ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$24.74
|
|
Service Code
|
HCPCS J0153
|
Hospital Charge Code |
8975
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$15.09 |
Max. Negotiated Rate |
$22.27 |
Rate for Payer: Aetna Commercial |
$21.03
|
Rate for Payer: Aetna Commercial |
$15.34
|
Rate for Payer: Aetna Commercial |
$21.50
|
Rate for Payer: Aetna Commercial |
$21.47
|
Rate for Payer: BCBS Trust/PPO |
$19.52
|
Rate for Payer: BCBS Trust/PPO |
$13.95
|
Rate for Payer: BCBS Trust/PPO |
$19.12
|
Rate for Payer: BCBS Trust/PPO |
$19.54
|
Rate for Payer: BCN Commercial |
$19.52
|
Rate for Payer: BCN Commercial |
$19.54
|
Rate for Payer: BCN Commercial |
$19.12
|
Rate for Payer: BCN Commercial |
$13.95
|
Rate for Payer: Cash Price |
$14.44
|
Rate for Payer: Cash Price |
$20.23
|
Rate for Payer: Cash Price |
$20.21
|
Rate for Payer: Cash Price |
$19.79
|
Rate for Payer: Cofinity Commercial |
$21.28
|
Rate for Payer: Cofinity Commercial |
$15.52
|
Rate for Payer: Cofinity Commercial |
$21.72
|
Rate for Payer: Cofinity Commercial |
$21.75
|
Rate for Payer: Encore Health Key Benefits Commercial |
$20.21
|
Rate for Payer: Encore Health Key Benefits Commercial |
$19.79
|
Rate for Payer: Encore Health Key Benefits Commercial |
$20.23
|
Rate for Payer: Encore Health Key Benefits Commercial |
$14.44
|
Rate for Payer: Healthscope Commercial |
$22.73
|
Rate for Payer: Healthscope Commercial |
$16.24
|
Rate for Payer: Healthscope Commercial |
$22.27
|
Rate for Payer: Healthscope Commercial |
$22.76
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.97
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.56
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.94
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.54
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.34
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.03
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.47
|
Rate for Payer: PHP Commercial |
$15.34
|
Rate for Payer: PHP Commercial |
$21.03
|
Rate for Payer: PHP Commercial |
$21.47
|
Rate for Payer: PHP Commercial |
$21.50
|
Rate for Payer: Priority Health Cigna Priority Health |
$17.32
|
Rate for Payer: Priority Health Cigna Priority Health |
$17.68
|
Rate for Payer: Priority Health Cigna Priority Health |
$12.64
|
Rate for Payer: Priority Health Cigna Priority Health |
$17.70
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.70
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.52
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.00
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.98
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$11.01
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$15.09
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$15.41
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$15.42
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$22.23
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$22.26
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$21.77
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$15.88
|
Rate for Payer: UHC Core |
$15.07
|
Rate for Payer: UHC Core |
$20.66
|
Rate for Payer: UHC Core |
$21.09
|
Rate for Payer: UHC Core |
$21.12
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.94
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.54
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.56
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.97
|
|
ADENOSINE 3 MG/ML IV (CODE)
|
Facility
IP
|
$18.05
|
|
Service Code
|
HCPCS J0153
|
Hospital Charge Code |
163702
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$11.01 |
Max. Negotiated Rate |
$16.24 |
Rate for Payer: Aetna Commercial |
$15.34
|
Rate for Payer: BCBS Trust/PPO |
$13.95
|
Rate for Payer: BCN Commercial |
$13.95
|
Rate for Payer: Cash Price |
$14.44
|
Rate for Payer: Cofinity Commercial |
$15.52
|
Rate for Payer: Encore Health Key Benefits Commercial |
$14.44
|
Rate for Payer: Healthscope Commercial |
$16.24
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.54
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.34
|
Rate for Payer: PHP Commercial |
$15.34
|
Rate for Payer: Priority Health Cigna Priority Health |
$12.64
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.70
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$11.01
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$15.88
|
Rate for Payer: UHC Core |
$15.07
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.54
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION
|
Facility
IP
|
$4.09
|
|
Service Code
|
HCPCS J7613
|
Hospital Charge Code |
250
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$2.49 |
Max. Negotiated Rate |
$3.68 |
Rate for Payer: Aetna Commercial |
$3.48
|
Rate for Payer: Aetna Commercial |
$3.24
|
Rate for Payer: Aetna Commercial |
$3.72
|
Rate for Payer: BCBS Trust/PPO |
$3.16
|
Rate for Payer: BCBS Trust/PPO |
$2.94
|
Rate for Payer: BCBS Trust/PPO |
$3.38
|
Rate for Payer: BCN Commercial |
$3.16
|
Rate for Payer: BCN Commercial |
$2.94
|
Rate for Payer: BCN Commercial |
$3.38
|
Rate for Payer: Cash Price |
$3.50
|
Rate for Payer: Cash Price |
$3.05
|
Rate for Payer: Cash Price |
$3.27
|
Rate for Payer: Cofinity Commercial |
$3.52
|
Rate for Payer: Cofinity Commercial |
$3.28
|
Rate for Payer: Cofinity Commercial |
$3.77
|
Rate for Payer: Encore Health Key Benefits Commercial |
$3.05
|
Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
Rate for Payer: Healthscope Commercial |
$3.43
|
Rate for Payer: Healthscope Commercial |
$3.68
|
Rate for Payer: Healthscope Commercial |
$3.94
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.86
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.07
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.72
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.48
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.24
|
Rate for Payer: PHP Commercial |
$3.24
|
Rate for Payer: PHP Commercial |
$3.72
|
Rate for Payer: PHP Commercial |
$3.48
|
Rate for Payer: Priority Health Cigna Priority Health |
$2.67
|
Rate for Payer: Priority Health Cigna Priority Health |
$3.07
|
Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.31
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.56
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.81
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$2.32
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$2.67
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$2.49
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$3.60
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$3.85
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$3.35
|
Rate for Payer: UHC Core |
$3.66
|
Rate for Payer: UHC Core |
$3.42
|
Rate for Payer: UHC Core |
$3.18
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.07
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.86
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
IP
|
$3.36
|
|
Service Code
|
HCPCS J7611
|
Hospital Charge Code |
115221
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$2.05 |
Max. Negotiated Rate |
$3.02 |
Rate for Payer: Aetna Commercial |
$2.86
|
Rate for Payer: BCBS Trust/PPO |
$2.60
|
Rate for Payer: BCN Commercial |
$2.60
|
Rate for Payer: Cash Price |
$2.69
|
Rate for Payer: Cofinity Commercial |
$2.89
|
Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
Rate for Payer: Healthscope Commercial |
$3.02
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.52
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.86
|
Rate for Payer: PHP Commercial |
$2.86
|
Rate for Payer: Priority Health Cigna Priority Health |
$2.35
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.92
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$2.05
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$2.96
|
Rate for Payer: UHC Core |
$2.81
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.52
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
IP
|
$109.20
|
|
Service Code
|
NDC 9900-0011-69
|
Hospital Charge Code |
300450
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$66.60 |
Max. Negotiated Rate |
$98.28 |
Rate for Payer: Aetna Commercial |
$92.82
|
Rate for Payer: BCBS Trust/PPO |
$84.39
|
Rate for Payer: BCN Commercial |
$84.39
|
Rate for Payer: Cash Price |
$87.36
|
Rate for Payer: Cofinity Commercial |
$93.91
|
Rate for Payer: Encore Health Key Benefits Commercial |
$87.36
|
Rate for Payer: Healthscope Commercial |
$98.28
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.90
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.82
|
Rate for Payer: PHP Commercial |
$92.82
|
Rate for Payer: Priority Health Cigna Priority Health |
$76.44
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.00
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$66.60
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$96.10
|
Rate for Payer: UHC Core |
$91.18
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.90
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
IP
|
$146.30
|
|
Service Code
|
NDC 68180-963-01
|
Hospital Charge Code |
300450
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$89.23 |
Max. Negotiated Rate |
$131.67 |
Rate for Payer: Aetna Commercial |
$124.36
|
Rate for Payer: BCBS Trust/PPO |
$113.06
|
Rate for Payer: BCN Commercial |
$113.06
|
Rate for Payer: Cash Price |
$117.04
|
Rate for Payer: Cofinity Commercial |
$125.82
|
Rate for Payer: Encore Health Key Benefits Commercial |
$117.04
|
Rate for Payer: Healthscope Commercial |
$131.67
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.72
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.36
|
Rate for Payer: PHP Commercial |
$124.36
|
Rate for Payer: Priority Health Cigna Priority Health |
$102.41
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.28
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$89.23
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$128.74
|
Rate for Payer: UHC Core |
$122.16
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.72
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
IP
|
$146.30
|
|
Service Code
|
NDC 68180-963-01
|
Hospital Charge Code |
17837
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$89.23 |
Max. Negotiated Rate |
$131.67 |
Rate for Payer: Aetna Commercial |
$124.36
|
Rate for Payer: BCBS Trust/PPO |
$113.06
|
Rate for Payer: BCN Commercial |
$113.06
|
Rate for Payer: Cash Price |
$117.04
|
Rate for Payer: Cofinity Commercial |
$125.82
|
Rate for Payer: Encore Health Key Benefits Commercial |
$117.04
|
Rate for Payer: Healthscope Commercial |
$131.67
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.72
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.36
|
Rate for Payer: PHP Commercial |
$124.36
|
Rate for Payer: Priority Health Cigna Priority Health |
$102.41
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.28
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$89.23
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$128.74
|
Rate for Payer: UHC Core |
$122.16
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.72
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
IP
|
$253.80
|
|
Service Code
|
NDC 53489-156-01
|
Hospital Charge Code |
310
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$154.79 |
Max. Negotiated Rate |
$228.42 |
Rate for Payer: Aetna Commercial |
$215.73
|
Rate for Payer: BCBS Trust/PPO |
$196.14
|
Rate for Payer: BCN Commercial |
$196.14
|
Rate for Payer: Cash Price |
$203.04
|
Rate for Payer: Cofinity Commercial |
$218.27
|
Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
Rate for Payer: Healthscope Commercial |
$228.42
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.35
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.73
|
Rate for Payer: PHP Commercial |
$215.73
|
Rate for Payer: Priority Health Cigna Priority Health |
$177.66
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.81
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$154.79
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$223.34
|
Rate for Payer: UHC Core |
$211.92
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.35
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
IP
|
$446.50
|
|
Service Code
|
NDC 0904-7041-61
|
Hospital Charge Code |
310
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$272.32 |
Max. Negotiated Rate |
$401.85 |
Rate for Payer: Aetna Commercial |
$379.52
|
Rate for Payer: BCBS Trust/PPO |
$345.06
|
Rate for Payer: BCN Commercial |
$345.06
|
Rate for Payer: Cash Price |
$357.20
|
Rate for Payer: Cofinity Commercial |
$383.99
|
Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
Rate for Payer: Healthscope Commercial |
$401.85
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.88
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$379.52
|
Rate for Payer: PHP Commercial |
$379.52
|
Rate for Payer: Priority Health Cigna Priority Health |
$312.55
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$388.46
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$272.32
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$392.92
|
Rate for Payer: UHC Core |
$372.83
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
IP
|
$2.78
|
|
Service Code
|
NDC 51079-205-01
|
Hospital Charge Code |
310
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$1.70 |
Max. Negotiated Rate |
$2.50 |
Rate for Payer: Aetna Commercial |
$2.36
|
Rate for Payer: BCBS Trust/PPO |
$2.15
|
Rate for Payer: BCN Commercial |
$2.15
|
Rate for Payer: Cash Price |
$2.22
|
Rate for Payer: Cofinity Commercial |
$2.39
|
Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
Rate for Payer: Healthscope Commercial |
$2.50
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.08
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.36
|
Rate for Payer: PHP Commercial |
$2.36
|
Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.42
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$1.70
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$2.45
|
Rate for Payer: UHC Core |
$2.32
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.08
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
IP
|
$254.40
|
|
Service Code
|
NDC 0378-0181-01
|
Hospital Charge Code |
311
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$155.16 |
Max. Negotiated Rate |
$228.96 |
Rate for Payer: Aetna Commercial |
$216.24
|
Rate for Payer: BCBS Trust/PPO |
$196.60
|
Rate for Payer: BCN Commercial |
$196.60
|
Rate for Payer: Cash Price |
$203.52
|
Rate for Payer: Cofinity Commercial |
$218.78
|
Rate for Payer: Encore Health Key Benefits Commercial |
$203.52
|
Rate for Payer: Healthscope Commercial |
$228.96
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.80
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.24
|
Rate for Payer: PHP Commercial |
$216.24
|
Rate for Payer: Priority Health Cigna Priority Health |
$178.08
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$221.33
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$155.16
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$223.87
|
Rate for Payer: UHC Core |
$212.42
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.80
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
IP
|
$267.84
|
|
Service Code
|
NDC 0591-5544-01
|
Hospital Charge Code |
311
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$163.36 |
Max. Negotiated Rate |
$241.06 |
Rate for Payer: Aetna Commercial |
$227.66
|
Rate for Payer: BCBS Trust/PPO |
$206.99
|
Rate for Payer: BCN Commercial |
$206.99
|
Rate for Payer: Cash Price |
$214.27
|
Rate for Payer: Cofinity Commercial |
$230.34
|
Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
Rate for Payer: Healthscope Commercial |
$241.06
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.66
|
Rate for Payer: PHP Commercial |
$227.66
|
Rate for Payer: Priority Health Cigna Priority Health |
$187.49
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.02
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$163.36
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$235.70
|
Rate for Payer: UHC Core |
$223.65
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
IP
|
$325.85
|
|
Service Code
|
NDC 0904-6572-61
|
Hospital Charge Code |
311
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$198.74 |
Max. Negotiated Rate |
$293.26 |
Rate for Payer: Aetna Commercial |
$276.97
|
Rate for Payer: BCBS Trust/PPO |
$251.82
|
Rate for Payer: BCN Commercial |
$251.82
|
Rate for Payer: Cash Price |
$260.68
|
Rate for Payer: Cofinity Commercial |
$280.23
|
Rate for Payer: Encore Health Key Benefits Commercial |
$260.68
|
Rate for Payer: Healthscope Commercial |
$293.26
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.39
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.97
|
Rate for Payer: PHP Commercial |
$276.97
|
Rate for Payer: Priority Health Cigna Priority Health |
$228.10
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.49
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$198.74
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$286.75
|
Rate for Payer: UHC Core |
$272.08
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.39
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
IP
|
$273.60
|
|
Service Code
|
NDC 0603-2116-21
|
Hospital Charge Code |
311
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$166.87 |
Max. Negotiated Rate |
$246.24 |
Rate for Payer: Aetna Commercial |
$232.56
|
Rate for Payer: BCBS Trust/PPO |
$211.44
|
Rate for Payer: BCN Commercial |
$211.44
|
Rate for Payer: Cash Price |
$218.88
|
Rate for Payer: Cofinity Commercial |
$235.30
|
Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
Rate for Payer: Healthscope Commercial |
$246.24
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.56
|
Rate for Payer: PHP Commercial |
$232.56
|
Rate for Payer: Priority Health Cigna Priority Health |
$191.52
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.03
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$166.87
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$240.77
|
Rate for Payer: UHC Core |
$228.46
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
IP
|
$64.75
|
|
Service Code
|
NDC 65862-676-01
|
Hospital Charge Code |
324
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$39.49 |
Max. Negotiated Rate |
$58.28 |
Rate for Payer: Aetna Commercial |
$55.04
|
Rate for Payer: BCBS Trust/PPO |
$50.04
|
Rate for Payer: BCN Commercial |
$50.04
|
Rate for Payer: Cash Price |
$51.80
|
Rate for Payer: Cofinity Commercial |
$55.68
|
Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
Rate for Payer: Healthscope Commercial |
$58.28
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.56
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.04
|
Rate for Payer: PHP Commercial |
$55.04
|
Rate for Payer: Priority Health Cigna Priority Health |
$45.32
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.33
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$39.49
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$56.98
|
Rate for Payer: UHC Core |
$54.07
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.56
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
IP
|
$47.25
|
|
Service Code
|
NDC 0781-1061-01
|
Hospital Charge Code |
324
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$28.82 |
Max. Negotiated Rate |
$42.52 |
Rate for Payer: Aetna Commercial |
$40.16
|
Rate for Payer: BCBS Trust/PPO |
$36.51
|
Rate for Payer: BCN Commercial |
$36.51
|
Rate for Payer: Cash Price |
$37.80
|
Rate for Payer: Cofinity Commercial |
$40.64
|
Rate for Payer: Encore Health Key Benefits Commercial |
$37.80
|
Rate for Payer: Healthscope Commercial |
$42.52
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.44
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.16
|
Rate for Payer: PHP Commercial |
$40.16
|
Rate for Payer: Priority Health Cigna Priority Health |
$33.08
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.11
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$28.82
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$41.58
|
Rate for Payer: UHC Core |
$39.45
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.44
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
IP
|
$57.75
|
|
Service Code
|
NDC 65862-677-01
|
Hospital Charge Code |
325
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$35.22 |
Max. Negotiated Rate |
$51.98 |
Rate for Payer: Aetna Commercial |
$49.09
|
Rate for Payer: BCBS Trust/PPO |
$44.63
|
Rate for Payer: BCN Commercial |
$44.63
|
Rate for Payer: Cash Price |
$46.20
|
Rate for Payer: Cofinity Commercial |
$49.66
|
Rate for Payer: Encore Health Key Benefits Commercial |
$46.20
|
Rate for Payer: Healthscope Commercial |
$51.98
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.31
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.09
|
Rate for Payer: PHP Commercial |
$49.09
|
Rate for Payer: Priority Health Cigna Priority Health |
$40.42
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.24
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$35.22
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$50.82
|
Rate for Payer: UHC Core |
$48.22
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.31
|
|
ALPRAZOLAM 1 MG TABLET
|
Facility
IP
|
$86.95
|
|
Service Code
|
NDC 65862-678-01
|
Hospital Charge Code |
326
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$53.03 |
Max. Negotiated Rate |
$78.26 |
Rate for Payer: Aetna Commercial |
$73.91
|
Rate for Payer: BCBS Trust/PPO |
$67.19
|
Rate for Payer: BCN Commercial |
$67.19
|
Rate for Payer: Cash Price |
$69.56
|
Rate for Payer: Cofinity Commercial |
$74.78
|
Rate for Payer: Encore Health Key Benefits Commercial |
$69.56
|
Rate for Payer: Healthscope Commercial |
$78.26
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.21
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.91
|
Rate for Payer: PHP Commercial |
$73.91
|
Rate for Payer: Priority Health Cigna Priority Health |
$60.86
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.65
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$53.03
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$76.52
|
Rate for Payer: UHC Core |
$72.60
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.21
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$28,836.00
|
|
Service Code
|
HCPCS J2997
|
Hospital Charge Code |
9002
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$17,587.08 |
Max. Negotiated Rate |
$25,952.40 |
Rate for Payer: Aetna Commercial |
$24,510.60
|
Rate for Payer: BCBS Trust/PPO |
$22,284.46
|
Rate for Payer: BCN Commercial |
$22,284.46
|
Rate for Payer: Cash Price |
$23,068.80
|
Rate for Payer: Cofinity Commercial |
$24,798.96
|
Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
Rate for Payer: Healthscope Commercial |
$25,952.40
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,510.60
|
Rate for Payer: PHP Commercial |
$24,510.60
|
Rate for Payer: Priority Health Cigna Priority Health |
$20,185.20
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,087.32
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$17,587.08
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$25,375.68
|
Rate for Payer: UHC Core |
$24,078.06
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
ALTEPLASE 100 MG IV INFUSION FOR STROKE
|
Facility
IP
|
$28,836.00
|
|
Service Code
|
HCPCS J2997
|
Hospital Charge Code |
150807
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$17,587.08 |
Max. Negotiated Rate |
$25,952.40 |
Rate for Payer: Aetna Commercial |
$24,510.60
|
Rate for Payer: BCBS Trust/PPO |
$22,284.46
|
Rate for Payer: BCN Commercial |
$22,284.46
|
Rate for Payer: Cash Price |
$23,068.80
|
Rate for Payer: Cofinity Commercial |
$24,798.96
|
Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
Rate for Payer: Healthscope Commercial |
$25,952.40
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,510.60
|
Rate for Payer: PHP Commercial |
$24,510.60
|
Rate for Payer: Priority Health Cigna Priority Health |
$20,185.20
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,087.32
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$17,587.08
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$25,375.68
|
Rate for Payer: UHC Core |
$24,078.06
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
ALTEPLASE 100MG IV SOLUTION FOR PE
|
Facility
IP
|
$28,836.00
|
|
Service Code
|
HCPCS J2997
|
Hospital Charge Code |
150806
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$17,587.08 |
Max. Negotiated Rate |
$25,952.40 |
Rate for Payer: Aetna Commercial |
$24,510.60
|
Rate for Payer: BCBS Trust/PPO |
$22,284.46
|
Rate for Payer: BCN Commercial |
$22,284.46
|
Rate for Payer: Cash Price |
$23,068.80
|
Rate for Payer: Cofinity Commercial |
$24,798.96
|
Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
Rate for Payer: Healthscope Commercial |
$25,952.40
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,510.60
|
Rate for Payer: PHP Commercial |
$24,510.60
|
Rate for Payer: Priority Health Cigna Priority Health |
$20,185.20
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,087.32
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$17,587.08
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$25,375.68
|
Rate for Payer: UHC Core |
$24,078.06
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION
|
Facility
IP
|
$582.24
|
|
Service Code
|
HCPCS J2997
|
Hospital Charge Code |
31310
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$355.11 |
Max. Negotiated Rate |
$524.02 |
Rate for Payer: Aetna Commercial |
$494.90
|
Rate for Payer: BCBS Trust/PPO |
$449.96
|
Rate for Payer: BCN Commercial |
$449.96
|
Rate for Payer: Cash Price |
$465.79
|
Rate for Payer: Cofinity Commercial |
$500.73
|
Rate for Payer: Encore Health Key Benefits Commercial |
$465.79
|
Rate for Payer: Healthscope Commercial |
$524.02
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.68
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$494.90
|
Rate for Payer: PHP Commercial |
$494.90
|
Rate for Payer: Priority Health Cigna Priority Health |
$407.57
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$506.55
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$355.11
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$512.37
|
Rate for Payer: UHC Core |
$486.17
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.68
|
|
ALTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$14,418.00
|
|
Service Code
|
HCPCS J2997
|
Hospital Charge Code |
9003
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$8,793.54 |
Max. Negotiated Rate |
$12,976.20 |
Rate for Payer: Aetna Commercial |
$12,255.30
|
Rate for Payer: BCBS Trust/PPO |
$11,142.23
|
Rate for Payer: BCN Commercial |
$11,142.23
|
Rate for Payer: Cash Price |
$11,534.40
|
Rate for Payer: Cofinity Commercial |
$12,399.48
|
Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
Rate for Payer: Healthscope Commercial |
$12,976.20
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,255.30
|
Rate for Payer: PHP Commercial |
$12,255.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$10,092.60
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,543.66
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$8,793.54
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$12,687.84
|
Rate for Payer: UHC Core |
$12,039.03
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
ALTEPLASE INFUSION FOR CARDIAC ARREST
|
Facility
IP
|
$14,418.00
|
|
Service Code
|
HCPCS J2997
|
Hospital Charge Code |
300766
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$8,793.54 |
Max. Negotiated Rate |
$12,976.20 |
Rate for Payer: Aetna Commercial |
$12,255.30
|
Rate for Payer: BCBS Trust/PPO |
$11,142.23
|
Rate for Payer: BCN Commercial |
$11,142.23
|
Rate for Payer: Cash Price |
$11,534.40
|
Rate for Payer: Cofinity Commercial |
$12,399.48
|
Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
Rate for Payer: Healthscope Commercial |
$12,976.20
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,255.30
|
Rate for Payer: PHP Commercial |
$12,255.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$10,092.60
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,543.66
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$8,793.54
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$12,687.84
|
Rate for Payer: UHC Core |
$12,039.03
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
IP
|
$10.88
|
|
Service Code
|
NDC 9900-0001-91
|
Hospital Charge Code |
38285
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$6.64 |
Max. Negotiated Rate |
$9.79 |
Rate for Payer: Aetna Commercial |
$9.25
|
Rate for Payer: BCBS Trust/PPO |
$8.41
|
Rate for Payer: BCN Commercial |
$8.41
|
Rate for Payer: Cash Price |
$8.70
|
Rate for Payer: Cofinity Commercial |
$9.36
|
Rate for Payer: Encore Health Key Benefits Commercial |
$8.70
|
Rate for Payer: Healthscope Commercial |
$9.79
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.16
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.25
|
Rate for Payer: PHP Commercial |
$9.25
|
Rate for Payer: Priority Health Cigna Priority Health |
$7.62
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.47
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$6.64
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$9.57
|
Rate for Payer: UHC Core |
$9.08
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.16
|
|