|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$409.92
|
|
|
Service Code
|
NDC 00904714361
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.67 |
| Max. Negotiated Rate |
$368.93 |
| Rate for Payer: Aetna American Axle |
$266.45
|
| Rate for Payer: Aetna Commercial |
$348.43
|
| Rate for Payer: Aetna Medicare |
$204.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.45
|
| Rate for Payer: BCBS Complete |
$163.97
|
| Rate for Payer: Cash Price |
$327.94
|
| Rate for Payer: Cofinity Commercial |
$286.94
|
| Rate for Payer: Cofinity Commercial |
$352.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$286.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.94
|
| Rate for Payer: Healthscope Commercial |
$368.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$286.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.43
|
| Rate for Payer: PHP Commercial |
$348.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.45
|
| Rate for Payer: Priority Health SBD |
$258.25
|
| Rate for Payer: UMR Bronson Commercial |
$151.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.44
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
NDC 00245001201
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.28 |
| Max. Negotiated Rate |
$399.60 |
| Rate for Payer: Aetna American Axle |
$288.60
|
| Rate for Payer: Aetna Commercial |
$377.40
|
| Rate for Payer: Aetna Medicare |
$222.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.60
|
| Rate for Payer: BCBS Complete |
$177.60
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cofinity Commercial |
$310.80
|
| Rate for Payer: Cofinity Commercial |
$381.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.20
|
| Rate for Payer: Healthscope Commercial |
$399.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.40
|
| Rate for Payer: PHP Commercial |
$377.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.60
|
| Rate for Payer: Priority Health SBD |
$279.72
|
| Rate for Payer: UMR Bronson Commercial |
$164.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.00
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
NDC 00245001201
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.36 |
| Max. Negotiated Rate |
$399.60 |
| Rate for Payer: Aetna American Axle |
$288.60
|
| Rate for Payer: Aetna Commercial |
$377.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.60
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cofinity Commercial |
$310.80
|
| Rate for Payer: Cofinity Commercial |
$381.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.20
|
| Rate for Payer: Healthscope Commercial |
$399.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.40
|
| Rate for Payer: PHP Commercial |
$377.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.60
|
| Rate for Payer: Priority Health SBD |
$279.72
|
| Rate for Payer: UMR Bronson Commercial |
$195.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.00
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$122.20
|
|
|
Service Code
|
NDC 60505008000
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.21 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna American Axle |
$79.43
|
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna Medicare |
$61.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Cofinity Commercial |
$85.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health SBD |
$76.99
|
| Rate for Payer: UMR Bronson Commercial |
$45.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
NDC 60505008000
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.77 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna American Axle |
$79.43
|
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Cofinity Commercial |
$85.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health SBD |
$76.99
|
| Rate for Payer: UMR Bronson Commercial |
$53.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 00245001289
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna American Axle |
$2.89
|
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Aetna Medicare |
$2.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.89
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Cofinity Commercial |
$3.11
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.55
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.77
|
| Rate for Payer: PHP Commercial |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.89
|
| Rate for Payer: Priority Health SBD |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.33
|
|
|
SPESOLIMAB-SBZO 60 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$72,548.53
|
|
|
Service Code
|
HCPCS J1747
|
| Hospital Charge Code |
201556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$65,293.68 |
| Rate for Payer: Aetna American Axle |
$47,156.54
|
| Rate for Payer: Aetna Commercial |
$61,666.25
|
| Rate for Payer: Aetna Medicare |
$63.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47,156.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.79
|
| Rate for Payer: BCBS Complete |
$34.57
|
| Rate for Payer: BCBS MAPPO |
$61.43
|
| Rate for Payer: BCBS Trust/PPO |
$165.61
|
| Rate for Payer: BCN Commercial |
$165.61
|
| Rate for Payer: BCN Medicare Advantage |
$61.43
|
| Rate for Payer: Cash Price |
$58,038.82
|
| Rate for Payer: Cash Price |
$58,038.82
|
| Rate for Payer: Cofinity Commercial |
$62,391.74
|
| Rate for Payer: Cofinity Commercial |
$50,783.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$50,783.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58,038.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.43
|
| Rate for Payer: Healthscope Commercial |
$65,293.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50,783.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54,411.40
|
| Rate for Payer: Mclaren Medicaid |
$32.93
|
| Rate for Payer: Mclaren Medicare |
$61.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.50
|
| Rate for Payer: Meridian Medicaid |
$34.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61,666.25
|
| Rate for Payer: Nomi Health Commercial |
$184.29
|
| Rate for Payer: PACE Medicare |
$58.36
|
| Rate for Payer: PACE SWMI |
$61.43
|
| Rate for Payer: PHP Commercial |
$61,666.25
|
| Rate for Payer: PHP Medicare Advantage |
$61.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47,156.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.79
|
| Rate for Payer: Priority Health Medicare |
$61.43
|
| Rate for Payer: Priority Health Narrow Network |
$141.43
|
| Rate for Payer: Priority Health SBD |
$45,705.57
|
| Rate for Payer: Railroad Medicare Medicare |
$61.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.43
|
| Rate for Payer: UHC Exchange |
$117.40
|
| Rate for Payer: UHC Medicare Advantage |
$61.43
|
| Rate for Payer: UHCCP Medicaid |
$32.93
|
| Rate for Payer: UMR Bronson Commercial |
$26,842.96
|
| Rate for Payer: VA VA |
$61.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54,411.40
|
|
|
SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE OR PROLAPSE; ADULT
|
Facility
|
OP
|
$8,445.02
|
|
|
Service Code
|
CPT 46750
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$723.44 |
| Max. Negotiated Rate |
$8,445.02 |
| Rate for Payer: Aetna Medicare |
$2,794.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,358.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,358.68
|
| Rate for Payer: BCBS Complete |
$1,512.21
|
| Rate for Payer: BCBS MAPPO |
$2,686.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,241.26
|
| Rate for Payer: BCN Commercial |
$2,241.26
|
| Rate for Payer: BCN Medicare Advantage |
$2,686.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,686.94
|
| Rate for Payer: Mclaren Medicaid |
$1,440.20
|
| Rate for Payer: Mclaren Medicare |
$2,686.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,821.29
|
| Rate for Payer: Meridian Medicaid |
$1,512.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,089.98
|
| Rate for Payer: Nomi Health Commercial |
$5,642.57
|
| Rate for Payer: PACE Medicare |
$2,552.59
|
| Rate for Payer: PACE SWMI |
$2,686.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,686.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,440.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,445.02
|
| Rate for Payer: Priority Health Medicare |
$2,686.94
|
| Rate for Payer: Priority Health Narrow Network |
$6,756.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2,686.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$795.78
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,686.94
|
| Rate for Payer: UHC Exchange |
$723.44
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.94
|
| Rate for Payer: UHCCP Medicaid |
$1,440.20
|
| Rate for Payer: VA VA |
$2,686.94
|
|
|
SPHINCTEROTOMY, ANAL, DIVISION OF SPHINCTER (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$8,445.02
|
|
|
Service Code
|
CPT 46080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$8,445.02 |
| Rate for Payer: Aetna Medicare |
$2,794.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,358.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,358.68
|
| Rate for Payer: BCBS Complete |
$1,512.21
|
| Rate for Payer: BCBS MAPPO |
$2,686.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,238.33
|
| Rate for Payer: BCN Commercial |
$2,238.33
|
| Rate for Payer: BCN Medicare Advantage |
$2,686.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,686.94
|
| Rate for Payer: Mclaren Medicaid |
$1,440.20
|
| Rate for Payer: Mclaren Medicare |
$2,686.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,821.29
|
| Rate for Payer: Meridian Medicaid |
$1,512.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,089.98
|
| Rate for Payer: Nomi Health Commercial |
$5,642.57
|
| Rate for Payer: PACE Medicare |
$2,552.59
|
| Rate for Payer: PACE SWMI |
$2,686.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,686.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,440.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,445.02
|
| Rate for Payer: Priority Health Medicare |
$2,686.94
|
| Rate for Payer: Priority Health Narrow Network |
$6,756.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2,686.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.56
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,686.94
|
| Rate for Payer: UHC Exchange |
$153.24
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.94
|
| Rate for Payer: UHCCP Medicaid |
$1,440.20
|
| Rate for Payer: VA VA |
$2,686.94
|
|
|
SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC;
|
Facility
|
OP
|
$2,132.58
|
|
|
Service Code
|
CPT 62270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$62.55 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$951.34
|
| Rate for Payer: BCN Commercial |
$951.34
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.80
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$62.55
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC;
|
Facility
|
OP
|
$2,132.58
|
|
|
Service Code
|
CPT 62270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.55 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$951.34
|
| Rate for Payer: BCN Commercial |
$951.34
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.80
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$62.55
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF CEREBROSPINAL FLUID (BY NEEDLE OR CATHETER);
|
Facility
|
OP
|
$2,132.58
|
|
|
Service Code
|
CPT 62272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$90.58 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$426.89
|
| Rate for Payer: BCN Commercial |
$426.89
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.64
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$90.58
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
SPIRONOLACTONE 100 MG TABLET
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
NDC 60687048701
|
| Hospital Charge Code |
11425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.12 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna American Axle |
$179.40
|
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$138.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: BCBS Complete |
$110.40
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health SBD |
$173.88
|
| Rate for Payer: UMR Bronson Commercial |
$102.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
SPIRONOLACTONE 100 MG TABLET
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
NDC 60687048701
|
| Hospital Charge Code |
11425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.44 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna American Axle |
$179.40
|
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health SBD |
$173.88
|
| Rate for Payer: UMR Bronson Commercial |
$121.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
SPIRONOLACTONE 100 MG TABLET
|
Facility
|
OP
|
$2.76
|
|
|
Service Code
|
NDC 60687048711
|
| Hospital Charge Code |
11425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna American Axle |
$1.79
|
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.79
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cofinity Commercial |
$1.93
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.21
|
| Rate for Payer: Healthscope Commercial |
$2.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.35
|
| Rate for Payer: PHP Commercial |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: Priority Health SBD |
$1.74
|
| Rate for Payer: UMR Bronson Commercial |
$1.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.07
|
|
|
SPIRONOLACTONE 100 MG TABLET
|
Facility
|
IP
|
$2.76
|
|
|
Service Code
|
NDC 60687048711
|
| Hospital Charge Code |
11425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna American Axle |
$1.79
|
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.79
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cofinity Commercial |
$1.93
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.21
|
| Rate for Payer: Healthscope Commercial |
$2.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.35
|
| Rate for Payer: PHP Commercial |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: Priority Health SBD |
$1.74
|
| Rate for Payer: UMR Bronson Commercial |
$1.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.07
|
|
|
SPIRONOLACTONE 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,373.11
|
|
|
Service Code
|
NDC 46287002004
|
| Hospital Charge Code |
184259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$508.05 |
| Max. Negotiated Rate |
$1,235.80 |
| Rate for Payer: Aetna American Axle |
$892.52
|
| Rate for Payer: Aetna Commercial |
$1,167.14
|
| Rate for Payer: Aetna Medicare |
$686.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$892.52
|
| Rate for Payer: BCBS Complete |
$549.24
|
| Rate for Payer: Cash Price |
$1,098.49
|
| Rate for Payer: Cofinity Commercial |
$1,180.87
|
| Rate for Payer: Cofinity Commercial |
$961.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$961.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,098.49
|
| Rate for Payer: Healthscope Commercial |
$1,235.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$961.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,029.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,167.14
|
| Rate for Payer: PHP Commercial |
$1,167.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.52
|
| Rate for Payer: Priority Health SBD |
$865.06
|
| Rate for Payer: UMR Bronson Commercial |
$508.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,029.83
|
|
|
SPIRONOLACTONE 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,373.11
|
|
|
Service Code
|
NDC 46287002004
|
| Hospital Charge Code |
184259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$604.17 |
| Max. Negotiated Rate |
$1,235.80 |
| Rate for Payer: Aetna American Axle |
$892.52
|
| Rate for Payer: Aetna Commercial |
$1,167.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$892.52
|
| Rate for Payer: Cash Price |
$1,098.49
|
| Rate for Payer: Cofinity Commercial |
$1,180.87
|
| Rate for Payer: Cofinity Commercial |
$961.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$961.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,098.49
|
| Rate for Payer: Healthscope Commercial |
$1,235.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$961.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,029.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,167.14
|
| Rate for Payer: PHP Commercial |
$1,167.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.52
|
| Rate for Payer: Priority Health SBD |
$865.06
|
| Rate for Payer: UMR Bronson Commercial |
$604.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,029.83
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$274.95
|
|
|
Service Code
|
NDC 53746051101
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.73 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna American Axle |
$178.72
|
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna Medicare |
$137.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.72
|
| Rate for Payer: BCBS Complete |
$109.98
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$192.46
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health SBD |
$173.22
|
| Rate for Payer: UMR Bronson Commercial |
$101.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$126.90
|
|
|
Service Code
|
NDC 59746021601
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.84 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna American Axle |
$82.48
|
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Cofinity Commercial |
$88.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.48
|
| Rate for Payer: Priority Health SBD |
$79.95
|
| Rate for Payer: UMR Bronson Commercial |
$55.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.18
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$3.88
|
|
|
Service Code
|
NDC 51079010301
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna American Axle |
$2.52
|
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health SBD |
$2.44
|
| Rate for Payer: UMR Bronson Commercial |
$1.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.91
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 51079010301
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna American Axle |
$2.52
|
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna Medicare |
$1.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health SBD |
$2.44
|
| Rate for Payer: UMR Bronson Commercial |
$1.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.91
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 53746051101
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.98 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna American Axle |
$178.72
|
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.72
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$192.46
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health SBD |
$173.22
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$387.75
|
|
|
Service Code
|
NDC 51079010320
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.47 |
| Max. Negotiated Rate |
$348.98 |
| Rate for Payer: Aetna American Axle |
$252.04
|
| Rate for Payer: Aetna Commercial |
$329.59
|
| Rate for Payer: Aetna Medicare |
$193.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.04
|
| Rate for Payer: BCBS Complete |
$155.10
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$271.42
|
| Rate for Payer: Cofinity Commercial |
$333.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$348.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.59
|
| Rate for Payer: PHP Commercial |
$329.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.04
|
| Rate for Payer: Priority Health SBD |
$244.28
|
| Rate for Payer: UMR Bronson Commercial |
$143.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.81
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$126.90
|
|
|
Service Code
|
NDC 59746021601
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna American Axle |
$82.48
|
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna Medicare |
$63.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| Rate for Payer: BCBS Complete |
$50.76
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Cofinity Commercial |
$88.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.48
|
| Rate for Payer: Priority Health SBD |
$79.95
|
| Rate for Payer: UMR Bronson Commercial |
$46.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.18
|
|
