|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$424.65
|
|
|
Service Code
|
NDC 63739001610
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.02 |
| Max. Negotiated Rate |
$382.18 |
| Rate for Payer: Aetna Commercial |
$360.95
|
| Rate for Payer: BCBS Trust/PPO |
$346.64
|
| Rate for Payer: BCN Commercial |
$328.17
|
| Rate for Payer: Cash Price |
$339.72
|
| Rate for Payer: Cofinity Commercial |
$365.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.72
|
| Rate for Payer: Healthscope Commercial |
$382.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.95
|
| Rate for Payer: Nomi Health Commercial |
$348.21
|
| Rate for Payer: PHP Commercial |
$360.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.02
|
| Rate for Payer: Priority Health HMO/PPO |
$369.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$284.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.69
|
| Rate for Payer: UHC Core |
$354.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.49
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$2.54
|
|
|
Service Code
|
NDC 60687021711
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna Medicare |
$0.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.79
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: BCBS MAPPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$1.97
|
| Rate for Payer: BCN Medicare Advantage |
$0.64
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.64
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Nomi Health Commercial |
$2.08
|
| Rate for Payer: PACE Senior Care Partners |
$0.60
|
| Rate for Payer: PACE SWMI |
$0.64
|
| Rate for Payer: PHP Commercial |
$2.16
|
| Rate for Payer: PHP Medicare Advantage |
$0.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.65
|
| Rate for Payer: Priority Health HMO/PPO |
$2.21
|
| Rate for Payer: Priority Health Medicare |
$0.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.70
|
| Rate for Payer: Railroad Medicare Medicare |
$0.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.24
|
| Rate for Payer: UHC Core |
$2.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.64
|
| Rate for Payer: UHC Exchange |
$0.64
|
| Rate for Payer: UHC Medicare Advantage |
$0.64
|
| Rate for Payer: VA VA |
$0.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.90
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
NDC 00904721961
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.30 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: BCBS Trust/PPO |
$279.17
|
| Rate for Payer: BCN Commercial |
$264.30
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.60
|
| Rate for Payer: Healthscope Commercial |
$307.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.70
|
| Rate for Payer: Nomi Health Commercial |
$280.44
|
| Rate for Payer: PHP Commercial |
$290.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.30
|
| Rate for Payer: Priority Health HMO/PPO |
$297.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.96
|
| Rate for Payer: UHC Core |
$285.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.50
|
|
|
DILTIAZEM ER (XR/XT) 180 MG CAPSULE,EXTENDED RELEASE 24 HR, CONTROLLED
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
NDC 60505001506
|
| Hospital Charge Code |
29347
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.79 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Medicare |
$113.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136.56
|
| Rate for Payer: BCBS Complete |
$174.80
|
| Rate for Payer: BCBS MAPPO |
$109.25
|
| Rate for Payer: BCBS Trust/PPO |
$359.26
|
| Rate for Payer: BCN Commercial |
$339.77
|
| Rate for Payer: BCN Medicare Advantage |
$109.25
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cofinity Commercial |
$375.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.25
|
| Rate for Payer: Healthscope Commercial |
$393.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.45
|
| Rate for Payer: Nomi Health Commercial |
$358.34
|
| Rate for Payer: PACE Senior Care Partners |
$103.79
|
| Rate for Payer: PACE SWMI |
$109.25
|
| Rate for Payer: PHP Commercial |
$371.45
|
| Rate for Payer: PHP Medicare Advantage |
$109.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.05
|
| Rate for Payer: Priority Health HMO/PPO |
$380.19
|
| Rate for Payer: Priority Health Medicare |
$110.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.79
|
| Rate for Payer: Railroad Medicare Medicare |
$109.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.56
|
| Rate for Payer: UHC Core |
$364.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.25
|
| Rate for Payer: UHC Exchange |
$109.25
|
| Rate for Payer: UHC Medicare Advantage |
$109.25
|
| Rate for Payer: VA VA |
$109.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.75
|
|
|
DILTIAZEM ER (XR/XT) 180 MG CAPSULE,EXTENDED RELEASE 24 HR, CONTROLLED
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
NDC 60505001506
|
| Hospital Charge Code |
29347
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.05 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: BCBS Trust/PPO |
$356.72
|
| Rate for Payer: BCN Commercial |
$337.71
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cofinity Commercial |
$375.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.60
|
| Rate for Payer: Healthscope Commercial |
$393.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.45
|
| Rate for Payer: Nomi Health Commercial |
$358.34
|
| Rate for Payer: PHP Commercial |
$371.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.05
|
| Rate for Payer: Priority Health HMO/PPO |
$380.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.56
|
| Rate for Payer: UHC Core |
$364.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.75
|
|
|
DIMENHYDRINATE 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$24.01
|
|
|
Service Code
|
HCPCS J1240
|
| Hospital Charge Code |
2483
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Aetna Commercial |
$20.41
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.50
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$6.00
|
| Rate for Payer: BCBS Trust/PPO |
$19.74
|
| Rate for Payer: BCN Commercial |
$18.67
|
| Rate for Payer: BCN Medicare Advantage |
$6.00
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Cofinity Commercial |
$20.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.00
|
| Rate for Payer: Healthscope Commercial |
$21.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.41
|
| Rate for Payer: Nomi Health Commercial |
$19.69
|
| Rate for Payer: PACE Senior Care Partners |
$5.70
|
| Rate for Payer: PACE SWMI |
$6.00
|
| Rate for Payer: PHP Commercial |
$20.41
|
| Rate for Payer: PHP Medicare Advantage |
$6.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.61
|
| Rate for Payer: Priority Health HMO/PPO |
$20.89
|
| Rate for Payer: Priority Health Medicare |
$6.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.09
|
| Rate for Payer: Railroad Medicare Medicare |
$6.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.13
|
| Rate for Payer: UHC Core |
$20.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.00
|
| Rate for Payer: UHC Exchange |
$6.00
|
| Rate for Payer: UHC Medicare Advantage |
$6.00
|
| Rate for Payer: VA VA |
$6.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.01
|
|
|
DIMENHYDRINATE 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.01
|
|
|
Service Code
|
HCPCS J1240
|
| Hospital Charge Code |
2483
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.61 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Aetna Commercial |
$20.41
|
| Rate for Payer: BCBS Trust/PPO |
$19.60
|
| Rate for Payer: BCN Commercial |
$18.55
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Cofinity Commercial |
$20.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.21
|
| Rate for Payer: Healthscope Commercial |
$21.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.41
|
| Rate for Payer: Nomi Health Commercial |
$19.69
|
| Rate for Payer: PHP Commercial |
$20.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.61
|
| Rate for Payer: Priority Health HMO/PPO |
$20.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.13
|
| Rate for Payer: UHC Core |
$20.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.01
|
|
|
DIMENHYDRINATE 50 MG TABLET
|
Facility
|
IP
|
$88.20
|
|
|
Service Code
|
NDC 00904205159
|
| Hospital Charge Code |
2485
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.33 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: Aetna Commercial |
$74.97
|
| Rate for Payer: BCBS Trust/PPO |
$72.00
|
| Rate for Payer: BCN Commercial |
$68.16
|
| Rate for Payer: Cash Price |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$75.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.56
|
| Rate for Payer: Healthscope Commercial |
$79.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.97
|
| Rate for Payer: Nomi Health Commercial |
$72.32
|
| Rate for Payer: PHP Commercial |
$74.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.33
|
| Rate for Payer: Priority Health HMO/PPO |
$76.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.62
|
| Rate for Payer: UHC Core |
$73.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.15
|
|
|
DIMENHYDRINATE 50 MG TABLET
|
Facility
|
IP
|
$14.52
|
|
|
Service Code
|
NDC 09629520033
|
| Hospital Charge Code |
2485
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$13.07 |
| Rate for Payer: Aetna Commercial |
$12.34
|
| Rate for Payer: BCBS Trust/PPO |
$11.85
|
| Rate for Payer: BCN Commercial |
$11.22
|
| Rate for Payer: Cash Price |
$11.62
|
| Rate for Payer: Cofinity Commercial |
$12.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.62
|
| Rate for Payer: Healthscope Commercial |
$13.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.34
|
| Rate for Payer: Nomi Health Commercial |
$11.91
|
| Rate for Payer: PHP Commercial |
$12.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.44
|
| Rate for Payer: Priority Health HMO/PPO |
$12.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.78
|
| Rate for Payer: UHC Core |
$12.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.89
|
|
|
DIMENHYDRINATE 50 MG TABLET
|
Facility
|
OP
|
$88.20
|
|
|
Service Code
|
NDC 00904205159
|
| Hospital Charge Code |
2485
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: Aetna Commercial |
$74.97
|
| Rate for Payer: Aetna Medicare |
$22.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.56
|
| Rate for Payer: BCBS Complete |
$35.28
|
| Rate for Payer: BCBS MAPPO |
$22.05
|
| Rate for Payer: BCBS Trust/PPO |
$72.51
|
| Rate for Payer: BCN Commercial |
$68.58
|
| Rate for Payer: BCN Medicare Advantage |
$22.05
|
| Rate for Payer: Cash Price |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$75.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.05
|
| Rate for Payer: Healthscope Commercial |
$79.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.97
|
| Rate for Payer: Nomi Health Commercial |
$72.32
|
| Rate for Payer: PACE Senior Care Partners |
$20.95
|
| Rate for Payer: PACE SWMI |
$22.05
|
| Rate for Payer: PHP Commercial |
$74.97
|
| Rate for Payer: PHP Medicare Advantage |
$22.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.33
|
| Rate for Payer: Priority Health HMO/PPO |
$76.73
|
| Rate for Payer: Priority Health Medicare |
$22.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.09
|
| Rate for Payer: Railroad Medicare Medicare |
$22.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.62
|
| Rate for Payer: UHC Core |
$73.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.05
|
| Rate for Payer: UHC Exchange |
$22.05
|
| Rate for Payer: UHC Medicare Advantage |
$22.05
|
| Rate for Payer: VA VA |
$22.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.15
|
|
|
DIMENHYDRINATE 50 MG TABLET
|
Facility
|
OP
|
$14.52
|
|
|
Service Code
|
NDC 09629520033
|
| Hospital Charge Code |
2485
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$13.07 |
| Rate for Payer: Aetna Commercial |
$12.34
|
| Rate for Payer: Aetna Medicare |
$3.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.54
|
| Rate for Payer: BCBS Complete |
$5.81
|
| Rate for Payer: BCBS MAPPO |
$3.63
|
| Rate for Payer: BCBS Trust/PPO |
$11.94
|
| Rate for Payer: BCN Commercial |
$11.29
|
| Rate for Payer: BCN Medicare Advantage |
$3.63
|
| Rate for Payer: Cash Price |
$11.62
|
| Rate for Payer: Cofinity Commercial |
$12.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.63
|
| Rate for Payer: Healthscope Commercial |
$13.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.34
|
| Rate for Payer: Nomi Health Commercial |
$11.91
|
| Rate for Payer: PACE Senior Care Partners |
$3.45
|
| Rate for Payer: PACE SWMI |
$3.63
|
| Rate for Payer: PHP Commercial |
$12.34
|
| Rate for Payer: PHP Medicare Advantage |
$3.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.44
|
| Rate for Payer: Priority Health HMO/PPO |
$12.63
|
| Rate for Payer: Priority Health Medicare |
$3.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.73
|
| Rate for Payer: Railroad Medicare Medicare |
$3.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.78
|
| Rate for Payer: UHC Core |
$12.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.63
|
| Rate for Payer: UHC Exchange |
$3.63
|
| Rate for Payer: UHC Medicare Advantage |
$3.63
|
| Rate for Payer: VA VA |
$3.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.89
|
|
|
DIPHENHYD 25 MG-LIDO 200 MG-MAG,AL 400 MG-SIMETH 40 MG/30 ML MOUTHWASH
|
Facility
|
OP
|
$426.37
|
|
|
Service Code
|
NDC 65628005001
|
| Hospital Charge Code |
39984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.26 |
| Max. Negotiated Rate |
$383.73 |
| Rate for Payer: Aetna Commercial |
$362.41
|
| Rate for Payer: Aetna Medicare |
$110.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.24
|
| Rate for Payer: BCBS Complete |
$170.55
|
| Rate for Payer: BCBS MAPPO |
$106.59
|
| Rate for Payer: BCBS Trust/PPO |
$350.52
|
| Rate for Payer: BCN Commercial |
$331.50
|
| Rate for Payer: BCN Medicare Advantage |
$106.59
|
| Rate for Payer: Cash Price |
$341.10
|
| Rate for Payer: Cofinity Commercial |
$366.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.59
|
| Rate for Payer: Healthscope Commercial |
$383.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.41
|
| Rate for Payer: Nomi Health Commercial |
$349.62
|
| Rate for Payer: PACE Senior Care Partners |
$101.26
|
| Rate for Payer: PACE SWMI |
$106.59
|
| Rate for Payer: PHP Commercial |
$362.41
|
| Rate for Payer: PHP Medicare Advantage |
$106.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.14
|
| Rate for Payer: Priority Health HMO/PPO |
$370.94
|
| Rate for Payer: Priority Health Medicare |
$107.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.67
|
| Rate for Payer: Railroad Medicare Medicare |
$106.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.21
|
| Rate for Payer: UHC Core |
$356.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.59
|
| Rate for Payer: UHC Exchange |
$106.59
|
| Rate for Payer: UHC Medicare Advantage |
$106.59
|
| Rate for Payer: VA VA |
$106.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.78
|
|
|
DIPHENHYD 25 MG-LIDO 200 MG-MAG,AL 400 MG-SIMETH 40 MG/30 ML MOUTHWASH
|
Facility
|
IP
|
$426.37
|
|
|
Service Code
|
NDC 65628005001
|
| Hospital Charge Code |
39984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.14 |
| Max. Negotiated Rate |
$383.73 |
| Rate for Payer: Aetna Commercial |
$362.41
|
| Rate for Payer: BCBS Trust/PPO |
$348.05
|
| Rate for Payer: BCN Commercial |
$329.50
|
| Rate for Payer: Cash Price |
$341.10
|
| Rate for Payer: Cofinity Commercial |
$366.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.10
|
| Rate for Payer: Healthscope Commercial |
$383.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.41
|
| Rate for Payer: Nomi Health Commercial |
$349.62
|
| Rate for Payer: PHP Commercial |
$362.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.14
|
| Rate for Payer: Priority Health HMO/PPO |
$370.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.21
|
| Rate for Payer: UHC Core |
$356.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.78
|
|
|
DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR
|
Facility
|
OP
|
$13.55
|
|
|
Service Code
|
HCPCS Q0163
|
| Hospital Charge Code |
2511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$12.20 |
| Rate for Payer: Aetna Commercial |
$11.52
|
| Rate for Payer: Aetna Medicare |
$3.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.23
|
| Rate for Payer: BCBS Complete |
$5.42
|
| Rate for Payer: BCBS MAPPO |
$3.39
|
| Rate for Payer: BCBS Trust/PPO |
$11.14
|
| Rate for Payer: BCN Commercial |
$10.54
|
| Rate for Payer: BCN Medicare Advantage |
$3.39
|
| Rate for Payer: Cash Price |
$10.84
|
| Rate for Payer: Cofinity Commercial |
$11.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$12.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.52
|
| Rate for Payer: Nomi Health Commercial |
$11.11
|
| Rate for Payer: PACE Senior Care Partners |
$3.22
|
| Rate for Payer: PACE SWMI |
$3.39
|
| Rate for Payer: PHP Commercial |
$11.52
|
| Rate for Payer: PHP Medicare Advantage |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.81
|
| Rate for Payer: Priority Health HMO/PPO |
$11.79
|
| Rate for Payer: Priority Health Medicare |
$3.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.08
|
| Rate for Payer: Railroad Medicare Medicare |
$3.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.92
|
| Rate for Payer: UHC Core |
$11.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.39
|
| Rate for Payer: UHC Exchange |
$3.39
|
| Rate for Payer: UHC Medicare Advantage |
$3.39
|
| Rate for Payer: VA VA |
$3.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.16
|
|
|
DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR
|
Facility
|
IP
|
$13.55
|
|
|
Service Code
|
HCPCS Q0163
|
| Hospital Charge Code |
2511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$12.20 |
| Rate for Payer: Aetna Commercial |
$11.52
|
| Rate for Payer: BCBS Trust/PPO |
$11.06
|
| Rate for Payer: BCN Commercial |
$10.47
|
| Rate for Payer: Cash Price |
$10.84
|
| Rate for Payer: Cofinity Commercial |
$11.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.84
|
| Rate for Payer: Healthscope Commercial |
$12.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.52
|
| Rate for Payer: Nomi Health Commercial |
$11.11
|
| Rate for Payer: PHP Commercial |
$11.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.81
|
| Rate for Payer: Priority Health HMO/PPO |
$11.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.92
|
| Rate for Payer: UHC Core |
$11.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.16
|
|
|
DIPHENHYDRAMINE 25 MG TABLET
|
Facility
|
OP
|
$100.80
|
|
|
Service Code
|
NDC 00904555159
|
| Hospital Charge Code |
2505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.94 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: Aetna Medicare |
$26.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.50
|
| Rate for Payer: BCBS Complete |
$40.32
|
| Rate for Payer: BCBS MAPPO |
$25.20
|
| Rate for Payer: BCBS Trust/PPO |
$82.87
|
| Rate for Payer: BCN Commercial |
$78.37
|
| Rate for Payer: BCN Medicare Advantage |
$25.20
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cofinity Commercial |
$86.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.20
|
| Rate for Payer: Healthscope Commercial |
$90.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.68
|
| Rate for Payer: Nomi Health Commercial |
$82.66
|
| Rate for Payer: PACE Senior Care Partners |
$23.94
|
| Rate for Payer: PACE SWMI |
$25.20
|
| Rate for Payer: PHP Commercial |
$85.68
|
| Rate for Payer: PHP Medicare Advantage |
$25.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.52
|
| Rate for Payer: Priority Health HMO/PPO |
$87.70
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.54
|
| Rate for Payer: Railroad Medicare Medicare |
$25.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.70
|
| Rate for Payer: UHC Core |
$84.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.20
|
| Rate for Payer: UHC Exchange |
$25.20
|
| Rate for Payer: UHC Medicare Advantage |
$25.20
|
| Rate for Payer: VA VA |
$25.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.60
|
|
|
DIPHENHYDRAMINE 25 MG TABLET
|
Facility
|
OP
|
$142.80
|
|
|
Service Code
|
NDC 68094001861
|
| Hospital Charge Code |
2505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.92 |
| Max. Negotiated Rate |
$128.52 |
| Rate for Payer: Aetna Commercial |
$121.38
|
| Rate for Payer: Aetna Medicare |
$37.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.62
|
| Rate for Payer: BCBS Complete |
$57.12
|
| Rate for Payer: BCBS MAPPO |
$35.70
|
| Rate for Payer: BCBS Trust/PPO |
$117.40
|
| Rate for Payer: BCN Commercial |
$111.03
|
| Rate for Payer: BCN Medicare Advantage |
$35.70
|
| Rate for Payer: Cash Price |
$114.24
|
| Rate for Payer: Cofinity Commercial |
$122.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.70
|
| Rate for Payer: Healthscope Commercial |
$128.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.38
|
| Rate for Payer: Nomi Health Commercial |
$117.10
|
| Rate for Payer: PACE Senior Care Partners |
$33.92
|
| Rate for Payer: PACE SWMI |
$35.70
|
| Rate for Payer: PHP Commercial |
$121.38
|
| Rate for Payer: PHP Medicare Advantage |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.82
|
| Rate for Payer: Priority Health HMO/PPO |
$124.24
|
| Rate for Payer: Priority Health Medicare |
$36.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.68
|
| Rate for Payer: Railroad Medicare Medicare |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.66
|
| Rate for Payer: UHC Core |
$119.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.70
|
| Rate for Payer: UHC Exchange |
$35.70
|
| Rate for Payer: UHC Medicare Advantage |
$35.70
|
| Rate for Payer: VA VA |
$35.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.10
|
|
|
DIPHENHYDRAMINE 25 MG TABLET
|
Facility
|
OP
|
$1.43
|
|
|
Service Code
|
NDC 68094001859
|
| Hospital Charge Code |
2505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna Commercial |
$1.22
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.45
|
| Rate for Payer: BCBS Complete |
$0.57
|
| Rate for Payer: BCBS MAPPO |
$0.36
|
| Rate for Payer: BCBS Trust/PPO |
$1.18
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: BCN Medicare Advantage |
$0.36
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Cofinity Commercial |
$1.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.36
|
| Rate for Payer: Healthscope Commercial |
$1.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.22
|
| Rate for Payer: Nomi Health Commercial |
$1.17
|
| Rate for Payer: PACE Senior Care Partners |
$0.34
|
| Rate for Payer: PACE SWMI |
$0.36
|
| Rate for Payer: PHP Commercial |
$1.22
|
| Rate for Payer: PHP Medicare Advantage |
$0.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.93
|
| Rate for Payer: Priority Health HMO/PPO |
$1.24
|
| Rate for Payer: Priority Health Medicare |
$0.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.96
|
| Rate for Payer: Railroad Medicare Medicare |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.26
|
| Rate for Payer: UHC Core |
$1.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.36
|
| Rate for Payer: UHC Exchange |
$0.36
|
| Rate for Payer: UHC Medicare Advantage |
$0.36
|
| Rate for Payer: VA VA |
$0.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.07
|
|
|
DIPHENHYDRAMINE 25 MG TABLET
|
Facility
|
IP
|
$100.80
|
|
|
Service Code
|
NDC 00904555159
|
| Hospital Charge Code |
2505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.52 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: BCBS Trust/PPO |
$82.28
|
| Rate for Payer: BCN Commercial |
$77.90
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cofinity Commercial |
$86.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.64
|
| Rate for Payer: Healthscope Commercial |
$90.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.68
|
| Rate for Payer: Nomi Health Commercial |
$82.66
|
| Rate for Payer: PHP Commercial |
$85.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.52
|
| Rate for Payer: Priority Health HMO/PPO |
$87.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.70
|
| Rate for Payer: UHC Core |
$84.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.60
|
|
|
DIPHENHYDRAMINE 25 MG TABLET
|
Facility
|
IP
|
$1.43
|
|
|
Service Code
|
NDC 68094001859
|
| Hospital Charge Code |
2505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna Commercial |
$1.22
|
| Rate for Payer: BCBS Trust/PPO |
$1.17
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Cofinity Commercial |
$1.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.14
|
| Rate for Payer: Healthscope Commercial |
$1.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.22
|
| Rate for Payer: Nomi Health Commercial |
$1.17
|
| Rate for Payer: PHP Commercial |
$1.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.93
|
| Rate for Payer: Priority Health HMO/PPO |
$1.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.26
|
| Rate for Payer: UHC Core |
$1.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.07
|
|
|
DIPHENHYDRAMINE 25 MG TABLET
|
Facility
|
IP
|
$142.80
|
|
|
Service Code
|
NDC 68094001861
|
| Hospital Charge Code |
2505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$128.52 |
| Rate for Payer: Aetna Commercial |
$121.38
|
| Rate for Payer: BCBS Trust/PPO |
$116.57
|
| Rate for Payer: BCN Commercial |
$110.36
|
| Rate for Payer: Cash Price |
$114.24
|
| Rate for Payer: Cofinity Commercial |
$122.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.24
|
| Rate for Payer: Healthscope Commercial |
$128.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.38
|
| Rate for Payer: Nomi Health Commercial |
$117.10
|
| Rate for Payer: PHP Commercial |
$121.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.82
|
| Rate for Payer: Priority Health HMO/PPO |
$124.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.66
|
| Rate for Payer: UHC Core |
$119.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.10
|
|
|
DIPHENHYDRAMINE 50 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$12.13
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
163710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$10.92 |
| Rate for Payer: Aetna Commercial |
$10.31
|
| Rate for Payer: BCBS Trust/PPO |
$9.90
|
| Rate for Payer: BCN Commercial |
$9.37
|
| Rate for Payer: Cash Price |
$9.70
|
| Rate for Payer: Cofinity Commercial |
$10.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.70
|
| Rate for Payer: Healthscope Commercial |
$10.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.31
|
| Rate for Payer: Nomi Health Commercial |
$9.95
|
| Rate for Payer: PHP Commercial |
$10.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.88
|
| Rate for Payer: Priority Health HMO/PPO |
$10.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.67
|
| Rate for Payer: UHC Core |
$10.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.10
|
|
|
DIPHENHYDRAMINE 50 MG/ML INJECTION (CODE)
|
Facility
|
OP
|
$12.13
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
163710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$10.92 |
| Rate for Payer: Aetna Commercial |
$10.31
|
| Rate for Payer: Aetna Medicare |
$3.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.79
|
| Rate for Payer: BCBS Complete |
$4.85
|
| Rate for Payer: BCBS MAPPO |
$3.03
|
| Rate for Payer: BCBS Trust/PPO |
$9.97
|
| Rate for Payer: BCN Commercial |
$9.43
|
| Rate for Payer: BCN Medicare Advantage |
$3.03
|
| Rate for Payer: Cash Price |
$9.70
|
| Rate for Payer: Cofinity Commercial |
$10.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.03
|
| Rate for Payer: Healthscope Commercial |
$10.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.31
|
| Rate for Payer: Nomi Health Commercial |
$9.95
|
| Rate for Payer: PACE Senior Care Partners |
$2.88
|
| Rate for Payer: PACE SWMI |
$3.03
|
| Rate for Payer: PHP Commercial |
$10.31
|
| Rate for Payer: PHP Medicare Advantage |
$3.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.88
|
| Rate for Payer: Priority Health HMO/PPO |
$10.55
|
| Rate for Payer: Priority Health Medicare |
$3.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.13
|
| Rate for Payer: Railroad Medicare Medicare |
$3.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.67
|
| Rate for Payer: UHC Core |
$10.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.03
|
| Rate for Payer: UHC Exchange |
$3.03
|
| Rate for Payer: UHC Medicare Advantage |
$3.03
|
| Rate for Payer: VA VA |
$3.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.10
|
|
|
DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$12.13
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
2508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$10.92 |
| Rate for Payer: Aetna Commercial |
$10.31
|
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna Medicare |
$5.37
|
| Rate for Payer: Aetna Medicare |
$3.15
|
| Rate for Payer: Aetna Medicare |
$3.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.45
|
| Rate for Payer: BCBS Complete |
$5.40
|
| Rate for Payer: BCBS Complete |
$4.85
|
| Rate for Payer: BCBS Complete |
$8.26
|
| Rate for Payer: BCBS MAPPO |
$5.16
|
| Rate for Payer: BCBS MAPPO |
$3.03
|
| Rate for Payer: BCBS MAPPO |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$11.09
|
| Rate for Payer: BCBS Trust/PPO |
$9.97
|
| Rate for Payer: BCBS Trust/PPO |
$16.98
|
| Rate for Payer: BCN Commercial |
$10.49
|
| Rate for Payer: BCN Commercial |
$16.06
|
| Rate for Payer: BCN Commercial |
$9.43
|
| Rate for Payer: BCN Medicare Advantage |
$3.03
|
| Rate for Payer: BCN Medicare Advantage |
$3.37
|
| Rate for Payer: BCN Medicare Advantage |
$5.16
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cash Price |
$9.70
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$10.43
|
| Rate for Payer: Cofinity Commercial |
$11.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.03
|
| Rate for Payer: Healthscope Commercial |
$12.14
|
| Rate for Payer: Healthscope Commercial |
$10.92
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.31
|
| Rate for Payer: Nomi Health Commercial |
$16.93
|
| Rate for Payer: Nomi Health Commercial |
$9.95
|
| Rate for Payer: Nomi Health Commercial |
$11.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.90
|
| Rate for Payer: PACE Senior Care Partners |
$2.88
|
| Rate for Payer: PACE Senior Care Partners |
$3.20
|
| Rate for Payer: PACE SWMI |
$3.37
|
| Rate for Payer: PACE SWMI |
$3.03
|
| Rate for Payer: PACE SWMI |
$5.16
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: PHP Commercial |
$10.31
|
| Rate for Payer: PHP Medicare Advantage |
$3.37
|
| Rate for Payer: PHP Medicare Advantage |
$5.16
|
| Rate for Payer: PHP Medicare Advantage |
$3.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.77
|
| Rate for Payer: Priority Health HMO/PPO |
$17.97
|
| Rate for Payer: Priority Health HMO/PPO |
$10.55
|
| Rate for Payer: Priority Health HMO/PPO |
$11.74
|
| Rate for Payer: Priority Health Medicare |
$3.06
|
| Rate for Payer: Priority Health Medicare |
$5.21
|
| Rate for Payer: Priority Health Medicare |
$3.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.13
|
| Rate for Payer: Railroad Medicare Medicare |
$3.37
|
| Rate for Payer: Railroad Medicare Medicare |
$5.16
|
| Rate for Payer: Railroad Medicare Medicare |
$3.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.67
|
| Rate for Payer: UHC Core |
$17.24
|
| Rate for Payer: UHC Core |
$11.26
|
| Rate for Payer: UHC Core |
$10.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.37
|
| Rate for Payer: UHC Exchange |
$3.37
|
| Rate for Payer: UHC Exchange |
$3.03
|
| Rate for Payer: UHC Exchange |
$5.16
|
| Rate for Payer: UHC Medicare Advantage |
$3.03
|
| Rate for Payer: UHC Medicare Advantage |
$3.37
|
| Rate for Payer: UHC Medicare Advantage |
$5.16
|
| Rate for Payer: VA VA |
$3.37
|
| Rate for Payer: VA VA |
$5.16
|
| Rate for Payer: VA VA |
$3.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$12.13
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
2508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$10.92 |
| Rate for Payer: Aetna Commercial |
$10.31
|
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.01
|
| Rate for Payer: BCBS Trust/PPO |
$9.90
|
| Rate for Payer: BCBS Trust/PPO |
$16.86
|
| Rate for Payer: BCN Commercial |
$15.96
|
| Rate for Payer: BCN Commercial |
$9.37
|
| Rate for Payer: BCN Commercial |
$10.43
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cash Price |
$9.70
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$10.43
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$11.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Healthscope Commercial |
$10.92
|
| Rate for Payer: Healthscope Commercial |
$12.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.31
|
| Rate for Payer: Nomi Health Commercial |
$9.95
|
| Rate for Payer: Nomi Health Commercial |
$16.93
|
| Rate for Payer: Nomi Health Commercial |
$11.06
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: PHP Commercial |
$10.31
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.88
|
| Rate for Payer: Priority Health HMO/PPO |
$17.97
|
| Rate for Payer: Priority Health HMO/PPO |
$11.74
|
| Rate for Payer: Priority Health HMO/PPO |
$10.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.17
|
| Rate for Payer: UHC Core |
$10.13
|
| Rate for Payer: UHC Core |
$11.26
|
| Rate for Payer: UHC Core |
$17.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.10
|
|
