|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$524.64
|
|
|
Service Code
|
NDC 60687049301
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.60 |
| Max. Negotiated Rate |
$472.18 |
| Rate for Payer: Aetna Commercial |
$445.94
|
| Rate for Payer: Aetna Medicare |
$136.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$163.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$163.95
|
| Rate for Payer: BCBS Complete |
$209.86
|
| Rate for Payer: BCBS MAPPO |
$131.16
|
| Rate for Payer: BCBS Trust/PPO |
$431.31
|
| Rate for Payer: BCN Commercial |
$407.91
|
| Rate for Payer: BCN Medicare Advantage |
$131.16
|
| Rate for Payer: Cash Price |
$419.71
|
| Rate for Payer: Cofinity Commercial |
$451.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.16
|
| Rate for Payer: Healthscope Commercial |
$472.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.94
|
| Rate for Payer: Nomi Health Commercial |
$430.20
|
| Rate for Payer: PACE Senior Care Partners |
$124.60
|
| Rate for Payer: PACE SWMI |
$131.16
|
| Rate for Payer: PHP Commercial |
$445.94
|
| Rate for Payer: PHP Medicare Advantage |
$131.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.02
|
| Rate for Payer: Priority Health HMO/PPO |
$456.44
|
| Rate for Payer: Priority Health Medicare |
$132.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$351.51
|
| Rate for Payer: Railroad Medicare Medicare |
$131.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.68
|
| Rate for Payer: UHC Core |
$438.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.16
|
| Rate for Payer: UHC Exchange |
$131.16
|
| Rate for Payer: UHC Medicare Advantage |
$131.16
|
| Rate for Payer: VA VA |
$131.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.48
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$524.64
|
|
|
Service Code
|
NDC 60687049301
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$341.02 |
| Max. Negotiated Rate |
$472.18 |
| Rate for Payer: Aetna Commercial |
$445.94
|
| Rate for Payer: BCBS Trust/PPO |
$428.26
|
| Rate for Payer: BCN Commercial |
$405.44
|
| Rate for Payer: Cash Price |
$419.71
|
| Rate for Payer: Cofinity Commercial |
$451.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.71
|
| Rate for Payer: Healthscope Commercial |
$472.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.94
|
| Rate for Payer: Nomi Health Commercial |
$430.20
|
| Rate for Payer: PHP Commercial |
$445.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.02
|
| Rate for Payer: Priority Health HMO/PPO |
$456.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$351.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.68
|
| Rate for Payer: UHC Core |
$438.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.48
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$200.45
|
|
|
Service Code
|
NDC 68462029201
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.61 |
| Max. Negotiated Rate |
$180.40 |
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna Medicare |
$52.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.64
|
| Rate for Payer: BCBS Complete |
$80.18
|
| Rate for Payer: BCBS MAPPO |
$50.11
|
| Rate for Payer: BCBS Trust/PPO |
$164.79
|
| Rate for Payer: BCN Commercial |
$155.85
|
| Rate for Payer: BCN Medicare Advantage |
$50.11
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.11
|
| Rate for Payer: Healthscope Commercial |
$180.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: PACE Senior Care Partners |
$47.61
|
| Rate for Payer: PACE SWMI |
$50.11
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: PHP Medicare Advantage |
$50.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: Priority Health HMO/PPO |
$174.39
|
| Rate for Payer: Priority Health Medicare |
$50.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.30
|
| Rate for Payer: Railroad Medicare Medicare |
$50.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.40
|
| Rate for Payer: UHC Core |
$167.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.11
|
| Rate for Payer: UHC Exchange |
$50.11
|
| Rate for Payer: UHC Medicare Advantage |
$50.11
|
| Rate for Payer: VA VA |
$50.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$200.45
|
|
|
Service Code
|
NDC 68462029201
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.29 |
| Max. Negotiated Rate |
$180.40 |
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: BCBS Trust/PPO |
$163.63
|
| Rate for Payer: BCN Commercial |
$154.91
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: Priority Health HMO/PPO |
$174.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.40
|
| Rate for Payer: UHC Core |
$167.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$5.25
|
|
|
Service Code
|
NDC 60687049311
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna Commercial |
$4.46
|
| Rate for Payer: Aetna Medicare |
$1.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.64
|
| Rate for Payer: BCBS Complete |
$2.10
|
| Rate for Payer: BCBS MAPPO |
$1.31
|
| Rate for Payer: BCBS Trust/PPO |
$4.32
|
| Rate for Payer: BCN Commercial |
$4.08
|
| Rate for Payer: BCN Medicare Advantage |
$1.31
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$4.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.31
|
| Rate for Payer: Healthscope Commercial |
$4.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.46
|
| Rate for Payer: Nomi Health Commercial |
$4.30
|
| Rate for Payer: PACE Senior Care Partners |
$1.25
|
| Rate for Payer: PACE SWMI |
$1.31
|
| Rate for Payer: PHP Commercial |
$4.46
|
| Rate for Payer: PHP Medicare Advantage |
$1.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.41
|
| Rate for Payer: Priority Health HMO/PPO |
$4.57
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.52
|
| Rate for Payer: Railroad Medicare Medicare |
$1.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.62
|
| Rate for Payer: UHC Core |
$4.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.31
|
| Rate for Payer: UHC Exchange |
$1.31
|
| Rate for Payer: UHC Medicare Advantage |
$1.31
|
| Rate for Payer: VA VA |
$1.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.94
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$432.40
|
|
|
Service Code
|
NDC 68462029301
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.70 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: Aetna Medicare |
$112.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$135.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$135.12
|
| Rate for Payer: BCBS Complete |
$172.96
|
| Rate for Payer: BCBS MAPPO |
$108.10
|
| Rate for Payer: BCBS Trust/PPO |
$355.48
|
| Rate for Payer: BCN Commercial |
$336.19
|
| Rate for Payer: BCN Medicare Advantage |
$108.10
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.10
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Nomi Health Commercial |
$354.57
|
| Rate for Payer: PACE Senior Care Partners |
$102.70
|
| Rate for Payer: PACE SWMI |
$108.10
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: PHP Medicare Advantage |
$108.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.06
|
| Rate for Payer: Priority Health HMO/PPO |
$376.19
|
| Rate for Payer: Priority Health Medicare |
$109.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.71
|
| Rate for Payer: Railroad Medicare Medicare |
$108.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.51
|
| Rate for Payer: UHC Core |
$361.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.10
|
| Rate for Payer: UHC Exchange |
$108.10
|
| Rate for Payer: UHC Medicare Advantage |
$108.10
|
| Rate for Payer: VA VA |
$108.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$432.40
|
|
|
Service Code
|
NDC 68462029301
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.06 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: BCBS Trust/PPO |
$352.97
|
| Rate for Payer: BCN Commercial |
$334.16
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Nomi Health Commercial |
$354.57
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.06
|
| Rate for Payer: Priority Health HMO/PPO |
$376.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.51
|
| Rate for Payer: UHC Core |
$361.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
|
|
VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$303.15
|
|
|
Service Code
|
NDC 68462026001
|
| Hospital Charge Code |
8531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.05 |
| Max. Negotiated Rate |
$272.84 |
| Rate for Payer: Aetna Commercial |
$257.68
|
| Rate for Payer: BCBS Trust/PPO |
$247.46
|
| Rate for Payer: BCN Commercial |
$234.27
|
| Rate for Payer: Cash Price |
$242.52
|
| Rate for Payer: Cofinity Commercial |
$260.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.52
|
| Rate for Payer: Healthscope Commercial |
$272.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.68
|
| Rate for Payer: Nomi Health Commercial |
$248.58
|
| Rate for Payer: PHP Commercial |
$257.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.05
|
| Rate for Payer: Priority Health HMO/PPO |
$263.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.77
|
| Rate for Payer: UHC Core |
$253.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.36
|
|
|
VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$303.15
|
|
|
Service Code
|
NDC 68462026001
|
| Hospital Charge Code |
8531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$272.84 |
| Rate for Payer: Aetna Commercial |
$257.68
|
| Rate for Payer: Aetna Medicare |
$78.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.73
|
| Rate for Payer: BCBS Complete |
$121.26
|
| Rate for Payer: BCBS MAPPO |
$75.79
|
| Rate for Payer: BCBS Trust/PPO |
$249.22
|
| Rate for Payer: BCN Commercial |
$235.70
|
| Rate for Payer: BCN Medicare Advantage |
$75.79
|
| Rate for Payer: Cash Price |
$242.52
|
| Rate for Payer: Cofinity Commercial |
$260.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.79
|
| Rate for Payer: Healthscope Commercial |
$272.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.68
|
| Rate for Payer: Nomi Health Commercial |
$248.58
|
| Rate for Payer: PACE Senior Care Partners |
$72.00
|
| Rate for Payer: PACE SWMI |
$75.79
|
| Rate for Payer: PHP Commercial |
$257.68
|
| Rate for Payer: PHP Medicare Advantage |
$75.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.05
|
| Rate for Payer: Priority Health HMO/PPO |
$263.74
|
| Rate for Payer: Priority Health Medicare |
$76.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.11
|
| Rate for Payer: Railroad Medicare Medicare |
$75.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.77
|
| Rate for Payer: UHC Core |
$253.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.79
|
| Rate for Payer: UHC Exchange |
$75.79
|
| Rate for Payer: UHC Medicare Advantage |
$75.79
|
| Rate for Payer: VA VA |
$75.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.36
|
|
|
VIT A-D3-E-ALOE VERA-ZINC TOPICAL OINTMENT
|
Facility
|
OP
|
$15.75
|
|
|
Service Code
|
NDC 61924020504
|
| Hospital Charge Code |
115852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$14.18 |
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: Aetna Medicare |
$4.10
|
| 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 |
$6.30
|
| Rate for Payer: BCBS MAPPO |
$3.94
|
| Rate for Payer: BCBS Trust/PPO |
$12.95
|
| Rate for Payer: BCN Commercial |
$12.25
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.39
|
| Rate for Payer: Nomi Health Commercial |
$12.92
|
| 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 Cigna Priority Health |
$10.24
|
| Rate for Payer: Priority Health HMO/PPO |
$13.70
|
| Rate for Payer: Priority Health Medicare |
$3.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.55
|
| 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 Dual Complete DSNP |
$3.94
|
| Rate for Payer: UHC Exchange |
$3.94
|
| Rate for Payer: UHC Medicare Advantage |
$3.94
|
| 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
|
IP
|
$15.75
|
|
|
Service Code
|
NDC 61924020504
|
| Hospital Charge Code |
115852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$14.18 |
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: BCBS Trust/PPO |
$12.86
|
| Rate for Payer: BCN Commercial |
$12.17
|
| 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 |
$12.92
|
| Rate for Payer: PHP Commercial |
$13.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.24
|
| Rate for Payer: Priority Health HMO/PPO |
$13.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.55
|
| 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
|
OP
|
$9.57
|
|
|
Service Code
|
NDC 67777021402
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.27 |
| 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 |
$3.83
|
| Rate for Payer: BCBS MAPPO |
$2.39
|
| Rate for Payer: BCBS Trust/PPO |
$7.87
|
| Rate for Payer: BCN Commercial |
$7.44
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: Nomi Health Commercial |
$7.85
|
| 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 Cigna Priority Health |
$6.22
|
| Rate for Payer: Priority Health HMO/PPO |
$8.33
|
| Rate for Payer: Priority Health Medicare |
$2.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.41
|
| 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 Dual Complete DSNP |
$2.39
|
| Rate for Payer: UHC Exchange |
$2.39
|
| Rate for Payer: UHC Medicare Advantage |
$2.39
|
| 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
|
IP
|
$10.68
|
|
|
Service Code
|
NDC 45802039504
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$9.61 |
| Rate for Payer: Aetna Commercial |
$9.08
|
| Rate for Payer: BCBS Trust/PPO |
$8.72
|
| Rate for Payer: BCN Commercial |
$8.25
|
| 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: PHP Commercial |
$9.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.94
|
| Rate for Payer: Priority Health HMO/PPO |
$9.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.16
|
| 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
|
OP
|
$16.79
|
|
|
Service Code
|
NDC 65197040101
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$15.11 |
| Rate for Payer: Aetna Commercial |
$14.27
|
| Rate for Payer: Aetna Medicare |
$4.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.25
|
| Rate for Payer: BCBS Complete |
$6.72
|
| Rate for Payer: BCBS MAPPO |
$4.20
|
| Rate for Payer: BCBS Trust/PPO |
$13.80
|
| Rate for Payer: BCN Commercial |
$13.05
|
| Rate for Payer: BCN Medicare Advantage |
$4.20
|
| 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: Health Alliance Plan Medicare Advantage |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$15.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.27
|
| Rate for Payer: Nomi Health Commercial |
$13.77
|
| Rate for Payer: PACE Senior Care Partners |
$3.99
|
| Rate for Payer: PACE SWMI |
$4.20
|
| Rate for Payer: PHP Commercial |
$14.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.91
|
| Rate for Payer: Priority Health HMO/PPO |
$14.61
|
| Rate for Payer: Priority Health Medicare |
$4.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.25
|
| Rate for Payer: Railroad Medicare Medicare |
$4.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.78
|
| Rate for Payer: UHC Core |
$14.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.20
|
| Rate for Payer: UHC Exchange |
$4.20
|
| Rate for Payer: UHC Medicare Advantage |
$4.20
|
| Rate for Payer: VA VA |
$4.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.59
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
IP
|
$16.79
|
|
|
Service Code
|
NDC 65197040101
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$15.11 |
| Rate for Payer: Aetna Commercial |
$14.27
|
| Rate for Payer: BCBS Trust/PPO |
$13.71
|
| Rate for Payer: BCN Commercial |
$12.98
|
| 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: PHP Commercial |
$14.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.91
|
| Rate for Payer: Priority Health HMO/PPO |
$14.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.25
|
| 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
|
IP
|
$9.57
|
|
|
Service Code
|
NDC 67777021402
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: BCBS Trust/PPO |
$7.81
|
| Rate for Payer: BCN Commercial |
$7.40
|
| 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: Healthscope Commercial |
$8.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: Nomi Health Commercial |
$7.85
|
| Rate for Payer: PHP Commercial |
$8.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.22
|
| Rate for Payer: Priority Health HMO/PPO |
$8.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.42
|
| Rate for Payer: UHC Core |
$7.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.18
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
OP
|
$10.68
|
|
|
Service Code
|
NDC 45802039504
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.54 |
| 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 |
$4.27
|
| Rate for Payer: BCBS MAPPO |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$8.78
|
| Rate for Payer: BCN Commercial |
$8.30
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.08
|
| Rate for Payer: Nomi Health Commercial |
$8.76
|
| 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 Cigna Priority Health |
$6.94
|
| Rate for Payer: Priority Health HMO/PPO |
$9.29
|
| Rate for Payer: Priority Health Medicare |
$2.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.16
|
| 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 Dual Complete DSNP |
$2.67
|
| Rate for Payer: UHC Exchange |
$2.67
|
| Rate for Payer: UHC Medicare Advantage |
$2.67
|
| Rate for Payer: VA VA |
$2.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.01
|
|
|
VORTIOXETINE 20 MG TABLET
|
Facility
|
OP
|
$1,769.23
|
|
|
Service Code
|
NDC 64764075030
|
| Hospital Charge Code |
168417
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$420.19 |
| Max. Negotiated Rate |
$1,592.31 |
| Rate for Payer: Aetna Commercial |
$1,503.85
|
| Rate for Payer: Aetna Medicare |
$460.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$552.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$552.88
|
| Rate for Payer: BCBS Complete |
$707.69
|
| Rate for Payer: BCBS MAPPO |
$442.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,454.48
|
| Rate for Payer: BCN Commercial |
$1,375.58
|
| Rate for Payer: BCN Medicare Advantage |
$442.31
|
| Rate for Payer: Cash Price |
$1,415.38
|
| Rate for Payer: Cofinity Commercial |
$1,521.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$442.31
|
| Rate for Payer: Healthscope Commercial |
$1,592.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,326.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$464.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$508.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,503.85
|
| Rate for Payer: Nomi Health Commercial |
$1,450.77
|
| Rate for Payer: PACE Senior Care Partners |
$420.19
|
| Rate for Payer: PACE SWMI |
$442.31
|
| Rate for Payer: PHP Commercial |
$1,503.85
|
| Rate for Payer: PHP Medicare Advantage |
$442.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,150.00
|
| Rate for Payer: Priority Health HMO/PPO |
$1,539.23
|
| Rate for Payer: Priority Health Medicare |
$446.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,185.38
|
| Rate for Payer: Railroad Medicare Medicare |
$442.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,556.92
|
| Rate for Payer: UHC Core |
$1,477.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$442.31
|
| Rate for Payer: UHC Exchange |
$442.31
|
| Rate for Payer: UHC Medicare Advantage |
$442.31
|
| Rate for Payer: VA VA |
$442.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,326.92
|
|
|
VORTIOXETINE 20 MG TABLET
|
Facility
|
IP
|
$1,769.23
|
|
|
Service Code
|
NDC 64764075030
|
| Hospital Charge Code |
168417
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,150.00 |
| Max. Negotiated Rate |
$1,592.31 |
| Rate for Payer: Aetna Commercial |
$1,503.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,444.22
|
| Rate for Payer: BCN Commercial |
$1,367.26
|
| Rate for Payer: Cash Price |
$1,415.38
|
| Rate for Payer: Cofinity Commercial |
$1,521.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.38
|
| Rate for Payer: Healthscope Commercial |
$1,592.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,326.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,503.85
|
| Rate for Payer: Nomi Health Commercial |
$1,450.77
|
| Rate for Payer: PHP Commercial |
$1,503.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,150.00
|
| Rate for Payer: Priority Health HMO/PPO |
$1,539.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,185.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,556.92
|
| Rate for Payer: UHC Core |
$1,477.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,326.92
|
|
|
VULVECTOMY SIMPLE; PARTIAL
|
Facility
|
OP
|
$2,365.09
|
|
|
Service Code
|
CPT 56620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$2,365.09 |
| Rate for Payer: BCBS Complete |
$2,365.09
|
| Rate for Payer: Mclaren Medicaid |
$2,252.32
|
| Rate for Payer: Meridian Medicaid |
$2,365.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,252.32
|
| Rate for Payer: UHCCP Medicaid |
$2,252.32
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
NDC 00832121189
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna Medicare |
$0.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.16
|
| Rate for Payer: BCBS Complete |
$1.49
|
| Rate for Payer: BCBS MAPPO |
$0.93
|
| Rate for Payer: BCBS Trust/PPO |
$3.06
|
| Rate for Payer: BCN Commercial |
$2.89
|
| Rate for Payer: BCN Medicare Advantage |
$0.93
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.93
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: Nomi Health Commercial |
$3.05
|
| Rate for Payer: PACE Senior Care Partners |
$0.88
|
| Rate for Payer: PACE SWMI |
$0.93
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: PHP Medicare Advantage |
$0.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health HMO/PPO |
$3.24
|
| Rate for Payer: Priority Health Medicare |
$0.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.49
|
| Rate for Payer: Railroad Medicare Medicare |
$0.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.27
|
| Rate for Payer: UHC Core |
$3.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.93
|
| Rate for Payer: UHC Exchange |
$0.93
|
| Rate for Payer: UHC Medicare Advantage |
$0.93
|
| Rate for Payer: VA VA |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$371.30
|
|
|
Service Code
|
NDC 00832121101
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.34 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna Commercial |
$315.60
|
| Rate for Payer: BCBS Trust/PPO |
$303.09
|
| Rate for Payer: BCN Commercial |
$286.94
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.60
|
| Rate for Payer: Nomi Health Commercial |
$304.47
|
| Rate for Payer: PHP Commercial |
$315.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.34
|
| Rate for Payer: Priority Health HMO/PPO |
$323.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.74
|
| Rate for Payer: UHC Core |
$310.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 00832121189
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: BCBS Trust/PPO |
$3.04
|
| Rate for Payer: BCN Commercial |
$2.87
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: Nomi Health Commercial |
$3.05
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health HMO/PPO |
$3.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.27
|
| Rate for Payer: UHC Core |
$3.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
OP
|
$371.30
|
|
|
Service Code
|
NDC 00832121101
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.18 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna Commercial |
$315.60
|
| Rate for Payer: Aetna Medicare |
$96.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.03
|
| Rate for Payer: BCBS Complete |
$148.52
|
| Rate for Payer: BCBS MAPPO |
$92.82
|
| Rate for Payer: BCBS Trust/PPO |
$305.25
|
| Rate for Payer: BCN Commercial |
$288.69
|
| Rate for Payer: BCN Medicare Advantage |
$92.82
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.82
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.60
|
| Rate for Payer: Nomi Health Commercial |
$304.47
|
| Rate for Payer: PACE Senior Care Partners |
$88.18
|
| Rate for Payer: PACE SWMI |
$92.82
|
| Rate for Payer: PHP Commercial |
$315.60
|
| Rate for Payer: PHP Medicare Advantage |
$92.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.34
|
| Rate for Payer: Priority Health HMO/PPO |
$323.03
|
| Rate for Payer: Priority Health Medicare |
$93.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.77
|
| Rate for Payer: Railroad Medicare Medicare |
$92.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.74
|
| Rate for Payer: UHC Core |
$310.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.82
|
| Rate for Payer: UHC Exchange |
$92.82
|
| Rate for Payer: UHC Medicare Advantage |
$92.82
|
| Rate for Payer: VA VA |
$92.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 00832121389
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna Medicare |
$0.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.15
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: BCBS MAPPO |
$0.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.03
|
| Rate for Payer: BCN Commercial |
$2.87
|
| Rate for Payer: BCN Medicare Advantage |
$0.92
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.92
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Nomi Health Commercial |
$3.03
|
| Rate for Payer: PACE Senior Care Partners |
$0.88
|
| Rate for Payer: PACE SWMI |
$0.92
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: PHP Medicare Advantage |
$0.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health HMO/PPO |
$3.21
|
| Rate for Payer: Priority Health Medicare |
$0.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.47
|
| Rate for Payer: Railroad Medicare Medicare |
$0.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.25
|
| Rate for Payer: UHC Core |
$3.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.92
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UHC Medicare Advantage |
$0.92
|
| Rate for Payer: VA VA |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
