|
SUMATRIPTAN 100 MG TABLET
|
Facility
|
OP
|
$7.92
|
|
|
Service Code
|
NDC 63304009911
|
| Hospital Charge Code |
13369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Aetna Commercial |
$6.73
|
| Rate for Payer: Aetna Medicare |
$2.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.48
|
| Rate for Payer: BCBS Complete |
$1.47
|
| Rate for Payer: BCBS MAPPO |
$1.98
|
| Rate for Payer: BCBS Trust/PPO |
$6.51
|
| Rate for Payer: BCN Commercial |
$6.51
|
| Rate for Payer: BCN Medicare Advantage |
$1.98
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cofinity Commercial |
$6.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$7.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.94
|
| Rate for Payer: Mclaren Medicaid |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.08
|
| Rate for Payer: Meridian Medicaid |
$1.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.73
|
| Rate for Payer: Nomi Health Commercial |
$6.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.94
|
| Rate for Payer: PACE Senior Care Partners |
$1.88
|
| Rate for Payer: PACE SWMI |
$1.98
|
| Rate for Payer: PHP Commercial |
$6.73
|
| Rate for Payer: PHP Medicare Advantage |
$1.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.89
|
| Rate for Payer: Priority Health Medicare |
$2.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.51
|
| Rate for Payer: Railroad Medicare Medicare |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.97
|
| Rate for Payer: UHC Core |
$6.61
|
| Rate for Payer: UHC Exchange |
$1.98
|
| Rate for Payer: UHC Medicaid |
$1.40
|
| Rate for Payer: UHC Medicare Advantage |
$1.98
|
| Rate for Payer: UHCCP Medicaid |
$1.40
|
| Rate for Payer: VA VA |
$1.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.94
|
|
|
SUMATRIPTAN 100 MG TABLET
|
Facility
|
IP
|
$71.20
|
|
|
Service Code
|
NDC 63304009919
|
| Hospital Charge Code |
13369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Aetna Commercial |
$60.52
|
| Rate for Payer: BCBS Trust/PPO |
$58.80
|
| Rate for Payer: BCN Commercial |
$58.80
|
| Rate for Payer: Cash Price |
$56.96
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.96
|
| Rate for Payer: Healthscope Commercial |
$64.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.52
|
| Rate for Payer: Nomi Health Commercial |
$58.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.40
|
| Rate for Payer: PHP Commercial |
$60.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.66
|
| Rate for Payer: UHC Core |
$59.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.40
|
|
|
SUMATRIPTAN 100 MG TABLET
|
Facility
|
OP
|
$26.75
|
|
|
Service Code
|
NDC 65862014836
|
| Hospital Charge Code |
13369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$24.07 |
| Rate for Payer: Aetna Commercial |
$22.74
|
| Rate for Payer: Aetna Medicare |
$6.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.36
|
| Rate for Payer: BCBS Complete |
$4.95
|
| Rate for Payer: BCBS MAPPO |
$6.69
|
| Rate for Payer: BCBS Trust/PPO |
$21.99
|
| Rate for Payer: BCN Commercial |
$21.99
|
| Rate for Payer: BCN Medicare Advantage |
$6.69
|
| Rate for Payer: Cash Price |
$21.40
|
| Rate for Payer: Cofinity Commercial |
$23.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.69
|
| Rate for Payer: Healthscope Commercial |
$24.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.06
|
| Rate for Payer: Mclaren Medicaid |
$4.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.02
|
| Rate for Payer: Meridian Medicaid |
$4.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.74
|
| Rate for Payer: Nomi Health Commercial |
$21.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.06
|
| Rate for Payer: PACE Senior Care Partners |
$6.35
|
| Rate for Payer: PACE SWMI |
$6.69
|
| Rate for Payer: PHP Commercial |
$22.74
|
| Rate for Payer: PHP Medicare Advantage |
$6.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.27
|
| Rate for Payer: Priority Health Medicare |
$6.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.62
|
| Rate for Payer: Railroad Medicare Medicare |
$6.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.54
|
| Rate for Payer: UHC Core |
$22.34
|
| Rate for Payer: UHC Exchange |
$6.69
|
| Rate for Payer: UHC Medicaid |
$4.72
|
| Rate for Payer: UHC Medicare Advantage |
$6.69
|
| Rate for Payer: UHCCP Medicaid |
$4.72
|
| Rate for Payer: VA VA |
$6.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.06
|
|
|
SUMATRIPTAN 100 MG TABLET
|
Facility
|
IP
|
$26.75
|
|
|
Service Code
|
NDC 65862014836
|
| Hospital Charge Code |
13369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$24.07 |
| Rate for Payer: Aetna Commercial |
$22.74
|
| Rate for Payer: BCBS Trust/PPO |
$22.09
|
| Rate for Payer: BCN Commercial |
$22.09
|
| Rate for Payer: Cash Price |
$21.40
|
| Rate for Payer: Cofinity Commercial |
$23.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.40
|
| Rate for Payer: Healthscope Commercial |
$24.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.74
|
| Rate for Payer: Nomi Health Commercial |
$21.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.06
|
| Rate for Payer: PHP Commercial |
$22.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.54
|
| Rate for Payer: UHC Core |
$22.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.06
|
|
|
SUMATRIPTAN 100 MG TABLET
|
Facility
|
IP
|
$7.92
|
|
|
Service Code
|
NDC 63304009911
|
| Hospital Charge Code |
13369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Aetna Commercial |
$6.73
|
| Rate for Payer: BCBS Trust/PPO |
$6.54
|
| Rate for Payer: BCN Commercial |
$6.54
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cofinity Commercial |
$6.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.34
|
| Rate for Payer: Healthscope Commercial |
$7.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.73
|
| Rate for Payer: Nomi Health Commercial |
$6.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.94
|
| Rate for Payer: PHP Commercial |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.97
|
| Rate for Payer: UHC Core |
$6.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.94
|
|
|
SUMATRIPTAN 100 MG TABLET
|
Facility
|
OP
|
$71.20
|
|
|
Service Code
|
NDC 62756052269
|
| Hospital Charge Code |
13369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Aetna Commercial |
$60.52
|
| Rate for Payer: Aetna Medicare |
$18.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.25
|
| Rate for Payer: BCBS Complete |
$13.18
|
| Rate for Payer: BCBS MAPPO |
$17.80
|
| Rate for Payer: BCBS Trust/PPO |
$58.53
|
| Rate for Payer: BCN Commercial |
$58.53
|
| Rate for Payer: BCN Medicare Advantage |
$17.80
|
| Rate for Payer: Cash Price |
$56.96
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.80
|
| Rate for Payer: Healthscope Commercial |
$64.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.40
|
| Rate for Payer: Mclaren Medicaid |
$12.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.69
|
| Rate for Payer: Meridian Medicaid |
$13.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.52
|
| Rate for Payer: Nomi Health Commercial |
$58.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.40
|
| Rate for Payer: PACE Senior Care Partners |
$16.91
|
| Rate for Payer: PACE SWMI |
$17.80
|
| Rate for Payer: PHP Commercial |
$60.52
|
| Rate for Payer: PHP Medicare Advantage |
$17.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.94
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.56
|
| Rate for Payer: Railroad Medicare Medicare |
$17.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.66
|
| Rate for Payer: UHC Core |
$59.45
|
| Rate for Payer: UHC Exchange |
$17.80
|
| Rate for Payer: UHC Medicaid |
$12.55
|
| Rate for Payer: UHC Medicare Advantage |
$17.80
|
| Rate for Payer: UHCCP Medicaid |
$12.55
|
| Rate for Payer: VA VA |
$17.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.40
|
|
|
SUMATRIPTAN 100 MG TABLET
|
Facility
|
OP
|
$71.20
|
|
|
Service Code
|
NDC 63304009919
|
| Hospital Charge Code |
13369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Aetna Commercial |
$60.52
|
| Rate for Payer: Aetna Medicare |
$18.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.25
|
| Rate for Payer: BCBS Complete |
$13.18
|
| Rate for Payer: BCBS MAPPO |
$17.80
|
| Rate for Payer: BCBS Trust/PPO |
$58.53
|
| Rate for Payer: BCN Commercial |
$58.53
|
| Rate for Payer: BCN Medicare Advantage |
$17.80
|
| Rate for Payer: Cash Price |
$56.96
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.80
|
| Rate for Payer: Healthscope Commercial |
$64.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.40
|
| Rate for Payer: Mclaren Medicaid |
$12.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.69
|
| Rate for Payer: Meridian Medicaid |
$13.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.52
|
| Rate for Payer: Nomi Health Commercial |
$58.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.40
|
| Rate for Payer: PACE Senior Care Partners |
$16.91
|
| Rate for Payer: PACE SWMI |
$17.80
|
| Rate for Payer: PHP Commercial |
$60.52
|
| Rate for Payer: PHP Medicare Advantage |
$17.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.94
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.56
|
| Rate for Payer: Railroad Medicare Medicare |
$17.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.66
|
| Rate for Payer: UHC Core |
$59.45
|
| Rate for Payer: UHC Exchange |
$17.80
|
| Rate for Payer: UHC Medicaid |
$12.55
|
| Rate for Payer: UHC Medicare Advantage |
$17.80
|
| Rate for Payer: UHCCP Medicaid |
$12.55
|
| Rate for Payer: VA VA |
$17.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.40
|
|
|
SUMATRIPTAN 25 MG TABLET
|
Facility
|
IP
|
$41.78
|
|
|
Service Code
|
NDC 00378563059
|
| Hospital Charge Code |
15327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.08 |
| Max. Negotiated Rate |
$37.60 |
| Rate for Payer: Aetna Commercial |
$35.51
|
| Rate for Payer: BCBS Trust/PPO |
$34.51
|
| Rate for Payer: BCN Commercial |
$34.51
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cofinity Commercial |
$35.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.42
|
| Rate for Payer: Healthscope Commercial |
$37.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.51
|
| Rate for Payer: Nomi Health Commercial |
$34.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.34
|
| Rate for Payer: PHP Commercial |
$35.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.77
|
| Rate for Payer: UHC Core |
$34.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.34
|
|
|
SUMATRIPTAN 25 MG TABLET
|
Facility
|
OP
|
$41.78
|
|
|
Service Code
|
NDC 00378563059
|
| Hospital Charge Code |
15327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$37.60 |
| Rate for Payer: Aetna Commercial |
$35.51
|
| Rate for Payer: Aetna Medicare |
$10.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.06
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS MAPPO |
$10.45
|
| Rate for Payer: BCBS Trust/PPO |
$34.35
|
| Rate for Payer: BCN Commercial |
$34.35
|
| Rate for Payer: BCN Medicare Advantage |
$10.45
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cofinity Commercial |
$35.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.45
|
| Rate for Payer: Healthscope Commercial |
$37.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.34
|
| Rate for Payer: Mclaren Medicaid |
$7.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.97
|
| Rate for Payer: Meridian Medicaid |
$7.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.51
|
| Rate for Payer: Nomi Health Commercial |
$34.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.34
|
| Rate for Payer: PACE Senior Care Partners |
$9.92
|
| Rate for Payer: PACE SWMI |
$10.45
|
| Rate for Payer: PHP Commercial |
$35.51
|
| Rate for Payer: PHP Medicare Advantage |
$10.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.35
|
| Rate for Payer: Priority Health Medicare |
$10.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.08
|
| Rate for Payer: Railroad Medicare Medicare |
$10.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.77
|
| Rate for Payer: UHC Core |
$34.89
|
| Rate for Payer: UHC Exchange |
$10.45
|
| Rate for Payer: UHC Medicaid |
$7.37
|
| Rate for Payer: UHC Medicare Advantage |
$10.45
|
| Rate for Payer: UHCCP Medicaid |
$7.37
|
| Rate for Payer: VA VA |
$10.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.34
|
|
|
SUMATRIPTAN 25 MG TABLET
|
Facility
|
OP
|
$71.20
|
|
|
Service Code
|
NDC 62756052069
|
| Hospital Charge Code |
15327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Aetna Commercial |
$60.52
|
| Rate for Payer: Aetna Medicare |
$18.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.25
|
| Rate for Payer: BCBS Complete |
$13.18
|
| Rate for Payer: BCBS MAPPO |
$17.80
|
| Rate for Payer: BCBS Trust/PPO |
$58.53
|
| Rate for Payer: BCN Commercial |
$58.53
|
| Rate for Payer: BCN Medicare Advantage |
$17.80
|
| Rate for Payer: Cash Price |
$56.96
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.80
|
| Rate for Payer: Healthscope Commercial |
$64.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.40
|
| Rate for Payer: Mclaren Medicaid |
$12.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.69
|
| Rate for Payer: Meridian Medicaid |
$13.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.52
|
| Rate for Payer: Nomi Health Commercial |
$58.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.40
|
| Rate for Payer: PACE Senior Care Partners |
$16.91
|
| Rate for Payer: PACE SWMI |
$17.80
|
| Rate for Payer: PHP Commercial |
$60.52
|
| Rate for Payer: PHP Medicare Advantage |
$17.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.94
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.56
|
| Rate for Payer: Railroad Medicare Medicare |
$17.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.66
|
| Rate for Payer: UHC Core |
$59.45
|
| Rate for Payer: UHC Exchange |
$17.80
|
| Rate for Payer: UHC Medicaid |
$12.55
|
| Rate for Payer: UHC Medicare Advantage |
$17.80
|
| Rate for Payer: UHCCP Medicaid |
$12.55
|
| Rate for Payer: VA VA |
$17.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.40
|
|
|
SUMATRIPTAN 25 MG TABLET
|
Facility
|
OP
|
$25.40
|
|
|
Service Code
|
NDC 65862014636
|
| Hospital Charge Code |
15327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$22.86 |
| Rate for Payer: Aetna Commercial |
$21.59
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.94
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.88
|
| Rate for Payer: BCN Commercial |
$20.88
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.32
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.05
|
| Rate for Payer: Mclaren Medicaid |
$4.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.67
|
| Rate for Payer: Meridian Medicaid |
$4.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.59
|
| Rate for Payer: Nomi Health Commercial |
$20.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.05
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.59
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.10
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.68
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.35
|
| Rate for Payer: UHC Core |
$21.21
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicaid |
$4.48
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$4.48
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.05
|
|
|
SUMATRIPTAN 25 MG TABLET
|
Facility
|
IP
|
$25.40
|
|
|
Service Code
|
NDC 65862014636
|
| Hospital Charge Code |
15327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$22.86 |
| Rate for Payer: Aetna Commercial |
$21.59
|
| Rate for Payer: BCBS Trust/PPO |
$20.98
|
| Rate for Payer: BCN Commercial |
$20.98
|
| Rate for Payer: Cash Price |
$20.32
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.32
|
| Rate for Payer: Healthscope Commercial |
$22.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.59
|
| Rate for Payer: Nomi Health Commercial |
$20.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.05
|
| Rate for Payer: PHP Commercial |
$21.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.35
|
| Rate for Payer: UHC Core |
$21.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.05
|
|
|
SUMATRIPTAN 25 MG TABLET
|
Facility
|
IP
|
$71.20
|
|
|
Service Code
|
NDC 62756052069
|
| Hospital Charge Code |
15327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Aetna Commercial |
$60.52
|
| Rate for Payer: BCBS Trust/PPO |
$58.80
|
| Rate for Payer: BCN Commercial |
$58.80
|
| Rate for Payer: Cash Price |
$56.96
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.96
|
| Rate for Payer: Healthscope Commercial |
$64.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.52
|
| Rate for Payer: Nomi Health Commercial |
$58.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.40
|
| Rate for Payer: PHP Commercial |
$60.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.66
|
| Rate for Payer: UHC Core |
$59.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.40
|
|
|
SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$20.70
|
|
|
Service Code
|
HCPCS J3030
|
| Hospital Charge Code |
97342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$22.42
|
| Rate for Payer: Aetna Commercial |
$23.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCBS Trust/PPO |
$17.10
|
| Rate for Payer: BCBS Trust/PPO |
$22.46
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: BCN Commercial |
$17.10
|
| Rate for Payer: BCN Commercial |
$22.46
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cofinity Commercial |
$23.38
|
| Rate for Payer: Cofinity Commercial |
$22.69
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.75
|
| Rate for Payer: Healthscope Commercial |
$23.74
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$24.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.11
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$21.63
|
| Rate for Payer: Nomi Health Commercial |
$22.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.39
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$23.11
|
| Rate for Payer: PHP Commercial |
$22.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.22
|
| Rate for Payer: UHC Core |
$17.28
|
| Rate for Payer: UHC Core |
$22.70
|
| Rate for Payer: UHC Core |
$22.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.79
|
|
|
SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$20.70
|
|
|
Service Code
|
HCPCS J3030
|
| Hospital Charge Code |
97342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$23.11
|
| Rate for Payer: Aetna Commercial |
$22.42
|
| Rate for Payer: Aetna Medicare |
$7.07
|
| Rate for Payer: Aetna Medicare |
$5.38
|
| Rate for Payer: Aetna Medicare |
$6.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.50
|
| Rate for Payer: BCBS Complete |
$4.88
|
| Rate for Payer: BCBS Complete |
$3.83
|
| Rate for Payer: BCBS Complete |
$5.03
|
| Rate for Payer: BCBS MAPPO |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$5.17
|
| Rate for Payer: BCBS MAPPO |
$6.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.69
|
| Rate for Payer: BCBS Trust/PPO |
$22.35
|
| Rate for Payer: BCN Commercial |
$21.69
|
| Rate for Payer: BCN Commercial |
$22.35
|
| Rate for Payer: BCN Commercial |
$17.02
|
| Rate for Payer: BCN Medicare Advantage |
$6.80
|
| Rate for Payer: BCN Medicare Advantage |
$6.59
|
| Rate for Payer: BCN Medicare Advantage |
$5.17
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$22.69
|
| Rate for Payer: Cofinity Commercial |
$23.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.17
|
| Rate for Payer: Healthscope Commercial |
$23.74
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$24.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.79
|
| Rate for Payer: Mclaren Medicaid |
$3.65
|
| Rate for Payer: Mclaren Medicaid |
$4.79
|
| Rate for Payer: Mclaren Medicaid |
$4.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.14
|
| Rate for Payer: Meridian Medicaid |
$5.03
|
| Rate for Payer: Meridian Medicaid |
$3.83
|
| Rate for Payer: Meridian Medicaid |
$4.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.42
|
| Rate for Payer: Nomi Health Commercial |
$22.30
|
| Rate for Payer: Nomi Health Commercial |
$21.63
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: PACE Senior Care Partners |
$6.27
|
| Rate for Payer: PACE Senior Care Partners |
$4.92
|
| Rate for Payer: PACE Senior Care Partners |
$6.46
|
| Rate for Payer: PACE SWMI |
$6.80
|
| Rate for Payer: PACE SWMI |
$6.59
|
| Rate for Payer: PACE SWMI |
$5.17
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$23.11
|
| Rate for Payer: PHP Commercial |
$22.42
|
| Rate for Payer: PHP Medicare Advantage |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$5.17
|
| Rate for Payer: PHP Medicare Advantage |
$6.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.66
|
| Rate for Payer: Priority Health Medicare |
$6.87
|
| Rate for Payer: Priority Health Medicare |
$6.66
|
| Rate for Payer: Priority Health Medicare |
$5.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.41
|
| Rate for Payer: Railroad Medicare Medicare |
$6.59
|
| Rate for Payer: Railroad Medicare Medicare |
$6.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.22
|
| Rate for Payer: UHC Core |
$17.28
|
| Rate for Payer: UHC Core |
$22.70
|
| Rate for Payer: UHC Core |
$22.03
|
| Rate for Payer: UHC Exchange |
$6.80
|
| Rate for Payer: UHC Exchange |
$6.59
|
| Rate for Payer: UHC Exchange |
$5.17
|
| Rate for Payer: UHC Medicaid |
$3.65
|
| Rate for Payer: UHC Medicaid |
$4.79
|
| Rate for Payer: UHC Medicaid |
$4.65
|
| Rate for Payer: UHC Medicare Advantage |
$6.59
|
| Rate for Payer: UHC Medicare Advantage |
$5.17
|
| Rate for Payer: UHC Medicare Advantage |
$6.80
|
| Rate for Payer: UHCCP Medicaid |
$4.65
|
| Rate for Payer: UHCCP Medicaid |
$3.65
|
| Rate for Payer: UHCCP Medicaid |
$4.79
|
| Rate for Payer: VA VA |
$5.17
|
| Rate for Payer: VA VA |
$6.80
|
| Rate for Payer: VA VA |
$6.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.39
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$9,310.00
|
|
|
Service Code
|
APR-DRG 2044
|
| 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
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$3,771.32
|
|
|
Service Code
|
APR-DRG 2041
|
| Min. Negotiated Rate |
$3,591.74 |
| Max. Negotiated Rate |
$3,771.32 |
| Rate for Payer: BCBS Complete |
$3,771.32
|
| Rate for Payer: Mclaren Medicaid |
$3,591.74
|
| Rate for Payer: Meridian Medicaid |
$3,771.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,591.74
|
| Rate for Payer: UHC Medicaid |
$3,591.74
|
| Rate for Payer: UHCCP Medicaid |
$3,591.74
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$4,604.78
|
|
|
Service Code
|
APR-DRG 2042
|
| Min. Negotiated Rate |
$4,385.51 |
| Max. Negotiated Rate |
$4,604.78 |
| Rate for Payer: BCBS Complete |
$4,604.78
|
| Rate for Payer: Mclaren Medicaid |
$4,385.51
|
| Rate for Payer: Meridian Medicaid |
$4,604.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,385.51
|
| Rate for Payer: UHC Medicaid |
$4,385.51
|
| Rate for Payer: UHCCP Medicaid |
$4,385.51
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$5,632.80
|
|
|
Service Code
|
APR-DRG 2043
|
| Min. Negotiated Rate |
$5,364.57 |
| Max. Negotiated Rate |
$5,632.80 |
| Rate for Payer: BCBS Complete |
$5,632.80
|
| Rate for Payer: Mclaren Medicaid |
$5,364.57
|
| Rate for Payer: Meridian Medicaid |
$5,632.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,364.57
|
| Rate for Payer: UHC Medicaid |
$5,364.57
|
| Rate for Payer: UHCCP Medicaid |
$5,364.57
|
|
|
TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$406.56
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
24914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$282.97 |
| Max. Negotiated Rate |
$365.90 |
| Rate for Payer: Aetna Commercial |
$345.58
|
| Rate for Payer: BCBS Trust/PPO |
$335.78
|
| Rate for Payer: BCN Commercial |
$335.78
|
| Rate for Payer: Cash Price |
$325.25
|
| Rate for Payer: Cofinity Commercial |
$349.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.25
|
| Rate for Payer: Healthscope Commercial |
$365.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.58
|
| Rate for Payer: Nomi Health Commercial |
$333.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.92
|
| Rate for Payer: PHP Commercial |
$345.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$353.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.77
|
| Rate for Payer: UHC Core |
$339.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.92
|
|
|
TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
OP
|
$406.56
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
24914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$365.90 |
| Rate for Payer: Aetna Commercial |
$345.58
|
| Rate for Payer: Aetna Medicare |
$105.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.05
|
| Rate for Payer: BCBS Complete |
$75.25
|
| Rate for Payer: BCBS MAPPO |
$101.64
|
| Rate for Payer: BCBS Trust/PPO |
$334.23
|
| Rate for Payer: BCN Commercial |
$334.23
|
| Rate for Payer: BCN Medicare Advantage |
$101.64
|
| Rate for Payer: Cash Price |
$325.25
|
| Rate for Payer: Cofinity Commercial |
$349.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.64
|
| Rate for Payer: Healthscope Commercial |
$365.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.92
|
| Rate for Payer: Mclaren Medicaid |
$71.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.72
|
| Rate for Payer: Meridian Medicaid |
$75.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.58
|
| Rate for Payer: Nomi Health Commercial |
$333.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.92
|
| Rate for Payer: PACE Senior Care Partners |
$96.56
|
| Rate for Payer: PACE SWMI |
$101.64
|
| Rate for Payer: PHP Commercial |
$345.58
|
| Rate for Payer: PHP Medicare Advantage |
$101.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$353.71
|
| Rate for Payer: Priority Health Medicare |
$102.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.97
|
| Rate for Payer: Railroad Medicare Medicare |
$101.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.77
|
| Rate for Payer: UHC Core |
$339.48
|
| Rate for Payer: UHC Exchange |
$101.64
|
| Rate for Payer: UHC Medicaid |
$71.68
|
| Rate for Payer: UHC Medicare Advantage |
$101.64
|
| Rate for Payer: UHCCP Medicaid |
$71.68
|
| Rate for Payer: VA VA |
$101.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.92
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
OP
|
$260.64
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.95 |
| Max. Negotiated Rate |
$234.58 |
| Rate for Payer: Aetna Commercial |
$221.54
|
| Rate for Payer: Aetna Commercial |
$486.74
|
| Rate for Payer: Aetna Commercial |
$441.46
|
| Rate for Payer: Aetna Medicare |
$148.89
|
| Rate for Payer: Aetna Medicare |
$67.77
|
| Rate for Payer: Aetna Medicare |
$135.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.95
|
| Rate for Payer: BCBS Complete |
$96.13
|
| Rate for Payer: BCBS Complete |
$48.24
|
| Rate for Payer: BCBS Complete |
$106.00
|
| Rate for Payer: BCBS MAPPO |
$143.16
|
| Rate for Payer: BCBS MAPPO |
$65.16
|
| Rate for Payer: BCBS MAPPO |
$129.84
|
| Rate for Payer: BCBS Trust/PPO |
$214.27
|
| Rate for Payer: BCBS Trust/PPO |
$426.97
|
| Rate for Payer: BCBS Trust/PPO |
$470.77
|
| Rate for Payer: BCN Commercial |
$426.97
|
| Rate for Payer: BCN Commercial |
$470.77
|
| Rate for Payer: BCN Commercial |
$214.27
|
| Rate for Payer: BCN Medicare Advantage |
$143.16
|
| Rate for Payer: BCN Medicare Advantage |
$129.84
|
| Rate for Payer: BCN Medicare Advantage |
$65.16
|
| Rate for Payer: Cash Price |
$458.11
|
| Rate for Payer: Cash Price |
$415.49
|
| Rate for Payer: Cash Price |
$208.51
|
| Rate for Payer: Cofinity Commercial |
$224.15
|
| Rate for Payer: Cofinity Commercial |
$446.65
|
| Rate for Payer: Cofinity Commercial |
$492.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.16
|
| Rate for Payer: Healthscope Commercial |
$467.42
|
| Rate for Payer: Healthscope Commercial |
$234.58
|
| Rate for Payer: Healthscope Commercial |
$515.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$389.52
|
| Rate for Payer: Mclaren Medicaid |
$45.95
|
| Rate for Payer: Mclaren Medicaid |
$100.96
|
| Rate for Payer: Mclaren Medicaid |
$91.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.32
|
| Rate for Payer: Meridian Medicaid |
$106.00
|
| Rate for Payer: Meridian Medicaid |
$48.24
|
| Rate for Payer: Meridian Medicaid |
$96.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$157.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$142.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.46
|
| Rate for Payer: Nomi Health Commercial |
$469.56
|
| Rate for Payer: Nomi Health Commercial |
$425.88
|
| Rate for Payer: Nomi Health Commercial |
$213.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$389.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.48
|
| Rate for Payer: PACE Senior Care Partners |
$123.35
|
| Rate for Payer: PACE Senior Care Partners |
$61.90
|
| Rate for Payer: PACE Senior Care Partners |
$136.00
|
| Rate for Payer: PACE SWMI |
$143.16
|
| Rate for Payer: PACE SWMI |
$129.84
|
| Rate for Payer: PACE SWMI |
$65.16
|
| Rate for Payer: PHP Commercial |
$221.54
|
| Rate for Payer: PHP Commercial |
$486.74
|
| Rate for Payer: PHP Commercial |
$441.46
|
| Rate for Payer: PHP Medicare Advantage |
$129.84
|
| Rate for Payer: PHP Medicare Advantage |
$65.16
|
| Rate for Payer: PHP Medicare Advantage |
$143.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$451.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$498.20
|
| Rate for Payer: Priority Health Medicare |
$144.59
|
| Rate for Payer: Priority Health Medicare |
$131.14
|
| Rate for Payer: Priority Health Medicare |
$65.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$361.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.41
|
| Rate for Payer: Railroad Medicare Medicare |
$129.84
|
| Rate for Payer: Railroad Medicare Medicare |
$143.16
|
| Rate for Payer: Railroad Medicare Medicare |
$65.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$503.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.36
|
| Rate for Payer: UHC Core |
$217.63
|
| Rate for Payer: UHC Core |
$478.15
|
| Rate for Payer: UHC Core |
$433.67
|
| Rate for Payer: UHC Exchange |
$143.16
|
| Rate for Payer: UHC Exchange |
$129.84
|
| Rate for Payer: UHC Exchange |
$65.16
|
| Rate for Payer: UHC Medicaid |
$45.95
|
| Rate for Payer: UHC Medicaid |
$100.96
|
| Rate for Payer: UHC Medicaid |
$91.56
|
| Rate for Payer: UHC Medicare Advantage |
$129.84
|
| Rate for Payer: UHC Medicare Advantage |
$65.16
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: UHCCP Medicaid |
$91.56
|
| Rate for Payer: UHCCP Medicaid |
$45.95
|
| Rate for Payer: UHCCP Medicaid |
$100.96
|
| Rate for Payer: VA VA |
$65.16
|
| Rate for Payer: VA VA |
$143.16
|
| Rate for Payer: VA VA |
$129.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$389.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.48
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$260.64
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.41 |
| Max. Negotiated Rate |
$234.58 |
| Rate for Payer: Aetna Commercial |
$221.54
|
| Rate for Payer: Aetna Commercial |
$441.46
|
| Rate for Payer: Aetna Commercial |
$486.74
|
| Rate for Payer: BCBS Trust/PPO |
$428.94
|
| Rate for Payer: BCBS Trust/PPO |
$215.26
|
| Rate for Payer: BCBS Trust/PPO |
$472.94
|
| Rate for Payer: BCN Commercial |
$428.94
|
| Rate for Payer: BCN Commercial |
$215.26
|
| Rate for Payer: BCN Commercial |
$472.94
|
| Rate for Payer: Cash Price |
$208.51
|
| Rate for Payer: Cash Price |
$458.11
|
| Rate for Payer: Cash Price |
$415.49
|
| Rate for Payer: Cofinity Commercial |
$492.47
|
| Rate for Payer: Cofinity Commercial |
$446.65
|
| Rate for Payer: Cofinity Commercial |
$224.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.11
|
| Rate for Payer: Healthscope Commercial |
$467.42
|
| Rate for Payer: Healthscope Commercial |
$234.58
|
| Rate for Payer: Healthscope Commercial |
$515.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$389.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.74
|
| Rate for Payer: Nomi Health Commercial |
$213.72
|
| Rate for Payer: Nomi Health Commercial |
$425.88
|
| Rate for Payer: Nomi Health Commercial |
$469.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$389.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.48
|
| Rate for Payer: PHP Commercial |
$221.54
|
| Rate for Payer: PHP Commercial |
$486.74
|
| Rate for Payer: PHP Commercial |
$441.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$498.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$451.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$361.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$503.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.36
|
| Rate for Payer: UHC Core |
$217.63
|
| Rate for Payer: UHC Core |
$478.15
|
| Rate for Payer: UHC Core |
$433.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$389.52
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
OP
|
$201.78
|
|
|
Service Code
|
NDC 00378014491
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$181.60 |
| Rate for Payer: Aetna Commercial |
$171.51
|
| Rate for Payer: Aetna Medicare |
$52.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.06
|
| Rate for Payer: BCBS Complete |
$37.35
|
| Rate for Payer: BCBS MAPPO |
$50.45
|
| Rate for Payer: BCBS Trust/PPO |
$165.88
|
| Rate for Payer: BCN Commercial |
$165.88
|
| Rate for Payer: BCN Medicare Advantage |
$50.45
|
| Rate for Payer: Cash Price |
$161.42
|
| Rate for Payer: Cofinity Commercial |
$173.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.45
|
| Rate for Payer: Healthscope Commercial |
$181.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.34
|
| Rate for Payer: Mclaren Medicaid |
$35.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.97
|
| Rate for Payer: Meridian Medicaid |
$37.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$55.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.51
|
| Rate for Payer: Nomi Health Commercial |
$165.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.34
|
| Rate for Payer: PACE Senior Care Partners |
$47.92
|
| Rate for Payer: PACE SWMI |
$50.45
|
| Rate for Payer: PHP Commercial |
$171.51
|
| Rate for Payer: PHP Medicare Advantage |
$50.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$175.55
|
| Rate for Payer: Priority Health Medicare |
$50.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.44
|
| Rate for Payer: Railroad Medicare Medicare |
$50.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.57
|
| Rate for Payer: UHC Core |
$168.49
|
| Rate for Payer: UHC Exchange |
$50.45
|
| Rate for Payer: UHC Medicaid |
$35.57
|
| Rate for Payer: UHC Medicare Advantage |
$50.45
|
| Rate for Payer: UHCCP Medicaid |
$35.57
|
| Rate for Payer: VA VA |
$50.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.34
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
IP
|
$201.78
|
|
|
Service Code
|
NDC 00378014491
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.44 |
| Max. Negotiated Rate |
$181.60 |
| Rate for Payer: Aetna Commercial |
$171.51
|
| Rate for Payer: BCBS Trust/PPO |
$166.65
|
| Rate for Payer: BCN Commercial |
$166.65
|
| Rate for Payer: Cash Price |
$161.42
|
| Rate for Payer: Cofinity Commercial |
$173.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.42
|
| Rate for Payer: Healthscope Commercial |
$181.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.51
|
| Rate for Payer: Nomi Health Commercial |
$165.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.34
|
| Rate for Payer: PHP Commercial |
$171.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$175.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.57
|
| Rate for Payer: UHC Core |
$168.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.34
|
|
