|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM
|
Facility
IP
|
$137.55
|
|
|
Service Code
|
NDC 0168-0055-15
|
| Hospital Charge Code |
1027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.89 |
| Max. Negotiated Rate |
$123.80 |
| Rate for Payer: Aetna Commercial |
$116.92
|
| Rate for Payer: BCBS Trust/PPO |
$106.30
|
| Rate for Payer: BCN Commercial |
$106.30
|
| Rate for Payer: Cash Price |
$110.04
|
| Rate for Payer: Cofinity Commercial |
$118.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.04
|
| Rate for Payer: Healthscope Commercial |
$123.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.92
|
| Rate for Payer: PHP Commercial |
$116.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.04
|
| Rate for Payer: UHC Core |
$114.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.16
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT
|
Facility
IP
|
$76.13
|
|
|
Service Code
|
NDC 72578-093-01
|
| Hospital Charge Code |
1029
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.43 |
| Max. Negotiated Rate |
$68.52 |
| Rate for Payer: Aetna Commercial |
$64.71
|
| Rate for Payer: BCBS Trust/PPO |
$58.83
|
| Rate for Payer: BCN Commercial |
$58.83
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Cofinity Commercial |
$65.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.90
|
| Rate for Payer: Healthscope Commercial |
$68.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.71
|
| Rate for Payer: PHP Commercial |
$64.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.99
|
| Rate for Payer: UHC Core |
$63.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.10
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT
|
Facility
IP
|
$160.13
|
|
|
Service Code
|
NDC 0168-0056-15
|
| Hospital Charge Code |
1029
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.66 |
| Max. Negotiated Rate |
$144.12 |
| Rate for Payer: Aetna Commercial |
$136.11
|
| Rate for Payer: BCBS Trust/PPO |
$123.75
|
| Rate for Payer: BCN Commercial |
$123.75
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cofinity Commercial |
$137.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.10
|
| Rate for Payer: Healthscope Commercial |
$144.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.11
|
| Rate for Payer: PHP Commercial |
$136.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.91
|
| Rate for Payer: UHC Core |
$133.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.10
|
|
|
BIOPSY, MUSCLE; SUPERFICIAL
|
Facility
OP
|
$1,116.73
|
|
|
Service Code
|
CPT 20200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,063.55 |
| Max. Negotiated Rate |
$1,116.73 |
| Rate for Payer: BCBS Complete |
$1,116.73
|
| Rate for Payer: Mclaren Medicaid |
$1,063.55
|
| Rate for Payer: Meridian Medicaid |
$1,116.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,063.55
|
|
|
BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); 1 LESION
|
Facility
OP
|
$553.73
|
|
|
Service Code
|
CPT 56605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$527.36 |
| Max. Negotiated Rate |
$553.73 |
| Rate for Payer: BCBS Complete |
$553.73
|
| Rate for Payer: Mclaren Medicaid |
$527.36
|
| Rate for Payer: Meridian Medicaid |
$553.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$527.36
|
|
|
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S)
|
Facility
OP
|
$2,625.49
|
|
|
Service Code
|
CPT 38510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,500.47 |
| Max. Negotiated Rate |
$2,625.49 |
| Rate for Payer: BCBS Complete |
$2,625.49
|
| Rate for Payer: Mclaren Medicaid |
$2,500.47
|
| Rate for Payer: Meridian Medicaid |
$2,625.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,500.47
|
|
|
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, SUPERFICIAL
|
Facility
OP
|
$2,625.49
|
|
|
Service Code
|
CPT 38500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,500.47 |
| Max. Negotiated Rate |
$2,625.49 |
| Rate for Payer: BCBS Complete |
$2,625.49
|
| Rate for Payer: Mclaren Medicaid |
$2,500.47
|
| Rate for Payer: Meridian Medicaid |
$2,625.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,500.47
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$124.06
|
|
|
Service Code
|
NDC 8142102105
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.66 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: BCBS Trust/PPO |
$95.87
|
| Rate for Payer: BCN Commercial |
$95.87
|
| Rate for Payer: Cash Price |
$99.25
|
| Rate for Payer: Cofinity Commercial |
$106.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.25
|
| Rate for Payer: Healthscope Commercial |
$111.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.45
|
| Rate for Payer: PHP Commercial |
$105.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.17
|
| Rate for Payer: UHC Core |
$103.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.04
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$52.46
|
|
|
Service Code
|
NDC 0904-7142-12
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$47.21 |
| Rate for Payer: Aetna Commercial |
$44.59
|
| Rate for Payer: BCBS Trust/PPO |
$40.54
|
| Rate for Payer: BCN Commercial |
$40.54
|
| Rate for Payer: Cash Price |
$41.97
|
| Rate for Payer: Cofinity Commercial |
$45.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.97
|
| Rate for Payer: Healthscope Commercial |
$47.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.59
|
| Rate for Payer: PHP Commercial |
$44.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.16
|
| Rate for Payer: UHC Core |
$43.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.34
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$25.43
|
|
|
Service Code
|
NDC 0574-7050-12
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$22.89 |
| Rate for Payer: Aetna Commercial |
$21.62
|
| Rate for Payer: BCBS Trust/PPO |
$19.65
|
| Rate for Payer: BCN Commercial |
$19.65
|
| Rate for Payer: Cash Price |
$20.34
|
| Rate for Payer: Cofinity Commercial |
$21.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.34
|
| Rate for Payer: Healthscope Commercial |
$22.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.62
|
| Rate for Payer: PHP Commercial |
$21.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.38
|
| Rate for Payer: UHC Core |
$21.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.07
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
IP
|
$5.88
|
|
|
Service Code
|
NDC 0904-6407-61
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna Commercial |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$4.54
|
| Rate for Payer: BCN Commercial |
$4.54
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cofinity Commercial |
$5.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.70
|
| Rate for Payer: Healthscope Commercial |
$5.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.00
|
| Rate for Payer: PHP Commercial |
$5.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.17
|
| Rate for Payer: UHC Core |
$4.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.41
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
IP
|
$82.80
|
|
|
Service Code
|
NDC 29300-126-13
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: BCBS Trust/PPO |
$63.99
|
| Rate for Payer: BCN Commercial |
$63.99
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.24
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.38
|
| Rate for Payer: PHP Commercial |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.86
|
| Rate for Payer: UHC Core |
$69.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.10
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
IP
|
$77.04
|
|
|
Service Code
|
NDC 52817-270-30
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.99 |
| Max. Negotiated Rate |
$69.34 |
| Rate for Payer: Aetna Commercial |
$65.48
|
| Rate for Payer: BCBS Trust/PPO |
$59.54
|
| Rate for Payer: BCN Commercial |
$59.54
|
| Rate for Payer: Cash Price |
$61.63
|
| Rate for Payer: Cofinity Commercial |
$66.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.63
|
| Rate for Payer: Healthscope Commercial |
$69.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.48
|
| Rate for Payer: PHP Commercial |
$65.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.80
|
| Rate for Payer: UHC Core |
$64.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.78
|
|
|
BREAST REDUCTION
|
Facility
OP
|
$4,491.68
|
|
|
Service Code
|
CPT 19318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,277.79 |
| Max. Negotiated Rate |
$4,491.68 |
| Rate for Payer: BCBS Complete |
$4,491.68
|
| Rate for Payer: Mclaren Medicaid |
$4,277.79
|
| Rate for Payer: Meridian Medicaid |
$4,491.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,277.79
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
IP
|
$632.59
|
|
|
Service Code
|
NDC 0023-9321-05
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$385.82 |
| Max. Negotiated Rate |
$569.33 |
| Rate for Payer: Aetna Commercial |
$537.70
|
| Rate for Payer: BCBS Trust/PPO |
$488.87
|
| Rate for Payer: BCN Commercial |
$488.87
|
| Rate for Payer: Cash Price |
$506.07
|
| Rate for Payer: Cofinity Commercial |
$544.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.07
|
| Rate for Payer: Healthscope Commercial |
$569.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$474.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$537.70
|
| Rate for Payer: PHP Commercial |
$537.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$550.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$385.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$556.68
|
| Rate for Payer: UHC Core |
$528.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$474.44
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
IP
|
$19.93
|
|
|
Service Code
|
NDC 70069-233-01
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$15.40
|
| Rate for Payer: BCN Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$15.94
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.94
|
| Rate for Payer: Healthscope Commercial |
$17.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.94
|
| Rate for Payer: PHP Commercial |
$16.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.54
|
| Rate for Payer: UHC Core |
$16.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.95
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
IP
|
$22.26
|
|
|
Service Code
|
NDC 61314-143-15
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$20.03 |
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: BCBS Trust/PPO |
$17.20
|
| Rate for Payer: BCN Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Healthscope Commercial |
$20.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.92
|
| Rate for Payer: PHP Commercial |
$18.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.59
|
| Rate for Payer: UHC Core |
$18.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.70
|
|
|
BRIMONIDINE-TIMOLOL 0.2 %-0.5 % EYE DROPS
|
Facility
IP
|
$664.13
|
|
|
Service Code
|
NDC 0023-9211-05
|
| Hospital Charge Code |
87834
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$405.05 |
| Max. Negotiated Rate |
$597.72 |
| Rate for Payer: Aetna Commercial |
$564.51
|
| Rate for Payer: BCBS Trust/PPO |
$513.24
|
| Rate for Payer: BCN Commercial |
$513.24
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Cofinity Commercial |
$571.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.30
|
| Rate for Payer: Healthscope Commercial |
$597.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$498.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$564.51
|
| Rate for Payer: PHP Commercial |
$564.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$577.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$584.43
|
| Rate for Payer: UHC Core |
$554.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$498.10
|
|
|
BRINZOLAMIDE 1 %-BRIMONIDINE 0.2 % EYE DROPS,SUSPENSION
|
Facility
IP
|
$636.25
|
|
|
Service Code
|
NDC 0065-4147-27
|
| Hospital Charge Code |
166167
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$388.05 |
| Max. Negotiated Rate |
$572.62 |
| Rate for Payer: Aetna Commercial |
$540.81
|
| Rate for Payer: BCBS Trust/PPO |
$491.69
|
| Rate for Payer: BCN Commercial |
$491.69
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cofinity Commercial |
$547.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.00
|
| Rate for Payer: Healthscope Commercial |
$572.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$477.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$540.81
|
| Rate for Payer: PHP Commercial |
$540.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$553.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$388.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$559.90
|
| Rate for Payer: UHC Core |
$531.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.19
|
|
|
BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION
|
Facility
IP
|
$1,114.61
|
|
|
Service Code
|
NDC 0065-0275-10
|
| Hospital Charge Code |
22953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$679.80 |
| Max. Negotiated Rate |
$1,003.15 |
| Rate for Payer: Aetna Commercial |
$947.42
|
| Rate for Payer: BCBS Trust/PPO |
$861.37
|
| Rate for Payer: BCN Commercial |
$861.37
|
| Rate for Payer: Cash Price |
$891.69
|
| Rate for Payer: Cofinity Commercial |
$958.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.69
|
| Rate for Payer: Healthscope Commercial |
$1,003.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$835.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$947.42
|
| Rate for Payer: PHP Commercial |
$947.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$969.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$679.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.86
|
| Rate for Payer: UHC Core |
$930.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$835.96
|
|
|
BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION
|
Facility
IP
|
$965.27
|
|
|
Service Code
|
NDC 0591-2127-79
|
| Hospital Charge Code |
22953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$588.72 |
| Max. Negotiated Rate |
$868.74 |
| Rate for Payer: Aetna Commercial |
$820.48
|
| Rate for Payer: BCBS Trust/PPO |
$745.96
|
| Rate for Payer: BCN Commercial |
$745.96
|
| Rate for Payer: Cash Price |
$772.22
|
| Rate for Payer: Cofinity Commercial |
$830.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.22
|
| Rate for Payer: Healthscope Commercial |
$868.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$820.48
|
| Rate for Payer: PHP Commercial |
$820.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$839.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$588.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$849.44
|
| Rate for Payer: UHC Core |
$806.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.95
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
IP
|
$9.49
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$8.54 |
| Rate for Payer: Aetna Commercial |
$8.07
|
| Rate for Payer: Aetna Commercial |
$23.26
|
| Rate for Payer: Aetna Commercial |
$7.30
|
| Rate for Payer: BCBS Trust/PPO |
$7.33
|
| Rate for Payer: BCBS Trust/PPO |
$21.14
|
| Rate for Payer: BCBS Trust/PPO |
$6.64
|
| Rate for Payer: BCN Commercial |
$21.14
|
| Rate for Payer: BCN Commercial |
$6.64
|
| Rate for Payer: BCN Commercial |
$7.33
|
| Rate for Payer: Cash Price |
$7.59
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Cash Price |
$6.87
|
| Rate for Payer: Cofinity Commercial |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$23.53
|
| Rate for Payer: Cofinity Commercial |
$7.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.87
|
| Rate for Payer: Healthscope Commercial |
$24.62
|
| Rate for Payer: Healthscope Commercial |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$7.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.07
|
| Rate for Payer: PHP Commercial |
$7.30
|
| Rate for Payer: PHP Commercial |
$23.26
|
| Rate for Payer: PHP Commercial |
$8.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.56
|
| Rate for Payer: UHC Core |
$7.17
|
| Rate for Payer: UHC Core |
$22.85
|
| Rate for Payer: UHC Core |
$7.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.44
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
IP
|
$7.89
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna Commercial |
$10.28
|
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: BCBS Trust/PPO |
$24.71
|
| Rate for Payer: BCBS Trust/PPO |
$9.35
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCN Commercial |
$24.71
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$9.35
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Healthscope Commercial |
$10.89
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.28
|
| Rate for Payer: PHP Commercial |
$10.28
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.65
|
| Rate for Payer: UHC Core |
$26.69
|
| Rate for Payer: UHC Core |
$10.10
|
| Rate for Payer: UHC Core |
$6.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
|
BUDESONIDE 1 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
IP
|
$31.11
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
88223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna Commercial |
$59.98
|
| Rate for Payer: BCBS Trust/PPO |
$54.53
|
| Rate for Payer: BCBS Trust/PPO |
$24.04
|
| Rate for Payer: BCN Commercial |
$54.53
|
| Rate for Payer: BCN Commercial |
$24.04
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cash Price |
$56.45
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Commercial |
$60.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$63.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.44
|
| Rate for Payer: PHP Commercial |
$59.98
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.38
|
| Rate for Payer: UHC Core |
$25.98
|
| Rate for Payer: UHC Core |
$58.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.92
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
IP
|
$185.64
|
|
|
Service Code
|
NDC 0186-0370-28
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.22 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: BCBS Trust/PPO |
$143.46
|
| Rate for Payer: BCN Commercial |
$143.46
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.79
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.36
|
| Rate for Payer: UHC Core |
$155.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
