|
SERTRALINE 25 MG TABLET
|
Facility
|
OP
|
$271.70
|
|
|
Service Code
|
NDC 60687023101
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$244.53 |
| Rate for Payer: Aetna American Axle |
$176.60
|
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: Aetna Medicare |
$135.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.60
|
| Rate for Payer: BCBS Complete |
$108.68
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Advantage |
$190.19
|
| Rate for Payer: Cofinity Commercial |
$233.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$244.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.78
|
| Rate for Payer: PHP Commercial |
$230.94
|
| Rate for Payer: Priority Health SBD |
$171.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.60
|
| Rate for Payer: UHC Core |
$141.56
|
| Rate for Payer: UHC Exchange |
$106.78
|
| Rate for Payer: UMR Bronson Commercial |
$100.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.78
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$1,537.80
|
|
|
Service Code
|
NDC 00049490030
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$568.99 |
| Max. Negotiated Rate |
$1,384.02 |
| Rate for Payer: Aetna American Axle |
$999.57
|
| Rate for Payer: Aetna Commercial |
$1,307.13
|
| Rate for Payer: Aetna Medicare |
$768.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.57
|
| Rate for Payer: BCBS Complete |
$615.12
|
| Rate for Payer: Cash Price |
$1,230.24
|
| Rate for Payer: Cofinity Advantage |
$1,076.46
|
| Rate for Payer: Cofinity Commercial |
$1,322.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,230.24
|
| Rate for Payer: Healthscope Commercial |
$1,384.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,076.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,153.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,230.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,307.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,153.35
|
| Rate for Payer: PHP Commercial |
$1,307.13
|
| Rate for Payer: Priority Health SBD |
$968.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$999.57
|
| Rate for Payer: UHC Core |
$801.19
|
| Rate for Payer: UHC Exchange |
$604.36
|
| Rate for Payer: UMR Bronson Commercial |
$568.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,153.35
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$225.60
|
|
|
Service Code
|
NDC 59762490003
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.26 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna American Axle |
$146.64
|
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.64
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Advantage |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.20
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: Priority Health SBD |
$142.13
|
| Rate for Payer: UMR Bronson Commercial |
$99.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.20
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$225.60
|
|
|
Service Code
|
NDC 59762490003
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.47 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna American Axle |
$146.64
|
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: Aetna Medicare |
$112.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.64
|
| Rate for Payer: BCBS Complete |
$90.24
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Advantage |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.20
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: Priority Health SBD |
$142.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.64
|
| Rate for Payer: UHC Core |
$117.54
|
| Rate for Payer: UHC Exchange |
$88.66
|
| Rate for Payer: UMR Bronson Commercial |
$83.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.20
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$306.85
|
|
|
Service Code
|
NDC 60687024201
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.53 |
| Max. Negotiated Rate |
$276.17 |
| Rate for Payer: Aetna American Axle |
$199.45
|
| Rate for Payer: Aetna Commercial |
$260.82
|
| Rate for Payer: Aetna Medicare |
$153.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.45
|
| Rate for Payer: BCBS Complete |
$122.74
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Advantage |
$214.79
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$276.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$245.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.14
|
| Rate for Payer: PHP Commercial |
$260.82
|
| Rate for Payer: Priority Health SBD |
$193.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.45
|
| Rate for Payer: UHC Core |
$159.87
|
| Rate for Payer: UHC Exchange |
$120.59
|
| Rate for Payer: UMR Bronson Commercial |
$113.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.14
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$71.91
|
|
|
Service Code
|
NDC 68180035209
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Aetna American Axle |
$46.74
|
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: Aetna Medicare |
$35.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.74
|
| Rate for Payer: BCBS Complete |
$28.76
|
| Rate for Payer: Cash Price |
$57.53
|
| Rate for Payer: Cofinity Advantage |
$50.34
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.53
|
| Rate for Payer: Healthscope Commercial |
$64.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.93
|
| Rate for Payer: PHP Commercial |
$61.12
|
| Rate for Payer: Priority Health SBD |
$45.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.74
|
| Rate for Payer: UHC Core |
$37.47
|
| Rate for Payer: UHC Exchange |
$28.26
|
| Rate for Payer: UMR Bronson Commercial |
$26.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.93
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$210.90
|
|
|
Service Code
|
NDC 59762490004
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$189.81 |
| Rate for Payer: Aetna American Axle |
$137.09
|
| Rate for Payer: Aetna Commercial |
$179.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.09
|
| Rate for Payer: Cash Price |
$168.72
|
| Rate for Payer: Cofinity Advantage |
$147.63
|
| Rate for Payer: Cofinity Commercial |
$181.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.72
|
| Rate for Payer: Healthscope Commercial |
$189.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.18
|
| Rate for Payer: PHP Commercial |
$179.26
|
| Rate for Payer: Priority Health SBD |
$132.87
|
| Rate for Payer: UMR Bronson Commercial |
$92.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.18
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$1,537.80
|
|
|
Service Code
|
NDC 00049490030
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$676.63 |
| Max. Negotiated Rate |
$1,384.02 |
| Rate for Payer: Aetna American Axle |
$999.57
|
| Rate for Payer: Aetna Commercial |
$1,307.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.57
|
| Rate for Payer: Cash Price |
$1,230.24
|
| Rate for Payer: Cofinity Advantage |
$1,076.46
|
| Rate for Payer: Cofinity Commercial |
$1,322.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,230.24
|
| Rate for Payer: Healthscope Commercial |
$1,384.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,076.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,153.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,307.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,153.35
|
| Rate for Payer: PHP Commercial |
$1,307.13
|
| Rate for Payer: Priority Health SBD |
$968.81
|
| Rate for Payer: UMR Bronson Commercial |
$676.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,153.35
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$3.07
|
|
|
Service Code
|
NDC 60687024211
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna American Axle |
$2.00
|
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.00
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Advantage |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.30
|
| Rate for Payer: PHP Commercial |
$2.61
|
| Rate for Payer: Priority Health SBD |
$1.93
|
| Rate for Payer: UMR Bronson Commercial |
$1.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.30
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$210.90
|
|
|
Service Code
|
NDC 59762490004
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.03 |
| Max. Negotiated Rate |
$189.81 |
| Rate for Payer: Aetna American Axle |
$137.09
|
| Rate for Payer: Aetna Commercial |
$179.26
|
| Rate for Payer: Aetna Medicare |
$105.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.09
|
| Rate for Payer: BCBS Complete |
$84.36
|
| Rate for Payer: Cash Price |
$168.72
|
| Rate for Payer: Cofinity Advantage |
$147.63
|
| Rate for Payer: Cofinity Commercial |
$181.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.72
|
| Rate for Payer: Healthscope Commercial |
$189.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.18
|
| Rate for Payer: PHP Commercial |
$179.26
|
| Rate for Payer: Priority Health SBD |
$132.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.09
|
| Rate for Payer: UHC Core |
$109.88
|
| Rate for Payer: UHC Exchange |
$82.88
|
| Rate for Payer: UMR Bronson Commercial |
$78.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.18
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$306.85
|
|
|
Service Code
|
NDC 60687024201
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.01 |
| Max. Negotiated Rate |
$276.17 |
| Rate for Payer: Aetna American Axle |
$199.45
|
| Rate for Payer: Aetna Commercial |
$260.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.45
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Advantage |
$214.79
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$276.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.14
|
| Rate for Payer: PHP Commercial |
$260.82
|
| Rate for Payer: Priority Health SBD |
$193.32
|
| Rate for Payer: UMR Bronson Commercial |
$135.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.14
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$279.30
|
|
|
Service Code
|
NDC 00904692561
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.34 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna American Axle |
$181.54
|
| Rate for Payer: Aetna Commercial |
$237.41
|
| Rate for Payer: Aetna Medicare |
$139.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: BCBS Complete |
$111.72
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Advantage |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.47
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: Priority Health SBD |
$175.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.54
|
| Rate for Payer: UHC Core |
$145.52
|
| Rate for Payer: UHC Exchange |
$109.76
|
| Rate for Payer: UMR Bronson Commercial |
$103.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.47
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$3.07
|
|
|
Service Code
|
NDC 60687024211
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna American Axle |
$2.00
|
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: Aetna Medicare |
$1.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.00
|
| Rate for Payer: BCBS Complete |
$1.23
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Advantage |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.30
|
| Rate for Payer: PHP Commercial |
$2.61
|
| Rate for Payer: Priority Health SBD |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.00
|
| Rate for Payer: UHC Core |
$1.60
|
| Rate for Payer: UHC Exchange |
$1.21
|
| Rate for Payer: UMR Bronson Commercial |
$1.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.30
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$71.91
|
|
|
Service Code
|
NDC 68180035209
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Aetna American Axle |
$46.74
|
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.74
|
| Rate for Payer: Cash Price |
$57.53
|
| Rate for Payer: Cofinity Advantage |
$50.34
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.53
|
| Rate for Payer: Healthscope Commercial |
$64.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.93
|
| Rate for Payer: PHP Commercial |
$61.12
|
| Rate for Payer: Priority Health SBD |
$45.30
|
| Rate for Payer: UMR Bronson Commercial |
$31.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.93
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
NDC 00904692561
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.89 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna American Axle |
$181.54
|
| Rate for Payer: Aetna Commercial |
$237.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Advantage |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.47
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: Priority Health SBD |
$175.96
|
| Rate for Payer: UMR Bronson Commercial |
$122.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.47
|
|
|
SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$32.54
|
|
|
Service Code
|
NDC 43598047801
|
| Hospital Charge Code |
99694
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$29.29 |
| Rate for Payer: Aetna American Axle |
$21.15
|
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.15
|
| Rate for Payer: Cash Price |
$26.03
|
| Rate for Payer: Cofinity Advantage |
$22.78
|
| Rate for Payer: Cofinity Commercial |
$27.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.03
|
| Rate for Payer: Healthscope Commercial |
$29.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.41
|
| Rate for Payer: PHP Commercial |
$27.66
|
| Rate for Payer: Priority Health SBD |
$20.50
|
| Rate for Payer: UMR Bronson Commercial |
$14.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.41
|
|
|
SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$2,928.41
|
|
|
Service Code
|
NDC 43598047890
|
| Hospital Charge Code |
99694
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,083.51 |
| Max. Negotiated Rate |
$2,635.57 |
| Rate for Payer: Aetna American Axle |
$1,903.47
|
| Rate for Payer: Aetna Commercial |
$2,489.15
|
| Rate for Payer: Aetna Medicare |
$1,464.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,903.47
|
| Rate for Payer: BCBS Complete |
$1,171.36
|
| Rate for Payer: Cash Price |
$2,342.73
|
| Rate for Payer: Cofinity Advantage |
$2,049.89
|
| Rate for Payer: Cofinity Commercial |
$2,518.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,342.73
|
| Rate for Payer: Healthscope Commercial |
$2,635.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,049.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,196.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,342.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,489.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,196.31
|
| Rate for Payer: PHP Commercial |
$2,489.15
|
| Rate for Payer: Priority Health SBD |
$1,844.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,903.47
|
| Rate for Payer: UHC Core |
$1,525.70
|
| Rate for Payer: UHC Exchange |
$1,150.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,083.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,196.31
|
|
|
SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$2,928.41
|
|
|
Service Code
|
NDC 43598047890
|
| Hospital Charge Code |
99694
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,288.50 |
| Max. Negotiated Rate |
$2,635.57 |
| Rate for Payer: Aetna American Axle |
$1,903.47
|
| Rate for Payer: Aetna Commercial |
$2,489.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,903.47
|
| Rate for Payer: Cash Price |
$2,342.73
|
| Rate for Payer: Cofinity Advantage |
$2,049.89
|
| Rate for Payer: Cofinity Commercial |
$2,518.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,342.73
|
| Rate for Payer: Healthscope Commercial |
$2,635.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,049.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,196.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,489.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,196.31
|
| Rate for Payer: PHP Commercial |
$2,489.15
|
| Rate for Payer: Priority Health SBD |
$1,844.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,288.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,196.31
|
|
|
SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$32.54
|
|
|
Service Code
|
NDC 43598047801
|
| Hospital Charge Code |
99694
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$29.29 |
| Rate for Payer: Aetna American Axle |
$21.15
|
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Aetna Medicare |
$16.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.15
|
| Rate for Payer: BCBS Complete |
$13.02
|
| Rate for Payer: Cash Price |
$26.03
|
| Rate for Payer: Cofinity Advantage |
$22.78
|
| Rate for Payer: Cofinity Commercial |
$27.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.03
|
| Rate for Payer: Healthscope Commercial |
$29.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.41
|
| Rate for Payer: PHP Commercial |
$27.66
|
| Rate for Payer: Priority Health SBD |
$20.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.15
|
| Rate for Payer: UHC Core |
$16.95
|
| Rate for Payer: UHC Exchange |
$12.79
|
| Rate for Payer: UMR Bronson Commercial |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.41
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$61.42
|
|
|
Service Code
|
NDC 58468013102
|
| Hospital Charge Code |
99695
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$55.28 |
| Rate for Payer: Aetna American Axle |
$39.92
|
| Rate for Payer: Aetna Commercial |
$52.21
|
| Rate for Payer: Aetna Medicare |
$30.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.92
|
| Rate for Payer: BCBS Complete |
$24.57
|
| Rate for Payer: Cash Price |
$49.14
|
| Rate for Payer: Cofinity Advantage |
$42.99
|
| Rate for Payer: Cofinity Commercial |
$52.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.14
|
| Rate for Payer: Healthscope Commercial |
$55.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.06
|
| Rate for Payer: PHP Commercial |
$52.21
|
| Rate for Payer: Priority Health SBD |
$38.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.92
|
| Rate for Payer: UHC Core |
$32.00
|
| Rate for Payer: UHC Exchange |
$24.14
|
| Rate for Payer: UMR Bronson Commercial |
$22.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.06
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$759.03
|
|
|
Service Code
|
NDC 65862093190
|
| Hospital Charge Code |
99695
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$333.97 |
| Max. Negotiated Rate |
$683.13 |
| Rate for Payer: Aetna American Axle |
$493.37
|
| Rate for Payer: Aetna Commercial |
$645.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.37
|
| Rate for Payer: Cash Price |
$607.22
|
| Rate for Payer: Cofinity Advantage |
$531.32
|
| Rate for Payer: Cofinity Commercial |
$652.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.22
|
| Rate for Payer: Healthscope Commercial |
$683.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$569.27
|
| Rate for Payer: PHP Commercial |
$645.18
|
| Rate for Payer: Priority Health SBD |
$478.19
|
| Rate for Payer: UMR Bronson Commercial |
$333.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.27
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$8.44
|
|
|
Service Code
|
NDC 65862093108
|
| Hospital Charge Code |
99695
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Aetna American Axle |
$5.49
|
| Rate for Payer: Aetna Commercial |
$7.17
|
| Rate for Payer: Aetna Medicare |
$4.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.49
|
| Rate for Payer: BCBS Complete |
$3.38
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cofinity Advantage |
$5.91
|
| Rate for Payer: Cofinity Commercial |
$7.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.75
|
| Rate for Payer: Healthscope Commercial |
$7.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.33
|
| Rate for Payer: PHP Commercial |
$7.17
|
| Rate for Payer: Priority Health SBD |
$5.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.49
|
| Rate for Payer: UHC Core |
$4.40
|
| Rate for Payer: UHC Exchange |
$3.32
|
| Rate for Payer: UMR Bronson Commercial |
$3.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.33
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$8.44
|
|
|
Service Code
|
NDC 65862093108
|
| Hospital Charge Code |
99695
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Aetna American Axle |
$5.49
|
| Rate for Payer: Aetna Commercial |
$7.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.49
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cofinity Advantage |
$5.91
|
| Rate for Payer: Cofinity Commercial |
$7.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.75
|
| Rate for Payer: Healthscope Commercial |
$7.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.33
|
| Rate for Payer: PHP Commercial |
$7.17
|
| Rate for Payer: Priority Health SBD |
$5.32
|
| Rate for Payer: UMR Bronson Commercial |
$3.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.33
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$759.03
|
|
|
Service Code
|
NDC 65862093190
|
| Hospital Charge Code |
99695
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.84 |
| Max. Negotiated Rate |
$683.13 |
| Rate for Payer: Aetna American Axle |
$493.37
|
| Rate for Payer: Aetna Commercial |
$645.18
|
| Rate for Payer: Aetna Medicare |
$379.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.37
|
| Rate for Payer: BCBS Complete |
$303.61
|
| Rate for Payer: Cash Price |
$607.22
|
| Rate for Payer: Cofinity Advantage |
$531.32
|
| Rate for Payer: Cofinity Commercial |
$652.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.22
|
| Rate for Payer: Healthscope Commercial |
$683.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$607.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$569.27
|
| Rate for Payer: PHP Commercial |
$645.18
|
| Rate for Payer: Priority Health SBD |
$478.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$493.37
|
| Rate for Payer: UHC Core |
$395.45
|
| Rate for Payer: UHC Exchange |
$298.30
|
| Rate for Payer: UMR Bronson Commercial |
$280.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.27
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$61.42
|
|
|
Service Code
|
NDC 58468013101
|
| Hospital Charge Code |
99695
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.02 |
| Max. Negotiated Rate |
$55.28 |
| Rate for Payer: Aetna American Axle |
$39.92
|
| Rate for Payer: Aetna Commercial |
$52.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.92
|
| Rate for Payer: Cash Price |
$49.14
|
| Rate for Payer: Cofinity Advantage |
$42.99
|
| Rate for Payer: Cofinity Commercial |
$52.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.14
|
| Rate for Payer: Healthscope Commercial |
$55.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.06
|
| Rate for Payer: PHP Commercial |
$52.21
|
| Rate for Payer: Priority Health SBD |
$38.69
|
| Rate for Payer: UMR Bronson Commercial |
$27.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.06
|
|
