Rate for Payer: Cofinity Commercial |
$302.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.20
|
| Rate for Payer: Healthscope Commercial |
$316.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.77
|
| Rate for Payer: Nomi Health Commercial |
$288.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.62
|
| Rate for Payer: PHP Commercial |
$298.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$305.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.32
|
| Rate for Payer: UHC Core |
$293.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.62
|
|
|
SERTRALINE 100 MG TABLET
|
Facility
|
OP
|
$351.50
|
|
|
Service Code
|
NDC 60687025301
|
| Hospital Charge Code |
11350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.97 |
| Max. Negotiated Rate |
$316.35 |
| Rate for Payer: Aetna Commercial |
$298.77
|
| Rate for Payer: Aetna Medicare |
$91.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.84
|
| Rate for Payer: BCBS Complete |
$65.06
|
| Rate for Payer: BCBS MAPPO |
$87.88
|
| Rate for Payer: BCBS Trust/PPO |
$288.97
|
| Rate for Payer: BCN Commercial |
$288.97
|
| Rate for Payer: BCN Medicare Advantage |
$87.88
|
| Rate for Payer: Cash Price |
$281.20
|
| Rate for Payer: Cofinity Commercial |
$302.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.88
|
| Rate for Payer: Healthscope Commercial |
$316.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.62
|
| Rate for Payer: Mclaren Medicaid |
$61.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.27
|
| Rate for Payer: Meridian Medicaid |
$65.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$96.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.77
|
| Rate for Payer: Nomi Health Commercial |
$288.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.62
|
| Rate for Payer: PACE Senior Care Partners |
$83.48
|
| Rate for Payer: PACE SWMI |
$87.88
|
| Rate for Payer: PHP Commercial |
$298.77
|
| Rate for Payer: PHP Medicare Advantage |
$87.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$305.81
|
| Rate for Payer: Priority Health Medicare |
$88.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.64
|
| Rate for Payer: Railroad Medicare Medicare |
$87.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.32
|
| Rate for Payer: UHC Core |
$293.50
|
| Rate for Payer: UHC Exchange |
$87.88
|
| Rate for Payer: UHC Medicaid |
$61.97
|
| Rate for Payer: UHC Medicare Advantage |
$87.88
|
| Rate for Payer: UHCCP Medicaid |
$61.97
|
| Rate for Payer: VA VA |
$87.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.62
|
|
|
SERTRALINE 100 MG TABLET
|
Facility
|
IP
|
$3.52
|
|
|
Service Code
|
NDC 60687025311
|
| Hospital Charge Code |
11350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Aetna Commercial |
$2.99
|
| Rate for Payer: BCBS Trust/PPO |
$2.91
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cofinity Commercial |
$3.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$3.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.99
|
| Rate for Payer: Nomi Health Commercial |
$2.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.64
|
| Rate for Payer: PHP Commercial |
$2.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.10
|
| Rate for Payer: UHC Core |
$2.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.64
|
|
|
SERTRALINE 100 MG TABLET
|
Facility
|
OP
|
$195.05
|
|
|
Service Code
|
NDC 59762491003
|
| Hospital Charge Code |
11350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.39 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$50.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.95
|
| Rate for Payer: BCBS Complete |
$36.10
|
| Rate for Payer: BCBS MAPPO |
$48.76
|
| Rate for Payer: BCBS Trust/PPO |
$160.35
|
| Rate for Payer: BCN Commercial |
$160.35
|
| Rate for Payer: BCN Medicare Advantage |
$48.76
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.76
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Mclaren Medicaid |
$34.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.20
|
| Rate for Payer: Meridian Medicaid |
$36.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Nomi Health Commercial |
$159.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PACE Senior Care Partners |
$46.32
|
| Rate for Payer: PACE SWMI |
$48.76
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: PHP Medicare Advantage |
$48.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$169.69
|
| Rate for Payer: Priority Health Medicare |
$49.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.75
|
| Rate for Payer: Railroad Medicare Medicare |
$48.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.64
|
| Rate for Payer: UHC Core |
$162.87
|
| Rate for Payer: UHC Exchange |
$48.76
|
| Rate for Payer: UHC Medicaid |
$34.39
|
| Rate for Payer: UHC Medicare Advantage |
$48.76
|
| Rate for Payer: UHCCP Medicaid |
$34.39
|
| Rate for Payer: VA VA |
$48.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
SERTRALINE 100 MG TABLET
|
Facility
|
IP
|
$319.20
|
|
|
Service Code
|
NDC 00904692661
|
| Hospital Charge Code |
11350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.16 |
| Max. Negotiated Rate |
$287.28 |
| Rate for Payer: Aetna Commercial |
$271.32
|
| Rate for Payer: BCBS Trust/PPO |
$263.63
|
| Rate for Payer: BCN Commercial |
$263.63
|
| Rate for Payer: Cash Price |
$255.36
|
| Rate for Payer: Cofinity Commercial |
$274.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.36
|
| Rate for Payer: Healthscope Commercial |
$287.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.32
|
| Rate for Payer: Nomi Health Commercial |
$261.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$239.40
|
| Rate for Payer: PHP Commercial |
$271.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$277.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$222.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.90
|
| Rate for Payer: UHC Core |
$266.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.40
|
|
|
SERTRALINE 20 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$249.70
|
|
|
Service Code
|
NDC 59762006701
|
| Hospital Charge Code |
28011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.79 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$212.25
|
| Rate for Payer: BCBS Trust/PPO |
$206.23
|
| Rate for Payer: BCN Commercial |
$206.23
|
| Rate for Payer: Cash Price |
$199.76
|
| Rate for Payer: Cofinity Commercial |
$214.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.76
|
| Rate for Payer: Healthscope Commercial |
$224.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.25
|
| Rate for Payer: Nomi Health Commercial |
$204.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.28
|
| Rate for Payer: PHP Commercial |
$212.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$217.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.74
|
| Rate for Payer: UHC Core |
$208.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.28
|
|
|
SERTRALINE 20 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$249.70
|
|
|
Service Code
|
NDC 59762006701
|
| Hospital Charge Code |
28011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.02 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$212.25
|
| Rate for Payer: Aetna Medicare |
$64.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.03
|
| Rate for Payer: BCBS Complete |
$46.22
|
| Rate for Payer: BCBS MAPPO |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$205.28
|
| Rate for Payer: BCN Commercial |
$205.28
|
| Rate for Payer: BCN Medicare Advantage |
$62.42
|
| Rate for Payer: Cash Price |
$199.76
|
| Rate for Payer: Cofinity Commercial |
$214.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$224.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.28
|
| Rate for Payer: Mclaren Medicaid |
$44.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.55
|
| Rate for Payer: Meridian Medicaid |
$46.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.25
|
| Rate for Payer: Nomi Health Commercial |
$204.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.28
|
| Rate for Payer: PACE Senior Care Partners |
$59.30
|
| Rate for Payer: PACE SWMI |
$62.42
|
| Rate for Payer: PHP Commercial |
$212.25
|
| Rate for Payer: PHP Medicare Advantage |
$62.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$217.24
|
| Rate for Payer: Priority Health Medicare |
$63.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.79
|
| Rate for Payer: Railroad Medicare Medicare |
$62.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.74
|
| Rate for Payer: UHC Core |
$208.50
|
| Rate for Payer: UHC Exchange |
$62.42
|
| Rate for Payer: UHC Medicaid |
$44.02
|
| Rate for Payer: UHC Medicare Advantage |
$62.42
|
| Rate for Payer: UHCCP Medicaid |
$44.02
|
| Rate for Payer: VA VA |
$62.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.28
|
|
|
SERTRALINE 20 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$9.76
|
|
|
Service Code
|
NDC 09900000350
|
| Hospital Charge Code |
28011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: Aetna Medicare |
$2.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.05
|
| Rate for Payer: BCBS Complete |
$1.81
|
| Rate for Payer: BCBS MAPPO |
$2.44
|
| Rate for Payer: BCBS Trust/PPO |
$8.02
|
| Rate for Payer: BCN Commercial |
$8.02
|
| Rate for Payer: BCN Medicare Advantage |
$2.44
|
| Rate for Payer: Cash Price |
$7.81
|
| Rate for Payer: Cofinity Commercial |
$8.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.44
|
| Rate for Payer: Healthscope Commercial |
$8.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.32
|
| Rate for Payer: Mclaren Medicaid |
$1.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.56
|
| Rate for Payer: Meridian Medicaid |
$1.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.30
|
| Rate for Payer: Nomi Health Commercial |
$8.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.32
|
| Rate for Payer: PACE Senior Care Partners |
$2.32
|
| Rate for Payer: PACE SWMI |
$2.44
|
| Rate for Payer: PHP Commercial |
$8.30
|
| Rate for Payer: PHP Medicare Advantage |
$2.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.49
|
| Rate for Payer: Priority Health Medicare |
$2.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.59
|
| Rate for Payer: UHC Core |
$8.15
|
| Rate for Payer: UHC Exchange |
$2.44
|
| Rate for Payer: UHC Medicaid |
$1.72
|
| Rate for Payer: UHC Medicare Advantage |
$2.44
|
| Rate for Payer: UHCCP Medicaid |
$1.72
|
| Rate for Payer: VA VA |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.32
|
|
