|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
OP
|
$84.60
|
|
|
Service Code
|
NDC 20555003300
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.44
|
| Rate for Payer: BCBS Complete |
$33.84
|
| Rate for Payer: BCBS MAPPO |
$21.15
|
| Rate for Payer: BCBS Trust/PPO |
$69.55
|
| Rate for Payer: BCN Commercial |
$65.78
|
| Rate for Payer: BCN Medicare Advantage |
$21.15
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$72.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.15
|
| Rate for Payer: Healthscope Commercial |
$76.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Nomi Health Commercial |
$69.37
|
| Rate for Payer: PACE Senior Care Partners |
$20.09
|
| Rate for Payer: PACE SWMI |
$21.15
|
| Rate for Payer: PHP Commercial |
$71.91
|
| Rate for Payer: PHP Medicare Advantage |
$21.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.99
|
| Rate for Payer: Priority Health HMO/PPO |
$73.60
|
| Rate for Payer: Priority Health Medicare |
$21.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.68
|
| Rate for Payer: Railroad Medicare Medicare |
$21.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.45
|
| Rate for Payer: UHC Core |
$70.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.15
|
| Rate for Payer: UHC Exchange |
$21.15
|
| Rate for Payer: UHC Medicare Advantage |
$21.15
|
| Rate for Payer: VA VA |
$21.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.45
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET
|
Facility
|
OP
|
$4.19
|
|
|
Service Code
|
NDC 50268086511
|
| Hospital Charge Code |
94284
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Aetna Medicare |
$1.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.31
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$1.05
|
| Rate for Payer: BCBS Trust/PPO |
$3.44
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$1.05
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cofinity Commercial |
$3.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.05
|
| Rate for Payer: Healthscope Commercial |
$3.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.56
|
| Rate for Payer: Nomi Health Commercial |
$3.44
|
| Rate for Payer: PACE Senior Care Partners |
$1.00
|
| Rate for Payer: PACE SWMI |
$1.05
|
| Rate for Payer: PHP Commercial |
$3.56
|
| Rate for Payer: PHP Medicare Advantage |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.72
|
| Rate for Payer: Priority Health HMO/PPO |
$3.65
|
| Rate for Payer: Priority Health Medicare |
$1.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.69
|
| Rate for Payer: UHC Core |
$3.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.05
|
| Rate for Payer: UHC Exchange |
$1.05
|
| Rate for Payer: UHC Medicare Advantage |
$1.05
|
| Rate for Payer: VA VA |
$1.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.14
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET
|
Facility
|
IP
|
$209.15
|
|
|
Service Code
|
NDC 50268086515
|
| Hospital Charge Code |
94284
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.95 |
| Max. Negotiated Rate |
$188.24 |
| Rate for Payer: Aetna Commercial |
$177.78
|
| Rate for Payer: BCBS Trust/PPO |
$170.73
|
| Rate for Payer: BCN Commercial |
$161.63
|
| Rate for Payer: Cash Price |
$167.32
|
| Rate for Payer: Cofinity Commercial |
$179.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.32
|
| Rate for Payer: Healthscope Commercial |
$188.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.78
|
| Rate for Payer: Nomi Health Commercial |
$171.50
|
| Rate for Payer: PHP Commercial |
$177.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.95
|
| Rate for Payer: Priority Health HMO/PPO |
$181.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.05
|
| Rate for Payer: UHC Core |
$174.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.86
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET
|
Facility
|
OP
|
$209.15
|
|
|
Service Code
|
NDC 50268086515
|
| Hospital Charge Code |
94284
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.67 |
| Max. Negotiated Rate |
$188.24 |
| Rate for Payer: Aetna Commercial |
$177.78
|
| Rate for Payer: Aetna Medicare |
$54.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.36
|
| Rate for Payer: BCBS Complete |
$83.66
|
| Rate for Payer: BCBS MAPPO |
$52.29
|
| Rate for Payer: BCBS Trust/PPO |
$171.94
|
| Rate for Payer: BCN Commercial |
$162.61
|
| Rate for Payer: BCN Medicare Advantage |
$52.29
|
| Rate for Payer: Cash Price |
$167.32
|
| Rate for Payer: Cofinity Commercial |
$179.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.29
|
| Rate for Payer: Healthscope Commercial |
$188.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.78
|
| Rate for Payer: Nomi Health Commercial |
$171.50
|
| Rate for Payer: PACE Senior Care Partners |
$49.67
|
| Rate for Payer: PACE SWMI |
$52.29
|
| Rate for Payer: PHP Commercial |
$177.78
|
| Rate for Payer: PHP Medicare Advantage |
$52.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.95
|
| Rate for Payer: Priority Health HMO/PPO |
$181.96
|
| Rate for Payer: Priority Health Medicare |
$52.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.13
|
| Rate for Payer: Railroad Medicare Medicare |
$52.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.05
|
| Rate for Payer: UHC Core |
$174.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.29
|
| Rate for Payer: UHC Exchange |
$52.29
|
| Rate for Payer: UHC Medicare Advantage |
$52.29
|
| Rate for Payer: VA VA |
$52.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.86
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET
|
Facility
|
OP
|
$58.75
|
|
|
Service Code
|
NDC 80681017000
|
| Hospital Charge Code |
94284
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: Aetna Medicare |
$15.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.36
|
| Rate for Payer: BCBS Complete |
$23.50
|
| Rate for Payer: BCBS MAPPO |
$14.69
|
| Rate for Payer: BCBS Trust/PPO |
$48.30
|
| Rate for Payer: BCN Commercial |
$45.68
|
| Rate for Payer: BCN Medicare Advantage |
$14.69
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.94
|
| Rate for Payer: Nomi Health Commercial |
$48.17
|
| Rate for Payer: PACE Senior Care Partners |
$13.95
|
| Rate for Payer: PACE SWMI |
$14.69
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: PHP Medicare Advantage |
$14.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.19
|
| Rate for Payer: Priority Health HMO/PPO |
$51.11
|
| Rate for Payer: Priority Health Medicare |
$14.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.36
|
| Rate for Payer: Railroad Medicare Medicare |
$14.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.70
|
| Rate for Payer: UHC Core |
$49.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.69
|
| Rate for Payer: UHC Exchange |
$14.69
|
| Rate for Payer: UHC Medicare Advantage |
$14.69
|
| Rate for Payer: VA VA |
$14.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.06
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET
|
Facility
|
IP
|
$4.19
|
|
|
Service Code
|
NDC 50268086511
|
| Hospital Charge Code |
94284
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: BCBS Trust/PPO |
$3.42
|
| Rate for Payer: BCN Commercial |
$3.24
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cofinity Commercial |
$3.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.35
|
| Rate for Payer: Healthscope Commercial |
$3.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.56
|
| Rate for Payer: Nomi Health Commercial |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.72
|
| Rate for Payer: Priority Health HMO/PPO |
$3.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.69
|
| Rate for Payer: UHC Core |
$3.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.14
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET
|
Facility
|
IP
|
$58.75
|
|
|
Service Code
|
NDC 80681017000
|
| Hospital Charge Code |
94284
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: BCBS Trust/PPO |
$47.96
|
| Rate for Payer: BCN Commercial |
$45.40
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.94
|
| Rate for Payer: Nomi Health Commercial |
$48.17
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.19
|
| Rate for Payer: Priority Health HMO/PPO |
$51.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.70
|
| Rate for Payer: UHC Core |
$49.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.06
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 49884046564
|
| Hospital Charge Code |
9588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna Medicare |
$1.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.34
|
| Rate for Payer: BCBS Complete |
$1.72
|
| Rate for Payer: BCBS MAPPO |
$1.07
|
| Rate for Payer: BCBS Trust/PPO |
$3.54
|
| Rate for Payer: BCN Commercial |
$3.34
|
| Rate for Payer: BCN Medicare Advantage |
$1.07
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.07
|
| Rate for Payer: Healthscope Commercial |
$3.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Nomi Health Commercial |
$3.53
|
| Rate for Payer: PACE Senior Care Partners |
$1.02
|
| Rate for Payer: PACE SWMI |
$1.07
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: PHP Medicare Advantage |
$1.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.79
|
| Rate for Payer: Priority Health HMO/PPO |
$3.74
|
| Rate for Payer: Priority Health Medicare |
$1.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.78
|
| Rate for Payer: UHC Core |
$3.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Medicare Advantage |
$1.07
|
| Rate for Payer: VA VA |
$1.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
NDC 49884046564
|
| Hospital Charge Code |
9588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: BCBS Trust/PPO |
$3.51
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$3.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Nomi Health Commercial |
$3.53
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.79
|
| Rate for Payer: Priority Health HMO/PPO |
$3.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.78
|
| Rate for Payer: UHC Core |
$3.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE
|
Facility
|
OP
|
$233.06
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
28923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.35 |
| Max. Negotiated Rate |
$483.30 |
| Rate for Payer: Aetna Commercial |
$198.10
|
| Rate for Payer: Aetna Medicare |
$60.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.83
|
| Rate for Payer: BCBS Complete |
$483.30
|
| Rate for Payer: BCBS MAPPO |
$58.27
|
| Rate for Payer: BCBS Trust/PPO |
$191.60
|
| Rate for Payer: BCN Commercial |
$181.20
|
| Rate for Payer: BCN Medicare Advantage |
$58.27
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cofinity Commercial |
$200.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.27
|
| Rate for Payer: Healthscope Commercial |
$209.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.79
|
| Rate for Payer: Mclaren Medicaid |
$460.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.18
|
| Rate for Payer: Meridian Medicaid |
$483.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.10
|
| Rate for Payer: Nomi Health Commercial |
$191.11
|
| Rate for Payer: PACE Senior Care Partners |
$55.35
|
| Rate for Payer: PACE SWMI |
$58.27
|
| Rate for Payer: PHP Commercial |
$198.10
|
| Rate for Payer: PHP Medicare Advantage |
$58.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.49
|
| Rate for Payer: Priority Health HMO/PPO |
$202.76
|
| Rate for Payer: Priority Health Medicare |
$58.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.15
|
| Rate for Payer: Railroad Medicare Medicare |
$58.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.09
|
| Rate for Payer: UHC Core |
$194.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.27
|
| Rate for Payer: UHC Exchange |
$58.27
|
| Rate for Payer: UHC Medicare Advantage |
$58.27
|
| Rate for Payer: UHCCP Medicaid |
$460.25
|
| Rate for Payer: VA VA |
$58.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.79
|
|
|
CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$233.06
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
28923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$151.49 |
| Max. Negotiated Rate |
$209.75 |
| Rate for Payer: Aetna Commercial |
$198.10
|
| Rate for Payer: BCBS Trust/PPO |
$190.25
|
| Rate for Payer: BCN Commercial |
$180.11
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cofinity Commercial |
$200.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.45
|
| Rate for Payer: Healthscope Commercial |
$209.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.10
|
| Rate for Payer: Nomi Health Commercial |
$191.11
|
| Rate for Payer: PHP Commercial |
$198.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.49
|
| Rate for Payer: Priority Health HMO/PPO |
$202.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.09
|
| Rate for Payer: UHC Core |
$194.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.79
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
IP
|
$165.84
|
|
|
Service Code
|
NDC 50268017715
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$149.26 |
| Rate for Payer: Aetna Commercial |
$140.96
|
| Rate for Payer: BCBS Trust/PPO |
$135.38
|
| Rate for Payer: BCN Commercial |
$128.16
|
| Rate for Payer: Cash Price |
$132.67
|
| Rate for Payer: Cofinity Commercial |
$142.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.67
|
| Rate for Payer: Healthscope Commercial |
$149.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.96
|
| Rate for Payer: Nomi Health Commercial |
$135.99
|
| Rate for Payer: PHP Commercial |
$140.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.80
|
| Rate for Payer: Priority Health HMO/PPO |
$144.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.94
|
| Rate for Payer: UHC Core |
$138.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.38
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
OP
|
$3.32
|
|
|
Service Code
|
NDC 50268017711
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna Medicare |
$0.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.04
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$0.83
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.58
|
| Rate for Payer: BCN Medicare Advantage |
$0.83
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.82
|
| Rate for Payer: Nomi Health Commercial |
$2.72
|
| Rate for Payer: PACE Senior Care Partners |
$0.79
|
| Rate for Payer: PACE SWMI |
$0.83
|
| Rate for Payer: PHP Commercial |
$2.82
|
| Rate for Payer: PHP Medicare Advantage |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health HMO/PPO |
$2.89
|
| Rate for Payer: Priority Health Medicare |
$0.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.22
|
| Rate for Payer: Railroad Medicare Medicare |
$0.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.92
|
| Rate for Payer: UHC Core |
$2.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.83
|
| Rate for Payer: UHC Exchange |
$0.83
|
| Rate for Payer: UHC Medicare Advantage |
$0.83
|
| Rate for Payer: VA VA |
$0.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.49
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
OP
|
$172.71
|
|
|
Service Code
|
NDC 70436005106
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.02 |
| Max. Negotiated Rate |
$155.44 |
| Rate for Payer: Aetna Commercial |
$146.80
|
| Rate for Payer: Aetna Medicare |
$44.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.97
|
| Rate for Payer: BCBS Complete |
$69.08
|
| Rate for Payer: BCBS MAPPO |
$43.18
|
| Rate for Payer: BCBS Trust/PPO |
$141.98
|
| Rate for Payer: BCN Commercial |
$134.28
|
| Rate for Payer: BCN Medicare Advantage |
$43.18
|
| Rate for Payer: Cash Price |
$138.17
|
| Rate for Payer: Cofinity Commercial |
$148.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.18
|
| Rate for Payer: Healthscope Commercial |
$155.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.80
|
| Rate for Payer: Nomi Health Commercial |
$141.62
|
| Rate for Payer: PACE Senior Care Partners |
$41.02
|
| Rate for Payer: PACE SWMI |
$43.18
|
| Rate for Payer: PHP Commercial |
$146.80
|
| Rate for Payer: PHP Medicare Advantage |
$43.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.26
|
| Rate for Payer: Priority Health HMO/PPO |
$150.26
|
| Rate for Payer: Priority Health Medicare |
$43.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.72
|
| Rate for Payer: Railroad Medicare Medicare |
$43.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.98
|
| Rate for Payer: UHC Core |
$144.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.18
|
| Rate for Payer: UHC Exchange |
$43.18
|
| Rate for Payer: UHC Medicare Advantage |
$43.18
|
| Rate for Payer: VA VA |
$43.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.53
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
OP
|
$136.77
|
|
|
Service Code
|
NDC 60505252201
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.48 |
| Max. Negotiated Rate |
$123.09 |
| Rate for Payer: Aetna Commercial |
$116.25
|
| Rate for Payer: Aetna Medicare |
$35.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.74
|
| Rate for Payer: BCBS Complete |
$54.71
|
| Rate for Payer: BCBS MAPPO |
$34.19
|
| Rate for Payer: BCBS Trust/PPO |
$112.44
|
| Rate for Payer: BCN Commercial |
$106.34
|
| Rate for Payer: BCN Medicare Advantage |
$34.19
|
| Rate for Payer: Cash Price |
$109.42
|
| Rate for Payer: Cofinity Commercial |
$117.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.19
|
| Rate for Payer: Healthscope Commercial |
$123.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.25
|
| Rate for Payer: Nomi Health Commercial |
$112.15
|
| Rate for Payer: PACE Senior Care Partners |
$32.48
|
| Rate for Payer: PACE SWMI |
$34.19
|
| Rate for Payer: PHP Commercial |
$116.25
|
| Rate for Payer: PHP Medicare Advantage |
$34.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.90
|
| Rate for Payer: Priority Health HMO/PPO |
$118.99
|
| Rate for Payer: Priority Health Medicare |
$34.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.64
|
| Rate for Payer: Railroad Medicare Medicare |
$34.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.36
|
| Rate for Payer: UHC Core |
$114.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.19
|
| Rate for Payer: UHC Exchange |
$34.19
|
| Rate for Payer: UHC Medicare Advantage |
$34.19
|
| Rate for Payer: VA VA |
$34.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.58
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
IP
|
$172.71
|
|
|
Service Code
|
NDC 70436005106
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.26 |
| Max. Negotiated Rate |
$155.44 |
| Rate for Payer: Aetna Commercial |
$146.80
|
| Rate for Payer: BCBS Trust/PPO |
$140.98
|
| Rate for Payer: BCN Commercial |
$133.47
|
| Rate for Payer: Cash Price |
$138.17
|
| Rate for Payer: Cofinity Commercial |
$148.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.17
|
| Rate for Payer: Healthscope Commercial |
$155.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.80
|
| Rate for Payer: Nomi Health Commercial |
$141.62
|
| Rate for Payer: PHP Commercial |
$146.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.26
|
| Rate for Payer: Priority Health HMO/PPO |
$150.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.98
|
| Rate for Payer: UHC Core |
$144.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.53
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
IP
|
$136.77
|
|
|
Service Code
|
NDC 60505252201
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$123.09 |
| Rate for Payer: Aetna Commercial |
$116.25
|
| Rate for Payer: BCBS Trust/PPO |
$111.65
|
| Rate for Payer: BCN Commercial |
$105.70
|
| Rate for Payer: Cash Price |
$109.42
|
| Rate for Payer: Cofinity Commercial |
$117.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.42
|
| Rate for Payer: Healthscope Commercial |
$123.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.25
|
| Rate for Payer: Nomi Health Commercial |
$112.15
|
| Rate for Payer: PHP Commercial |
$116.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.90
|
| Rate for Payer: Priority Health HMO/PPO |
$118.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.36
|
| Rate for Payer: UHC Core |
$114.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.58
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
IP
|
$3.32
|
|
|
Service Code
|
NDC 50268017711
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.57
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.82
|
| Rate for Payer: Nomi Health Commercial |
$2.72
|
| Rate for Payer: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health HMO/PPO |
$2.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.92
|
| Rate for Payer: UHC Core |
$2.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.49
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
OP
|
$165.84
|
|
|
Service Code
|
NDC 50268017715
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.39 |
| Max. Negotiated Rate |
$149.26 |
| Rate for Payer: Aetna Commercial |
$140.96
|
| Rate for Payer: Aetna Medicare |
$43.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.83
|
| Rate for Payer: BCBS Complete |
$66.34
|
| Rate for Payer: BCBS MAPPO |
$41.46
|
| Rate for Payer: BCBS Trust/PPO |
$136.34
|
| Rate for Payer: BCN Commercial |
$128.94
|
| Rate for Payer: BCN Medicare Advantage |
$41.46
|
| Rate for Payer: Cash Price |
$132.67
|
| Rate for Payer: Cofinity Commercial |
$142.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.46
|
| Rate for Payer: Healthscope Commercial |
$149.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.96
|
| Rate for Payer: Nomi Health Commercial |
$135.99
|
| Rate for Payer: PACE Senior Care Partners |
$39.39
|
| Rate for Payer: PACE SWMI |
$41.46
|
| Rate for Payer: PHP Commercial |
$140.96
|
| Rate for Payer: PHP Medicare Advantage |
$41.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.80
|
| Rate for Payer: Priority Health HMO/PPO |
$144.28
|
| Rate for Payer: Priority Health Medicare |
$41.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.11
|
| Rate for Payer: Railroad Medicare Medicare |
$41.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.94
|
| Rate for Payer: UHC Core |
$138.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.46
|
| Rate for Payer: UHC Exchange |
$41.46
|
| Rate for Payer: UHC Medicare Advantage |
$41.46
|
| Rate for Payer: VA VA |
$41.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.38
|
|
|
CINACALCET 30 MG TABLET
|
Facility
|
IP
|
$2,496.62
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
38100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,622.80 |
| Max. Negotiated Rate |
$2,246.96 |
| Rate for Payer: Aetna Commercial |
$2,122.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,037.99
|
| Rate for Payer: BCN Commercial |
$1,929.39
|
| Rate for Payer: Cash Price |
$1,997.30
|
| Rate for Payer: Cofinity Commercial |
$2,147.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,997.30
|
| Rate for Payer: Healthscope Commercial |
$2,246.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,872.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,122.13
|
| Rate for Payer: Nomi Health Commercial |
$2,047.23
|
| Rate for Payer: PHP Commercial |
$2,122.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,622.80
|
| Rate for Payer: Priority Health HMO/PPO |
$2,172.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,672.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,197.03
|
| Rate for Payer: UHC Core |
$2,084.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,872.46
|
|
|
CINACALCET 30 MG TABLET
|
Facility
|
OP
|
$2,496.62
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
38100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$592.95 |
| Max. Negotiated Rate |
$2,246.96 |
| Rate for Payer: Aetna Commercial |
$2,122.13
|
| Rate for Payer: Aetna Medicare |
$649.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$780.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$780.19
|
| Rate for Payer: BCBS Complete |
$998.65
|
| Rate for Payer: BCBS MAPPO |
$624.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,052.47
|
| Rate for Payer: BCN Commercial |
$1,941.12
|
| Rate for Payer: BCN Medicare Advantage |
$624.15
|
| Rate for Payer: Cash Price |
$1,997.30
|
| Rate for Payer: Cofinity Commercial |
$2,147.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,997.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.15
|
| Rate for Payer: Healthscope Commercial |
$2,246.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,872.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$717.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,122.13
|
| Rate for Payer: Nomi Health Commercial |
$2,047.23
|
| Rate for Payer: PACE Senior Care Partners |
$592.95
|
| Rate for Payer: PACE SWMI |
$624.15
|
| Rate for Payer: PHP Commercial |
$2,122.13
|
| Rate for Payer: PHP Medicare Advantage |
$624.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,622.80
|
| Rate for Payer: Priority Health HMO/PPO |
$2,172.06
|
| Rate for Payer: Priority Health Medicare |
$630.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,672.74
|
| Rate for Payer: Railroad Medicare Medicare |
$624.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,197.03
|
| Rate for Payer: UHC Core |
$2,084.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$624.15
|
| Rate for Payer: UHC Exchange |
$624.15
|
| Rate for Payer: UHC Medicare Advantage |
$624.15
|
| Rate for Payer: VA VA |
$624.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,872.46
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$729.73
|
|
|
Service Code
|
NDC 00781618667
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$474.32 |
| Max. Negotiated Rate |
$656.76 |
| Rate for Payer: Aetna Commercial |
$620.27
|
| Rate for Payer: BCBS Trust/PPO |
$595.68
|
| Rate for Payer: BCN Commercial |
$563.94
|
| Rate for Payer: Cash Price |
$583.78
|
| Rate for Payer: Cofinity Commercial |
$627.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.78
|
| Rate for Payer: Healthscope Commercial |
$656.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.27
|
| Rate for Payer: Nomi Health Commercial |
$598.38
|
| Rate for Payer: PHP Commercial |
$620.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.32
|
| Rate for Payer: Priority Health HMO/PPO |
$634.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$642.16
|
| Rate for Payer: UHC Core |
$609.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.30
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$729.73
|
|
|
Service Code
|
NDC 62756042790
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$474.32 |
| Max. Negotiated Rate |
$656.76 |
| Rate for Payer: Aetna Commercial |
$620.27
|
| Rate for Payer: BCBS Trust/PPO |
$595.68
|
| Rate for Payer: BCN Commercial |
$563.94
|
| Rate for Payer: Cash Price |
$583.78
|
| Rate for Payer: Cofinity Commercial |
$627.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.78
|
| Rate for Payer: Healthscope Commercial |
$656.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.27
|
| Rate for Payer: Nomi Health Commercial |
$598.38
|
| Rate for Payer: PHP Commercial |
$620.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.32
|
| Rate for Payer: Priority Health HMO/PPO |
$634.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$642.16
|
| Rate for Payer: UHC Core |
$609.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.30
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$399.95
|
|
|
Service Code
|
NDC 43598032675
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.97 |
| Max. Negotiated Rate |
$359.95 |
| Rate for Payer: Aetna Commercial |
$339.96
|
| Rate for Payer: BCBS Trust/PPO |
$326.48
|
| Rate for Payer: BCN Commercial |
$309.08
|
| Rate for Payer: Cash Price |
$319.96
|
| Rate for Payer: Cofinity Commercial |
$343.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.96
|
| Rate for Payer: Healthscope Commercial |
$359.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.96
|
| Rate for Payer: Nomi Health Commercial |
$327.96
|
| Rate for Payer: PHP Commercial |
$339.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.97
|
| Rate for Payer: Priority Health HMO/PPO |
$347.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.96
|
| Rate for Payer: UHC Core |
$333.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.96
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$399.95
|
|
|
Service Code
|
NDC 43598032675
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.99 |
| Max. Negotiated Rate |
$359.95 |
| Rate for Payer: Aetna Commercial |
$339.96
|
| Rate for Payer: Aetna Medicare |
$103.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.98
|
| Rate for Payer: BCBS Complete |
$159.98
|
| Rate for Payer: BCBS MAPPO |
$99.99
|
| Rate for Payer: BCBS Trust/PPO |
$328.80
|
| Rate for Payer: BCN Commercial |
$310.96
|
| Rate for Payer: BCN Medicare Advantage |
$99.99
|
| Rate for Payer: Cash Price |
$319.96
|
| Rate for Payer: Cofinity Commercial |
$343.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.99
|
| Rate for Payer: Healthscope Commercial |
$359.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.96
|
| Rate for Payer: Nomi Health Commercial |
$327.96
|
| Rate for Payer: PACE Senior Care Partners |
$94.99
|
| Rate for Payer: PACE SWMI |
$99.99
|
| Rate for Payer: PHP Commercial |
$339.96
|
| Rate for Payer: PHP Medicare Advantage |
$99.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.97
|
| Rate for Payer: Priority Health HMO/PPO |
$347.96
|
| Rate for Payer: Priority Health Medicare |
$100.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.97
|
| Rate for Payer: Railroad Medicare Medicare |
$99.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.96
|
| Rate for Payer: UHC Core |
$333.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.99
|
| Rate for Payer: UHC Exchange |
$99.99
|
| Rate for Payer: UHC Medicare Advantage |
$99.99
|
| Rate for Payer: VA VA |
$99.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.96
|
|
