|
SERTRALINE 20 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$9.76
|
|
|
Service Code
|
NDC 09900000350
|
| Hospital Charge Code |
28011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: BCBS Trust/PPO |
$8.06
|
| Rate for Payer: BCN Commercial |
$8.06
|
| 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: Healthscope Commercial |
$8.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.32
|
| 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: PHP Commercial |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.59
|
| Rate for Payer: UHC Core |
$8.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.32
|
|
|
SERTRALINE 25 MG TABLET
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
NDC 00904692461
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$209.95
|
| Rate for Payer: Aetna Medicare |
$64.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.19
|
| Rate for Payer: BCBS Complete |
$45.72
|
| Rate for Payer: BCBS MAPPO |
$61.75
|
| Rate for Payer: BCBS Trust/PPO |
$203.06
|
| Rate for Payer: BCN Commercial |
$203.06
|
| Rate for Payer: BCN Medicare Advantage |
$61.75
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$212.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.75
|
| Rate for Payer: Healthscope Commercial |
$222.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.25
|
| Rate for Payer: Mclaren Medicaid |
$43.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.84
|
| Rate for Payer: Meridian Medicaid |
$45.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.95
|
| Rate for Payer: Nomi Health Commercial |
$202.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.25
|
| Rate for Payer: PACE Senior Care Partners |
$58.66
|
| Rate for Payer: PACE SWMI |
$61.75
|
| Rate for Payer: PHP Commercial |
$209.95
|
| Rate for Payer: PHP Medicare Advantage |
$61.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$214.89
|
| Rate for Payer: Priority Health Medicare |
$62.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.91
|
| Rate for Payer: Railroad Medicare Medicare |
$61.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.36
|
| Rate for Payer: UHC Core |
$206.25
|
| Rate for Payer: UHC Exchange |
$61.75
|
| Rate for Payer: UHC Medicaid |
$43.55
|
| Rate for Payer: UHC Medicare Advantage |
$61.75
|
| Rate for Payer: UHCCP Medicaid |
$43.55
|
| Rate for Payer: VA VA |
$61.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.25
|
|
|
SERTRALINE 25 MG TABLET
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
NDC 00904692461
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.91 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$209.95
|
| Rate for Payer: BCBS Trust/PPO |
$204.00
|
| Rate for Payer: BCN Commercial |
$204.00
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$212.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.60
|
| Rate for Payer: Healthscope Commercial |
$222.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.95
|
| Rate for Payer: Nomi Health Commercial |
$202.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.25
|
| Rate for Payer: PHP Commercial |
$209.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$214.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.36
|
| Rate for Payer: UHC Core |
$206.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.25
|
|
|
SERTRALINE 25 MG TABLET
|
Facility
|
OP
|
$271.70
|
|
|
Service Code
|
NDC 60687023101
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$244.53 |
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: Aetna Medicare |
$70.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.91
|
| Rate for Payer: BCBS Complete |
$50.29
|
| Rate for Payer: BCBS MAPPO |
$67.92
|
| Rate for Payer: BCBS Trust/PPO |
$223.36
|
| Rate for Payer: BCN Commercial |
$223.36
|
| Rate for Payer: BCN Medicare Advantage |
$67.92
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Commercial |
$233.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.92
|
| Rate for Payer: Healthscope Commercial |
$244.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.78
|
| Rate for Payer: Mclaren Medicaid |
$47.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.32
|
| Rate for Payer: Meridian Medicaid |
$50.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: Nomi Health Commercial |
$222.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.78
|
| Rate for Payer: PACE Senior Care Partners |
$64.53
|
| Rate for Payer: PACE SWMI |
$67.92
|
| Rate for Payer: PHP Commercial |
$230.94
|
| Rate for Payer: PHP Medicare Advantage |
$67.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$236.38
|
| Rate for Payer: Priority Health Medicare |
$68.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.10
|
| Rate for Payer: Railroad Medicare Medicare |
$67.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.10
|
| Rate for Payer: UHC Core |
$226.87
|
| Rate for Payer: UHC Exchange |
$67.92
|
| Rate for Payer: UHC Medicaid |
$47.90
|
| Rate for Payer: UHC Medicare Advantage |
$67.92
|
| Rate for Payer: UHCCP Medicaid |
$47.90
|
| Rate for Payer: VA VA |
$67.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.78
|
|
|
SERTRALINE 25 MG TABLET
|
Facility
|
IP
|
$2.72
|
|
|
Service Code
|
NDC 60687023111
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: BCBS Trust/PPO |
$2.25
|
| Rate for Payer: BCN Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Nomi Health Commercial |
$2.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.04
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.39
|
| Rate for Payer: UHC Core |
$2.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
SERTRALINE 25 MG TABLET
|
Facility
|
OP
|
$2.72
|
|
|
Service Code
|
NDC 60687023111
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna Medicare |
$0.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.85
|
| Rate for Payer: BCBS Complete |
$0.50
|
| Rate for Payer: BCBS MAPPO |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.24
|
| Rate for Payer: BCN Medicare Advantage |
$0.68
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.68
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Mclaren Medicaid |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.71
|
| Rate for Payer: Meridian Medicaid |
$0.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Nomi Health Commercial |
$2.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.04
|
| Rate for Payer: PACE Senior Care Partners |
$0.65
|
| Rate for Payer: PACE SWMI |
$0.68
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: PHP Medicare Advantage |
$0.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.37
|
| Rate for Payer: Priority Health Medicare |
$0.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.89
|
| Rate for Payer: Railroad Medicare Medicare |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.39
|
| Rate for Payer: UHC Core |
$2.27
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Medicaid |
$0.48
|
| Rate for Payer: UHC Medicare Advantage |
$0.68
|
| Rate for Payer: UHCCP Medicaid |
$0.48
|
| Rate for Payer: VA VA |
$0.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
SERTRALINE 25 MG TABLET
|
Facility
|
IP
|
$271.70
|
|
|
Service Code
|
NDC 60687023101
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.10 |
| Max. Negotiated Rate |
$244.53 |
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: BCBS Trust/PPO |
$224.40
|
| Rate for Payer: BCN Commercial |
$224.40
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Commercial |
$233.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$244.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: Nomi Health Commercial |
$222.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.78
|
| Rate for Payer: PHP Commercial |
$230.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$236.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.10
|
| Rate for Payer: UHC Core |
$226.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.78
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
NDC 00904692561
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna Commercial |
$237.41
|
| Rate for Payer: BCBS Trust/PPO |
$230.67
|
| Rate for Payer: BCN Commercial |
$230.67
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Nomi Health Commercial |
$229.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.47
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$242.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.78
|
| Rate for Payer: UHC Core |
$233.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.47
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$71.91
|
|
|
Service Code
|
NDC 68180035209
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: Aetna Medicare |
$18.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.47
|
| Rate for Payer: BCBS Complete |
$13.31
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCBS Trust/PPO |
$59.12
|
| Rate for Payer: BCN Commercial |
$59.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$57.53
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$64.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.93
|
| Rate for Payer: Mclaren Medicaid |
$12.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: Meridian Medicaid |
$13.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.12
|
| Rate for Payer: Nomi Health Commercial |
$58.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.93
|
| Rate for Payer: PACE Senior Care Partners |
$17.08
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Commercial |
$61.12
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.56
|
| Rate for Payer: Priority Health Medicare |
$18.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.05
|
| Rate for Payer: Railroad Medicare Medicare |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.28
|
| Rate for Payer: UHC Core |
$60.04
|
| Rate for Payer: UHC Exchange |
$17.98
|
| Rate for Payer: UHC Medicaid |
$12.68
|
| Rate for Payer: UHC Medicare Advantage |
$17.98
|
| Rate for Payer: UHCCP Medicaid |
$12.68
|
| Rate for Payer: VA VA |
$17.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.93
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 65862001201
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.85 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: BCBS Trust/PPO |
$155.27
|
| Rate for Payer: BCN Commercial |
$155.27
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$163.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.44
|
| Rate for Payer: UHC Core |
$156.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$225.60
|
|
|
Service Code
|
NDC 59762490003
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.02 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: BCBS Trust/PPO |
$186.32
|
| Rate for Payer: BCN Commercial |
$186.32
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.76
|
| Rate for Payer: Nomi Health Commercial |
$184.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.20
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$196.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.53
|
| Rate for Payer: UHC Core |
$188.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.20
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 65862001201
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna Medicare |
$48.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.75
|
| Rate for Payer: BCBS Complete |
$34.80
|
| Rate for Payer: BCBS MAPPO |
$47.00
|
| Rate for Payer: BCBS Trust/PPO |
$154.55
|
| Rate for Payer: BCN Commercial |
$154.55
|
| Rate for Payer: BCN Medicare Advantage |
$47.00
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Mclaren Medicaid |
$33.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.35
|
| Rate for Payer: Meridian Medicaid |
$34.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PACE Senior Care Partners |
$44.65
|
| Rate for Payer: PACE SWMI |
$47.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: PHP Medicare Advantage |
$47.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$163.56
|
| Rate for Payer: Priority Health Medicare |
$47.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.85
|
| Rate for Payer: Railroad Medicare Medicare |
$47.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.44
|
| Rate for Payer: UHC Core |
$156.98
|
| Rate for Payer: UHC Exchange |
$47.00
|
| Rate for Payer: UHC Medicaid |
$33.14
|
| Rate for Payer: UHC Medicare Advantage |
$47.00
|
| Rate for Payer: UHCCP Medicaid |
$33.14
|
| Rate for Payer: VA VA |
$47.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$279.30
|
|
|
Service Code
|
NDC 00904692561
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.24 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna Commercial |
$237.41
|
| Rate for Payer: Aetna Medicare |
$72.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.28
|
| Rate for Payer: BCBS Complete |
$51.70
|
| Rate for Payer: BCBS MAPPO |
$69.83
|
| Rate for Payer: BCBS Trust/PPO |
$229.61
|
| Rate for Payer: BCN Commercial |
$229.61
|
| Rate for Payer: BCN Medicare Advantage |
$69.83
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.83
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.47
|
| Rate for Payer: Mclaren Medicaid |
$49.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.32
|
| Rate for Payer: Meridian Medicaid |
$51.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Nomi Health Commercial |
$229.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.47
|
| Rate for Payer: PACE Senior Care Partners |
$66.33
|
| Rate for Payer: PACE SWMI |
$69.83
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: PHP Medicare Advantage |
$69.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$242.99
|
| Rate for Payer: Priority Health Medicare |
$70.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.39
|
| Rate for Payer: Railroad Medicare Medicare |
$69.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.78
|
| Rate for Payer: UHC Core |
$233.22
|
| Rate for Payer: UHC Exchange |
$69.83
|
| Rate for Payer: UHC Medicaid |
$49.24
|
| Rate for Payer: UHC Medicare Advantage |
$69.83
|
| Rate for Payer: UHCCP Medicaid |
$49.24
|
| Rate for Payer: VA VA |
$69.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.47
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$3.07
|
|
|
Service Code
|
NDC 60687024211
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.96
|
| Rate for Payer: BCBS Complete |
$0.57
|
| Rate for Payer: BCBS MAPPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$2.52
|
| Rate for Payer: BCN Commercial |
$2.52
|
| Rate for Payer: BCN Medicare Advantage |
$0.77
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.77
|
| Rate for Payer: Healthscope Commercial |
$2.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.30
|
| Rate for Payer: Mclaren Medicaid |
$0.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.81
|
| Rate for Payer: Meridian Medicaid |
$0.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.61
|
| Rate for Payer: Nomi Health Commercial |
$2.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.30
|
| Rate for Payer: PACE Senior Care Partners |
$0.73
|
| Rate for Payer: PACE SWMI |
$0.77
|
| Rate for Payer: PHP Commercial |
$2.61
|
| Rate for Payer: PHP Medicare Advantage |
$0.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.67
|
| Rate for Payer: Priority Health Medicare |
$0.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.14
|
| Rate for Payer: Railroad Medicare Medicare |
$0.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.70
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Exchange |
$0.77
|
| Rate for Payer: UHC Medicaid |
$0.54
|
| Rate for Payer: UHC Medicare Advantage |
$0.77
|
| Rate for Payer: UHCCP Medicaid |
$0.54
|
| Rate for Payer: VA VA |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.30
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$306.85
|
|
|
Service Code
|
NDC 60687024201
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.10 |
| Max. Negotiated Rate |
$276.17 |
| Rate for Payer: Aetna Commercial |
$260.82
|
| Rate for Payer: Aetna Medicare |
$79.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.89
|
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: BCBS MAPPO |
$76.71
|
| Rate for Payer: BCBS Trust/PPO |
$252.26
|
| Rate for Payer: BCN Commercial |
$252.26
|
| Rate for Payer: BCN Medicare Advantage |
$76.71
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.71
|
| Rate for Payer: Healthscope Commercial |
$276.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.14
|
| Rate for Payer: Mclaren Medicaid |
$54.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.55
|
| Rate for Payer: Meridian Medicaid |
$56.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Nomi Health Commercial |
$251.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.14
|
| Rate for Payer: PACE Senior Care Partners |
$72.88
|
| Rate for Payer: PACE SWMI |
$76.71
|
| Rate for Payer: PHP Commercial |
$260.82
|
| Rate for Payer: PHP Medicare Advantage |
$76.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$266.96
|
| Rate for Payer: Priority Health Medicare |
$77.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.57
|
| Rate for Payer: Railroad Medicare Medicare |
$76.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.03
|
| Rate for Payer: UHC Core |
$256.22
|
| Rate for Payer: UHC Exchange |
$76.71
|
| Rate for Payer: UHC Medicaid |
$54.10
|
| Rate for Payer: UHC Medicare Advantage |
$76.71
|
| Rate for Payer: UHCCP Medicaid |
$54.10
|
| Rate for Payer: VA VA |
$76.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.14
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$3.07
|
|
|
Service Code
|
NDC 60687024211
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.54
|
| Rate for Payer: BCN Commercial |
$2.54
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.61
|
| Rate for Payer: Nomi Health Commercial |
$2.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.30
|
| Rate for Payer: PHP Commercial |
$2.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.70
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.30
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$71.91
|
|
|
Service Code
|
NDC 68180035209
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: BCBS Trust/PPO |
$59.39
|
| Rate for Payer: BCN Commercial |
$59.39
|
| Rate for Payer: Cash Price |
$57.53
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.53
|
| Rate for Payer: Healthscope Commercial |
$64.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.12
|
| Rate for Payer: Nomi Health Commercial |
$58.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.93
|
| Rate for Payer: PHP Commercial |
$61.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.28
|
| Rate for Payer: UHC Core |
$60.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.93
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$225.60
|
|
|
Service Code
|
NDC 59762490003
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.77 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: Aetna Medicare |
$58.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.50
|
| Rate for Payer: BCBS Complete |
$41.76
|
| Rate for Payer: BCBS MAPPO |
$56.40
|
| Rate for Payer: BCBS Trust/PPO |
$185.47
|
| Rate for Payer: BCN Commercial |
$185.47
|
| Rate for Payer: BCN Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.20
|
| Rate for Payer: Mclaren Medicaid |
$39.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.22
|
| Rate for Payer: Meridian Medicaid |
$41.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.76
|
| Rate for Payer: Nomi Health Commercial |
$184.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.20
|
| Rate for Payer: PACE Senior Care Partners |
$53.58
|
| Rate for Payer: PACE SWMI |
$56.40
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: PHP Medicare Advantage |
$56.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$196.27
|
| Rate for Payer: Priority Health Medicare |
$56.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.02
|
| Rate for Payer: Railroad Medicare Medicare |
$56.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.53
|
| Rate for Payer: UHC Core |
$188.38
|
| Rate for Payer: UHC Exchange |
$56.40
|
| Rate for Payer: UHC Medicaid |
$39.77
|
| Rate for Payer: UHC Medicare Advantage |
$56.40
|
| Rate for Payer: UHCCP Medicaid |
$39.77
|
| Rate for Payer: VA VA |
$56.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.20
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$306.85
|
|
|
Service Code
|
NDC 60687024201
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.57 |
| Max. Negotiated Rate |
$276.17 |
| Rate for Payer: Aetna Commercial |
$260.82
|
| Rate for Payer: BCBS Trust/PPO |
$253.43
|
| Rate for Payer: BCN Commercial |
$253.43
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$276.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Nomi Health Commercial |
$251.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.14
|
| Rate for Payer: PHP Commercial |
$260.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$266.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.03
|
| Rate for Payer: UHC Core |
$256.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.14
|
|
|
SEVOFLURANE 99.97 % INHALATION LIQUID
|
Facility
|
IP
|
$214.38
|
|
|
Service Code
|
NDC 00074445604
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.21 |
| Max. Negotiated Rate |
$192.94 |
| Rate for Payer: Aetna Commercial |
$182.22
|
| Rate for Payer: BCBS Trust/PPO |
$177.06
|
| Rate for Payer: BCN Commercial |
$177.06
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$184.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.50
|
| Rate for Payer: Healthscope Commercial |
$192.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.22
|
| Rate for Payer: Nomi Health Commercial |
$175.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.78
|
| Rate for Payer: PHP Commercial |
$182.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$186.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.65
|
| Rate for Payer: UHC Core |
$179.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.78
|
|
|
SEVOFLURANE 99.97 % INHALATION LIQUID
|
Facility
|
OP
|
$223.13
|
|
|
Service Code
|
NDC 10019065164
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.34 |
| Max. Negotiated Rate |
$200.82 |
| Rate for Payer: Aetna Commercial |
$189.66
|
| Rate for Payer: Aetna Medicare |
$58.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.73
|
| Rate for Payer: BCBS Complete |
$41.30
|
| Rate for Payer: BCBS MAPPO |
$55.78
|
| Rate for Payer: BCBS Trust/PPO |
$183.44
|
| Rate for Payer: BCN Commercial |
$183.44
|
| Rate for Payer: BCN Medicare Advantage |
$55.78
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cofinity Commercial |
$191.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.78
|
| Rate for Payer: Healthscope Commercial |
$200.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.35
|
| Rate for Payer: Mclaren Medicaid |
$39.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.57
|
| Rate for Payer: Meridian Medicaid |
$41.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.66
|
| Rate for Payer: Nomi Health Commercial |
$182.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.35
|
| Rate for Payer: PACE Senior Care Partners |
$52.99
|
| Rate for Payer: PACE SWMI |
$55.78
|
| Rate for Payer: PHP Commercial |
$189.66
|
| Rate for Payer: PHP Medicare Advantage |
$55.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$194.12
|
| Rate for Payer: Priority Health Medicare |
$56.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.30
|
| Rate for Payer: Railroad Medicare Medicare |
$55.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.35
|
| Rate for Payer: UHC Core |
$186.31
|
| Rate for Payer: UHC Exchange |
$55.78
|
| Rate for Payer: UHC Medicaid |
$39.34
|
| Rate for Payer: UHC Medicare Advantage |
$55.78
|
| Rate for Payer: UHCCP Medicaid |
$39.34
|
| Rate for Payer: VA VA |
$55.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.35
|
|
|
SEVOFLURANE 99.97 % INHALATION LIQUID
|
Facility
|
IP
|
$211.75
|
|
|
Service Code
|
NDC 66794001525
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.38 |
| Max. Negotiated Rate |
$190.57 |
| Rate for Payer: Aetna Commercial |
$179.99
|
| Rate for Payer: BCBS Trust/PPO |
$174.88
|
| Rate for Payer: BCN Commercial |
$174.88
|
| Rate for Payer: Cash Price |
$169.40
|
| Rate for Payer: Cofinity Commercial |
$182.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.40
|
| Rate for Payer: Healthscope Commercial |
$190.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.99
|
| Rate for Payer: Nomi Health Commercial |
$173.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.81
|
| Rate for Payer: PHP Commercial |
$179.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.34
|
| Rate for Payer: UHC Core |
$176.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.81
|
|
|
SEVOFLURANE 99.97 % INHALATION LIQUID
|
Facility
|
IP
|
$211.75
|
|
|
Service Code
|
NDC 66794002225
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.38 |
| Max. Negotiated Rate |
$190.57 |
| Rate for Payer: Aetna Commercial |
$179.99
|
| Rate for Payer: BCBS Trust/PPO |
$174.88
|
| Rate for Payer: BCN Commercial |
$174.88
|
| Rate for Payer: Cash Price |
$169.40
|
| Rate for Payer: Cofinity Commercial |
$182.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.40
|
| Rate for Payer: Healthscope Commercial |
$190.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.99
|
| Rate for Payer: Nomi Health Commercial |
$173.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.81
|
| Rate for Payer: PHP Commercial |
$179.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.34
|
| Rate for Payer: UHC Core |
$176.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.81
|
|
|
SEVOFLURANE 99.97 % INHALATION LIQUID
|
Facility
|
OP
|
$211.75
|
|
|
Service Code
|
NDC 66794001525
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.33 |
| Max. Negotiated Rate |
$190.57 |
| Rate for Payer: Aetna Commercial |
$179.99
|
| Rate for Payer: Aetna Medicare |
$55.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.17
|
| Rate for Payer: BCBS Complete |
$39.19
|
| Rate for Payer: BCBS MAPPO |
$52.94
|
| Rate for Payer: BCBS Trust/PPO |
$174.08
|
| Rate for Payer: BCN Commercial |
$174.08
|
| Rate for Payer: BCN Medicare Advantage |
$52.94
|
| Rate for Payer: Cash Price |
$169.40
|
| Rate for Payer: Cofinity Commercial |
$182.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.94
|
| Rate for Payer: Healthscope Commercial |
$190.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.81
|
| Rate for Payer: Mclaren Medicaid |
$37.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.58
|
| Rate for Payer: Meridian Medicaid |
$39.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.99
|
| Rate for Payer: Nomi Health Commercial |
$173.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.81
|
| Rate for Payer: PACE Senior Care Partners |
$50.29
|
| Rate for Payer: PACE SWMI |
$52.94
|
| Rate for Payer: PHP Commercial |
$179.99
|
| Rate for Payer: PHP Medicare Advantage |
$52.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.22
|
| Rate for Payer: Priority Health Medicare |
$53.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.38
|
| Rate for Payer: Railroad Medicare Medicare |
$52.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.34
|
| Rate for Payer: UHC Core |
$176.81
|
| Rate for Payer: UHC Exchange |
$52.94
|
| Rate for Payer: UHC Medicaid |
$37.33
|
| Rate for Payer: UHC Medicare Advantage |
$52.94
|
| Rate for Payer: UHCCP Medicaid |
$37.33
|
| Rate for Payer: VA VA |
$52.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.81
|
|
|
SEVOFLURANE 99.97 % INHALATION LIQUID
|
Facility
|
IP
|
$223.13
|
|
|
Service Code
|
NDC 10019065164
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.30 |
| Max. Negotiated Rate |
$200.82 |
| Rate for Payer: Aetna Commercial |
$189.66
|
| Rate for Payer: BCBS Trust/PPO |
$184.28
|
| Rate for Payer: BCN Commercial |
$184.28
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cofinity Commercial |
$191.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.50
|
| Rate for Payer: Healthscope Commercial |
$200.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.66
|
| Rate for Payer: Nomi Health Commercial |
$182.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.35
|
| Rate for Payer: PHP Commercial |
$189.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$194.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.35
|
| Rate for Payer: UHC Core |
$186.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.35
|
|
