Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE

Facility

$205.20

Service Code	NDC 75834015901
Hospital Charge Code	8531
Hospital Revenue Code	637
Min. Negotiated Rate	$142.82
Max. Negotiated Rate	$184.68
Rate for Payer: Aetna Commercial	$174.42
Rate for Payer: BCBS Trust/PPO	$169.47
Rate for Payer: BCN Commercial	$169.47
Rate for Payer: Cash Price	$164.16
Rate for Payer: Cofinity Commercial	$176.47
Rate for Payer: Encore Health Key Benefits Commercial	$164.16
Rate for Payer: Healthscope Commercial	$184.68
Rate for Payer: Lakeland Regional Health Systems Commercial	$153.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$174.42
Rate for Payer: Nomi Health Commercial	$168.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$153.90
Rate for Payer: PHP Commercial	$174.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$178.52
Rate for Payer: Priority Health Narrow/Tiered Network	$142.82
Rate for Payer: UHC All Payor (Choice/PPO)	$180.58
Rate for Payer: UHC Core	$171.34
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$153.90

VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE

Facility

$305.50

Service Code	NDC 68462026001
Hospital Charge Code	8531
Hospital Revenue Code	637
Min. Negotiated Rate	$212.63
Max. Negotiated Rate	$274.95
Rate for Payer: Aetna Commercial	$259.68
Rate for Payer: BCBS Trust/PPO	$252.31
Rate for Payer: BCN Commercial	$252.31
Rate for Payer: Cash Price	$244.40
Rate for Payer: Cofinity Commercial	$262.73
Rate for Payer: Encore Health Key Benefits Commercial	$244.40
Rate for Payer: Healthscope Commercial	$274.95
Rate for Payer: Lakeland Regional Health Systems Commercial	$229.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$259.68
Rate for Payer: Nomi Health Commercial	$250.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$229.12
Rate for Payer: PHP Commercial	$259.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$265.79
Rate for Payer: Priority Health Narrow/Tiered Network	$212.63
Rate for Payer: UHC All Payor (Choice/PPO)	$268.84
Rate for Payer: UHC Core	$255.09
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$229.12

VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE

Facility

$205.20

Service Code	NDC 75834015901
Hospital Charge Code	8531
Hospital Revenue Code	637
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$184.68
Rate for Payer: Aetna Commercial	$174.42
Rate for Payer: Aetna Medicare	$53.35
Rate for Payer: Allen County Amish Medical Aid Commercial	$64.12
Rate for Payer: Amish Plain Church Group Commercial	$64.12
Rate for Payer: BCBS Complete	$37.98
Rate for Payer: BCBS MAPPO	$51.30
Rate for Payer: BCBS Trust/PPO	$168.69
Rate for Payer: BCN Commercial	$168.69
Rate for Payer: BCN Medicare Advantage	$51.30
Rate for Payer: Cash Price	$164.16
Rate for Payer: Cofinity Commercial	$176.47
Rate for Payer: Encore Health Key Benefits Commercial	$164.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$51.30
Rate for Payer: Healthscope Commercial	$184.68
Rate for Payer: Lakeland Regional Health Systems Commercial	$153.90
Rate for Payer: Mclaren Medicaid	$36.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$53.87
Rate for Payer: Meridian Medicaid	$37.98
Rate for Payer: MI Amish Medical Board Commercial	$58.99
Rate for Payer: Molina Medicare/Medicaid	$56.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$174.42
Rate for Payer: Nomi Health Commercial	$168.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$153.90
Rate for Payer: PACE Senior Care Partners	$48.73
Rate for Payer: PACE SWMI	$51.30
Rate for Payer: PHP Commercial	$174.42
Rate for Payer: PHP Medicare Advantage	$51.30
Rate for Payer: Priority Health Choice Medicaid	$36.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$178.52
Rate for Payer: Priority Health Medicare	$51.81
Rate for Payer: Priority Health Narrow/Tiered Network	$142.82
Rate for Payer: Railroad Medicare Medicare	$51.30
Rate for Payer: UHC All Payor (Choice/PPO)	$180.58
Rate for Payer: UHC Core	$171.34
Rate for Payer: UHC Exchange	$51.30
Rate for Payer: UHC Medicaid	$36.18
Rate for Payer: UHC Medicare Advantage	$51.30
Rate for Payer: UHCCP Medicaid	$36.18
Rate for Payer: VA VA	$51.30
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$153.90

VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$11,851.91

Service Code	APR-DRG 3102
Min. Negotiated Rate	$11,287.53
Max. Negotiated Rate	$11,851.91
Rate for Payer: BCBS Complete	$11,851.91
Rate for Payer: Mclaren Medicaid	$11,287.53
Rate for Payer: Meridian Medicaid	$11,851.91
Rate for Payer: Priority Health Choice Medicaid	$11,287.53
Rate for Payer: UHC Medicaid	$11,287.53
Rate for Payer: UHCCP Medicaid	$11,287.53

VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$7,925.99

Service Code	APR-DRG 3101
Min. Negotiated Rate	$7,548.56
Max. Negotiated Rate	$7,925.99
Rate for Payer: BCBS Complete	$7,925.99
Rate for Payer: Mclaren Medicaid	$7,548.56
Rate for Payer: Meridian Medicaid	$7,925.99
Rate for Payer: Priority Health Choice Medicaid	$7,548.56
Rate for Payer: UHC Medicaid	$7,548.56
Rate for Payer: UHCCP Medicaid	$7,548.56

VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$25,858.71

Service Code	APR-DRG 3104
Min. Negotiated Rate	$24,627.34
Max. Negotiated Rate	$25,858.71
Rate for Payer: BCBS Complete	$25,858.71
Rate for Payer: Mclaren Medicaid	$24,627.34
Rate for Payer: Meridian Medicaid	$25,858.71
Rate for Payer: Priority Health Choice Medicaid	$24,627.34
Rate for Payer: UHC Medicaid	$24,627.34
Rate for Payer: UHCCP Medicaid	$24,627.34

VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$18,819.81

Service Code	APR-DRG 3103
Min. Negotiated Rate	$17,923.63
Max. Negotiated Rate	$18,819.81
Rate for Payer: BCBS Complete	$18,819.81
Rate for Payer: Mclaren Medicaid	$17,923.63
Rate for Payer: Meridian Medicaid	$18,819.81
Rate for Payer: Priority Health Choice Medicaid	$17,923.63
Rate for Payer: UHC Medicaid	$17,923.63
Rate for Payer: UHCCP Medicaid	$17,923.63

VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$8,217.30

Service Code	APR-DRG 1114
Min. Negotiated Rate	$7,826.00
Max. Negotiated Rate	$8,217.30
Rate for Payer: BCBS Complete	$8,217.30
Rate for Payer: Mclaren Medicaid	$7,826.00
Rate for Payer: Meridian Medicaid	$8,217.30
Rate for Payer: Priority Health Choice Medicaid	$7,826.00
Rate for Payer: UHC Medicaid	$7,826.00
Rate for Payer: UHCCP Medicaid	$7,826.00

VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$3,808.13

Service Code	APR-DRG 1111
Min. Negotiated Rate	$3,626.79
Max. Negotiated Rate	$3,808.13
Rate for Payer: BCBS Complete	$3,808.13
Rate for Payer: Mclaren Medicaid	$3,626.79
Rate for Payer: Meridian Medicaid	$3,808.13
Rate for Payer: Priority Health Choice Medicaid	$3,626.79
Rate for Payer: UHC Medicaid	$3,626.79
Rate for Payer: UHCCP Medicaid	$3,626.79

VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$4,398.65

Service Code	APR-DRG 1112
Min. Negotiated Rate	$4,189.19
Max. Negotiated Rate	$4,398.65
Rate for Payer: BCBS Complete	$4,398.65
Rate for Payer: Mclaren Medicaid	$4,189.19
Rate for Payer: Meridian Medicaid	$4,398.65
Rate for Payer: Priority Health Choice Medicaid	$4,189.19
Rate for Payer: UHC Medicaid	$4,189.19
Rate for Payer: UHCCP Medicaid	$4,189.19

VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$5,463.48

Service Code	APR-DRG 1113
Min. Negotiated Rate	$5,203.31
Max. Negotiated Rate	$5,463.48
Rate for Payer: BCBS Complete	$5,463.48
Rate for Payer: Mclaren Medicaid	$5,203.31
Rate for Payer: Meridian Medicaid	$5,463.48
Rate for Payer: Priority Health Choice Medicaid	$5,203.31
Rate for Payer: UHC Medicaid	$5,203.31
Rate for Payer: UHCCP Medicaid	$5,203.31

VIRAL ILLNESS

Facility

$5,500.29

Service Code	APR-DRG 7233
Min. Negotiated Rate	$5,238.37
Max. Negotiated Rate	$5,500.29
Rate for Payer: BCBS Complete	$5,500.29
Rate for Payer: Mclaren Medicaid	$5,238.37
Rate for Payer: Meridian Medicaid	$5,500.29
Rate for Payer: Priority Health Choice Medicaid	$5,238.37
Rate for Payer: UHC Medicaid	$5,238.37
Rate for Payer: UHCCP Medicaid	$5,238.37

VIRAL ILLNESS

Facility

$3,115.60

Service Code	APR-DRG 7232
Min. Negotiated Rate	$2,967.24
Max. Negotiated Rate	$3,115.60
Rate for Payer: BCBS Complete	$3,115.60
Rate for Payer: Mclaren Medicaid	$2,967.24
Rate for Payer: Meridian Medicaid	$3,115.60
Rate for Payer: Priority Health Choice Medicaid	$2,967.24
Rate for Payer: UHC Medicaid	$2,967.24
Rate for Payer: UHCCP Medicaid	$2,967.24

VIRAL ILLNESS

Facility

$7,833.96

Service Code	APR-DRG 7234
Min. Negotiated Rate	$7,460.92
Max. Negotiated Rate	$7,833.96
Rate for Payer: BCBS Complete	$7,833.96
Rate for Payer: Mclaren Medicaid	$7,460.92
Rate for Payer: Meridian Medicaid	$7,833.96
Rate for Payer: Priority Health Choice Medicaid	$7,460.92
Rate for Payer: UHC Medicaid	$7,460.92
Rate for Payer: UHCCP Medicaid	$7,460.92

VIRAL ILLNESS

Facility

$2,485.65

Service Code	APR-DRG 7231
Min. Negotiated Rate	$2,367.28
Max. Negotiated Rate	$2,485.65
Rate for Payer: BCBS Complete	$2,485.65
Rate for Payer: Mclaren Medicaid	$2,367.28
Rate for Payer: Meridian Medicaid	$2,485.65
Rate for Payer: Priority Health Choice Medicaid	$2,367.28
Rate for Payer: UHC Medicaid	$2,367.28
Rate for Payer: UHCCP Medicaid	$2,367.28

VIRAL MENINGITIS

Facility

$10,406.90

Service Code	APR-DRG 0514
Min. Negotiated Rate	$9,911.33
Max. Negotiated Rate	$10,406.90
Rate for Payer: BCBS Complete	$10,406.90
Rate for Payer: Mclaren Medicaid	$9,911.33
Rate for Payer: Meridian Medicaid	$10,406.90
Rate for Payer: Priority Health Choice Medicaid	$9,911.33
Rate for Payer: UHC Medicaid	$9,911.33
Rate for Payer: UHCCP Medicaid	$9,911.33

VIRAL MENINGITIS

Facility

$6,570.90

Service Code	APR-DRG 0513
Min. Negotiated Rate	$6,258.00
Max. Negotiated Rate	$6,570.90
Rate for Payer: BCBS Complete	$6,570.90
Rate for Payer: Mclaren Medicaid	$6,258.00
Rate for Payer: Meridian Medicaid	$6,570.90
Rate for Payer: Priority Health Choice Medicaid	$6,258.00
Rate for Payer: UHC Medicaid	$6,258.00
Rate for Payer: UHCCP Medicaid	$6,258.00

VIRAL MENINGITIS

Facility

$3,980.61

Service Code	APR-DRG 0512
Min. Negotiated Rate	$3,791.06
Max. Negotiated Rate	$3,980.61
Rate for Payer: BCBS Complete	$3,980.61
Rate for Payer: Mclaren Medicaid	$3,791.06
Rate for Payer: Meridian Medicaid	$3,980.61
Rate for Payer: Priority Health Choice Medicaid	$3,791.06
Rate for Payer: UHC Medicaid	$3,791.06
Rate for Payer: UHCCP Medicaid	$3,791.06

VIRAL MENINGITIS

Facility

$2,963.11

Service Code	APR-DRG 0511
Min. Negotiated Rate	$2,822.01
Max. Negotiated Rate	$2,963.11
Rate for Payer: BCBS Complete	$2,963.11
Rate for Payer: Mclaren Medicaid	$2,822.01
Rate for Payer: Meridian Medicaid	$2,963.11
Rate for Payer: Priority Health Choice Medicaid	$2,822.01
Rate for Payer: UHC Medicaid	$2,822.01
Rate for Payer: UHCCP Medicaid	$2,822.01

VIT A-D3-E-ALOE VERA-ZINC TOPICAL OINTMENT

Facility

$15.75

Service Code	NDC 61924020504
Hospital Charge Code	115852
Hospital Revenue Code	637
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$14.18
Rate for Payer: Aetna Commercial	$13.39
Rate for Payer: Aetna Medicare	$4.09
Rate for Payer: Allen County Amish Medical Aid Commercial	$4.92
Rate for Payer: Amish Plain Church Group Commercial	$4.92
Rate for Payer: BCBS Complete	$2.92
Rate for Payer: BCBS MAPPO	$3.94
Rate for Payer: BCBS Trust/PPO	$12.95
Rate for Payer: BCN Commercial	$12.95
Rate for Payer: BCN Medicare Advantage	$3.94
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cofinity Commercial	$13.54
Rate for Payer: Encore Health Key Benefits Commercial	$12.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$3.94
Rate for Payer: Healthscope Commercial	$14.18
Rate for Payer: Lakeland Regional Health Systems Commercial	$11.81
Rate for Payer: Mclaren Medicaid	$2.78
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$4.13
Rate for Payer: Meridian Medicaid	$2.92
Rate for Payer: MI Amish Medical Board Commercial	$4.53
Rate for Payer: Molina Medicare/Medicaid	$4.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.39
Rate for Payer: Nomi Health Commercial	$12.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.81
Rate for Payer: PACE Senior Care Partners	$3.74
Rate for Payer: PACE SWMI	$3.94
Rate for Payer: PHP Commercial	$13.39
Rate for Payer: PHP Medicare Advantage	$3.94
Rate for Payer: Priority Health Choice Medicaid	$2.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$13.70
Rate for Payer: Priority Health Medicare	$3.98
Rate for Payer: Priority Health Narrow/Tiered Network	$10.96
Rate for Payer: Railroad Medicare Medicare	$3.94
Rate for Payer: UHC All Payor (Choice/PPO)	$13.86
Rate for Payer: UHC Core	$13.15
Rate for Payer: UHC Exchange	$3.94
Rate for Payer: UHC Medicaid	$2.78
Rate for Payer: UHC Medicare Advantage	$3.94
Rate for Payer: UHCCP Medicaid	$2.78
Rate for Payer: VA VA	$3.94
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$11.81

VIT A-D3-E-ALOE VERA-ZINC TOPICAL OINTMENT

Facility

$15.75

Service Code	NDC 61924020504
Hospital Charge Code	115852
Hospital Revenue Code	637
Min. Negotiated Rate	$10.96
Max. Negotiated Rate	$14.18
Rate for Payer: Aetna Commercial	$13.39
Rate for Payer: BCBS Trust/PPO	$13.01
Rate for Payer: BCN Commercial	$13.01
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cofinity Commercial	$13.54
Rate for Payer: Encore Health Key Benefits Commercial	$12.60
Rate for Payer: Healthscope Commercial	$14.18
Rate for Payer: Lakeland Regional Health Systems Commercial	$11.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.39
Rate for Payer: Nomi Health Commercial	$12.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.81
Rate for Payer: PHP Commercial	$13.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$13.70
Rate for Payer: Priority Health Narrow/Tiered Network	$10.96
Rate for Payer: UHC All Payor (Choice/PPO)	$13.86
Rate for Payer: UHC Core	$13.15
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$11.81

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT

Facility

$10.68

Service Code	NDC 45802039504
Hospital Charge Code	118725
Hospital Revenue Code	637
Min. Negotiated Rate	$7.43
Max. Negotiated Rate	$9.61
Rate for Payer: Aetna Commercial	$9.08
Rate for Payer: BCBS Trust/PPO	$8.82
Rate for Payer: BCN Commercial	$8.82
Rate for Payer: Cash Price	$8.54
Rate for Payer: Cofinity Commercial	$9.18
Rate for Payer: Encore Health Key Benefits Commercial	$8.54
Rate for Payer: Healthscope Commercial	$9.61
Rate for Payer: Lakeland Regional Health Systems Commercial	$8.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.08
Rate for Payer: Nomi Health Commercial	$8.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$8.01
Rate for Payer: PHP Commercial	$9.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$9.29
Rate for Payer: Priority Health Narrow/Tiered Network	$7.43
Rate for Payer: UHC All Payor (Choice/PPO)	$9.40
Rate for Payer: UHC Core	$8.92
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$8.01

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT

Facility

$16.79

Service Code	NDC 65197040101
Hospital Charge Code	118725
Hospital Revenue Code	637
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$15.11
Rate for Payer: Aetna Commercial	$14.27
Rate for Payer: BCBS Trust/PPO	$13.87
Rate for Payer: BCN Commercial	$13.87
Rate for Payer: Cash Price	$13.43
Rate for Payer: Cofinity Commercial	$14.44
Rate for Payer: Encore Health Key Benefits Commercial	$13.43
Rate for Payer: Healthscope Commercial	$15.11
Rate for Payer: Lakeland Regional Health Systems Commercial	$12.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.27
Rate for Payer: Nomi Health Commercial	$13.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$12.59
Rate for Payer: PHP Commercial	$14.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$14.61
Rate for Payer: Priority Health Narrow/Tiered Network	$11.69
Rate for Payer: UHC All Payor (Choice/PPO)	$14.78
Rate for Payer: UHC Core	$14.02
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$12.59

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT

Facility

$9.57

Service Code	NDC 67777021402
Hospital Charge Code	118725
Hospital Revenue Code	637
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$8.61
Rate for Payer: Aetna Commercial	$8.13
Rate for Payer: Aetna Medicare	$2.49
Rate for Payer: Allen County Amish Medical Aid Commercial	$2.99
Rate for Payer: Amish Plain Church Group Commercial	$2.99
Rate for Payer: BCBS Complete	$1.77
Rate for Payer: BCBS MAPPO	$2.39
Rate for Payer: BCBS Trust/PPO	$7.87
Rate for Payer: BCN Commercial	$7.87
Rate for Payer: BCN Medicare Advantage	$2.39
Rate for Payer: Cash Price	$7.66
Rate for Payer: Cofinity Commercial	$8.23
Rate for Payer: Encore Health Key Benefits Commercial	$7.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$2.39
Rate for Payer: Healthscope Commercial	$8.61
Rate for Payer: Lakeland Regional Health Systems Commercial	$7.18
Rate for Payer: Mclaren Medicaid	$1.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2.51
Rate for Payer: Meridian Medicaid	$1.77
Rate for Payer: MI Amish Medical Board Commercial	$2.75
Rate for Payer: Molina Medicare/Medicaid	$2.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.13
Rate for Payer: Nomi Health Commercial	$7.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.18
Rate for Payer: PACE Senior Care Partners	$2.27
Rate for Payer: PACE SWMI	$2.39
Rate for Payer: PHP Commercial	$8.13
Rate for Payer: PHP Medicare Advantage	$2.39
Rate for Payer: Priority Health Choice Medicaid	$1.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$8.33
Rate for Payer: Priority Health Medicare	$2.42
Rate for Payer: Priority Health Narrow/Tiered Network	$6.66
Rate for Payer: Railroad Medicare Medicare	$2.39
Rate for Payer: UHC All Payor (Choice/PPO)	$8.42
Rate for Payer: UHC Core	$7.99
Rate for Payer: UHC Exchange	$2.39
Rate for Payer: UHC Medicaid	$1.69
Rate for Payer: UHC Medicare Advantage	$2.39
Rate for Payer: UHCCP Medicaid	$1.69
Rate for Payer: VA VA	$2.39
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$7.18

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT

Facility

$10.68

Service Code	NDC 45802039504
Hospital Charge Code	118725
Hospital Revenue Code	637
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$9.61
Rate for Payer: Aetna Commercial	$9.08
Rate for Payer: Aetna Medicare	$2.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$3.34
Rate for Payer: Amish Plain Church Group Commercial	$3.34
Rate for Payer: BCBS Complete	$1.98
Rate for Payer: BCBS MAPPO	$2.67
Rate for Payer: BCBS Trust/PPO	$8.78
Rate for Payer: BCN Commercial	$8.78
Rate for Payer: BCN Medicare Advantage	$2.67
Rate for Payer: Cash Price	$8.54
Rate for Payer: Cofinity Commercial	$9.18
Rate for Payer: Encore Health Key Benefits Commercial	$8.54
Rate for Payer: Health Alliance Plan Medicare Advantage	$2.67
Rate for Payer: Healthscope Commercial	$9.61
Rate for Payer: Lakeland Regional Health Systems Commercial	$8.01
Rate for Payer: Mclaren Medicaid	$1.88
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2.80
Rate for Payer: Meridian Medicaid	$1.98
Rate for Payer: MI Amish Medical Board Commercial	$3.07
Rate for Payer: Molina Medicare/Medicaid	$2.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.08
Rate for Payer: Nomi Health Commercial	$8.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$8.01
Rate for Payer: PACE Senior Care Partners	$2.54
Rate for Payer: PACE SWMI	$2.67
Rate for Payer: PHP Commercial	$9.08
Rate for Payer: PHP Medicare Advantage	$2.67
Rate for Payer: Priority Health Choice Medicaid	$1.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$9.29
Rate for Payer: Priority Health Medicare	$2.70
Rate for Payer: Priority Health Narrow/Tiered Network	$7.43
Rate for Payer: Railroad Medicare Medicare	$2.67
Rate for Payer: UHC All Payor (Choice/PPO)	$9.40
Rate for Payer: UHC Core	$8.92
Rate for Payer: UHC Exchange	$2.67
Rate for Payer: UHC Medicaid	$1.88
Rate for Payer: UHC Medicare Advantage	$2.67
Rate for Payer: UHCCP Medicaid	$1.88
Rate for Payer: VA VA	$2.67
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$8.01

Know your out-of-pocket cost for care.

All Charges