|
INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION
|
Facility
|
IP
|
$66.31
|
|
|
Service Code
|
NDC 0338-0126-12
|
| Hospital Charge Code |
191217
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: BCBS Trust/PPO |
$51.24
|
| Rate for Payer: BCN Commercial |
$51.24
|
| Rate for Payer: Cash Price |
$53.05
|
| Rate for Payer: Cofinity Commercial |
$57.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Healthscope Commercial |
$59.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.35
|
| Rate for Payer: UHC Core |
$55.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.73
|
|
|
INSULIN REGULAR 1 UNIT/ML IN 0.9 % NACL IV PUSH (CUSTOM)
|
Facility
|
IP
|
$66.31
|
|
|
Service Code
|
NDC 0338-0126-12
|
| Hospital Charge Code |
301039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: BCBS Trust/PPO |
$51.24
|
| Rate for Payer: BCN Commercial |
$51.24
|
| Rate for Payer: Cash Price |
$53.05
|
| Rate for Payer: Cofinity Commercial |
$57.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Healthscope Commercial |
$59.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.35
|
| Rate for Payer: UHC Core |
$55.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.73
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
IP
|
$56.95
|
|
|
Service Code
|
NDC 0169-1833-11
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$51.26 |
| Rate for Payer: Aetna Commercial |
$48.41
|
| Rate for Payer: BCBS Trust/PPO |
$44.01
|
| Rate for Payer: BCN Commercial |
$44.01
|
| Rate for Payer: Cash Price |
$45.56
|
| Rate for Payer: Cofinity Commercial |
$48.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.56
|
| Rate for Payer: Healthscope Commercial |
$51.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.41
|
| Rate for Payer: PHP Commercial |
$48.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.12
|
| Rate for Payer: UHC Core |
$47.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.71
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
IP
|
$19.46
|
|
|
Service Code
|
NDC 0002-8215-17
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$17.51 |
| Rate for Payer: Aetna Commercial |
$16.54
|
| Rate for Payer: BCBS Trust/PPO |
$15.04
|
| Rate for Payer: BCN Commercial |
$15.04
|
| Rate for Payer: Cash Price |
$15.57
|
| Rate for Payer: Cofinity Commercial |
$16.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.57
|
| Rate for Payer: Healthscope Commercial |
$17.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.54
|
| Rate for Payer: PHP Commercial |
$16.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.12
|
| Rate for Payer: UHC Core |
$16.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.60
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - INSULIN GLULISINE (APIDRA)
|
Facility
|
IP
|
$290.23
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
180908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.01 |
| Max. Negotiated Rate |
$261.21 |
| Rate for Payer: Aetna Commercial |
$246.70
|
| Rate for Payer: BCBS Trust/PPO |
$224.29
|
| Rate for Payer: BCN Commercial |
$224.29
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cofinity Commercial |
$249.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.18
|
| Rate for Payer: Healthscope Commercial |
$261.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.70
|
| Rate for Payer: PHP Commercial |
$246.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.40
|
| Rate for Payer: UHC Core |
$242.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.67
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - LISPRO (HUMALOG)
|
Facility
|
IP
|
$46.55
|
|
|
Service Code
|
NDC 0002-7510-17
|
| Hospital Charge Code |
180914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.39 |
| Max. Negotiated Rate |
$41.90 |
| Rate for Payer: Aetna Commercial |
$39.57
|
| Rate for Payer: BCBS Trust/PPO |
$35.97
|
| Rate for Payer: BCN Commercial |
$35.97
|
| Rate for Payer: Cash Price |
$37.24
|
| Rate for Payer: Cofinity Commercial |
$40.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.24
|
| Rate for Payer: Healthscope Commercial |
$41.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.57
|
| Rate for Payer: PHP Commercial |
$39.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.96
|
| Rate for Payer: UHC Core |
$38.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.91
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - REGULAR HUMAN (U-500)
|
Facility
|
IP
|
$5,065.60
|
|
|
Service Code
|
NDC 0002-8501-01
|
| Hospital Charge Code |
180916
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,089.51 |
| Max. Negotiated Rate |
$4,559.04 |
| Rate for Payer: Aetna Commercial |
$4,305.76
|
| Rate for Payer: BCBS Trust/PPO |
$3,914.70
|
| Rate for Payer: BCN Commercial |
$3,914.70
|
| Rate for Payer: Cash Price |
$4,052.48
|
| Rate for Payer: Cofinity Commercial |
$4,356.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,052.48
|
| Rate for Payer: Healthscope Commercial |
$4,559.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,799.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,305.76
|
| Rate for Payer: PHP Commercial |
$4,305.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,545.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,407.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,089.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,457.73
|
| Rate for Payer: UHC Core |
$4,229.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,799.20
|
|
|
INSULIN SUBCUTANEOUS BOLUS PUMP - HUMAN (HUMULIN R)
|
Facility
|
IP
|
$56.95
|
|
|
Service Code
|
NDC 0169-1833-11
|
| Hospital Charge Code |
180911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$51.26 |
| Rate for Payer: Aetna Commercial |
$48.41
|
| Rate for Payer: BCBS Trust/PPO |
$44.01
|
| Rate for Payer: BCN Commercial |
$44.01
|
| Rate for Payer: Cash Price |
$45.56
|
| Rate for Payer: Cofinity Commercial |
$48.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.56
|
| Rate for Payer: Healthscope Commercial |
$51.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.41
|
| Rate for Payer: PHP Commercial |
$48.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.12
|
| Rate for Payer: UHC Core |
$47.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.71
|
|
|
INSULIN SUBCUTANEOUS CONTINUOUS BASAL PUMP - ASPARTATE (NOVOLOG)
|
Facility
|
IP
|
$248.94
|
|
|
Service Code
|
NDC 0169-7501-11
|
| Hospital Charge Code |
180912
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.83 |
| Max. Negotiated Rate |
$224.05 |
| Rate for Payer: Aetna Commercial |
$211.60
|
| Rate for Payer: BCBS Trust/PPO |
$192.38
|
| Rate for Payer: BCN Commercial |
$192.38
|
| Rate for Payer: Cash Price |
$199.15
|
| Rate for Payer: Cofinity Commercial |
$214.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.15
|
| Rate for Payer: Healthscope Commercial |
$224.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.60
|
| Rate for Payer: PHP Commercial |
$211.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.07
|
| Rate for Payer: UHC Core |
$207.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.70
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$56.95
|
|
|
Service Code
|
NDC 0169-1833-11
|
| Hospital Charge Code |
10289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$51.26 |
| Rate for Payer: Aetna Commercial |
$48.41
|
| Rate for Payer: BCBS Trust/PPO |
$44.01
|
| Rate for Payer: BCN Commercial |
$44.01
|
| Rate for Payer: Cash Price |
$45.56
|
| Rate for Payer: Cofinity Commercial |
$48.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.56
|
| Rate for Payer: Healthscope Commercial |
$51.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.41
|
| Rate for Payer: PHP Commercial |
$48.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.12
|
| Rate for Payer: UHC Core |
$47.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.71
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$19.46
|
|
|
Service Code
|
NDC 0002-8215-17
|
| Hospital Charge Code |
10289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$17.51 |
| Rate for Payer: Aetna Commercial |
$16.54
|
| Rate for Payer: BCBS Trust/PPO |
$15.04
|
| Rate for Payer: BCN Commercial |
$15.04
|
| Rate for Payer: Cash Price |
$15.57
|
| Rate for Payer: Cofinity Commercial |
$16.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.57
|
| Rate for Payer: Healthscope Commercial |
$17.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.54
|
| Rate for Payer: PHP Commercial |
$16.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.12
|
| Rate for Payer: UHC Core |
$16.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.60
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION
|
Facility
|
IP
|
$110.96
|
|
|
Service Code
|
NDC 48433-230-15
|
| Hospital Charge Code |
108150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.67 |
| Max. Negotiated Rate |
$99.86 |
| Rate for Payer: Aetna Commercial |
$94.32
|
| Rate for Payer: BCBS Trust/PPO |
$85.75
|
| Rate for Payer: BCN Commercial |
$85.75
|
| Rate for Payer: Cash Price |
$88.77
|
| Rate for Payer: Cofinity Commercial |
$95.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.77
|
| Rate for Payer: Healthscope Commercial |
$99.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.32
|
| Rate for Payer: PHP Commercial |
$94.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.64
|
| Rate for Payer: UHC Core |
$92.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.22
|
|
|
IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$116.11
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
10321
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.82 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Aetna Commercial |
$98.69
|
| Rate for Payer: BCBS Trust/PPO |
$89.73
|
| Rate for Payer: BCN Commercial |
$89.73
|
| Rate for Payer: Cash Price |
$92.89
|
| Rate for Payer: Cofinity Commercial |
$99.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.89
|
| Rate for Payer: Healthscope Commercial |
$104.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.69
|
| Rate for Payer: PHP Commercial |
$98.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.18
|
| Rate for Payer: UHC Core |
$96.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.08
|
|
|
IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$202.50
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$182.25 |
| Rate for Payer: Aetna Commercial |
$172.12
|
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: BCBS Trust/PPO |
$156.49
|
| Rate for Payer: BCBS Trust/PPO |
$3.36
|
| Rate for Payer: BCN Commercial |
$3.36
|
| Rate for Payer: BCN Commercial |
$156.49
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cofinity Commercial |
$174.15
|
| Rate for Payer: Cofinity Commercial |
$3.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Healthscope Commercial |
$182.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.70
|
| Rate for Payer: PHP Commercial |
$3.70
|
| Rate for Payer: PHP Commercial |
$172.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.20
|
| Rate for Payer: UHC Core |
$169.09
|
| Rate for Payer: UHC Core |
$3.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.26
|
|
|
IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$442.18 |
| Max. Negotiated Rate |
$652.50 |
| Rate for Payer: Aetna Commercial |
$616.25
|
| Rate for Payer: Aetna Commercial |
$851.06
|
| Rate for Payer: BCBS Trust/PPO |
$773.77
|
| Rate for Payer: BCBS Trust/PPO |
$560.28
|
| Rate for Payer: BCN Commercial |
$773.77
|
| Rate for Payer: BCN Commercial |
$560.28
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cofinity Commercial |
$861.08
|
| Rate for Payer: Cofinity Commercial |
$623.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$801.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$580.00
|
| Rate for Payer: Healthscope Commercial |
$901.12
|
| Rate for Payer: Healthscope Commercial |
$652.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$543.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$851.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$616.25
|
| Rate for Payer: PHP Commercial |
$616.25
|
| Rate for Payer: PHP Commercial |
$851.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$507.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$871.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$630.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$442.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$881.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$638.00
|
| Rate for Payer: UHC Core |
$605.38
|
| Rate for Payer: UHC Core |
$836.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$543.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.94
|
|
|
IOPAMIDOL 300 MG IODINE/ML (61 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
27737
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.02 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna Commercial |
$104.55
|
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna Commercial |
$71.74
|
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: BCBS Trust/PPO |
$95.05
|
| Rate for Payer: BCBS Trust/PPO |
$32.46
|
| Rate for Payer: BCBS Trust/PPO |
$65.22
|
| Rate for Payer: BCBS Trust/PPO |
$33.38
|
| Rate for Payer: BCN Commercial |
$33.38
|
| Rate for Payer: BCN Commercial |
$95.05
|
| Rate for Payer: BCN Commercial |
$32.46
|
| Rate for Payer: BCN Commercial |
$65.22
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$67.52
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cofinity Commercial |
$37.15
|
| Rate for Payer: Cofinity Commercial |
$105.78
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Cofinity Commercial |
$72.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.52
|
| Rate for Payer: Healthscope Commercial |
$75.96
|
| Rate for Payer: Healthscope Commercial |
$110.70
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Healthscope Commercial |
$38.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.72
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: PHP Commercial |
$71.74
|
| Rate for Payer: PHP Commercial |
$104.55
|
| Rate for Payer: PHP Commercial |
$36.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.24
|
| Rate for Payer: UHC Core |
$102.70
|
| Rate for Payer: UHC Core |
$36.07
|
| Rate for Payer: UHC Core |
$35.07
|
| Rate for Payer: UHC Core |
$70.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.30
|
|
|
IOPAMIDOL 370 MG IODINE/ML (76 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10328
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.73 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna Commercial |
$119.00
|
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: BCBS Trust/PPO |
$162.29
|
| Rate for Payer: BCBS Trust/PPO |
$108.19
|
| Rate for Payer: BCBS Trust/PPO |
$135.24
|
| Rate for Payer: BCN Commercial |
$162.29
|
| Rate for Payer: BCN Commercial |
$108.19
|
| Rate for Payer: BCN Commercial |
$135.24
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.00
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: PHP Commercial |
$119.00
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.80
|
| Rate for Payer: UHC Core |
$116.90
|
| Rate for Payer: UHC Core |
$146.12
|
| Rate for Payer: UHC Core |
$175.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
|
|
IOPAMIDOL 61 % ORAL SOLUTION
|
Facility
|
IP
|
$11.20
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
180462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: BCBS Trust/PPO |
$8.66
|
| Rate for Payer: BCN Commercial |
$8.66
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cofinity Commercial |
$9.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.96
|
| Rate for Payer: Healthscope Commercial |
$10.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.52
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.86
|
| Rate for Payer: UHC Core |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.40
|
|
|
IPL CHEEKS FIRST
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 00126
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
|
|
IPL CHEST FIRST
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 00128
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
|
|
IPL CHEST SECOND
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 00129
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
|
|
IPL FACE FIRST
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 00130
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
|
|
IPL FACE, NECK, CHEST FIRST
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 00132
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: BCBS Complete |
$160.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
|
|
IPL FACE, NECK, CHEST SECOND
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 00133
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
|
|
IPL FACE & NECK FIRST
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 00134
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
|
