|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$481.40
|
|
|
Service Code
|
NDC 00310111039
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$335.05 |
| Max. Negotiated Rate |
$433.26 |
| Rate for Payer: Aetna Commercial |
$409.19
|
| Rate for Payer: BCBS Trust/PPO |
$397.59
|
| Rate for Payer: BCN Commercial |
$397.59
|
| Rate for Payer: Cash Price |
$385.12
|
| Rate for Payer: Cofinity Commercial |
$414.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.12
|
| Rate for Payer: Healthscope Commercial |
$433.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.19
|
| Rate for Payer: Nomi Health Commercial |
$394.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$361.05
|
| Rate for Payer: PHP Commercial |
$409.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$418.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.63
|
| Rate for Payer: UHC Core |
$401.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.05
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$481.40
|
|
|
Service Code
|
NDC 00310111039
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.87 |
| Max. Negotiated Rate |
$433.26 |
| Rate for Payer: Aetna Commercial |
$409.19
|
| Rate for Payer: Aetna Medicare |
$125.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.44
|
| Rate for Payer: BCBS Complete |
$89.11
|
| Rate for Payer: BCBS MAPPO |
$120.35
|
| Rate for Payer: BCBS Trust/PPO |
$395.76
|
| Rate for Payer: BCN Commercial |
$395.76
|
| Rate for Payer: BCN Medicare Advantage |
$120.35
|
| Rate for Payer: Cash Price |
$385.12
|
| Rate for Payer: Cofinity Commercial |
$414.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.35
|
| Rate for Payer: Healthscope Commercial |
$433.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.05
|
| Rate for Payer: Mclaren Medicaid |
$84.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.37
|
| Rate for Payer: Meridian Medicaid |
$89.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$132.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.19
|
| Rate for Payer: Nomi Health Commercial |
$394.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$361.05
|
| Rate for Payer: PACE Senior Care Partners |
$114.33
|
| Rate for Payer: PACE SWMI |
$120.35
|
| Rate for Payer: PHP Commercial |
$409.19
|
| Rate for Payer: PHP Medicare Advantage |
$120.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$418.82
|
| Rate for Payer: Priority Health Medicare |
$121.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.05
|
| Rate for Payer: Railroad Medicare Medicare |
$120.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.63
|
| Rate for Payer: UHC Core |
$401.97
|
| Rate for Payer: UHC Exchange |
$120.35
|
| Rate for Payer: UHC Medicaid |
$84.87
|
| Rate for Payer: UHC Medicare Advantage |
$120.35
|
| Rate for Payer: UHCCP Medicaid |
$84.87
|
| Rate for Payer: VA VA |
$120.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.05
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$43.77
|
|
|
Service Code
|
NDC 00310111001
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$39.39 |
| Rate for Payer: Aetna Commercial |
$37.20
|
| Rate for Payer: BCBS Trust/PPO |
$36.15
|
| Rate for Payer: BCN Commercial |
$36.15
|
| Rate for Payer: Cash Price |
$35.02
|
| Rate for Payer: Cofinity Commercial |
$37.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.02
|
| Rate for Payer: Healthscope Commercial |
$39.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.20
|
| Rate for Payer: Nomi Health Commercial |
$35.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.83
|
| Rate for Payer: PHP Commercial |
$37.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$38.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.52
|
| Rate for Payer: UHC Core |
$36.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.83
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$2.28
|
|
|
Service Code
|
NDC 50268072411
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna Medicare |
$0.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.71
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: BCBS MAPPO |
$0.57
|
| Rate for Payer: BCBS Trust/PPO |
$1.87
|
| Rate for Payer: BCN Commercial |
$1.87
|
| Rate for Payer: BCN Medicare Advantage |
$0.57
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.57
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.71
|
| Rate for Payer: Mclaren Medicaid |
$0.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.60
|
| Rate for Payer: Meridian Medicaid |
$0.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.94
|
| Rate for Payer: Nomi Health Commercial |
$1.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.71
|
| Rate for Payer: PACE Senior Care Partners |
$0.54
|
| Rate for Payer: PACE SWMI |
$0.57
|
| Rate for Payer: PHP Commercial |
$1.94
|
| Rate for Payer: PHP Medicare Advantage |
$0.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.98
|
| Rate for Payer: Priority Health Medicare |
$0.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.59
|
| Rate for Payer: Railroad Medicare Medicare |
$0.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.01
|
| Rate for Payer: UHC Core |
$1.90
|
| Rate for Payer: UHC Exchange |
$0.57
|
| Rate for Payer: UHC Medicaid |
$0.40
|
| Rate for Payer: UHC Medicare Advantage |
$0.57
|
| Rate for Payer: UHCCP Medicaid |
$0.40
|
| Rate for Payer: VA VA |
$0.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.71
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$442.56
|
|
|
Service Code
|
NDC 00904714361
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.02 |
| Max. Negotiated Rate |
$398.30 |
| Rate for Payer: Aetna Commercial |
$376.18
|
| Rate for Payer: BCBS Trust/PPO |
$365.51
|
| Rate for Payer: BCN Commercial |
$365.51
|
| Rate for Payer: Cash Price |
$354.05
|
| Rate for Payer: Cofinity Commercial |
$380.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.05
|
| Rate for Payer: Healthscope Commercial |
$398.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.18
|
| Rate for Payer: Nomi Health Commercial |
$362.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.92
|
| Rate for Payer: PHP Commercial |
$376.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$385.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$308.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.45
|
| Rate for Payer: UHC Core |
$369.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.92
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
NDC 00093106101
|
| Hospital Charge Code |
11421
|
|
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
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$143.35
|
|
|
Service Code
|
NDC 60505008000
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.77 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: BCBS Trust/PPO |
$118.39
|
| Rate for Payer: BCN Commercial |
$118.39
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: Nomi Health Commercial |
$117.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.51
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$124.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.15
|
| Rate for Payer: UHC Core |
$119.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.51
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$2.28
|
|
|
Service Code
|
NDC 50268072411
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: BCBS Trust/PPO |
$1.88
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.82
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.94
|
| Rate for Payer: Nomi Health Commercial |
$1.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.71
|
| Rate for Payer: PHP Commercial |
$1.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.01
|
| Rate for Payer: UHC Core |
$1.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.71
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$442.56
|
|
|
Service Code
|
NDC 00904714361
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.02 |
| Max. Negotiated Rate |
$398.30 |
| Rate for Payer: Aetna Commercial |
$376.18
|
| Rate for Payer: Aetna Medicare |
$115.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$138.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$138.30
|
| Rate for Payer: BCBS Complete |
$81.92
|
| Rate for Payer: BCBS MAPPO |
$110.64
|
| Rate for Payer: BCBS Trust/PPO |
$363.83
|
| Rate for Payer: BCN Commercial |
$363.83
|
| Rate for Payer: BCN Medicare Advantage |
$110.64
|
| Rate for Payer: Cash Price |
$354.05
|
| Rate for Payer: Cofinity Commercial |
$380.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.64
|
| Rate for Payer: Healthscope Commercial |
$398.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.92
|
| Rate for Payer: Mclaren Medicaid |
$78.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.17
|
| Rate for Payer: Meridian Medicaid |
$81.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$121.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.18
|
| Rate for Payer: Nomi Health Commercial |
$362.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.92
|
| Rate for Payer: PACE Senior Care Partners |
$105.11
|
| Rate for Payer: PACE SWMI |
$110.64
|
| Rate for Payer: PHP Commercial |
$376.18
|
| Rate for Payer: PHP Medicare Advantage |
$110.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$385.03
|
| Rate for Payer: Priority Health Medicare |
$111.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$308.02
|
| Rate for Payer: Railroad Medicare Medicare |
$110.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.45
|
| Rate for Payer: UHC Core |
$369.54
|
| Rate for Payer: UHC Exchange |
$110.64
|
| Rate for Payer: UHC Medicaid |
$78.02
|
| Rate for Payer: UHC Medicare Advantage |
$110.64
|
| Rate for Payer: UHCCP Medicaid |
$78.02
|
| Rate for Payer: VA VA |
$110.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.92
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$143.35
|
|
|
Service Code
|
NDC 60505008000
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna Medicare |
$37.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.80
|
| Rate for Payer: BCBS Complete |
$26.53
|
| Rate for Payer: BCBS MAPPO |
$35.84
|
| Rate for Payer: BCBS Trust/PPO |
$117.85
|
| Rate for Payer: BCN Commercial |
$117.85
|
| Rate for Payer: BCN Medicare Advantage |
$35.84
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.84
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.51
|
| Rate for Payer: Mclaren Medicaid |
$25.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.63
|
| Rate for Payer: Meridian Medicaid |
$26.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: Nomi Health Commercial |
$117.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.51
|
| Rate for Payer: PACE Senior Care Partners |
$34.05
|
| Rate for Payer: PACE SWMI |
$35.84
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: PHP Medicare Advantage |
$35.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$124.71
|
| Rate for Payer: Priority Health Medicare |
$36.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.77
|
| Rate for Payer: Railroad Medicare Medicare |
$35.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.15
|
| Rate for Payer: UHC Core |
$119.70
|
| Rate for Payer: UHC Exchange |
$35.84
|
| Rate for Payer: UHC Medicaid |
$25.27
|
| Rate for Payer: UHC Medicare Advantage |
$35.84
|
| Rate for Payer: UHCCP Medicaid |
$25.27
|
| Rate for Payer: VA VA |
$35.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.51
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$113.53
|
|
|
Service Code
|
NDC 50268072415
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$102.18 |
| Rate for Payer: Aetna Commercial |
$96.50
|
| Rate for Payer: Aetna Medicare |
$29.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.48
|
| Rate for Payer: BCBS Complete |
$21.01
|
| Rate for Payer: BCBS MAPPO |
$28.38
|
| Rate for Payer: BCBS Trust/PPO |
$93.33
|
| Rate for Payer: BCN Commercial |
$93.33
|
| Rate for Payer: BCN Medicare Advantage |
$28.38
|
| Rate for Payer: Cash Price |
$90.82
|
| Rate for Payer: Cofinity Commercial |
$97.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.38
|
| Rate for Payer: Healthscope Commercial |
$102.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.15
|
| Rate for Payer: Mclaren Medicaid |
$20.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.80
|
| Rate for Payer: Meridian Medicaid |
$21.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.50
|
| Rate for Payer: Nomi Health Commercial |
$93.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.15
|
| Rate for Payer: PACE Senior Care Partners |
$26.96
|
| Rate for Payer: PACE SWMI |
$28.38
|
| Rate for Payer: PHP Commercial |
$96.50
|
| Rate for Payer: PHP Medicare Advantage |
$28.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$98.77
|
| Rate for Payer: Priority Health Medicare |
$28.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.02
|
| Rate for Payer: Railroad Medicare Medicare |
$28.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.91
|
| Rate for Payer: UHC Core |
$94.80
|
| Rate for Payer: UHC Exchange |
$28.38
|
| Rate for Payer: UHC Medicaid |
$20.02
|
| Rate for Payer: UHC Medicare Advantage |
$28.38
|
| Rate for Payer: UHCCP Medicaid |
$20.02
|
| Rate for Payer: VA VA |
$28.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.15
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$113.53
|
|
|
Service Code
|
NDC 50268072415
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.02 |
| Max. Negotiated Rate |
$102.18 |
| Rate for Payer: Aetna Commercial |
$96.50
|
| Rate for Payer: BCBS Trust/PPO |
$93.76
|
| Rate for Payer: BCN Commercial |
$93.76
|
| Rate for Payer: Cash Price |
$90.82
|
| Rate for Payer: Cofinity Commercial |
$97.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.82
|
| Rate for Payer: Healthscope Commercial |
$102.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.50
|
| Rate for Payer: Nomi Health Commercial |
$93.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.15
|
| Rate for Payer: PHP Commercial |
$96.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$98.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.91
|
| Rate for Payer: UHC Core |
$94.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.15
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
NDC 00093106101
|
| Hospital Charge Code |
11421
|
|
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
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$8,592.75
|
|
|
Service Code
|
APR-DRG 0402
|
| Min. Negotiated Rate |
$8,183.57 |
| Max. Negotiated Rate |
$8,592.75 |
| Rate for Payer: BCBS Complete |
$8,592.75
|
| Rate for Payer: Mclaren Medicaid |
$8,183.57
|
| Rate for Payer: Meridian Medicaid |
$8,592.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,183.57
|
| Rate for Payer: UHC Medicaid |
$8,183.57
|
| Rate for Payer: UHCCP Medicaid |
$8,183.57
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$13,384.73
|
|
|
Service Code
|
APR-DRG 0404
|
| Min. Negotiated Rate |
$12,747.36 |
| Max. Negotiated Rate |
$13,384.73 |
| Rate for Payer: BCBS Complete |
$13,384.73
|
| Rate for Payer: Mclaren Medicaid |
$12,747.36
|
| Rate for Payer: Meridian Medicaid |
$13,384.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,747.36
|
| Rate for Payer: UHC Medicaid |
$12,747.36
|
| Rate for Payer: UHCCP Medicaid |
$12,747.36
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$10,101.91
|
|
|
Service Code
|
APR-DRG 0403
|
| Min. Negotiated Rate |
$9,620.87 |
| Max. Negotiated Rate |
$10,101.91 |
| Rate for Payer: BCBS Complete |
$10,101.91
|
| Rate for Payer: Mclaren Medicaid |
$9,620.87
|
| Rate for Payer: Meridian Medicaid |
$10,101.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,620.87
|
| Rate for Payer: UHC Medicaid |
$9,620.87
|
| Rate for Payer: UHCCP Medicaid |
$9,620.87
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$6,618.22
|
|
|
Service Code
|
APR-DRG 0401
|
| Min. Negotiated Rate |
$6,303.07 |
| Max. Negotiated Rate |
$6,618.22 |
| Rate for Payer: BCBS Complete |
$6,618.22
|
| Rate for Payer: Mclaren Medicaid |
$6,303.07
|
| Rate for Payer: Meridian Medicaid |
$6,618.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,303.07
|
| Rate for Payer: UHC Medicaid |
$6,303.07
|
| Rate for Payer: UHCCP Medicaid |
$6,303.07
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$12,201.59
|
|
|
Service Code
|
APR-DRG 3212
|
| Min. Negotiated Rate |
$11,620.56 |
| Max. Negotiated Rate |
$12,201.59 |
| Rate for Payer: BCBS Complete |
$12,201.59
|
| Rate for Payer: Mclaren Medicaid |
$11,620.56
|
| Rate for Payer: Meridian Medicaid |
$12,201.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,620.56
|
| Rate for Payer: UHC Medicaid |
$11,620.56
|
| Rate for Payer: UHCCP Medicaid |
$11,620.56
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$24,249.11
|
|
|
Service Code
|
APR-DRG 3214
|
| Min. Negotiated Rate |
$23,094.39 |
| Max. Negotiated Rate |
$24,249.11 |
| Rate for Payer: BCBS Complete |
$24,249.11
|
| Rate for Payer: Mclaren Medicaid |
$23,094.39
|
| Rate for Payer: Meridian Medicaid |
$24,249.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,094.39
|
| Rate for Payer: UHC Medicaid |
$23,094.39
|
| Rate for Payer: UHCCP Medicaid |
$23,094.39
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$20,079.73
|
|
|
Service Code
|
APR-DRG 3213
|
| Min. Negotiated Rate |
$19,123.55 |
| Max. Negotiated Rate |
$20,079.73 |
| Rate for Payer: BCBS Complete |
$20,079.73
|
| Rate for Payer: Mclaren Medicaid |
$19,123.55
|
| Rate for Payer: Meridian Medicaid |
$20,079.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,123.55
|
| Rate for Payer: UHC Medicaid |
$19,123.55
|
| Rate for Payer: UHCCP Medicaid |
$19,123.55
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$9,310.00
|
|
|
Service Code
|
APR-DRG 3211
|
| Min. Negotiated Rate |
$8,866.66 |
| Max. Negotiated Rate |
$9,310.00 |
| Rate for Payer: BCBS Complete |
$9,310.00
|
| Rate for Payer: Mclaren Medicaid |
$8,866.66
|
| Rate for Payer: Meridian Medicaid |
$9,310.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,866.66
|
| Rate for Payer: UHC Medicaid |
$8,866.66
|
| Rate for Payer: UHCCP Medicaid |
$8,866.66
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$27,009.77
|
|
|
Service Code
|
APR-DRG 0234
|
| Min. Negotiated Rate |
$25,723.59 |
| Max. Negotiated Rate |
$27,009.77 |
| Rate for Payer: BCBS Complete |
$27,009.77
|
| Rate for Payer: Mclaren Medicaid |
$25,723.59
|
| Rate for Payer: Meridian Medicaid |
$27,009.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$25,723.59
|
| Rate for Payer: UHC Medicaid |
$25,723.59
|
| Rate for Payer: UHCCP Medicaid |
$25,723.59
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$13,555.10
|
|
|
Service Code
|
APR-DRG 0232
|
| Min. Negotiated Rate |
$12,909.62 |
| Max. Negotiated Rate |
$13,555.10 |
| Rate for Payer: BCBS Complete |
$13,555.10
|
| Rate for Payer: Mclaren Medicaid |
$12,909.62
|
| Rate for Payer: Meridian Medicaid |
$13,555.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,909.62
|
| Rate for Payer: UHC Medicaid |
$12,909.62
|
| Rate for Payer: UHCCP Medicaid |
$12,909.62
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$21,161.90
|
|
|
Service Code
|
APR-DRG 0233
|
| Min. Negotiated Rate |
$20,154.20 |
| Max. Negotiated Rate |
$21,161.90 |
| Rate for Payer: BCBS Complete |
$21,161.90
|
| Rate for Payer: Mclaren Medicaid |
$20,154.20
|
| Rate for Payer: Meridian Medicaid |
$21,161.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,154.20
|
| Rate for Payer: UHC Medicaid |
$20,154.20
|
| Rate for Payer: UHCCP Medicaid |
$20,154.20
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$8,946.64
|
|
|
Service Code
|
APR-DRG 0231
|
| Min. Negotiated Rate |
$8,520.61 |
| Max. Negotiated Rate |
$8,946.64 |
| Rate for Payer: BCBS Complete |
$8,946.64
|
| Rate for Payer: Mclaren Medicaid |
$8,520.61
|
| Rate for Payer: Meridian Medicaid |
$8,946.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,520.61
|
| Rate for Payer: UHC Medicaid |
$8,520.61
|
| Rate for Payer: UHCCP Medicaid |
$8,520.61
|
|
