|
CHG X-RAY TRUNK SPINE SCOLIOSIS
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 72069
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna Medicare |
$30.00
|
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.00
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
NDC 51079037501
|
| Hospital Charge Code |
1622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna Medicare |
$1.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.36
|
| Rate for Payer: BCBS Complete |
$1.74
|
| Rate for Payer: BCBS MAPPO |
$1.09
|
| Rate for Payer: BCBS Trust/PPO |
$3.58
|
| Rate for Payer: BCN Commercial |
$3.39
|
| Rate for Payer: BCN Medicare Advantage |
$1.09
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: Cofinity Commercial |
$3.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.09
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: Nomi Health Commercial |
$3.58
|
| Rate for Payer: PACE Senior Care Partners |
$1.04
|
| Rate for Payer: PACE SWMI |
$1.09
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: PHP Medicare Advantage |
$1.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.83
|
| Rate for Payer: Priority Health HMO/PPO |
$3.79
|
| Rate for Payer: Priority Health Medicare |
$1.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.92
|
| Rate for Payer: Railroad Medicare Medicare |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.84
|
| Rate for Payer: UHC Core |
$3.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UHC Medicare Advantage |
$1.09
|
| Rate for Payer: VA VA |
$1.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.27
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE
|
Facility
|
IP
|
$4.36
|
|
|
Service Code
|
NDC 51079037501
|
| Hospital Charge Code |
1622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: BCBS Trust/PPO |
$3.56
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: Cofinity Commercial |
$3.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.49
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: Nomi Health Commercial |
$3.58
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.83
|
| Rate for Payer: Priority Health HMO/PPO |
$3.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.84
|
| Rate for Payer: UHC Core |
$3.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.27
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE
|
Facility
|
OP
|
$286.70
|
|
|
Service Code
|
NDC 00555003302
|
| Hospital Charge Code |
1622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.09 |
| Max. Negotiated Rate |
$258.03 |
| Rate for Payer: Aetna Commercial |
$243.69
|
| Rate for Payer: Aetna Medicare |
$74.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.59
|
| Rate for Payer: BCBS Complete |
$114.68
|
| Rate for Payer: BCBS MAPPO |
$71.67
|
| Rate for Payer: BCBS Trust/PPO |
$235.70
|
| Rate for Payer: BCN Commercial |
$222.91
|
| Rate for Payer: BCN Medicare Advantage |
$71.67
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cofinity Commercial |
$246.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.67
|
| Rate for Payer: Healthscope Commercial |
$258.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.69
|
| Rate for Payer: Nomi Health Commercial |
$235.09
|
| Rate for Payer: PACE Senior Care Partners |
$68.09
|
| Rate for Payer: PACE SWMI |
$71.67
|
| Rate for Payer: PHP Commercial |
$243.69
|
| Rate for Payer: PHP Medicare Advantage |
$71.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.35
|
| Rate for Payer: Priority Health HMO/PPO |
$249.43
|
| Rate for Payer: Priority Health Medicare |
$72.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.09
|
| Rate for Payer: Railroad Medicare Medicare |
$71.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.30
|
| Rate for Payer: UHC Core |
$239.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.67
|
| Rate for Payer: UHC Exchange |
$71.67
|
| Rate for Payer: UHC Medicare Advantage |
$71.67
|
| Rate for Payer: VA VA |
$71.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.03
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE
|
Facility
|
IP
|
$286.70
|
|
|
Service Code
|
NDC 00555003302
|
| Hospital Charge Code |
1622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.35 |
| Max. Negotiated Rate |
$258.03 |
| Rate for Payer: Aetna Commercial |
$243.69
|
| Rate for Payer: BCBS Trust/PPO |
$234.03
|
| Rate for Payer: BCN Commercial |
$221.56
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cofinity Commercial |
$246.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.36
|
| Rate for Payer: Healthscope Commercial |
$258.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.69
|
| Rate for Payer: Nomi Health Commercial |
$235.09
|
| Rate for Payer: PHP Commercial |
$243.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.35
|
| Rate for Payer: Priority Health HMO/PPO |
$249.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.30
|
| Rate for Payer: UHC Core |
$239.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.03
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE
|
Facility
|
OP
|
$1,527.50
|
|
|
Service Code
|
NDC 00555015904
|
| Hospital Charge Code |
1623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$362.78 |
| Max. Negotiated Rate |
$1,374.75 |
| Rate for Payer: Aetna Commercial |
$1,298.38
|
| Rate for Payer: Aetna Medicare |
$397.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$477.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$477.34
|
| Rate for Payer: BCBS Complete |
$611.00
|
| Rate for Payer: BCBS MAPPO |
$381.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,255.76
|
| Rate for Payer: BCN Commercial |
$1,187.63
|
| Rate for Payer: BCN Medicare Advantage |
$381.88
|
| Rate for Payer: Cash Price |
$1,222.00
|
| Rate for Payer: Cofinity Commercial |
$1,313.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,222.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$381.88
|
| Rate for Payer: Healthscope Commercial |
$1,374.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,145.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$400.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$439.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,298.38
|
| Rate for Payer: Nomi Health Commercial |
$1,252.55
|
| Rate for Payer: PACE Senior Care Partners |
$362.78
|
| Rate for Payer: PACE SWMI |
$381.88
|
| Rate for Payer: PHP Commercial |
$1,298.38
|
| Rate for Payer: PHP Medicare Advantage |
$381.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$992.88
|
| Rate for Payer: Priority Health HMO/PPO |
$1,328.92
|
| Rate for Payer: Priority Health Medicare |
$385.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,023.42
|
| Rate for Payer: Railroad Medicare Medicare |
$381.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,344.20
|
| Rate for Payer: UHC Core |
$1,275.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$381.88
|
| Rate for Payer: UHC Exchange |
$381.88
|
| Rate for Payer: UHC Medicare Advantage |
$381.88
|
| Rate for Payer: VA VA |
$381.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,145.62
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE
|
Facility
|
OP
|
$354.85
|
|
|
Service Code
|
NDC 00555015902
|
| Hospital Charge Code |
1623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.28 |
| Max. Negotiated Rate |
$319.37 |
| Rate for Payer: Aetna Commercial |
$301.62
|
| Rate for Payer: Aetna Medicare |
$92.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.89
|
| Rate for Payer: BCBS Complete |
$141.94
|
| Rate for Payer: BCBS MAPPO |
$88.71
|
| Rate for Payer: BCBS Trust/PPO |
$291.72
|
| Rate for Payer: BCN Commercial |
$275.90
|
| Rate for Payer: BCN Medicare Advantage |
$88.71
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Commercial |
$305.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.71
|
| Rate for Payer: Healthscope Commercial |
$319.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.62
|
| Rate for Payer: Nomi Health Commercial |
$290.98
|
| Rate for Payer: PACE Senior Care Partners |
$84.28
|
| Rate for Payer: PACE SWMI |
$88.71
|
| Rate for Payer: PHP Commercial |
$301.62
|
| Rate for Payer: PHP Medicare Advantage |
$88.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.65
|
| Rate for Payer: Priority Health HMO/PPO |
$308.72
|
| Rate for Payer: Priority Health Medicare |
$89.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.75
|
| Rate for Payer: Railroad Medicare Medicare |
$88.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.27
|
| Rate for Payer: UHC Core |
$296.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.71
|
| Rate for Payer: UHC Exchange |
$88.71
|
| Rate for Payer: UHC Medicare Advantage |
$88.71
|
| Rate for Payer: VA VA |
$88.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.14
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE
|
Facility
|
IP
|
$354.85
|
|
|
Service Code
|
NDC 00555015902
|
| Hospital Charge Code |
1623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.65 |
| Max. Negotiated Rate |
$319.37 |
| Rate for Payer: Aetna Commercial |
$301.62
|
| Rate for Payer: BCBS Trust/PPO |
$289.66
|
| Rate for Payer: BCN Commercial |
$274.23
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Commercial |
$305.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Healthscope Commercial |
$319.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.62
|
| Rate for Payer: Nomi Health Commercial |
$290.98
|
| Rate for Payer: PHP Commercial |
$301.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.65
|
| Rate for Payer: Priority Health HMO/PPO |
$308.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.27
|
| Rate for Payer: UHC Core |
$296.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.14
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE
|
Facility
|
IP
|
$1,527.50
|
|
|
Service Code
|
NDC 00555015904
|
| Hospital Charge Code |
1623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$992.88 |
| Max. Negotiated Rate |
$1,374.75 |
| Rate for Payer: Aetna Commercial |
$1,298.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,246.90
|
| Rate for Payer: BCN Commercial |
$1,180.45
|
| Rate for Payer: Cash Price |
$1,222.00
|
| Rate for Payer: Cofinity Commercial |
$1,313.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,222.00
|
| Rate for Payer: Healthscope Commercial |
$1,374.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,145.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,298.38
|
| Rate for Payer: Nomi Health Commercial |
$1,252.55
|
| Rate for Payer: PHP Commercial |
$1,298.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$992.88
|
| Rate for Payer: Priority Health HMO/PPO |
$1,328.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,023.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,344.20
|
| Rate for Payer: UHC Core |
$1,275.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,145.62
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$66.70
|
|
|
Service Code
|
NDC 00116200116
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.35 |
| Max. Negotiated Rate |
$60.03 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: BCBS Trust/PPO |
$54.45
|
| Rate for Payer: BCN Commercial |
$51.55
|
| Rate for Payer: Cash Price |
$53.36
|
| Rate for Payer: Cofinity Commercial |
$57.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.36
|
| Rate for Payer: Healthscope Commercial |
$60.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.70
|
| Rate for Payer: Nomi Health Commercial |
$54.69
|
| Rate for Payer: PHP Commercial |
$56.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.35
|
| Rate for Payer: Priority Health HMO/PPO |
$58.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.70
|
| Rate for Payer: UHC Core |
$55.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.02
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$32.08
|
|
|
Service Code
|
NDC 66689010650
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$28.87 |
| Rate for Payer: Aetna Commercial |
$27.27
|
| Rate for Payer: Aetna Medicare |
$8.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.03
|
| Rate for Payer: BCBS Complete |
$12.83
|
| Rate for Payer: BCBS MAPPO |
$8.02
|
| Rate for Payer: BCBS Trust/PPO |
$26.37
|
| Rate for Payer: BCN Commercial |
$24.94
|
| Rate for Payer: BCN Medicare Advantage |
$8.02
|
| Rate for Payer: Cash Price |
$25.66
|
| Rate for Payer: Cofinity Commercial |
$27.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.02
|
| Rate for Payer: Healthscope Commercial |
$28.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.27
|
| Rate for Payer: Nomi Health Commercial |
$26.31
|
| Rate for Payer: PACE Senior Care Partners |
$7.62
|
| Rate for Payer: PACE SWMI |
$8.02
|
| Rate for Payer: PHP Commercial |
$27.27
|
| Rate for Payer: PHP Medicare Advantage |
$8.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.85
|
| Rate for Payer: Priority Health HMO/PPO |
$27.91
|
| Rate for Payer: Priority Health Medicare |
$8.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.49
|
| Rate for Payer: Railroad Medicare Medicare |
$8.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.23
|
| Rate for Payer: UHC Core |
$26.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.02
|
| Rate for Payer: UHC Exchange |
$8.02
|
| Rate for Payer: UHC Medicare Advantage |
$8.02
|
| Rate for Payer: VA VA |
$8.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.06
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$3.88
|
|
|
Service Code
|
NDC 09900000023
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: BCBS Trust/PPO |
$3.17
|
| Rate for Payer: BCN Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Nomi Health Commercial |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health HMO/PPO |
$3.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.91
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$66.70
|
|
|
Service Code
|
NDC 00116200116
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$60.03 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Aetna Medicare |
$17.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.84
|
| Rate for Payer: BCBS Complete |
$26.68
|
| Rate for Payer: BCBS MAPPO |
$16.68
|
| Rate for Payer: BCBS Trust/PPO |
$54.83
|
| Rate for Payer: BCN Commercial |
$51.86
|
| Rate for Payer: BCN Medicare Advantage |
$16.68
|
| Rate for Payer: Cash Price |
$53.36
|
| Rate for Payer: Cofinity Commercial |
$57.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.68
|
| Rate for Payer: Healthscope Commercial |
$60.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.70
|
| Rate for Payer: Nomi Health Commercial |
$54.69
|
| Rate for Payer: PACE Senior Care Partners |
$15.84
|
| Rate for Payer: PACE SWMI |
$16.68
|
| Rate for Payer: PHP Commercial |
$56.70
|
| Rate for Payer: PHP Medicare Advantage |
$16.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.35
|
| Rate for Payer: Priority Health HMO/PPO |
$58.03
|
| Rate for Payer: Priority Health Medicare |
$16.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.69
|
| Rate for Payer: Railroad Medicare Medicare |
$16.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.70
|
| Rate for Payer: UHC Core |
$55.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.68
|
| Rate for Payer: UHC Exchange |
$16.68
|
| Rate for Payer: UHC Medicare Advantage |
$16.68
|
| Rate for Payer: VA VA |
$16.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.02
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 09900000023
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.21
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: BCBS MAPPO |
$0.97
|
| Rate for Payer: BCBS Trust/PPO |
$3.19
|
| Rate for Payer: BCN Commercial |
$3.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.97
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.97
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Nomi Health Commercial |
$3.18
|
| Rate for Payer: PACE Senior Care Partners |
$0.92
|
| Rate for Payer: PACE SWMI |
$0.97
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health HMO/PPO |
$3.38
|
| Rate for Payer: Priority Health Medicare |
$0.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.60
|
| Rate for Payer: Railroad Medicare Medicare |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Medicare Advantage |
$0.97
|
| Rate for Payer: VA VA |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.91
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$32.08
|
|
|
Service Code
|
NDC 66689010650
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$28.87 |
| Rate for Payer: Aetna Commercial |
$27.27
|
| Rate for Payer: BCBS Trust/PPO |
$26.19
|
| Rate for Payer: BCN Commercial |
$24.79
|
| Rate for Payer: Cash Price |
$25.66
|
| Rate for Payer: Cofinity Commercial |
$27.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.66
|
| Rate for Payer: Healthscope Commercial |
$28.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.27
|
| Rate for Payer: Nomi Health Commercial |
$26.31
|
| Rate for Payer: PHP Commercial |
$27.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.85
|
| Rate for Payer: Priority Health HMO/PPO |
$27.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.23
|
| Rate for Payer: UHC Core |
$26.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.06
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$32.08
|
|
|
Service Code
|
NDC 66689010601
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$28.87 |
| Rate for Payer: Aetna Commercial |
$27.27
|
| Rate for Payer: BCBS Trust/PPO |
$26.19
|
| Rate for Payer: BCN Commercial |
$24.79
|
| Rate for Payer: Cash Price |
$25.66
|
| Rate for Payer: Cofinity Commercial |
$27.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.66
|
| Rate for Payer: Healthscope Commercial |
$28.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.27
|
| Rate for Payer: Nomi Health Commercial |
$26.31
|
| Rate for Payer: PHP Commercial |
$27.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.85
|
| Rate for Payer: Priority Health HMO/PPO |
$27.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.23
|
| Rate for Payer: UHC Core |
$26.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.06
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$32.08
|
|
|
Service Code
|
NDC 66689010601
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$28.87 |
| Rate for Payer: Aetna Commercial |
$27.27
|
| Rate for Payer: Aetna Medicare |
$8.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.03
|
| Rate for Payer: BCBS Complete |
$12.83
|
| Rate for Payer: BCBS MAPPO |
$8.02
|
| Rate for Payer: BCBS Trust/PPO |
$26.37
|
| Rate for Payer: BCN Commercial |
$24.94
|
| Rate for Payer: BCN Medicare Advantage |
$8.02
|
| Rate for Payer: Cash Price |
$25.66
|
| Rate for Payer: Cofinity Commercial |
$27.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.02
|
| Rate for Payer: Healthscope Commercial |
$28.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.27
|
| Rate for Payer: Nomi Health Commercial |
$26.31
|
| Rate for Payer: PACE Senior Care Partners |
$7.62
|
| Rate for Payer: PACE SWMI |
$8.02
|
| Rate for Payer: PHP Commercial |
$27.27
|
| Rate for Payer: PHP Medicare Advantage |
$8.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.85
|
| Rate for Payer: Priority Health HMO/PPO |
$27.91
|
| Rate for Payer: Priority Health Medicare |
$8.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.49
|
| Rate for Payer: Railroad Medicare Medicare |
$8.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.23
|
| Rate for Payer: UHC Core |
$26.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.02
|
| Rate for Payer: UHC Exchange |
$8.02
|
| Rate for Payer: UHC Medicare Advantage |
$8.02
|
| Rate for Payer: VA VA |
$8.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.06
|
|
|
CHLOROPROCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$82.86
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
150549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$74.57 |
| Rate for Payer: Aetna Commercial |
$70.43
|
| Rate for Payer: BCBS Trust/PPO |
$67.64
|
| Rate for Payer: BCN Commercial |
$64.03
|
| Rate for Payer: Cash Price |
$66.29
|
| Rate for Payer: Cofinity Commercial |
$71.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.29
|
| Rate for Payer: Healthscope Commercial |
$74.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.43
|
| Rate for Payer: Nomi Health Commercial |
$67.95
|
| Rate for Payer: PHP Commercial |
$70.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.86
|
| Rate for Payer: Priority Health HMO/PPO |
$72.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.92
|
| Rate for Payer: UHC Core |
$69.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.15
|
|
|
CHLOROPROCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$82.86
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
150549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.68 |
| Max. Negotiated Rate |
$74.57 |
| Rate for Payer: Aetna Commercial |
$70.43
|
| Rate for Payer: Aetna Medicare |
$21.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.89
|
| Rate for Payer: BCBS Complete |
$33.14
|
| Rate for Payer: BCBS MAPPO |
$20.71
|
| Rate for Payer: BCBS Trust/PPO |
$68.12
|
| Rate for Payer: BCN Commercial |
$64.42
|
| Rate for Payer: BCN Medicare Advantage |
$20.71
|
| Rate for Payer: Cash Price |
$66.29
|
| Rate for Payer: Cofinity Commercial |
$71.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.71
|
| Rate for Payer: Healthscope Commercial |
$74.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.43
|
| Rate for Payer: Nomi Health Commercial |
$67.95
|
| Rate for Payer: PACE Senior Care Partners |
$19.68
|
| Rate for Payer: PACE SWMI |
$20.71
|
| Rate for Payer: PHP Commercial |
$70.43
|
| Rate for Payer: PHP Medicare Advantage |
$20.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.86
|
| Rate for Payer: Priority Health HMO/PPO |
$72.09
|
| Rate for Payer: Priority Health Medicare |
$20.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.52
|
| Rate for Payer: Railroad Medicare Medicare |
$20.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.92
|
| Rate for Payer: UHC Core |
$69.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.71
|
| Rate for Payer: UHC Exchange |
$20.71
|
| Rate for Payer: UHC Medicare Advantage |
$20.71
|
| Rate for Payer: VA VA |
$20.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.15
|
|
|
CHLORPHENIRAMINE 8 MG HYDROCODONE 10 MG/5 ML ORAL SUSP EXTEND.REL 12HR
|
Facility
|
OP
|
$919.72
|
|
|
Service Code
|
NDC 27808008601
|
| Hospital Charge Code |
9582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$218.43 |
| Max. Negotiated Rate |
$827.75 |
| Rate for Payer: Aetna Commercial |
$781.76
|
| Rate for Payer: Aetna Medicare |
$239.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$287.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$287.41
|
| Rate for Payer: BCBS Complete |
$367.89
|
| Rate for Payer: BCBS MAPPO |
$229.93
|
| Rate for Payer: BCBS Trust/PPO |
$756.10
|
| Rate for Payer: BCN Commercial |
$715.08
|
| Rate for Payer: BCN Medicare Advantage |
$229.93
|
| Rate for Payer: Cash Price |
$735.78
|
| Rate for Payer: Cofinity Commercial |
$790.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$735.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.93
|
| Rate for Payer: Healthscope Commercial |
$827.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$689.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$264.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.76
|
| Rate for Payer: Nomi Health Commercial |
$754.17
|
| Rate for Payer: PACE Senior Care Partners |
$218.43
|
| Rate for Payer: PACE SWMI |
$229.93
|
| Rate for Payer: PHP Commercial |
$781.76
|
| Rate for Payer: PHP Medicare Advantage |
$229.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.82
|
| Rate for Payer: Priority Health HMO/PPO |
$800.16
|
| Rate for Payer: Priority Health Medicare |
$232.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$616.21
|
| Rate for Payer: Railroad Medicare Medicare |
$229.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$809.35
|
| Rate for Payer: UHC Core |
$767.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.93
|
| Rate for Payer: UHC Exchange |
$229.93
|
| Rate for Payer: UHC Medicare Advantage |
$229.93
|
| Rate for Payer: VA VA |
$229.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$689.79
|
|
|
CHLORPHENIRAMINE 8 MG HYDROCODONE 10 MG/5 ML ORAL SUSP EXTEND.REL 12HR
|
Facility
|
IP
|
$43.65
|
|
|
Service Code
|
NDC 09900000025
|
| Hospital Charge Code |
9582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.37 |
| Max. Negotiated Rate |
$39.28 |
| Rate for Payer: Aetna Commercial |
$37.10
|
| Rate for Payer: BCBS Trust/PPO |
$35.63
|
| Rate for Payer: BCN Commercial |
$33.73
|
| Rate for Payer: Cash Price |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$37.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.92
|
| Rate for Payer: Healthscope Commercial |
$39.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.10
|
| Rate for Payer: Nomi Health Commercial |
$35.79
|
| Rate for Payer: PHP Commercial |
$37.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.37
|
| Rate for Payer: Priority Health HMO/PPO |
$37.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.41
|
| Rate for Payer: UHC Core |
$36.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.74
|
|
|
CHLORPHENIRAMINE 8 MG HYDROCODONE 10 MG/5 ML ORAL SUSP EXTEND.REL 12HR
|
Facility
|
OP
|
$43.65
|
|
|
Service Code
|
NDC 09900000025
|
| Hospital Charge Code |
9582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$39.28 |
| Rate for Payer: Aetna Commercial |
$37.10
|
| Rate for Payer: Aetna Medicare |
$11.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.64
|
| Rate for Payer: BCBS Complete |
$17.46
|
| Rate for Payer: BCBS MAPPO |
$10.91
|
| Rate for Payer: BCBS Trust/PPO |
$35.88
|
| Rate for Payer: BCN Commercial |
$33.94
|
| Rate for Payer: BCN Medicare Advantage |
$10.91
|
| Rate for Payer: Cash Price |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$37.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.91
|
| Rate for Payer: Healthscope Commercial |
$39.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.10
|
| Rate for Payer: Nomi Health Commercial |
$35.79
|
| Rate for Payer: PACE Senior Care Partners |
$10.37
|
| Rate for Payer: PACE SWMI |
$10.91
|
| Rate for Payer: PHP Commercial |
$37.10
|
| Rate for Payer: PHP Medicare Advantage |
$10.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.37
|
| Rate for Payer: Priority Health HMO/PPO |
$37.98
|
| Rate for Payer: Priority Health Medicare |
$11.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.25
|
| Rate for Payer: Railroad Medicare Medicare |
$10.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.41
|
| Rate for Payer: UHC Core |
$36.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.91
|
| Rate for Payer: UHC Exchange |
$10.91
|
| Rate for Payer: UHC Medicare Advantage |
$10.91
|
| Rate for Payer: VA VA |
$10.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.74
|
|
|
CHLORPHENIRAMINE 8 MG HYDROCODONE 10 MG/5 ML ORAL SUSP EXTEND.REL 12HR
|
Facility
|
IP
|
$919.72
|
|
|
Service Code
|
NDC 27808008601
|
| Hospital Charge Code |
9582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$597.82 |
| Max. Negotiated Rate |
$827.75 |
| Rate for Payer: Aetna Commercial |
$781.76
|
| Rate for Payer: BCBS Trust/PPO |
$750.77
|
| Rate for Payer: BCN Commercial |
$710.76
|
| Rate for Payer: Cash Price |
$735.78
|
| Rate for Payer: Cofinity Commercial |
$790.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$735.78
|
| Rate for Payer: Healthscope Commercial |
$827.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$689.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.76
|
| Rate for Payer: Nomi Health Commercial |
$754.17
|
| Rate for Payer: PHP Commercial |
$781.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.82
|
| Rate for Payer: Priority Health HMO/PPO |
$800.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$616.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$809.35
|
| Rate for Payer: UHC Core |
$767.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$689.79
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
IP
|
$319.92
|
|
|
Service Code
|
NDC 50268016215
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.95 |
| Max. Negotiated Rate |
$287.93 |
| Rate for Payer: Aetna Commercial |
$271.93
|
| Rate for Payer: BCBS Trust/PPO |
$261.15
|
| Rate for Payer: BCN Commercial |
$247.23
|
| Rate for Payer: Cash Price |
$255.94
|
| Rate for Payer: Cofinity Commercial |
$275.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.94
|
| Rate for Payer: Healthscope Commercial |
$287.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.93
|
| Rate for Payer: Nomi Health Commercial |
$262.33
|
| Rate for Payer: PHP Commercial |
$271.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.95
|
| Rate for Payer: Priority Health HMO/PPO |
$278.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.53
|
| Rate for Payer: UHC Core |
$267.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.94
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
OP
|
$319.92
|
|
|
Service Code
|
NDC 50268016215
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.98 |
| Max. Negotiated Rate |
$287.93 |
| Rate for Payer: Aetna Commercial |
$271.93
|
| Rate for Payer: Aetna Medicare |
$83.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.97
|
| Rate for Payer: BCBS Complete |
$127.97
|
| Rate for Payer: BCBS MAPPO |
$79.98
|
| Rate for Payer: BCBS Trust/PPO |
$263.01
|
| Rate for Payer: BCN Commercial |
$248.74
|
| Rate for Payer: BCN Medicare Advantage |
$79.98
|
| Rate for Payer: Cash Price |
$255.94
|
| Rate for Payer: Cofinity Commercial |
$275.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.98
|
| Rate for Payer: Healthscope Commercial |
$287.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.93
|
| Rate for Payer: Nomi Health Commercial |
$262.33
|
| Rate for Payer: PACE Senior Care Partners |
$75.98
|
| Rate for Payer: PACE SWMI |
$79.98
|
| Rate for Payer: PHP Commercial |
$271.93
|
| Rate for Payer: PHP Medicare Advantage |
$79.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.95
|
| Rate for Payer: Priority Health HMO/PPO |
$278.33
|
| Rate for Payer: Priority Health Medicare |
$80.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.35
|
| Rate for Payer: Railroad Medicare Medicare |
$79.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.53
|
| Rate for Payer: UHC Core |
$267.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.98
|
| Rate for Payer: UHC Exchange |
$79.98
|
| Rate for Payer: UHC Medicare Advantage |
$79.98
|
| Rate for Payer: VA VA |
$79.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.94
|
|
