|
SELENIUM 60 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$734.01
|
|
|
Service Code
|
NDC 0517-6560-01
|
| Hospital Charge Code |
190643
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$322.96 |
| Max. Negotiated Rate |
$660.61 |
| Rate for Payer: Aetna American Axle |
$477.11
|
| Rate for Payer: Aetna Commercial |
$623.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.11
|
| Rate for Payer: Cash Price |
$587.21
|
| Rate for Payer: Cofinity Commercial |
$513.81
|
| Rate for Payer: Cofinity Commercial |
$631.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.21
|
| Rate for Payer: Healthscope Commercial |
$660.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$623.91
|
| Rate for Payer: PHP Commercial |
$623.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.81
|
| Rate for Payer: Priority Health SBD |
$462.43
|
| Rate for Payer: UMR Bronson Commercial |
$322.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.51
|
|
|
SELENIUM 60 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$705.82
|
|
|
Service Code
|
NDC 0517-6560-25
|
| Hospital Charge Code |
190643
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$310.56 |
| Max. Negotiated Rate |
$635.24 |
| Rate for Payer: Aetna American Axle |
$458.78
|
| Rate for Payer: Aetna Commercial |
$599.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.78
|
| Rate for Payer: Cash Price |
$564.66
|
| Rate for Payer: Cofinity Commercial |
$494.07
|
| Rate for Payer: Cofinity Commercial |
$607.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.66
|
| Rate for Payer: Healthscope Commercial |
$635.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$494.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$529.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$599.95
|
| Rate for Payer: PHP Commercial |
$599.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.07
|
| Rate for Payer: Priority Health SBD |
$444.67
|
| Rate for Payer: UMR Bronson Commercial |
$310.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$529.36
|
|
|
SELENIUM SD 10 MCG/ML IV
|
Facility
|
IP
|
$33.14
|
|
|
Service Code
|
NDC 0990-0000-56
|
| Hospital Charge Code |
157114
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.58 |
| Max. Negotiated Rate |
$29.83 |
| Rate for Payer: Aetna American Axle |
$21.54
|
| Rate for Payer: Aetna Commercial |
$28.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.54
|
| Rate for Payer: Cash Price |
$26.51
|
| Rate for Payer: Cofinity Commercial |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$28.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.51
|
| Rate for Payer: Healthscope Commercial |
$29.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.17
|
| Rate for Payer: PHP Commercial |
$28.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: Priority Health SBD |
$20.88
|
| Rate for Payer: UMR Bronson Commercial |
$14.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.86
|
|
|
SELENIUM SULFIDE 2.5 % LOTION
|
Facility
|
IP
|
$23.52
|
|
|
Service Code
|
NDC 45802-040-64
|
| Hospital Charge Code |
177121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$21.17 |
| Rate for Payer: Aetna American Axle |
$15.29
|
| Rate for Payer: Aetna Commercial |
$19.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.29
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$20.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.82
|
| Rate for Payer: Healthscope Commercial |
$21.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.99
|
| Rate for Payer: PHP Commercial |
$19.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.46
|
| Rate for Payer: Priority Health SBD |
$14.82
|
| Rate for Payer: UMR Bronson Commercial |
$10.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.64
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$144.90
|
|
|
Service Code
|
NDC 0536-1248-01
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.76 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna American Axle |
$94.18
|
| Rate for Payer: Aetna Commercial |
$123.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.18
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: Cofinity Commercial |
$101.43
|
| Rate for Payer: Cofinity Commercial |
$124.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.92
|
| Rate for Payer: Healthscope Commercial |
$130.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.16
|
| Rate for Payer: PHP Commercial |
$123.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.43
|
| Rate for Payer: Priority Health SBD |
$91.29
|
| Rate for Payer: UMR Bronson Commercial |
$63.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.68
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
NDC 0536-1247-01
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna American Axle |
$96.20
|
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.80
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.60
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| Rate for Payer: UMR Bronson Commercial |
$65.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$43.10
|
|
|
Service Code
|
NDC 67618-310-30
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$38.79 |
| Rate for Payer: Aetna American Axle |
$28.02
|
| Rate for Payer: Aetna Commercial |
$36.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.02
|
| Rate for Payer: Cash Price |
$34.48
|
| Rate for Payer: Cofinity Commercial |
$30.17
|
| Rate for Payer: Cofinity Commercial |
$37.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.48
|
| Rate for Payer: Healthscope Commercial |
$38.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.64
|
| Rate for Payer: PHP Commercial |
$36.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.17
|
| Rate for Payer: Priority Health SBD |
$27.15
|
| Rate for Payer: UMR Bronson Commercial |
$18.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.32
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$183.96
|
|
|
Service Code
|
NDC 67618-310-60
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.94 |
| Max. Negotiated Rate |
$165.56 |
| Rate for Payer: Aetna American Axle |
$119.57
|
| Rate for Payer: Aetna Commercial |
$156.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.57
|
| Rate for Payer: Cash Price |
$147.17
|
| Rate for Payer: Cofinity Commercial |
$128.77
|
| Rate for Payer: Cofinity Commercial |
$158.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.17
|
| Rate for Payer: Healthscope Commercial |
$165.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.37
|
| Rate for Payer: PHP Commercial |
$156.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.77
|
| Rate for Payer: Priority Health SBD |
$115.89
|
| Rate for Payer: UMR Bronson Commercial |
$80.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.97
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$103.62
|
|
|
Service Code
|
NDC 60258-951-06
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.59 |
| Max. Negotiated Rate |
$93.26 |
| Rate for Payer: Aetna American Axle |
$67.35
|
| Rate for Payer: Aetna Commercial |
$88.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.35
|
| Rate for Payer: Cash Price |
$82.90
|
| Rate for Payer: Cofinity Commercial |
$72.53
|
| Rate for Payer: Cofinity Commercial |
$89.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.90
|
| Rate for Payer: Healthscope Commercial |
$93.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.08
|
| Rate for Payer: PHP Commercial |
$88.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.53
|
| Rate for Payer: Priority Health SBD |
$65.28
|
| Rate for Payer: UMR Bronson Commercial |
$45.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.72
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$84.63
|
|
|
Service Code
|
NDC 67618-110-30
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$76.17 |
| Rate for Payer: Aetna American Axle |
$55.01
|
| Rate for Payer: Aetna Commercial |
$71.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.01
|
| Rate for Payer: Cash Price |
$67.70
|
| Rate for Payer: Cofinity Commercial |
$59.24
|
| Rate for Payer: Cofinity Commercial |
$72.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.70
|
| Rate for Payer: Healthscope Commercial |
$76.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.94
|
| Rate for Payer: PHP Commercial |
$71.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.24
|
| Rate for Payer: Priority Health SBD |
$53.32
|
| Rate for Payer: UMR Bronson Commercial |
$37.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.47
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$146.16
|
|
|
Service Code
|
NDC 67618-110-60
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.31 |
| Max. Negotiated Rate |
$131.54 |
| Rate for Payer: Aetna American Axle |
$95.00
|
| Rate for Payer: Aetna Commercial |
$124.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.00
|
| Rate for Payer: Cash Price |
$116.93
|
| Rate for Payer: Cofinity Commercial |
$102.31
|
| Rate for Payer: Cofinity Commercial |
$125.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.93
|
| Rate for Payer: Healthscope Commercial |
$131.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.24
|
| Rate for Payer: PHP Commercial |
$124.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.31
|
| Rate for Payer: Priority Health SBD |
$92.08
|
| Rate for Payer: UMR Bronson Commercial |
$64.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.62
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
NDC 761035920
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.28 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna American Axle |
$137.80
|
| Rate for Payer: Aetna Commercial |
$180.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.80
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$148.40
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Healthscope Commercial |
$190.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.20
|
| Rate for Payer: PHP Commercial |
$180.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: Priority Health SBD |
$133.56
|
| Rate for Payer: UMR Bronson Commercial |
$93.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.00
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$157.50
|
|
|
Service Code
|
NDC 69618-065-01
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna American Axle |
$102.38
|
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.38
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$110.25
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$141.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.88
|
| Rate for Payer: PHP Commercial |
$133.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.25
|
| Rate for Payer: Priority Health SBD |
$99.22
|
| Rate for Payer: UMR Bronson Commercial |
$69.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.12
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
NDC 0761-0359-20
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna American Axle |
$96.20
|
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.80
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.60
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| Rate for Payer: UMR Bronson Commercial |
$65.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$145.20
|
|
|
Service Code
|
NDC 60687-622-01
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.89 |
| Max. Negotiated Rate |
$130.68 |
| Rate for Payer: Aetna American Axle |
$94.38
|
| Rate for Payer: Aetna Commercial |
$123.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.38
|
| Rate for Payer: Cash Price |
$116.16
|
| Rate for Payer: Cofinity Commercial |
$101.64
|
| Rate for Payer: Cofinity Commercial |
$124.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.16
|
| Rate for Payer: Healthscope Commercial |
$130.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.42
|
| Rate for Payer: PHP Commercial |
$123.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.64
|
| Rate for Payer: Priority Health SBD |
$91.48
|
| Rate for Payer: UMR Bronson Commercial |
$63.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.90
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$90.72
|
|
|
Service Code
|
NDC 57896-458-06
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.92 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Aetna American Axle |
$58.97
|
| Rate for Payer: Aetna Commercial |
$77.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.97
|
| Rate for Payer: Cash Price |
$72.58
|
| Rate for Payer: Cofinity Commercial |
$63.50
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.58
|
| Rate for Payer: Healthscope Commercial |
$81.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.11
|
| Rate for Payer: PHP Commercial |
$77.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.50
|
| Rate for Payer: Priority Health SBD |
$57.15
|
| Rate for Payer: UMR Bronson Commercial |
$39.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.04
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$1.46
|
|
|
Service Code
|
NDC 60687-622-11
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Aetna American Axle |
$0.95
|
| Rate for Payer: Aetna Commercial |
$1.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.95
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cofinity Commercial |
$1.02
|
| Rate for Payer: Cofinity Commercial |
$1.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.17
|
| Rate for Payer: Healthscope Commercial |
$1.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.24
|
| Rate for Payer: PHP Commercial |
$1.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.02
|
| Rate for Payer: Priority Health SBD |
$0.92
|
| Rate for Payer: UMR Bronson Commercial |
$0.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.10
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$119.70
|
|
|
Service Code
|
NDC 49483-080-01
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.67 |
| Max. Negotiated Rate |
$107.73 |
| Rate for Payer: Aetna American Axle |
$77.80
|
| Rate for Payer: Aetna Commercial |
$101.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.80
|
| Rate for Payer: Cash Price |
$95.76
|
| Rate for Payer: Cofinity Commercial |
$102.94
|
| Rate for Payer: Cofinity Commercial |
$83.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.76
|
| Rate for Payer: Healthscope Commercial |
$107.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.74
|
| Rate for Payer: PHP Commercial |
$101.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.79
|
| Rate for Payer: Priority Health SBD |
$75.41
|
| Rate for Payer: UMR Bronson Commercial |
$52.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.78
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$149.10
|
|
|
Service Code
|
NDC 67618-300-10
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$134.19 |
| Rate for Payer: Aetna American Axle |
$96.92
|
| Rate for Payer: Aetna Commercial |
$126.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.92
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cofinity Commercial |
$104.37
|
| Rate for Payer: Cofinity Commercial |
$128.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.28
|
| Rate for Payer: Healthscope Commercial |
$134.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.74
|
| Rate for Payer: PHP Commercial |
$126.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.37
|
| Rate for Payer: Priority Health SBD |
$93.93
|
| Rate for Payer: UMR Bronson Commercial |
$65.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.82
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
NDC 0904-7252-61
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna American Axle |
$91.00
|
| Rate for Payer: Aetna Commercial |
$119.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$98.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Healthscope Commercial |
$126.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.00
|
| Rate for Payer: PHP Commercial |
$119.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.00
|
| Rate for Payer: Priority Health SBD |
$88.20
|
| Rate for Payer: UMR Bronson Commercial |
$61.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.00
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
NDC 0904-6522-61
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.08 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna American Axle |
$85.80
|
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Cofinity Commercial |
$92.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Healthscope Commercial |
$118.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.20
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
| Rate for Payer: Priority Health SBD |
$83.16
|
| Rate for Payer: UMR Bronson Commercial |
$58.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
NDC 96295-13289
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Aetna American Axle |
$79.30
|
| Rate for Payer: Aetna Commercial |
$103.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.30
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cofinity Commercial |
$104.92
|
| Rate for Payer: Cofinity Commercial |
$85.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.60
|
| Rate for Payer: Healthscope Commercial |
$109.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.70
|
| Rate for Payer: PHP Commercial |
$103.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.40
|
| Rate for Payer: Priority Health SBD |
$76.86
|
| Rate for Payer: UMR Bronson Commercial |
$53.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.50
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$90.30
|
|
|
Service Code
|
NDC 67618-300-50
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.73 |
| Max. Negotiated Rate |
$81.27 |
| Rate for Payer: Aetna American Axle |
$58.70
|
| Rate for Payer: Aetna Commercial |
$76.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.70
|
| Rate for Payer: Cash Price |
$72.24
|
| Rate for Payer: Cofinity Commercial |
$63.21
|
| Rate for Payer: Cofinity Commercial |
$77.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.24
|
| Rate for Payer: Healthscope Commercial |
$81.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.76
|
| Rate for Payer: PHP Commercial |
$76.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.21
|
| Rate for Payer: Priority Health SBD |
$56.89
|
| Rate for Payer: UMR Bronson Commercial |
$39.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.72
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$132.30
|
|
|
Service Code
|
NDC 0904-6725-59
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.21 |
| Max. Negotiated Rate |
$119.07 |
| Rate for Payer: Aetna American Axle |
$86.00
|
| Rate for Payer: Aetna Commercial |
$112.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.00
|
| Rate for Payer: Cash Price |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$113.78
|
| Rate for Payer: Cofinity Commercial |
$92.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.84
|
| Rate for Payer: Healthscope Commercial |
$119.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.46
|
| Rate for Payer: PHP Commercial |
$112.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.61
|
| Rate for Payer: Priority Health SBD |
$83.35
|
| Rate for Payer: UMR Bronson Commercial |
$58.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.22
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$30.70
|
|
|
Service Code
|
NDC 39328-020-08
|
| Hospital Charge Code |
15168
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.51 |
| Max. Negotiated Rate |
$27.63 |
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$21.49
|
| Rate for Payer: Cofinity Commercial |
$26.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.56
|
| Rate for Payer: Healthscope Commercial |
$27.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.10
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.49
|
| Rate for Payer: Priority Health SBD |
$19.34
|
| Rate for Payer: UMR Bronson Commercial |
$13.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.02
|
|
