|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$90.30
|
|
|
Service Code
|
NDC 67618030050
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.41 |
| Max. Negotiated Rate |
$81.27 |
| Rate for Payer: Aetna American Axle |
$58.70
|
| Rate for Payer: Aetna Commercial |
$76.76
|
| Rate for Payer: Aetna Medicare |
$45.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.70
|
| Rate for Payer: BCBS Complete |
$36.12
|
| Rate for Payer: Cash Price |
$72.24
|
| Rate for Payer: Cofinity Commercial |
$63.21
|
| Rate for Payer: Cofinity Commercial |
$77.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.21
|
| 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 Commercial |
$76.76
|
| Rate for Payer: PHP Commercial |
$76.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.70
|
| Rate for Payer: Priority Health SBD |
$56.89
|
| Rate for Payer: UMR Bronson Commercial |
$33.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.72
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
NDC 96295013289
|
| 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: Cofinity Medicare Advantage |
$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 Commercial |
$103.70
|
| Rate for Payer: PHP Commercial |
$103.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| 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
|
OP
|
$149.10
|
|
|
Service Code
|
NDC 67618030010
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.17 |
| Max. Negotiated Rate |
$134.19 |
| Rate for Payer: Aetna American Axle |
$96.92
|
| Rate for Payer: Aetna Commercial |
$126.74
|
| Rate for Payer: Aetna Medicare |
$74.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.92
|
| Rate for Payer: BCBS Complete |
$59.64
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cofinity Commercial |
$104.37
|
| Rate for Payer: Cofinity Commercial |
$128.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.37
|
| 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 Commercial |
$126.74
|
| Rate for Payer: PHP Commercial |
$126.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.92
|
| Rate for Payer: Priority Health SBD |
$93.93
|
| Rate for Payer: UMR Bronson Commercial |
$55.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.82
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$94.50
|
|
|
Service Code
|
NDC 00904725260
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$85.05 |
| Rate for Payer: Aetna American Axle |
$61.42
|
| Rate for Payer: Aetna Commercial |
$80.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.42
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$66.15
|
| Rate for Payer: Cofinity Commercial |
$81.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.60
|
| Rate for Payer: Healthscope Commercial |
$85.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.32
|
| Rate for Payer: PHP Commercial |
$80.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.42
|
| Rate for Payer: Priority Health SBD |
$59.54
|
| Rate for Payer: UMR Bronson Commercial |
$41.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.88
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$149.10
|
|
|
Service Code
|
NDC 67618030010
|
| 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: Cofinity Medicare Advantage |
$104.37
|
| 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 Commercial |
$126.74
|
| Rate for Payer: PHP Commercial |
$126.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.92
|
| 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
|
$132.00
|
|
|
Service Code
|
NDC 00904652261
|
| 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: Cofinity Medicare Advantage |
$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 Commercial |
$112.20
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| 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
|
OP
|
$113.40
|
|
|
Service Code
|
NDC 49483008001
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$102.06 |
| Rate for Payer: Aetna American Axle |
$73.71
|
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: Aetna Medicare |
$56.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.71
|
| Rate for Payer: BCBS Complete |
$45.36
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cofinity Commercial |
$79.38
|
| Rate for Payer: Cofinity Commercial |
$97.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.72
|
| Rate for Payer: Healthscope Commercial |
$102.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.39
|
| Rate for Payer: PHP Commercial |
$96.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.71
|
| Rate for Payer: Priority Health SBD |
$71.44
|
| Rate for Payer: UMR Bronson Commercial |
$41.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.05
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
NDC 00904725261
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna American Axle |
$91.00
|
| Rate for Payer: Aetna Commercial |
$119.00
|
| Rate for Payer: Aetna Medicare |
$70.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.00
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$98.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$119.00
|
| Rate for Payer: PHP Commercial |
$119.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health SBD |
$88.20
|
| Rate for Payer: UMR Bronson Commercial |
$51.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.00
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 09900000019
|
| Hospital Charge Code |
15168
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna American Axle |
$2.60
|
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.20
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: Priority Health SBD |
$2.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.00
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$28.07
|
|
|
Service Code
|
NDC 57237030124
|
| Hospital Charge Code |
15168
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$25.26 |
| Rate for Payer: Aetna American Axle |
$18.25
|
| Rate for Payer: Aetna Commercial |
$23.86
|
| Rate for Payer: Aetna Medicare |
$14.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.25
|
| Rate for Payer: BCBS Complete |
$11.23
|
| Rate for Payer: Cash Price |
$22.46
|
| Rate for Payer: Cofinity Commercial |
$19.65
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.46
|
| Rate for Payer: Healthscope Commercial |
$25.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.86
|
| Rate for Payer: PHP Commercial |
$23.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.25
|
| Rate for Payer: Priority Health SBD |
$17.68
|
| Rate for Payer: UMR Bronson Commercial |
$10.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.05
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 09900000019
|
| Hospital Charge Code |
15168
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna American Axle |
$2.60
|
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.60
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.20
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: Priority Health SBD |
$2.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.00
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 09900000565
|
| Hospital Charge Code |
15168
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna American Axle |
$2.60
|
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.20
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: Priority Health SBD |
$2.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.00
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 09900000565
|
| Hospital Charge Code |
15168
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna American Axle |
$2.60
|
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.60
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.20
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: Priority Health SBD |
$2.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.00
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$28.07
|
|
|
Service Code
|
NDC 57237030124
|
| Hospital Charge Code |
15168
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$25.26 |
| Rate for Payer: Aetna American Axle |
$18.25
|
| Rate for Payer: Aetna Commercial |
$23.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.25
|
| Rate for Payer: Cash Price |
$22.46
|
| Rate for Payer: Cofinity Commercial |
$19.65
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.46
|
| Rate for Payer: Healthscope Commercial |
$25.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.86
|
| Rate for Payer: PHP Commercial |
$23.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.25
|
| Rate for Payer: Priority Health SBD |
$17.68
|
| Rate for Payer: UMR Bronson Commercial |
$12.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.05
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$31.57
|
|
|
Service Code
|
NDC 00536126659
|
| Hospital Charge Code |
15168
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$28.41 |
| Rate for Payer: Aetna American Axle |
$20.52
|
| Rate for Payer: Aetna Commercial |
$26.83
|
| Rate for Payer: Aetna Medicare |
$15.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.52
|
| Rate for Payer: BCBS Complete |
$12.63
|
| Rate for Payer: Cash Price |
$25.26
|
| Rate for Payer: Cofinity Commercial |
$22.10
|
| Rate for Payer: Cofinity Commercial |
$27.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.26
|
| Rate for Payer: Healthscope Commercial |
$28.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.83
|
| Rate for Payer: PHP Commercial |
$26.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.52
|
| Rate for Payer: Priority Health SBD |
$19.89
|
| Rate for Payer: UMR Bronson Commercial |
$11.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.68
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$30.70
|
|
|
Service Code
|
NDC 39328002008
|
| Hospital Charge Code |
15168
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$27.63 |
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Medicare |
$15.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: BCBS Complete |
$12.28
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$21.49
|
| Rate for Payer: Cofinity Commercial |
$26.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.49
|
| 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 Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| Rate for Payer: Priority Health SBD |
$19.34
|
| Rate for Payer: UMR Bronson Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.02
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$31.57
|
|
|
Service Code
|
NDC 00536126659
|
| Hospital Charge Code |
15168
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.89 |
| Max. Negotiated Rate |
$28.41 |
| Rate for Payer: Aetna American Axle |
$20.52
|
| Rate for Payer: Aetna Commercial |
$26.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.52
|
| Rate for Payer: Cash Price |
$25.26
|
| Rate for Payer: Cofinity Commercial |
$22.10
|
| Rate for Payer: Cofinity Commercial |
$27.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.26
|
| Rate for Payer: Healthscope Commercial |
$28.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.83
|
| Rate for Payer: PHP Commercial |
$26.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.52
|
| Rate for Payer: Priority Health SBD |
$19.89
|
| Rate for Payer: UMR Bronson Commercial |
$13.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.68
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$30.70
|
|
|
Service Code
|
NDC 39328002008
|
| 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: Cofinity Medicare Advantage |
$21.49
|
| 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 Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| 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
|
|
|
SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING, CONTOURING OR REPLACEMENT WITH GRAFT
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 30520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$638.78 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,300.30
|
| Rate for Payer: BCN Commercial |
$3,300.30
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$702.66
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$638.78
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
SERTRALINE 20 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$217.16
|
|
|
Service Code
|
NDC 64980040906
|
| Hospital Charge Code |
28011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$195.44 |
| Rate for Payer: Aetna American Axle |
$141.15
|
| Rate for Payer: Aetna Commercial |
$184.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.15
|
| Rate for Payer: Cash Price |
$173.73
|
| Rate for Payer: Cofinity Commercial |
$152.01
|
| Rate for Payer: Cofinity Commercial |
$186.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.73
|
| Rate for Payer: Healthscope Commercial |
$195.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.59
|
| Rate for Payer: PHP Commercial |
$184.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.15
|
| Rate for Payer: Priority Health SBD |
$136.81
|
| Rate for Payer: UMR Bronson Commercial |
$95.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.87
|
|
|
SERTRALINE 20 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$249.70
|
|
|
Service Code
|
NDC 59762006701
|
| Hospital Charge Code |
28011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.39 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Cofinity Medicare Advantage |
$174.79
|
| Rate for Payer: Aetna American Axle |
$162.30
|
| Rate for Payer: Aetna Commercial |
$212.24
|
| Rate for Payer: Aetna Medicare |
$124.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.30
|
| Rate for Payer: BCBS Complete |
$99.88
|
| Rate for Payer: Cash Price |
$199.76
|
| Rate for Payer: Cofinity Commercial |
$174.79
|
| Rate for Payer: Cofinity Commercial |
$214.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.76
|
| Rate for Payer: Healthscope Commercial |
$224.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.24
|
| Rate for Payer: PHP Commercial |
$212.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.30
|
| Rate for Payer: Priority Health SBD |
$157.31
|
| Rate for Payer: UMR Bronson Commercial |
$92.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.28
|
|
|
SERTRALINE 20 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$217.16
|
|
|
Service Code
|
NDC 64980040906
|
| Hospital Charge Code |
28011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.35 |
| Max. Negotiated Rate |
$195.44 |
| Rate for Payer: Aetna American Axle |
$141.15
|
| Rate for Payer: Aetna Commercial |
$184.59
|
| Rate for Payer: Aetna Medicare |
$108.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.15
|
| Rate for Payer: BCBS Complete |
$86.86
|
| Rate for Payer: Cash Price |
$173.73
|
| Rate for Payer: Cofinity Commercial |
$152.01
|
| Rate for Payer: Cofinity Commercial |
$186.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.73
|
| Rate for Payer: Healthscope Commercial |
$195.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.59
|
| Rate for Payer: PHP Commercial |
$184.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.15
|
| Rate for Payer: Priority Health SBD |
$136.81
|
| Rate for Payer: UMR Bronson Commercial |
$80.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.87
|
|
|
SERTRALINE 20 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$249.70
|
|
|
Service Code
|
NDC 59762006701
|
| Hospital Charge Code |
28011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.87 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna American Axle |
$162.30
|
| Rate for Payer: Aetna Commercial |
$212.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.30
|
| Rate for Payer: Cash Price |
$199.76
|
| Rate for Payer: Cofinity Commercial |
$174.79
|
| Rate for Payer: Cofinity Commercial |
$214.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.76
|
| Rate for Payer: Healthscope Commercial |
$224.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.24
|
| Rate for Payer: PHP Commercial |
$212.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.30
|
| Rate for Payer: Priority Health SBD |
$157.31
|
| Rate for Payer: UMR Bronson Commercial |
$109.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.28
|
|
|
SERTRALINE 25 MG TABLET
|
Facility
|
IP
|
$156.51
|
|
|
Service Code
|
NDC 69097083305
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.86 |
| Max. Negotiated Rate |
$140.86 |
| Rate for Payer: Aetna American Axle |
$101.73
|
| Rate for Payer: Aetna Commercial |
$133.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.73
|
| Rate for Payer: Cash Price |
$125.21
|
| Rate for Payer: Cofinity Commercial |
$109.56
|
| Rate for Payer: Cofinity Commercial |
$134.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.21
|
| Rate for Payer: Healthscope Commercial |
$140.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.03
|
| Rate for Payer: PHP Commercial |
$133.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.73
|
| Rate for Payer: Priority Health SBD |
$98.60
|
| Rate for Payer: UMR Bronson Commercial |
$68.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.38
|
|
|
SERTRALINE 25 MG TABLET
|
Facility
|
OP
|
$156.51
|
|
|
Service Code
|
NDC 69097083305
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.91 |
| Max. Negotiated Rate |
$140.86 |
| Rate for Payer: Cofinity Commercial |
$134.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.56
|
| Rate for Payer: Aetna American Axle |
$101.73
|
| Rate for Payer: Aetna Commercial |
$133.03
|
| Rate for Payer: Aetna Medicare |
$78.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.73
|
| Rate for Payer: BCBS Complete |
$62.60
|
| Rate for Payer: Cash Price |
$125.21
|
| Rate for Payer: Cofinity Commercial |
$109.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.21
|
| Rate for Payer: Healthscope Commercial |
$140.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.03
|
| Rate for Payer: PHP Commercial |
$133.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.73
|
| Rate for Payer: Priority Health SBD |
$98.60
|
| Rate for Payer: UMR Bronson Commercial |
$57.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.38
|
|
