|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB
|
Professional
|
Both
|
$902.00
|
|
|
Service Code
|
HCPCS 41017
|
| Min. Negotiated Rate |
$322.30 |
| Max. Negotiated Rate |
$586.30 |
| Rate for Payer: Aetna Commercial |
$431.88
|
| Rate for Payer: Aetna Medicare |
$335.19
|
| Rate for Payer: BCBS Complete |
$360.80
|
| Rate for Payer: BCBS MAPPO |
$322.30
|
| Rate for Payer: BCN Medicare Advantage |
$322.30
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cofinity Commercial |
$464.11
|
| Rate for Payer: Cofinity Commercial |
$431.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.42
|
| Rate for Payer: Nomi Health Commercial |
$386.76
|
| Rate for Payer: PACE SWMI |
$322.30
|
| Rate for Payer: PHP Medicare Advantage |
$322.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.30
|
| Rate for Payer: Priority Health Medicare |
$325.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.30
|
| Rate for Payer: UHC Exchange |
$322.30
|
| Rate for Payer: UHC Medicare Advantage |
$322.30
|
|
|
PR ZINC PASTE BAND W >=3""<5""/YD
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS A6456
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: Aetna Medicare |
$1.82
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: BCBS MAPPO |
$1.75
|
| Rate for Payer: BCN Medicare Advantage |
$1.75
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$2.10
|
| Rate for Payer: PACE SWMI |
$1.75
|
| Rate for Payer: PHP Medicare Advantage |
$1.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.70
|
| Rate for Payer: Priority Health Medicare |
$1.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.75
|
| Rate for Payer: UHC Exchange |
$1.75
|
| Rate for Payer: UHC Medicare Advantage |
$1.75
|
|
|
PR ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 90736
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
IP
|
$44.65
|
|
|
Service Code
|
NDC 00904505359
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.02 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: BCBS Trust/PPO |
$36.45
|
| Rate for Payer: BCN Commercial |
$34.51
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$38.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$40.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.95
|
| Rate for Payer: Nomi Health Commercial |
$36.61
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.02
|
| Rate for Payer: Priority Health HMO/PPO |
$38.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.29
|
| Rate for Payer: UHC Core |
$37.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.49
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
OP
|
$44.65
|
|
|
Service Code
|
NDC 00904505359
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: Aetna Medicare |
$11.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.95
|
| Rate for Payer: BCBS Complete |
$17.86
|
| Rate for Payer: BCBS MAPPO |
$11.16
|
| Rate for Payer: BCBS Trust/PPO |
$36.71
|
| Rate for Payer: BCN Commercial |
$34.72
|
| Rate for Payer: BCN Medicare Advantage |
$11.16
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$38.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$40.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.95
|
| Rate for Payer: Nomi Health Commercial |
$36.61
|
| Rate for Payer: PACE Senior Care Partners |
$10.60
|
| Rate for Payer: PACE SWMI |
$11.16
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: PHP Medicare Advantage |
$11.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.02
|
| Rate for Payer: Priority Health HMO/PPO |
$38.85
|
| Rate for Payer: Priority Health Medicare |
$11.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.92
|
| Rate for Payer: Railroad Medicare Medicare |
$11.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.29
|
| Rate for Payer: UHC Core |
$37.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.16
|
| Rate for Payer: UHC Exchange |
$11.16
|
| Rate for Payer: UHC Medicare Advantage |
$11.16
|
| Rate for Payer: VA VA |
$11.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.49
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
IP
|
$22.56
|
|
|
Service Code
|
NDC 00904633724
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$20.30 |
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: BCBS Trust/PPO |
$18.42
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$19.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$20.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.18
|
| Rate for Payer: Nomi Health Commercial |
$18.50
|
| Rate for Payer: PHP Commercial |
$19.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.66
|
| Rate for Payer: Priority Health HMO/PPO |
$19.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.85
|
| Rate for Payer: UHC Core |
$18.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.92
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
OP
|
$22.56
|
|
|
Service Code
|
NDC 00904633724
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$20.30 |
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: Aetna Medicare |
$5.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.05
|
| Rate for Payer: BCBS Complete |
$9.02
|
| Rate for Payer: BCBS MAPPO |
$5.64
|
| Rate for Payer: BCBS Trust/PPO |
$18.55
|
| Rate for Payer: BCN Commercial |
$17.54
|
| Rate for Payer: BCN Medicare Advantage |
$5.64
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$19.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.64
|
| Rate for Payer: Healthscope Commercial |
$20.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.18
|
| Rate for Payer: Nomi Health Commercial |
$18.50
|
| Rate for Payer: PACE Senior Care Partners |
$5.36
|
| Rate for Payer: PACE SWMI |
$5.64
|
| Rate for Payer: PHP Commercial |
$19.18
|
| Rate for Payer: PHP Medicare Advantage |
$5.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.66
|
| Rate for Payer: Priority Health HMO/PPO |
$19.63
|
| Rate for Payer: Priority Health Medicare |
$5.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.12
|
| Rate for Payer: Railroad Medicare Medicare |
$5.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.85
|
| Rate for Payer: UHC Core |
$18.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.64
|
| Rate for Payer: UHC Exchange |
$5.64
|
| Rate for Payer: UHC Medicare Advantage |
$5.64
|
| Rate for Payer: VA VA |
$5.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.92
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$27.74
|
|
|
Service Code
|
NDC 45802010752
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$24.97 |
| Rate for Payer: Aetna Commercial |
$23.58
|
| Rate for Payer: BCBS Trust/PPO |
$22.64
|
| Rate for Payer: BCN Commercial |
$21.44
|
| Rate for Payer: Cash Price |
$22.19
|
| Rate for Payer: Cofinity Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.19
|
| Rate for Payer: Healthscope Commercial |
$24.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.58
|
| Rate for Payer: Nomi Health Commercial |
$22.75
|
| Rate for Payer: PHP Commercial |
$23.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.03
|
| Rate for Payer: Priority Health HMO/PPO |
$24.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.41
|
| Rate for Payer: UHC Core |
$23.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.80
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
NDC 00904675415
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Medicare |
$8.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.95
|
| Rate for Payer: BCBS Complete |
$12.73
|
| Rate for Payer: BCBS MAPPO |
$7.96
|
| Rate for Payer: BCBS Trust/PPO |
$26.17
|
| Rate for Payer: BCN Commercial |
$24.75
|
| Rate for Payer: BCN Medicare Advantage |
$7.96
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.96
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: PACE Senior Care Partners |
$7.56
|
| Rate for Payer: PACE SWMI |
$7.96
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Medicare Advantage |
$7.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.69
|
| Rate for Payer: Priority Health HMO/PPO |
$27.69
|
| Rate for Payer: Priority Health Medicare |
$8.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.33
|
| Rate for Payer: Railroad Medicare Medicare |
$7.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.01
|
| Rate for Payer: UHC Core |
$26.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.96
|
| Rate for Payer: UHC Exchange |
$7.96
|
| Rate for Payer: UHC Medicare Advantage |
$7.96
|
| Rate for Payer: VA VA |
$7.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.87
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$27.74
|
|
|
Service Code
|
NDC 45802010752
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$24.97 |
| Rate for Payer: Aetna Commercial |
$23.58
|
| Rate for Payer: Aetna Medicare |
$7.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.67
|
| Rate for Payer: BCBS Complete |
$11.10
|
| Rate for Payer: BCBS MAPPO |
$6.93
|
| Rate for Payer: BCBS Trust/PPO |
$22.81
|
| Rate for Payer: BCN Commercial |
$21.57
|
| Rate for Payer: BCN Medicare Advantage |
$6.93
|
| Rate for Payer: Cash Price |
$22.19
|
| Rate for Payer: Cofinity Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.93
|
| Rate for Payer: Healthscope Commercial |
$24.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.58
|
| Rate for Payer: Nomi Health Commercial |
$22.75
|
| Rate for Payer: PACE Senior Care Partners |
$6.59
|
| Rate for Payer: PACE SWMI |
$6.93
|
| Rate for Payer: PHP Commercial |
$23.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.03
|
| Rate for Payer: Priority Health HMO/PPO |
$24.13
|
| Rate for Payer: Priority Health Medicare |
$7.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.59
|
| Rate for Payer: Railroad Medicare Medicare |
$6.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.41
|
| Rate for Payer: UHC Core |
$23.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.93
|
| Rate for Payer: UHC Exchange |
$6.93
|
| Rate for Payer: UHC Medicare Advantage |
$6.93
|
| Rate for Payer: VA VA |
$6.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.80
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
NDC 00904675415
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.69 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: BCBS Trust/PPO |
$25.98
|
| Rate for Payer: BCN Commercial |
$24.60
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.69
|
| Rate for Payer: Priority Health HMO/PPO |
$27.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.01
|
| Rate for Payer: UHC Core |
$26.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.87
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
IP
|
$8.85
|
|
|
Service Code
|
NDC 37000002410
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: BCBS Trust/PPO |
$7.22
|
| Rate for Payer: BCN Commercial |
$6.84
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Healthscope Commercial |
$7.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.52
|
| Rate for Payer: Nomi Health Commercial |
$7.26
|
| Rate for Payer: PHP Commercial |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.75
|
| Rate for Payer: Priority Health HMO/PPO |
$7.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.79
|
| Rate for Payer: UHC Core |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
OP
|
$8.85
|
|
|
Service Code
|
NDC 37000002410
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: Aetna Medicare |
$2.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.77
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: BCBS MAPPO |
$2.21
|
| Rate for Payer: BCBS Trust/PPO |
$7.28
|
| Rate for Payer: BCN Commercial |
$6.88
|
| Rate for Payer: BCN Medicare Advantage |
$2.21
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.21
|
| Rate for Payer: Healthscope Commercial |
$7.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.52
|
| Rate for Payer: Nomi Health Commercial |
$7.26
|
| Rate for Payer: PACE Senior Care Partners |
$2.10
|
| Rate for Payer: PACE SWMI |
$2.21
|
| Rate for Payer: PHP Commercial |
$7.52
|
| Rate for Payer: PHP Medicare Advantage |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.75
|
| Rate for Payer: Priority Health HMO/PPO |
$7.70
|
| Rate for Payer: Priority Health Medicare |
$2.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.93
|
| Rate for Payer: Railroad Medicare Medicare |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.79
|
| Rate for Payer: UHC Core |
$7.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Medicare Advantage |
$2.21
|
| Rate for Payer: VA VA |
$2.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
IP
|
$429.60
|
|
|
Service Code
|
NDC 00904662261
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.24 |
| Max. Negotiated Rate |
$386.64 |
| Rate for Payer: Aetna Commercial |
$365.16
|
| Rate for Payer: BCBS Trust/PPO |
$350.68
|
| Rate for Payer: BCN Commercial |
$331.99
|
| Rate for Payer: Cash Price |
$343.68
|
| Rate for Payer: Cofinity Commercial |
$369.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.68
|
| Rate for Payer: Healthscope Commercial |
$386.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.16
|
| Rate for Payer: Nomi Health Commercial |
$352.27
|
| Rate for Payer: PHP Commercial |
$365.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.24
|
| Rate for Payer: Priority Health HMO/PPO |
$373.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.05
|
| Rate for Payer: UHC Core |
$358.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.20
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
OP
|
$429.60
|
|
|
Service Code
|
NDC 00904662261
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.03 |
| Max. Negotiated Rate |
$386.64 |
| Rate for Payer: Aetna Commercial |
$365.16
|
| Rate for Payer: Aetna Medicare |
$111.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.25
|
| Rate for Payer: BCBS Complete |
$171.84
|
| Rate for Payer: BCBS MAPPO |
$107.40
|
| Rate for Payer: BCBS Trust/PPO |
$353.17
|
| Rate for Payer: BCN Commercial |
$334.01
|
| Rate for Payer: BCN Medicare Advantage |
$107.40
|
| Rate for Payer: Cash Price |
$343.68
|
| Rate for Payer: Cofinity Commercial |
$369.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.40
|
| Rate for Payer: Healthscope Commercial |
$386.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.16
|
| Rate for Payer: Nomi Health Commercial |
$352.27
|
| Rate for Payer: PACE Senior Care Partners |
$102.03
|
| Rate for Payer: PACE SWMI |
$107.40
|
| Rate for Payer: PHP Commercial |
$365.16
|
| Rate for Payer: PHP Medicare Advantage |
$107.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.24
|
| Rate for Payer: Priority Health HMO/PPO |
$373.75
|
| Rate for Payer: Priority Health Medicare |
$108.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.83
|
| Rate for Payer: Railroad Medicare Medicare |
$107.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.05
|
| Rate for Payer: UHC Core |
$358.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.40
|
| Rate for Payer: UHC Exchange |
$107.40
|
| Rate for Payer: UHC Medicare Advantage |
$107.40
|
| Rate for Payer: VA VA |
$107.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.20
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$124.30
|
|
|
Service Code
|
NDC 77333094010
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.52 |
| Max. Negotiated Rate |
$111.87 |
| Rate for Payer: Aetna Commercial |
$105.66
|
| Rate for Payer: Aetna Medicare |
$32.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.84
|
| Rate for Payer: BCBS Complete |
$49.72
|
| Rate for Payer: BCBS MAPPO |
$31.07
|
| Rate for Payer: BCBS Trust/PPO |
$102.19
|
| Rate for Payer: BCN Commercial |
$96.64
|
| Rate for Payer: BCN Medicare Advantage |
$31.07
|
| Rate for Payer: Cash Price |
$99.44
|
| Rate for Payer: Cofinity Commercial |
$106.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.07
|
| Rate for Payer: Healthscope Commercial |
$111.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.66
|
| Rate for Payer: Nomi Health Commercial |
$101.93
|
| Rate for Payer: PACE Senior Care Partners |
$29.52
|
| Rate for Payer: PACE SWMI |
$31.07
|
| Rate for Payer: PHP Commercial |
$105.66
|
| Rate for Payer: PHP Medicare Advantage |
$31.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.80
|
| Rate for Payer: Priority Health HMO/PPO |
$108.14
|
| Rate for Payer: Priority Health Medicare |
$31.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.28
|
| Rate for Payer: Railroad Medicare Medicare |
$31.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.38
|
| Rate for Payer: UHC Core |
$103.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.07
|
| Rate for Payer: UHC Exchange |
$31.07
|
| Rate for Payer: UHC Medicare Advantage |
$31.07
|
| Rate for Payer: VA VA |
$31.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.22
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$157.50
|
|
|
Service Code
|
NDC 57896085301
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.41 |
| 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 |
$63.00
|
| Rate for Payer: BCBS MAPPO |
$39.38
|
| Rate for Payer: BCBS Trust/PPO |
$129.48
|
| Rate for Payer: BCN Commercial |
$122.46
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.88
|
| Rate for Payer: Nomi Health Commercial |
$129.15
|
| 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 Cigna Priority Health |
$102.38
|
| Rate for Payer: Priority Health HMO/PPO |
$137.03
|
| Rate for Payer: Priority Health Medicare |
$39.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.53
|
| 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 Dual Complete DSNP |
$39.38
|
| Rate for Payer: UHC Exchange |
$39.38
|
| Rate for Payer: UHC Medicare Advantage |
$39.38
|
| Rate for Payer: VA VA |
$39.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.12
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$157.50
|
|
|
Service Code
|
NDC 57896085301
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: BCBS Trust/PPO |
$128.57
|
| Rate for Payer: BCN Commercial |
$121.72
|
| 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: PHP Commercial |
$133.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.38
|
| Rate for Payer: Priority Health HMO/PPO |
$137.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.60
|
| Rate for Payer: UHC Core |
$131.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.12
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$1.25
|
|
|
Service Code
|
NDC 77333094025
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna Commercial |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCN Commercial |
$0.97
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cofinity Commercial |
$1.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.00
|
| Rate for Payer: Healthscope Commercial |
$1.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.06
|
| Rate for Payer: Nomi Health Commercial |
$1.02
|
| Rate for Payer: PHP Commercial |
$1.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.81
|
| Rate for Payer: Priority Health HMO/PPO |
$1.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.10
|
| Rate for Payer: UHC Core |
$1.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.94
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$1.25
|
|
|
Service Code
|
NDC 77333094025
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna Commercial |
$1.06
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.39
|
| Rate for Payer: BCBS Complete |
$0.50
|
| Rate for Payer: BCBS MAPPO |
$0.31
|
| Rate for Payer: BCBS Trust/PPO |
$1.03
|
| Rate for Payer: BCN Commercial |
$0.97
|
| Rate for Payer: BCN Medicare Advantage |
$0.31
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cofinity Commercial |
$1.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.31
|
| Rate for Payer: Healthscope Commercial |
$1.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.06
|
| Rate for Payer: Nomi Health Commercial |
$1.02
|
| Rate for Payer: PACE Senior Care Partners |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.31
|
| Rate for Payer: PHP Commercial |
$1.06
|
| Rate for Payer: PHP Medicare Advantage |
$0.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.81
|
| Rate for Payer: Priority Health HMO/PPO |
$1.09
|
| Rate for Payer: Priority Health Medicare |
$0.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.84
|
| Rate for Payer: Railroad Medicare Medicare |
$0.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.10
|
| Rate for Payer: UHC Core |
$1.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.31
|
| Rate for Payer: UHC Exchange |
$0.31
|
| Rate for Payer: UHC Medicare Advantage |
$0.31
|
| Rate for Payer: VA VA |
$0.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.94
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$124.30
|
|
|
Service Code
|
NDC 77333094010
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$111.87 |
| Rate for Payer: Aetna Commercial |
$105.66
|
| Rate for Payer: BCBS Trust/PPO |
$101.47
|
| Rate for Payer: BCN Commercial |
$96.06
|
| Rate for Payer: Cash Price |
$99.44
|
| Rate for Payer: Cofinity Commercial |
$106.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.44
|
| Rate for Payer: Healthscope Commercial |
$111.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.66
|
| Rate for Payer: Nomi Health Commercial |
$101.93
|
| Rate for Payer: PHP Commercial |
$105.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.80
|
| Rate for Payer: Priority Health HMO/PPO |
$108.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.38
|
| Rate for Payer: UHC Core |
$103.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.22
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$451.20
|
|
|
Service Code
|
NDC 00904664061
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.16 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: Aetna Medicare |
$117.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.00
|
| Rate for Payer: BCBS Complete |
$180.48
|
| Rate for Payer: BCBS MAPPO |
$112.80
|
| Rate for Payer: BCBS Trust/PPO |
$370.93
|
| Rate for Payer: BCN Commercial |
$350.81
|
| Rate for Payer: BCN Medicare Advantage |
$112.80
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: Nomi Health Commercial |
$369.98
|
| Rate for Payer: PACE Senior Care Partners |
$107.16
|
| Rate for Payer: PACE SWMI |
$112.80
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: PHP Medicare Advantage |
$112.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: Priority Health HMO/PPO |
$392.54
|
| Rate for Payer: Priority Health Medicare |
$113.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.30
|
| Rate for Payer: Railroad Medicare Medicare |
$112.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.06
|
| Rate for Payer: UHC Core |
$376.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.80
|
| Rate for Payer: UHC Exchange |
$112.80
|
| Rate for Payer: UHC Medicare Advantage |
$112.80
|
| Rate for Payer: VA VA |
$112.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.40
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$442.70
|
|
|
Service Code
|
NDC 63739066510
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.14 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: Aetna Medicare |
$115.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$138.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$138.34
|
| Rate for Payer: BCBS Complete |
$177.08
|
| Rate for Payer: BCBS MAPPO |
$110.67
|
| Rate for Payer: BCBS Trust/PPO |
$363.94
|
| Rate for Payer: BCN Commercial |
$344.20
|
| Rate for Payer: BCN Medicare Advantage |
$110.67
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.67
|
| Rate for Payer: Healthscope Commercial |
$398.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.30
|
| Rate for Payer: Nomi Health Commercial |
$363.01
|
| Rate for Payer: PACE Senior Care Partners |
$105.14
|
| Rate for Payer: PACE SWMI |
$110.67
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: PHP Medicare Advantage |
$110.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.75
|
| Rate for Payer: Priority Health HMO/PPO |
$385.15
|
| Rate for Payer: Priority Health Medicare |
$111.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.61
|
| Rate for Payer: Railroad Medicare Medicare |
$110.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.58
|
| Rate for Payer: UHC Core |
$369.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.67
|
| Rate for Payer: UHC Exchange |
$110.67
|
| Rate for Payer: UHC Medicare Advantage |
$110.67
|
| Rate for Payer: VA VA |
$110.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.02
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$442.70
|
|
|
Service Code
|
NDC 63739066510
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.75 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: BCBS Trust/PPO |
$361.38
|
| Rate for Payer: BCN Commercial |
$342.12
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$398.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.30
|
| Rate for Payer: Nomi Health Commercial |
$363.01
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.75
|
| Rate for Payer: Priority Health HMO/PPO |
$385.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.58
|
| Rate for Payer: UHC Core |
$369.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.02
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 16729014701
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.12 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: BCBS Trust/PPO |
$113.18
|
| Rate for Payer: BCN Commercial |
$107.15
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Nomi Health Commercial |
$113.69
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| Rate for Payer: Priority Health HMO/PPO |
$120.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.01
|
| Rate for Payer: UHC Core |
$115.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
