|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION
|
Facility
|
OP
|
$2,413.90
|
|
|
Service Code
|
CPT 57522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,298.80 |
| Max. Negotiated Rate |
$2,413.90 |
| Rate for Payer: BCBS Complete |
$2,413.90
|
| Rate for Payer: Mclaren Medicaid |
$2,298.80
|
| Rate for Payer: Meridian Medicaid |
$2,413.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.80
|
| Rate for Payer: UHCCP Medicaid |
$2,298.80
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET
|
Facility
|
IP
|
$2,551.15
|
|
|
Service Code
|
NDC 00046110081
|
| Hospital Charge Code |
9973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,658.25 |
| Max. Negotiated Rate |
$2,296.03 |
| Rate for Payer: Aetna Commercial |
$2,168.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,082.50
|
| Rate for Payer: BCN Commercial |
$1,971.53
|
| Rate for Payer: Cash Price |
$2,040.92
|
| Rate for Payer: Cofinity Commercial |
$2,193.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.92
|
| Rate for Payer: Healthscope Commercial |
$2,296.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,913.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.48
|
| Rate for Payer: Nomi Health Commercial |
$2,091.94
|
| Rate for Payer: PHP Commercial |
$2,168.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.25
|
| Rate for Payer: Priority Health HMO/PPO |
$2,219.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,709.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,245.01
|
| Rate for Payer: UHC Core |
$2,130.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,913.36
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET
|
Facility
|
OP
|
$2,551.15
|
|
|
Service Code
|
NDC 00046110081
|
| Hospital Charge Code |
9973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$605.90 |
| Max. Negotiated Rate |
$2,296.03 |
| Rate for Payer: Aetna Commercial |
$2,168.48
|
| Rate for Payer: Aetna Medicare |
$663.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$797.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$797.23
|
| Rate for Payer: BCBS Complete |
$1,020.46
|
| Rate for Payer: BCBS MAPPO |
$637.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,097.30
|
| Rate for Payer: BCN Commercial |
$1,983.52
|
| Rate for Payer: BCN Medicare Advantage |
$637.79
|
| Rate for Payer: Cash Price |
$2,040.92
|
| Rate for Payer: Cofinity Commercial |
$2,193.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.79
|
| Rate for Payer: Healthscope Commercial |
$2,296.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,913.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$669.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.48
|
| Rate for Payer: Nomi Health Commercial |
$2,091.94
|
| Rate for Payer: PACE Senior Care Partners |
$605.90
|
| Rate for Payer: PACE SWMI |
$637.79
|
| Rate for Payer: PHP Commercial |
$2,168.48
|
| Rate for Payer: PHP Medicare Advantage |
$637.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.25
|
| Rate for Payer: Priority Health HMO/PPO |
$2,219.50
|
| Rate for Payer: Priority Health Medicare |
$644.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,709.27
|
| Rate for Payer: Railroad Medicare Medicare |
$637.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,245.01
|
| Rate for Payer: UHC Core |
$2,130.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.79
|
| Rate for Payer: UHC Exchange |
$637.79
|
| Rate for Payer: UHC Medicare Advantage |
$637.79
|
| Rate for Payer: VA VA |
$637.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,913.36
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
OP
|
$1,572.69
|
|
|
Service Code
|
NDC 00046087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$373.51 |
| Max. Negotiated Rate |
$1,415.42 |
| Rate for Payer: Aetna Commercial |
$1,336.79
|
| Rate for Payer: Aetna Medicare |
$408.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$491.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$491.47
|
| Rate for Payer: BCBS Complete |
$629.08
|
| Rate for Payer: BCBS MAPPO |
$393.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,292.91
|
| Rate for Payer: BCN Commercial |
$1,222.77
|
| Rate for Payer: BCN Medicare Advantage |
$393.17
|
| Rate for Payer: Cash Price |
$1,258.15
|
| Rate for Payer: Cofinity Commercial |
$1,352.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,258.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.17
|
| Rate for Payer: Healthscope Commercial |
$1,415.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,179.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,336.79
|
| Rate for Payer: Nomi Health Commercial |
$1,289.61
|
| Rate for Payer: PACE Senior Care Partners |
$373.51
|
| Rate for Payer: PACE SWMI |
$393.17
|
| Rate for Payer: PHP Commercial |
$1,336.79
|
| Rate for Payer: PHP Medicare Advantage |
$393.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,022.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,368.24
|
| Rate for Payer: Priority Health Medicare |
$397.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,053.70
|
| Rate for Payer: Railroad Medicare Medicare |
$393.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,383.97
|
| Rate for Payer: UHC Core |
$1,313.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.17
|
| Rate for Payer: UHC Exchange |
$393.17
|
| Rate for Payer: UHC Medicare Advantage |
$393.17
|
| Rate for Payer: VA VA |
$393.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,179.52
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
IP
|
$1,572.69
|
|
|
Service Code
|
NDC 00046087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,022.25 |
| Max. Negotiated Rate |
$1,415.42 |
| Rate for Payer: Aetna Commercial |
$1,336.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,283.79
|
| Rate for Payer: BCN Commercial |
$1,215.37
|
| Rate for Payer: Cash Price |
$1,258.15
|
| Rate for Payer: Cofinity Commercial |
$1,352.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,258.15
|
| Rate for Payer: Healthscope Commercial |
$1,415.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,179.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,336.79
|
| Rate for Payer: Nomi Health Commercial |
$1,289.61
|
| Rate for Payer: PHP Commercial |
$1,336.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,022.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,368.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,053.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,383.97
|
| Rate for Payer: UHC Core |
$1,313.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,179.52
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET
|
Facility
|
OP
|
$2,551.15
|
|
|
Service Code
|
NDC 00046110281
|
| Hospital Charge Code |
9974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$605.90 |
| Max. Negotiated Rate |
$2,296.03 |
| Rate for Payer: Aetna Commercial |
$2,168.48
|
| Rate for Payer: Aetna Medicare |
$663.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$797.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$797.23
|
| Rate for Payer: BCBS Complete |
$1,020.46
|
| Rate for Payer: BCBS MAPPO |
$637.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,097.30
|
| Rate for Payer: BCN Commercial |
$1,983.52
|
| Rate for Payer: BCN Medicare Advantage |
$637.79
|
| Rate for Payer: Cash Price |
$2,040.92
|
| Rate for Payer: Cofinity Commercial |
$2,193.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.79
|
| Rate for Payer: Healthscope Commercial |
$2,296.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,913.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$669.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.48
|
| Rate for Payer: Nomi Health Commercial |
$2,091.94
|
| Rate for Payer: PACE Senior Care Partners |
$605.90
|
| Rate for Payer: PACE SWMI |
$637.79
|
| Rate for Payer: PHP Commercial |
$2,168.48
|
| Rate for Payer: PHP Medicare Advantage |
$637.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.25
|
| Rate for Payer: Priority Health HMO/PPO |
$2,219.50
|
| Rate for Payer: Priority Health Medicare |
$644.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,709.27
|
| Rate for Payer: Railroad Medicare Medicare |
$637.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,245.01
|
| Rate for Payer: UHC Core |
$2,130.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.79
|
| Rate for Payer: UHC Exchange |
$637.79
|
| Rate for Payer: UHC Medicare Advantage |
$637.79
|
| Rate for Payer: VA VA |
$637.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,913.36
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET
|
Facility
|
IP
|
$2,551.15
|
|
|
Service Code
|
NDC 00046110281
|
| Hospital Charge Code |
9974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,658.25 |
| Max. Negotiated Rate |
$2,296.03 |
| Rate for Payer: Aetna Commercial |
$2,168.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,082.50
|
| Rate for Payer: BCN Commercial |
$1,971.53
|
| Rate for Payer: Cash Price |
$2,040.92
|
| Rate for Payer: Cofinity Commercial |
$2,193.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.92
|
| Rate for Payer: Healthscope Commercial |
$2,296.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,913.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.48
|
| Rate for Payer: Nomi Health Commercial |
$2,091.94
|
| Rate for Payer: PHP Commercial |
$2,168.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.25
|
| Rate for Payer: Priority Health HMO/PPO |
$2,219.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,709.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,245.01
|
| Rate for Payer: UHC Core |
$2,130.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,913.36
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DOUBLE OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$5,423.52
|
|
|
Service Code
|
CPT 28299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,164.92 |
| Max. Negotiated Rate |
$5,423.52 |
| Rate for Payer: BCBS Complete |
$5,423.52
|
| Rate for Payer: Mclaren Medicaid |
$5,164.92
|
| Rate for Payer: Meridian Medicaid |
$5,423.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,164.92
|
| Rate for Payer: UHCCP Medicaid |
$5,164.92
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH PROXIMAL METATARSAL OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$2,463.31
|
|
|
Service Code
|
CPT 28295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,345.85 |
| Max. Negotiated Rate |
$2,463.31 |
| Rate for Payer: BCBS Complete |
$2,463.31
|
| Rate for Payer: Mclaren Medicaid |
$2,345.85
|
| Rate for Payer: Meridian Medicaid |
$2,463.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,345.85
|
| Rate for Payer: UHCCP Medicaid |
$2,345.85
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH RESECTION OF PROXIMAL PHALANX BASE, WHEN PERFORMED, ANY METHOD
|
Facility
|
OP
|
$2,463.31
|
|
|
Service Code
|
CPT 28292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,345.85 |
| Max. Negotiated Rate |
$2,463.31 |
| Rate for Payer: BCBS Complete |
$2,463.31
|
| Rate for Payer: Mclaren Medicaid |
$2,345.85
|
| Rate for Payer: Meridian Medicaid |
$2,463.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,345.85
|
| Rate for Payer: UHCCP Medicaid |
$2,345.85
|
|
|
CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY)
|
Facility
|
OP
|
$2,463.31
|
|
|
Service Code
|
CPT 28285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,345.85 |
| Max. Negotiated Rate |
$2,463.31 |
| Rate for Payer: BCBS Complete |
$2,463.31
|
| Rate for Payer: Mclaren Medicaid |
$2,345.85
|
| Rate for Payer: Meridian Medicaid |
$2,463.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,345.85
|
| Rate for Payer: UHCCP Medicaid |
$2,345.85
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$131.82
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.68 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: BCBS Trust/PPO |
$107.60
|
| Rate for Payer: BCN Commercial |
$101.87
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cofinity Commercial |
$113.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.46
|
| Rate for Payer: Healthscope Commercial |
$118.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.05
|
| Rate for Payer: Nomi Health Commercial |
$108.09
|
| Rate for Payer: PHP Commercial |
$112.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.68
|
| Rate for Payer: Priority Health HMO/PPO |
$114.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.00
|
| Rate for Payer: UHC Core |
$110.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.86
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$131.82
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: Aetna Medicare |
$34.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.19
|
| Rate for Payer: BCBS Complete |
$52.73
|
| Rate for Payer: BCBS MAPPO |
$32.95
|
| Rate for Payer: BCBS Trust/PPO |
$108.37
|
| Rate for Payer: BCN Commercial |
$102.49
|
| Rate for Payer: BCN Medicare Advantage |
$32.95
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cofinity Commercial |
$113.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.95
|
| Rate for Payer: Healthscope Commercial |
$118.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.05
|
| Rate for Payer: Nomi Health Commercial |
$108.09
|
| Rate for Payer: PACE Senior Care Partners |
$31.31
|
| Rate for Payer: PACE SWMI |
$32.95
|
| Rate for Payer: PHP Commercial |
$112.05
|
| Rate for Payer: PHP Medicare Advantage |
$32.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.68
|
| Rate for Payer: Priority Health HMO/PPO |
$114.68
|
| Rate for Payer: Priority Health Medicare |
$33.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.32
|
| Rate for Payer: Railroad Medicare Medicare |
$32.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.00
|
| Rate for Payer: UHC Core |
$110.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.95
|
| Rate for Payer: UHC Exchange |
$32.95
|
| Rate for Payer: UHC Medicare Advantage |
$32.95
|
| Rate for Payer: VA VA |
$32.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.86
|
|
|
CPT 0255T
|
Professional
|
Both
|
$455.00
|
|
|
Service Code
|
HCPCS 0255T
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$295.75 |
| Rate for Payer: Aetna Medicare |
$227.50
|
| Rate for Payer: BCBS Complete |
$182.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.75
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$12.82
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$11.54 |
| Rate for Payer: Aetna Commercial |
$10.90
|
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: BCBS Trust/PPO |
$10.46
|
| Rate for Payer: BCBS Trust/PPO |
$14.32
|
| Rate for Payer: BCN Commercial |
$9.91
|
| Rate for Payer: BCN Commercial |
$13.55
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$11.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.26
|
| Rate for Payer: Healthscope Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Nomi Health Commercial |
$10.51
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: PHP Commercial |
$10.90
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.33
|
| Rate for Payer: Priority Health HMO/PPO |
$15.26
|
| Rate for Payer: Priority Health HMO/PPO |
$11.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$10.70
|
| Rate for Payer: UHC Core |
$14.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$17.54
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna Commercial |
$10.90
|
| Rate for Payer: Aetna Medicare |
$4.56
|
| Rate for Payer: Aetna Medicare |
$3.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.01
|
| Rate for Payer: BCBS Complete |
$5.13
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS MAPPO |
$3.21
|
| Rate for Payer: BCBS MAPPO |
$4.38
|
| Rate for Payer: BCBS Trust/PPO |
$14.42
|
| Rate for Payer: BCBS Trust/PPO |
$10.54
|
| Rate for Payer: BCN Commercial |
$13.64
|
| Rate for Payer: BCN Commercial |
$9.97
|
| Rate for Payer: BCN Medicare Advantage |
$4.38
|
| Rate for Payer: BCN Medicare Advantage |
$3.21
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Cofinity Commercial |
$11.03
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.90
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: Nomi Health Commercial |
$10.51
|
| Rate for Payer: PACE Senior Care Partners |
$4.17
|
| Rate for Payer: PACE Senior Care Partners |
$3.04
|
| Rate for Payer: PACE SWMI |
$4.38
|
| Rate for Payer: PACE SWMI |
$3.21
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: PHP Commercial |
$10.90
|
| Rate for Payer: PHP Medicare Advantage |
$3.21
|
| Rate for Payer: PHP Medicare Advantage |
$4.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.33
|
| Rate for Payer: Priority Health HMO/PPO |
$11.15
|
| Rate for Payer: Priority Health HMO/PPO |
$15.26
|
| Rate for Payer: Priority Health Medicare |
$4.43
|
| Rate for Payer: Priority Health Medicare |
$3.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.59
|
| Rate for Payer: Railroad Medicare Medicare |
$3.21
|
| Rate for Payer: Railroad Medicare Medicare |
$4.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$14.65
|
| Rate for Payer: UHC Core |
$10.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.21
|
| Rate for Payer: UHC Exchange |
$3.21
|
| Rate for Payer: UHC Exchange |
$4.38
|
| Rate for Payer: UHC Medicare Advantage |
$3.21
|
| Rate for Payer: UHC Medicare Advantage |
$4.38
|
| Rate for Payer: VA VA |
$3.21
|
| Rate for Payer: VA VA |
$4.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.62
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 77333093810
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.32 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: BCBS Trust/PPO |
$266.64
|
| Rate for Payer: BCN Commercial |
$252.44
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Nomi Health Commercial |
$267.85
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health HMO/PPO |
$284.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.45
|
| Rate for Payer: UHC Core |
$272.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$3.27
|
|
|
Service Code
|
NDC 77333093825
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Aetna Commercial |
$2.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.53
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$2.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$2.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.78
|
| Rate for Payer: Nomi Health Commercial |
$2.68
|
| Rate for Payer: PHP Commercial |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.13
|
| Rate for Payer: Priority Health HMO/PPO |
$2.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.88
|
| Rate for Payer: UHC Core |
$2.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.45
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
OP
|
$3.27
|
|
|
Service Code
|
NDC 77333093825
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Aetna Commercial |
$2.78
|
| Rate for Payer: Aetna Medicare |
$0.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.02
|
| Rate for Payer: BCBS Complete |
$1.31
|
| Rate for Payer: BCBS MAPPO |
$0.82
|
| Rate for Payer: BCBS Trust/PPO |
$2.69
|
| Rate for Payer: BCN Commercial |
$2.54
|
| Rate for Payer: BCN Medicare Advantage |
$0.82
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$2.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$2.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.78
|
| Rate for Payer: Nomi Health Commercial |
$2.68
|
| Rate for Payer: PACE Senior Care Partners |
$0.78
|
| Rate for Payer: PACE SWMI |
$0.82
|
| Rate for Payer: PHP Commercial |
$2.78
|
| Rate for Payer: PHP Medicare Advantage |
$0.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.13
|
| Rate for Payer: Priority Health HMO/PPO |
$2.84
|
| Rate for Payer: Priority Health Medicare |
$0.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.19
|
| Rate for Payer: Railroad Medicare Medicare |
$0.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.88
|
| Rate for Payer: UHC Core |
$2.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.82
|
| Rate for Payer: UHC Exchange |
$0.82
|
| Rate for Payer: UHC Medicare Advantage |
$0.82
|
| Rate for Payer: VA VA |
$0.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.45
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
OP
|
$326.65
|
|
|
Service Code
|
NDC 77333093810
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.58 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna Medicare |
$84.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.08
|
| Rate for Payer: BCBS Complete |
$130.66
|
| Rate for Payer: BCBS MAPPO |
$81.66
|
| Rate for Payer: BCBS Trust/PPO |
$268.54
|
| Rate for Payer: BCN Commercial |
$253.97
|
| Rate for Payer: BCN Medicare Advantage |
$81.66
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.66
|
| Rate for Payer: Healthscope Commercial |
$293.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Nomi Health Commercial |
$267.85
|
| Rate for Payer: PACE Senior Care Partners |
$77.58
|
| Rate for Payer: PACE SWMI |
$81.66
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: PHP Medicare Advantage |
$81.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health HMO/PPO |
$284.19
|
| Rate for Payer: Priority Health Medicare |
$82.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.86
|
| Rate for Payer: Railroad Medicare Medicare |
$81.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.45
|
| Rate for Payer: UHC Core |
$272.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.66
|
| Rate for Payer: UHC Exchange |
$81.66
|
| Rate for Payer: UHC Medicare Advantage |
$81.66
|
| Rate for Payer: VA VA |
$81.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
OP
|
$133.10
|
|
|
Service Code
|
NDC 77333093710
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.61 |
| Max. Negotiated Rate |
$119.79 |
| Rate for Payer: Aetna Commercial |
$113.14
|
| Rate for Payer: Aetna Medicare |
$34.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.59
|
| Rate for Payer: BCBS Complete |
$53.24
|
| Rate for Payer: BCBS MAPPO |
$33.27
|
| Rate for Payer: BCBS Trust/PPO |
$109.42
|
| Rate for Payer: BCN Commercial |
$103.49
|
| Rate for Payer: BCN Medicare Advantage |
$33.27
|
| Rate for Payer: Cash Price |
$106.48
|
| Rate for Payer: Cofinity Commercial |
$114.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.27
|
| Rate for Payer: Healthscope Commercial |
$119.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.14
|
| Rate for Payer: Nomi Health Commercial |
$109.14
|
| Rate for Payer: PACE Senior Care Partners |
$31.61
|
| Rate for Payer: PACE SWMI |
$33.27
|
| Rate for Payer: PHP Commercial |
$113.14
|
| Rate for Payer: PHP Medicare Advantage |
$33.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.52
|
| Rate for Payer: Priority Health HMO/PPO |
$115.80
|
| Rate for Payer: Priority Health Medicare |
$33.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.18
|
| Rate for Payer: Railroad Medicare Medicare |
$33.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.13
|
| Rate for Payer: UHC Core |
$111.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.27
|
| Rate for Payer: UHC Exchange |
$33.27
|
| Rate for Payer: UHC Medicare Advantage |
$33.27
|
| Rate for Payer: VA VA |
$33.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.83
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
NDC 79854020060
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna Medicare |
$52.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.50
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCBS MAPPO |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$164.42
|
| Rate for Payer: BCN Commercial |
$155.50
|
| Rate for Payer: BCN Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Nomi Health Commercial |
$164.00
|
| Rate for Payer: PACE Senior Care Partners |
$47.50
|
| Rate for Payer: PACE SWMI |
$50.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: PHP Medicare Advantage |
$50.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health HMO/PPO |
$174.00
|
| Rate for Payer: Priority Health Medicare |
$50.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.00
|
| Rate for Payer: Railroad Medicare Medicare |
$50.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC Core |
$167.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.00
|
| Rate for Payer: UHC Exchange |
$50.00
|
| Rate for Payer: UHC Medicare Advantage |
$50.00
|
| Rate for Payer: VA VA |
$50.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
IP
|
$1.34
|
|
|
Service Code
|
NDC 77333093725
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Aetna Commercial |
$1.14
|
| Rate for Payer: BCBS Trust/PPO |
$1.09
|
| Rate for Payer: BCN Commercial |
$1.04
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cofinity Commercial |
$1.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.07
|
| Rate for Payer: Healthscope Commercial |
$1.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.14
|
| Rate for Payer: Nomi Health Commercial |
$1.10
|
| Rate for Payer: PHP Commercial |
$1.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.87
|
| Rate for Payer: Priority Health HMO/PPO |
$1.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.18
|
| Rate for Payer: UHC Core |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.00
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
NDC 79854020060
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: BCBS Trust/PPO |
$163.26
|
| Rate for Payer: BCN Commercial |
$154.56
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Nomi Health Commercial |
$164.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health HMO/PPO |
$174.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC Core |
$167.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
IP
|
$133.10
|
|
|
Service Code
|
NDC 77333093710
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.52 |
| Max. Negotiated Rate |
$119.79 |
| Rate for Payer: Aetna Commercial |
$113.14
|
| Rate for Payer: BCBS Trust/PPO |
$108.65
|
| Rate for Payer: BCN Commercial |
$102.86
|
| Rate for Payer: Cash Price |
$106.48
|
| Rate for Payer: Cofinity Commercial |
$114.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.48
|
| Rate for Payer: Healthscope Commercial |
$119.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.14
|
| Rate for Payer: Nomi Health Commercial |
$109.14
|
| Rate for Payer: PHP Commercial |
$113.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.52
|
| Rate for Payer: Priority Health HMO/PPO |
$115.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.13
|
| Rate for Payer: UHC Core |
$111.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.83
|
|
