|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$36.57
|
|
|
Service Code
|
NDC 00054327099
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$32.91 |
| Rate for Payer: Aetna Commercial |
$31.08
|
| Rate for Payer: BCBS Trust/PPO |
$30.20
|
| Rate for Payer: BCN Commercial |
$30.20
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cofinity Commercial |
$31.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Healthscope Commercial |
$32.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.08
|
| Rate for Payer: Nomi Health Commercial |
$29.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.43
|
| Rate for Payer: PHP Commercial |
$31.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.18
|
| Rate for Payer: UHC Core |
$30.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.43
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$14.55
|
|
|
Service Code
|
NDC 60432026415
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Aetna Commercial |
$12.37
|
| Rate for Payer: Aetna Medicare |
$3.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.55
|
| Rate for Payer: BCBS Complete |
$2.69
|
| Rate for Payer: BCBS MAPPO |
$3.64
|
| Rate for Payer: BCBS Trust/PPO |
$11.96
|
| Rate for Payer: BCN Commercial |
$11.96
|
| Rate for Payer: BCN Medicare Advantage |
$3.64
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cofinity Commercial |
$12.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$13.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.91
|
| Rate for Payer: Mclaren Medicaid |
$2.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.82
|
| Rate for Payer: Meridian Medicaid |
$2.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.37
|
| Rate for Payer: Nomi Health Commercial |
$11.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.91
|
| Rate for Payer: PACE Senior Care Partners |
$3.46
|
| Rate for Payer: PACE SWMI |
$3.64
|
| Rate for Payer: PHP Commercial |
$12.37
|
| Rate for Payer: PHP Medicare Advantage |
$3.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.66
|
| Rate for Payer: Priority Health Medicare |
$3.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.13
|
| Rate for Payer: Railroad Medicare Medicare |
$3.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.80
|
| Rate for Payer: UHC Core |
$12.15
|
| Rate for Payer: UHC Exchange |
$3.64
|
| Rate for Payer: UHC Medicaid |
$2.57
|
| Rate for Payer: UHC Medicare Advantage |
$3.64
|
| Rate for Payer: UHCCP Medicaid |
$2.57
|
| Rate for Payer: VA VA |
$3.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.91
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$36.57
|
|
|
Service Code
|
NDC 00054327099
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$32.91 |
| Rate for Payer: Aetna Commercial |
$31.08
|
| Rate for Payer: Aetna Medicare |
$9.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.43
|
| Rate for Payer: BCBS Complete |
$6.77
|
| Rate for Payer: BCBS MAPPO |
$9.14
|
| Rate for Payer: BCBS Trust/PPO |
$30.06
|
| Rate for Payer: BCN Commercial |
$30.06
|
| Rate for Payer: BCN Medicare Advantage |
$9.14
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cofinity Commercial |
$31.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.14
|
| Rate for Payer: Healthscope Commercial |
$32.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.43
|
| Rate for Payer: Mclaren Medicaid |
$6.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.60
|
| Rate for Payer: Meridian Medicaid |
$6.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.08
|
| Rate for Payer: Nomi Health Commercial |
$29.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.43
|
| Rate for Payer: PACE Senior Care Partners |
$8.69
|
| Rate for Payer: PACE SWMI |
$9.14
|
| Rate for Payer: PHP Commercial |
$31.08
|
| Rate for Payer: PHP Medicare Advantage |
$9.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.82
|
| Rate for Payer: Priority Health Medicare |
$9.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.45
|
| Rate for Payer: Railroad Medicare Medicare |
$9.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.18
|
| Rate for Payer: UHC Core |
$30.54
|
| Rate for Payer: UHC Exchange |
$9.14
|
| Rate for Payer: UHC Medicaid |
$6.45
|
| Rate for Payer: UHC Medicare Advantage |
$9.14
|
| Rate for Payer: UHCCP Medicaid |
$6.45
|
| Rate for Payer: VA VA |
$9.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.43
|
|
|
FLU VACCINE TS2025-26(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$234.60
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
212355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.36 |
| Max. Negotiated Rate |
$211.14 |
| Rate for Payer: Aetna Commercial |
$199.41
|
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.31
|
| Rate for Payer: BCBS Complete |
$43.42
|
| Rate for Payer: BCBS MAPPO |
$58.65
|
| Rate for Payer: BCBS Trust/PPO |
$192.86
|
| Rate for Payer: BCN Commercial |
$192.86
|
| Rate for Payer: BCN Medicare Advantage |
$58.65
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$201.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.65
|
| Rate for Payer: Healthscope Commercial |
$211.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.95
|
| Rate for Payer: Mclaren Medicaid |
$41.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.58
|
| Rate for Payer: Meridian Medicaid |
$43.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.41
|
| Rate for Payer: Nomi Health Commercial |
$192.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.95
|
| Rate for Payer: PACE Senior Care Partners |
$55.72
|
| Rate for Payer: PACE SWMI |
$58.65
|
| Rate for Payer: PHP Commercial |
$199.41
|
| Rate for Payer: PHP Medicare Advantage |
$58.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$204.10
|
| Rate for Payer: Priority Health Medicare |
$59.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.28
|
| Rate for Payer: Railroad Medicare Medicare |
$58.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.45
|
| Rate for Payer: UHC Core |
$195.89
|
| Rate for Payer: UHC Exchange |
$58.65
|
| Rate for Payer: UHC Medicaid |
$41.36
|
| Rate for Payer: UHC Medicare Advantage |
$58.65
|
| Rate for Payer: UHCCP Medicaid |
$41.36
|
| Rate for Payer: VA VA |
$58.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.95
|
|
|
FLU VACCINE TS2025-26(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$234.60
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
212355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.28 |
| Max. Negotiated Rate |
$211.14 |
| Rate for Payer: Aetna Commercial |
$199.41
|
| Rate for Payer: BCBS Trust/PPO |
$193.76
|
| Rate for Payer: BCN Commercial |
$193.76
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$201.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.68
|
| Rate for Payer: Healthscope Commercial |
$211.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.41
|
| Rate for Payer: Nomi Health Commercial |
$192.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.95
|
| Rate for Payer: PHP Commercial |
$199.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$204.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.45
|
| Rate for Payer: UHC Core |
$195.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.95
|
|
|
FLU VACCINE TS 2025-26(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE
|
Facility
|
IP
|
$82.13
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
212359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.16 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$69.81
|
| Rate for Payer: BCBS Trust/PPO |
$67.83
|
| Rate for Payer: BCN Commercial |
$67.83
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cofinity Commercial |
$70.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.70
|
| Rate for Payer: Healthscope Commercial |
$73.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.81
|
| Rate for Payer: Nomi Health Commercial |
$67.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.60
|
| Rate for Payer: PHP Commercial |
$69.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.27
|
| Rate for Payer: UHC Core |
$68.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.60
|
|
|
FLU VACCINE TS 2025-26(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE
|
Facility
|
OP
|
$82.13
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
212359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$69.81
|
| Rate for Payer: Aetna Medicare |
$21.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.67
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$20.53
|
| Rate for Payer: BCBS Trust/PPO |
$67.52
|
| Rate for Payer: BCN Commercial |
$67.52
|
| Rate for Payer: BCN Medicare Advantage |
$20.53
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cofinity Commercial |
$70.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.53
|
| Rate for Payer: Healthscope Commercial |
$73.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.60
|
| Rate for Payer: Mclaren Medicaid |
$14.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.56
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.81
|
| Rate for Payer: Nomi Health Commercial |
$67.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.60
|
| Rate for Payer: PACE Senior Care Partners |
$19.51
|
| Rate for Payer: PACE SWMI |
$20.53
|
| Rate for Payer: PHP Commercial |
$69.81
|
| Rate for Payer: PHP Medicare Advantage |
$20.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.45
|
| Rate for Payer: Priority Health Medicare |
$20.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.16
|
| Rate for Payer: Railroad Medicare Medicare |
$20.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.27
|
| Rate for Payer: UHC Core |
$68.58
|
| Rate for Payer: UHC Exchange |
$20.53
|
| Rate for Payer: UHC Medicaid |
$14.48
|
| Rate for Payer: UHC Medicare Advantage |
$20.53
|
| Rate for Payer: UHCCP Medicaid |
$14.48
|
| Rate for Payer: VA VA |
$20.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.60
|
|
|
FLUVOXAMINE 50 MG TABLET
|
Facility
|
OP
|
$206.15
|
|
|
Service Code
|
NDC 62559015901
|
| Hospital Charge Code |
10085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.34 |
| Max. Negotiated Rate |
$185.53 |
| Rate for Payer: Aetna Commercial |
$175.23
|
| Rate for Payer: Aetna Medicare |
$53.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.42
|
| Rate for Payer: BCBS Complete |
$38.16
|
| Rate for Payer: BCBS MAPPO |
$51.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.48
|
| Rate for Payer: BCN Commercial |
$169.48
|
| Rate for Payer: BCN Medicare Advantage |
$51.54
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Cofinity Commercial |
$177.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.54
|
| Rate for Payer: Healthscope Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.61
|
| Rate for Payer: Mclaren Medicaid |
$36.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.11
|
| Rate for Payer: Meridian Medicaid |
$38.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.23
|
| Rate for Payer: Nomi Health Commercial |
$169.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.61
|
| Rate for Payer: PACE Senior Care Partners |
$48.96
|
| Rate for Payer: PACE SWMI |
$51.54
|
| Rate for Payer: PHP Commercial |
$175.23
|
| Rate for Payer: PHP Medicare Advantage |
$51.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$179.35
|
| Rate for Payer: Priority Health Medicare |
$52.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.48
|
| Rate for Payer: Railroad Medicare Medicare |
$51.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.41
|
| Rate for Payer: UHC Core |
$172.14
|
| Rate for Payer: UHC Exchange |
$51.54
|
| Rate for Payer: UHC Medicaid |
$36.34
|
| Rate for Payer: UHC Medicare Advantage |
$51.54
|
| Rate for Payer: UHCCP Medicaid |
$36.34
|
| Rate for Payer: VA VA |
$51.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.61
|
|
|
FLUVOXAMINE 50 MG TABLET
|
Facility
|
IP
|
$206.15
|
|
|
Service Code
|
NDC 62559015901
|
| Hospital Charge Code |
10085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.48 |
| Max. Negotiated Rate |
$185.53 |
| Rate for Payer: Aetna Commercial |
$175.23
|
| Rate for Payer: BCBS Trust/PPO |
$170.26
|
| Rate for Payer: BCN Commercial |
$170.26
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Cofinity Commercial |
$177.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.92
|
| Rate for Payer: Healthscope Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.23
|
| Rate for Payer: Nomi Health Commercial |
$169.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.61
|
| Rate for Payer: PHP Commercial |
$175.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$179.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.41
|
| Rate for Payer: UHC Core |
$172.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.61
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
NDC 69315012701
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.62 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna Commercial |
$142.80
|
| Rate for Payer: Aetna Medicare |
$43.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.50
|
| Rate for Payer: BCBS Complete |
$31.10
|
| Rate for Payer: BCBS MAPPO |
$42.00
|
| Rate for Payer: BCBS Trust/PPO |
$138.11
|
| Rate for Payer: BCN Commercial |
$138.11
|
| Rate for Payer: BCN Medicare Advantage |
$42.00
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$144.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.00
|
| Rate for Payer: Healthscope Commercial |
$151.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.00
|
| Rate for Payer: Mclaren Medicaid |
$29.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.10
|
| Rate for Payer: Meridian Medicaid |
$31.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.80
|
| Rate for Payer: Nomi Health Commercial |
$137.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: PACE Senior Care Partners |
$39.90
|
| Rate for Payer: PACE SWMI |
$42.00
|
| Rate for Payer: PHP Commercial |
$142.80
|
| Rate for Payer: PHP Medicare Advantage |
$42.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$146.16
|
| Rate for Payer: Priority Health Medicare |
$42.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.93
|
| Rate for Payer: Railroad Medicare Medicare |
$42.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.84
|
| Rate for Payer: UHC Core |
$140.28
|
| Rate for Payer: UHC Exchange |
$42.00
|
| Rate for Payer: UHC Medicaid |
$29.62
|
| Rate for Payer: UHC Medicare Advantage |
$42.00
|
| Rate for Payer: UHCCP Medicaid |
$29.62
|
| Rate for Payer: VA VA |
$42.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.00
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
NDC 11534016501
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.90 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: BCBS Trust/PPO |
$185.00
|
| Rate for Payer: BCN Commercial |
$185.00
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.20
|
| Rate for Payer: Healthscope Commercial |
$201.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.40
|
| Rate for Payer: Nomi Health Commercial |
$183.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.00
|
| Rate for Payer: PHP Commercial |
$190.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$194.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.12
|
| Rate for Payer: UHC Core |
$187.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.00
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
NDC 69315012701
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna Commercial |
$142.80
|
| Rate for Payer: BCBS Trust/PPO |
$138.75
|
| Rate for Payer: BCN Commercial |
$138.75
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$144.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Healthscope Commercial |
$151.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.80
|
| Rate for Payer: Nomi Health Commercial |
$137.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: PHP Commercial |
$142.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$146.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.84
|
| Rate for Payer: UHC Core |
$140.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.00
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$1.65
|
|
|
Service Code
|
NDC 60687068111
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna Commercial |
$1.40
|
| Rate for Payer: Aetna Medicare |
$0.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.52
|
| Rate for Payer: BCBS Complete |
$0.31
|
| Rate for Payer: BCBS MAPPO |
$0.41
|
| Rate for Payer: BCBS Trust/PPO |
$1.36
|
| Rate for Payer: BCN Commercial |
$1.36
|
| Rate for Payer: BCN Medicare Advantage |
$0.41
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Cofinity Commercial |
$1.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.41
|
| Rate for Payer: Healthscope Commercial |
$1.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.24
|
| Rate for Payer: Mclaren Medicaid |
$0.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.43
|
| Rate for Payer: Meridian Medicaid |
$0.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.40
|
| Rate for Payer: Nomi Health Commercial |
$1.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.24
|
| Rate for Payer: PACE Senior Care Partners |
$0.39
|
| Rate for Payer: PACE SWMI |
$0.41
|
| Rate for Payer: PHP Commercial |
$1.40
|
| Rate for Payer: PHP Medicare Advantage |
$0.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.44
|
| Rate for Payer: Priority Health Medicare |
$0.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.15
|
| Rate for Payer: Railroad Medicare Medicare |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.45
|
| Rate for Payer: UHC Core |
$1.38
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Medicaid |
$0.29
|
| Rate for Payer: UHC Medicare Advantage |
$0.41
|
| Rate for Payer: UHCCP Medicaid |
$0.29
|
| Rate for Payer: VA VA |
$0.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.24
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$1.65
|
|
|
Service Code
|
NDC 60687068111
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna Commercial |
$1.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.36
|
| Rate for Payer: BCN Commercial |
$1.36
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Cofinity Commercial |
$1.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.32
|
| Rate for Payer: Healthscope Commercial |
$1.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.40
|
| Rate for Payer: Nomi Health Commercial |
$1.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.24
|
| Rate for Payer: PHP Commercial |
$1.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.45
|
| Rate for Payer: UHC Core |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.24
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
NDC 60687068101
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.09 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna Commercial |
$140.25
|
| Rate for Payer: Aetna Medicare |
$42.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.56
|
| Rate for Payer: BCBS Complete |
$30.54
|
| Rate for Payer: BCBS MAPPO |
$41.25
|
| Rate for Payer: BCBS Trust/PPO |
$135.65
|
| Rate for Payer: BCN Commercial |
$135.65
|
| Rate for Payer: BCN Medicare Advantage |
$41.25
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.25
|
| Rate for Payer: Healthscope Commercial |
$148.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.75
|
| Rate for Payer: Mclaren Medicaid |
$29.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.31
|
| Rate for Payer: Meridian Medicaid |
$30.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.25
|
| Rate for Payer: Nomi Health Commercial |
$135.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.75
|
| Rate for Payer: PACE Senior Care Partners |
$39.19
|
| Rate for Payer: PACE SWMI |
$41.25
|
| Rate for Payer: PHP Commercial |
$140.25
|
| Rate for Payer: PHP Medicare Advantage |
$41.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.55
|
| Rate for Payer: Priority Health Medicare |
$41.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.84
|
| Rate for Payer: Railroad Medicare Medicare |
$41.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.20
|
| Rate for Payer: UHC Core |
$137.78
|
| Rate for Payer: UHC Exchange |
$41.25
|
| Rate for Payer: UHC Medicaid |
$29.09
|
| Rate for Payer: UHC Medicare Advantage |
$41.25
|
| Rate for Payer: UHCCP Medicaid |
$29.09
|
| Rate for Payer: VA VA |
$41.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.75
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
NDC 11534016501
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.49 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: Aetna Medicare |
$58.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.00
|
| Rate for Payer: BCBS Complete |
$41.46
|
| Rate for Payer: BCBS MAPPO |
$56.00
|
| Rate for Payer: BCBS Trust/PPO |
$184.15
|
| Rate for Payer: BCN Commercial |
$184.15
|
| Rate for Payer: BCN Medicare Advantage |
$56.00
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$201.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.00
|
| Rate for Payer: Mclaren Medicaid |
$39.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.80
|
| Rate for Payer: Meridian Medicaid |
$41.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.40
|
| Rate for Payer: Nomi Health Commercial |
$183.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.00
|
| Rate for Payer: PACE Senior Care Partners |
$53.20
|
| Rate for Payer: PACE SWMI |
$56.00
|
| Rate for Payer: PHP Commercial |
$190.40
|
| Rate for Payer: PHP Medicare Advantage |
$56.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$194.88
|
| Rate for Payer: Priority Health Medicare |
$56.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.90
|
| Rate for Payer: Railroad Medicare Medicare |
$56.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.12
|
| Rate for Payer: UHC Core |
$187.04
|
| Rate for Payer: UHC Exchange |
$56.00
|
| Rate for Payer: UHC Medicaid |
$39.49
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: UHCCP Medicaid |
$39.49
|
| Rate for Payer: VA VA |
$56.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.00
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$149.60
|
|
|
Service Code
|
NDC 00904722461
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.37 |
| Max. Negotiated Rate |
$134.64 |
| Rate for Payer: Aetna Commercial |
$127.16
|
| Rate for Payer: Aetna Medicare |
$38.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.75
|
| Rate for Payer: BCBS Complete |
$27.69
|
| Rate for Payer: BCBS MAPPO |
$37.40
|
| Rate for Payer: BCBS Trust/PPO |
$122.99
|
| Rate for Payer: BCN Commercial |
$122.99
|
| Rate for Payer: BCN Medicare Advantage |
$37.40
|
| Rate for Payer: Cash Price |
$119.68
|
| Rate for Payer: Cofinity Commercial |
$128.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.40
|
| Rate for Payer: Healthscope Commercial |
$134.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.20
|
| Rate for Payer: Mclaren Medicaid |
$26.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.27
|
| Rate for Payer: Meridian Medicaid |
$27.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.16
|
| Rate for Payer: Nomi Health Commercial |
$122.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.20
|
| Rate for Payer: PACE Senior Care Partners |
$35.53
|
| Rate for Payer: PACE SWMI |
$37.40
|
| Rate for Payer: PHP Commercial |
$127.16
|
| Rate for Payer: PHP Medicare Advantage |
$37.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.15
|
| Rate for Payer: Priority Health Medicare |
$37.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.12
|
| Rate for Payer: Railroad Medicare Medicare |
$37.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.65
|
| Rate for Payer: UHC Core |
$124.92
|
| Rate for Payer: UHC Exchange |
$37.40
|
| Rate for Payer: UHC Medicaid |
$26.37
|
| Rate for Payer: UHC Medicare Advantage |
$37.40
|
| Rate for Payer: UHCCP Medicaid |
$26.37
|
| Rate for Payer: VA VA |
$37.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.20
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$149.60
|
|
|
Service Code
|
NDC 00904722461
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.12 |
| Max. Negotiated Rate |
$134.64 |
| Rate for Payer: Aetna Commercial |
$127.16
|
| Rate for Payer: BCBS Trust/PPO |
$123.55
|
| Rate for Payer: BCN Commercial |
$123.55
|
| Rate for Payer: Cash Price |
$119.68
|
| Rate for Payer: Cofinity Commercial |
$128.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.68
|
| Rate for Payer: Healthscope Commercial |
$134.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.16
|
| Rate for Payer: Nomi Health Commercial |
$122.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.20
|
| Rate for Payer: PHP Commercial |
$127.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.65
|
| Rate for Payer: UHC Core |
$124.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.20
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
NDC 60687068101
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna Commercial |
$140.25
|
| Rate for Payer: BCBS Trust/PPO |
$136.27
|
| Rate for Payer: BCN Commercial |
$136.27
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.00
|
| Rate for Payer: Healthscope Commercial |
$148.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.25
|
| Rate for Payer: Nomi Health Commercial |
$135.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.75
|
| Rate for Payer: PHP Commercial |
$140.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.20
|
| Rate for Payer: UHC Core |
$137.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.75
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$206.46
|
|
|
Service Code
|
HCPCS J1808
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna Commercial |
$9.67
|
| Rate for Payer: Aetna Commercial |
$14.51
|
| Rate for Payer: Aetna Commercial |
$24.18
|
| Rate for Payer: Aetna Commercial |
$134.73
|
| Rate for Payer: Aetna Commercial |
$19.35
|
| Rate for Payer: Aetna Medicare |
$41.21
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna Medicare |
$1.48
|
| Rate for Payer: Aetna Medicare |
$53.68
|
| Rate for Payer: Aetna Medicare |
$2.96
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: Aetna Medicare |
$5.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.56
|
| Rate for Payer: BCBS Complete |
$1.05
|
| Rate for Payer: BCBS Complete |
$2.11
|
| Rate for Payer: BCBS Complete |
$29.34
|
| Rate for Payer: BCBS Complete |
$38.22
|
| Rate for Payer: BCBS Complete |
$4.21
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: BCBS Complete |
$5.27
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS MAPPO |
$5.69
|
| Rate for Payer: BCBS MAPPO |
$51.62
|
| Rate for Payer: BCBS MAPPO |
$2.85
|
| Rate for Payer: BCBS MAPPO |
$7.11
|
| Rate for Payer: BCBS MAPPO |
$39.63
|
| Rate for Payer: BCBS MAPPO |
$1.42
|
| Rate for Payer: BCBS Trust/PPO |
$4.68
|
| Rate for Payer: BCBS Trust/PPO |
$18.71
|
| Rate for Payer: BCBS Trust/PPO |
$23.39
|
| Rate for Payer: BCBS Trust/PPO |
$169.73
|
| Rate for Payer: BCBS Trust/PPO |
$9.36
|
| Rate for Payer: BCBS Trust/PPO |
$130.31
|
| Rate for Payer: BCBS Trust/PPO |
$14.03
|
| Rate for Payer: BCN Commercial |
$130.31
|
| Rate for Payer: BCN Commercial |
$9.36
|
| Rate for Payer: BCN Commercial |
$4.68
|
| Rate for Payer: BCN Commercial |
$23.39
|
| Rate for Payer: BCN Commercial |
$18.71
|
| Rate for Payer: BCN Commercial |
$14.03
|
| Rate for Payer: BCN Commercial |
$169.73
|
| Rate for Payer: BCN Medicare Advantage |
$51.62
|
| Rate for Payer: BCN Medicare Advantage |
$39.63
|
| Rate for Payer: BCN Medicare Advantage |
$1.42
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: BCN Medicare Advantage |
$2.85
|
| Rate for Payer: BCN Medicare Advantage |
$7.11
|
| Rate for Payer: BCN Medicare Advantage |
$5.69
|
| Rate for Payer: Cash Price |
$18.21
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cash Price |
$22.76
|
| Rate for Payer: Cash Price |
$126.81
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Cofinity Commercial |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$19.57
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Cofinity Commercial |
$24.47
|
| Rate for Payer: Cofinity Commercial |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$14.68
|
| Rate for Payer: Cofinity Commercial |
$4.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.69
|
| Rate for Payer: Healthscope Commercial |
$25.61
|
| Rate for Payer: Healthscope Commercial |
$5.12
|
| Rate for Payer: Healthscope Commercial |
$20.48
|
| Rate for Payer: Healthscope Commercial |
$15.36
|
| Rate for Payer: Healthscope Commercial |
$142.66
|
| Rate for Payer: Healthscope Commercial |
$10.24
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.27
|
| Rate for Payer: Mclaren Medicaid |
$5.02
|
| Rate for Payer: Mclaren Medicaid |
$27.95
|
| Rate for Payer: Mclaren Medicaid |
$2.01
|
| Rate for Payer: Mclaren Medicaid |
$36.40
|
| Rate for Payer: Mclaren Medicaid |
$4.01
|
| Rate for Payer: Mclaren Medicaid |
$1.00
|
| Rate for Payer: Mclaren Medicaid |
$3.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.20
|
| Rate for Payer: Meridian Medicaid |
$29.34
|
| Rate for Payer: Meridian Medicaid |
$2.11
|
| Rate for Payer: Meridian Medicaid |
$3.16
|
| Rate for Payer: Meridian Medicaid |
$38.22
|
| Rate for Payer: Meridian Medicaid |
$4.21
|
| Rate for Payer: Meridian Medicaid |
$5.27
|
| Rate for Payer: Meridian Medicaid |
$1.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.18
|
| Rate for Payer: Nomi Health Commercial |
$14.00
|
| Rate for Payer: Nomi Health Commercial |
$18.66
|
| Rate for Payer: Nomi Health Commercial |
$169.30
|
| Rate for Payer: Nomi Health Commercial |
$129.98
|
| Rate for Payer: Nomi Health Commercial |
$9.33
|
| Rate for Payer: Nomi Health Commercial |
$23.33
|
| Rate for Payer: Nomi Health Commercial |
$4.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.34
|
| Rate for Payer: PACE Senior Care Partners |
$5.41
|
| Rate for Payer: PACE Senior Care Partners |
$37.65
|
| Rate for Payer: PACE Senior Care Partners |
$2.70
|
| Rate for Payer: PACE Senior Care Partners |
$6.76
|
| Rate for Payer: PACE Senior Care Partners |
$4.05
|
| Rate for Payer: PACE Senior Care Partners |
$1.35
|
| Rate for Payer: PACE Senior Care Partners |
$49.03
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PACE SWMI |
$7.11
|
| Rate for Payer: PACE SWMI |
$5.69
|
| Rate for Payer: PACE SWMI |
$39.63
|
| Rate for Payer: PACE SWMI |
$51.62
|
| Rate for Payer: PACE SWMI |
$1.42
|
| Rate for Payer: PACE SWMI |
$2.85
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Commercial |
$19.35
|
| Rate for Payer: PHP Commercial |
$134.73
|
| Rate for Payer: PHP Commercial |
$24.18
|
| Rate for Payer: PHP Commercial |
$9.67
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: PHP Medicare Advantage |
$39.63
|
| Rate for Payer: PHP Medicare Advantage |
$5.69
|
| Rate for Payer: PHP Medicare Advantage |
$2.85
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: PHP Medicare Advantage |
$51.62
|
| Rate for Payer: PHP Medicare Advantage |
$7.11
|
| Rate for Payer: PHP Medicare Advantage |
$1.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$137.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$179.62
|
| Rate for Payer: Priority Health Medicare |
$7.18
|
| Rate for Payer: Priority Health Medicare |
$1.44
|
| Rate for Payer: Priority Health Medicare |
$5.75
|
| Rate for Payer: Priority Health Medicare |
$4.31
|
| Rate for Payer: Priority Health Medicare |
$40.02
|
| Rate for Payer: Priority Health Medicare |
$52.13
|
| Rate for Payer: Priority Health Medicare |
$2.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.32
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: Railroad Medicare Medicare |
$5.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1.42
|
| Rate for Payer: Railroad Medicare Medicare |
$2.85
|
| Rate for Payer: Railroad Medicare Medicare |
$7.11
|
| Rate for Payer: Railroad Medicare Medicare |
$39.63
|
| Rate for Payer: Railroad Medicare Medicare |
$51.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.01
|
| Rate for Payer: UHC Core |
$172.39
|
| Rate for Payer: UHC Core |
$9.50
|
| Rate for Payer: UHC Core |
$14.25
|
| Rate for Payer: UHC Core |
$23.76
|
| Rate for Payer: UHC Core |
$4.75
|
| Rate for Payer: UHC Core |
$132.36
|
| Rate for Payer: UHC Core |
$19.00
|
| Rate for Payer: UHC Exchange |
$39.63
|
| Rate for Payer: UHC Exchange |
$5.69
|
| Rate for Payer: UHC Exchange |
$2.85
|
| Rate for Payer: UHC Exchange |
$7.11
|
| Rate for Payer: UHC Exchange |
$51.62
|
| Rate for Payer: UHC Exchange |
$4.27
|
| Rate for Payer: UHC Exchange |
$1.42
|
| Rate for Payer: UHC Medicaid |
$1.00
|
| Rate for Payer: UHC Medicaid |
$5.02
|
| Rate for Payer: UHC Medicaid |
$3.01
|
| Rate for Payer: UHC Medicaid |
$2.01
|
| Rate for Payer: UHC Medicaid |
$27.95
|
| Rate for Payer: UHC Medicaid |
$4.01
|
| Rate for Payer: UHC Medicaid |
$36.40
|
| Rate for Payer: UHC Medicare Advantage |
$39.63
|
| Rate for Payer: UHC Medicare Advantage |
$1.42
|
| Rate for Payer: UHC Medicare Advantage |
$2.85
|
| Rate for Payer: UHC Medicare Advantage |
$51.62
|
| Rate for Payer: UHC Medicare Advantage |
$7.11
|
| Rate for Payer: UHC Medicare Advantage |
$5.69
|
| Rate for Payer: UHC Medicare Advantage |
$4.27
|
| Rate for Payer: UHCCP Medicaid |
$2.01
|
| Rate for Payer: UHCCP Medicaid |
$1.00
|
| Rate for Payer: UHCCP Medicaid |
$27.95
|
| Rate for Payer: UHCCP Medicaid |
$36.40
|
| Rate for Payer: UHCCP Medicaid |
$4.01
|
| Rate for Payer: UHCCP Medicaid |
$5.02
|
| Rate for Payer: UHCCP Medicaid |
$3.01
|
| Rate for Payer: VA VA |
$2.85
|
| Rate for Payer: VA VA |
$7.11
|
| Rate for Payer: VA VA |
$4.27
|
| Rate for Payer: VA VA |
$5.69
|
| Rate for Payer: VA VA |
$1.42
|
| Rate for Payer: VA VA |
$39.63
|
| Rate for Payer: VA VA |
$51.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$5.69
|
|
|
Service Code
|
HCPCS J1808
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna Commercial |
$134.73
|
| Rate for Payer: Aetna Commercial |
$14.51
|
| Rate for Payer: Aetna Commercial |
$19.35
|
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna Commercial |
$9.67
|
| Rate for Payer: Aetna Commercial |
$24.18
|
| Rate for Payer: BCBS Trust/PPO |
$4.70
|
| Rate for Payer: BCBS Trust/PPO |
$130.91
|
| Rate for Payer: BCBS Trust/PPO |
$23.50
|
| Rate for Payer: BCBS Trust/PPO |
$9.40
|
| Rate for Payer: BCBS Trust/PPO |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$14.10
|
| Rate for Payer: BCBS Trust/PPO |
$170.52
|
| Rate for Payer: BCN Commercial |
$14.10
|
| Rate for Payer: BCN Commercial |
$23.50
|
| Rate for Payer: BCN Commercial |
$4.70
|
| Rate for Payer: BCN Commercial |
$18.80
|
| Rate for Payer: BCN Commercial |
$130.91
|
| Rate for Payer: BCN Commercial |
$170.52
|
| Rate for Payer: BCN Commercial |
$9.40
|
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cash Price |
$18.21
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cash Price |
$22.76
|
| Rate for Payer: Cash Price |
$126.81
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Cofinity Commercial |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$19.57
|
| Rate for Payer: Cofinity Commercial |
$14.68
|
| Rate for Payer: Cofinity Commercial |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$4.89
|
| Rate for Payer: Cofinity Commercial |
$24.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$142.66
|
| Rate for Payer: Healthscope Commercial |
$15.36
|
| Rate for Payer: Healthscope Commercial |
$25.61
|
| Rate for Payer: Healthscope Commercial |
$20.48
|
| Rate for Payer: Healthscope Commercial |
$10.24
|
| Rate for Payer: Healthscope Commercial |
$5.12
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.51
|
| Rate for Payer: Nomi Health Commercial |
$169.30
|
| Rate for Payer: Nomi Health Commercial |
$9.33
|
| Rate for Payer: Nomi Health Commercial |
$4.67
|
| Rate for Payer: Nomi Health Commercial |
$23.33
|
| Rate for Payer: Nomi Health Commercial |
$18.66
|
| Rate for Payer: Nomi Health Commercial |
$14.00
|
| Rate for Payer: Nomi Health Commercial |
$129.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.80
|
| Rate for Payer: PHP Commercial |
$9.67
|
| Rate for Payer: PHP Commercial |
$134.73
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Commercial |
$19.35
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: PHP Commercial |
$24.18
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$137.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$179.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.02
|
| Rate for Payer: UHC Core |
$9.50
|
| Rate for Payer: UHC Core |
$23.76
|
| Rate for Payer: UHC Core |
$132.36
|
| Rate for Payer: UHC Core |
$14.25
|
| Rate for Payer: UHC Core |
$19.00
|
| Rate for Payer: UHC Core |
$4.75
|
| Rate for Payer: UHC Core |
$172.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.34
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,493.96
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
22185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,039.80 |
| Max. Negotiated Rate |
$1,344.56 |
| Rate for Payer: Aetna Commercial |
$1,269.87
|
| Rate for Payer: Aetna Commercial |
$1,291.38
|
| Rate for Payer: Aetna Commercial |
$2,494.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,254.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,233.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,423.45
|
| Rate for Payer: BCN Commercial |
$1,254.77
|
| Rate for Payer: BCN Commercial |
$1,233.86
|
| Rate for Payer: BCN Commercial |
$2,423.45
|
| Rate for Payer: Cash Price |
$1,195.17
|
| Rate for Payer: Cash Price |
$2,347.45
|
| Rate for Payer: Cash Price |
$1,215.42
|
| Rate for Payer: Cofinity Commercial |
$2,523.51
|
| Rate for Payer: Cofinity Commercial |
$1,306.57
|
| Rate for Payer: Cofinity Commercial |
$1,284.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,215.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,195.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,347.45
|
| Rate for Payer: Healthscope Commercial |
$1,367.34
|
| Rate for Payer: Healthscope Commercial |
$1,344.56
|
| Rate for Payer: Healthscope Commercial |
$2,640.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,200.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,120.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,139.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,291.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,269.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,494.16
|
| Rate for Payer: Nomi Health Commercial |
$1,225.05
|
| Rate for Payer: Nomi Health Commercial |
$1,245.80
|
| Rate for Payer: Nomi Health Commercial |
$2,406.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,139.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,120.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,200.73
|
| Rate for Payer: PHP Commercial |
$1,269.87
|
| Rate for Payer: PHP Commercial |
$2,494.16
|
| Rate for Payer: PHP Commercial |
$1,291.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,552.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,321.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,299.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,057.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,042.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,039.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,582.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,336.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,314.68
|
| Rate for Payer: UHC Core |
$1,247.46
|
| Rate for Payer: UHC Core |
$2,450.15
|
| Rate for Payer: UHC Core |
$1,268.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,200.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,120.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,139.45
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,493.96
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
22185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$263.39 |
| Max. Negotiated Rate |
$1,344.56 |
| Rate for Payer: Aetna Commercial |
$1,269.87
|
| Rate for Payer: Aetna Commercial |
$2,494.16
|
| Rate for Payer: Aetna Commercial |
$1,291.38
|
| Rate for Payer: Aetna Medicare |
$762.92
|
| Rate for Payer: Aetna Medicare |
$388.43
|
| Rate for Payer: Aetna Medicare |
$395.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$916.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$474.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$474.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$916.97
|
| Rate for Payer: BCBS Complete |
$281.22
|
| Rate for Payer: BCBS Complete |
$276.53
|
| Rate for Payer: BCBS Complete |
$543.14
|
| Rate for Payer: BCBS MAPPO |
$733.58
|
| Rate for Payer: BCBS MAPPO |
$373.49
|
| Rate for Payer: BCBS MAPPO |
$379.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,228.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,248.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,412.30
|
| Rate for Payer: BCN Commercial |
$1,248.99
|
| Rate for Payer: BCN Commercial |
$2,412.30
|
| Rate for Payer: BCN Commercial |
$1,228.18
|
| Rate for Payer: BCN Medicare Advantage |
$733.58
|
| Rate for Payer: BCN Medicare Advantage |
$379.82
|
| Rate for Payer: BCN Medicare Advantage |
$373.49
|
| Rate for Payer: Cash Price |
$2,347.45
|
| Rate for Payer: Cash Price |
$1,215.42
|
| Rate for Payer: Cash Price |
$1,195.17
|
| Rate for Payer: Cofinity Commercial |
$1,284.81
|
| Rate for Payer: Cofinity Commercial |
$1,306.57
|
| Rate for Payer: Cofinity Commercial |
$2,523.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,195.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,215.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,347.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$733.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.49
|
| Rate for Payer: Healthscope Commercial |
$1,367.34
|
| Rate for Payer: Healthscope Commercial |
$1,344.56
|
| Rate for Payer: Healthscope Commercial |
$2,640.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,200.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,120.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,139.45
|
| Rate for Payer: Mclaren Medicaid |
$263.39
|
| Rate for Payer: Mclaren Medicaid |
$517.32
|
| Rate for Payer: Mclaren Medicaid |
$267.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$392.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$398.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$770.26
|
| Rate for Payer: Meridian Medicaid |
$543.14
|
| Rate for Payer: Meridian Medicaid |
$276.53
|
| Rate for Payer: Meridian Medicaid |
$281.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$436.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$843.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$806.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$417.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,494.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,269.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,291.38
|
| Rate for Payer: Nomi Health Commercial |
$2,406.13
|
| Rate for Payer: Nomi Health Commercial |
$1,245.80
|
| Rate for Payer: Nomi Health Commercial |
$1,225.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,200.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,139.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,120.47
|
| Rate for Payer: PACE Senior Care Partners |
$360.83
|
| Rate for Payer: PACE Senior Care Partners |
$354.82
|
| Rate for Payer: PACE Senior Care Partners |
$696.90
|
| Rate for Payer: PACE SWMI |
$733.58
|
| Rate for Payer: PACE SWMI |
$379.82
|
| Rate for Payer: PACE SWMI |
$373.49
|
| Rate for Payer: PHP Commercial |
$1,269.87
|
| Rate for Payer: PHP Commercial |
$2,494.16
|
| Rate for Payer: PHP Commercial |
$1,291.38
|
| Rate for Payer: PHP Medicare Advantage |
$379.82
|
| Rate for Payer: PHP Medicare Advantage |
$373.49
|
| Rate for Payer: PHP Medicare Advantage |
$733.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$263.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$517.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,321.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,299.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,552.85
|
| Rate for Payer: Priority Health Medicare |
$740.91
|
| Rate for Payer: Priority Health Medicare |
$383.62
|
| Rate for Payer: Priority Health Medicare |
$377.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,057.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,042.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,039.80
|
| Rate for Payer: Railroad Medicare Medicare |
$379.82
|
| Rate for Payer: Railroad Medicare Medicare |
$733.58
|
| Rate for Payer: Railroad Medicare Medicare |
$373.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,336.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,582.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,314.68
|
| Rate for Payer: UHC Core |
$1,247.46
|
| Rate for Payer: UHC Core |
$2,450.15
|
| Rate for Payer: UHC Core |
$1,268.59
|
| Rate for Payer: UHC Exchange |
$733.58
|
| Rate for Payer: UHC Exchange |
$379.82
|
| Rate for Payer: UHC Exchange |
$373.49
|
| Rate for Payer: UHC Medicaid |
$263.39
|
| Rate for Payer: UHC Medicaid |
$517.32
|
| Rate for Payer: UHC Medicaid |
$267.85
|
| Rate for Payer: UHC Medicare Advantage |
$379.82
|
| Rate for Payer: UHC Medicare Advantage |
$373.49
|
| Rate for Payer: UHC Medicare Advantage |
$733.58
|
| Rate for Payer: UHCCP Medicaid |
$267.85
|
| Rate for Payer: UHCCP Medicaid |
$263.39
|
| Rate for Payer: UHCCP Medicaid |
$517.32
|
| Rate for Payer: VA VA |
$373.49
|
| Rate for Payer: VA VA |
$733.58
|
| Rate for Payer: VA VA |
$379.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,139.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,120.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,200.73
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
OP
|
$33.67
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
32215
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$30.30 |
| Rate for Payer: Aetna Commercial |
$28.62
|
| Rate for Payer: Aetna Commercial |
$35.34
|
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Aetna Medicare |
$10.81
|
| Rate for Payer: Aetna Medicare |
$8.75
|
| Rate for Payer: Aetna Medicare |
$10.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.99
|
| Rate for Payer: BCBS Complete |
$7.68
|
| Rate for Payer: BCBS Complete |
$6.23
|
| Rate for Payer: BCBS Complete |
$7.70
|
| Rate for Payer: BCBS MAPPO |
$10.39
|
| Rate for Payer: BCBS MAPPO |
$8.42
|
| Rate for Payer: BCBS MAPPO |
$10.37
|
| Rate for Payer: BCBS Trust/PPO |
$27.68
|
| Rate for Payer: BCBS Trust/PPO |
$34.09
|
| Rate for Payer: BCBS Trust/PPO |
$34.18
|
| Rate for Payer: BCN Commercial |
$34.09
|
| Rate for Payer: BCN Commercial |
$34.18
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: BCN Medicare Advantage |
$10.39
|
| Rate for Payer: BCN Medicare Advantage |
$10.37
|
| Rate for Payer: BCN Medicare Advantage |
$8.42
|
| Rate for Payer: Cash Price |
$33.26
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$26.94
|
| Rate for Payer: Cofinity Commercial |
$28.96
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$35.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$37.32
|
| Rate for Payer: Healthscope Commercial |
$30.30
|
| Rate for Payer: Healthscope Commercial |
$37.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.10
|
| Rate for Payer: Mclaren Medicaid |
$5.94
|
| Rate for Payer: Mclaren Medicaid |
$7.33
|
| Rate for Payer: Mclaren Medicaid |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.91
|
| Rate for Payer: Meridian Medicaid |
$7.70
|
| Rate for Payer: Meridian Medicaid |
$6.23
|
| Rate for Payer: Meridian Medicaid |
$7.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.25
|
| Rate for Payer: Nomi Health Commercial |
$34.10
|
| Rate for Payer: Nomi Health Commercial |
$34.01
|
| Rate for Payer: Nomi Health Commercial |
$27.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.25
|
| Rate for Payer: PACE Senior Care Partners |
$9.85
|
| Rate for Payer: PACE Senior Care Partners |
$8.00
|
| Rate for Payer: PACE Senior Care Partners |
$9.88
|
| Rate for Payer: PACE SWMI |
$10.39
|
| Rate for Payer: PACE SWMI |
$10.37
|
| Rate for Payer: PACE SWMI |
$8.42
|
| Rate for Payer: PHP Commercial |
$28.62
|
| Rate for Payer: PHP Commercial |
$35.34
|
| Rate for Payer: PHP Commercial |
$35.25
|
| Rate for Payer: PHP Medicare Advantage |
$10.37
|
| Rate for Payer: PHP Medicare Advantage |
$8.42
|
| Rate for Payer: PHP Medicare Advantage |
$10.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.17
|
| Rate for Payer: Priority Health Medicare |
$10.50
|
| Rate for Payer: Priority Health Medicare |
$10.47
|
| Rate for Payer: Priority Health Medicare |
$8.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.43
|
| Rate for Payer: Railroad Medicare Medicare |
$10.37
|
| Rate for Payer: Railroad Medicare Medicare |
$10.39
|
| Rate for Payer: Railroad Medicare Medicare |
$8.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.63
|
| Rate for Payer: UHC Core |
$28.11
|
| Rate for Payer: UHC Core |
$34.72
|
| Rate for Payer: UHC Core |
$34.63
|
| Rate for Payer: UHC Exchange |
$10.39
|
| Rate for Payer: UHC Exchange |
$10.37
|
| Rate for Payer: UHC Exchange |
$8.42
|
| Rate for Payer: UHC Medicaid |
$5.94
|
| Rate for Payer: UHC Medicaid |
$7.33
|
| Rate for Payer: UHC Medicaid |
$7.31
|
| Rate for Payer: UHC Medicare Advantage |
$10.37
|
| Rate for Payer: UHC Medicare Advantage |
$8.42
|
| Rate for Payer: UHC Medicare Advantage |
$10.39
|
| Rate for Payer: UHCCP Medicaid |
$7.31
|
| Rate for Payer: UHCCP Medicaid |
$5.94
|
| Rate for Payer: UHCCP Medicaid |
$7.33
|
| Rate for Payer: VA VA |
$8.42
|
| Rate for Payer: VA VA |
$10.39
|
| Rate for Payer: VA VA |
$10.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.18
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$33.67
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
32215
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$30.30 |
| Rate for Payer: Aetna Commercial |
$28.62
|
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Aetna Commercial |
$35.34
|
| Rate for Payer: BCBS Trust/PPO |
$34.25
|
| Rate for Payer: BCBS Trust/PPO |
$27.81
|
| Rate for Payer: BCBS Trust/PPO |
$34.34
|
| Rate for Payer: BCN Commercial |
$34.25
|
| Rate for Payer: BCN Commercial |
$27.81
|
| Rate for Payer: BCN Commercial |
$34.34
|
| Rate for Payer: Cash Price |
$26.94
|
| Rate for Payer: Cash Price |
$33.26
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cofinity Commercial |
$35.76
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$28.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.26
|
| Rate for Payer: Healthscope Commercial |
$37.32
|
| Rate for Payer: Healthscope Commercial |
$30.30
|
| Rate for Payer: Healthscope Commercial |
$37.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.34
|
| Rate for Payer: Nomi Health Commercial |
$27.61
|
| Rate for Payer: Nomi Health Commercial |
$34.01
|
| Rate for Payer: Nomi Health Commercial |
$34.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.18
|
| Rate for Payer: PHP Commercial |
$28.62
|
| Rate for Payer: PHP Commercial |
$35.34
|
| Rate for Payer: PHP Commercial |
$35.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.63
|
| Rate for Payer: UHC Core |
$28.11
|
| Rate for Payer: UHC Core |
$34.72
|
| Rate for Payer: UHC Core |
$34.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.10
|
|
