|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
OP
|
$2,499.50
|
|
|
Service Code
|
NDC 00078065920
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$924.82 |
| Max. Negotiated Rate |
$2,249.55 |
| Rate for Payer: Aetna American Axle |
$1,624.67
|
| Rate for Payer: Aetna Commercial |
$2,124.57
|
| Rate for Payer: Aetna Medicare |
$1,249.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,624.67
|
| Rate for Payer: BCBS Complete |
$999.80
|
| Rate for Payer: Cash Price |
$1,999.60
|
| Rate for Payer: Cofinity Advantage |
$1,749.65
|
| Rate for Payer: Cofinity Commercial |
$2,149.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,999.60
|
| Rate for Payer: Healthscope Commercial |
$2,249.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,749.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,874.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,999.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,124.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,874.62
|
| Rate for Payer: PHP Commercial |
$2,124.57
|
| Rate for Payer: Priority Health SBD |
$1,574.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,624.67
|
| Rate for Payer: UHC Core |
$1,302.24
|
| Rate for Payer: UHC Exchange |
$982.30
|
| Rate for Payer: UMR Bronson Commercial |
$924.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,874.62
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
OP
|
$379.59
|
|
|
Service Code
|
NDC 13668063460
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$341.63 |
| Rate for Payer: Aetna American Axle |
$246.73
|
| Rate for Payer: Aetna Commercial |
$322.65
|
| Rate for Payer: Aetna Medicare |
$189.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.73
|
| Rate for Payer: BCBS Complete |
$151.84
|
| Rate for Payer: Cash Price |
$303.67
|
| Rate for Payer: Cofinity Advantage |
$265.71
|
| Rate for Payer: Cofinity Commercial |
$326.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.67
|
| Rate for Payer: Healthscope Commercial |
$341.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.69
|
| Rate for Payer: PHP Commercial |
$322.65
|
| Rate for Payer: Priority Health SBD |
$239.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.73
|
| Rate for Payer: UHC Core |
$197.77
|
| Rate for Payer: UHC Exchange |
$149.18
|
| Rate for Payer: UMR Bronson Commercial |
$140.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.69
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
OP
|
$1,138.76
|
|
|
Service Code
|
NDC 67877070751
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$421.34 |
| Max. Negotiated Rate |
$1,024.88 |
| Rate for Payer: Aetna American Axle |
$740.19
|
| Rate for Payer: Aetna Commercial |
$967.95
|
| Rate for Payer: Aetna Medicare |
$569.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$740.19
|
| Rate for Payer: BCBS Complete |
$455.50
|
| Rate for Payer: Cash Price |
$911.01
|
| Rate for Payer: Cofinity Advantage |
$797.13
|
| Rate for Payer: Cofinity Commercial |
$979.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$911.01
|
| Rate for Payer: Healthscope Commercial |
$1,024.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$797.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$854.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$911.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$854.07
|
| Rate for Payer: PHP Commercial |
$967.95
|
| Rate for Payer: Priority Health SBD |
$717.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$740.19
|
| Rate for Payer: UHC Core |
$593.29
|
| Rate for Payer: UHC Exchange |
$447.53
|
| Rate for Payer: UMR Bronson Commercial |
$421.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$854.07
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
IP
|
$275.04
|
|
|
Service Code
|
NDC 43598064360
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.02 |
| Max. Negotiated Rate |
$247.54 |
| Rate for Payer: Aetna American Axle |
$178.78
|
| Rate for Payer: Aetna Commercial |
$233.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.78
|
| Rate for Payer: Cash Price |
$220.03
|
| Rate for Payer: Cofinity Advantage |
$192.53
|
| Rate for Payer: Cofinity Commercial |
$236.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.03
|
| Rate for Payer: Healthscope Commercial |
$247.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.28
|
| Rate for Payer: PHP Commercial |
$233.78
|
| Rate for Payer: Priority Health SBD |
$173.28
|
| Rate for Payer: UMR Bronson Commercial |
$121.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.28
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
OP
|
$7,498.50
|
|
|
Service Code
|
NDC 00078065967
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,774.45 |
| Max. Negotiated Rate |
$6,748.65 |
| Rate for Payer: Aetna American Axle |
$4,874.02
|
| Rate for Payer: Aetna Commercial |
$6,373.73
|
| Rate for Payer: Aetna Medicare |
$3,749.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,874.02
|
| Rate for Payer: BCBS Complete |
$2,999.40
|
| Rate for Payer: Cash Price |
$5,998.80
|
| Rate for Payer: Cofinity Advantage |
$5,248.95
|
| Rate for Payer: Cofinity Commercial |
$6,448.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,998.80
|
| Rate for Payer: Healthscope Commercial |
$6,748.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,248.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,623.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,998.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,373.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,623.88
|
| Rate for Payer: PHP Commercial |
$6,373.73
|
| Rate for Payer: Priority Health SBD |
$4,724.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,874.02
|
| Rate for Payer: UHC Core |
$3,906.72
|
| Rate for Payer: UHC Exchange |
$2,946.91
|
| Rate for Payer: UMR Bronson Commercial |
$2,774.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,623.88
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
IP
|
$379.59
|
|
|
Service Code
|
NDC 67877070760
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.02 |
| Max. Negotiated Rate |
$341.63 |
| Rate for Payer: Aetna American Axle |
$246.73
|
| Rate for Payer: Aetna Commercial |
$322.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.73
|
| Rate for Payer: Cash Price |
$303.67
|
| Rate for Payer: Cofinity Advantage |
$265.71
|
| Rate for Payer: Cofinity Commercial |
$326.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.67
|
| Rate for Payer: Healthscope Commercial |
$341.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.69
|
| Rate for Payer: PHP Commercial |
$322.65
|
| Rate for Payer: Priority Health SBD |
$239.14
|
| Rate for Payer: UMR Bronson Commercial |
$167.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.69
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
OP
|
$275.04
|
|
|
Service Code
|
NDC 43598064360
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.76 |
| Max. Negotiated Rate |
$247.54 |
| Rate for Payer: Aetna American Axle |
$178.78
|
| Rate for Payer: Aetna Commercial |
$233.78
|
| Rate for Payer: Aetna Medicare |
$137.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.78
|
| Rate for Payer: BCBS Complete |
$110.02
|
| Rate for Payer: Cash Price |
$220.03
|
| Rate for Payer: Cofinity Advantage |
$192.53
|
| Rate for Payer: Cofinity Commercial |
$236.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.03
|
| Rate for Payer: Healthscope Commercial |
$247.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$220.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.28
|
| Rate for Payer: PHP Commercial |
$233.78
|
| Rate for Payer: Priority Health SBD |
$173.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.78
|
| Rate for Payer: UHC Core |
$143.30
|
| Rate for Payer: UHC Exchange |
$108.09
|
| Rate for Payer: UMR Bronson Commercial |
$101.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.28
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
IP
|
$7,498.50
|
|
|
Service Code
|
NDC 00078065967
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,299.34 |
| Max. Negotiated Rate |
$6,748.65 |
| Rate for Payer: Aetna American Axle |
$4,874.02
|
| Rate for Payer: Aetna Commercial |
$6,373.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,874.02
|
| Rate for Payer: Cash Price |
$5,998.80
|
| Rate for Payer: Cofinity Advantage |
$5,248.95
|
| Rate for Payer: Cofinity Commercial |
$6,448.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,998.80
|
| Rate for Payer: Healthscope Commercial |
$6,748.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,248.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,623.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,373.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,623.88
|
| Rate for Payer: PHP Commercial |
$6,373.73
|
| Rate for Payer: Priority Health SBD |
$4,724.06
|
| Rate for Payer: UMR Bronson Commercial |
$3,299.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,623.88
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
IP
|
$2,499.50
|
|
|
Service Code
|
NDC 00078065920
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,099.78 |
| Max. Negotiated Rate |
$2,249.55 |
| Rate for Payer: Aetna American Axle |
$1,624.67
|
| Rate for Payer: Aetna Commercial |
$2,124.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,624.67
|
| Rate for Payer: Cash Price |
$1,999.60
|
| Rate for Payer: Cofinity Advantage |
$1,749.65
|
| Rate for Payer: Cofinity Commercial |
$2,149.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,999.60
|
| Rate for Payer: Healthscope Commercial |
$2,249.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,749.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,874.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,124.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,874.62
|
| Rate for Payer: PHP Commercial |
$2,124.57
|
| Rate for Payer: Priority Health SBD |
$1,574.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,099.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,874.62
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
OP
|
$379.59
|
|
|
Service Code
|
NDC 67877070760
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$341.63 |
| Rate for Payer: Aetna American Axle |
$246.73
|
| Rate for Payer: Aetna Commercial |
$322.65
|
| Rate for Payer: Aetna Medicare |
$189.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.73
|
| Rate for Payer: BCBS Complete |
$151.84
|
| Rate for Payer: Cash Price |
$303.67
|
| Rate for Payer: Cofinity Advantage |
$265.71
|
| Rate for Payer: Cofinity Commercial |
$326.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.67
|
| Rate for Payer: Healthscope Commercial |
$341.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.69
|
| Rate for Payer: PHP Commercial |
$322.65
|
| Rate for Payer: Priority Health SBD |
$239.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.73
|
| Rate for Payer: UHC Core |
$197.77
|
| Rate for Payer: UHC Exchange |
$149.18
|
| Rate for Payer: UMR Bronson Commercial |
$140.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.69
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
IP
|
$379.59
|
|
|
Service Code
|
NDC 13668063460
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.02 |
| Max. Negotiated Rate |
$341.63 |
| Rate for Payer: Aetna American Axle |
$246.73
|
| Rate for Payer: Aetna Commercial |
$322.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.73
|
| Rate for Payer: Cash Price |
$303.67
|
| Rate for Payer: Cofinity Advantage |
$265.71
|
| Rate for Payer: Cofinity Commercial |
$326.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.67
|
| Rate for Payer: Healthscope Commercial |
$341.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.69
|
| Rate for Payer: PHP Commercial |
$322.65
|
| Rate for Payer: Priority Health SBD |
$239.14
|
| Rate for Payer: UMR Bronson Commercial |
$167.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.69
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
IP
|
$1,138.76
|
|
|
Service Code
|
NDC 67877070751
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$501.05 |
| Max. Negotiated Rate |
$1,024.88 |
| Rate for Payer: Aetna American Axle |
$740.19
|
| Rate for Payer: Aetna Commercial |
$967.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$740.19
|
| Rate for Payer: Cash Price |
$911.01
|
| Rate for Payer: Cofinity Advantage |
$797.13
|
| Rate for Payer: Cofinity Commercial |
$979.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$911.01
|
| Rate for Payer: Healthscope Commercial |
$1,024.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$797.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$854.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$854.07
|
| Rate for Payer: PHP Commercial |
$967.95
|
| Rate for Payer: Priority Health SBD |
$717.42
|
| Rate for Payer: UMR Bronson Commercial |
$501.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$854.07
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET
|
Facility
|
OP
|
$379.59
|
|
|
Service Code
|
NDC 67877094960
|
| Hospital Charge Code |
174640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$341.63 |
| Rate for Payer: Aetna American Axle |
$246.73
|
| Rate for Payer: Aetna Commercial |
$322.65
|
| Rate for Payer: Aetna Medicare |
$189.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.73
|
| Rate for Payer: BCBS Complete |
$151.84
|
| Rate for Payer: Cash Price |
$303.67
|
| Rate for Payer: Cofinity Advantage |
$265.71
|
| Rate for Payer: Cofinity Commercial |
$326.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.67
|
| Rate for Payer: Healthscope Commercial |
$341.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.69
|
| Rate for Payer: PHP Commercial |
$322.65
|
| Rate for Payer: Priority Health SBD |
$239.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.73
|
| Rate for Payer: UHC Core |
$197.77
|
| Rate for Payer: UHC Exchange |
$149.18
|
| Rate for Payer: UMR Bronson Commercial |
$140.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.69
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET
|
Facility
|
IP
|
$294.05
|
|
|
Service Code
|
NDC 43598064460
|
| Hospital Charge Code |
174640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.38 |
| Max. Negotiated Rate |
$264.64 |
| Rate for Payer: Aetna American Axle |
$191.13
|
| Rate for Payer: Aetna Commercial |
$249.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.13
|
| Rate for Payer: Cash Price |
$235.24
|
| Rate for Payer: Cofinity Advantage |
$205.84
|
| Rate for Payer: Cofinity Commercial |
$252.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.24
|
| Rate for Payer: Healthscope Commercial |
$264.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.54
|
| Rate for Payer: PHP Commercial |
$249.94
|
| Rate for Payer: Priority Health SBD |
$185.25
|
| Rate for Payer: UMR Bronson Commercial |
$129.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.54
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET
|
Facility
|
IP
|
$379.59
|
|
|
Service Code
|
NDC 67877094960
|
| Hospital Charge Code |
174640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.02 |
| Max. Negotiated Rate |
$341.63 |
| Rate for Payer: Aetna American Axle |
$246.73
|
| Rate for Payer: Aetna Commercial |
$322.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.73
|
| Rate for Payer: Cash Price |
$303.67
|
| Rate for Payer: Cofinity Advantage |
$265.71
|
| Rate for Payer: Cofinity Commercial |
$326.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.67
|
| Rate for Payer: Healthscope Commercial |
$341.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.69
|
| Rate for Payer: PHP Commercial |
$322.65
|
| Rate for Payer: Priority Health SBD |
$239.14
|
| Rate for Payer: UMR Bronson Commercial |
$167.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.69
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET
|
Facility
|
OP
|
$294.05
|
|
|
Service Code
|
NDC 43598064460
|
| Hospital Charge Code |
174640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$264.64 |
| Rate for Payer: Aetna American Axle |
$191.13
|
| Rate for Payer: Aetna Commercial |
$249.94
|
| Rate for Payer: Aetna Medicare |
$147.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.13
|
| Rate for Payer: BCBS Complete |
$117.62
|
| Rate for Payer: Cash Price |
$235.24
|
| Rate for Payer: Cofinity Advantage |
$205.84
|
| Rate for Payer: Cofinity Commercial |
$252.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.24
|
| Rate for Payer: Healthscope Commercial |
$264.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$235.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.54
|
| Rate for Payer: PHP Commercial |
$249.94
|
| Rate for Payer: Priority Health SBD |
$185.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.13
|
| Rate for Payer: UHC Core |
$153.20
|
| Rate for Payer: UHC Exchange |
$115.56
|
| Rate for Payer: UMR Bronson Commercial |
$108.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.54
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET
|
Facility
|
OP
|
$2,499.50
|
|
|
Service Code
|
NDC 00078077720
|
| Hospital Charge Code |
174640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$924.82 |
| Max. Negotiated Rate |
$2,249.55 |
| Rate for Payer: Aetna American Axle |
$1,624.67
|
| Rate for Payer: Aetna Commercial |
$2,124.57
|
| Rate for Payer: Aetna Medicare |
$1,249.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,624.67
|
| Rate for Payer: BCBS Complete |
$999.80
|
| Rate for Payer: Cash Price |
$1,999.60
|
| Rate for Payer: Cofinity Advantage |
$1,749.65
|
| Rate for Payer: Cofinity Commercial |
$2,149.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,999.60
|
| Rate for Payer: Healthscope Commercial |
$2,249.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,749.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,874.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,999.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,124.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,874.62
|
| Rate for Payer: PHP Commercial |
$2,124.57
|
| Rate for Payer: Priority Health SBD |
$1,574.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,624.67
|
| Rate for Payer: UHC Core |
$1,302.24
|
| Rate for Payer: UHC Exchange |
$982.30
|
| Rate for Payer: UMR Bronson Commercial |
$924.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,874.62
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET
|
Facility
|
IP
|
$2,499.50
|
|
|
Service Code
|
NDC 00078077720
|
| Hospital Charge Code |
174640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,099.78 |
| Max. Negotiated Rate |
$2,249.55 |
| Rate for Payer: Aetna American Axle |
$1,624.67
|
| Rate for Payer: Aetna Commercial |
$2,124.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,624.67
|
| Rate for Payer: Cash Price |
$1,999.60
|
| Rate for Payer: Cofinity Advantage |
$1,749.65
|
| Rate for Payer: Cofinity Commercial |
$2,149.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,999.60
|
| Rate for Payer: Healthscope Commercial |
$2,249.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,749.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,874.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,124.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,874.62
|
| Rate for Payer: PHP Commercial |
$2,124.57
|
| Rate for Payer: Priority Health SBD |
$1,574.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,099.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,874.62
|
|
|
SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET
|
Facility
|
OP
|
$2,499.50
|
|
|
Service Code
|
NDC 00078069620
|
| Hospital Charge Code |
174641
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$924.82 |
| Max. Negotiated Rate |
$2,249.55 |
| Rate for Payer: Aetna American Axle |
$1,624.67
|
| Rate for Payer: Aetna Commercial |
$2,124.57
|
| Rate for Payer: Aetna Medicare |
$1,249.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,624.67
|
| Rate for Payer: BCBS Complete |
$999.80
|
| Rate for Payer: Cash Price |
$1,999.60
|
| Rate for Payer: Cofinity Advantage |
$1,749.65
|
| Rate for Payer: Cofinity Commercial |
$2,149.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,999.60
|
| Rate for Payer: Healthscope Commercial |
$2,249.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,749.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,874.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,999.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,124.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,874.62
|
| Rate for Payer: PHP Commercial |
$2,124.57
|
| Rate for Payer: Priority Health SBD |
$1,574.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,624.67
|
| Rate for Payer: UHC Core |
$1,302.24
|
| Rate for Payer: UHC Exchange |
$982.30
|
| Rate for Payer: UMR Bronson Commercial |
$924.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,874.62
|
|
|
SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET
|
Facility
|
OP
|
$294.05
|
|
|
Service Code
|
NDC 43598064560
|
| Hospital Charge Code |
174641
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$264.64 |
| Rate for Payer: Aetna American Axle |
$191.13
|
| Rate for Payer: Aetna Commercial |
$249.94
|
| Rate for Payer: Aetna Medicare |
$147.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.13
|
| Rate for Payer: BCBS Complete |
$117.62
|
| Rate for Payer: Cash Price |
$235.24
|
| Rate for Payer: Cofinity Advantage |
$205.84
|
| Rate for Payer: Cofinity Commercial |
$252.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.24
|
| Rate for Payer: Healthscope Commercial |
$264.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$235.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.54
|
| Rate for Payer: PHP Commercial |
$249.94
|
| Rate for Payer: Priority Health SBD |
$185.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.13
|
| Rate for Payer: UHC Core |
$153.20
|
| Rate for Payer: UHC Exchange |
$115.56
|
| Rate for Payer: UMR Bronson Commercial |
$108.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.54
|
|
|
SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET
|
Facility
|
IP
|
$2,499.50
|
|
|
Service Code
|
NDC 00078069620
|
| Hospital Charge Code |
174641
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,099.78 |
| Max. Negotiated Rate |
$2,249.55 |
| Rate for Payer: Aetna American Axle |
$1,624.67
|
| Rate for Payer: Aetna Commercial |
$2,124.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,624.67
|
| Rate for Payer: Cash Price |
$1,999.60
|
| Rate for Payer: Cofinity Advantage |
$1,749.65
|
| Rate for Payer: Cofinity Commercial |
$2,149.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,999.60
|
| Rate for Payer: Healthscope Commercial |
$2,249.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,749.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,874.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,124.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,874.62
|
| Rate for Payer: PHP Commercial |
$2,124.57
|
| Rate for Payer: Priority Health SBD |
$1,574.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,099.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,874.62
|
|
|
SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET
|
Facility
|
IP
|
$294.05
|
|
|
Service Code
|
NDC 43598064560
|
| Hospital Charge Code |
174641
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.38 |
| Max. Negotiated Rate |
$264.64 |
| Rate for Payer: Aetna American Axle |
$191.13
|
| Rate for Payer: Aetna Commercial |
$249.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.13
|
| Rate for Payer: Cash Price |
$235.24
|
| Rate for Payer: Cofinity Advantage |
$205.84
|
| Rate for Payer: Cofinity Commercial |
$252.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.24
|
| Rate for Payer: Healthscope Commercial |
$264.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.54
|
| Rate for Payer: PHP Commercial |
$249.94
|
| Rate for Payer: Priority Health SBD |
$185.25
|
| Rate for Payer: UMR Bronson Commercial |
$129.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.54
|
|
|
SALIVARY GLAND PROCEDURES
|
Facility
|
IP
|
$26,723.55
|
|
|
Service Code
|
MSDRG 139
|
| Min. Negotiated Rate |
$10,380.42 |
| Max. Negotiated Rate |
$26,723.55 |
| Rate for Payer: Aetna Medicare |
$11,363.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,658.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,658.45
|
| Rate for Payer: BCBS MAPPO |
$10,926.76
|
| Rate for Payer: BCBS Trust/PPO |
$26,723.55
|
| Rate for Payer: BCN Commercial |
$26,723.55
|
| Rate for Payer: BCN Medicare Advantage |
$10,926.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,926.76
|
| Rate for Payer: Mclaren Medicare |
$10,926.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,473.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,565.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,019.44
|
| Rate for Payer: Nomi Health Commercial |
$15,590.94
|
| Rate for Payer: PACE Medicare |
$10,380.42
|
| Rate for Payer: PACE SWMI |
$10,926.76
|
| Rate for Payer: PHP Medicare Advantage |
$10,926.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,922.13
|
| Rate for Payer: Priority Health Medicare |
$10,926.76
|
| Rate for Payer: Priority Health Tiered Network |
$15,937.70
|
| Rate for Payer: Railroad Medicare Medicare |
$10,926.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,700.18
|
| Rate for Payer: UHC Core |
$16,481.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,926.76
|
| Rate for Payer: UHC Exchange |
$13,460.18
|
| Rate for Payer: VA VA |
$10,926.76
|
|
|
SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
NDC 48582000155
|
| Hospital Charge Code |
118454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.99 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna American Axle |
$16.23
|
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.23
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Advantage |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.73
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health SBD |
$15.73
|
| Rate for Payer: UMR Bronson Commercial |
$10.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
NDC 48582000155
|
| Hospital Charge Code |
118454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna American Axle |
$16.23
|
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.23
|
| Rate for Payer: BCBS Complete |
$9.99
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Advantage |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.73
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health SBD |
$15.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.23
|
| Rate for Payer: UHC Core |
$13.01
|
| Rate for Payer: UHC Exchange |
$9.81
|
| Rate for Payer: UMR Bronson Commercial |
$9.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
