|
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
|
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
|
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 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 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 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
|
$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 |
$23.45
|
| 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 |
$23.45
|
|
|
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 |
$23.45
|
| 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 |
$23.45
|
|
|
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
|
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
|
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
|
|
|
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
|
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
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
NDC 60505008000
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.43 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: BCBS Trust/PPO |
$99.75
|
| Rate for Payer: BCN Commercial |
$94.44
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: Nomi Health Commercial |
$100.20
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health HMO/PPO |
$106.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.54
|
| Rate for Payer: UHC Core |
$102.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
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 |
$206.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.25
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$122.20
|
|
|
Service Code
|
NDC 60505008000
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.02 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna Medicare |
$31.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.19
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: BCBS MAPPO |
$30.55
|
| Rate for Payer: BCBS Trust/PPO |
$100.46
|
| Rate for Payer: BCN Commercial |
$95.01
|
| Rate for Payer: BCN Medicare Advantage |
$30.55
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.55
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: Nomi Health Commercial |
$100.20
|
| Rate for Payer: PACE Senior Care Partners |
$29.02
|
| Rate for Payer: PACE SWMI |
$30.55
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$30.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health HMO/PPO |
$106.31
|
| Rate for Payer: Priority Health Medicare |
$30.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.87
|
| Rate for Payer: Railroad Medicare Medicare |
$30.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.54
|
| Rate for Payer: UHC Core |
$102.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.55
|
| Rate for Payer: UHC Exchange |
$30.55
|
| Rate for Payer: UHC Medicare Advantage |
$30.55
|
| Rate for Payer: VA VA |
$30.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$409.92
|
|
|
Service Code
|
NDC 00904714361
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$368.93 |
| Rate for Payer: Aetna Commercial |
$348.43
|
| Rate for Payer: BCBS Trust/PPO |
$334.62
|
| Rate for Payer: BCN Commercial |
$316.79
|
| 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: Healthscope Commercial |
$368.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.43
|
| Rate for Payer: Nomi Health Commercial |
$336.13
|
| Rate for Payer: PHP Commercial |
$348.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.45
|
| Rate for Payer: Priority Health HMO/PPO |
$356.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.73
|
| Rate for Payer: UHC Core |
$342.28
|
| 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 |
$206.25
|
| 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
|
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
|
|
|
SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC;
|
Facility
|
OP
|
$525.76
|
|
|
Service Code
|
CPT 62270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.69 |
| Max. Negotiated Rate |
$525.76 |
| Rate for Payer: BCBS Complete |
$525.76
|
| Rate for Payer: Mclaren Medicaid |
$500.69
|
| Rate for Payer: Meridian Medicaid |
$525.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.69
|
| Rate for Payer: UHCCP Medicaid |
$500.69
|
|
|
SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF CEREBROSPINAL FLUID (BY NEEDLE OR CATHETER);
|
Facility
|
OP
|
$525.76
|
|
|
Service Code
|
CPT 62272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.69 |
| Max. Negotiated Rate |
$525.76 |
| Rate for Payer: BCBS Complete |
$525.76
|
| Rate for Payer: Mclaren Medicaid |
$500.69
|
| Rate for Payer: Meridian Medicaid |
$525.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.69
|
| Rate for Payer: UHCCP Medicaid |
$500.69
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
NDC 63739054410
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.30 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: BCBS Trust/PPO |
$230.20
|
| Rate for Payer: BCN Commercial |
$217.93
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Nomi Health Commercial |
$231.24
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health HMO/PPO |
$245.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.16
|
| Rate for Payer: UHC Core |
$235.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.50
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$253.80
|
|
|
Service Code
|
NDC 00904692761
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.97 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: BCBS Trust/PPO |
$207.18
|
| Rate for Payer: BCN Commercial |
$196.14
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Nomi Health Commercial |
$208.12
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.97
|
| Rate for Payer: Priority Health HMO/PPO |
$220.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.34
|
| Rate for Payer: UHC Core |
$211.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.35
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
NDC 63739054410
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna Medicare |
$73.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.12
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: BCBS MAPPO |
$70.50
|
| Rate for Payer: BCBS Trust/PPO |
$231.83
|
| Rate for Payer: BCN Commercial |
$219.25
|
| Rate for Payer: BCN Medicare Advantage |
$70.50
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.50
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Nomi Health Commercial |
$231.24
|
| Rate for Payer: PACE Senior Care Partners |
$66.97
|
| Rate for Payer: PACE SWMI |
$70.50
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: PHP Medicare Advantage |
$70.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health HMO/PPO |
$245.34
|
| Rate for Payer: Priority Health Medicare |
$71.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.94
|
| Rate for Payer: Railroad Medicare Medicare |
$70.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.16
|
| Rate for Payer: UHC Core |
$235.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.50
|
| Rate for Payer: UHC Exchange |
$70.50
|
| Rate for Payer: UHC Medicare Advantage |
$70.50
|
| Rate for Payer: VA VA |
$70.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.50
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 53746051101
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.72 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: BCBS Trust/PPO |
$224.44
|
| Rate for Payer: BCN Commercial |
$212.48
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health HMO/PPO |
$239.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.96
|
| Rate for Payer: UHC Core |
$229.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
