|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$3.78
|
|
|
Service Code
|
NDC 49884-465-64
|
| Hospital Charge Code |
9588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Aetna Commercial |
$3.21
|
| Rate for Payer: BCBS Trust/PPO |
$2.92
|
| Rate for Payer: BCN Commercial |
$2.92
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.21
|
| Rate for Payer: PHP Commercial |
$3.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.33
|
| Rate for Payer: UHC Core |
$3.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.84
|
|
|
CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$233.06
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
28923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$142.14 |
| Max. Negotiated Rate |
$209.75 |
| Rate for Payer: Aetna Commercial |
$198.10
|
| Rate for Payer: BCBS Trust/PPO |
$180.11
|
| Rate for Payer: BCN Commercial |
$180.11
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cofinity Commercial |
$200.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.45
|
| Rate for Payer: Healthscope Commercial |
$209.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$198.10
|
| Rate for Payer: PHP Commercial |
$198.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.09
|
| Rate for Payer: UHC Core |
$194.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.80
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
IP
|
$172.71
|
|
|
Service Code
|
NDC 70436-051-06
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.34 |
| Max. Negotiated Rate |
$155.44 |
| Rate for Payer: Aetna Commercial |
$146.80
|
| Rate for Payer: BCBS Trust/PPO |
$133.47
|
| Rate for Payer: BCN Commercial |
$133.47
|
| Rate for Payer: Cash Price |
$138.17
|
| Rate for Payer: Cofinity Commercial |
$148.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.17
|
| Rate for Payer: Healthscope Commercial |
$155.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$146.80
|
| Rate for Payer: PHP Commercial |
$146.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.98
|
| Rate for Payer: UHC Core |
$144.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.53
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
IP
|
$3.25
|
|
|
Service Code
|
NDC 50268-177-11
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna Commercial |
$2.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.76
|
| Rate for Payer: PHP Commercial |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.86
|
| Rate for Payer: UHC Core |
$2.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.44
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
IP
|
$133.95
|
|
|
Service Code
|
NDC 60505-2522-1
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.70 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$113.86
|
| Rate for Payer: BCBS Trust/PPO |
$103.52
|
| Rate for Payer: BCN Commercial |
$103.52
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$115.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.16
|
| Rate for Payer: Healthscope Commercial |
$120.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.86
|
| Rate for Payer: PHP Commercial |
$113.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.88
|
| Rate for Payer: UHC Core |
$111.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.46
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
IP
|
$161.57
|
|
|
Service Code
|
NDC 0185-0223-60
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.54 |
| Max. Negotiated Rate |
$145.41 |
| Rate for Payer: Aetna Commercial |
$137.33
|
| Rate for Payer: BCBS Trust/PPO |
$124.86
|
| Rate for Payer: BCN Commercial |
$124.86
|
| Rate for Payer: Cash Price |
$129.26
|
| Rate for Payer: Cofinity Commercial |
$138.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.26
|
| Rate for Payer: Healthscope Commercial |
$145.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.33
|
| Rate for Payer: PHP Commercial |
$137.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.18
|
| Rate for Payer: UHC Core |
$134.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.18
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
IP
|
$162.24
|
|
|
Service Code
|
NDC 50268-177-15
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.95 |
| Max. Negotiated Rate |
$146.02 |
| Rate for Payer: Aetna Commercial |
$137.90
|
| Rate for Payer: BCBS Trust/PPO |
$125.38
|
| Rate for Payer: BCN Commercial |
$125.38
|
| Rate for Payer: Cash Price |
$129.79
|
| Rate for Payer: Cofinity Commercial |
$139.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.79
|
| Rate for Payer: Healthscope Commercial |
$146.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.90
|
| Rate for Payer: PHP Commercial |
$137.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.77
|
| Rate for Payer: UHC Core |
$135.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.68
|
|
|
CINACALCET 30 MG TABLET
|
Facility
|
IP
|
$2,448.11
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
38100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,493.10 |
| Max. Negotiated Rate |
$2,203.30 |
| Rate for Payer: Aetna Commercial |
$2,080.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,891.90
|
| Rate for Payer: BCN Commercial |
$1,891.90
|
| Rate for Payer: Cash Price |
$1,958.49
|
| Rate for Payer: Cofinity Commercial |
$2,105.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,958.49
|
| Rate for Payer: Healthscope Commercial |
$2,203.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,836.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,080.89
|
| Rate for Payer: PHP Commercial |
$2,080.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,713.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,129.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,493.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,154.34
|
| Rate for Payer: UHC Core |
$2,044.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,836.08
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$394.15
|
|
|
Service Code
|
NDC 43598-326-75
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.39 |
| Max. Negotiated Rate |
$354.74 |
| Rate for Payer: Aetna Commercial |
$335.03
|
| Rate for Payer: BCBS Trust/PPO |
$304.60
|
| Rate for Payer: BCN Commercial |
$304.60
|
| Rate for Payer: Cash Price |
$315.32
|
| Rate for Payer: Cofinity Commercial |
$338.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.32
|
| Rate for Payer: Healthscope Commercial |
$354.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$335.03
|
| Rate for Payer: PHP Commercial |
$335.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$342.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.85
|
| Rate for Payer: UHC Core |
$329.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.61
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$729.73
|
|
|
Service Code
|
NDC 0781-6186-67
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$445.06 |
| Max. Negotiated Rate |
$656.76 |
| Rate for Payer: Aetna Commercial |
$620.27
|
| Rate for Payer: BCBS Trust/PPO |
$563.94
|
| Rate for Payer: BCN Commercial |
$563.94
|
| Rate for Payer: Cash Price |
$583.78
|
| Rate for Payer: Cofinity Commercial |
$627.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.78
|
| Rate for Payer: Healthscope Commercial |
$656.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$620.27
|
| Rate for Payer: PHP Commercial |
$620.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$634.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$445.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$642.16
|
| Rate for Payer: UHC Core |
$609.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.30
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$810.79
|
|
|
Service Code
|
NDC 0078-0799-75
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$494.50 |
| Max. Negotiated Rate |
$729.71 |
| Rate for Payer: Aetna Commercial |
$689.17
|
| Rate for Payer: BCBS Trust/PPO |
$626.58
|
| Rate for Payer: BCN Commercial |
$626.58
|
| Rate for Payer: Cash Price |
$648.63
|
| Rate for Payer: Cofinity Commercial |
$697.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.63
|
| Rate for Payer: Healthscope Commercial |
$729.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$608.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$689.17
|
| Rate for Payer: PHP Commercial |
$689.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$705.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$494.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$713.50
|
| Rate for Payer: UHC Core |
$677.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$608.09
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 60687-528-01
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: BCBS Trust/PPO |
$261.52
|
| Rate for Payer: BCN Commercial |
$261.52
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$287.64
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.79
|
| Rate for Payer: UHC Core |
$282.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
NDC 63739-700-10
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: BCBS Trust/PPO |
$290.57
|
| Rate for Payer: BCN Commercial |
$290.57
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$319.60
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.88
|
| Rate for Payer: UHC Core |
$313.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.00
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
NDC 60687-528-11
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.88
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.98
|
| Rate for Payer: UHC Core |
$2.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$51.04
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
9611
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$45.94 |
| Rate for Payer: Aetna Commercial |
$43.38
|
| Rate for Payer: BCBS Trust/PPO |
$39.44
|
| Rate for Payer: BCN Commercial |
$39.44
|
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: Cofinity Commercial |
$43.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.83
|
| Rate for Payer: Healthscope Commercial |
$45.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.38
|
| Rate for Payer: PHP Commercial |
$43.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.92
|
| Rate for Payer: UHC Core |
$42.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.28
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 51079-182-20
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: BCBS Trust/PPO |
$261.52
|
| Rate for Payer: BCN Commercial |
$261.52
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$287.64
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.79
|
| Rate for Payer: UHC Core |
$282.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
NDC 51079-182-01
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.88
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.98
|
| Rate for Payer: UHC Core |
$2.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$340.75
|
|
|
Service Code
|
NDC 0904-7083-61
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.82 |
| Max. Negotiated Rate |
$306.68 |
| Rate for Payer: Aetna Commercial |
$289.64
|
| Rate for Payer: BCBS Trust/PPO |
$263.33
|
| Rate for Payer: BCN Commercial |
$263.33
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$293.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$306.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.64
|
| Rate for Payer: PHP Commercial |
$289.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.86
|
| Rate for Payer: UHC Core |
$284.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.56
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$308.75
|
|
|
Service Code
|
NDC 68084-070-01
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.31 |
| Max. Negotiated Rate |
$277.88 |
| Rate for Payer: Aetna Commercial |
$262.44
|
| Rate for Payer: BCBS Trust/PPO |
$238.60
|
| Rate for Payer: BCN Commercial |
$238.60
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cofinity Commercial |
$265.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.00
|
| Rate for Payer: Healthscope Commercial |
$277.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.44
|
| Rate for Payer: PHP Commercial |
$262.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.70
|
| Rate for Payer: UHC Core |
$257.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.56
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$3.09
|
|
|
Service Code
|
NDC 68084-070-11
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.78 |
| Rate for Payer: Aetna Commercial |
$2.63
|
| Rate for Payer: BCBS Trust/PPO |
$2.39
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$2.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.47
|
| Rate for Payer: Healthscope Commercial |
$2.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.63
|
| Rate for Payer: PHP Commercial |
$2.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.72
|
| Rate for Payer: UHC Core |
$2.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.32
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 0143-9928-01
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.49 |
| Max. Negotiated Rate |
$412.42 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: BCBS Trust/PPO |
$354.14
|
| Rate for Payer: BCN Commercial |
$354.14
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$389.51
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$398.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$279.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.26
|
| Rate for Payer: UHC Core |
$382.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
CIPROFLOXACIN 6 % (6 MG/0.1 ML) INTRATYMPANIC SUSPENSION
|
Facility
|
IP
|
$981.30
|
|
|
Service Code
|
HCPCS J7342
|
| Hospital Charge Code |
177132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$598.49 |
| Max. Negotiated Rate |
$883.17 |
| Rate for Payer: Aetna Commercial |
$834.10
|
| Rate for Payer: BCBS Trust/PPO |
$758.35
|
| Rate for Payer: BCN Commercial |
$758.35
|
| Rate for Payer: Cash Price |
$785.04
|
| Rate for Payer: Cofinity Commercial |
$843.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.04
|
| Rate for Payer: Healthscope Commercial |
$883.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$735.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$834.10
|
| Rate for Payer: PHP Commercial |
$834.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$853.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$598.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$863.54
|
| Rate for Payer: UHC Core |
$819.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$735.98
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
NDC 0904-6084-61
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.53 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: BCBS Trust/PPO |
$94.44
|
| Rate for Payer: BCN Commercial |
$94.44
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.87
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.54
|
| Rate for Payer: UHC Core |
$102.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$13.16
|
|
|
Service Code
|
NDC 0904-6085-61
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna Commercial |
$11.19
|
| Rate for Payer: BCBS Trust/PPO |
$10.17
|
| Rate for Payer: BCN Commercial |
$10.17
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$11.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.19
|
| Rate for Payer: PHP Commercial |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.58
|
| Rate for Payer: UHC Core |
$10.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.87
|
|
|
CITALOPRAM 5 MG CUSTOM TAB
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 9900-0003-20
|
| Hospital Charge Code |
155135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna Commercial |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cofinity Commercial |
$0.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.30
|
| Rate for Payer: Healthscope Commercial |
$0.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.32
|
| Rate for Payer: PHP Commercial |
$0.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC Core |
$0.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.29
|
|
