|
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
|
OP
|
$132.00
|
|
|
Service Code
|
NDC 00904652261
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: Aetna Medicare |
$34.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.25
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$33.00
|
| Rate for Payer: BCBS Trust/PPO |
$108.52
|
| Rate for Payer: BCN Commercial |
$102.63
|
| Rate for Payer: BCN Medicare Advantage |
$33.00
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.00
|
| Rate for Payer: Healthscope Commercial |
$118.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.20
|
| Rate for Payer: Nomi Health Commercial |
$108.24
|
| Rate for Payer: PACE Senior Care Partners |
$31.35
|
| Rate for Payer: PACE SWMI |
$33.00
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: PHP Medicare Advantage |
$33.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health HMO/PPO |
$114.84
|
| Rate for Payer: Priority Health Medicare |
$33.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.44
|
| Rate for Payer: Railroad Medicare Medicare |
$33.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.16
|
| Rate for Payer: UHC Core |
$110.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.00
|
| Rate for Payer: UHC Exchange |
$33.00
|
| Rate for Payer: UHC Medicare Advantage |
$33.00
|
| Rate for Payer: VA VA |
$33.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$149.10
|
|
|
Service Code
|
NDC 67618030010
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.41 |
| Max. Negotiated Rate |
$134.19 |
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: Aetna Medicare |
$38.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.59
|
| Rate for Payer: BCBS Complete |
$59.64
|
| Rate for Payer: BCBS MAPPO |
$37.27
|
| Rate for Payer: BCBS Trust/PPO |
$122.58
|
| Rate for Payer: BCN Commercial |
$115.93
|
| Rate for Payer: BCN Medicare Advantage |
$37.27
|
| 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: Health Alliance Plan Medicare Advantage |
$37.27
|
| Rate for Payer: Healthscope Commercial |
$134.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.73
|
| Rate for Payer: Nomi Health Commercial |
$122.26
|
| Rate for Payer: PACE Senior Care Partners |
$35.41
|
| Rate for Payer: PACE SWMI |
$37.27
|
| Rate for Payer: PHP Commercial |
$126.73
|
| Rate for Payer: PHP Medicare Advantage |
$37.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.92
|
| Rate for Payer: Priority Health HMO/PPO |
$129.72
|
| Rate for Payer: Priority Health Medicare |
$37.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.90
|
| Rate for Payer: Railroad Medicare Medicare |
$37.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.21
|
| Rate for Payer: UHC Core |
$124.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.27
|
| Rate for Payer: UHC Exchange |
$37.27
|
| Rate for Payer: UHC Medicare Advantage |
$37.27
|
| Rate for Payer: VA VA |
$37.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.83
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
NDC 00904725261
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna Commercial |
$119.00
|
| Rate for Payer: Aetna Medicare |
$36.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.75
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCBS MAPPO |
$35.00
|
| Rate for Payer: BCBS Trust/PPO |
$115.09
|
| Rate for Payer: BCN Commercial |
$108.85
|
| Rate for Payer: BCN Medicare Advantage |
$35.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.00
|
| Rate for Payer: Healthscope Commercial |
$126.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.00
|
| Rate for Payer: Nomi Health Commercial |
$114.80
|
| Rate for Payer: PACE Senior Care Partners |
$33.25
|
| Rate for Payer: PACE SWMI |
$35.00
|
| Rate for Payer: PHP Commercial |
$119.00
|
| Rate for Payer: PHP Medicare Advantage |
$35.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health HMO/PPO |
$121.80
|
| Rate for Payer: Priority Health Medicare |
$35.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.80
|
| Rate for Payer: Railroad Medicare Medicare |
$35.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.20
|
| Rate for Payer: UHC Core |
$116.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.00
|
| Rate for Payer: UHC Exchange |
$35.00
|
| Rate for Payer: UHC Medicare Advantage |
$35.00
|
| Rate for Payer: VA VA |
$35.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.00
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
NDC 00904725261
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna Commercial |
$119.00
|
| Rate for Payer: BCBS Trust/PPO |
$114.28
|
| Rate for Payer: BCN Commercial |
$108.19
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Healthscope Commercial |
$126.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.00
|
| Rate for Payer: Nomi Health Commercial |
$114.80
|
| Rate for Payer: PHP Commercial |
$119.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health HMO/PPO |
$121.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.20
|
| Rate for Payer: UHC Core |
$116.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.00
|
|
|
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
|
IP
|
$154.00
|
|
|
Service Code
|
NDC 70000044702
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: BCBS Trust/PPO |
$125.71
|
| Rate for Payer: BCN Commercial |
$119.01
|
| 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: Healthscope Commercial |
$138.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.90
|
| Rate for Payer: Nomi Health Commercial |
$126.28
|
| Rate for Payer: PHP Commercial |
$130.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.10
|
| Rate for Payer: Priority Health HMO/PPO |
$133.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.52
|
| Rate for Payer: UHC Core |
$128.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.50
|
|
|
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
|
|
|
SERTRALINE 100 MG TABLET
|
Facility
|
OP
|
$348.65
|
|
|
Service Code
|
NDC 60687025301
|
| Hospital Charge Code |
11350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$313.79 |
| Rate for Payer: Aetna Commercial |
$296.35
|
| Rate for Payer: Aetna Medicare |
$90.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.95
|
| Rate for Payer: BCBS Complete |
$139.46
|
| Rate for Payer: BCBS MAPPO |
$87.16
|
| Rate for Payer: BCBS Trust/PPO |
$286.63
|
| Rate for Payer: BCN Commercial |
$271.08
|
| Rate for Payer: BCN Medicare Advantage |
$87.16
|
| Rate for Payer: Cash Price |
$278.92
|
| Rate for Payer: Cofinity Commercial |
$299.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.16
|
| Rate for Payer: Healthscope Commercial |
$313.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.35
|
| Rate for Payer: Nomi Health Commercial |
$285.89
|
| Rate for Payer: PACE Senior Care Partners |
$82.80
|
| Rate for Payer: PACE SWMI |
$87.16
|
| Rate for Payer: PHP Commercial |
$296.35
|
| Rate for Payer: PHP Medicare Advantage |
$87.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.62
|
| Rate for Payer: Priority Health HMO/PPO |
$303.33
|
| Rate for Payer: Priority Health Medicare |
$88.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.60
|
| Rate for Payer: Railroad Medicare Medicare |
$87.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.81
|
| Rate for Payer: UHC Core |
$291.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.16
|
| Rate for Payer: UHC Exchange |
$87.16
|
| Rate for Payer: UHC Medicare Advantage |
$87.16
|
| Rate for Payer: VA VA |
$87.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.49
|
|
|
SERTRALINE 100 MG TABLET
|
Facility
|
IP
|
$3.49
|
|
|
Service Code
|
NDC 60687025311
|
| Hospital Charge Code |
11350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Aetna Commercial |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$2.85
|
| Rate for Payer: BCN Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.79
|
| Rate for Payer: Healthscope Commercial |
$3.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.97
|
| Rate for Payer: Nomi Health Commercial |
$2.86
|
| Rate for Payer: PHP Commercial |
$2.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.27
|
| Rate for Payer: Priority Health HMO/PPO |
$3.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.07
|
| Rate for Payer: UHC Core |
$2.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.62
|
|
|
SERTRALINE 100 MG TABLET
|
Facility
|
OP
|
$3.49
|
|
|
Service Code
|
NDC 60687025311
|
| Hospital Charge Code |
11350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Aetna Commercial |
$2.97
|
| Rate for Payer: Aetna Medicare |
$0.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.09
|
| Rate for Payer: BCBS Complete |
$1.40
|
| Rate for Payer: BCBS MAPPO |
$0.87
|
| Rate for Payer: BCBS Trust/PPO |
$2.87
|
| Rate for Payer: BCN Commercial |
$2.71
|
| Rate for Payer: BCN Medicare Advantage |
$0.87
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.87
|
| Rate for Payer: Healthscope Commercial |
$3.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.97
|
| Rate for Payer: Nomi Health Commercial |
$2.86
|
| Rate for Payer: PACE Senior Care Partners |
$0.83
|
| Rate for Payer: PACE SWMI |
$0.87
|
| Rate for Payer: PHP Commercial |
$2.97
|
| Rate for Payer: PHP Medicare Advantage |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.27
|
| Rate for Payer: Priority Health HMO/PPO |
$3.04
|
| Rate for Payer: Priority Health Medicare |
$0.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.34
|
| Rate for Payer: Railroad Medicare Medicare |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.07
|
| Rate for Payer: UHC Core |
$2.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Medicare Advantage |
$0.87
|
| Rate for Payer: VA VA |
$0.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.62
|
|
|
SERTRALINE 100 MG TABLET
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
NDC 59762491003
|
| Hospital Charge Code |
11350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.78 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: BCBS Trust/PPO |
$159.22
|
| Rate for Payer: BCN Commercial |
$150.73
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Nomi Health Commercial |
$159.94
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.78
|
| Rate for Payer: Priority Health HMO/PPO |
$169.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.64
|
| Rate for Payer: UHC Core |
$162.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
SERTRALINE 100 MG TABLET
|
Facility
|
OP
|
$317.30
|
|
|
Service Code
|
NDC 00904692661
|
| Hospital Charge Code |
11350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.36 |
| Max. Negotiated Rate |
$285.57 |
| Rate for Payer: Aetna Commercial |
$269.70
|
| Rate for Payer: Aetna Medicare |
$82.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.16
|
| Rate for Payer: BCBS Complete |
$126.92
|
| Rate for Payer: BCBS MAPPO |
$79.33
|
| Rate for Payer: BCBS Trust/PPO |
$260.85
|
| Rate for Payer: BCN Commercial |
$246.70
|
| Rate for Payer: BCN Medicare Advantage |
$79.33
|
| Rate for Payer: Cash Price |
$253.84
|
| Rate for Payer: Cofinity Commercial |
$272.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.33
|
| Rate for Payer: Healthscope Commercial |
$285.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.70
|
| Rate for Payer: Nomi Health Commercial |
$260.19
|
| Rate for Payer: PACE Senior Care Partners |
$75.36
|
| Rate for Payer: PACE SWMI |
$79.33
|
| Rate for Payer: PHP Commercial |
$269.70
|
| Rate for Payer: PHP Medicare Advantage |
$79.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.25
|
| Rate for Payer: Priority Health HMO/PPO |
$276.05
|
| Rate for Payer: Priority Health Medicare |
$80.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.59
|
| Rate for Payer: Railroad Medicare Medicare |
$79.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.22
|
| Rate for Payer: UHC Core |
$264.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.33
|
| Rate for Payer: UHC Exchange |
$79.33
|
| Rate for Payer: UHC Medicare Advantage |
$79.33
|
| Rate for Payer: VA VA |
$79.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.97
|
|
|
SERTRALINE 100 MG TABLET
|
Facility
|
OP
|
$195.05
|
|
|
Service Code
|
NDC 59762491003
|
| Hospital Charge Code |
11350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.32 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$50.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.95
|
| Rate for Payer: BCBS Complete |
$78.02
|
| Rate for Payer: BCBS MAPPO |
$48.76
|
| Rate for Payer: BCBS Trust/PPO |
$160.35
|
| Rate for Payer: BCN Commercial |
$151.65
|
| Rate for Payer: BCN Medicare Advantage |
$48.76
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.76
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Nomi Health Commercial |
$159.94
|
| Rate for Payer: PACE Senior Care Partners |
$46.32
|
| Rate for Payer: PACE SWMI |
$48.76
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: PHP Medicare Advantage |
$48.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.78
|
| Rate for Payer: Priority Health HMO/PPO |
$169.69
|
| Rate for Payer: Priority Health Medicare |
$49.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.68
|
| Rate for Payer: Railroad Medicare Medicare |
$48.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.64
|
| Rate for Payer: UHC Core |
$162.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.76
|
| Rate for Payer: UHC Exchange |
$48.76
|
| Rate for Payer: UHC Medicare Advantage |
$48.76
|
| Rate for Payer: VA VA |
$48.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
SERTRALINE 100 MG TABLET
|
Facility
|
IP
|
$348.65
|
|
|
Service Code
|
NDC 60687025301
|
| Hospital Charge Code |
11350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.62 |
| Max. Negotiated Rate |
$313.79 |
| Rate for Payer: Aetna Commercial |
$296.35
|
| Rate for Payer: BCBS Trust/PPO |
$284.60
|
| Rate for Payer: BCN Commercial |
$269.44
|
| Rate for Payer: Cash Price |
$278.92
|
| Rate for Payer: Cofinity Commercial |
$299.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.92
|
| Rate for Payer: Healthscope Commercial |
$313.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.35
|
| Rate for Payer: Nomi Health Commercial |
$285.89
|
| Rate for Payer: PHP Commercial |
$296.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.62
|
| Rate for Payer: Priority Health HMO/PPO |
$303.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.81
|
| Rate for Payer: UHC Core |
$291.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.49
|
|
|
SERTRALINE 100 MG TABLET
|
Facility
|
IP
|
$317.30
|
|
|
Service Code
|
NDC 00904692661
|
| Hospital Charge Code |
11350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.25 |
| Max. Negotiated Rate |
$285.57 |
| Rate for Payer: Aetna Commercial |
$269.70
|
| Rate for Payer: BCBS Trust/PPO |
$259.01
|
| Rate for Payer: BCN Commercial |
$245.21
|
| Rate for Payer: Cash Price |
$253.84
|
| Rate for Payer: Cofinity Commercial |
$272.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.84
|
| Rate for Payer: Healthscope Commercial |
$285.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.70
|
| Rate for Payer: Nomi Health Commercial |
$260.19
|
| Rate for Payer: PHP Commercial |
$269.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.25
|
| Rate for Payer: Priority Health HMO/PPO |
$276.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.22
|
| Rate for Payer: UHC Core |
$264.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.97
|
|
|
SERTRALINE 20 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$249.70
|
|
|
Service Code
|
NDC 59762006701
|
| Hospital Charge Code |
28011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.30 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$212.25
|
| Rate for Payer: Aetna Medicare |
$64.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.03
|
| Rate for Payer: BCBS Complete |
$99.88
|
| Rate for Payer: BCBS MAPPO |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$205.28
|
| Rate for Payer: BCN Commercial |
$194.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.42
|
| Rate for Payer: Cash Price |
$199.76
|
| Rate for Payer: Cofinity Commercial |
$214.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$224.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.25
|
| Rate for Payer: Nomi Health Commercial |
$204.75
|
| Rate for Payer: PACE Senior Care Partners |
$59.30
|
| Rate for Payer: PACE SWMI |
$62.42
|
| Rate for Payer: PHP Commercial |
$212.25
|
| Rate for Payer: PHP Medicare Advantage |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.31
|
| Rate for Payer: Priority Health HMO/PPO |
$217.24
|
| Rate for Payer: Priority Health Medicare |
$63.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.30
|
| Rate for Payer: Railroad Medicare Medicare |
$62.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.74
|
| Rate for Payer: UHC Core |
$208.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.42
|
| Rate for Payer: UHC Exchange |
$62.42
|
| Rate for Payer: UHC Medicare Advantage |
$62.42
|
| Rate for Payer: VA VA |
$62.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.28
|
|
|
SERTRALINE 20 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$249.70
|
|
|
Service Code
|
NDC 59762006701
|
| Hospital Charge Code |
28011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.31 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$212.25
|
| Rate for Payer: BCBS Trust/PPO |
$203.83
|
| Rate for Payer: BCN Commercial |
$192.97
|
| Rate for Payer: Cash Price |
$199.76
|
| Rate for Payer: Cofinity Commercial |
$214.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.76
|
| Rate for Payer: Healthscope Commercial |
$224.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.25
|
| Rate for Payer: Nomi Health Commercial |
$204.75
|
| Rate for Payer: PHP Commercial |
$212.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.31
|
| Rate for Payer: Priority Health HMO/PPO |
$217.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.74
|
| Rate for Payer: UHC Core |
$208.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.28
|
|
|
SERTRALINE 20 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$9.76
|
|
|
Service Code
|
NDC 09900000350
|
| Hospital Charge Code |
28011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: Aetna Medicare |
$2.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.05
|
| Rate for Payer: BCBS Complete |
$3.90
|
| Rate for Payer: BCBS MAPPO |
$2.44
|
| Rate for Payer: BCBS Trust/PPO |
$8.02
|
| Rate for Payer: BCN Commercial |
$7.59
|
| Rate for Payer: BCN Medicare Advantage |
$2.44
|
| Rate for Payer: Cash Price |
$7.81
|
| Rate for Payer: Cofinity Commercial |
$8.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.44
|
| Rate for Payer: Healthscope Commercial |
$8.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.30
|
| Rate for Payer: Nomi Health Commercial |
$8.00
|
| Rate for Payer: PACE Senior Care Partners |
$2.32
|
| Rate for Payer: PACE SWMI |
$2.44
|
| Rate for Payer: PHP Commercial |
$8.30
|
| Rate for Payer: PHP Medicare Advantage |
$2.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.34
|
| Rate for Payer: Priority Health HMO/PPO |
$8.49
|
| Rate for Payer: Priority Health Medicare |
$2.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.54
|
| Rate for Payer: Railroad Medicare Medicare |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.59
|
| Rate for Payer: UHC Core |
$8.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.44
|
| Rate for Payer: UHC Exchange |
$2.44
|
| Rate for Payer: UHC Medicare Advantage |
$2.44
|
| Rate for Payer: VA VA |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.32
|
|
|
SERTRALINE 20 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$9.76
|
|
|
Service Code
|
NDC 09900000350
|
| Hospital Charge Code |
28011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: BCBS Trust/PPO |
$7.97
|
| Rate for Payer: BCN Commercial |
$7.54
|
| Rate for Payer: Cash Price |
$7.81
|
| Rate for Payer: Cofinity Commercial |
$8.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.81
|
| Rate for Payer: Healthscope Commercial |
$8.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.30
|
| Rate for Payer: Nomi Health Commercial |
$8.00
|
| Rate for Payer: PHP Commercial |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.34
|
| Rate for Payer: Priority Health HMO/PPO |
$8.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.59
|
| Rate for Payer: UHC Core |
$8.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.32
|
|
|
SERTRALINE 25 MG TABLET
|
Facility
|
OP
|
$244.15
|
|
|
Service Code
|
NDC 00904692461
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.99 |
| Max. Negotiated Rate |
$219.74 |
| Rate for Payer: Aetna Commercial |
$207.53
|
| Rate for Payer: Aetna Medicare |
$63.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.30
|
| Rate for Payer: BCBS Complete |
$97.66
|
| Rate for Payer: BCBS MAPPO |
$61.04
|
| Rate for Payer: BCBS Trust/PPO |
$200.72
|
| Rate for Payer: BCN Commercial |
$189.83
|
| Rate for Payer: BCN Medicare Advantage |
$61.04
|
| Rate for Payer: Cash Price |
$195.32
|
| Rate for Payer: Cofinity Commercial |
$209.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.04
|
| Rate for Payer: Healthscope Commercial |
$219.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.53
|
| Rate for Payer: Nomi Health Commercial |
$200.20
|
| Rate for Payer: PACE Senior Care Partners |
$57.99
|
| Rate for Payer: PACE SWMI |
$61.04
|
| Rate for Payer: PHP Commercial |
$207.53
|
| Rate for Payer: PHP Medicare Advantage |
$61.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.70
|
| Rate for Payer: Priority Health HMO/PPO |
$212.41
|
| Rate for Payer: Priority Health Medicare |
$61.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.58
|
| Rate for Payer: Railroad Medicare Medicare |
$61.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.85
|
| Rate for Payer: UHC Core |
$203.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.04
|
| Rate for Payer: UHC Exchange |
$61.04
|
| Rate for Payer: UHC Medicare Advantage |
$61.04
|
| Rate for Payer: VA VA |
$61.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.11
|
|
|
SERTRALINE 25 MG TABLET
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 60687023111
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare |
$0.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.84
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: BCBS MAPPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.08
|
| Rate for Payer: BCN Medicare Advantage |
$0.67
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.67
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: PACE Senior Care Partners |
$0.64
|
| Rate for Payer: PACE SWMI |
$0.67
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: PHP Medicare Advantage |
$0.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health HMO/PPO |
$2.33
|
| Rate for Payer: Priority Health Medicare |
$0.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: Railroad Medicare Medicare |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.67
|
| Rate for Payer: UHC Exchange |
$0.67
|
| Rate for Payer: UHC Medicare Advantage |
$0.67
|
| Rate for Payer: VA VA |
$0.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
SERTRALINE 25 MG TABLET
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 60687023101
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.13 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: BCBS Trust/PPO |
$218.69
|
| Rate for Payer: BCN Commercial |
$207.03
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Nomi Health Commercial |
$219.68
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health HMO/PPO |
$233.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.75
|
| Rate for Payer: UHC Core |
$223.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.93
|
|
|
SERTRALINE 25 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 60687023111
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health HMO/PPO |
$2.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
SERTRALINE 25 MG TABLET
|
Facility
|
OP
|
$267.90
|
|
|
Service Code
|
NDC 60687023101
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.63 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna Medicare |
$69.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.72
|
| Rate for Payer: BCBS Complete |
$107.16
|
| Rate for Payer: BCBS MAPPO |
$66.97
|
| Rate for Payer: BCBS Trust/PPO |
$220.24
|
| Rate for Payer: BCN Commercial |
$208.29
|
| Rate for Payer: BCN Medicare Advantage |
$66.97
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.97
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Nomi Health Commercial |
$219.68
|
| Rate for Payer: PACE Senior Care Partners |
$63.63
|
| Rate for Payer: PACE SWMI |
$66.97
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: PHP Medicare Advantage |
$66.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health HMO/PPO |
$233.07
|
| Rate for Payer: Priority Health Medicare |
$67.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.49
|
| Rate for Payer: Railroad Medicare Medicare |
$66.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.75
|
| Rate for Payer: UHC Core |
$223.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.97
|
| Rate for Payer: UHC Exchange |
$66.97
|
| Rate for Payer: UHC Medicare Advantage |
$66.97
|
| Rate for Payer: VA VA |
$66.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.93
|
|
