|
IPL FACE & NECK SECOND
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 00135
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
|
|
IPL FACE SECOND
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 00131
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
|
|
IPL HANDS & ARMS FIRST
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 00136
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
|
|
IPL HANDS & ARMS SECOND
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 00137
|
|
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 NECK
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 00138
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
|
|
IPL NOSE & CHEEKS FIRST
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 00127
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN
|
Facility
|
IP
|
$4.42
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
30510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Commercial |
$2.67
|
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: BCBS Trust/PPO |
$2.56
|
| Rate for Payer: BCBS Trust/PPO |
$3.42
|
| Rate for Payer: BCBS Trust/PPO |
$2.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.43
|
| Rate for Payer: BCN Commercial |
$3.42
|
| Rate for Payer: BCN Commercial |
$2.06
|
| Rate for Payer: BCN Commercial |
$2.56
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cash Price |
$2.65
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.98
|
| Rate for Payer: Healthscope Commercial |
$2.83
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: PHP Commercial |
$3.76
|
| Rate for Payer: PHP Commercial |
$2.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.91
|
| Rate for Payer: UHC Core |
$2.76
|
| Rate for Payer: UHC Core |
$2.22
|
| Rate for Payer: UHC Core |
$2.62
|
| Rate for Payer: UHC Core |
$3.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.32
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION
|
Facility
|
IP
|
$5.70
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
12580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.55
|
| Rate for Payer: BCBS Trust/PPO |
$4.40
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: BCN Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.90
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.56
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Healthscope Commercial |
$5.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.84
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: UHC Core |
$4.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.28
|
|
|
IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER
|
Facility
|
IP
|
$1,624.40
|
|
|
Service Code
|
NDC 0597-0087-17
|
| Hospital Charge Code |
41142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$990.72 |
| Max. Negotiated Rate |
$1,461.96 |
| Rate for Payer: Aetna Commercial |
$1,380.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,255.34
|
| Rate for Payer: BCN Commercial |
$1,255.34
|
| Rate for Payer: Cash Price |
$1,299.52
|
| Rate for Payer: Cofinity Commercial |
$1,396.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,299.52
|
| Rate for Payer: Healthscope Commercial |
$1,461.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,218.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,380.74
|
| Rate for Payer: PHP Commercial |
$1,380.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,137.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,413.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$990.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,429.47
|
| Rate for Payer: UHC Core |
$1,356.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,218.30
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
NDC 0054-0045-44
|
| Hospital Charge Code |
16070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.85 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: BCBS Trust/PPO |
$97.37
|
| Rate for Payer: BCN Commercial |
$97.37
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$108.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.80
|
| Rate for Payer: Healthscope Commercial |
$113.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.10
|
| Rate for Payer: PHP Commercial |
$107.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.88
|
| Rate for Payer: UHC Core |
$105.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.50
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY
|
Facility
|
IP
|
$60.90
|
|
|
Service Code
|
NDC 69238-2016-3
|
| Hospital Charge Code |
16070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.14 |
| Max. Negotiated Rate |
$54.81 |
| Rate for Payer: Aetna Commercial |
$51.76
|
| Rate for Payer: BCBS Trust/PPO |
$47.06
|
| Rate for Payer: BCN Commercial |
$47.06
|
| Rate for Payer: Cash Price |
$48.72
|
| Rate for Payer: Cofinity Commercial |
$52.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.72
|
| Rate for Payer: Healthscope Commercial |
$54.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.76
|
| Rate for Payer: PHP Commercial |
$51.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.59
|
| Rate for Payer: UHC Core |
$50.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.68
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$146.88
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.58 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna Commercial |
$124.85
|
| Rate for Payer: BCBS Trust/PPO |
$113.51
|
| Rate for Payer: BCN Commercial |
$113.51
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cofinity Commercial |
$126.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$132.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.85
|
| Rate for Payer: PHP Commercial |
$124.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.25
|
| Rate for Payer: UHC Core |
$122.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.16
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$146.94
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.62 |
| Max. Negotiated Rate |
$132.25 |
| Rate for Payer: Aetna Commercial |
$124.90
|
| Rate for Payer: BCBS Trust/PPO |
$113.56
|
| Rate for Payer: BCN Commercial |
$113.56
|
| Rate for Payer: Cash Price |
$117.55
|
| Rate for Payer: Cofinity Commercial |
$126.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.55
|
| Rate for Payer: Healthscope Commercial |
$132.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.90
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.31
|
| Rate for Payer: UHC Core |
$122.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.20
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$17.58
|
|
|
Service Code
|
NDC 66794-019-25
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: Aetna Commercial |
$14.94
|
| Rate for Payer: BCBS Trust/PPO |
$13.59
|
| Rate for Payer: BCN Commercial |
$13.59
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cofinity Commercial |
$15.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.06
|
| Rate for Payer: Healthscope Commercial |
$15.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.94
|
| Rate for Payer: PHP Commercial |
$14.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.47
|
| Rate for Payer: UHC Core |
$14.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.18
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$79.55
|
|
|
Service Code
|
NDC 10019-360-40
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna Commercial |
$67.62
|
| Rate for Payer: BCBS Trust/PPO |
$61.48
|
| Rate for Payer: BCN Commercial |
$61.48
|
| Rate for Payer: Cash Price |
$63.64
|
| Rate for Payer: Cofinity Commercial |
$68.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.64
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.62
|
| Rate for Payer: PHP Commercial |
$67.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.00
|
| Rate for Payer: UHC Core |
$66.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.66
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$8.88
|
|
|
Service Code
|
NDC 66794-019-10
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: BCBS Trust/PPO |
$6.86
|
| Rate for Payer: BCN Commercial |
$6.86
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.55
|
| Rate for Payer: PHP Commercial |
$7.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.81
|
| Rate for Payer: UHC Core |
$7.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.66
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$415.15
|
|
|
Service Code
|
NDC 0904-6619-61
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.20 |
| Max. Negotiated Rate |
$373.64 |
| Rate for Payer: Aetna Commercial |
$352.88
|
| Rate for Payer: BCBS Trust/PPO |
$320.83
|
| Rate for Payer: BCN Commercial |
$320.83
|
| Rate for Payer: Cash Price |
$332.12
|
| Rate for Payer: Cofinity Commercial |
$357.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.12
|
| Rate for Payer: Healthscope Commercial |
$373.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.88
|
| Rate for Payer: PHP Commercial |
$352.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$361.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$365.33
|
| Rate for Payer: UHC Core |
$346.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.36
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$251.04
|
|
|
Service Code
|
NDC 63739-569-10
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.11 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Aetna Commercial |
$213.38
|
| Rate for Payer: BCBS Trust/PPO |
$194.00
|
| Rate for Payer: BCN Commercial |
$194.00
|
| Rate for Payer: Cash Price |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$215.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.83
|
| Rate for Payer: Healthscope Commercial |
$225.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.38
|
| Rate for Payer: PHP Commercial |
$213.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.92
|
| Rate for Payer: UHC Core |
$209.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.28
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$448.40
|
|
|
Service Code
|
NDC 0781-1556-13
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.48 |
| Max. Negotiated Rate |
$403.56 |
| Rate for Payer: Aetna Commercial |
$381.14
|
| Rate for Payer: BCBS Trust/PPO |
$346.52
|
| Rate for Payer: BCN Commercial |
$346.52
|
| Rate for Payer: Cash Price |
$358.72
|
| Rate for Payer: Cofinity Commercial |
$385.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.72
|
| Rate for Payer: Healthscope Commercial |
$403.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.14
|
| Rate for Payer: PHP Commercial |
$381.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.59
|
| Rate for Payer: UHC Core |
$374.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.30
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 68084-082-11
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.10
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.17
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$243.20
|
|
|
Service Code
|
NDC 0904-6449-61
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.33 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: BCBS Trust/PPO |
$187.94
|
| Rate for Payer: BCN Commercial |
$187.94
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.56
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$206.72
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.02
|
| Rate for Payer: UHC Core |
$203.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$289.75
|
|
|
Service Code
|
NDC 0904-6450-61
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$260.78 |
| Rate for Payer: Aetna Commercial |
$246.29
|
| Rate for Payer: BCBS Trust/PPO |
$223.92
|
| Rate for Payer: BCN Commercial |
$223.92
|
| Rate for Payer: Cash Price |
$231.80
|
| Rate for Payer: Cofinity Commercial |
$249.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.80
|
| Rate for Payer: Healthscope Commercial |
$260.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.29
|
| Rate for Payer: PHP Commercial |
$246.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.98
|
| Rate for Payer: UHC Core |
$241.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.31
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$310.56
|
|
|
Service Code
|
NDC 68084-592-01
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.41 |
| Max. Negotiated Rate |
$279.50 |
| Rate for Payer: Aetna Commercial |
$263.98
|
| Rate for Payer: BCBS Trust/PPO |
$240.00
|
| Rate for Payer: BCN Commercial |
$240.00
|
| Rate for Payer: Cash Price |
$248.45
|
| Rate for Payer: Cofinity Commercial |
$267.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.45
|
| Rate for Payer: Healthscope Commercial |
$279.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.98
|
| Rate for Payer: PHP Commercial |
$263.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.29
|
| Rate for Payer: UHC Core |
$259.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.92
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.11
|
|
|
Service Code
|
NDC 68084-592-11
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.40
|
| Rate for Payer: BCN Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.49
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.64
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.74
|
| Rate for Payer: UHC Core |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.33
|
|
|
ISOSOURCE 1.5 BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 4390018150
|
| Hospital Charge Code |
150768
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.67
|
| Rate for Payer: BCN Commercial |
$3.67
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.18
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
