|
SUMATRIPTAN 100 MG TABLET
|
Facility
|
IP
|
$71.20
|
|
|
Service Code
|
NDC 63304009919
|
| Hospital Charge Code |
13369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.28 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Aetna Commercial |
$60.52
|
| Rate for Payer: BCBS Trust/PPO |
$58.12
|
| Rate for Payer: BCN Commercial |
$55.02
|
| Rate for Payer: Cash Price |
$56.96
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.96
|
| Rate for Payer: Healthscope Commercial |
$64.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.52
|
| Rate for Payer: Nomi Health Commercial |
$58.38
|
| Rate for Payer: PHP Commercial |
$60.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.28
|
| Rate for Payer: Priority Health HMO/PPO |
$61.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.66
|
| Rate for Payer: UHC Core |
$59.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.40
|
|
|
SUMATRIPTAN 100 MG TABLET
|
Facility
|
IP
|
$21.99
|
|
|
Service Code
|
NDC 65862014836
|
| Hospital Charge Code |
13369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$19.79 |
| Rate for Payer: Aetna Commercial |
$18.69
|
| Rate for Payer: BCBS Trust/PPO |
$17.95
|
| Rate for Payer: BCN Commercial |
$16.99
|
| Rate for Payer: Cash Price |
$17.59
|
| Rate for Payer: Cofinity Commercial |
$18.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.59
|
| Rate for Payer: Healthscope Commercial |
$19.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.69
|
| Rate for Payer: Nomi Health Commercial |
$18.03
|
| Rate for Payer: PHP Commercial |
$18.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.29
|
| Rate for Payer: Priority Health HMO/PPO |
$19.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.35
|
| Rate for Payer: UHC Core |
$18.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.49
|
|
|
SUMATRIPTAN 25 MG TABLET
|
Facility
|
OP
|
$21.55
|
|
|
Service Code
|
NDC 65862014636
|
| Hospital Charge Code |
15327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Aetna Commercial |
$18.32
|
| Rate for Payer: Aetna Medicare |
$5.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.73
|
| Rate for Payer: BCBS Complete |
$8.62
|
| Rate for Payer: BCBS MAPPO |
$5.39
|
| Rate for Payer: BCBS Trust/PPO |
$17.72
|
| Rate for Payer: BCN Commercial |
$16.76
|
| Rate for Payer: BCN Medicare Advantage |
$5.39
|
| Rate for Payer: Cash Price |
$17.24
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.39
|
| Rate for Payer: Healthscope Commercial |
$19.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.32
|
| Rate for Payer: Nomi Health Commercial |
$17.67
|
| Rate for Payer: PACE Senior Care Partners |
$5.12
|
| Rate for Payer: PACE SWMI |
$5.39
|
| Rate for Payer: PHP Commercial |
$18.32
|
| Rate for Payer: PHP Medicare Advantage |
$5.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.01
|
| Rate for Payer: Priority Health HMO/PPO |
$18.75
|
| Rate for Payer: Priority Health Medicare |
$5.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.96
|
| Rate for Payer: UHC Core |
$17.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.39
|
| Rate for Payer: UHC Exchange |
$5.39
|
| Rate for Payer: UHC Medicare Advantage |
$5.39
|
| Rate for Payer: VA VA |
$5.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.16
|
|
|
SUMATRIPTAN 25 MG TABLET
|
Facility
|
OP
|
$41.78
|
|
|
Service Code
|
NDC 00378563059
|
| Hospital Charge Code |
15327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$37.60 |
| Rate for Payer: Aetna Commercial |
$35.51
|
| Rate for Payer: Aetna Medicare |
$10.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.06
|
| Rate for Payer: BCBS Complete |
$16.71
|
| Rate for Payer: BCBS MAPPO |
$10.44
|
| Rate for Payer: BCBS Trust/PPO |
$34.35
|
| Rate for Payer: BCN Commercial |
$32.48
|
| Rate for Payer: BCN Medicare Advantage |
$10.44
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cofinity Commercial |
$35.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.44
|
| Rate for Payer: Healthscope Commercial |
$37.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.51
|
| Rate for Payer: Nomi Health Commercial |
$34.26
|
| Rate for Payer: PACE Senior Care Partners |
$9.92
|
| Rate for Payer: PACE SWMI |
$10.44
|
| Rate for Payer: PHP Commercial |
$35.51
|
| Rate for Payer: PHP Medicare Advantage |
$10.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.16
|
| Rate for Payer: Priority Health HMO/PPO |
$36.35
|
| Rate for Payer: Priority Health Medicare |
$10.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.99
|
| Rate for Payer: Railroad Medicare Medicare |
$10.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.77
|
| Rate for Payer: UHC Core |
$34.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.44
|
| Rate for Payer: UHC Exchange |
$10.44
|
| Rate for Payer: UHC Medicare Advantage |
$10.44
|
| Rate for Payer: VA VA |
$10.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.34
|
|
|
SUMATRIPTAN 25 MG TABLET
|
Facility
|
IP
|
$41.78
|
|
|
Service Code
|
NDC 00378563059
|
| Hospital Charge Code |
15327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.16 |
| Max. Negotiated Rate |
$37.60 |
| Rate for Payer: Aetna Commercial |
$35.51
|
| Rate for Payer: BCBS Trust/PPO |
$34.11
|
| Rate for Payer: BCN Commercial |
$32.29
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cofinity Commercial |
$35.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.42
|
| Rate for Payer: Healthscope Commercial |
$37.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.51
|
| Rate for Payer: Nomi Health Commercial |
$34.26
|
| Rate for Payer: PHP Commercial |
$35.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.16
|
| Rate for Payer: Priority Health HMO/PPO |
$36.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.77
|
| Rate for Payer: UHC Core |
$34.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.34
|
|
|
SUMATRIPTAN 25 MG TABLET
|
Facility
|
OP
|
$71.20
|
|
|
Service Code
|
NDC 62756052069
|
| Hospital Charge Code |
15327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Aetna Commercial |
$60.52
|
| Rate for Payer: Aetna Medicare |
$18.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.25
|
| Rate for Payer: BCBS Complete |
$28.48
|
| Rate for Payer: BCBS MAPPO |
$17.80
|
| Rate for Payer: BCBS Trust/PPO |
$58.53
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: BCN Medicare Advantage |
$17.80
|
| Rate for Payer: Cash Price |
$56.96
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.80
|
| Rate for Payer: Healthscope Commercial |
$64.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.52
|
| Rate for Payer: Nomi Health Commercial |
$58.38
|
| Rate for Payer: PACE Senior Care Partners |
$16.91
|
| Rate for Payer: PACE SWMI |
$17.80
|
| Rate for Payer: PHP Commercial |
$60.52
|
| Rate for Payer: PHP Medicare Advantage |
$17.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.28
|
| Rate for Payer: Priority Health HMO/PPO |
$61.94
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.70
|
| Rate for Payer: Railroad Medicare Medicare |
$17.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.66
|
| Rate for Payer: UHC Core |
$59.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.80
|
| Rate for Payer: UHC Exchange |
$17.80
|
| Rate for Payer: UHC Medicare Advantage |
$17.80
|
| Rate for Payer: VA VA |
$17.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.40
|
|
|
SUMATRIPTAN 25 MG TABLET
|
Facility
|
IP
|
$21.55
|
|
|
Service Code
|
NDC 65862014636
|
| Hospital Charge Code |
15327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Aetna Commercial |
$18.32
|
| Rate for Payer: BCBS Trust/PPO |
$17.59
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$17.24
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.24
|
| Rate for Payer: Healthscope Commercial |
$19.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.32
|
| Rate for Payer: Nomi Health Commercial |
$17.67
|
| Rate for Payer: PHP Commercial |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.01
|
| Rate for Payer: Priority Health HMO/PPO |
$18.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.96
|
| Rate for Payer: UHC Core |
$17.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.16
|
|
|
SUMATRIPTAN 25 MG TABLET
|
Facility
|
IP
|
$71.20
|
|
|
Service Code
|
NDC 62756052069
|
| Hospital Charge Code |
15327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.28 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Aetna Commercial |
$60.52
|
| Rate for Payer: BCBS Trust/PPO |
$58.12
|
| Rate for Payer: BCN Commercial |
$55.02
|
| Rate for Payer: Cash Price |
$56.96
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.96
|
| Rate for Payer: Healthscope Commercial |
$64.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.52
|
| Rate for Payer: Nomi Health Commercial |
$58.38
|
| Rate for Payer: PHP Commercial |
$60.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.28
|
| Rate for Payer: Priority Health HMO/PPO |
$61.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.66
|
| Rate for Payer: UHC Core |
$59.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.40
|
|
|
SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$20.70
|
|
|
Service Code
|
HCPCS J3030
|
| Hospital Charge Code |
97342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Commercial |
$23.11
|
| Rate for Payer: Aetna Commercial |
$22.42
|
| Rate for Payer: Aetna Medicare |
$7.07
|
| Rate for Payer: Aetna Medicare |
$5.38
|
| Rate for Payer: Aetna Medicare |
$6.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.50
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Complete |
$10.88
|
| Rate for Payer: BCBS MAPPO |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS MAPPO |
$6.60
|
| Rate for Payer: BCBS Trust/PPO |
$21.69
|
| Rate for Payer: BCBS Trust/PPO |
$17.02
|
| Rate for Payer: BCBS Trust/PPO |
$22.35
|
| Rate for Payer: BCN Commercial |
$20.51
|
| Rate for Payer: BCN Commercial |
$21.14
|
| Rate for Payer: BCN Commercial |
$16.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$6.60
|
| Rate for Payer: BCN Medicare Advantage |
$6.80
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cofinity Commercial |
$23.38
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$22.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$23.74
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$24.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.60
|
| Rate for Payer: Nomi Health Commercial |
$22.30
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$21.63
|
| Rate for Payer: PACE Senior Care Partners |
$6.46
|
| Rate for Payer: PACE Senior Care Partners |
$4.92
|
| Rate for Payer: PACE Senior Care Partners |
$6.27
|
| Rate for Payer: PACE SWMI |
$6.60
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PACE SWMI |
$6.80
|
| Rate for Payer: PHP Commercial |
$23.11
|
| Rate for Payer: PHP Commercial |
$22.42
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: PHP Medicare Advantage |
$6.60
|
| Rate for Payer: PHP Medicare Advantage |
$6.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.15
|
| Rate for Payer: Priority Health HMO/PPO |
$23.66
|
| Rate for Payer: Priority Health HMO/PPO |
$18.01
|
| Rate for Payer: Priority Health HMO/PPO |
$22.95
|
| Rate for Payer: Priority Health Medicare |
$5.23
|
| Rate for Payer: Priority Health Medicare |
$6.87
|
| Rate for Payer: Priority Health Medicare |
$6.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.87
|
| Rate for Payer: Railroad Medicare Medicare |
$6.60
|
| Rate for Payer: Railroad Medicare Medicare |
$6.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.22
|
| Rate for Payer: UHC Core |
$22.70
|
| Rate for Payer: UHC Core |
$22.03
|
| Rate for Payer: UHC Core |
$17.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.60
|
| Rate for Payer: UHC Exchange |
$6.60
|
| Rate for Payer: UHC Exchange |
$5.18
|
| Rate for Payer: UHC Exchange |
$6.80
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$6.60
|
| Rate for Payer: UHC Medicare Advantage |
$6.80
|
| Rate for Payer: VA VA |
$6.60
|
| Rate for Payer: VA VA |
$6.80
|
| Rate for Payer: VA VA |
$5.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.78
|
|
|
SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$20.70
|
|
|
Service Code
|
HCPCS J3030
|
| Hospital Charge Code |
97342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Commercial |
$22.42
|
| Rate for Payer: Aetna Commercial |
$23.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.53
|
| Rate for Payer: BCBS Trust/PPO |
$16.90
|
| Rate for Payer: BCBS Trust/PPO |
$22.20
|
| Rate for Payer: BCN Commercial |
$20.39
|
| Rate for Payer: BCN Commercial |
$16.00
|
| Rate for Payer: BCN Commercial |
$21.01
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cofinity Commercial |
$23.38
|
| Rate for Payer: Cofinity Commercial |
$22.69
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.75
|
| Rate for Payer: Healthscope Commercial |
$23.74
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$24.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.11
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$21.63
|
| Rate for Payer: Nomi Health Commercial |
$22.30
|
| Rate for Payer: PHP Commercial |
$22.42
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: PHP Commercial |
$23.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.15
|
| Rate for Payer: Priority Health HMO/PPO |
$23.66
|
| Rate for Payer: Priority Health HMO/PPO |
$22.95
|
| Rate for Payer: Priority Health HMO/PPO |
$18.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.22
|
| Rate for Payer: UHC Core |
$17.28
|
| Rate for Payer: UHC Core |
$22.70
|
| Rate for Payer: UHC Core |
$22.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.78
|
|
|
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SUBCUTANEOUS
|
Facility
|
OP
|
$2,039.92
|
|
|
Service Code
|
CPT 46270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,942.66 |
| Max. Negotiated Rate |
$2,039.92 |
| Rate for Payer: BCBS Complete |
$2,039.92
|
| Rate for Payer: Mclaren Medicaid |
$1,942.66
|
| Rate for Payer: Meridian Medicaid |
$2,039.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,942.66
|
| Rate for Payer: UHCCP Medicaid |
$1,942.66
|
|
|
SUTURE OF INFRAPATELLAR TENDON; PRIMARY
|
Facility
|
OP
|
$5,313.85
|
|
|
Service Code
|
CPT 27380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,060.48 |
| Max. Negotiated Rate |
$5,313.85 |
| Rate for Payer: BCBS Complete |
$5,313.85
|
| Rate for Payer: Mclaren Medicaid |
$5,060.48
|
| Rate for Payer: Meridian Medicaid |
$5,313.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,060.48
|
| Rate for Payer: UHCCP Medicaid |
$5,060.48
|
|
|
TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$353.76
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
24914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$229.94 |
| Max. Negotiated Rate |
$318.38 |
| Rate for Payer: Aetna Commercial |
$300.70
|
| Rate for Payer: BCBS Trust/PPO |
$288.77
|
| Rate for Payer: BCN Commercial |
$273.39
|
| Rate for Payer: Cash Price |
$283.01
|
| Rate for Payer: Cofinity Commercial |
$304.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.01
|
| Rate for Payer: Healthscope Commercial |
$318.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.70
|
| Rate for Payer: Nomi Health Commercial |
$290.08
|
| Rate for Payer: PHP Commercial |
$300.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.94
|
| Rate for Payer: Priority Health HMO/PPO |
$307.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.31
|
| Rate for Payer: UHC Core |
$295.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.32
|
|
|
TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
OP
|
$353.76
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
24914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.02 |
| Max. Negotiated Rate |
$318.38 |
| Rate for Payer: Aetna Commercial |
$300.70
|
| Rate for Payer: Aetna Medicare |
$91.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.55
|
| Rate for Payer: BCBS Complete |
$141.50
|
| Rate for Payer: BCBS MAPPO |
$88.44
|
| Rate for Payer: BCBS Trust/PPO |
$290.83
|
| Rate for Payer: BCN Commercial |
$275.05
|
| Rate for Payer: BCN Medicare Advantage |
$88.44
|
| Rate for Payer: Cash Price |
$283.01
|
| Rate for Payer: Cofinity Commercial |
$304.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.44
|
| Rate for Payer: Healthscope Commercial |
$318.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.70
|
| Rate for Payer: Nomi Health Commercial |
$290.08
|
| Rate for Payer: PACE Senior Care Partners |
$84.02
|
| Rate for Payer: PACE SWMI |
$88.44
|
| Rate for Payer: PHP Commercial |
$300.70
|
| Rate for Payer: PHP Medicare Advantage |
$88.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.94
|
| Rate for Payer: Priority Health HMO/PPO |
$307.77
|
| Rate for Payer: Priority Health Medicare |
$89.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.02
|
| Rate for Payer: Railroad Medicare Medicare |
$88.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.31
|
| Rate for Payer: UHC Core |
$295.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.44
|
| Rate for Payer: UHC Exchange |
$88.44
|
| Rate for Payer: UHC Medicare Advantage |
$88.44
|
| Rate for Payer: VA VA |
$88.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.32
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$260.64
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.42 |
| Max. Negotiated Rate |
$234.58 |
| Rate for Payer: Aetna Commercial |
$221.54
|
| Rate for Payer: Aetna Commercial |
$432.89
|
| Rate for Payer: Aetna Commercial |
$494.50
|
| Rate for Payer: BCBS Trust/PPO |
$415.73
|
| Rate for Payer: BCBS Trust/PPO |
$212.76
|
| Rate for Payer: BCBS Trust/PPO |
$474.89
|
| Rate for Payer: BCN Commercial |
$393.57
|
| Rate for Payer: BCN Commercial |
$201.42
|
| Rate for Payer: BCN Commercial |
$449.58
|
| Rate for Payer: Cash Price |
$208.51
|
| Rate for Payer: Cash Price |
$465.41
|
| Rate for Payer: Cash Price |
$407.42
|
| Rate for Payer: Cofinity Commercial |
$500.31
|
| Rate for Payer: Cofinity Commercial |
$437.98
|
| Rate for Payer: Cofinity Commercial |
$224.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.41
|
| Rate for Payer: Healthscope Commercial |
$458.35
|
| Rate for Payer: Healthscope Commercial |
$234.58
|
| Rate for Payer: Healthscope Commercial |
$523.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.50
|
| Rate for Payer: Nomi Health Commercial |
$213.72
|
| Rate for Payer: Nomi Health Commercial |
$417.61
|
| Rate for Payer: Nomi Health Commercial |
$477.04
|
| Rate for Payer: PHP Commercial |
$432.89
|
| Rate for Payer: PHP Commercial |
$221.54
|
| Rate for Payer: PHP Commercial |
$494.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.03
|
| Rate for Payer: Priority Health HMO/PPO |
$506.13
|
| Rate for Payer: Priority Health HMO/PPO |
$443.07
|
| Rate for Payer: Priority Health HMO/PPO |
$226.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$389.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$511.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.36
|
| Rate for Payer: UHC Core |
$217.63
|
| Rate for Payer: UHC Core |
$485.77
|
| Rate for Payer: UHC Core |
$425.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.96
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
OP
|
$260.64
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$234.58 |
| Rate for Payer: Aetna Commercial |
$221.54
|
| Rate for Payer: Aetna Commercial |
$494.50
|
| Rate for Payer: Aetna Commercial |
$432.89
|
| Rate for Payer: Aetna Medicare |
$151.26
|
| Rate for Payer: Aetna Medicare |
$67.77
|
| Rate for Payer: Aetna Medicare |
$132.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$181.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$181.80
|
| Rate for Payer: BCBS Complete |
$203.71
|
| Rate for Payer: BCBS Complete |
$104.26
|
| Rate for Payer: BCBS Complete |
$232.70
|
| Rate for Payer: BCBS MAPPO |
$145.44
|
| Rate for Payer: BCBS MAPPO |
$65.16
|
| Rate for Payer: BCBS MAPPO |
$127.32
|
| Rate for Payer: BCBS Trust/PPO |
$418.68
|
| Rate for Payer: BCBS Trust/PPO |
$214.27
|
| Rate for Payer: BCBS Trust/PPO |
$478.26
|
| Rate for Payer: BCN Commercial |
$395.97
|
| Rate for Payer: BCN Commercial |
$452.32
|
| Rate for Payer: BCN Commercial |
$202.65
|
| Rate for Payer: BCN Medicare Advantage |
$65.16
|
| Rate for Payer: BCN Medicare Advantage |
$127.32
|
| Rate for Payer: BCN Medicare Advantage |
$145.44
|
| Rate for Payer: Cash Price |
$407.42
|
| Rate for Payer: Cash Price |
$465.41
|
| Rate for Payer: Cash Price |
$208.51
|
| Rate for Payer: Cofinity Commercial |
$500.31
|
| Rate for Payer: Cofinity Commercial |
$224.15
|
| Rate for Payer: Cofinity Commercial |
$437.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.16
|
| Rate for Payer: Healthscope Commercial |
$458.35
|
| Rate for Payer: Healthscope Commercial |
$234.58
|
| Rate for Payer: Healthscope Commercial |
$523.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.54
|
| Rate for Payer: Nomi Health Commercial |
$477.04
|
| Rate for Payer: Nomi Health Commercial |
$213.72
|
| Rate for Payer: Nomi Health Commercial |
$417.61
|
| Rate for Payer: PACE Senior Care Partners |
$138.17
|
| Rate for Payer: PACE Senior Care Partners |
$61.90
|
| Rate for Payer: PACE Senior Care Partners |
$120.95
|
| Rate for Payer: PACE SWMI |
$127.32
|
| Rate for Payer: PACE SWMI |
$65.16
|
| Rate for Payer: PACE SWMI |
$145.44
|
| Rate for Payer: PHP Commercial |
$494.50
|
| Rate for Payer: PHP Commercial |
$432.89
|
| Rate for Payer: PHP Commercial |
$221.54
|
| Rate for Payer: PHP Medicare Advantage |
$127.32
|
| Rate for Payer: PHP Medicare Advantage |
$145.44
|
| Rate for Payer: PHP Medicare Advantage |
$65.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.03
|
| Rate for Payer: Priority Health HMO/PPO |
$506.13
|
| Rate for Payer: Priority Health HMO/PPO |
$226.76
|
| Rate for Payer: Priority Health HMO/PPO |
$443.07
|
| Rate for Payer: Priority Health Medicare |
$65.81
|
| Rate for Payer: Priority Health Medicare |
$146.89
|
| Rate for Payer: Priority Health Medicare |
$128.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$389.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.63
|
| Rate for Payer: Railroad Medicare Medicare |
$127.32
|
| Rate for Payer: Railroad Medicare Medicare |
$145.44
|
| Rate for Payer: Railroad Medicare Medicare |
$65.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$511.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.36
|
| Rate for Payer: UHC Core |
$485.77
|
| Rate for Payer: UHC Core |
$425.25
|
| Rate for Payer: UHC Core |
$217.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.32
|
| Rate for Payer: UHC Exchange |
$127.32
|
| Rate for Payer: UHC Exchange |
$65.16
|
| Rate for Payer: UHC Exchange |
$145.44
|
| Rate for Payer: UHC Medicare Advantage |
$65.16
|
| Rate for Payer: UHC Medicare Advantage |
$127.32
|
| Rate for Payer: UHC Medicare Advantage |
$145.44
|
| Rate for Payer: VA VA |
$127.32
|
| Rate for Payer: VA VA |
$145.44
|
| Rate for Payer: VA VA |
$65.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.96
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
OP
|
$279.18
|
|
|
Service Code
|
NDC 00378014491
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.31 |
| Max. Negotiated Rate |
$251.26 |
| Rate for Payer: Aetna Commercial |
$237.30
|
| Rate for Payer: Aetna Medicare |
$72.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.24
|
| Rate for Payer: BCBS Complete |
$111.67
|
| Rate for Payer: BCBS MAPPO |
$69.80
|
| Rate for Payer: BCBS Trust/PPO |
$229.51
|
| Rate for Payer: BCN Commercial |
$217.06
|
| Rate for Payer: BCN Medicare Advantage |
$69.80
|
| Rate for Payer: Cash Price |
$223.34
|
| Rate for Payer: Cofinity Commercial |
$240.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.80
|
| Rate for Payer: Healthscope Commercial |
$251.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.30
|
| Rate for Payer: Nomi Health Commercial |
$228.93
|
| Rate for Payer: PACE Senior Care Partners |
$66.31
|
| Rate for Payer: PACE SWMI |
$69.80
|
| Rate for Payer: PHP Commercial |
$237.30
|
| Rate for Payer: PHP Medicare Advantage |
$69.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.47
|
| Rate for Payer: Priority Health HMO/PPO |
$242.89
|
| Rate for Payer: Priority Health Medicare |
$70.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.05
|
| Rate for Payer: Railroad Medicare Medicare |
$69.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.68
|
| Rate for Payer: UHC Core |
$233.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.80
|
| Rate for Payer: UHC Exchange |
$69.80
|
| Rate for Payer: UHC Medicare Advantage |
$69.80
|
| Rate for Payer: VA VA |
$69.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.38
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
IP
|
$279.18
|
|
|
Service Code
|
NDC 00378014491
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.47 |
| Max. Negotiated Rate |
$251.26 |
| Rate for Payer: Aetna Commercial |
$237.30
|
| Rate for Payer: BCBS Trust/PPO |
$227.89
|
| Rate for Payer: BCN Commercial |
$215.75
|
| Rate for Payer: Cash Price |
$223.34
|
| Rate for Payer: Cofinity Commercial |
$240.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.34
|
| Rate for Payer: Healthscope Commercial |
$251.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.30
|
| Rate for Payer: Nomi Health Commercial |
$228.93
|
| Rate for Payer: PHP Commercial |
$237.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.47
|
| Rate for Payer: Priority Health HMO/PPO |
$242.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.68
|
| Rate for Payer: UHC Core |
$233.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.38
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$441.75
|
|
|
Service Code
|
NDC 00781207601
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.92 |
| Max. Negotiated Rate |
$397.58 |
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: Aetna Medicare |
$114.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$138.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$138.05
|
| Rate for Payer: BCBS Complete |
$176.70
|
| Rate for Payer: BCBS MAPPO |
$110.44
|
| Rate for Payer: BCBS Trust/PPO |
$363.16
|
| Rate for Payer: BCN Commercial |
$343.46
|
| Rate for Payer: BCN Medicare Advantage |
$110.44
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.44
|
| Rate for Payer: Healthscope Commercial |
$397.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: Nomi Health Commercial |
$362.24
|
| Rate for Payer: PACE Senior Care Partners |
$104.92
|
| Rate for Payer: PACE SWMI |
$110.44
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: PHP Medicare Advantage |
$110.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.14
|
| Rate for Payer: Priority Health HMO/PPO |
$384.32
|
| Rate for Payer: Priority Health Medicare |
$111.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.97
|
| Rate for Payer: Railroad Medicare Medicare |
$110.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.74
|
| Rate for Payer: UHC Core |
$368.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.44
|
| Rate for Payer: UHC Exchange |
$110.44
|
| Rate for Payer: UHC Medicare Advantage |
$110.44
|
| Rate for Payer: VA VA |
$110.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$192.85
|
|
|
Service Code
|
NDC 00904738361
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna Medicare |
$50.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.27
|
| Rate for Payer: BCBS Complete |
$77.14
|
| Rate for Payer: BCBS MAPPO |
$48.21
|
| Rate for Payer: BCBS Trust/PPO |
$158.54
|
| Rate for Payer: BCN Commercial |
$149.94
|
| Rate for Payer: BCN Medicare Advantage |
$48.21
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.21
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Nomi Health Commercial |
$158.14
|
| Rate for Payer: PACE Senior Care Partners |
$45.80
|
| Rate for Payer: PACE SWMI |
$48.21
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: PHP Medicare Advantage |
$48.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: Priority Health HMO/PPO |
$167.78
|
| Rate for Payer: Priority Health Medicare |
$48.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: Railroad Medicare Medicare |
$48.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Core |
$161.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.21
|
| Rate for Payer: UHC Exchange |
$48.21
|
| Rate for Payer: UHC Medicare Advantage |
$48.21
|
| Rate for Payer: VA VA |
$48.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$192.85
|
|
|
Service Code
|
NDC 00904640161
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna Medicare |
$50.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.27
|
| Rate for Payer: BCBS Complete |
$77.14
|
| Rate for Payer: BCBS MAPPO |
$48.21
|
| Rate for Payer: BCBS Trust/PPO |
$158.54
|
| Rate for Payer: BCN Commercial |
$149.94
|
| Rate for Payer: BCN Medicare Advantage |
$48.21
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.21
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Nomi Health Commercial |
$158.14
|
| Rate for Payer: PACE Senior Care Partners |
$45.80
|
| Rate for Payer: PACE SWMI |
$48.21
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: PHP Medicare Advantage |
$48.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: Priority Health HMO/PPO |
$167.78
|
| Rate for Payer: Priority Health Medicare |
$48.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: Railroad Medicare Medicare |
$48.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Core |
$161.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.21
|
| Rate for Payer: UHC Exchange |
$48.21
|
| Rate for Payer: UHC Medicare Advantage |
$48.21
|
| Rate for Payer: VA VA |
$48.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$441.75
|
|
|
Service Code
|
NDC 00781207601
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.14 |
| Max. Negotiated Rate |
$397.58 |
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: BCBS Trust/PPO |
$360.60
|
| Rate for Payer: BCN Commercial |
$341.38
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: Nomi Health Commercial |
$362.24
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.14
|
| Rate for Payer: Priority Health HMO/PPO |
$384.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.74
|
| Rate for Payer: UHC Core |
$368.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 00904640161
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.35 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: BCBS Trust/PPO |
$157.42
|
| Rate for Payer: BCN Commercial |
$149.03
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Nomi Health Commercial |
$158.14
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: Priority Health HMO/PPO |
$167.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Core |
$161.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$230.85
|
|
|
Service Code
|
NDC 68084029901
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.83 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna Medicare |
$60.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.14
|
| Rate for Payer: BCBS Complete |
$92.34
|
| Rate for Payer: BCBS MAPPO |
$57.71
|
| Rate for Payer: BCBS Trust/PPO |
$189.78
|
| Rate for Payer: BCN Commercial |
$179.49
|
| Rate for Payer: BCN Medicare Advantage |
$57.71
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.71
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: PACE Senior Care Partners |
$54.83
|
| Rate for Payer: PACE SWMI |
$57.71
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: PHP Medicare Advantage |
$57.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: Priority Health HMO/PPO |
$200.84
|
| Rate for Payer: Priority Health Medicare |
$58.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.67
|
| Rate for Payer: Railroad Medicare Medicare |
$57.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.15
|
| Rate for Payer: UHC Core |
$192.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.71
|
| Rate for Payer: UHC Exchange |
$57.71
|
| Rate for Payer: UHC Medicare Advantage |
$57.71
|
| Rate for Payer: VA VA |
$57.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$2.31
|
|
|
Service Code
|
NDC 68084029911
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.08 |
| Rate for Payer: Aetna Commercial |
$1.96
|
| Rate for Payer: BCBS Trust/PPO |
$1.89
|
| Rate for Payer: BCN Commercial |
$1.79
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cofinity Commercial |
$1.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.85
|
| Rate for Payer: Healthscope Commercial |
$2.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.96
|
| Rate for Payer: Nomi Health Commercial |
$1.89
|
| Rate for Payer: PHP Commercial |
$1.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.50
|
| Rate for Payer: Priority Health HMO/PPO |
$2.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.03
|
| Rate for Payer: UHC Core |
$1.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.73
|
|
