|
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 |
$220.81 |
| 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 |
$220.81
|
| 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
|
|
|
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
|
$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
|
$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
|
IP
|
$222.45
|
|
|
Service Code
|
NDC 00378647099
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.59 |
| Max. Negotiated Rate |
$200.21 |
| 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 |
$200.21
|
| 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
|
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 |
$16.45
|
| 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 |
$51.87
|
| 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
|
$222.45
|
|
|
Service Code
|
NDC 00378647099
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.83 |
| Max. Negotiated Rate |
$200.21 |
| 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 |
$200.21
|
| 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
|
$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
|
|
|
SCREENING OF A PATIENT
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS D0190
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
|
|
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 |
$135.57
|
| 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 |
$135.57
|
| 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 |
$135.57
|
| Rate for Payer: PHP Medicare Advantage |
$39.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.67
|
| 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
|
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
|
$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
|
$103.62
|
|
|
Service Code
|
NDC 60258095106
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$93.26 |
| Rate for Payer: Aetna Commercial |
$88.08
|
| Rate for Payer: Aetna Medicare |
$26.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.38
|
| Rate for Payer: BCBS Complete |
$41.45
|
| Rate for Payer: BCBS MAPPO |
$25.91
|
| Rate for Payer: BCBS Trust/PPO |
$85.19
|
| Rate for Payer: BCN Commercial |
$80.56
|
| Rate for Payer: BCN Medicare Advantage |
$25.91
|
| 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: Health Alliance Plan Medicare Advantage |
$25.91
|
| Rate for Payer: Healthscope Commercial |
$93.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.08
|
| Rate for Payer: Nomi Health Commercial |
$84.97
|
| Rate for Payer: PACE Senior Care Partners |
$24.61
|
| Rate for Payer: PACE SWMI |
$25.91
|
| Rate for Payer: PHP Commercial |
$88.08
|
| Rate for Payer: PHP Medicare Advantage |
$25.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.35
|
| Rate for Payer: Priority Health HMO/PPO |
$90.15
|
| Rate for Payer: Priority Health Medicare |
$26.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.43
|
| Rate for Payer: Railroad Medicare Medicare |
$25.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.19
|
| Rate for Payer: UHC Core |
$86.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.91
|
| Rate for Payer: UHC Exchange |
$25.91
|
| Rate for Payer: UHC Medicare Advantage |
$25.91
|
| Rate for Payer: VA VA |
$25.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.72
|
|
|
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
|
$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
|
$144.90
|
|
|
Service Code
|
NDC 00536124801
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.41 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna Commercial |
$123.17
|
| Rate for Payer: Aetna Medicare |
$37.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.28
|
| Rate for Payer: BCBS Complete |
$57.96
|
| Rate for Payer: BCBS MAPPO |
$36.23
|
| Rate for Payer: BCBS Trust/PPO |
$119.12
|
| Rate for Payer: BCN Commercial |
$112.66
|
| Rate for Payer: BCN Medicare Advantage |
$36.23
|
| 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: Health Alliance Plan Medicare Advantage |
$36.23
|
| Rate for Payer: Healthscope Commercial |
$130.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.17
|
| Rate for Payer: Nomi Health Commercial |
$118.82
|
| Rate for Payer: PACE Senior Care Partners |
$34.41
|
| Rate for Payer: PACE SWMI |
$36.23
|
| Rate for Payer: PHP Commercial |
$123.17
|
| Rate for Payer: PHP Medicare Advantage |
$36.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.19
|
| Rate for Payer: Priority Health HMO/PPO |
$126.06
|
| Rate for Payer: Priority Health Medicare |
$36.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.08
|
| Rate for Payer: Railroad Medicare Medicare |
$36.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.51
|
| Rate for Payer: UHC Core |
$120.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.23
|
| Rate for Payer: UHC Exchange |
$36.23
|
| Rate for Payer: UHC Medicare Advantage |
$36.23
|
| Rate for Payer: VA VA |
$36.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.67
|
|
|
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 |
$94.19 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna Commercial |
$123.17
|
| 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 |
$108.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.17
|
| Rate for Payer: Nomi Health Commercial |
$118.82
|
| Rate for Payer: PHP Commercial |
$123.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.19
|
| 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 |
$108.67
|
|
|
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 |
$103.67 |
| Max. Negotiated Rate |
$143.55 |
| Rate for Payer: Aetna Commercial |
$135.57
|
| 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 |
$135.57
|
| Rate for Payer: Nomi Health Commercial |
$130.79
|
| Rate for Payer: PHP Commercial |
$135.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.67
|
| 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
|
OP
|
$1.60
|
|
|
Service Code
|
NDC 60687062211
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna Commercial |
$1.36
|
| Rate for Payer: Aetna Medicare |
$0.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.50
|
| Rate for Payer: BCBS Complete |
$0.64
|
| Rate for Payer: BCBS MAPPO |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.32
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Medicare Advantage |
$0.40
|
| 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: Health Alliance Plan Medicare Advantage |
$0.40
|
| Rate for Payer: Healthscope Commercial |
$1.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.36
|
| Rate for Payer: Nomi Health Commercial |
$1.31
|
| Rate for Payer: PACE Senior Care Partners |
$0.38
|
| Rate for Payer: PACE SWMI |
$0.40
|
| Rate for Payer: PHP Commercial |
$1.36
|
| Rate for Payer: PHP Medicare Advantage |
$0.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.04
|
| Rate for Payer: Priority Health HMO/PPO |
$1.39
|
| Rate for Payer: Priority Health Medicare |
$0.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.07
|
| Rate for Payer: Railroad Medicare Medicare |
$0.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.41
|
| Rate for Payer: UHC Core |
$1.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.40
|
| Rate for Payer: UHC Exchange |
$0.40
|
| Rate for Payer: UHC Medicare Advantage |
$0.40
|
| Rate for Payer: VA VA |
$0.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.20
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$163.80
|
|
|
Service Code
|
NDC 37864000033
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.47 |
| Max. Negotiated Rate |
$147.42 |
| Rate for Payer: Aetna Commercial |
$139.23
|
| Rate for Payer: BCBS Trust/PPO |
$133.71
|
| Rate for Payer: BCN Commercial |
$126.58
|
| Rate for Payer: Cash Price |
$131.04
|
| Rate for Payer: Cofinity Commercial |
$140.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.04
|
| Rate for Payer: Healthscope Commercial |
$147.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.23
|
| Rate for Payer: Nomi Health Commercial |
$134.32
|
| Rate for Payer: PHP Commercial |
$139.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.47
|
| Rate for Payer: Priority Health HMO/PPO |
$142.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.14
|
| Rate for Payer: UHC Core |
$136.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.85
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
NDC 70000044702
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.58 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: Aetna Medicare |
$40.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.12
|
| Rate for Payer: BCBS Complete |
$61.60
|
| Rate for Payer: BCBS MAPPO |
$38.50
|
| Rate for Payer: BCBS Trust/PPO |
$126.60
|
| Rate for Payer: BCN Commercial |
$119.73
|
| Rate for Payer: BCN Medicare Advantage |
$38.50
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cofinity Commercial |
$132.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.50
|
| Rate for Payer: Healthscope Commercial |
$138.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.90
|
| Rate for Payer: Nomi Health Commercial |
$126.28
|
| Rate for Payer: PACE Senior Care Partners |
$36.58
|
| Rate for Payer: PACE SWMI |
$38.50
|
| Rate for Payer: PHP Commercial |
$130.90
|
| Rate for Payer: PHP Medicare Advantage |
$38.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.10
|
| Rate for Payer: Priority Health HMO/PPO |
$133.98
|
| Rate for Payer: Priority Health Medicare |
$38.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.18
|
| Rate for Payer: Railroad Medicare Medicare |
$38.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.52
|
| Rate for Payer: UHC Core |
$128.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.50
|
| Rate for Payer: UHC Exchange |
$38.50
|
| Rate for Payer: UHC Medicare Advantage |
$38.50
|
| Rate for Payer: VA VA |
$38.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.50
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$132.30
|
|
|
Service Code
|
NDC 00904672559
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$119.07 |
| Rate for Payer: Aetna Commercial |
$112.45
|
| Rate for Payer: Aetna Medicare |
$34.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.34
|
| Rate for Payer: BCBS Complete |
$52.92
|
| Rate for Payer: BCBS MAPPO |
$33.08
|
| Rate for Payer: BCBS Trust/PPO |
$108.76
|
| Rate for Payer: BCN Commercial |
$102.86
|
| Rate for Payer: BCN Medicare Advantage |
$33.08
|
| Rate for Payer: Cash Price |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$113.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.08
|
| Rate for Payer: Healthscope Commercial |
$119.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.45
|
| Rate for Payer: Nomi Health Commercial |
$108.49
|
| Rate for Payer: PACE Senior Care Partners |
$31.42
|
| Rate for Payer: PACE SWMI |
$33.08
|
| Rate for Payer: PHP Commercial |
$112.45
|
| Rate for Payer: PHP Medicare Advantage |
$33.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.00
|
| Rate for Payer: Priority Health HMO/PPO |
$115.10
|
| Rate for Payer: Priority Health Medicare |
$33.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.64
|
| Rate for Payer: Railroad Medicare Medicare |
$33.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.42
|
| Rate for Payer: UHC Core |
$110.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.08
|
| Rate for Payer: UHC Exchange |
$33.08
|
| Rate for Payer: UHC Medicare Advantage |
$33.08
|
| Rate for Payer: VA VA |
$33.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.22
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$132.30
|
|
|
Service Code
|
NDC 00904672559
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$119.07 |
| Rate for Payer: Aetna Commercial |
$112.45
|
| Rate for Payer: BCBS Trust/PPO |
$108.00
|
| Rate for Payer: BCN Commercial |
$102.24
|
| Rate for Payer: Cash Price |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$113.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.84
|
| Rate for Payer: Healthscope Commercial |
$119.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.45
|
| Rate for Payer: Nomi Health Commercial |
$108.49
|
| Rate for Payer: PHP Commercial |
$112.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.00
|
| Rate for Payer: Priority Health HMO/PPO |
$115.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.42
|
| Rate for Payer: UHC Core |
$110.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.22
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$149.10
|
|
|
Service Code
|
NDC 67618030010
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$134.19 |
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: BCBS Trust/PPO |
$121.71
|
| Rate for Payer: BCN Commercial |
$115.22
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cofinity Commercial |
$128.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.28
|
| Rate for Payer: Healthscope Commercial |
$134.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.73
|
| Rate for Payer: Nomi Health Commercial |
$122.26
|
| Rate for Payer: PHP Commercial |
$126.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.92
|
| Rate for Payer: Priority Health HMO/PPO |
$129.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.21
|
| Rate for Payer: UHC Core |
$124.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.83
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$163.80
|
|
|
Service Code
|
NDC 51645085101
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.90 |
| Max. Negotiated Rate |
$147.42 |
| Rate for Payer: Aetna Commercial |
$139.23
|
| Rate for Payer: Aetna Medicare |
$42.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.19
|
| Rate for Payer: BCBS Complete |
$65.52
|
| Rate for Payer: BCBS MAPPO |
$40.95
|
| Rate for Payer: BCBS Trust/PPO |
$134.66
|
| Rate for Payer: BCN Commercial |
$127.35
|
| Rate for Payer: BCN Medicare Advantage |
$40.95
|
| Rate for Payer: Cash Price |
$131.04
|
| Rate for Payer: Cofinity Commercial |
$140.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.95
|
| Rate for Payer: Healthscope Commercial |
$147.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.23
|
| Rate for Payer: Nomi Health Commercial |
$134.32
|
| Rate for Payer: PACE Senior Care Partners |
$38.90
|
| Rate for Payer: PACE SWMI |
$40.95
|
| Rate for Payer: PHP Commercial |
$139.23
|
| Rate for Payer: PHP Medicare Advantage |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.47
|
| Rate for Payer: Priority Health HMO/PPO |
$142.51
|
| Rate for Payer: Priority Health Medicare |
$41.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.75
|
| Rate for Payer: Railroad Medicare Medicare |
$40.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.14
|
| Rate for Payer: UHC Core |
$136.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.95
|
| Rate for Payer: UHC Exchange |
$40.95
|
| Rate for Payer: UHC Medicare Advantage |
$40.95
|
| Rate for Payer: VA VA |
$40.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.85
|
|
