|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$84.55
|
|
|
Service Code
|
NDC 25021031066
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.08 |
| Max. Negotiated Rate |
$76.10 |
| Rate for Payer: Aetna Commercial |
$71.87
|
| Rate for Payer: Aetna Medicare |
$21.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.42
|
| Rate for Payer: BCBS Complete |
$33.82
|
| Rate for Payer: BCBS MAPPO |
$21.14
|
| Rate for Payer: BCBS Trust/PPO |
$69.51
|
| Rate for Payer: BCN Commercial |
$65.74
|
| Rate for Payer: BCN Medicare Advantage |
$21.14
|
| Rate for Payer: Cash Price |
$67.64
|
| Rate for Payer: Cofinity Commercial |
$72.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.14
|
| Rate for Payer: Healthscope Commercial |
$76.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.87
|
| Rate for Payer: Nomi Health Commercial |
$69.33
|
| Rate for Payer: PACE Senior Care Partners |
$20.08
|
| Rate for Payer: PACE SWMI |
$21.14
|
| Rate for Payer: PHP Commercial |
$71.87
|
| Rate for Payer: PHP Medicare Advantage |
$21.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.96
|
| Rate for Payer: Priority Health HMO/PPO |
$73.56
|
| Rate for Payer: Priority Health Medicare |
$21.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.65
|
| Rate for Payer: Railroad Medicare Medicare |
$21.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.40
|
| Rate for Payer: UHC Core |
$70.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.14
|
| Rate for Payer: UHC Exchange |
$21.14
|
| Rate for Payer: UHC Medicare Advantage |
$21.14
|
| Rate for Payer: VA VA |
$21.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.41
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$76.59
|
|
|
Service Code
|
NDC 70121118901
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$68.93 |
| Rate for Payer: Aetna Commercial |
$65.10
|
| Rate for Payer: BCBS Trust/PPO |
$62.52
|
| Rate for Payer: BCN Commercial |
$59.19
|
| Rate for Payer: Cash Price |
$61.27
|
| Rate for Payer: Cofinity Commercial |
$65.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.27
|
| Rate for Payer: Healthscope Commercial |
$68.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.10
|
| Rate for Payer: Nomi Health Commercial |
$62.80
|
| Rate for Payer: PHP Commercial |
$65.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.78
|
| Rate for Payer: Priority Health HMO/PPO |
$66.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.40
|
| Rate for Payer: UHC Core |
$63.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.44
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$84.55
|
|
|
Service Code
|
NDC 25021031066
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$76.10 |
| Rate for Payer: Aetna Commercial |
$71.87
|
| Rate for Payer: BCBS Trust/PPO |
$69.02
|
| Rate for Payer: BCN Commercial |
$65.34
|
| Rate for Payer: Cash Price |
$67.64
|
| Rate for Payer: Cofinity Commercial |
$72.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.64
|
| Rate for Payer: Healthscope Commercial |
$76.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.87
|
| Rate for Payer: Nomi Health Commercial |
$69.33
|
| Rate for Payer: PHP Commercial |
$71.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.96
|
| Rate for Payer: Priority Health HMO/PPO |
$73.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.40
|
| Rate for Payer: UHC Core |
$70.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.41
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47.93
|
|
|
Service Code
|
NDC 70069026101
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.15 |
| Max. Negotiated Rate |
$43.14 |
| Rate for Payer: Aetna Commercial |
$40.74
|
| Rate for Payer: BCBS Trust/PPO |
$39.13
|
| Rate for Payer: BCN Commercial |
$37.04
|
| Rate for Payer: Cash Price |
$38.34
|
| Rate for Payer: Cofinity Commercial |
$41.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.34
|
| Rate for Payer: Healthscope Commercial |
$43.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.74
|
| Rate for Payer: Nomi Health Commercial |
$39.30
|
| Rate for Payer: PHP Commercial |
$40.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.15
|
| Rate for Payer: Priority Health HMO/PPO |
$41.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.18
|
| Rate for Payer: UHC Core |
$40.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.95
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$231.11
|
|
|
Service Code
|
NDC 14789001202
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$150.22 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$196.44
|
| Rate for Payer: BCBS Trust/PPO |
$188.66
|
| Rate for Payer: BCN Commercial |
$178.60
|
| Rate for Payer: Cash Price |
$184.89
|
| Rate for Payer: Cofinity Commercial |
$198.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.89
|
| Rate for Payer: Healthscope Commercial |
$208.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.44
|
| Rate for Payer: Nomi Health Commercial |
$189.51
|
| Rate for Payer: PHP Commercial |
$196.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.22
|
| Rate for Payer: Priority Health HMO/PPO |
$201.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.38
|
| Rate for Payer: UHC Core |
$192.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.33
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$430.62
|
|
|
Service Code
|
NDC 25021031002
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.27 |
| Max. Negotiated Rate |
$387.56 |
| Rate for Payer: Aetna Commercial |
$366.03
|
| Rate for Payer: Aetna Medicare |
$111.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.57
|
| Rate for Payer: BCBS Complete |
$172.25
|
| Rate for Payer: BCBS MAPPO |
$107.66
|
| Rate for Payer: BCBS Trust/PPO |
$354.01
|
| Rate for Payer: BCN Commercial |
$334.81
|
| Rate for Payer: BCN Medicare Advantage |
$107.66
|
| Rate for Payer: Cash Price |
$344.50
|
| Rate for Payer: Cofinity Commercial |
$370.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.66
|
| Rate for Payer: Healthscope Commercial |
$387.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.03
|
| Rate for Payer: Nomi Health Commercial |
$353.11
|
| Rate for Payer: PACE Senior Care Partners |
$102.27
|
| Rate for Payer: PACE SWMI |
$107.66
|
| Rate for Payer: PHP Commercial |
$366.03
|
| Rate for Payer: PHP Medicare Advantage |
$107.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.90
|
| Rate for Payer: Priority Health HMO/PPO |
$374.64
|
| Rate for Payer: Priority Health Medicare |
$108.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.52
|
| Rate for Payer: Railroad Medicare Medicare |
$107.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.95
|
| Rate for Payer: UHC Core |
$359.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.66
|
| Rate for Payer: UHC Exchange |
$107.66
|
| Rate for Payer: UHC Medicare Advantage |
$107.66
|
| Rate for Payer: VA VA |
$107.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.96
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$231.11
|
|
|
Service Code
|
NDC 14789001202
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.89 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$196.44
|
| Rate for Payer: Aetna Medicare |
$60.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.22
|
| Rate for Payer: BCBS Complete |
$92.44
|
| Rate for Payer: BCBS MAPPO |
$57.78
|
| Rate for Payer: BCBS Trust/PPO |
$190.00
|
| Rate for Payer: BCN Commercial |
$179.69
|
| Rate for Payer: BCN Medicare Advantage |
$57.78
|
| Rate for Payer: Cash Price |
$184.89
|
| Rate for Payer: Cofinity Commercial |
$198.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.78
|
| Rate for Payer: Healthscope Commercial |
$208.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.44
|
| Rate for Payer: Nomi Health Commercial |
$189.51
|
| Rate for Payer: PACE Senior Care Partners |
$54.89
|
| Rate for Payer: PACE SWMI |
$57.78
|
| Rate for Payer: PHP Commercial |
$196.44
|
| Rate for Payer: PHP Medicare Advantage |
$57.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.22
|
| Rate for Payer: Priority Health HMO/PPO |
$201.07
|
| Rate for Payer: Priority Health Medicare |
$58.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.84
|
| Rate for Payer: Railroad Medicare Medicare |
$57.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.38
|
| Rate for Payer: UHC Core |
$192.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.78
|
| Rate for Payer: UHC Exchange |
$57.78
|
| Rate for Payer: UHC Medicare Advantage |
$57.78
|
| Rate for Payer: VA VA |
$57.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.33
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$76.59
|
|
|
Service Code
|
NDC 70121118901
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$68.93 |
| Rate for Payer: Aetna Commercial |
$65.10
|
| Rate for Payer: Aetna Medicare |
$19.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.93
|
| Rate for Payer: BCBS Complete |
$30.64
|
| Rate for Payer: BCBS MAPPO |
$19.15
|
| Rate for Payer: BCBS Trust/PPO |
$62.96
|
| Rate for Payer: BCN Commercial |
$59.55
|
| Rate for Payer: BCN Medicare Advantage |
$19.15
|
| Rate for Payer: Cash Price |
$61.27
|
| Rate for Payer: Cofinity Commercial |
$65.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.15
|
| Rate for Payer: Healthscope Commercial |
$68.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.10
|
| Rate for Payer: Nomi Health Commercial |
$62.80
|
| Rate for Payer: PACE Senior Care Partners |
$18.19
|
| Rate for Payer: PACE SWMI |
$19.15
|
| Rate for Payer: PHP Commercial |
$65.10
|
| Rate for Payer: PHP Medicare Advantage |
$19.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.78
|
| Rate for Payer: Priority Health HMO/PPO |
$66.63
|
| Rate for Payer: Priority Health Medicare |
$19.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.32
|
| Rate for Payer: Railroad Medicare Medicare |
$19.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.40
|
| Rate for Payer: UHC Core |
$63.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.15
|
| Rate for Payer: UHC Exchange |
$19.15
|
| Rate for Payer: UHC Medicare Advantage |
$19.15
|
| Rate for Payer: VA VA |
$19.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.44
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$430.62
|
|
|
Service Code
|
NDC 25021031002
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$279.90 |
| Max. Negotiated Rate |
$387.56 |
| Rate for Payer: Aetna Commercial |
$366.03
|
| Rate for Payer: BCBS Trust/PPO |
$351.52
|
| Rate for Payer: BCN Commercial |
$332.78
|
| Rate for Payer: Cash Price |
$344.50
|
| Rate for Payer: Cofinity Commercial |
$370.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.50
|
| Rate for Payer: Healthscope Commercial |
$387.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.03
|
| Rate for Payer: Nomi Health Commercial |
$353.11
|
| Rate for Payer: PHP Commercial |
$366.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.90
|
| Rate for Payer: Priority Health HMO/PPO |
$374.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.95
|
| Rate for Payer: UHC Core |
$359.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.96
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$49.44
|
|
|
Service Code
|
NDC 72485010501
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.74 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Aetna Commercial |
$42.02
|
| Rate for Payer: Aetna Medicare |
$12.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.45
|
| Rate for Payer: BCBS Complete |
$19.78
|
| Rate for Payer: BCBS MAPPO |
$12.36
|
| Rate for Payer: BCBS Trust/PPO |
$40.64
|
| Rate for Payer: BCN Commercial |
$38.44
|
| Rate for Payer: BCN Medicare Advantage |
$12.36
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Cofinity Commercial |
$42.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.36
|
| Rate for Payer: Healthscope Commercial |
$44.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.02
|
| Rate for Payer: Nomi Health Commercial |
$40.54
|
| Rate for Payer: PACE Senior Care Partners |
$11.74
|
| Rate for Payer: PACE SWMI |
$12.36
|
| Rate for Payer: PHP Commercial |
$42.02
|
| Rate for Payer: PHP Medicare Advantage |
$12.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.14
|
| Rate for Payer: Priority Health HMO/PPO |
$43.01
|
| Rate for Payer: Priority Health Medicare |
$12.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.12
|
| Rate for Payer: Railroad Medicare Medicare |
$12.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.51
|
| Rate for Payer: UHC Core |
$41.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.36
|
| Rate for Payer: UHC Exchange |
$12.36
|
| Rate for Payer: UHC Medicare Advantage |
$12.36
|
| Rate for Payer: VA VA |
$12.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.08
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47.93
|
|
|
Service Code
|
NDC 70069026101
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$43.14 |
| Rate for Payer: Aetna Commercial |
$40.74
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: BCBS Complete |
$19.17
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$39.40
|
| Rate for Payer: BCN Commercial |
$37.27
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$38.34
|
| Rate for Payer: Cofinity Commercial |
$41.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$43.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.74
|
| Rate for Payer: Nomi Health Commercial |
$39.30
|
| Rate for Payer: PACE Senior Care Partners |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$40.74
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.15
|
| Rate for Payer: Priority Health HMO/PPO |
$41.70
|
| Rate for Payer: Priority Health Medicare |
$12.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.11
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.18
|
| Rate for Payer: UHC Core |
$40.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Exchange |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$11.98
|
| Rate for Payer: VA VA |
$11.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.95
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$49.44
|
|
|
Service Code
|
NDC 72485010501
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.14 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Aetna Commercial |
$42.02
|
| Rate for Payer: BCBS Trust/PPO |
$40.36
|
| Rate for Payer: BCN Commercial |
$38.21
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Cofinity Commercial |
$42.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.55
|
| Rate for Payer: Healthscope Commercial |
$44.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.02
|
| Rate for Payer: Nomi Health Commercial |
$40.54
|
| Rate for Payer: PHP Commercial |
$42.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.14
|
| Rate for Payer: Priority Health HMO/PPO |
$43.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.51
|
| Rate for Payer: UHC Core |
$41.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.08
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$246.43
|
|
|
Service Code
|
NDC 00409739172
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.53 |
| Max. Negotiated Rate |
$221.79 |
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: Aetna Medicare |
$64.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.01
|
| Rate for Payer: BCBS Complete |
$98.57
|
| Rate for Payer: BCBS MAPPO |
$61.61
|
| Rate for Payer: BCBS Trust/PPO |
$202.59
|
| Rate for Payer: BCN Commercial |
$191.60
|
| Rate for Payer: BCN Medicare Advantage |
$61.61
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$211.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.61
|
| Rate for Payer: Healthscope Commercial |
$221.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.47
|
| Rate for Payer: Nomi Health Commercial |
$202.07
|
| Rate for Payer: PACE Senior Care Partners |
$58.53
|
| Rate for Payer: PACE SWMI |
$61.61
|
| Rate for Payer: PHP Commercial |
$209.47
|
| Rate for Payer: PHP Medicare Advantage |
$61.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.18
|
| Rate for Payer: Priority Health HMO/PPO |
$214.39
|
| Rate for Payer: Priority Health Medicare |
$62.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$165.11
|
| Rate for Payer: Railroad Medicare Medicare |
$61.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.86
|
| Rate for Payer: UHC Core |
$205.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.61
|
| Rate for Payer: UHC Exchange |
$61.61
|
| Rate for Payer: UHC Medicare Advantage |
$61.61
|
| Rate for Payer: VA VA |
$61.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.82
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$246.43
|
|
|
Service Code
|
NDC 00409739172
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$160.18 |
| Max. Negotiated Rate |
$221.79 |
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: BCBS Trust/PPO |
$201.16
|
| Rate for Payer: BCN Commercial |
$190.44
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$211.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$221.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.47
|
| Rate for Payer: Nomi Health Commercial |
$202.07
|
| Rate for Payer: PHP Commercial |
$209.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.18
|
| Rate for Payer: Priority Health HMO/PPO |
$214.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$165.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.86
|
| Rate for Payer: UHC Core |
$205.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.82
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
IP
|
$31.26
|
|
|
Service Code
|
NDC 00536741551
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: BCBS Trust/PPO |
$25.52
|
| Rate for Payer: BCN Commercial |
$24.16
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity Commercial |
$26.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.01
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.57
|
| Rate for Payer: Nomi Health Commercial |
$25.63
|
| Rate for Payer: PHP Commercial |
$26.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.32
|
| Rate for Payer: Priority Health HMO/PPO |
$27.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.51
|
| Rate for Payer: UHC Core |
$26.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.44
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
OP
|
$31.26
|
|
|
Service Code
|
NDC 00536741551
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: Aetna Medicare |
$8.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.77
|
| Rate for Payer: BCBS Complete |
$12.50
|
| Rate for Payer: BCBS MAPPO |
$7.82
|
| Rate for Payer: BCBS Trust/PPO |
$25.70
|
| Rate for Payer: BCN Commercial |
$24.30
|
| Rate for Payer: BCN Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity Commercial |
$26.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.57
|
| Rate for Payer: Nomi Health Commercial |
$25.63
|
| Rate for Payer: PACE Senior Care Partners |
$7.42
|
| Rate for Payer: PACE SWMI |
$7.82
|
| Rate for Payer: PHP Commercial |
$26.57
|
| Rate for Payer: PHP Medicare Advantage |
$7.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.32
|
| Rate for Payer: Priority Health HMO/PPO |
$27.20
|
| Rate for Payer: Priority Health Medicare |
$7.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.94
|
| Rate for Payer: Railroad Medicare Medicare |
$7.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.51
|
| Rate for Payer: UHC Core |
$26.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.82
|
| Rate for Payer: UHC Exchange |
$7.82
|
| Rate for Payer: UHC Medicare Advantage |
$7.82
|
| Rate for Payer: VA VA |
$7.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.44
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
IP
|
$34.39
|
|
|
Service Code
|
NDC 00132020140
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$30.95 |
| Rate for Payer: Aetna Commercial |
$29.23
|
| Rate for Payer: BCBS Trust/PPO |
$28.07
|
| Rate for Payer: BCN Commercial |
$26.58
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Cofinity Commercial |
$29.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.51
|
| Rate for Payer: Healthscope Commercial |
$30.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.23
|
| Rate for Payer: Nomi Health Commercial |
$28.20
|
| Rate for Payer: PHP Commercial |
$29.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.35
|
| Rate for Payer: Priority Health HMO/PPO |
$29.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.26
|
| Rate for Payer: UHC Core |
$28.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.79
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
OP
|
$34.39
|
|
|
Service Code
|
NDC 00132020140
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$30.95 |
| Rate for Payer: Aetna Commercial |
$29.23
|
| Rate for Payer: Aetna Medicare |
$8.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.75
|
| Rate for Payer: BCBS Complete |
$13.76
|
| Rate for Payer: BCBS MAPPO |
$8.60
|
| Rate for Payer: BCBS Trust/PPO |
$28.27
|
| Rate for Payer: BCN Commercial |
$26.74
|
| Rate for Payer: BCN Medicare Advantage |
$8.60
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Cofinity Commercial |
$29.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.60
|
| Rate for Payer: Healthscope Commercial |
$30.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.23
|
| Rate for Payer: Nomi Health Commercial |
$28.20
|
| Rate for Payer: PACE Senior Care Partners |
$8.17
|
| Rate for Payer: PACE SWMI |
$8.60
|
| Rate for Payer: PHP Commercial |
$29.23
|
| Rate for Payer: PHP Medicare Advantage |
$8.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.35
|
| Rate for Payer: Priority Health HMO/PPO |
$29.92
|
| Rate for Payer: Priority Health Medicare |
$8.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.04
|
| Rate for Payer: Railroad Medicare Medicare |
$8.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.26
|
| Rate for Payer: UHC Core |
$28.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.60
|
| Rate for Payer: UHC Exchange |
$8.60
|
| Rate for Payer: UHC Medicare Advantage |
$8.60
|
| Rate for Payer: VA VA |
$8.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.79
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$358.69
|
|
|
Service Code
|
NDC 00310111039
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.19 |
| Max. Negotiated Rate |
$322.82 |
| Rate for Payer: Aetna Commercial |
$304.89
|
| Rate for Payer: Aetna Medicare |
$93.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.09
|
| Rate for Payer: BCBS Complete |
$143.48
|
| Rate for Payer: BCBS MAPPO |
$89.67
|
| Rate for Payer: BCBS Trust/PPO |
$294.88
|
| Rate for Payer: BCN Commercial |
$278.88
|
| Rate for Payer: BCN Medicare Advantage |
$89.67
|
| Rate for Payer: Cash Price |
$286.95
|
| Rate for Payer: Cofinity Commercial |
$308.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.67
|
| Rate for Payer: Healthscope Commercial |
$322.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.89
|
| Rate for Payer: Nomi Health Commercial |
$294.13
|
| Rate for Payer: PACE Senior Care Partners |
$85.19
|
| Rate for Payer: PACE SWMI |
$89.67
|
| Rate for Payer: PHP Commercial |
$304.89
|
| Rate for Payer: PHP Medicare Advantage |
$89.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.15
|
| Rate for Payer: Priority Health HMO/PPO |
$312.06
|
| Rate for Payer: Priority Health Medicare |
$90.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.32
|
| Rate for Payer: Railroad Medicare Medicare |
$89.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.65
|
| Rate for Payer: UHC Core |
$299.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.67
|
| Rate for Payer: UHC Exchange |
$89.67
|
| Rate for Payer: UHC Medicare Advantage |
$89.67
|
| Rate for Payer: VA VA |
$89.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.02
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$32.61
|
|
|
Service Code
|
NDC 00310111001
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$29.35 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: BCBS Trust/PPO |
$26.62
|
| Rate for Payer: BCN Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$26.09
|
| Rate for Payer: Cofinity Commercial |
$28.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.09
|
| Rate for Payer: Healthscope Commercial |
$29.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.72
|
| Rate for Payer: Nomi Health Commercial |
$26.74
|
| Rate for Payer: PHP Commercial |
$27.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.20
|
| Rate for Payer: Priority Health HMO/PPO |
$28.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.70
|
| Rate for Payer: UHC Core |
$27.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.46
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$32.61
|
|
|
Service Code
|
NDC 00310111001
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$29.35 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Aetna Medicare |
$8.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.19
|
| Rate for Payer: BCBS Complete |
$13.04
|
| Rate for Payer: BCBS MAPPO |
$8.15
|
| Rate for Payer: BCBS Trust/PPO |
$26.81
|
| Rate for Payer: BCN Commercial |
$25.35
|
| Rate for Payer: BCN Medicare Advantage |
$8.15
|
| Rate for Payer: Cash Price |
$26.09
|
| Rate for Payer: Cofinity Commercial |
$28.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.15
|
| Rate for Payer: Healthscope Commercial |
$29.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.72
|
| Rate for Payer: Nomi Health Commercial |
$26.74
|
| Rate for Payer: PACE Senior Care Partners |
$7.74
|
| Rate for Payer: PACE SWMI |
$8.15
|
| Rate for Payer: PHP Commercial |
$27.72
|
| Rate for Payer: PHP Medicare Advantage |
$8.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.20
|
| Rate for Payer: Priority Health HMO/PPO |
$28.37
|
| Rate for Payer: Priority Health Medicare |
$8.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.85
|
| Rate for Payer: Railroad Medicare Medicare |
$8.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.70
|
| Rate for Payer: UHC Core |
$27.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.15
|
| Rate for Payer: UHC Exchange |
$8.15
|
| Rate for Payer: UHC Medicare Advantage |
$8.15
|
| Rate for Payer: VA VA |
$8.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.46
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$358.69
|
|
|
Service Code
|
NDC 00310111039
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.15 |
| Max. Negotiated Rate |
$322.82 |
| Rate for Payer: Aetna Commercial |
$304.89
|
| Rate for Payer: BCBS Trust/PPO |
$292.80
|
| Rate for Payer: BCN Commercial |
$277.20
|
| Rate for Payer: Cash Price |
$286.95
|
| Rate for Payer: Cofinity Commercial |
$308.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.95
|
| Rate for Payer: Healthscope Commercial |
$322.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.89
|
| Rate for Payer: Nomi Health Commercial |
$294.13
|
| Rate for Payer: PHP Commercial |
$304.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.15
|
| Rate for Payer: Priority Health HMO/PPO |
$312.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.65
|
| Rate for Payer: UHC Core |
$299.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.02
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$409.92
|
|
|
Service Code
|
NDC 00904714361
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.36 |
| Max. Negotiated Rate |
$368.93 |
| Rate for Payer: Aetna Commercial |
$348.43
|
| Rate for Payer: Aetna Medicare |
$106.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$128.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$128.10
|
| Rate for Payer: BCBS Complete |
$163.97
|
| Rate for Payer: BCBS MAPPO |
$102.48
|
| Rate for Payer: BCBS Trust/PPO |
$337.00
|
| Rate for Payer: BCN Commercial |
$318.71
|
| Rate for Payer: BCN Medicare Advantage |
$102.48
|
| Rate for Payer: Cash Price |
$327.94
|
| Rate for Payer: Cofinity Commercial |
$352.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.48
|
| Rate for Payer: Healthscope Commercial |
$368.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.43
|
| Rate for Payer: Nomi Health Commercial |
$336.13
|
| Rate for Payer: PACE Senior Care Partners |
$97.36
|
| Rate for Payer: PACE SWMI |
$102.48
|
| Rate for Payer: PHP Commercial |
$348.43
|
| Rate for Payer: PHP Medicare Advantage |
$102.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.45
|
| Rate for Payer: Priority Health HMO/PPO |
$356.63
|
| Rate for Payer: Priority Health Medicare |
$103.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.65
|
| Rate for Payer: Railroad Medicare Medicare |
$102.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.73
|
| Rate for Payer: UHC Core |
$342.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.48
|
| Rate for Payer: UHC Exchange |
$102.48
|
| Rate for Payer: UHC Medicare Advantage |
$102.48
|
| Rate for Payer: VA VA |
$102.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.44
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
NDC 00093106101
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.66 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$209.95
|
| Rate for Payer: Aetna Medicare |
$64.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.19
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: BCBS MAPPO |
$61.75
|
| Rate for Payer: BCBS Trust/PPO |
$203.06
|
| Rate for Payer: BCN Commercial |
$192.04
|
| Rate for Payer: BCN Medicare Advantage |
$61.75
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$212.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.75
|
| Rate for Payer: Healthscope Commercial |
$222.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.95
|
| Rate for Payer: Nomi Health Commercial |
$202.54
|
| Rate for Payer: PACE Senior Care Partners |
$58.66
|
| Rate for Payer: PACE SWMI |
$61.75
|
| Rate for Payer: PHP Commercial |
$209.95
|
| Rate for Payer: PHP Medicare Advantage |
$61.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health HMO/PPO |
$214.89
|
| Rate for Payer: Priority Health Medicare |
$62.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$165.49
|
| Rate for Payer: Railroad Medicare Medicare |
$61.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.36
|
| Rate for Payer: UHC Core |
$206.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.75
|
| Rate for Payer: UHC Exchange |
$61.75
|
| Rate for Payer: UHC Medicare Advantage |
$61.75
|
| Rate for Payer: VA VA |
$61.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.25
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
NDC 00093106101
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.55 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$209.95
|
| Rate for Payer: BCBS Trust/PPO |
$201.63
|
| Rate for Payer: BCN Commercial |
$190.88
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$212.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.60
|
| Rate for Payer: Healthscope Commercial |
$222.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.95
|
| Rate for Payer: Nomi Health Commercial |
$202.54
|
| Rate for Payer: PHP Commercial |
$209.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health HMO/PPO |
$214.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$165.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.36
|
| Rate for Payer: UHC Core |
$206.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.25
|
|
