|
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
|
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
|
|
|
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
|
|
|
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 |
$340.52 |
| 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 |
$340.52
|
| 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
|
|
|
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 |
$340.52 |
| 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 |
$340.52
|
| 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
|
|
|
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
|
$147.40
|
|
|
Service Code
|
NDC 00904722461
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.81 |
| Max. Negotiated Rate |
$132.66 |
| Rate for Payer: Aetna Commercial |
$125.29
|
| Rate for Payer: BCBS Trust/PPO |
$120.32
|
| Rate for Payer: BCN Commercial |
$113.91
|
| Rate for Payer: Cash Price |
$117.92
|
| Rate for Payer: Cofinity Commercial |
$126.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.92
|
| Rate for Payer: Healthscope Commercial |
$132.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.29
|
| Rate for Payer: Nomi Health Commercial |
$120.87
|
| Rate for Payer: PHP Commercial |
$125.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.81
|
| Rate for Payer: Priority Health HMO/PPO |
$128.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.71
|
| Rate for Payer: UHC Core |
$123.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.55
|
|
|
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
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
NDC 11534016501
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: Aetna Medicare |
$58.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.00
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: BCBS MAPPO |
$56.00
|
| Rate for Payer: BCBS Trust/PPO |
$184.15
|
| Rate for Payer: BCN Commercial |
$174.16
|
| Rate for Payer: BCN Medicare Advantage |
$56.00
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$201.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.40
|
| Rate for Payer: Nomi Health Commercial |
$183.68
|
| Rate for Payer: PACE Senior Care Partners |
$53.20
|
| Rate for Payer: PACE SWMI |
$56.00
|
| Rate for Payer: PHP Commercial |
$190.40
|
| Rate for Payer: PHP Medicare Advantage |
$56.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO |
$194.88
|
| Rate for Payer: Priority Health Medicare |
$56.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.08
|
| Rate for Payer: Railroad Medicare Medicare |
$56.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.12
|
| Rate for Payer: UHC Core |
$187.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.00
|
| Rate for Payer: UHC Exchange |
$56.00
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$56.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.00
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
NDC 11534016501
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: BCBS Trust/PPO |
$182.85
|
| Rate for Payer: BCN Commercial |
$173.11
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.20
|
| Rate for Payer: Healthscope Commercial |
$201.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.40
|
| Rate for Payer: Nomi Health Commercial |
$183.68
|
| Rate for Payer: PHP Commercial |
$190.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO |
$194.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.12
|
| Rate for Payer: UHC Core |
$187.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.00
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$161.70
|
|
|
Service Code
|
NDC 60687068101
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$145.53 |
| Rate for Payer: Aetna Commercial |
$137.44
|
| Rate for Payer: Aetna Medicare |
$42.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.53
|
| Rate for Payer: BCBS Complete |
$64.68
|
| Rate for Payer: BCBS MAPPO |
$40.42
|
| Rate for Payer: BCBS Trust/PPO |
$132.93
|
| Rate for Payer: BCN Commercial |
$125.72
|
| Rate for Payer: BCN Medicare Advantage |
$40.42
|
| 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: Health Alliance Plan Medicare Advantage |
$40.42
|
| Rate for Payer: Healthscope Commercial |
$145.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.44
|
| Rate for Payer: Nomi Health Commercial |
$132.59
|
| Rate for Payer: PACE Senior Care Partners |
$38.40
|
| Rate for Payer: PACE SWMI |
$40.42
|
| Rate for Payer: PHP Commercial |
$137.44
|
| Rate for Payer: PHP Medicare Advantage |
$40.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.10
|
| Rate for Payer: Priority Health HMO/PPO |
$140.68
|
| Rate for Payer: Priority Health Medicare |
$40.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.34
|
| Rate for Payer: Railroad Medicare Medicare |
$40.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.30
|
| Rate for Payer: UHC Core |
$135.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.42
|
| Rate for Payer: UHC Exchange |
$40.42
|
| Rate for Payer: UHC Medicare Advantage |
$40.42
|
| Rate for Payer: VA VA |
$40.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.28
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
NDC 69315012701
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Aetna Commercial |
$139.40
|
| Rate for Payer: Aetna Medicare |
$42.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.25
|
| Rate for Payer: BCBS Complete |
$65.60
|
| Rate for Payer: BCBS MAPPO |
$41.00
|
| Rate for Payer: BCBS Trust/PPO |
$134.82
|
| Rate for Payer: BCN Commercial |
$127.51
|
| Rate for Payer: BCN Medicare Advantage |
$41.00
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$141.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.00
|
| Rate for Payer: Healthscope Commercial |
$147.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.40
|
| Rate for Payer: Nomi Health Commercial |
$134.48
|
| Rate for Payer: PACE Senior Care Partners |
$38.95
|
| Rate for Payer: PACE SWMI |
$41.00
|
| Rate for Payer: PHP Commercial |
$139.40
|
| Rate for Payer: PHP Medicare Advantage |
$41.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.60
|
| Rate for Payer: Priority Health HMO/PPO |
$142.68
|
| Rate for Payer: Priority Health Medicare |
$41.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.88
|
| Rate for Payer: Railroad Medicare Medicare |
$41.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.32
|
| Rate for Payer: UHC Core |
$136.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.00
|
| Rate for Payer: UHC Exchange |
$41.00
|
| Rate for Payer: UHC Medicare Advantage |
$41.00
|
| Rate for Payer: VA VA |
$41.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.00
|
|
|
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
|
$1.50
|
|
|
Service Code
|
NDC 62584089711
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna Commercial |
$1.28
|
| Rate for Payer: BCBS Trust/PPO |
$1.22
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cofinity Commercial |
$1.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.20
|
| Rate for Payer: Healthscope Commercial |
$1.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.28
|
| Rate for Payer: Nomi Health Commercial |
$1.23
|
| Rate for Payer: PHP Commercial |
$1.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.98
|
| Rate for Payer: Priority Health HMO/PPO |
$1.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.32
|
| Rate for Payer: UHC Core |
$1.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$1.62
|
|
|
Service Code
|
NDC 60687068111
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Aetna Commercial |
$1.38
|
| Rate for Payer: Aetna Medicare |
$0.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.51
|
| Rate for Payer: BCBS Complete |
$0.65
|
| Rate for Payer: BCBS MAPPO |
$0.41
|
| Rate for Payer: BCBS Trust/PPO |
$1.33
|
| Rate for Payer: BCN Commercial |
$1.26
|
| Rate for Payer: BCN Medicare Advantage |
$0.41
|
| 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: Health Alliance Plan Medicare Advantage |
$0.41
|
| Rate for Payer: Healthscope Commercial |
$1.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.38
|
| Rate for Payer: Nomi Health Commercial |
$1.33
|
| Rate for Payer: PACE Senior Care Partners |
$0.38
|
| Rate for Payer: PACE SWMI |
$0.41
|
| Rate for Payer: PHP Commercial |
$1.38
|
| Rate for Payer: PHP Medicare Advantage |
$0.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1.41
|
| Rate for Payer: Priority Health Medicare |
$0.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.43
|
| Rate for Payer: UHC Core |
$1.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Medicare Advantage |
$0.41
|
| Rate for Payer: VA VA |
$0.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.22
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
NDC 62584089711
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna Commercial |
$1.28
|
| Rate for Payer: Aetna Medicare |
$0.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.47
|
| Rate for Payer: BCBS Complete |
$0.60
|
| Rate for Payer: BCBS MAPPO |
$0.38
|
| Rate for Payer: BCBS Trust/PPO |
$1.23
|
| Rate for Payer: BCN Commercial |
$1.17
|
| Rate for Payer: BCN Medicare Advantage |
$0.38
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cofinity Commercial |
$1.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.38
|
| Rate for Payer: Healthscope Commercial |
$1.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.28
|
| Rate for Payer: Nomi Health Commercial |
$1.23
|
| Rate for Payer: PACE Senior Care Partners |
$0.36
|
| Rate for Payer: PACE SWMI |
$0.38
|
| Rate for Payer: PHP Commercial |
$1.28
|
| Rate for Payer: PHP Medicare Advantage |
$0.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.98
|
| Rate for Payer: Priority Health HMO/PPO |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.00
|
| Rate for Payer: Railroad Medicare Medicare |
$0.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.32
|
| Rate for Payer: UHC Core |
$1.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.38
|
| Rate for Payer: UHC Exchange |
$0.38
|
| Rate for Payer: UHC Medicare Advantage |
$0.38
|
| Rate for Payer: VA VA |
$0.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
NDC 69315012701
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.60 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Aetna Commercial |
$139.40
|
| Rate for Payer: BCBS Trust/PPO |
$133.87
|
| Rate for Payer: BCN Commercial |
$126.74
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$141.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.20
|
| Rate for Payer: Healthscope Commercial |
$147.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.40
|
| Rate for Payer: Nomi Health Commercial |
$134.48
|
| Rate for Payer: PHP Commercial |
$139.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.60
|
| Rate for Payer: Priority Health HMO/PPO |
$142.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.32
|
| Rate for Payer: UHC Core |
$136.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.00
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$161.70
|
|
|
Service Code
|
NDC 60687068101
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.10 |
| 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 |
$105.10
|
| 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
|
$147.40
|
|
|
Service Code
|
NDC 00904722461
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$132.66 |
| Rate for Payer: Aetna Commercial |
$125.29
|
| Rate for Payer: Aetna Medicare |
$38.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.06
|
| Rate for Payer: BCBS Complete |
$58.96
|
| Rate for Payer: BCBS MAPPO |
$36.85
|
| Rate for Payer: BCBS Trust/PPO |
$121.18
|
| Rate for Payer: BCN Commercial |
$114.60
|
| Rate for Payer: BCN Medicare Advantage |
$36.85
|
| Rate for Payer: Cash Price |
$117.92
|
| Rate for Payer: Cofinity Commercial |
$126.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.85
|
| Rate for Payer: Healthscope Commercial |
$132.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.29
|
| Rate for Payer: Nomi Health Commercial |
$120.87
|
| Rate for Payer: PACE Senior Care Partners |
$35.01
|
| Rate for Payer: PACE SWMI |
$36.85
|
| Rate for Payer: PHP Commercial |
$125.29
|
| Rate for Payer: PHP Medicare Advantage |
$36.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.81
|
| Rate for Payer: Priority Health HMO/PPO |
$128.24
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.76
|
| Rate for Payer: Railroad Medicare Medicare |
$36.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.71
|
| Rate for Payer: UHC Core |
$123.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.85
|
| Rate for Payer: UHC Exchange |
$36.85
|
| Rate for Payer: UHC Medicare Advantage |
$36.85
|
| Rate for Payer: VA VA |
$36.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.55
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
NDC 39822110001
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: BCBS Trust/PPO |
$168.53
|
| Rate for Payer: BCN Commercial |
$159.55
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Nomi Health Commercial |
$169.30
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.20
|
| Rate for Payer: Priority Health HMO/PPO |
$179.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.68
|
| Rate for Payer: UHC Core |
$172.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$5.69
|
|
|
Service Code
|
NDC 63323018411
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna Commercial |
$14.51
|
| Rate for Payer: Aetna Commercial |
$19.35
|
| Rate for Payer: Aetna Commercial |
$24.18
|
| Rate for Payer: Aetna Commercial |
$9.67
|
| Rate for Payer: BCBS Trust/PPO |
$23.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.64
|
| Rate for Payer: BCBS Trust/PPO |
$18.58
|
| Rate for Payer: BCBS Trust/PPO |
$13.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.29
|
| Rate for Payer: BCN Commercial |
$21.99
|
| Rate for Payer: BCN Commercial |
$17.59
|
| Rate for Payer: BCN Commercial |
$8.79
|
| Rate for Payer: BCN Commercial |
$13.19
|
| Rate for Payer: BCN Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cash Price |
$18.21
|
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Cash Price |
$22.76
|
| Rate for Payer: Cofinity Commercial |
$4.89
|
| Rate for Payer: Cofinity Commercial |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$24.47
|
| Rate for Payer: Cofinity Commercial |
$19.57
|
| Rate for Payer: Cofinity Commercial |
$14.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$15.36
|
| Rate for Payer: Healthscope Commercial |
$20.48
|
| Rate for Payer: Healthscope Commercial |
$10.24
|
| Rate for Payer: Healthscope Commercial |
$25.60
|
| Rate for Payer: Healthscope Commercial |
$5.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.18
|
| Rate for Payer: Nomi Health Commercial |
$9.33
|
| Rate for Payer: Nomi Health Commercial |
$14.00
|
| Rate for Payer: Nomi Health Commercial |
$18.66
|
| Rate for Payer: Nomi Health Commercial |
$23.33
|
| Rate for Payer: Nomi Health Commercial |
$4.67
|
| Rate for Payer: PHP Commercial |
$19.35
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Commercial |
$9.67
|
| Rate for Payer: PHP Commercial |
$24.18
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.40
|
| Rate for Payer: Priority Health HMO/PPO |
$9.90
|
| Rate for Payer: Priority Health HMO/PPO |
$4.95
|
| Rate for Payer: Priority Health HMO/PPO |
$19.80
|
| Rate for Payer: Priority Health HMO/PPO |
$24.75
|
| Rate for Payer: Priority Health HMO/PPO |
$14.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.04
|
| Rate for Payer: UHC Core |
$9.50
|
| Rate for Payer: UHC Core |
$14.25
|
| Rate for Payer: UHC Core |
$23.76
|
| Rate for Payer: UHC Core |
$4.75
|
| Rate for Payer: UHC Core |
$19.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.34
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$206.46
|
|
|
Service Code
|
NDC 39822110001
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.03 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna Medicare |
$53.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.52
|
| Rate for Payer: BCBS Complete |
$82.58
|
| Rate for Payer: BCBS MAPPO |
$51.62
|
| Rate for Payer: BCBS Trust/PPO |
$169.73
|
| Rate for Payer: BCN Commercial |
$160.52
|
| Rate for Payer: BCN Medicare Advantage |
$51.62
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.62
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Nomi Health Commercial |
$169.30
|
| Rate for Payer: PACE Senior Care Partners |
$49.03
|
| Rate for Payer: PACE SWMI |
$51.62
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: PHP Medicare Advantage |
$51.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.20
|
| Rate for Payer: Priority Health HMO/PPO |
$179.62
|
| Rate for Payer: Priority Health Medicare |
$52.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.33
|
| Rate for Payer: Railroad Medicare Medicare |
$51.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.68
|
| Rate for Payer: UHC Core |
$172.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.62
|
| Rate for Payer: UHC Exchange |
$51.62
|
| Rate for Payer: UHC Medicare Advantage |
$51.62
|
| Rate for Payer: VA VA |
$51.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$158.59
|
|
|
Service Code
|
NDC 63323018410
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.08 |
| Max. Negotiated Rate |
$142.73 |
| Rate for Payer: Aetna Commercial |
$134.80
|
| Rate for Payer: BCBS Trust/PPO |
$129.46
|
| Rate for Payer: BCN Commercial |
$122.56
|
| Rate for Payer: Cash Price |
$126.87
|
| Rate for Payer: Cofinity Commercial |
$136.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.87
|
| Rate for Payer: Healthscope Commercial |
$142.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.80
|
| Rate for Payer: Nomi Health Commercial |
$130.04
|
| Rate for Payer: PHP Commercial |
$134.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.08
|
| Rate for Payer: Priority Health HMO/PPO |
$137.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.56
|
| Rate for Payer: UHC Core |
$132.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.94
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$158.59
|
|
|
Service Code
|
NDC 63323018410
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$142.73 |
| Rate for Payer: Aetna Commercial |
$134.80
|
| Rate for Payer: Aetna Medicare |
$41.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.56
|
| Rate for Payer: BCBS Complete |
$63.44
|
| Rate for Payer: BCBS MAPPO |
$39.65
|
| Rate for Payer: BCBS Trust/PPO |
$130.38
|
| Rate for Payer: BCN Commercial |
$123.30
|
| Rate for Payer: BCN Medicare Advantage |
$39.65
|
| Rate for Payer: Cash Price |
$126.87
|
| Rate for Payer: Cofinity Commercial |
$136.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.65
|
| Rate for Payer: Healthscope Commercial |
$142.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.80
|
| Rate for Payer: Nomi Health Commercial |
$130.04
|
| Rate for Payer: PACE Senior Care Partners |
$37.67
|
| Rate for Payer: PACE SWMI |
$39.65
|
| Rate for Payer: PHP Commercial |
$134.80
|
| Rate for Payer: PHP Medicare Advantage |
$39.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.08
|
| Rate for Payer: Priority Health HMO/PPO |
$137.97
|
| Rate for Payer: Priority Health Medicare |
$40.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.26
|
| Rate for Payer: Railroad Medicare Medicare |
$39.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.56
|
| Rate for Payer: UHC Core |
$132.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.65
|
| Rate for Payer: UHC Exchange |
$39.65
|
| Rate for Payer: UHC Medicare Advantage |
$39.65
|
| Rate for Payer: VA VA |
$39.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.94
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$17.07
|
|
|
Service Code
|
NDC 63323018411
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$15.36 |
| Rate for Payer: Aetna Commercial |
$14.51
|
| Rate for Payer: Aetna Commercial |
$19.35
|
| Rate for Payer: Aetna Commercial |
$24.18
|
| Rate for Payer: Aetna Commercial |
$9.67
|
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna Medicare |
$5.92
|
| Rate for Payer: Aetna Medicare |
$2.96
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: Aetna Medicare |
$1.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.89
|
| Rate for Payer: BCBS Complete |
$11.38
|
| Rate for Payer: BCBS Complete |
$4.55
|
| Rate for Payer: BCBS Complete |
$6.83
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: BCBS Complete |
$2.28
|
| Rate for Payer: BCBS MAPPO |
$5.69
|
| Rate for Payer: BCBS MAPPO |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS MAPPO |
$7.11
|
| Rate for Payer: BCBS MAPPO |
$1.42
|
| Rate for Payer: BCBS Trust/PPO |
$9.36
|
| Rate for Payer: BCBS Trust/PPO |
$14.03
|
| Rate for Payer: BCBS Trust/PPO |
$18.71
|
| Rate for Payer: BCBS Trust/PPO |
$4.68
|
| Rate for Payer: BCBS Trust/PPO |
$23.39
|
| Rate for Payer: BCN Commercial |
$4.42
|
| Rate for Payer: BCN Commercial |
$8.85
|
| Rate for Payer: BCN Commercial |
$13.27
|
| Rate for Payer: BCN Commercial |
$17.70
|
| Rate for Payer: BCN Commercial |
$22.12
|
| Rate for Payer: BCN Medicare Advantage |
$1.42
|
| Rate for Payer: BCN Medicare Advantage |
$7.11
|
| Rate for Payer: BCN Medicare Advantage |
$2.84
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.69
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cash Price |
$22.76
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cash Price |
$18.21
|
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Cofinity Commercial |
$4.89
|
| Rate for Payer: Cofinity Commercial |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$14.68
|
| Rate for Payer: Cofinity Commercial |
$24.47
|
| Rate for Payer: Cofinity Commercial |
$19.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.69
|
| Rate for Payer: Healthscope Commercial |
$15.36
|
| Rate for Payer: Healthscope Commercial |
$10.24
|
| Rate for Payer: Healthscope Commercial |
$25.60
|
| Rate for Payer: Healthscope Commercial |
$20.48
|
| Rate for Payer: Healthscope Commercial |
$5.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.84
|
| Rate for Payer: Nomi Health Commercial |
$14.00
|
| Rate for Payer: Nomi Health Commercial |
$23.33
|
| Rate for Payer: Nomi Health Commercial |
$18.66
|
| Rate for Payer: Nomi Health Commercial |
$4.67
|
| Rate for Payer: Nomi Health Commercial |
$9.33
|
| Rate for Payer: PACE Senior Care Partners |
$2.70
|
| Rate for Payer: PACE Senior Care Partners |
$6.76
|
| Rate for Payer: PACE Senior Care Partners |
$4.05
|
| Rate for Payer: PACE Senior Care Partners |
$5.41
|
| Rate for Payer: PACE Senior Care Partners |
$1.35
|
| Rate for Payer: PACE SWMI |
$2.84
|
| Rate for Payer: PACE SWMI |
$7.11
|
| Rate for Payer: PACE SWMI |
$5.69
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PACE SWMI |
$1.42
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: PHP Commercial |
$19.35
|
| Rate for Payer: PHP Commercial |
$24.18
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Commercial |
$9.67
|
| Rate for Payer: PHP Medicare Advantage |
$5.69
|
| Rate for Payer: PHP Medicare Advantage |
$7.11
|
| Rate for Payer: PHP Medicare Advantage |
$1.42
|
| Rate for Payer: PHP Medicare Advantage |
$2.84
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.40
|
| Rate for Payer: Priority Health HMO/PPO |
$9.90
|
| Rate for Payer: Priority Health HMO/PPO |
$19.80
|
| Rate for Payer: Priority Health HMO/PPO |
$4.95
|
| Rate for Payer: Priority Health HMO/PPO |
$24.75
|
| Rate for Payer: Priority Health HMO/PPO |
$14.85
|
| Rate for Payer: Priority Health Medicare |
$1.44
|
| Rate for Payer: Priority Health Medicare |
$5.75
|
| Rate for Payer: Priority Health Medicare |
$4.31
|
| Rate for Payer: Priority Health Medicare |
$7.18
|
| Rate for Payer: Priority Health Medicare |
$2.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.81
|
| Rate for Payer: Railroad Medicare Medicare |
$7.11
|
| Rate for Payer: Railroad Medicare Medicare |
$5.69
|
| Rate for Payer: Railroad Medicare Medicare |
$2.84
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: Railroad Medicare Medicare |
$1.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.03
|
| Rate for Payer: UHC Core |
$14.25
|
| Rate for Payer: UHC Core |
$4.75
|
| Rate for Payer: UHC Core |
$19.00
|
| Rate for Payer: UHC Core |
$23.76
|
| Rate for Payer: UHC Core |
$9.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.69
|
| Rate for Payer: UHC Exchange |
$5.69
|
| Rate for Payer: UHC Exchange |
$1.42
|
| Rate for Payer: UHC Exchange |
$2.84
|
| Rate for Payer: UHC Exchange |
$7.11
|
| Rate for Payer: UHC Exchange |
$4.27
|
| Rate for Payer: UHC Medicare Advantage |
$4.27
|
| Rate for Payer: UHC Medicare Advantage |
$1.42
|
| Rate for Payer: UHC Medicare Advantage |
$5.69
|
| Rate for Payer: UHC Medicare Advantage |
$2.84
|
| Rate for Payer: UHC Medicare Advantage |
$7.11
|
| Rate for Payer: VA VA |
$2.84
|
| Rate for Payer: VA VA |
$7.11
|
| Rate for Payer: VA VA |
$4.27
|
| Rate for Payer: VA VA |
$1.42
|
| Rate for Payer: VA VA |
$5.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.07
|
|
