|
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
|
|
|
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 |
$62.14
|
| 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 |
$62.14
|
|
|
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 |
$20.72
|
| Rate for Payer: BCBS Trust/PPO |
$68.12
|
| Rate for Payer: BCN Commercial |
$64.42
|
| Rate for Payer: BCN Medicare Advantage |
$20.72
|
| 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 |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$74.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.14
|
| 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 |
$20.72
|
| Rate for Payer: PHP Commercial |
$70.43
|
| Rate for Payer: PHP Medicare Advantage |
$20.72
|
| 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 |
$20.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.92
|
| Rate for Payer: UHC Core |
$69.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.72
|
| Rate for Payer: UHC Exchange |
$20.72
|
| Rate for Payer: UHC Medicare Advantage |
$20.72
|
| Rate for Payer: VA VA |
$20.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.14
|
|
|
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
|
$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
|
|
|
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
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
OP
|
$6.40
|
|
|
Service Code
|
NDC 50268016211
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Aetna Commercial |
$5.44
|
| Rate for Payer: Aetna Medicare |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.00
|
| Rate for Payer: BCBS Complete |
$2.56
|
| Rate for Payer: BCBS MAPPO |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$5.26
|
| Rate for Payer: BCN Commercial |
$4.98
|
| Rate for Payer: BCN Medicare Advantage |
$1.60
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cofinity Commercial |
$5.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$5.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.44
|
| Rate for Payer: Nomi Health Commercial |
$5.25
|
| Rate for Payer: PACE Senior Care Partners |
$1.52
|
| Rate for Payer: PACE SWMI |
$1.60
|
| Rate for Payer: PHP Commercial |
$5.44
|
| Rate for Payer: PHP Medicare Advantage |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.16
|
| Rate for Payer: Priority Health HMO/PPO |
$5.57
|
| Rate for Payer: Priority Health Medicare |
$1.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.63
|
| Rate for Payer: UHC Core |
$5.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.60
|
| Rate for Payer: UHC Exchange |
$1.60
|
| Rate for Payer: UHC Medicare Advantage |
$1.60
|
| Rate for Payer: VA VA |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.80
|
|
|
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 |
$99.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.98
|
| 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
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
IP
|
$6.40
|
|
|
Service Code
|
NDC 50268016211
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Aetna Commercial |
$5.44
|
| Rate for Payer: BCBS Trust/PPO |
$5.22
|
| Rate for Payer: BCN Commercial |
$4.95
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cofinity Commercial |
$5.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.12
|
| Rate for Payer: Healthscope Commercial |
$5.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.44
|
| Rate for Payer: Nomi Health Commercial |
$5.25
|
| Rate for Payer: PHP Commercial |
$5.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.16
|
| Rate for Payer: Priority Health HMO/PPO |
$5.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.63
|
| Rate for Payer: UHC Core |
$5.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.80
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$379.62
|
|
|
Service Code
|
NDC 50268016315
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.16 |
| Max. Negotiated Rate |
$341.66 |
| Rate for Payer: Aetna Commercial |
$322.68
|
| Rate for Payer: Aetna Medicare |
$98.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.63
|
| Rate for Payer: BCBS Complete |
$151.85
|
| Rate for Payer: BCBS MAPPO |
$94.90
|
| Rate for Payer: BCBS Trust/PPO |
$312.09
|
| Rate for Payer: BCN Commercial |
$295.15
|
| Rate for Payer: BCN Medicare Advantage |
$94.90
|
| Rate for Payer: Cash Price |
$303.70
|
| Rate for Payer: Cofinity Commercial |
$326.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.90
|
| Rate for Payer: Healthscope Commercial |
$341.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.68
|
| Rate for Payer: Nomi Health Commercial |
$311.29
|
| Rate for Payer: PACE Senior Care Partners |
$90.16
|
| Rate for Payer: PACE SWMI |
$94.90
|
| Rate for Payer: PHP Commercial |
$322.68
|
| Rate for Payer: PHP Medicare Advantage |
$94.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.75
|
| Rate for Payer: Priority Health HMO/PPO |
$330.27
|
| Rate for Payer: Priority Health Medicare |
$95.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.35
|
| Rate for Payer: Railroad Medicare Medicare |
$94.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.07
|
| Rate for Payer: UHC Core |
$316.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.90
|
| Rate for Payer: UHC Exchange |
$94.90
|
| Rate for Payer: UHC Medicare Advantage |
$94.90
|
| Rate for Payer: VA VA |
$94.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.72
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$1,307.95
|
|
|
Service Code
|
NDC 00832030100
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$850.17 |
| Max. Negotiated Rate |
$1,177.16 |
| Rate for Payer: Aetna Commercial |
$1,111.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,067.68
|
| Rate for Payer: BCN Commercial |
$1,010.78
|
| Rate for Payer: Cash Price |
$1,046.36
|
| Rate for Payer: Cofinity Commercial |
$1,124.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.36
|
| Rate for Payer: Healthscope Commercial |
$1,177.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.76
|
| Rate for Payer: Nomi Health Commercial |
$1,072.52
|
| Rate for Payer: PHP Commercial |
$1,111.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.17
|
| Rate for Payer: Priority Health HMO/PPO |
$1,137.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$876.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,151.00
|
| Rate for Payer: UHC Core |
$1,092.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.96
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$17.65
|
|
|
Service Code
|
NDC 00832030189
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: BCBS Trust/PPO |
$14.41
|
| Rate for Payer: BCN Commercial |
$13.64
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cofinity Commercial |
$15.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.00
|
| Rate for Payer: Nomi Health Commercial |
$14.47
|
| Rate for Payer: PHP Commercial |
$15.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.47
|
| Rate for Payer: Priority Health HMO/PPO |
$15.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.53
|
| Rate for Payer: UHC Core |
$14.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.24
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$1,177.71
|
|
|
Service Code
|
NDC 00904713061
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.71 |
| Max. Negotiated Rate |
$1,059.94 |
| Rate for Payer: Aetna Commercial |
$1,001.05
|
| Rate for Payer: Aetna Medicare |
$306.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$368.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$368.03
|
| Rate for Payer: BCBS Complete |
$471.08
|
| Rate for Payer: BCBS MAPPO |
$294.43
|
| Rate for Payer: BCBS Trust/PPO |
$968.20
|
| Rate for Payer: BCN Commercial |
$915.67
|
| Rate for Payer: BCN Medicare Advantage |
$294.43
|
| Rate for Payer: Cash Price |
$942.17
|
| Rate for Payer: Cofinity Commercial |
$1,012.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$942.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.43
|
| Rate for Payer: Healthscope Commercial |
$1,059.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$883.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,001.05
|
| Rate for Payer: Nomi Health Commercial |
$965.72
|
| Rate for Payer: PACE Senior Care Partners |
$279.71
|
| Rate for Payer: PACE SWMI |
$294.43
|
| Rate for Payer: PHP Commercial |
$1,001.05
|
| Rate for Payer: PHP Medicare Advantage |
$294.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$765.51
|
| Rate for Payer: Priority Health HMO/PPO |
$1,024.61
|
| Rate for Payer: Priority Health Medicare |
$297.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$789.07
|
| Rate for Payer: Railroad Medicare Medicare |
$294.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,036.38
|
| Rate for Payer: UHC Core |
$983.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.43
|
| Rate for Payer: UHC Exchange |
$294.43
|
| Rate for Payer: UHC Medicare Advantage |
$294.43
|
| Rate for Payer: VA VA |
$294.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$883.28
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$17.65
|
|
|
Service Code
|
NDC 00832030189
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Medicare |
$4.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.52
|
| Rate for Payer: BCBS Complete |
$7.06
|
| Rate for Payer: BCBS MAPPO |
$4.41
|
| Rate for Payer: BCBS Trust/PPO |
$14.51
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: BCN Medicare Advantage |
$4.41
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cofinity Commercial |
$15.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.41
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.00
|
| Rate for Payer: Nomi Health Commercial |
$14.47
|
| Rate for Payer: PACE Senior Care Partners |
$4.19
|
| Rate for Payer: PACE SWMI |
$4.41
|
| Rate for Payer: PHP Commercial |
$15.00
|
| Rate for Payer: PHP Medicare Advantage |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.47
|
| Rate for Payer: Priority Health HMO/PPO |
$15.36
|
| Rate for Payer: Priority Health Medicare |
$4.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.83
|
| Rate for Payer: Railroad Medicare Medicare |
$4.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.53
|
| Rate for Payer: UHC Core |
$14.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.41
|
| Rate for Payer: UHC Exchange |
$4.41
|
| Rate for Payer: UHC Medicare Advantage |
$4.41
|
| Rate for Payer: VA VA |
$4.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.24
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$7.60
|
|
|
Service Code
|
NDC 50268016311
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna Commercial |
$6.46
|
| Rate for Payer: Aetna Medicare |
$1.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.38
|
| Rate for Payer: BCBS Complete |
$3.04
|
| Rate for Payer: BCBS MAPPO |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$6.25
|
| Rate for Payer: BCN Commercial |
$5.91
|
| Rate for Payer: BCN Medicare Advantage |
$1.90
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.90
|
| Rate for Payer: Healthscope Commercial |
$6.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.46
|
| Rate for Payer: Nomi Health Commercial |
$6.23
|
| Rate for Payer: PACE Senior Care Partners |
$1.80
|
| Rate for Payer: PACE SWMI |
$1.90
|
| Rate for Payer: PHP Commercial |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$1.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.94
|
| Rate for Payer: Priority Health HMO/PPO |
$6.61
|
| Rate for Payer: Priority Health Medicare |
$1.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.69
|
| Rate for Payer: UHC Core |
$6.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.90
|
| Rate for Payer: UHC Exchange |
$1.90
|
| Rate for Payer: UHC Medicare Advantage |
$1.90
|
| Rate for Payer: VA VA |
$1.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.70
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$379.62
|
|
|
Service Code
|
NDC 50268016315
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.75 |
| Max. Negotiated Rate |
$341.66 |
| Rate for Payer: Aetna Commercial |
$322.68
|
| Rate for Payer: BCBS Trust/PPO |
$309.88
|
| Rate for Payer: BCN Commercial |
$293.37
|
| Rate for Payer: Cash Price |
$303.70
|
| Rate for Payer: Cofinity Commercial |
$326.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$341.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.68
|
| Rate for Payer: Nomi Health Commercial |
$311.29
|
| Rate for Payer: PHP Commercial |
$322.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.75
|
| Rate for Payer: Priority Health HMO/PPO |
$330.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.07
|
| Rate for Payer: UHC Core |
$316.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.72
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$7.60
|
|
|
Service Code
|
NDC 50268016311
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna Commercial |
$6.46
|
| Rate for Payer: BCBS Trust/PPO |
$6.20
|
| Rate for Payer: BCN Commercial |
$5.87
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.08
|
| Rate for Payer: Healthscope Commercial |
$6.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.46
|
| Rate for Payer: Nomi Health Commercial |
$6.23
|
| Rate for Payer: PHP Commercial |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.94
|
| Rate for Payer: Priority Health HMO/PPO |
$6.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.69
|
| Rate for Payer: UHC Core |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.70
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$1,764.16
|
|
|
Service Code
|
NDC 00832030101
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$418.99 |
| Max. Negotiated Rate |
$1,587.74 |
| Rate for Payer: Aetna Commercial |
$1,499.54
|
| Rate for Payer: Aetna Medicare |
$458.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$551.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$551.30
|
| Rate for Payer: BCBS Complete |
$705.66
|
| Rate for Payer: BCBS MAPPO |
$441.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,450.32
|
| Rate for Payer: BCN Commercial |
$1,371.63
|
| Rate for Payer: BCN Medicare Advantage |
$441.04
|
| Rate for Payer: Cash Price |
$1,411.33
|
| Rate for Payer: Cofinity Commercial |
$1,517.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,411.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$441.04
|
| Rate for Payer: Healthscope Commercial |
$1,587.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,323.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$463.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$507.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,499.54
|
| Rate for Payer: Nomi Health Commercial |
$1,446.61
|
| Rate for Payer: PACE Senior Care Partners |
$418.99
|
| Rate for Payer: PACE SWMI |
$441.04
|
| Rate for Payer: PHP Commercial |
$1,499.54
|
| Rate for Payer: PHP Medicare Advantage |
$441.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,146.70
|
| Rate for Payer: Priority Health HMO/PPO |
$1,534.82
|
| Rate for Payer: Priority Health Medicare |
$445.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,181.99
|
| Rate for Payer: Railroad Medicare Medicare |
$441.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,552.46
|
| Rate for Payer: UHC Core |
$1,473.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$441.04
|
| Rate for Payer: UHC Exchange |
$441.04
|
| Rate for Payer: UHC Medicare Advantage |
$441.04
|
| Rate for Payer: VA VA |
$441.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,323.12
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$1,177.71
|
|
|
Service Code
|
NDC 00904713061
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$765.51 |
| Max. Negotiated Rate |
$1,059.94 |
| Rate for Payer: Aetna Commercial |
$1,001.05
|
| Rate for Payer: BCBS Trust/PPO |
$961.36
|
| Rate for Payer: BCN Commercial |
$910.13
|
| Rate for Payer: Cash Price |
$942.17
|
| Rate for Payer: Cofinity Commercial |
$1,012.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$942.17
|
| Rate for Payer: Healthscope Commercial |
$1,059.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$883.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,001.05
|
| Rate for Payer: Nomi Health Commercial |
$965.72
|
| Rate for Payer: PHP Commercial |
$1,001.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$765.51
|
| Rate for Payer: Priority Health HMO/PPO |
$1,024.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$789.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,036.38
|
| Rate for Payer: UHC Core |
$983.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$883.28
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$1,307.95
|
|
|
Service Code
|
NDC 00832030100
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$310.64 |
| Max. Negotiated Rate |
$1,177.16 |
| Rate for Payer: Aetna Commercial |
$1,111.76
|
| Rate for Payer: Aetna Medicare |
$340.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$408.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$408.73
|
| Rate for Payer: BCBS Complete |
$523.18
|
| Rate for Payer: BCBS MAPPO |
$326.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,075.27
|
| Rate for Payer: BCN Commercial |
$1,016.93
|
| Rate for Payer: BCN Medicare Advantage |
$326.99
|
| Rate for Payer: Cash Price |
$1,046.36
|
| Rate for Payer: Cofinity Commercial |
$1,124.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.99
|
| Rate for Payer: Healthscope Commercial |
$1,177.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.76
|
| Rate for Payer: Nomi Health Commercial |
$1,072.52
|
| Rate for Payer: PACE Senior Care Partners |
$310.64
|
| Rate for Payer: PACE SWMI |
$326.99
|
| Rate for Payer: PHP Commercial |
$1,111.76
|
| Rate for Payer: PHP Medicare Advantage |
$326.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.17
|
| Rate for Payer: Priority Health HMO/PPO |
$1,137.92
|
| Rate for Payer: Priority Health Medicare |
$330.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$876.33
|
| Rate for Payer: Railroad Medicare Medicare |
$326.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,151.00
|
| Rate for Payer: UHC Core |
$1,092.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$326.99
|
| Rate for Payer: UHC Exchange |
$326.99
|
| Rate for Payer: UHC Medicare Advantage |
$326.99
|
| Rate for Payer: VA VA |
$326.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.96
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$1,764.16
|
|
|
Service Code
|
NDC 00832030101
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,146.70 |
| Max. Negotiated Rate |
$1,587.74 |
| Rate for Payer: Aetna Commercial |
$1,499.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,440.08
|
| Rate for Payer: BCN Commercial |
$1,363.34
|
| Rate for Payer: Cash Price |
$1,411.33
|
| Rate for Payer: Cofinity Commercial |
$1,517.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,411.33
|
| Rate for Payer: Healthscope Commercial |
$1,587.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,323.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,499.54
|
| Rate for Payer: Nomi Health Commercial |
$1,446.61
|
| Rate for Payer: PHP Commercial |
$1,499.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,146.70
|
| Rate for Payer: Priority Health HMO/PPO |
$1,534.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,181.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,552.46
|
| Rate for Payer: UHC Core |
$1,473.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,323.12
|
|
|
CHLORPROMAZINE (BULK) 100 % POWDER
|
Facility
|
OP
|
$194.40
|
|
|
Service Code
|
NDC 38779042304
|
| Hospital Charge Code |
12309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.17 |
| Max. Negotiated Rate |
$174.96 |
| Rate for Payer: Aetna Commercial |
$165.24
|
| Rate for Payer: Aetna Medicare |
$50.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.75
|
| Rate for Payer: BCBS Complete |
$77.76
|
| Rate for Payer: BCBS MAPPO |
$48.60
|
| Rate for Payer: BCBS Trust/PPO |
$159.82
|
| Rate for Payer: BCN Commercial |
$151.15
|
| Rate for Payer: BCN Medicare Advantage |
$48.60
|
| Rate for Payer: Cash Price |
$155.52
|
| Rate for Payer: Cofinity Commercial |
$167.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.60
|
| Rate for Payer: Healthscope Commercial |
$174.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.24
|
| Rate for Payer: Nomi Health Commercial |
$159.41
|
| Rate for Payer: PACE Senior Care Partners |
$46.17
|
| Rate for Payer: PACE SWMI |
$48.60
|
| Rate for Payer: PHP Commercial |
$165.24
|
| Rate for Payer: PHP Medicare Advantage |
$48.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.36
|
| Rate for Payer: Priority Health HMO/PPO |
$169.13
|
| Rate for Payer: Priority Health Medicare |
$49.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.25
|
| Rate for Payer: Railroad Medicare Medicare |
$48.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.07
|
| Rate for Payer: UHC Core |
$162.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.60
|
| Rate for Payer: UHC Exchange |
$48.60
|
| Rate for Payer: UHC Medicare Advantage |
$48.60
|
| Rate for Payer: VA VA |
$48.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.80
|
|
|
CHLORPROMAZINE (BULK) 100 % POWDER
|
Facility
|
IP
|
$194.40
|
|
|
Service Code
|
NDC 38779042304
|
| Hospital Charge Code |
12309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$174.96 |
| Rate for Payer: Aetna Commercial |
$165.24
|
| Rate for Payer: BCBS Trust/PPO |
$158.69
|
| Rate for Payer: BCN Commercial |
$150.23
|
| Rate for Payer: Cash Price |
$155.52
|
| Rate for Payer: Cofinity Commercial |
$167.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.52
|
| Rate for Payer: Healthscope Commercial |
$174.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.24
|
| Rate for Payer: Nomi Health Commercial |
$159.41
|
| Rate for Payer: PHP Commercial |
$165.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.36
|
| Rate for Payer: Priority Health HMO/PPO |
$169.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.07
|
| Rate for Payer: UHC Core |
$162.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.80
|
|
