|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$3.77
|
|
|
Service Code
|
NDC 68084028811
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna Medicare |
$0.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.18
|
| Rate for Payer: BCBS Complete |
$1.51
|
| Rate for Payer: BCBS MAPPO |
$0.94
|
| Rate for Payer: BCBS Trust/PPO |
$3.10
|
| Rate for Payer: BCN Commercial |
$2.93
|
| Rate for Payer: BCN Medicare Advantage |
$0.94
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.94
|
| Rate for Payer: Healthscope Commercial |
$3.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Nomi Health Commercial |
$3.09
|
| Rate for Payer: PACE Senior Care Partners |
$0.90
|
| Rate for Payer: PACE SWMI |
$0.94
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: PHP Medicare Advantage |
$0.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.45
|
| Rate for Payer: Priority Health HMO/PPO |
$3.28
|
| Rate for Payer: Priority Health Medicare |
$0.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.53
|
| Rate for Payer: Railroad Medicare Medicare |
$0.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.32
|
| Rate for Payer: UHC Core |
$3.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.94
|
| Rate for Payer: UHC Exchange |
$0.94
|
| Rate for Payer: UHC Medicare Advantage |
$0.94
|
| Rate for Payer: VA VA |
$0.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.83
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 50268033011
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna Medicare |
$1.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.44
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS MAPPO |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.79
|
| Rate for Payer: BCN Commercial |
$3.58
|
| Rate for Payer: BCN Medicare Advantage |
$1.15
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.15
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Nomi Health Commercial |
$3.78
|
| Rate for Payer: PACE Senior Care Partners |
$1.09
|
| Rate for Payer: PACE SWMI |
$1.15
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: PHP Medicare Advantage |
$1.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.00
|
| Rate for Payer: Priority Health HMO/PPO |
$4.01
|
| Rate for Payer: Priority Health Medicare |
$1.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.06
|
| Rate for Payer: UHC Core |
$3.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.15
|
| Rate for Payer: UHC Exchange |
$1.15
|
| Rate for Payer: UHC Medicare Advantage |
$1.15
|
| Rate for Payer: VA VA |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$376.80
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.49 |
| Max. Negotiated Rate |
$339.12 |
| Rate for Payer: Aetna Commercial |
$320.28
|
| Rate for Payer: Aetna Medicare |
$97.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.75
|
| Rate for Payer: BCBS Complete |
$150.72
|
| Rate for Payer: BCBS MAPPO |
$94.20
|
| Rate for Payer: BCBS Trust/PPO |
$309.77
|
| Rate for Payer: BCN Commercial |
$292.96
|
| Rate for Payer: BCN Medicare Advantage |
$94.20
|
| Rate for Payer: Cash Price |
$301.44
|
| Rate for Payer: Cofinity Commercial |
$324.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.20
|
| Rate for Payer: Healthscope Commercial |
$339.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.28
|
| Rate for Payer: Nomi Health Commercial |
$308.98
|
| Rate for Payer: PACE Senior Care Partners |
$89.49
|
| Rate for Payer: PACE SWMI |
$94.20
|
| Rate for Payer: PHP Commercial |
$320.28
|
| Rate for Payer: PHP Medicare Advantage |
$94.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.92
|
| Rate for Payer: Priority Health HMO/PPO |
$327.82
|
| Rate for Payer: Priority Health Medicare |
$95.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.46
|
| Rate for Payer: Railroad Medicare Medicare |
$94.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.58
|
| Rate for Payer: UHC Core |
$314.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.20
|
| Rate for Payer: UHC Exchange |
$94.20
|
| Rate for Payer: UHC Medicare Advantage |
$94.20
|
| Rate for Payer: VA VA |
$94.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.60
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$376.80
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.92 |
| Max. Negotiated Rate |
$339.12 |
| Rate for Payer: Aetna Commercial |
$320.28
|
| Rate for Payer: BCBS Trust/PPO |
$307.58
|
| Rate for Payer: BCN Commercial |
$291.19
|
| Rate for Payer: Cash Price |
$301.44
|
| Rate for Payer: Cofinity Commercial |
$324.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.44
|
| Rate for Payer: Healthscope Commercial |
$339.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.28
|
| Rate for Payer: Nomi Health Commercial |
$308.98
|
| Rate for Payer: PHP Commercial |
$320.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.92
|
| Rate for Payer: Priority Health HMO/PPO |
$327.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.58
|
| Rate for Payer: UHC Core |
$314.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.60
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$263.04
|
|
|
Service Code
|
NDC 00115703301
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.98 |
| Max. Negotiated Rate |
$236.74 |
| Rate for Payer: Aetna Commercial |
$223.58
|
| Rate for Payer: BCBS Trust/PPO |
$214.72
|
| Rate for Payer: BCN Commercial |
$203.28
|
| Rate for Payer: Cash Price |
$210.43
|
| Rate for Payer: Cofinity Commercial |
$226.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.43
|
| Rate for Payer: Healthscope Commercial |
$236.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.58
|
| Rate for Payer: Nomi Health Commercial |
$215.69
|
| Rate for Payer: PHP Commercial |
$223.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.98
|
| Rate for Payer: Priority Health HMO/PPO |
$228.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.48
|
| Rate for Payer: UHC Core |
$219.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.28
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$3.77
|
|
|
Service Code
|
NDC 68084028811
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: BCBS Trust/PPO |
$3.08
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Nomi Health Commercial |
$3.09
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.45
|
| Rate for Payer: Priority Health HMO/PPO |
$3.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.32
|
| Rate for Payer: UHC Core |
$3.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.83
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 50268033011
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.76
|
| Rate for Payer: BCN Commercial |
$3.56
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Nomi Health Commercial |
$3.78
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.00
|
| Rate for Payer: Priority Health HMO/PPO |
$4.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.06
|
| Rate for Payer: UHC Core |
$3.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143968401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$15.10
|
| Rate for Payer: BCN Commercial |
$14.30
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.03
|
| Rate for Payer: Priority Health HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00143978401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$4.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.78
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: BCBS MAPPO |
$4.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.21
|
| Rate for Payer: BCN Commercial |
$14.38
|
| Rate for Payer: BCN Medicare Advantage |
$4.62
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.62
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: PACE Senior Care Partners |
$4.39
|
| Rate for Payer: PACE SWMI |
$4.62
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: PHP Medicare Advantage |
$4.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.03
|
| Rate for Payer: Priority Health HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Medicare |
$4.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.39
|
| Rate for Payer: Railroad Medicare Medicare |
$4.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.62
|
| Rate for Payer: UHC Exchange |
$4.62
|
| Rate for Payer: UHC Medicare Advantage |
$4.62
|
| Rate for Payer: VA VA |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143978410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$15.10
|
| Rate for Payer: BCN Commercial |
$14.30
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.03
|
| Rate for Payer: Priority Health HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00143968401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$4.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.78
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: BCBS MAPPO |
$4.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.21
|
| Rate for Payer: BCN Commercial |
$14.38
|
| Rate for Payer: BCN Medicare Advantage |
$4.62
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.62
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: PACE Senior Care Partners |
$4.39
|
| Rate for Payer: PACE SWMI |
$4.62
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: PHP Medicare Advantage |
$4.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.03
|
| Rate for Payer: Priority Health HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Medicare |
$4.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.39
|
| Rate for Payer: Railroad Medicare Medicare |
$4.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.62
|
| Rate for Payer: UHC Exchange |
$4.62
|
| Rate for Payer: UHC Medicare Advantage |
$4.62
|
| Rate for Payer: VA VA |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143978401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$15.10
|
| Rate for Payer: BCN Commercial |
$14.30
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.03
|
| Rate for Payer: Priority Health HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00143978410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$4.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.78
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: BCBS MAPPO |
$4.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.21
|
| Rate for Payer: BCN Commercial |
$14.38
|
| Rate for Payer: BCN Medicare Advantage |
$4.62
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.62
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: PACE Senior Care Partners |
$4.39
|
| Rate for Payer: PACE SWMI |
$4.62
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: PHP Medicare Advantage |
$4.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.03
|
| Rate for Payer: Priority Health HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Medicare |
$4.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.39
|
| Rate for Payer: Railroad Medicare Medicare |
$4.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.62
|
| Rate for Payer: UHC Exchange |
$4.62
|
| Rate for Payer: UHC Medicare Advantage |
$4.62
|
| Rate for Payer: VA VA |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143968410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$15.10
|
| Rate for Payer: BCN Commercial |
$14.30
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.03
|
| Rate for Payer: Priority Health HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00143968410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$4.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.78
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: BCBS MAPPO |
$4.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.21
|
| Rate for Payer: BCN Commercial |
$14.38
|
| Rate for Payer: BCN Medicare Advantage |
$4.62
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.62
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: PACE Senior Care Partners |
$4.39
|
| Rate for Payer: PACE SWMI |
$4.62
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: PHP Medicare Advantage |
$4.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.03
|
| Rate for Payer: Priority Health HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Medicare |
$4.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.39
|
| Rate for Payer: Railroad Medicare Medicare |
$4.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.62
|
| Rate for Payer: UHC Exchange |
$4.62
|
| Rate for Payer: UHC Medicare Advantage |
$4.62
|
| Rate for Payer: VA VA |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML IV (CODE)
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00143968410
|
| Hospital Charge Code |
163712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$4.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.78
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: BCBS MAPPO |
$4.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.21
|
| Rate for Payer: BCN Commercial |
$14.38
|
| Rate for Payer: BCN Medicare Advantage |
$4.62
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.62
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: PACE Senior Care Partners |
$4.39
|
| Rate for Payer: PACE SWMI |
$4.62
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: PHP Medicare Advantage |
$4.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.03
|
| Rate for Payer: Priority Health HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Medicare |
$4.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.39
|
| Rate for Payer: Railroad Medicare Medicare |
$4.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.62
|
| Rate for Payer: UHC Exchange |
$4.62
|
| Rate for Payer: UHC Medicare Advantage |
$4.62
|
| Rate for Payer: VA VA |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML IV (CODE)
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00143968401
|
| Hospital Charge Code |
163712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$4.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.78
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: BCBS MAPPO |
$4.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.21
|
| Rate for Payer: BCN Commercial |
$14.38
|
| Rate for Payer: BCN Medicare Advantage |
$4.62
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.62
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: PACE Senior Care Partners |
$4.39
|
| Rate for Payer: PACE SWMI |
$4.62
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: PHP Medicare Advantage |
$4.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.03
|
| Rate for Payer: Priority Health HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Medicare |
$4.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.39
|
| Rate for Payer: Railroad Medicare Medicare |
$4.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.62
|
| Rate for Payer: UHC Exchange |
$4.62
|
| Rate for Payer: UHC Medicare Advantage |
$4.62
|
| Rate for Payer: VA VA |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML IV (CODE)
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143968401
|
| Hospital Charge Code |
163712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$15.10
|
| Rate for Payer: BCN Commercial |
$14.30
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.03
|
| Rate for Payer: Priority Health HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML IV (CODE)
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143968410
|
| Hospital Charge Code |
163712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$15.10
|
| Rate for Payer: BCN Commercial |
$14.30
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.03
|
| Rate for Payer: Priority Health HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUORESCEIN 0.6 MG EYE STRIPS
|
Facility
|
OP
|
$571.05
|
|
|
Service Code
|
NDC 17478040303
|
| Hospital Charge Code |
27662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$135.62 |
| Max. Negotiated Rate |
$513.95 |
| Rate for Payer: Aetna Commercial |
$485.39
|
| Rate for Payer: Aetna Medicare |
$148.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.45
|
| Rate for Payer: BCBS Complete |
$228.42
|
| Rate for Payer: BCBS MAPPO |
$142.76
|
| Rate for Payer: BCBS Trust/PPO |
$469.46
|
| Rate for Payer: BCN Commercial |
$443.99
|
| Rate for Payer: BCN Medicare Advantage |
$142.76
|
| Rate for Payer: Cash Price |
$456.84
|
| Rate for Payer: Cofinity Commercial |
$491.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.76
|
| Rate for Payer: Healthscope Commercial |
$513.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$428.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$485.39
|
| Rate for Payer: Nomi Health Commercial |
$468.26
|
| Rate for Payer: PACE Senior Care Partners |
$135.62
|
| Rate for Payer: PACE SWMI |
$142.76
|
| Rate for Payer: PHP Commercial |
$485.39
|
| Rate for Payer: PHP Medicare Advantage |
$142.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.18
|
| Rate for Payer: Priority Health HMO/PPO |
$496.81
|
| Rate for Payer: Priority Health Medicare |
$144.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$382.60
|
| Rate for Payer: Railroad Medicare Medicare |
$142.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$502.52
|
| Rate for Payer: UHC Core |
$476.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.76
|
| Rate for Payer: UHC Exchange |
$142.76
|
| Rate for Payer: UHC Medicare Advantage |
$142.76
|
| Rate for Payer: VA VA |
$142.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$428.29
|
|
|
FLUORESCEIN 0.6 MG EYE STRIPS
|
Facility
|
IP
|
$571.05
|
|
|
Service Code
|
NDC 17478040303
|
| Hospital Charge Code |
27662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$371.18 |
| Max. Negotiated Rate |
$513.95 |
| Rate for Payer: Aetna Commercial |
$485.39
|
| Rate for Payer: BCBS Trust/PPO |
$466.15
|
| Rate for Payer: BCN Commercial |
$441.31
|
| Rate for Payer: Cash Price |
$456.84
|
| Rate for Payer: Cofinity Commercial |
$491.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.84
|
| Rate for Payer: Healthscope Commercial |
$513.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$428.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$485.39
|
| Rate for Payer: Nomi Health Commercial |
$468.26
|
| Rate for Payer: PHP Commercial |
$485.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.18
|
| Rate for Payer: Priority Health HMO/PPO |
$496.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$382.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$502.52
|
| Rate for Payer: UHC Core |
$476.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$428.29
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 17238090099
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.75
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$2.33
|
|
|
Service Code
|
NDC 17478040401
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna Medicare |
$0.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.93
|
| Rate for Payer: BCBS MAPPO |
$0.58
|
| Rate for Payer: BCBS Trust/PPO |
$1.92
|
| Rate for Payer: BCN Commercial |
$1.81
|
| Rate for Payer: BCN Medicare Advantage |
$0.58
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.58
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Nomi Health Commercial |
$1.91
|
| Rate for Payer: PACE Senior Care Partners |
$0.55
|
| Rate for Payer: PACE SWMI |
$0.58
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: PHP Medicare Advantage |
$0.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.51
|
| Rate for Payer: Priority Health HMO/PPO |
$2.03
|
| Rate for Payer: Priority Health Medicare |
$0.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.56
|
| Rate for Payer: Railroad Medicare Medicare |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.05
|
| Rate for Payer: UHC Core |
$1.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Medicare Advantage |
$0.58
|
| Rate for Payer: VA VA |
$0.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.75
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 17238090099
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$1.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.43
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS MAPPO |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.77
|
| Rate for Payer: BCN Commercial |
$3.57
|
| Rate for Payer: BCN Medicare Advantage |
$1.15
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.15
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: PACE Senior Care Partners |
$1.09
|
| Rate for Payer: PACE SWMI |
$1.15
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: PHP Medicare Advantage |
$1.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Medicare |
$1.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.15
|
| Rate for Payer: UHC Exchange |
$1.15
|
| Rate for Payer: UHC Medicare Advantage |
$1.15
|
| Rate for Payer: VA VA |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.83 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna Medicare |
$119.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.20
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: BCBS MAPPO |
$114.56
|
| Rate for Payer: BCBS Trust/PPO |
$376.73
|
| Rate for Payer: BCN Commercial |
$356.29
|
| Rate for Payer: BCN Medicare Advantage |
$114.56
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.56
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: PACE Senior Care Partners |
$108.83
|
| Rate for Payer: PACE SWMI |
$114.56
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: PHP Medicare Advantage |
$114.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: Priority Health HMO/PPO |
$398.68
|
| Rate for Payer: Priority Health Medicare |
$115.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.03
|
| Rate for Payer: Railroad Medicare Medicare |
$114.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.26
|
| Rate for Payer: UHC Core |
$382.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.56
|
| Rate for Payer: UHC Exchange |
$114.56
|
| Rate for Payer: UHC Medicare Advantage |
$114.56
|
| Rate for Payer: VA VA |
$114.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
