|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
IP
|
$2,343.88
|
|
|
Service Code
|
NDC 00078065920
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,523.52 |
| Max. Negotiated Rate |
$2,109.49 |
| Rate for Payer: Aetna Commercial |
$1,992.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,913.31
|
| Rate for Payer: BCN Commercial |
$1,811.35
|
| Rate for Payer: Cash Price |
$1,875.10
|
| Rate for Payer: Cofinity Commercial |
$2,015.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,875.10
|
| Rate for Payer: Healthscope Commercial |
$2,109.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,757.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,992.30
|
| Rate for Payer: Nomi Health Commercial |
$1,921.98
|
| Rate for Payer: PHP Commercial |
$1,992.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,523.52
|
| Rate for Payer: Priority Health HMO/PPO |
$2,039.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,570.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,062.61
|
| Rate for Payer: UHC Core |
$1,957.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,757.91
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET
|
Facility
|
IP
|
$2,343.88
|
|
|
Service Code
|
NDC 00078077720
|
| Hospital Charge Code |
174640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,523.52 |
| Max. Negotiated Rate |
$2,109.49 |
| Rate for Payer: Aetna Commercial |
$1,992.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,913.31
|
| Rate for Payer: BCN Commercial |
$1,811.35
|
| Rate for Payer: Cash Price |
$1,875.10
|
| Rate for Payer: Cofinity Commercial |
$2,015.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,875.10
|
| Rate for Payer: Healthscope Commercial |
$2,109.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,757.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,992.30
|
| Rate for Payer: Nomi Health Commercial |
$1,921.98
|
| Rate for Payer: PHP Commercial |
$1,992.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,523.52
|
| Rate for Payer: Priority Health HMO/PPO |
$2,039.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,570.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,062.61
|
| Rate for Payer: UHC Core |
$1,957.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,757.91
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET
|
Facility
|
OP
|
$2,343.88
|
|
|
Service Code
|
NDC 00078077720
|
| Hospital Charge Code |
174640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$556.67 |
| Max. Negotiated Rate |
$2,109.49 |
| Rate for Payer: Aetna Commercial |
$1,992.30
|
| Rate for Payer: Aetna Medicare |
$609.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$732.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$732.46
|
| Rate for Payer: BCBS Complete |
$937.55
|
| Rate for Payer: BCBS MAPPO |
$585.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,926.90
|
| Rate for Payer: BCN Commercial |
$1,822.37
|
| Rate for Payer: BCN Medicare Advantage |
$585.97
|
| Rate for Payer: Cash Price |
$1,875.10
|
| Rate for Payer: Cofinity Commercial |
$2,015.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,875.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$585.97
|
| Rate for Payer: Healthscope Commercial |
$2,109.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,757.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$615.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$673.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,992.30
|
| Rate for Payer: Nomi Health Commercial |
$1,921.98
|
| Rate for Payer: PACE Senior Care Partners |
$556.67
|
| Rate for Payer: PACE SWMI |
$585.97
|
| Rate for Payer: PHP Commercial |
$1,992.30
|
| Rate for Payer: PHP Medicare Advantage |
$585.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,523.52
|
| Rate for Payer: Priority Health HMO/PPO |
$2,039.18
|
| Rate for Payer: Priority Health Medicare |
$591.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,570.40
|
| Rate for Payer: Railroad Medicare Medicare |
$585.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,062.61
|
| Rate for Payer: UHC Core |
$1,957.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$585.97
|
| Rate for Payer: UHC Exchange |
$585.97
|
| Rate for Payer: UHC Medicare Advantage |
$585.97
|
| Rate for Payer: VA VA |
$585.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,757.91
|
|
|
SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
NDC 48582000155
|
| Hospital Charge Code |
118454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.23 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.38
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health HMO/PPO |
$21.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.97
|
| Rate for Payer: UHC Core |
$20.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
NDC 48582000155
|
| Hospital Charge Code |
118454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Medicare |
$6.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.80
|
| Rate for Payer: BCBS Complete |
$9.99
|
| Rate for Payer: BCBS MAPPO |
$6.24
|
| Rate for Payer: BCBS Trust/PPO |
$20.53
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: BCN Medicare Advantage |
$6.24
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.24
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: PACE Senior Care Partners |
$5.93
|
| Rate for Payer: PACE SWMI |
$6.24
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: PHP Medicare Advantage |
$6.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health HMO/PPO |
$21.72
|
| Rate for Payer: Priority Health Medicare |
$6.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.97
|
| Rate for Payer: UHC Core |
$20.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.24
|
| Rate for Payer: UHC Exchange |
$6.24
|
| Rate for Payer: UHC Medicare Advantage |
$6.24
|
| Rate for Payer: VA VA |
$6.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$586.71
|
|
|
Service Code
|
NDC 50742050524
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.34 |
| Max. Negotiated Rate |
$528.04 |
| Rate for Payer: Aetna Commercial |
$498.70
|
| Rate for Payer: Aetna Medicare |
$152.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$183.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$183.35
|
| Rate for Payer: BCBS Complete |
$234.68
|
| Rate for Payer: BCBS MAPPO |
$146.68
|
| Rate for Payer: BCBS Trust/PPO |
$482.33
|
| Rate for Payer: BCN Commercial |
$456.17
|
| Rate for Payer: BCN Medicare Advantage |
$146.68
|
| Rate for Payer: Cash Price |
$469.37
|
| Rate for Payer: Cofinity Commercial |
$504.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$469.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.68
|
| Rate for Payer: Healthscope Commercial |
$528.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$440.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$498.70
|
| Rate for Payer: Nomi Health Commercial |
$481.10
|
| Rate for Payer: PACE Senior Care Partners |
$139.34
|
| Rate for Payer: PACE SWMI |
$146.68
|
| Rate for Payer: PHP Commercial |
$498.70
|
| Rate for Payer: PHP Medicare Advantage |
$146.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.36
|
| Rate for Payer: Priority Health HMO/PPO |
$510.44
|
| Rate for Payer: Priority Health Medicare |
$148.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$393.10
|
| Rate for Payer: Railroad Medicare Medicare |
$146.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$516.30
|
| Rate for Payer: UHC Core |
$489.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.68
|
| Rate for Payer: UHC Exchange |
$146.68
|
| Rate for Payer: UHC Medicare Advantage |
$146.68
|
| Rate for Payer: VA VA |
$146.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$440.03
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$63.25
|
|
|
Service Code
|
NDC 00378647016
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.76
|
| Rate for Payer: Aetna Medicare |
$16.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.77
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: BCBS MAPPO |
$15.81
|
| Rate for Payer: BCBS Trust/PPO |
$52.00
|
| Rate for Payer: BCN Commercial |
$49.18
|
| Rate for Payer: BCN Medicare Advantage |
$15.81
|
| Rate for Payer: Cash Price |
$50.60
|
| Rate for Payer: Cofinity Commercial |
$54.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.81
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.76
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: PACE Senior Care Partners |
$15.02
|
| Rate for Payer: PACE SWMI |
$15.81
|
| Rate for Payer: PHP Commercial |
$53.76
|
| Rate for Payer: PHP Medicare Advantage |
$15.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO |
$55.03
|
| Rate for Payer: Priority Health Medicare |
$15.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.38
|
| Rate for Payer: Railroad Medicare Medicare |
$15.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.66
|
| Rate for Payer: UHC Core |
$52.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.81
|
| Rate for Payer: UHC Exchange |
$15.81
|
| Rate for Payer: UHC Medicare Advantage |
$15.81
|
| Rate for Payer: VA VA |
$15.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.44
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$245.35
|
|
|
Service Code
|
NDC 50742050510
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.27 |
| Max. Negotiated Rate |
$220.82 |
| Rate for Payer: Aetna Commercial |
$208.55
|
| Rate for Payer: Aetna Medicare |
$63.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.67
|
| Rate for Payer: BCBS Complete |
$98.14
|
| Rate for Payer: BCBS MAPPO |
$61.34
|
| Rate for Payer: BCBS Trust/PPO |
$201.70
|
| Rate for Payer: BCN Commercial |
$190.76
|
| Rate for Payer: BCN Medicare Advantage |
$61.34
|
| Rate for Payer: Cash Price |
$196.28
|
| Rate for Payer: Cofinity Commercial |
$211.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.34
|
| Rate for Payer: Healthscope Commercial |
$220.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.55
|
| Rate for Payer: Nomi Health Commercial |
$201.19
|
| Rate for Payer: PACE Senior Care Partners |
$58.27
|
| Rate for Payer: PACE SWMI |
$61.34
|
| Rate for Payer: PHP Commercial |
$208.55
|
| Rate for Payer: PHP Medicare Advantage |
$61.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.48
|
| Rate for Payer: Priority Health HMO/PPO |
$213.45
|
| Rate for Payer: Priority Health Medicare |
$61.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.38
|
| Rate for Payer: Railroad Medicare Medicare |
$61.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.91
|
| Rate for Payer: UHC Core |
$204.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.34
|
| Rate for Payer: UHC Exchange |
$61.34
|
| Rate for Payer: UHC Medicare Advantage |
$61.34
|
| Rate for Payer: VA VA |
$61.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.01
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$43.81
|
|
|
Service Code
|
NDC 10019055390
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.48 |
| Max. Negotiated Rate |
$39.43 |
| Rate for Payer: Aetna Commercial |
$37.24
|
| Rate for Payer: BCBS Trust/PPO |
$35.76
|
| Rate for Payer: BCN Commercial |
$33.86
|
| Rate for Payer: Cash Price |
$35.05
|
| Rate for Payer: Cofinity Commercial |
$37.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.05
|
| Rate for Payer: Healthscope Commercial |
$39.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.24
|
| Rate for Payer: Nomi Health Commercial |
$35.92
|
| Rate for Payer: PHP Commercial |
$37.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.48
|
| Rate for Payer: Priority Health HMO/PPO |
$38.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.55
|
| Rate for Payer: UHC Core |
$36.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.86
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$43.81
|
|
|
Service Code
|
NDC 10019055390
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$39.43 |
| Rate for Payer: Aetna Commercial |
$37.24
|
| Rate for Payer: Aetna Medicare |
$11.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.69
|
| Rate for Payer: BCBS Complete |
$17.52
|
| Rate for Payer: BCBS MAPPO |
$10.95
|
| Rate for Payer: BCBS Trust/PPO |
$36.02
|
| Rate for Payer: BCN Commercial |
$34.06
|
| Rate for Payer: BCN Medicare Advantage |
$10.95
|
| Rate for Payer: Cash Price |
$35.05
|
| Rate for Payer: Cofinity Commercial |
$37.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.95
|
| Rate for Payer: Healthscope Commercial |
$39.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.24
|
| Rate for Payer: Nomi Health Commercial |
$35.92
|
| Rate for Payer: PACE Senior Care Partners |
$10.40
|
| Rate for Payer: PACE SWMI |
$10.95
|
| Rate for Payer: PHP Commercial |
$37.24
|
| Rate for Payer: PHP Medicare Advantage |
$10.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.48
|
| Rate for Payer: Priority Health HMO/PPO |
$38.11
|
| Rate for Payer: Priority Health Medicare |
$11.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.35
|
| Rate for Payer: Railroad Medicare Medicare |
$10.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.55
|
| Rate for Payer: UHC Core |
$36.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.95
|
| Rate for Payer: UHC Exchange |
$10.95
|
| Rate for Payer: UHC Medicare Advantage |
$10.95
|
| Rate for Payer: VA VA |
$10.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.86
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$586.71
|
|
|
Service Code
|
NDC 50742050524
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$381.36 |
| Max. Negotiated Rate |
$528.04 |
| Rate for Payer: Aetna Commercial |
$498.70
|
| Rate for Payer: BCBS Trust/PPO |
$478.93
|
| Rate for Payer: BCN Commercial |
$453.41
|
| Rate for Payer: Cash Price |
$469.37
|
| Rate for Payer: Cofinity Commercial |
$504.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$469.37
|
| Rate for Payer: Healthscope Commercial |
$528.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$440.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$498.70
|
| Rate for Payer: Nomi Health Commercial |
$481.10
|
| Rate for Payer: PHP Commercial |
$498.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.36
|
| Rate for Payer: Priority Health HMO/PPO |
$510.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$393.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$516.30
|
| Rate for Payer: UHC Core |
$489.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$440.03
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$63.25
|
|
|
Service Code
|
NDC 00378647016
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.76
|
| Rate for Payer: BCBS Trust/PPO |
$51.63
|
| Rate for Payer: BCN Commercial |
$48.88
|
| Rate for Payer: Cash Price |
$50.60
|
| Rate for Payer: Cofinity Commercial |
$54.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.60
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.76
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: PHP Commercial |
$53.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO |
$55.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.66
|
| Rate for Payer: UHC Core |
$52.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.44
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$222.45
|
|
|
Service Code
|
NDC 00378647099
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.83 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$189.08
|
| Rate for Payer: Aetna Medicare |
$57.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.52
|
| Rate for Payer: BCBS Complete |
$88.98
|
| Rate for Payer: BCBS MAPPO |
$55.61
|
| Rate for Payer: BCBS Trust/PPO |
$182.88
|
| Rate for Payer: BCN Commercial |
$172.95
|
| Rate for Payer: BCN Medicare Advantage |
$55.61
|
| Rate for Payer: Cash Price |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$191.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.61
|
| Rate for Payer: Healthscope Commercial |
$200.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.08
|
| Rate for Payer: Nomi Health Commercial |
$182.41
|
| Rate for Payer: PACE Senior Care Partners |
$52.83
|
| Rate for Payer: PACE SWMI |
$55.61
|
| Rate for Payer: PHP Commercial |
$189.08
|
| Rate for Payer: PHP Medicare Advantage |
$55.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.59
|
| Rate for Payer: Priority Health HMO/PPO |
$193.53
|
| Rate for Payer: Priority Health Medicare |
$56.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.04
|
| Rate for Payer: Railroad Medicare Medicare |
$55.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.76
|
| Rate for Payer: UHC Core |
$185.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.61
|
| Rate for Payer: UHC Exchange |
$55.61
|
| Rate for Payer: UHC Medicare Advantage |
$55.61
|
| Rate for Payer: VA VA |
$55.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.84
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$222.45
|
|
|
Service Code
|
NDC 00378647099
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.59 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$189.08
|
| Rate for Payer: BCBS Trust/PPO |
$181.59
|
| Rate for Payer: BCN Commercial |
$171.91
|
| Rate for Payer: Cash Price |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$191.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.96
|
| Rate for Payer: Healthscope Commercial |
$200.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.08
|
| Rate for Payer: Nomi Health Commercial |
$182.41
|
| Rate for Payer: PHP Commercial |
$189.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.59
|
| Rate for Payer: Priority Health HMO/PPO |
$193.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.76
|
| Rate for Payer: UHC Core |
$185.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.84
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$24.23
|
|
|
Service Code
|
NDC 50742050501
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$21.81 |
| Rate for Payer: Aetna Commercial |
$20.60
|
| Rate for Payer: BCBS Trust/PPO |
$19.78
|
| Rate for Payer: BCN Commercial |
$18.72
|
| Rate for Payer: Cash Price |
$19.38
|
| Rate for Payer: Cofinity Commercial |
$20.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.38
|
| Rate for Payer: Healthscope Commercial |
$21.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.60
|
| Rate for Payer: Nomi Health Commercial |
$19.87
|
| Rate for Payer: PHP Commercial |
$20.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.75
|
| Rate for Payer: Priority Health HMO/PPO |
$21.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.32
|
| Rate for Payer: UHC Core |
$20.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.17
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$24.23
|
|
|
Service Code
|
NDC 50742050501
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$21.81 |
| Rate for Payer: Aetna Commercial |
$20.60
|
| Rate for Payer: Aetna Medicare |
$6.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.57
|
| Rate for Payer: BCBS Complete |
$9.69
|
| Rate for Payer: BCBS MAPPO |
$6.06
|
| Rate for Payer: BCBS Trust/PPO |
$19.92
|
| Rate for Payer: BCN Commercial |
$18.84
|
| Rate for Payer: BCN Medicare Advantage |
$6.06
|
| Rate for Payer: Cash Price |
$19.38
|
| Rate for Payer: Cofinity Commercial |
$20.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.06
|
| Rate for Payer: Healthscope Commercial |
$21.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.60
|
| Rate for Payer: Nomi Health Commercial |
$19.87
|
| Rate for Payer: PACE Senior Care Partners |
$5.75
|
| Rate for Payer: PACE SWMI |
$6.06
|
| Rate for Payer: PHP Commercial |
$20.60
|
| Rate for Payer: PHP Medicare Advantage |
$6.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.75
|
| Rate for Payer: Priority Health HMO/PPO |
$21.08
|
| Rate for Payer: Priority Health Medicare |
$6.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.23
|
| Rate for Payer: Railroad Medicare Medicare |
$6.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.32
|
| Rate for Payer: UHC Core |
$20.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.06
|
| Rate for Payer: UHC Exchange |
$6.06
|
| Rate for Payer: UHC Medicare Advantage |
$6.06
|
| Rate for Payer: VA VA |
$6.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.17
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$245.35
|
|
|
Service Code
|
NDC 50742050510
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.48 |
| Max. Negotiated Rate |
$220.82 |
| Rate for Payer: Aetna Commercial |
$208.55
|
| Rate for Payer: BCBS Trust/PPO |
$200.28
|
| Rate for Payer: BCN Commercial |
$189.61
|
| Rate for Payer: Cash Price |
$196.28
|
| Rate for Payer: Cofinity Commercial |
$211.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.28
|
| Rate for Payer: Healthscope Commercial |
$220.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.55
|
| Rate for Payer: Nomi Health Commercial |
$201.19
|
| Rate for Payer: PHP Commercial |
$208.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.48
|
| Rate for Payer: Priority Health HMO/PPO |
$213.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.91
|
| Rate for Payer: UHC Core |
$204.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.01
|
|
|
SCREENING OF A PATIENT
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS D0190
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$20.16 |
| Rate for Payer: Aetna Commercial |
$13.35
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Mclaren Medicaid |
$19.20
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: UHCCP Medicaid |
$19.20
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
NDC 60687062211
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna Commercial |
$1.36
|
| Rate for Payer: BCBS Trust/PPO |
$1.31
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cofinity Commercial |
$1.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.28
|
| Rate for Payer: Healthscope Commercial |
$1.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.36
|
| Rate for Payer: Nomi Health Commercial |
$1.31
|
| Rate for Payer: PHP Commercial |
$1.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.04
|
| Rate for Payer: Priority Health HMO/PPO |
$1.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.41
|
| Rate for Payer: UHC Core |
$1.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.20
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$88.20
|
|
|
Service Code
|
NDC 09629513881
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.33 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: Aetna Commercial |
$74.97
|
| Rate for Payer: BCBS Trust/PPO |
$72.00
|
| Rate for Payer: BCN Commercial |
$68.16
|
| Rate for Payer: Cash Price |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$75.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.56
|
| Rate for Payer: Healthscope Commercial |
$79.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.97
|
| Rate for Payer: Nomi Health Commercial |
$72.32
|
| Rate for Payer: PHP Commercial |
$74.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.33
|
| Rate for Payer: Priority Health HMO/PPO |
$76.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.62
|
| Rate for Payer: UHC Core |
$73.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.15
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$88.20
|
|
|
Service Code
|
NDC 09629513881
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: Aetna Commercial |
$74.97
|
| Rate for Payer: Aetna Medicare |
$22.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.56
|
| Rate for Payer: BCBS Complete |
$35.28
|
| Rate for Payer: BCBS MAPPO |
$22.05
|
| Rate for Payer: BCBS Trust/PPO |
$72.51
|
| Rate for Payer: BCN Commercial |
$68.58
|
| Rate for Payer: BCN Medicare Advantage |
$22.05
|
| Rate for Payer: Cash Price |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$75.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.05
|
| Rate for Payer: Healthscope Commercial |
$79.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.97
|
| Rate for Payer: Nomi Health Commercial |
$72.32
|
| Rate for Payer: PACE Senior Care Partners |
$20.95
|
| Rate for Payer: PACE SWMI |
$22.05
|
| Rate for Payer: PHP Commercial |
$74.97
|
| Rate for Payer: PHP Medicare Advantage |
$22.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.33
|
| Rate for Payer: Priority Health HMO/PPO |
$76.73
|
| Rate for Payer: Priority Health Medicare |
$22.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.09
|
| Rate for Payer: Railroad Medicare Medicare |
$22.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.62
|
| Rate for Payer: UHC Core |
$73.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.05
|
| Rate for Payer: UHC Exchange |
$22.05
|
| Rate for Payer: UHC Medicare Advantage |
$22.05
|
| Rate for Payer: VA VA |
$22.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.15
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$159.50
|
|
|
Service Code
|
NDC 60687062201
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.68 |
| Max. Negotiated Rate |
$143.55 |
| Rate for Payer: Aetna Commercial |
$135.58
|
| Rate for Payer: BCBS Trust/PPO |
$130.20
|
| Rate for Payer: BCN Commercial |
$123.26
|
| Rate for Payer: Cash Price |
$127.60
|
| Rate for Payer: Cofinity Commercial |
$137.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.60
|
| Rate for Payer: Healthscope Commercial |
$143.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.58
|
| Rate for Payer: Nomi Health Commercial |
$130.79
|
| Rate for Payer: PHP Commercial |
$135.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.68
|
| Rate for Payer: Priority Health HMO/PPO |
$138.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.36
|
| Rate for Payer: UHC Core |
$133.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.62
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$103.62
|
|
|
Service Code
|
NDC 60258095106
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.35 |
| Max. Negotiated Rate |
$93.26 |
| Rate for Payer: Aetna Commercial |
$88.08
|
| Rate for Payer: BCBS Trust/PPO |
$84.59
|
| Rate for Payer: BCN Commercial |
$80.08
|
| Rate for Payer: Cash Price |
$82.90
|
| Rate for Payer: Cofinity Commercial |
$89.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.90
|
| Rate for Payer: Healthscope Commercial |
$93.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.08
|
| Rate for Payer: Nomi Health Commercial |
$84.97
|
| Rate for Payer: PHP Commercial |
$88.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.35
|
| Rate for Payer: Priority Health HMO/PPO |
$90.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.19
|
| Rate for Payer: UHC Core |
$86.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.72
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$159.50
|
|
|
Service Code
|
NDC 60687062201
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.88 |
| Max. Negotiated Rate |
$143.55 |
| Rate for Payer: Aetna Commercial |
$135.58
|
| Rate for Payer: Aetna Medicare |
$41.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.84
|
| Rate for Payer: BCBS Complete |
$63.80
|
| Rate for Payer: BCBS MAPPO |
$39.88
|
| Rate for Payer: BCBS Trust/PPO |
$131.12
|
| Rate for Payer: BCN Commercial |
$124.01
|
| Rate for Payer: BCN Medicare Advantage |
$39.88
|
| Rate for Payer: Cash Price |
$127.60
|
| Rate for Payer: Cofinity Commercial |
$137.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.88
|
| Rate for Payer: Healthscope Commercial |
$143.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.58
|
| Rate for Payer: Nomi Health Commercial |
$130.79
|
| Rate for Payer: PACE Senior Care Partners |
$37.88
|
| Rate for Payer: PACE SWMI |
$39.88
|
| Rate for Payer: PHP Commercial |
$135.58
|
| Rate for Payer: PHP Medicare Advantage |
$39.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.68
|
| Rate for Payer: Priority Health HMO/PPO |
$138.76
|
| Rate for Payer: Priority Health Medicare |
$40.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.86
|
| Rate for Payer: Railroad Medicare Medicare |
$39.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.36
|
| Rate for Payer: UHC Core |
$133.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.88
|
| Rate for Payer: UHC Exchange |
$39.88
|
| Rate for Payer: UHC Medicare Advantage |
$39.88
|
| Rate for Payer: VA VA |
$39.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.62
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$144.90
|
|
|
Service Code
|
NDC 00536124801
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.18 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna Commercial |
$123.16
|
| Rate for Payer: BCBS Trust/PPO |
$118.28
|
| Rate for Payer: BCN Commercial |
$111.98
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: Cofinity Commercial |
$124.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.92
|
| Rate for Payer: Healthscope Commercial |
$130.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.16
|
| Rate for Payer: Nomi Health Commercial |
$118.82
|
| Rate for Payer: PHP Commercial |
$123.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.18
|
| Rate for Payer: Priority Health HMO/PPO |
$126.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.51
|
| Rate for Payer: UHC Core |
$120.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.68
|
|
