|
ACETIC ACID 2 % EAR SOLUTION
|
Facility
|
IP
|
$96.35
|
|
|
Service Code
|
NDC 60432074115
|
| Hospital Charge Code |
17801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.63 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: BCBS Trust/PPO |
$78.65
|
| Rate for Payer: BCN Commercial |
$74.46
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Nomi Health Commercial |
$79.01
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.63
|
| Rate for Payer: Priority Health HMO/PPO |
$83.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.79
|
| Rate for Payer: UHC Core |
$80.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.26
|
|
|
ACETIC ACID (BULK) 3 % LIQUID
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
NDC 51552005106
|
| Hospital Charge Code |
15091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$163.20
|
| Rate for Payer: Aetna Medicare |
$49.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.00
|
| Rate for Payer: BCBS Complete |
$76.80
|
| Rate for Payer: BCBS MAPPO |
$48.00
|
| Rate for Payer: BCBS Trust/PPO |
$157.84
|
| Rate for Payer: BCN Commercial |
$149.28
|
| Rate for Payer: BCN Medicare Advantage |
$48.00
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cofinity Commercial |
$165.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$172.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.20
|
| Rate for Payer: Nomi Health Commercial |
$157.44
|
| Rate for Payer: PACE Senior Care Partners |
$45.60
|
| Rate for Payer: PACE SWMI |
$48.00
|
| Rate for Payer: PHP Commercial |
$163.20
|
| Rate for Payer: PHP Medicare Advantage |
$48.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.80
|
| Rate for Payer: Priority Health HMO/PPO |
$167.04
|
| Rate for Payer: Priority Health Medicare |
$48.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.64
|
| Rate for Payer: Railroad Medicare Medicare |
$48.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.96
|
| Rate for Payer: UHC Core |
$160.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.00
|
| Rate for Payer: UHC Exchange |
$48.00
|
| Rate for Payer: UHC Medicare Advantage |
$48.00
|
| Rate for Payer: VA VA |
$48.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.00
|
|
|
ACETIC ACID (BULK) 3 % LIQUID
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
NDC 51552005106
|
| Hospital Charge Code |
15091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$163.20
|
| Rate for Payer: BCBS Trust/PPO |
$156.73
|
| Rate for Payer: BCN Commercial |
$148.38
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cofinity Commercial |
$165.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.60
|
| Rate for Payer: Healthscope Commercial |
$172.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.20
|
| Rate for Payer: Nomi Health Commercial |
$157.44
|
| Rate for Payer: PHP Commercial |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.80
|
| Rate for Payer: Priority Health HMO/PPO |
$167.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.96
|
| Rate for Payer: UHC Core |
$160.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.00
|
|
|
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) INTRAOCULAR KIT
|
Facility
|
IP
|
$270.17
|
|
|
Service Code
|
NDC 24208053920
|
| Hospital Charge Code |
32559
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$175.61 |
| Max. Negotiated Rate |
$243.15 |
| Rate for Payer: Aetna Commercial |
$229.64
|
| Rate for Payer: BCBS Trust/PPO |
$220.54
|
| Rate for Payer: BCN Commercial |
$208.79
|
| Rate for Payer: Cash Price |
$216.14
|
| Rate for Payer: Cofinity Commercial |
$232.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.14
|
| Rate for Payer: Healthscope Commercial |
$243.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.64
|
| Rate for Payer: Nomi Health Commercial |
$221.54
|
| Rate for Payer: PHP Commercial |
$229.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.61
|
| Rate for Payer: Priority Health HMO/PPO |
$235.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.75
|
| Rate for Payer: UHC Core |
$225.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.63
|
|
|
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) INTRAOCULAR KIT
|
Facility
|
OP
|
$270.17
|
|
|
Service Code
|
NDC 24208053920
|
| Hospital Charge Code |
32559
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.17 |
| Max. Negotiated Rate |
$243.15 |
| Rate for Payer: Aetna Commercial |
$229.64
|
| Rate for Payer: Aetna Medicare |
$70.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.43
|
| Rate for Payer: BCBS Complete |
$108.07
|
| Rate for Payer: BCBS MAPPO |
$67.54
|
| Rate for Payer: BCBS Trust/PPO |
$222.11
|
| Rate for Payer: BCN Commercial |
$210.06
|
| Rate for Payer: BCN Medicare Advantage |
$67.54
|
| Rate for Payer: Cash Price |
$216.14
|
| Rate for Payer: Cofinity Commercial |
$232.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.54
|
| Rate for Payer: Healthscope Commercial |
$243.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.64
|
| Rate for Payer: Nomi Health Commercial |
$221.54
|
| Rate for Payer: PACE Senior Care Partners |
$64.17
|
| Rate for Payer: PACE SWMI |
$67.54
|
| Rate for Payer: PHP Commercial |
$229.64
|
| Rate for Payer: PHP Medicare Advantage |
$67.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.61
|
| Rate for Payer: Priority Health HMO/PPO |
$235.05
|
| Rate for Payer: Priority Health Medicare |
$68.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.01
|
| Rate for Payer: Railroad Medicare Medicare |
$67.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.75
|
| Rate for Payer: UHC Core |
$225.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.54
|
| Rate for Payer: UHC Exchange |
$67.54
|
| Rate for Payer: UHC Medicare Advantage |
$67.54
|
| Rate for Payer: VA VA |
$67.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.63
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$130.43
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
38303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.78 |
| Max. Negotiated Rate |
$117.39 |
| Rate for Payer: Aetna Commercial |
$110.87
|
| Rate for Payer: Aetna Commercial |
$146.05
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: BCBS Trust/PPO |
$140.26
|
| Rate for Payer: BCBS Trust/PPO |
$106.47
|
| Rate for Payer: BCBS Trust/PPO |
$77.70
|
| Rate for Payer: BCN Commercial |
$132.78
|
| Rate for Payer: BCN Commercial |
$100.80
|
| Rate for Payer: BCN Commercial |
$73.56
|
| Rate for Payer: Cash Price |
$104.34
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cash Price |
$137.46
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Commercial |
$147.77
|
| Rate for Payer: Cofinity Commercial |
$112.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$154.64
|
| Rate for Payer: Healthscope Commercial |
$117.39
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: Nomi Health Commercial |
$106.95
|
| Rate for Payer: Nomi Health Commercial |
$140.89
|
| Rate for Payer: Nomi Health Commercial |
$78.06
|
| Rate for Payer: PHP Commercial |
$146.05
|
| Rate for Payer: PHP Commercial |
$110.87
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.68
|
| Rate for Payer: Priority Health HMO/PPO |
$82.82
|
| Rate for Payer: Priority Health HMO/PPO |
$149.48
|
| Rate for Payer: Priority Health HMO/PPO |
$113.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.78
|
| Rate for Payer: UHC Core |
$108.91
|
| Rate for Payer: UHC Core |
$79.48
|
| Rate for Payer: UHC Core |
$143.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.86
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$130.43
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
38303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.98 |
| Max. Negotiated Rate |
$117.39 |
| Rate for Payer: Aetna Commercial |
$110.87
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Commercial |
$146.05
|
| Rate for Payer: Aetna Medicare |
$24.75
|
| Rate for Payer: Aetna Medicare |
$33.91
|
| Rate for Payer: Aetna Medicare |
$44.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.75
|
| Rate for Payer: BCBS Complete |
$68.73
|
| Rate for Payer: BCBS Complete |
$52.17
|
| Rate for Payer: BCBS Complete |
$38.08
|
| Rate for Payer: BCBS MAPPO |
$23.80
|
| Rate for Payer: BCBS MAPPO |
$32.61
|
| Rate for Payer: BCBS MAPPO |
$42.96
|
| Rate for Payer: BCBS Trust/PPO |
$141.25
|
| Rate for Payer: BCBS Trust/PPO |
$107.23
|
| Rate for Payer: BCBS Trust/PPO |
$78.26
|
| Rate for Payer: BCN Commercial |
$133.59
|
| Rate for Payer: BCN Commercial |
$74.01
|
| Rate for Payer: BCN Commercial |
$101.41
|
| Rate for Payer: BCN Medicare Advantage |
$32.61
|
| Rate for Payer: BCN Medicare Advantage |
$42.96
|
| Rate for Payer: BCN Medicare Advantage |
$23.80
|
| Rate for Payer: Cash Price |
$137.46
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cash Price |
$104.34
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Commercial |
$112.17
|
| Rate for Payer: Cofinity Commercial |
$147.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.61
|
| Rate for Payer: Healthscope Commercial |
$154.64
|
| Rate for Payer: Healthscope Commercial |
$117.39
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.87
|
| Rate for Payer: Nomi Health Commercial |
$78.06
|
| Rate for Payer: Nomi Health Commercial |
$106.95
|
| Rate for Payer: Nomi Health Commercial |
$140.89
|
| Rate for Payer: PACE Senior Care Partners |
$22.61
|
| Rate for Payer: PACE Senior Care Partners |
$30.98
|
| Rate for Payer: PACE Senior Care Partners |
$40.81
|
| Rate for Payer: PACE SWMI |
$42.96
|
| Rate for Payer: PACE SWMI |
$32.61
|
| Rate for Payer: PACE SWMI |
$23.80
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$146.05
|
| Rate for Payer: PHP Commercial |
$110.87
|
| Rate for Payer: PHP Medicare Advantage |
$42.96
|
| Rate for Payer: PHP Medicare Advantage |
$23.80
|
| Rate for Payer: PHP Medicare Advantage |
$32.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.68
|
| Rate for Payer: Priority Health HMO/PPO |
$82.82
|
| Rate for Payer: Priority Health HMO/PPO |
$113.47
|
| Rate for Payer: Priority Health HMO/PPO |
$149.48
|
| Rate for Payer: Priority Health Medicare |
$32.93
|
| Rate for Payer: Priority Health Medicare |
$24.04
|
| Rate for Payer: Priority Health Medicare |
$43.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.39
|
| Rate for Payer: Railroad Medicare Medicare |
$42.96
|
| Rate for Payer: Railroad Medicare Medicare |
$23.80
|
| Rate for Payer: Railroad Medicare Medicare |
$32.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.78
|
| Rate for Payer: UHC Core |
$79.48
|
| Rate for Payer: UHC Core |
$143.47
|
| Rate for Payer: UHC Core |
$108.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.96
|
| Rate for Payer: UHC Exchange |
$42.96
|
| Rate for Payer: UHC Exchange |
$32.61
|
| Rate for Payer: UHC Exchange |
$23.80
|
| Rate for Payer: UHC Medicare Advantage |
$32.61
|
| Rate for Payer: UHC Medicare Advantage |
$42.96
|
| Rate for Payer: UHC Medicare Advantage |
$23.80
|
| Rate for Payer: VA VA |
$42.96
|
| Rate for Payer: VA VA |
$23.80
|
| Rate for Payer: VA VA |
$32.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.86
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION
|
Facility
|
OP
|
$116.07
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.57 |
| Max. Negotiated Rate |
$104.46 |
| Rate for Payer: Aetna Commercial |
$98.66
|
| Rate for Payer: Aetna Commercial |
$71.95
|
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Medicare |
$22.01
|
| Rate for Payer: Aetna Medicare |
$30.18
|
| Rate for Payer: Aetna Medicare |
$17.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.45
|
| Rate for Payer: BCBS Complete |
$27.06
|
| Rate for Payer: BCBS Complete |
$46.43
|
| Rate for Payer: BCBS Complete |
$33.86
|
| Rate for Payer: BCBS MAPPO |
$21.16
|
| Rate for Payer: BCBS MAPPO |
$29.02
|
| Rate for Payer: BCBS MAPPO |
$16.91
|
| Rate for Payer: BCBS Trust/PPO |
$55.61
|
| Rate for Payer: BCBS Trust/PPO |
$95.42
|
| Rate for Payer: BCBS Trust/PPO |
$69.59
|
| Rate for Payer: BCN Commercial |
$52.59
|
| Rate for Payer: BCN Commercial |
$65.82
|
| Rate for Payer: BCN Commercial |
$90.24
|
| Rate for Payer: BCN Medicare Advantage |
$29.02
|
| Rate for Payer: BCN Medicare Advantage |
$16.91
|
| Rate for Payer: BCN Medicare Advantage |
$21.16
|
| Rate for Payer: Cash Price |
$54.11
|
| Rate for Payer: Cash Price |
$67.72
|
| Rate for Payer: Cash Price |
$92.86
|
| Rate for Payer: Cofinity Commercial |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$99.82
|
| Rate for Payer: Cofinity Commercial |
$58.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.02
|
| Rate for Payer: Healthscope Commercial |
$60.88
|
| Rate for Payer: Healthscope Commercial |
$104.46
|
| Rate for Payer: Healthscope Commercial |
$76.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.66
|
| Rate for Payer: Nomi Health Commercial |
$69.41
|
| Rate for Payer: Nomi Health Commercial |
$95.18
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: PACE Senior Care Partners |
$20.10
|
| Rate for Payer: PACE Senior Care Partners |
$27.57
|
| Rate for Payer: PACE Senior Care Partners |
$16.06
|
| Rate for Payer: PACE SWMI |
$16.91
|
| Rate for Payer: PACE SWMI |
$29.02
|
| Rate for Payer: PACE SWMI |
$21.16
|
| Rate for Payer: PHP Commercial |
$71.95
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Commercial |
$98.66
|
| Rate for Payer: PHP Medicare Advantage |
$16.91
|
| Rate for Payer: PHP Medicare Advantage |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$29.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.97
|
| Rate for Payer: Priority Health HMO/PPO |
$73.65
|
| Rate for Payer: Priority Health HMO/PPO |
$100.98
|
| Rate for Payer: Priority Health HMO/PPO |
$58.85
|
| Rate for Payer: Priority Health Medicare |
$29.31
|
| Rate for Payer: Priority Health Medicare |
$21.37
|
| Rate for Payer: Priority Health Medicare |
$17.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.77
|
| Rate for Payer: Railroad Medicare Medicare |
$16.91
|
| Rate for Payer: Railroad Medicare Medicare |
$21.16
|
| Rate for Payer: Railroad Medicare Medicare |
$29.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.14
|
| Rate for Payer: UHC Core |
$70.68
|
| Rate for Payer: UHC Core |
$56.48
|
| Rate for Payer: UHC Core |
$96.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.91
|
| Rate for Payer: UHC Exchange |
$16.91
|
| Rate for Payer: UHC Exchange |
$29.02
|
| Rate for Payer: UHC Exchange |
$21.16
|
| Rate for Payer: UHC Medicare Advantage |
$29.02
|
| Rate for Payer: UHC Medicare Advantage |
$16.91
|
| Rate for Payer: UHC Medicare Advantage |
$21.16
|
| Rate for Payer: VA VA |
$16.91
|
| Rate for Payer: VA VA |
$21.16
|
| Rate for Payer: VA VA |
$29.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.73
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION
|
Facility
|
IP
|
$116.07
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.45 |
| Max. Negotiated Rate |
$104.46 |
| Rate for Payer: Aetna Commercial |
$98.66
|
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Commercial |
$71.95
|
| Rate for Payer: BCBS Trust/PPO |
$55.21
|
| Rate for Payer: BCBS Trust/PPO |
$94.75
|
| Rate for Payer: BCBS Trust/PPO |
$69.10
|
| Rate for Payer: BCN Commercial |
$52.27
|
| Rate for Payer: BCN Commercial |
$89.70
|
| Rate for Payer: BCN Commercial |
$65.42
|
| Rate for Payer: Cash Price |
$92.86
|
| Rate for Payer: Cash Price |
$67.72
|
| Rate for Payer: Cash Price |
$54.11
|
| Rate for Payer: Cofinity Commercial |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$58.17
|
| Rate for Payer: Cofinity Commercial |
$99.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.72
|
| Rate for Payer: Healthscope Commercial |
$60.88
|
| Rate for Payer: Healthscope Commercial |
$104.46
|
| Rate for Payer: Healthscope Commercial |
$76.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.95
|
| Rate for Payer: Nomi Health Commercial |
$95.18
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Nomi Health Commercial |
$69.41
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Commercial |
$98.66
|
| Rate for Payer: PHP Commercial |
$71.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.97
|
| Rate for Payer: Priority Health HMO/PPO |
$73.65
|
| Rate for Payer: Priority Health HMO/PPO |
$58.85
|
| Rate for Payer: Priority Health HMO/PPO |
$100.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.14
|
| Rate for Payer: UHC Core |
$96.92
|
| Rate for Payer: UHC Core |
$70.68
|
| Rate for Payer: UHC Core |
$56.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.73
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
IP
|
$97.44
|
|
|
Service Code
|
NDC 66689020108
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$87.70 |
| Rate for Payer: Aetna Commercial |
$82.82
|
| Rate for Payer: BCBS Trust/PPO |
$79.54
|
| Rate for Payer: BCN Commercial |
$75.30
|
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Cofinity Commercial |
$83.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.95
|
| Rate for Payer: Healthscope Commercial |
$87.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.82
|
| Rate for Payer: Nomi Health Commercial |
$79.90
|
| Rate for Payer: PHP Commercial |
$82.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.34
|
| Rate for Payer: Priority Health HMO/PPO |
$84.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.75
|
| Rate for Payer: UHC Core |
$81.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.08
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
IP
|
$63.84
|
|
|
Service Code
|
NDC 00574052176
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$57.46 |
| Rate for Payer: Aetna Commercial |
$54.26
|
| Rate for Payer: BCBS Trust/PPO |
$52.11
|
| Rate for Payer: BCN Commercial |
$49.34
|
| Rate for Payer: Cash Price |
$51.07
|
| Rate for Payer: Cofinity Commercial |
$54.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.07
|
| Rate for Payer: Healthscope Commercial |
$57.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.26
|
| Rate for Payer: Nomi Health Commercial |
$52.35
|
| Rate for Payer: PHP Commercial |
$54.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.50
|
| Rate for Payer: Priority Health HMO/PPO |
$55.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.18
|
| Rate for Payer: UHC Core |
$53.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.88
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
OP
|
$97.44
|
|
|
Service Code
|
NDC 66689020108
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$87.70 |
| Rate for Payer: Aetna Commercial |
$82.82
|
| Rate for Payer: Aetna Medicare |
$25.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.45
|
| Rate for Payer: BCBS Complete |
$38.98
|
| Rate for Payer: BCBS MAPPO |
$24.36
|
| Rate for Payer: BCBS Trust/PPO |
$80.11
|
| Rate for Payer: BCN Commercial |
$75.76
|
| Rate for Payer: BCN Medicare Advantage |
$24.36
|
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Cofinity Commercial |
$83.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.36
|
| Rate for Payer: Healthscope Commercial |
$87.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.82
|
| Rate for Payer: Nomi Health Commercial |
$79.90
|
| Rate for Payer: PACE Senior Care Partners |
$23.14
|
| Rate for Payer: PACE SWMI |
$24.36
|
| Rate for Payer: PHP Commercial |
$82.82
|
| Rate for Payer: PHP Medicare Advantage |
$24.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.34
|
| Rate for Payer: Priority Health HMO/PPO |
$84.77
|
| Rate for Payer: Priority Health Medicare |
$24.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.28
|
| Rate for Payer: Railroad Medicare Medicare |
$24.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.75
|
| Rate for Payer: UHC Core |
$81.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.36
|
| Rate for Payer: UHC Exchange |
$24.36
|
| Rate for Payer: UHC Medicare Advantage |
$24.36
|
| Rate for Payer: VA VA |
$24.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.08
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
OP
|
$63.84
|
|
|
Service Code
|
NDC 00574052176
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$57.46 |
| Rate for Payer: Aetna Commercial |
$54.26
|
| Rate for Payer: Aetna Medicare |
$16.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.95
|
| Rate for Payer: BCBS Complete |
$25.54
|
| Rate for Payer: BCBS MAPPO |
$15.96
|
| Rate for Payer: BCBS Trust/PPO |
$52.48
|
| Rate for Payer: BCN Commercial |
$49.64
|
| Rate for Payer: BCN Medicare Advantage |
$15.96
|
| Rate for Payer: Cash Price |
$51.07
|
| Rate for Payer: Cofinity Commercial |
$54.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.96
|
| Rate for Payer: Healthscope Commercial |
$57.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.26
|
| Rate for Payer: Nomi Health Commercial |
$52.35
|
| Rate for Payer: PACE Senior Care Partners |
$15.16
|
| Rate for Payer: PACE SWMI |
$15.96
|
| Rate for Payer: PHP Commercial |
$54.26
|
| Rate for Payer: PHP Medicare Advantage |
$15.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.50
|
| Rate for Payer: Priority Health HMO/PPO |
$55.54
|
| Rate for Payer: Priority Health Medicare |
$16.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.77
|
| Rate for Payer: Railroad Medicare Medicare |
$15.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.18
|
| Rate for Payer: UHC Core |
$53.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.96
|
| Rate for Payer: UHC Exchange |
$15.96
|
| Rate for Payer: UHC Medicare Advantage |
$15.96
|
| Rate for Payer: VA VA |
$15.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.88
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
OP
|
$261.25
|
|
|
Service Code
|
NDC 68084010701
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.05 |
| Max. Negotiated Rate |
$235.12 |
| Rate for Payer: Aetna Commercial |
$222.06
|
| Rate for Payer: Aetna Medicare |
$67.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.64
|
| Rate for Payer: BCBS Complete |
$104.50
|
| Rate for Payer: BCBS MAPPO |
$65.31
|
| Rate for Payer: BCBS Trust/PPO |
$214.77
|
| Rate for Payer: BCN Commercial |
$203.12
|
| Rate for Payer: BCN Medicare Advantage |
$65.31
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cofinity Commercial |
$224.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.31
|
| Rate for Payer: Healthscope Commercial |
$235.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.06
|
| Rate for Payer: Nomi Health Commercial |
$214.22
|
| Rate for Payer: PACE Senior Care Partners |
$62.05
|
| Rate for Payer: PACE SWMI |
$65.31
|
| Rate for Payer: PHP Commercial |
$222.06
|
| Rate for Payer: PHP Medicare Advantage |
$65.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.81
|
| Rate for Payer: Priority Health HMO/PPO |
$227.29
|
| Rate for Payer: Priority Health Medicare |
$65.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.04
|
| Rate for Payer: Railroad Medicare Medicare |
$65.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.90
|
| Rate for Payer: UHC Core |
$218.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.31
|
| Rate for Payer: UHC Exchange |
$65.31
|
| Rate for Payer: UHC Medicare Advantage |
$65.31
|
| Rate for Payer: VA VA |
$65.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.94
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
OP
|
$2.62
|
|
|
Service Code
|
NDC 68084010711
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Aetna Medicare |
$0.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.82
|
| Rate for Payer: BCBS Complete |
$1.05
|
| Rate for Payer: BCBS MAPPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$2.15
|
| Rate for Payer: BCN Commercial |
$2.04
|
| Rate for Payer: BCN Medicare Advantage |
$0.66
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cofinity Commercial |
$2.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.66
|
| Rate for Payer: Healthscope Commercial |
$2.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.23
|
| Rate for Payer: Nomi Health Commercial |
$2.15
|
| Rate for Payer: PACE Senior Care Partners |
$0.62
|
| Rate for Payer: PACE SWMI |
$0.66
|
| Rate for Payer: PHP Commercial |
$2.23
|
| Rate for Payer: PHP Medicare Advantage |
$0.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| Rate for Payer: Priority Health HMO/PPO |
$2.28
|
| Rate for Payer: Priority Health Medicare |
$0.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.76
|
| Rate for Payer: Railroad Medicare Medicare |
$0.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.31
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.66
|
| Rate for Payer: UHC Exchange |
$0.66
|
| Rate for Payer: UHC Medicare Advantage |
$0.66
|
| Rate for Payer: VA VA |
$0.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.96
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
IP
|
$261.25
|
|
|
Service Code
|
NDC 68084010701
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.81 |
| Max. Negotiated Rate |
$235.12 |
| Rate for Payer: Aetna Commercial |
$222.06
|
| Rate for Payer: BCBS Trust/PPO |
$213.26
|
| Rate for Payer: BCN Commercial |
$201.89
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cofinity Commercial |
$224.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.00
|
| Rate for Payer: Healthscope Commercial |
$235.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.06
|
| Rate for Payer: Nomi Health Commercial |
$214.22
|
| Rate for Payer: PHP Commercial |
$222.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.81
|
| Rate for Payer: Priority Health HMO/PPO |
$227.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.90
|
| Rate for Payer: UHC Core |
$218.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.94
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
OP
|
$293.75
|
|
|
Service Code
|
NDC 00904578961
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.77 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Aetna Commercial |
$249.69
|
| Rate for Payer: Aetna Medicare |
$76.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.80
|
| Rate for Payer: BCBS Complete |
$117.50
|
| Rate for Payer: BCBS MAPPO |
$73.44
|
| Rate for Payer: BCBS Trust/PPO |
$241.49
|
| Rate for Payer: BCN Commercial |
$228.39
|
| Rate for Payer: BCN Medicare Advantage |
$73.44
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cofinity Commercial |
$252.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.69
|
| Rate for Payer: Nomi Health Commercial |
$240.88
|
| Rate for Payer: PACE Senior Care Partners |
$69.77
|
| Rate for Payer: PACE SWMI |
$73.44
|
| Rate for Payer: PHP Commercial |
$249.69
|
| Rate for Payer: PHP Medicare Advantage |
$73.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.94
|
| Rate for Payer: Priority Health HMO/PPO |
$255.56
|
| Rate for Payer: Priority Health Medicare |
$74.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.81
|
| Rate for Payer: Railroad Medicare Medicare |
$73.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.50
|
| Rate for Payer: UHC Core |
$245.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.44
|
| Rate for Payer: UHC Exchange |
$73.44
|
| Rate for Payer: UHC Medicare Advantage |
$73.44
|
| Rate for Payer: VA VA |
$73.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.31
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
IP
|
$2.62
|
|
|
Service Code
|
NDC 68084010711
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: BCBS Trust/PPO |
$2.14
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cofinity Commercial |
$2.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.10
|
| Rate for Payer: Healthscope Commercial |
$2.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.23
|
| Rate for Payer: Nomi Health Commercial |
$2.15
|
| Rate for Payer: PHP Commercial |
$2.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| Rate for Payer: Priority Health HMO/PPO |
$2.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.31
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.96
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
IP
|
$293.75
|
|
|
Service Code
|
NDC 00904578961
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.94 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Aetna Commercial |
$249.69
|
| Rate for Payer: BCBS Trust/PPO |
$239.79
|
| Rate for Payer: BCN Commercial |
$227.01
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cofinity Commercial |
$252.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.00
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.69
|
| Rate for Payer: Nomi Health Commercial |
$240.88
|
| Rate for Payer: PHP Commercial |
$249.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.94
|
| Rate for Payer: Priority Health HMO/PPO |
$255.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.50
|
| Rate for Payer: UHC Core |
$245.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.31
|
|
|
ACYCLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.18
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
8974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$17.26 |
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: Aetna Medicare |
$4.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.99
|
| Rate for Payer: BCBS Complete |
$7.67
|
| Rate for Payer: BCBS MAPPO |
$4.80
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$14.91
|
| Rate for Payer: BCN Medicare Advantage |
$4.80
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.80
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.30
|
| Rate for Payer: Nomi Health Commercial |
$15.73
|
| Rate for Payer: PACE Senior Care Partners |
$4.56
|
| Rate for Payer: PACE SWMI |
$4.80
|
| Rate for Payer: PHP Commercial |
$16.30
|
| Rate for Payer: PHP Medicare Advantage |
$4.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: Priority Health HMO/PPO |
$16.69
|
| Rate for Payer: Priority Health Medicare |
$4.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$4.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.88
|
| Rate for Payer: UHC Core |
$16.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.80
|
| Rate for Payer: UHC Exchange |
$4.80
|
| Rate for Payer: UHC Medicare Advantage |
$4.80
|
| Rate for Payer: VA VA |
$4.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.38
|
|
|
ACYCLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.18
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
8974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$17.26 |
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: BCBS Trust/PPO |
$15.66
|
| Rate for Payer: BCN Commercial |
$14.82
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.30
|
| Rate for Payer: Nomi Health Commercial |
$15.73
|
| Rate for Payer: PHP Commercial |
$16.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: Priority Health HMO/PPO |
$16.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.88
|
| Rate for Payer: UHC Core |
$16.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.38
|
|
|
ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.65
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
23128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Aetna Commercial |
$17.05
|
| Rate for Payer: Aetna Medicare |
$5.89
|
| Rate for Payer: Aetna Medicare |
$4.33
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.08
|
| Rate for Payer: BCBS Complete |
$8.02
|
| Rate for Payer: BCBS Complete |
$6.66
|
| Rate for Payer: BCBS Complete |
$9.06
|
| Rate for Payer: BCBS MAPPO |
$5.66
|
| Rate for Payer: BCBS MAPPO |
$4.16
|
| Rate for Payer: BCBS MAPPO |
$5.02
|
| Rate for Payer: BCBS Trust/PPO |
$16.49
|
| Rate for Payer: BCBS Trust/PPO |
$13.69
|
| Rate for Payer: BCBS Trust/PPO |
$18.62
|
| Rate for Payer: BCN Commercial |
$15.60
|
| Rate for Payer: BCN Commercial |
$17.61
|
| Rate for Payer: BCN Commercial |
$12.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.16
|
| Rate for Payer: BCN Medicare Advantage |
$5.02
|
| Rate for Payer: BCN Medicare Advantage |
$5.66
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$17.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.16
|
| Rate for Payer: Healthscope Commercial |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$20.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$18.57
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: Nomi Health Commercial |
$16.45
|
| Rate for Payer: PACE Senior Care Partners |
$5.38
|
| Rate for Payer: PACE Senior Care Partners |
$3.95
|
| Rate for Payer: PACE Senior Care Partners |
$4.76
|
| Rate for Payer: PACE SWMI |
$5.02
|
| Rate for Payer: PACE SWMI |
$4.16
|
| Rate for Payer: PACE SWMI |
$5.66
|
| Rate for Payer: PHP Commercial |
$19.25
|
| Rate for Payer: PHP Commercial |
$17.05
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Medicare Advantage |
$5.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.66
|
| Rate for Payer: PHP Medicare Advantage |
$4.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.04
|
| Rate for Payer: Priority Health HMO/PPO |
$19.71
|
| Rate for Payer: Priority Health HMO/PPO |
$14.49
|
| Rate for Payer: Priority Health HMO/PPO |
$17.45
|
| Rate for Payer: Priority Health Medicare |
$4.20
|
| Rate for Payer: Priority Health Medicare |
$5.72
|
| Rate for Payer: Priority Health Medicare |
$5.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.02
|
| Rate for Payer: Railroad Medicare Medicare |
$5.66
|
| Rate for Payer: Railroad Medicare Medicare |
$4.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.65
|
| Rate for Payer: UHC Core |
$18.91
|
| Rate for Payer: UHC Core |
$16.75
|
| Rate for Payer: UHC Core |
$13.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.02
|
| Rate for Payer: UHC Exchange |
$5.02
|
| Rate for Payer: UHC Exchange |
$4.16
|
| Rate for Payer: UHC Exchange |
$5.66
|
| Rate for Payer: UHC Medicare Advantage |
$4.16
|
| Rate for Payer: UHC Medicare Advantage |
$5.02
|
| Rate for Payer: UHC Medicare Advantage |
$5.66
|
| Rate for Payer: VA VA |
$5.02
|
| Rate for Payer: VA VA |
$5.66
|
| Rate for Payer: VA VA |
$4.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.04
|
|
|
ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.65
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
23128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Commercial |
$17.05
|
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: BCBS Trust/PPO |
$16.37
|
| Rate for Payer: BCBS Trust/PPO |
$13.59
|
| Rate for Payer: BCBS Trust/PPO |
$18.49
|
| Rate for Payer: BCN Commercial |
$15.50
|
| Rate for Payer: BCN Commercial |
$12.87
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.12
|
| Rate for Payer: Healthscope Commercial |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$20.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.25
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: Nomi Health Commercial |
$16.45
|
| Rate for Payer: Nomi Health Commercial |
$18.57
|
| Rate for Payer: PHP Commercial |
$17.05
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Commercial |
$19.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.04
|
| Rate for Payer: Priority Health HMO/PPO |
$19.71
|
| Rate for Payer: Priority Health HMO/PPO |
$17.45
|
| Rate for Payer: Priority Health HMO/PPO |
$14.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.65
|
| Rate for Payer: UHC Core |
$13.90
|
| Rate for Payer: UHC Core |
$18.91
|
| Rate for Payer: UHC Core |
$16.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.04
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.05
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
8975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$16.24 |
| Rate for Payer: Aetna Commercial |
$15.34
|
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Commercial |
$21.03
|
| Rate for Payer: Aetna Medicare |
$6.57
|
| Rate for Payer: Aetna Medicare |
$4.69
|
| Rate for Payer: Aetna Medicare |
$6.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.89
|
| Rate for Payer: BCBS Complete |
$9.90
|
| Rate for Payer: BCBS Complete |
$7.22
|
| Rate for Payer: BCBS Complete |
$10.10
|
| Rate for Payer: BCBS MAPPO |
$6.32
|
| Rate for Payer: BCBS MAPPO |
$4.51
|
| Rate for Payer: BCBS MAPPO |
$6.18
|
| Rate for Payer: BCBS Trust/PPO |
$20.34
|
| Rate for Payer: BCBS Trust/PPO |
$14.84
|
| Rate for Payer: BCBS Trust/PPO |
$20.77
|
| Rate for Payer: BCN Commercial |
$19.24
|
| Rate for Payer: BCN Commercial |
$19.64
|
| Rate for Payer: BCN Commercial |
$14.03
|
| Rate for Payer: BCN Medicare Advantage |
$4.51
|
| Rate for Payer: BCN Medicare Advantage |
$6.18
|
| Rate for Payer: BCN Medicare Advantage |
$6.32
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cash Price |
$14.44
|
| Rate for Payer: Cofinity Commercial |
$21.72
|
| Rate for Payer: Cofinity Commercial |
$15.52
|
| Rate for Payer: Cofinity Commercial |
$21.28
|
| 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 |
$14.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.51
|
| Rate for Payer: Healthscope Commercial |
$22.27
|
| Rate for Payer: Healthscope Commercial |
$16.24
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.34
|
| Rate for Payer: Nomi Health Commercial |
$20.71
|
| Rate for Payer: Nomi Health Commercial |
$14.80
|
| Rate for Payer: Nomi Health Commercial |
$20.29
|
| Rate for Payer: PACE Senior Care Partners |
$6.00
|
| Rate for Payer: PACE Senior Care Partners |
$4.29
|
| Rate for Payer: PACE Senior Care Partners |
$5.88
|
| Rate for Payer: PACE SWMI |
$6.18
|
| Rate for Payer: PACE SWMI |
$4.51
|
| Rate for Payer: PACE SWMI |
$6.32
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: PHP Commercial |
$21.03
|
| Rate for Payer: PHP Commercial |
$15.34
|
| Rate for Payer: PHP Medicare Advantage |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$6.32
|
| Rate for Payer: PHP Medicare Advantage |
$4.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.08
|
| Rate for Payer: Priority Health HMO/PPO |
$21.98
|
| Rate for Payer: Priority Health HMO/PPO |
$15.70
|
| Rate for Payer: Priority Health HMO/PPO |
$21.52
|
| Rate for Payer: Priority Health Medicare |
$4.56
|
| Rate for Payer: Priority Health Medicare |
$6.38
|
| Rate for Payer: Priority Health Medicare |
$6.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.09
|
| Rate for Payer: Railroad Medicare Medicare |
$6.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.32
|
| Rate for Payer: Railroad Medicare Medicare |
$4.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.88
|
| Rate for Payer: UHC Core |
$21.09
|
| Rate for Payer: UHC Core |
$20.66
|
| Rate for Payer: UHC Core |
$15.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.18
|
| Rate for Payer: UHC Exchange |
$6.18
|
| Rate for Payer: UHC Exchange |
$4.51
|
| Rate for Payer: UHC Exchange |
$6.32
|
| Rate for Payer: UHC Medicare Advantage |
$4.51
|
| Rate for Payer: UHC Medicare Advantage |
$6.18
|
| Rate for Payer: UHC Medicare Advantage |
$6.32
|
| Rate for Payer: VA VA |
$6.18
|
| Rate for Payer: VA VA |
$6.32
|
| Rate for Payer: VA VA |
$4.51
|
| 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
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.05
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
8975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$16.24 |
| Rate for Payer: Aetna Commercial |
$15.34
|
| Rate for Payer: Aetna Commercial |
$21.03
|
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: BCBS Trust/PPO |
$20.20
|
| Rate for Payer: BCBS Trust/PPO |
$14.73
|
| Rate for Payer: BCBS Trust/PPO |
$20.62
|
| Rate for Payer: BCN Commercial |
$19.12
|
| Rate for Payer: BCN Commercial |
$13.95
|
| Rate for Payer: BCN Commercial |
$19.52
|
| Rate for Payer: Cash Price |
$14.44
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Cofinity Commercial |
$21.72
|
| Rate for Payer: Cofinity Commercial |
$21.28
|
| Rate for Payer: Cofinity Commercial |
$15.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$22.27
|
| Rate for Payer: Healthscope Commercial |
$16.24
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.47
|
| Rate for Payer: Nomi Health Commercial |
$14.80
|
| Rate for Payer: Nomi Health Commercial |
$20.29
|
| Rate for Payer: Nomi Health Commercial |
$20.71
|
| Rate for Payer: PHP Commercial |
$21.03
|
| Rate for Payer: PHP Commercial |
$15.34
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.08
|
| Rate for Payer: Priority Health HMO/PPO |
$21.98
|
| Rate for Payer: Priority Health HMO/PPO |
$21.52
|
| Rate for Payer: Priority Health HMO/PPO |
$15.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.23
|
| 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 |
$21.09
|
| Rate for Payer: UHC Core |
$20.66
|
| 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
|
|
