|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
NDC 00641602201
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Aetna Commercial |
$11.01
|
| Rate for Payer: BCBS Trust/PPO |
$10.57
|
| Rate for Payer: BCN Commercial |
$10.01
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$11.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.36
|
| Rate for Payer: Healthscope Commercial |
$11.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.01
|
| Rate for Payer: Nomi Health Commercial |
$10.62
|
| Rate for Payer: PHP Commercial |
$11.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.42
|
| Rate for Payer: Priority Health HMO/PPO |
$11.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.40
|
| Rate for Payer: UHC Core |
$10.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.71
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12.05
|
|
|
Service Code
|
NDC 67457043322
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: BCBS Trust/PPO |
$9.84
|
| Rate for Payer: BCN Commercial |
$9.31
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.64
|
| Rate for Payer: Healthscope Commercial |
$10.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.24
|
| Rate for Payer: Nomi Health Commercial |
$9.88
|
| Rate for Payer: PHP Commercial |
$10.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.83
|
| Rate for Payer: Priority Health HMO/PPO |
$10.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.60
|
| Rate for Payer: UHC Core |
$10.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.04
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12.05
|
|
|
Service Code
|
NDC 67457043300
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: Aetna Medicare |
$3.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.77
|
| Rate for Payer: BCBS Complete |
$4.82
|
| Rate for Payer: BCBS MAPPO |
$3.01
|
| Rate for Payer: BCBS Trust/PPO |
$9.91
|
| Rate for Payer: BCN Commercial |
$9.37
|
| Rate for Payer: BCN Medicare Advantage |
$3.01
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.01
|
| Rate for Payer: Healthscope Commercial |
$10.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.24
|
| Rate for Payer: Nomi Health Commercial |
$9.88
|
| Rate for Payer: PACE Senior Care Partners |
$2.86
|
| Rate for Payer: PACE SWMI |
$3.01
|
| Rate for Payer: PHP Commercial |
$10.24
|
| Rate for Payer: PHP Medicare Advantage |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.83
|
| Rate for Payer: Priority Health HMO/PPO |
$10.48
|
| Rate for Payer: Priority Health Medicare |
$3.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.07
|
| Rate for Payer: Railroad Medicare Medicare |
$3.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.60
|
| Rate for Payer: UHC Core |
$10.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.01
|
| Rate for Payer: UHC Exchange |
$3.01
|
| Rate for Payer: UHC Medicare Advantage |
$3.01
|
| Rate for Payer: VA VA |
$3.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.04
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
NDC 00641602201
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Aetna Commercial |
$11.01
|
| Rate for Payer: Aetna Medicare |
$3.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.05
|
| Rate for Payer: BCBS Complete |
$5.18
|
| Rate for Payer: BCBS MAPPO |
$3.24
|
| Rate for Payer: BCBS Trust/PPO |
$10.65
|
| Rate for Payer: BCN Commercial |
$10.07
|
| Rate for Payer: BCN Medicare Advantage |
$3.24
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$11.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$11.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.01
|
| Rate for Payer: Nomi Health Commercial |
$10.62
|
| Rate for Payer: PACE Senior Care Partners |
$3.08
|
| Rate for Payer: PACE SWMI |
$3.24
|
| Rate for Payer: PHP Commercial |
$11.01
|
| Rate for Payer: PHP Medicare Advantage |
$3.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.42
|
| Rate for Payer: Priority Health HMO/PPO |
$11.27
|
| Rate for Payer: Priority Health Medicare |
$3.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.40
|
| Rate for Payer: UHC Core |
$10.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.24
|
| Rate for Payer: UHC Exchange |
$3.24
|
| Rate for Payer: UHC Medicare Advantage |
$3.24
|
| Rate for Payer: VA VA |
$3.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.71
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.05
|
|
|
Service Code
|
NDC 63323073912
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: BCBS Trust/PPO |
$13.10
|
| Rate for Payer: BCN Commercial |
$12.40
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: Nomi Health Commercial |
$13.16
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: Priority Health HMO/PPO |
$13.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.12
|
| Rate for Payer: UHC Core |
$13.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
NDC 00641602225
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Aetna Commercial |
$11.01
|
| Rate for Payer: BCBS Trust/PPO |
$10.57
|
| Rate for Payer: BCN Commercial |
$10.01
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$11.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.36
|
| Rate for Payer: Healthscope Commercial |
$11.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.01
|
| Rate for Payer: Nomi Health Commercial |
$10.62
|
| Rate for Payer: PHP Commercial |
$11.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.42
|
| Rate for Payer: Priority Health HMO/PPO |
$11.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.40
|
| Rate for Payer: UHC Core |
$10.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.71
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12.05
|
|
|
Service Code
|
NDC 67457043322
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: Aetna Medicare |
$3.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.77
|
| Rate for Payer: BCBS Complete |
$4.82
|
| Rate for Payer: BCBS MAPPO |
$3.01
|
| Rate for Payer: BCBS Trust/PPO |
$9.91
|
| Rate for Payer: BCN Commercial |
$9.37
|
| Rate for Payer: BCN Medicare Advantage |
$3.01
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.01
|
| Rate for Payer: Healthscope Commercial |
$10.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.24
|
| Rate for Payer: Nomi Health Commercial |
$9.88
|
| Rate for Payer: PACE Senior Care Partners |
$2.86
|
| Rate for Payer: PACE SWMI |
$3.01
|
| Rate for Payer: PHP Commercial |
$10.24
|
| Rate for Payer: PHP Medicare Advantage |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.83
|
| Rate for Payer: Priority Health HMO/PPO |
$10.48
|
| Rate for Payer: Priority Health Medicare |
$3.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.07
|
| Rate for Payer: Railroad Medicare Medicare |
$3.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.60
|
| Rate for Payer: UHC Core |
$10.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.01
|
| Rate for Payer: UHC Exchange |
$3.01
|
| Rate for Payer: UHC Medicare Advantage |
$3.01
|
| Rate for Payer: VA VA |
$3.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.04
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
NDC 00641602225
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Aetna Commercial |
$11.01
|
| Rate for Payer: Aetna Medicare |
$3.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.05
|
| Rate for Payer: BCBS Complete |
$5.18
|
| Rate for Payer: BCBS MAPPO |
$3.24
|
| Rate for Payer: BCBS Trust/PPO |
$10.65
|
| Rate for Payer: BCN Commercial |
$10.07
|
| Rate for Payer: BCN Medicare Advantage |
$3.24
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$11.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$11.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.01
|
| Rate for Payer: Nomi Health Commercial |
$10.62
|
| Rate for Payer: PACE Senior Care Partners |
$3.08
|
| Rate for Payer: PACE SWMI |
$3.24
|
| Rate for Payer: PHP Commercial |
$11.01
|
| Rate for Payer: PHP Medicare Advantage |
$3.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.42
|
| Rate for Payer: Priority Health HMO/PPO |
$11.27
|
| Rate for Payer: Priority Health Medicare |
$3.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.40
|
| Rate for Payer: UHC Core |
$10.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.24
|
| Rate for Payer: UHC Exchange |
$3.24
|
| Rate for Payer: UHC Medicare Advantage |
$3.24
|
| Rate for Payer: VA VA |
$3.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.71
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.05
|
|
|
Service Code
|
NDC 63323073912
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: Aetna Medicare |
$4.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.02
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: BCBS MAPPO |
$4.01
|
| Rate for Payer: BCBS Trust/PPO |
$13.19
|
| Rate for Payer: BCN Commercial |
$12.48
|
| Rate for Payer: BCN Medicare Advantage |
$4.01
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.01
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: Nomi Health Commercial |
$13.16
|
| Rate for Payer: PACE Senior Care Partners |
$3.81
|
| Rate for Payer: PACE SWMI |
$4.01
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: PHP Medicare Advantage |
$4.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: Priority Health HMO/PPO |
$13.96
|
| Rate for Payer: Priority Health Medicare |
$4.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.12
|
| Rate for Payer: UHC Core |
$13.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.01
|
| Rate for Payer: UHC Exchange |
$4.01
|
| Rate for Payer: UHC Medicare Advantage |
$4.01
|
| Rate for Payer: VA VA |
$4.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
|
|
FASCIECTOMY, PLANTAR FASCIA; PARTIAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,413.50
|
|
|
Service Code
|
CPT 28060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,298.42 |
| Max. Negotiated Rate |
$2,413.50 |
| Rate for Payer: BCBS Complete |
$2,413.50
|
| Rate for Payer: Mclaren Medicaid |
$2,298.42
|
| Rate for Payer: Meridian Medicaid |
$2,413.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.42
|
| Rate for Payer: UHCCP Medicaid |
$2,298.42
|
|
|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
NDC 00338051913
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
NDC 00338051913
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
NDC 00338954003
|
| Hospital Charge Code |
191280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna Commercial |
$11.48
|
| Rate for Payer: Aetna Medicare |
$3.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.22
|
| Rate for Payer: BCBS Complete |
$5.40
|
| Rate for Payer: BCBS MAPPO |
$3.38
|
| Rate for Payer: BCBS Trust/PPO |
$11.10
|
| Rate for Payer: BCN Commercial |
$10.50
|
| Rate for Payer: BCN Medicare Advantage |
$3.38
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.48
|
| Rate for Payer: Nomi Health Commercial |
$11.07
|
| Rate for Payer: PACE Senior Care Partners |
$3.21
|
| Rate for Payer: PACE SWMI |
$3.38
|
| Rate for Payer: PHP Commercial |
$11.48
|
| Rate for Payer: PHP Medicare Advantage |
$3.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.78
|
| Rate for Payer: Priority Health HMO/PPO |
$11.74
|
| Rate for Payer: Priority Health Medicare |
$3.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.04
|
| Rate for Payer: Railroad Medicare Medicare |
$3.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.88
|
| Rate for Payer: UHC Core |
$11.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.38
|
| Rate for Payer: UHC Exchange |
$3.38
|
| Rate for Payer: UHC Medicare Advantage |
$3.38
|
| Rate for Payer: VA VA |
$3.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
NDC 00338954003
|
| Hospital Charge Code |
191280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna Commercial |
$11.48
|
| Rate for Payer: BCBS Trust/PPO |
$11.02
|
| Rate for Payer: BCN Commercial |
$10.43
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.48
|
| Rate for Payer: Nomi Health Commercial |
$11.07
|
| Rate for Payer: PHP Commercial |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.78
|
| Rate for Payer: Priority Health HMO/PPO |
$11.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.88
|
| Rate for Payer: UHC Core |
$11.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
NDC 63323082074
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna Commercial |
$20.40
|
| 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 |
$19.73
|
| Rate for Payer: BCN Commercial |
$18.66
|
| Rate for Payer: BCN Medicare Advantage |
$6.00
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.00
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.00
|
| 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 |
$20.40
|
| Rate for Payer: Nomi Health Commercial |
$19.68
|
| Rate for Payer: PACE Senior Care Partners |
$5.70
|
| Rate for Payer: PACE SWMI |
$6.00
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: PHP Medicare Advantage |
$6.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health HMO/PPO |
$20.88
|
| Rate for Payer: Priority Health Medicare |
$6.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.08
|
| Rate for Payer: Railroad Medicare Medicare |
$6.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.12
|
| Rate for Payer: UHC Core |
$20.04
|
| 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 |
$18.00
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
NDC 63323082074
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$19.59
|
| Rate for Payer: BCN Commercial |
$18.55
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.40
|
| Rate for Payer: Nomi Health Commercial |
$19.68
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health HMO/PPO |
$20.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.12
|
| Rate for Payer: UHC Core |
$20.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.00
|
|
|
FEBUXOSTAT 40 MG TABLET
|
Facility
|
OP
|
$1,135.65
|
|
|
Service Code
|
NDC 64764091830
|
| Hospital Charge Code |
97133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.72 |
| Max. Negotiated Rate |
$1,022.08 |
| Rate for Payer: Aetna Commercial |
$965.30
|
| Rate for Payer: Aetna Medicare |
$295.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$354.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$354.89
|
| Rate for Payer: BCBS Complete |
$454.26
|
| Rate for Payer: BCBS MAPPO |
$283.91
|
| Rate for Payer: BCBS Trust/PPO |
$933.62
|
| Rate for Payer: BCN Commercial |
$882.97
|
| Rate for Payer: BCN Medicare Advantage |
$283.91
|
| Rate for Payer: Cash Price |
$908.52
|
| Rate for Payer: Cofinity Commercial |
$976.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$283.91
|
| Rate for Payer: Healthscope Commercial |
$1,022.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$851.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$326.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.30
|
| Rate for Payer: Nomi Health Commercial |
$931.23
|
| Rate for Payer: PACE Senior Care Partners |
$269.72
|
| Rate for Payer: PACE SWMI |
$283.91
|
| Rate for Payer: PHP Commercial |
$965.30
|
| Rate for Payer: PHP Medicare Advantage |
$283.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$738.17
|
| Rate for Payer: Priority Health HMO/PPO |
$988.02
|
| Rate for Payer: Priority Health Medicare |
$286.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$760.89
|
| Rate for Payer: Railroad Medicare Medicare |
$283.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$999.37
|
| Rate for Payer: UHC Core |
$948.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$283.91
|
| Rate for Payer: UHC Exchange |
$283.91
|
| Rate for Payer: UHC Medicare Advantage |
$283.91
|
| Rate for Payer: VA VA |
$283.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$851.74
|
|
|
FEBUXOSTAT 40 MG TABLET
|
Facility
|
IP
|
$1,135.65
|
|
|
Service Code
|
NDC 64764091830
|
| Hospital Charge Code |
97133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$738.17 |
| Max. Negotiated Rate |
$1,022.08 |
| Rate for Payer: Aetna Commercial |
$965.30
|
| Rate for Payer: BCBS Trust/PPO |
$927.03
|
| Rate for Payer: BCN Commercial |
$877.63
|
| Rate for Payer: Cash Price |
$908.52
|
| Rate for Payer: Cofinity Commercial |
$976.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.52
|
| Rate for Payer: Healthscope Commercial |
$1,022.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$851.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.30
|
| Rate for Payer: Nomi Health Commercial |
$931.23
|
| Rate for Payer: PHP Commercial |
$965.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$738.17
|
| Rate for Payer: Priority Health HMO/PPO |
$988.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$760.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$999.37
|
| Rate for Payer: UHC Core |
$948.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$851.74
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
OP
|
$9.41
|
|
|
Service Code
|
NDC 60687062911
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: Aetna Commercial |
$8.00
|
| Rate for Payer: Aetna Medicare |
$2.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.94
|
| Rate for Payer: BCBS Complete |
$3.76
|
| Rate for Payer: BCBS MAPPO |
$2.35
|
| Rate for Payer: BCBS Trust/PPO |
$7.74
|
| Rate for Payer: BCN Commercial |
$7.32
|
| Rate for Payer: BCN Medicare Advantage |
$2.35
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cofinity Commercial |
$8.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.35
|
| Rate for Payer: Healthscope Commercial |
$8.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.00
|
| Rate for Payer: Nomi Health Commercial |
$7.72
|
| Rate for Payer: PACE Senior Care Partners |
$2.23
|
| Rate for Payer: PACE SWMI |
$2.35
|
| Rate for Payer: PHP Commercial |
$8.00
|
| Rate for Payer: PHP Medicare Advantage |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.12
|
| Rate for Payer: Priority Health HMO/PPO |
$8.19
|
| Rate for Payer: Priority Health Medicare |
$2.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.28
|
| Rate for Payer: UHC Core |
$7.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.35
|
| Rate for Payer: UHC Exchange |
$2.35
|
| Rate for Payer: UHC Medicare Advantage |
$2.35
|
| Rate for Payer: VA VA |
$2.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.06
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$156.53
|
|
|
Service Code
|
NDC 00904716104
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.74 |
| Max. Negotiated Rate |
$140.88 |
| Rate for Payer: Aetna Commercial |
$133.05
|
| Rate for Payer: BCBS Trust/PPO |
$127.78
|
| Rate for Payer: BCN Commercial |
$120.97
|
| Rate for Payer: Cash Price |
$125.22
|
| Rate for Payer: Cofinity Commercial |
$134.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.22
|
| Rate for Payer: Healthscope Commercial |
$140.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.05
|
| Rate for Payer: Nomi Health Commercial |
$128.35
|
| Rate for Payer: PHP Commercial |
$133.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.74
|
| Rate for Payer: Priority Health HMO/PPO |
$136.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.75
|
| Rate for Payer: UHC Core |
$130.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.40
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
OP
|
$175.40
|
|
|
Service Code
|
NDC 60687062921
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.66 |
| Max. Negotiated Rate |
$157.86 |
| Rate for Payer: Aetna Commercial |
$149.09
|
| Rate for Payer: Aetna Medicare |
$45.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.81
|
| Rate for Payer: BCBS Complete |
$70.16
|
| Rate for Payer: BCBS MAPPO |
$43.85
|
| Rate for Payer: BCBS Trust/PPO |
$144.20
|
| Rate for Payer: BCN Commercial |
$136.37
|
| Rate for Payer: BCN Medicare Advantage |
$43.85
|
| Rate for Payer: Cash Price |
$140.32
|
| Rate for Payer: Cofinity Commercial |
$150.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.85
|
| Rate for Payer: Healthscope Commercial |
$157.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.09
|
| Rate for Payer: Nomi Health Commercial |
$143.83
|
| Rate for Payer: PACE Senior Care Partners |
$41.66
|
| Rate for Payer: PACE SWMI |
$43.85
|
| Rate for Payer: PHP Commercial |
$149.09
|
| Rate for Payer: PHP Medicare Advantage |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.01
|
| Rate for Payer: Priority Health HMO/PPO |
$152.60
|
| Rate for Payer: Priority Health Medicare |
$44.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.52
|
| Rate for Payer: Railroad Medicare Medicare |
$43.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.35
|
| Rate for Payer: UHC Core |
$146.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.85
|
| Rate for Payer: UHC Exchange |
$43.85
|
| Rate for Payer: UHC Medicare Advantage |
$43.85
|
| Rate for Payer: VA VA |
$43.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.55
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$9.41
|
|
|
Service Code
|
NDC 60687062911
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: Aetna Commercial |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$7.68
|
| Rate for Payer: BCN Commercial |
$7.27
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cofinity Commercial |
$8.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.53
|
| Rate for Payer: Healthscope Commercial |
$8.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.00
|
| Rate for Payer: Nomi Health Commercial |
$7.72
|
| Rate for Payer: PHP Commercial |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.12
|
| Rate for Payer: Priority Health HMO/PPO |
$8.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.28
|
| Rate for Payer: UHC Core |
$7.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.06
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$175.40
|
|
|
Service Code
|
NDC 60687062921
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.01 |
| Max. Negotiated Rate |
$157.86 |
| Rate for Payer: Aetna Commercial |
$149.09
|
| Rate for Payer: BCBS Trust/PPO |
$143.18
|
| Rate for Payer: BCN Commercial |
$135.55
|
| Rate for Payer: Cash Price |
$140.32
|
| Rate for Payer: Cofinity Commercial |
$150.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.32
|
| Rate for Payer: Healthscope Commercial |
$157.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.09
|
| Rate for Payer: Nomi Health Commercial |
$143.83
|
| Rate for Payer: PHP Commercial |
$149.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.01
|
| Rate for Payer: Priority Health HMO/PPO |
$152.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.35
|
| Rate for Payer: UHC Core |
$146.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.55
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
OP
|
$156.53
|
|
|
Service Code
|
NDC 00904716104
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$140.88 |
| Rate for Payer: Aetna Commercial |
$133.05
|
| Rate for Payer: Aetna Medicare |
$40.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.92
|
| Rate for Payer: BCBS Complete |
$62.61
|
| Rate for Payer: BCBS MAPPO |
$39.13
|
| Rate for Payer: BCBS Trust/PPO |
$128.68
|
| Rate for Payer: BCN Commercial |
$121.70
|
| Rate for Payer: BCN Medicare Advantage |
$39.13
|
| Rate for Payer: Cash Price |
$125.22
|
| Rate for Payer: Cofinity Commercial |
$134.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.13
|
| Rate for Payer: Healthscope Commercial |
$140.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.05
|
| Rate for Payer: Nomi Health Commercial |
$128.35
|
| Rate for Payer: PACE Senior Care Partners |
$37.18
|
| Rate for Payer: PACE SWMI |
$39.13
|
| Rate for Payer: PHP Commercial |
$133.05
|
| Rate for Payer: PHP Medicare Advantage |
$39.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.74
|
| Rate for Payer: Priority Health HMO/PPO |
$136.18
|
| Rate for Payer: Priority Health Medicare |
$39.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.88
|
| Rate for Payer: Railroad Medicare Medicare |
$39.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.75
|
| Rate for Payer: UHC Core |
$130.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.13
|
| Rate for Payer: UHC Exchange |
$39.13
|
| Rate for Payer: UHC Medicare Advantage |
$39.13
|
| Rate for Payer: VA VA |
$39.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.40
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
OP
|
$215.73
|
|
|
Service Code
|
NDC 69097045905
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.24 |
| Max. Negotiated Rate |
$194.16 |
| Rate for Payer: Aetna Commercial |
$183.37
|
| Rate for Payer: Aetna Medicare |
$56.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.42
|
| Rate for Payer: BCBS Complete |
$86.29
|
| Rate for Payer: BCBS MAPPO |
$53.93
|
| Rate for Payer: BCBS Trust/PPO |
$177.35
|
| Rate for Payer: BCN Commercial |
$167.73
|
| Rate for Payer: BCN Medicare Advantage |
$53.93
|
| Rate for Payer: Cash Price |
$172.58
|
| Rate for Payer: Cofinity Commercial |
$185.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.93
|
| Rate for Payer: Healthscope Commercial |
$194.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.37
|
| Rate for Payer: Nomi Health Commercial |
$176.90
|
| Rate for Payer: PACE Senior Care Partners |
$51.24
|
| Rate for Payer: PACE SWMI |
$53.93
|
| Rate for Payer: PHP Commercial |
$183.37
|
| Rate for Payer: PHP Medicare Advantage |
$53.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.22
|
| Rate for Payer: Priority Health HMO/PPO |
$187.69
|
| Rate for Payer: Priority Health Medicare |
$54.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.54
|
| Rate for Payer: Railroad Medicare Medicare |
$53.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.84
|
| Rate for Payer: UHC Core |
$180.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.93
|
| Rate for Payer: UHC Exchange |
$53.93
|
| Rate for Payer: UHC Medicare Advantage |
$53.93
|
| Rate for Payer: VA VA |
$53.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.80
|
|
