|
FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$332.60
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
3215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$216.19 |
| Max. Negotiated Rate |
$299.34 |
| Rate for Payer: Aetna Commercial |
$282.71
|
| Rate for Payer: BCBS Trust/PPO |
$271.50
|
| Rate for Payer: BCN Commercial |
$257.03
|
| Rate for Payer: Cash Price |
$266.08
|
| Rate for Payer: Cofinity Commercial |
$286.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.08
|
| Rate for Payer: Healthscope Commercial |
$299.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.71
|
| Rate for Payer: Nomi Health Commercial |
$272.73
|
| Rate for Payer: PHP Commercial |
$282.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.19
|
| Rate for Payer: Priority Health HMO/PPO |
$289.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$222.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.69
|
| Rate for Payer: UHC Core |
$277.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.45
|
|
|
FLURAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$409.45
|
|
|
Service Code
|
NDC 00378441501
|
| Hospital Charge Code |
3223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.24 |
| Max. Negotiated Rate |
$368.50 |
| Rate for Payer: Aetna Commercial |
$348.03
|
| Rate for Payer: Aetna Medicare |
$106.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.95
|
| Rate for Payer: BCBS Complete |
$163.78
|
| Rate for Payer: BCBS MAPPO |
$102.36
|
| Rate for Payer: BCBS Trust/PPO |
$336.61
|
| Rate for Payer: BCN Commercial |
$318.35
|
| Rate for Payer: BCN Medicare Advantage |
$102.36
|
| Rate for Payer: Cash Price |
$327.56
|
| Rate for Payer: Cofinity Commercial |
$352.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.36
|
| Rate for Payer: Healthscope Commercial |
$368.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.03
|
| Rate for Payer: Nomi Health Commercial |
$335.75
|
| Rate for Payer: PACE Senior Care Partners |
$97.24
|
| Rate for Payer: PACE SWMI |
$102.36
|
| Rate for Payer: PHP Commercial |
$348.03
|
| Rate for Payer: PHP Medicare Advantage |
$102.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.14
|
| Rate for Payer: Priority Health HMO/PPO |
$356.22
|
| Rate for Payer: Priority Health Medicare |
$103.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.33
|
| Rate for Payer: Railroad Medicare Medicare |
$102.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.32
|
| Rate for Payer: UHC Core |
$341.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.36
|
| Rate for Payer: UHC Exchange |
$102.36
|
| Rate for Payer: UHC Medicare Advantage |
$102.36
|
| Rate for Payer: VA VA |
$102.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.09
|
|
|
FLURAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$409.45
|
|
|
Service Code
|
NDC 00378441501
|
| Hospital Charge Code |
3223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.14 |
| Max. Negotiated Rate |
$368.50 |
| Rate for Payer: Aetna Commercial |
$348.03
|
| Rate for Payer: BCBS Trust/PPO |
$334.23
|
| Rate for Payer: BCN Commercial |
$316.42
|
| Rate for Payer: Cash Price |
$327.56
|
| Rate for Payer: Cofinity Commercial |
$352.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.56
|
| Rate for Payer: Healthscope Commercial |
$368.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.03
|
| Rate for Payer: Nomi Health Commercial |
$335.75
|
| Rate for Payer: PHP Commercial |
$348.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.14
|
| Rate for Payer: Priority Health HMO/PPO |
$356.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.32
|
| Rate for Payer: UHC Core |
$341.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.09
|
|
|
FLUTAMIDE 125 MG CAPSULE
|
Facility
|
OP
|
$19,026.96
|
|
|
Service Code
|
NDC 80725060018
|
| Hospital Charge Code |
10081
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,518.90 |
| Max. Negotiated Rate |
$17,124.26 |
| Rate for Payer: Aetna Commercial |
$16,172.92
|
| Rate for Payer: Aetna Medicare |
$4,947.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,945.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,945.93
|
| Rate for Payer: BCBS Complete |
$7,610.78
|
| Rate for Payer: BCBS MAPPO |
$4,756.74
|
| Rate for Payer: BCBS Trust/PPO |
$15,642.06
|
| Rate for Payer: BCN Commercial |
$14,793.46
|
| Rate for Payer: BCN Medicare Advantage |
$4,756.74
|
| Rate for Payer: Cash Price |
$15,221.57
|
| Rate for Payer: Cofinity Commercial |
$16,363.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,221.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,756.74
|
| Rate for Payer: Healthscope Commercial |
$17,124.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,270.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,994.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,470.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,172.92
|
| Rate for Payer: Nomi Health Commercial |
$15,602.11
|
| Rate for Payer: PACE Senior Care Partners |
$4,518.90
|
| Rate for Payer: PACE SWMI |
$4,756.74
|
| Rate for Payer: PHP Commercial |
$16,172.92
|
| Rate for Payer: PHP Medicare Advantage |
$4,756.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,367.52
|
| Rate for Payer: Priority Health HMO/PPO |
$16,553.46
|
| Rate for Payer: Priority Health Medicare |
$4,804.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,748.06
|
| Rate for Payer: Railroad Medicare Medicare |
$4,756.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,743.72
|
| Rate for Payer: UHC Core |
$15,887.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,756.74
|
| Rate for Payer: UHC Exchange |
$4,756.74
|
| Rate for Payer: UHC Medicare Advantage |
$4,756.74
|
| Rate for Payer: VA VA |
$4,756.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,270.22
|
|
|
FLUTAMIDE 125 MG CAPSULE
|
Facility
|
IP
|
$19,026.96
|
|
|
Service Code
|
NDC 80725060018
|
| Hospital Charge Code |
10081
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12,367.52 |
| Max. Negotiated Rate |
$17,124.26 |
| Rate for Payer: Aetna Commercial |
$16,172.92
|
| Rate for Payer: BCBS Trust/PPO |
$15,531.71
|
| Rate for Payer: BCN Commercial |
$14,704.03
|
| Rate for Payer: Cash Price |
$15,221.57
|
| Rate for Payer: Cofinity Commercial |
$16,363.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,221.57
|
| Rate for Payer: Healthscope Commercial |
$17,124.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,270.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,172.92
|
| Rate for Payer: Nomi Health Commercial |
$15,602.11
|
| Rate for Payer: PHP Commercial |
$16,172.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,367.52
|
| Rate for Payer: Priority Health HMO/PPO |
$16,553.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,748.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,743.72
|
| Rate for Payer: UHC Core |
$15,887.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,270.22
|
|
|
FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
OP
|
$237.06
|
|
|
Service Code
|
NDC 00173087414
|
| Hospital Charge Code |
173282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.30 |
| Max. Negotiated Rate |
$213.35 |
| Rate for Payer: Aetna Commercial |
$201.50
|
| Rate for Payer: Aetna Medicare |
$61.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.08
|
| Rate for Payer: BCBS Complete |
$94.82
|
| Rate for Payer: BCBS MAPPO |
$59.27
|
| Rate for Payer: BCBS Trust/PPO |
$194.89
|
| Rate for Payer: BCN Commercial |
$184.31
|
| Rate for Payer: BCN Medicare Advantage |
$59.27
|
| Rate for Payer: Cash Price |
$189.65
|
| Rate for Payer: Cofinity Commercial |
$203.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.27
|
| Rate for Payer: Healthscope Commercial |
$213.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.50
|
| Rate for Payer: Nomi Health Commercial |
$194.39
|
| Rate for Payer: PACE Senior Care Partners |
$56.30
|
| Rate for Payer: PACE SWMI |
$59.27
|
| Rate for Payer: PHP Commercial |
$201.50
|
| Rate for Payer: PHP Medicare Advantage |
$59.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.09
|
| Rate for Payer: Priority Health HMO/PPO |
$206.24
|
| Rate for Payer: Priority Health Medicare |
$59.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.83
|
| Rate for Payer: Railroad Medicare Medicare |
$59.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.61
|
| Rate for Payer: UHC Core |
$197.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.27
|
| Rate for Payer: UHC Exchange |
$59.27
|
| Rate for Payer: UHC Medicare Advantage |
$59.27
|
| Rate for Payer: VA VA |
$59.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.79
|
|
|
FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$237.06
|
|
|
Service Code
|
NDC 00173087414
|
| Hospital Charge Code |
173282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.09 |
| Max. Negotiated Rate |
$213.35 |
| Rate for Payer: Aetna Commercial |
$201.50
|
| Rate for Payer: BCBS Trust/PPO |
$193.51
|
| Rate for Payer: BCN Commercial |
$183.20
|
| Rate for Payer: Cash Price |
$189.65
|
| Rate for Payer: Cofinity Commercial |
$203.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.65
|
| Rate for Payer: Healthscope Commercial |
$213.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.50
|
| Rate for Payer: Nomi Health Commercial |
$194.39
|
| Rate for Payer: PHP Commercial |
$201.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.09
|
| Rate for Payer: Priority Health HMO/PPO |
$206.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.61
|
| Rate for Payer: UHC Core |
$197.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.79
|
|
|
FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
OP
|
$317.38
|
|
|
Service Code
|
NDC 00173087614
|
| Hospital Charge Code |
173283
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.38 |
| Max. Negotiated Rate |
$285.64 |
| Rate for Payer: Aetna Commercial |
$269.77
|
| Rate for Payer: Aetna Medicare |
$82.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.18
|
| Rate for Payer: BCBS Complete |
$126.95
|
| Rate for Payer: BCBS MAPPO |
$79.34
|
| Rate for Payer: BCBS Trust/PPO |
$260.92
|
| Rate for Payer: BCN Commercial |
$246.76
|
| Rate for Payer: BCN Medicare Advantage |
$79.34
|
| Rate for Payer: Cash Price |
$253.90
|
| Rate for Payer: Cofinity Commercial |
$272.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.34
|
| Rate for Payer: Healthscope Commercial |
$285.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.77
|
| Rate for Payer: Nomi Health Commercial |
$260.25
|
| Rate for Payer: PACE Senior Care Partners |
$75.38
|
| Rate for Payer: PACE SWMI |
$79.34
|
| Rate for Payer: PHP Commercial |
$269.77
|
| Rate for Payer: PHP Medicare Advantage |
$79.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.30
|
| Rate for Payer: Priority Health HMO/PPO |
$276.12
|
| Rate for Payer: Priority Health Medicare |
$80.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.64
|
| Rate for Payer: Railroad Medicare Medicare |
$79.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.29
|
| Rate for Payer: UHC Core |
$265.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.34
|
| Rate for Payer: UHC Exchange |
$79.34
|
| Rate for Payer: UHC Medicare Advantage |
$79.34
|
| Rate for Payer: VA VA |
$79.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.03
|
|
|
FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$317.38
|
|
|
Service Code
|
NDC 00173087614
|
| Hospital Charge Code |
173283
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.30 |
| Max. Negotiated Rate |
$285.64 |
| Rate for Payer: Aetna Commercial |
$269.77
|
| Rate for Payer: BCBS Trust/PPO |
$259.08
|
| Rate for Payer: BCN Commercial |
$245.27
|
| Rate for Payer: Cash Price |
$253.90
|
| Rate for Payer: Cofinity Commercial |
$272.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.90
|
| Rate for Payer: Healthscope Commercial |
$285.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.77
|
| Rate for Payer: Nomi Health Commercial |
$260.25
|
| Rate for Payer: PHP Commercial |
$269.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.30
|
| Rate for Payer: Priority Health HMO/PPO |
$276.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.29
|
| Rate for Payer: UHC Core |
$265.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.03
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$26.14
|
|
|
Service Code
|
NDC 60505082901
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$23.53 |
| Rate for Payer: Aetna Commercial |
$22.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.34
|
| Rate for Payer: BCN Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$20.91
|
| Rate for Payer: Cofinity Commercial |
$22.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.91
|
| Rate for Payer: Healthscope Commercial |
$23.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.22
|
| Rate for Payer: Nomi Health Commercial |
$21.43
|
| Rate for Payer: PHP Commercial |
$22.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.99
|
| Rate for Payer: Priority Health HMO/PPO |
$22.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.00
|
| Rate for Payer: UHC Core |
$21.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.61
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$14.55
|
|
|
Service Code
|
NDC 60432026415
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Aetna Commercial |
$12.37
|
| Rate for Payer: BCBS Trust/PPO |
$11.88
|
| Rate for Payer: BCN Commercial |
$11.24
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cofinity Commercial |
$12.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.64
|
| Rate for Payer: Healthscope Commercial |
$13.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.37
|
| Rate for Payer: Nomi Health Commercial |
$11.93
|
| Rate for Payer: PHP Commercial |
$12.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.46
|
| Rate for Payer: Priority Health HMO/PPO |
$12.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.80
|
| Rate for Payer: UHC Core |
$12.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.91
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$26.14
|
|
|
Service Code
|
NDC 60505082901
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$23.53 |
| Rate for Payer: Aetna Commercial |
$22.22
|
| Rate for Payer: Aetna Medicare |
$6.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.17
|
| Rate for Payer: BCBS Complete |
$10.46
|
| Rate for Payer: BCBS MAPPO |
$6.54
|
| Rate for Payer: BCBS Trust/PPO |
$21.49
|
| Rate for Payer: BCN Commercial |
$20.32
|
| Rate for Payer: BCN Medicare Advantage |
$6.54
|
| Rate for Payer: Cash Price |
$20.91
|
| Rate for Payer: Cofinity Commercial |
$22.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.54
|
| Rate for Payer: Healthscope Commercial |
$23.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.22
|
| Rate for Payer: Nomi Health Commercial |
$21.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.21
|
| Rate for Payer: PACE SWMI |
$6.54
|
| Rate for Payer: PHP Commercial |
$22.22
|
| Rate for Payer: PHP Medicare Advantage |
$6.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.99
|
| Rate for Payer: Priority Health HMO/PPO |
$22.74
|
| Rate for Payer: Priority Health Medicare |
$6.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.51
|
| Rate for Payer: Railroad Medicare Medicare |
$6.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.00
|
| Rate for Payer: UHC Core |
$21.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.54
|
| Rate for Payer: UHC Exchange |
$6.54
|
| Rate for Payer: UHC Medicare Advantage |
$6.54
|
| Rate for Payer: VA VA |
$6.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.61
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$14.55
|
|
|
Service Code
|
NDC 60432026415
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Aetna Commercial |
$12.37
|
| Rate for Payer: Aetna Medicare |
$3.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.55
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: BCBS MAPPO |
$3.64
|
| Rate for Payer: BCBS Trust/PPO |
$11.96
|
| Rate for Payer: BCN Commercial |
$11.31
|
| Rate for Payer: BCN Medicare Advantage |
$3.64
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cofinity Commercial |
$12.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$13.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.37
|
| Rate for Payer: Nomi Health Commercial |
$11.93
|
| Rate for Payer: PACE Senior Care Partners |
$3.46
|
| Rate for Payer: PACE SWMI |
$3.64
|
| Rate for Payer: PHP Commercial |
$12.37
|
| Rate for Payer: PHP Medicare Advantage |
$3.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.46
|
| Rate for Payer: Priority Health HMO/PPO |
$12.66
|
| Rate for Payer: Priority Health Medicare |
$3.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.75
|
| Rate for Payer: Railroad Medicare Medicare |
$3.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.80
|
| Rate for Payer: UHC Core |
$12.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.64
|
| Rate for Payer: UHC Exchange |
$3.64
|
| Rate for Payer: UHC Medicare Advantage |
$3.64
|
| Rate for Payer: VA VA |
$3.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.91
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$36.57
|
|
|
Service Code
|
NDC 00054327099
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$32.91 |
| Rate for Payer: Aetna Commercial |
$31.08
|
| Rate for Payer: BCBS Trust/PPO |
$29.85
|
| Rate for Payer: BCN Commercial |
$28.26
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cofinity Commercial |
$31.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Healthscope Commercial |
$32.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.08
|
| Rate for Payer: Nomi Health Commercial |
$29.99
|
| Rate for Payer: PHP Commercial |
$31.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.77
|
| Rate for Payer: Priority Health HMO/PPO |
$31.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.18
|
| Rate for Payer: UHC Core |
$30.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.43
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$36.57
|
|
|
Service Code
|
NDC 00054327099
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$32.91 |
| Rate for Payer: Aetna Commercial |
$31.08
|
| Rate for Payer: Aetna Medicare |
$9.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.43
|
| Rate for Payer: BCBS Complete |
$14.63
|
| Rate for Payer: BCBS MAPPO |
$9.14
|
| Rate for Payer: BCBS Trust/PPO |
$30.06
|
| Rate for Payer: BCN Commercial |
$28.43
|
| Rate for Payer: BCN Medicare Advantage |
$9.14
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cofinity Commercial |
$31.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.14
|
| Rate for Payer: Healthscope Commercial |
$32.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.08
|
| Rate for Payer: Nomi Health Commercial |
$29.99
|
| Rate for Payer: PACE Senior Care Partners |
$8.69
|
| Rate for Payer: PACE SWMI |
$9.14
|
| Rate for Payer: PHP Commercial |
$31.08
|
| Rate for Payer: PHP Medicare Advantage |
$9.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.77
|
| Rate for Payer: Priority Health HMO/PPO |
$31.82
|
| Rate for Payer: Priority Health Medicare |
$9.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.50
|
| Rate for Payer: Railroad Medicare Medicare |
$9.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.18
|
| Rate for Payer: UHC Core |
$30.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.14
|
| Rate for Payer: UHC Exchange |
$9.14
|
| Rate for Payer: UHC Medicare Advantage |
$9.14
|
| Rate for Payer: VA VA |
$9.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.43
|
|
|
FLU VACCINE TS2024-25(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$227.84
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
207828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$148.10 |
| Max. Negotiated Rate |
$205.06 |
| Rate for Payer: Aetna Commercial |
$193.66
|
| Rate for Payer: BCBS Trust/PPO |
$185.99
|
| Rate for Payer: BCN Commercial |
$176.07
|
| Rate for Payer: Cash Price |
$182.27
|
| Rate for Payer: Cofinity Commercial |
$195.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.27
|
| Rate for Payer: Healthscope Commercial |
$205.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.66
|
| Rate for Payer: Nomi Health Commercial |
$186.83
|
| Rate for Payer: PHP Commercial |
$193.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.10
|
| Rate for Payer: Priority Health HMO/PPO |
$198.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.50
|
| Rate for Payer: UHC Core |
$190.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.88
|
|
|
FLU VACCINE TS2024-25(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$227.84
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
207828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.11 |
| Max. Negotiated Rate |
$205.06 |
| Rate for Payer: Aetna Commercial |
$193.66
|
| Rate for Payer: Aetna Medicare |
$59.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.20
|
| Rate for Payer: BCBS Complete |
$91.14
|
| Rate for Payer: BCBS MAPPO |
$56.96
|
| Rate for Payer: BCBS Trust/PPO |
$187.31
|
| Rate for Payer: BCN Commercial |
$177.15
|
| Rate for Payer: BCN Medicare Advantage |
$56.96
|
| Rate for Payer: Cash Price |
$182.27
|
| Rate for Payer: Cofinity Commercial |
$195.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.96
|
| Rate for Payer: Healthscope Commercial |
$205.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.66
|
| Rate for Payer: Nomi Health Commercial |
$186.83
|
| Rate for Payer: PACE Senior Care Partners |
$54.11
|
| Rate for Payer: PACE SWMI |
$56.96
|
| Rate for Payer: PHP Commercial |
$193.66
|
| Rate for Payer: PHP Medicare Advantage |
$56.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.10
|
| Rate for Payer: Priority Health HMO/PPO |
$198.22
|
| Rate for Payer: Priority Health Medicare |
$57.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.65
|
| Rate for Payer: Railroad Medicare Medicare |
$56.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.50
|
| Rate for Payer: UHC Core |
$190.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.96
|
| Rate for Payer: UHC Exchange |
$56.96
|
| Rate for Payer: UHC Medicare Advantage |
$56.96
|
| Rate for Payer: VA VA |
$56.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.88
|
|
|
FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE
|
Facility
|
OP
|
$81.35
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
207827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$73.22 |
| Rate for Payer: Aetna Commercial |
$69.15
|
| Rate for Payer: Aetna Medicare |
$21.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.42
|
| Rate for Payer: BCBS Complete |
$32.54
|
| Rate for Payer: BCBS MAPPO |
$20.34
|
| Rate for Payer: BCBS Trust/PPO |
$66.88
|
| Rate for Payer: BCN Commercial |
$63.25
|
| Rate for Payer: BCN Medicare Advantage |
$20.34
|
| Rate for Payer: Cash Price |
$65.08
|
| Rate for Payer: Cofinity Commercial |
$69.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.34
|
| Rate for Payer: Healthscope Commercial |
$73.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.15
|
| Rate for Payer: Nomi Health Commercial |
$66.71
|
| Rate for Payer: PACE Senior Care Partners |
$19.32
|
| Rate for Payer: PACE SWMI |
$20.34
|
| Rate for Payer: PHP Commercial |
$69.15
|
| Rate for Payer: PHP Medicare Advantage |
$20.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.88
|
| Rate for Payer: Priority Health HMO/PPO |
$70.77
|
| Rate for Payer: Priority Health Medicare |
$20.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.50
|
| Rate for Payer: Railroad Medicare Medicare |
$20.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.59
|
| Rate for Payer: UHC Core |
$67.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.34
|
| Rate for Payer: UHC Exchange |
$20.34
|
| Rate for Payer: UHC Medicare Advantage |
$20.34
|
| Rate for Payer: VA VA |
$20.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.01
|
|
|
FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE
|
Facility
|
IP
|
$81.35
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
207827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.88 |
| Max. Negotiated Rate |
$73.22 |
| Rate for Payer: Aetna Commercial |
$69.15
|
| Rate for Payer: BCBS Trust/PPO |
$66.41
|
| Rate for Payer: BCN Commercial |
$62.87
|
| Rate for Payer: Cash Price |
$65.08
|
| Rate for Payer: Cofinity Commercial |
$69.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.08
|
| Rate for Payer: Healthscope Commercial |
$73.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.15
|
| Rate for Payer: Nomi Health Commercial |
$66.71
|
| Rate for Payer: PHP Commercial |
$69.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.88
|
| Rate for Payer: Priority Health HMO/PPO |
$70.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.59
|
| Rate for Payer: UHC Core |
$67.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.01
|
|
|
FLUVOXAMINE 50 MG TABLET
|
Facility
|
OP
|
$378.35
|
|
|
Service Code
|
NDC 62559015901
|
| Hospital Charge Code |
10085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.86 |
| Max. Negotiated Rate |
$340.51 |
| Rate for Payer: Aetna Commercial |
$321.60
|
| Rate for Payer: Aetna Medicare |
$98.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.23
|
| Rate for Payer: BCBS Complete |
$151.34
|
| Rate for Payer: BCBS MAPPO |
$94.59
|
| Rate for Payer: BCBS Trust/PPO |
$311.04
|
| Rate for Payer: BCN Commercial |
$294.17
|
| Rate for Payer: BCN Medicare Advantage |
$94.59
|
| Rate for Payer: Cash Price |
$302.68
|
| Rate for Payer: Cofinity Commercial |
$325.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.59
|
| Rate for Payer: Healthscope Commercial |
$340.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.60
|
| Rate for Payer: Nomi Health Commercial |
$310.25
|
| Rate for Payer: PACE Senior Care Partners |
$89.86
|
| Rate for Payer: PACE SWMI |
$94.59
|
| Rate for Payer: PHP Commercial |
$321.60
|
| Rate for Payer: PHP Medicare Advantage |
$94.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.93
|
| Rate for Payer: Priority Health HMO/PPO |
$329.16
|
| Rate for Payer: Priority Health Medicare |
$95.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.49
|
| Rate for Payer: Railroad Medicare Medicare |
$94.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.95
|
| Rate for Payer: UHC Core |
$315.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.59
|
| Rate for Payer: UHC Exchange |
$94.59
|
| Rate for Payer: UHC Medicare Advantage |
$94.59
|
| Rate for Payer: VA VA |
$94.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.76
|
|
|
FLUVOXAMINE 50 MG TABLET
|
Facility
|
IP
|
$378.35
|
|
|
Service Code
|
NDC 62559015901
|
| Hospital Charge Code |
10085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.93 |
| Max. Negotiated Rate |
$340.51 |
| Rate for Payer: Aetna Commercial |
$321.60
|
| Rate for Payer: BCBS Trust/PPO |
$308.85
|
| Rate for Payer: BCN Commercial |
$292.39
|
| Rate for Payer: Cash Price |
$302.68
|
| Rate for Payer: Cofinity Commercial |
$325.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.68
|
| Rate for Payer: Healthscope Commercial |
$340.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.60
|
| Rate for Payer: Nomi Health Commercial |
$310.25
|
| Rate for Payer: PHP Commercial |
$321.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.93
|
| Rate for Payer: Priority Health HMO/PPO |
$329.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.95
|
| Rate for Payer: UHC Core |
$315.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.76
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$161.70
|
|
|
Service Code
|
NDC 60687068101
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.11 |
| Max. Negotiated Rate |
$145.53 |
| Rate for Payer: Aetna Commercial |
$137.44
|
| Rate for Payer: BCBS Trust/PPO |
$132.00
|
| Rate for Payer: BCN Commercial |
$124.96
|
| Rate for Payer: Cash Price |
$129.36
|
| Rate for Payer: Cofinity Commercial |
$139.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.36
|
| Rate for Payer: Healthscope Commercial |
$145.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.44
|
| Rate for Payer: Nomi Health Commercial |
$132.59
|
| Rate for Payer: PHP Commercial |
$137.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.11
|
| Rate for Payer: Priority Health HMO/PPO |
$140.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.30
|
| Rate for Payer: UHC Core |
$135.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.28
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$149.60
|
|
|
Service Code
|
NDC 62584089701
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.53 |
| Max. Negotiated Rate |
$134.64 |
| Rate for Payer: Aetna Commercial |
$127.16
|
| Rate for Payer: Aetna Medicare |
$38.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.75
|
| Rate for Payer: BCBS Complete |
$59.84
|
| Rate for Payer: BCBS MAPPO |
$37.40
|
| Rate for Payer: BCBS Trust/PPO |
$122.99
|
| Rate for Payer: BCN Commercial |
$116.31
|
| Rate for Payer: BCN Medicare Advantage |
$37.40
|
| Rate for Payer: Cash Price |
$119.68
|
| Rate for Payer: Cofinity Commercial |
$128.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.40
|
| Rate for Payer: Healthscope Commercial |
$134.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.16
|
| Rate for Payer: Nomi Health Commercial |
$122.67
|
| Rate for Payer: PACE Senior Care Partners |
$35.53
|
| Rate for Payer: PACE SWMI |
$37.40
|
| Rate for Payer: PHP Commercial |
$127.16
|
| Rate for Payer: PHP Medicare Advantage |
$37.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.24
|
| Rate for Payer: Priority Health HMO/PPO |
$130.15
|
| Rate for Payer: Priority Health Medicare |
$37.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.23
|
| Rate for Payer: Railroad Medicare Medicare |
$37.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.65
|
| Rate for Payer: UHC Core |
$124.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.40
|
| Rate for Payer: UHC Exchange |
$37.40
|
| Rate for Payer: UHC Medicare Advantage |
$37.40
|
| Rate for Payer: VA VA |
$37.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.20
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$1.62
|
|
|
Service Code
|
NDC 60687068111
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Aetna Commercial |
$1.38
|
| Rate for Payer: BCBS Trust/PPO |
$1.32
|
| Rate for Payer: BCN Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.30
|
| Rate for Payer: Healthscope Commercial |
$1.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.38
|
| Rate for Payer: Nomi Health Commercial |
$1.33
|
| Rate for Payer: PHP Commercial |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.43
|
| Rate for Payer: UHC Core |
$1.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.22
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$149.60
|
|
|
Service Code
|
NDC 62584089701
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.24 |
| Max. Negotiated Rate |
$134.64 |
| Rate for Payer: Aetna Commercial |
$127.16
|
| Rate for Payer: BCBS Trust/PPO |
$122.12
|
| Rate for Payer: BCN Commercial |
$115.61
|
| Rate for Payer: Cash Price |
$119.68
|
| Rate for Payer: Cofinity Commercial |
$128.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.68
|
| Rate for Payer: Healthscope Commercial |
$134.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.16
|
| Rate for Payer: Nomi Health Commercial |
$122.67
|
| Rate for Payer: PHP Commercial |
$127.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.24
|
| Rate for Payer: Priority Health HMO/PPO |
$130.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.65
|
| Rate for Payer: UHC Core |
$124.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.20
|
|
