|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$78.24
|
|
|
Service Code
|
NDC 60505-7007-2
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$70.42 |
| Rate for Payer: Aetna Commercial |
$66.50
|
| Rate for Payer: BCBS Trust/PPO |
$60.46
|
| Rate for Payer: BCN Commercial |
$60.46
|
| Rate for Payer: Cash Price |
$62.59
|
| Rate for Payer: Cofinity Commercial |
$67.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.59
|
| Rate for Payer: Healthscope Commercial |
$70.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.50
|
| Rate for Payer: PHP Commercial |
$66.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.85
|
| Rate for Payer: UHC Core |
$65.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.68
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$150.39
|
|
|
Service Code
|
NDC 60505-7082-2
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$135.35 |
| Rate for Payer: Aetna Commercial |
$127.83
|
| Rate for Payer: BCBS Trust/PPO |
$116.22
|
| Rate for Payer: BCN Commercial |
$116.22
|
| Rate for Payer: Cash Price |
$120.31
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.31
|
| Rate for Payer: Healthscope Commercial |
$135.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.83
|
| Rate for Payer: PHP Commercial |
$127.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.34
|
| Rate for Payer: UHC Core |
$125.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.79
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION (CODE)
|
Facility
|
IP
|
$42.12
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
163724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.69 |
| Max. Negotiated Rate |
$37.91 |
| Rate for Payer: Aetna Commercial |
$35.80
|
| Rate for Payer: Aetna Commercial |
$29.50
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: BCBS Trust/PPO |
$26.82
|
| Rate for Payer: BCBS Trust/PPO |
$17.16
|
| Rate for Payer: BCBS Trust/PPO |
$32.55
|
| Rate for Payer: BCN Commercial |
$26.82
|
| Rate for Payer: BCN Commercial |
$17.16
|
| Rate for Payer: BCN Commercial |
$32.55
|
| Rate for Payer: Cash Price |
$27.77
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$33.70
|
| Rate for Payer: Cofinity Commercial |
$29.85
|
| Rate for Payer: Cofinity Commercial |
$36.22
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$37.91
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$31.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.80
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: PHP Commercial |
$35.80
|
| Rate for Payer: PHP Commercial |
$29.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.54
|
| Rate for Payer: UHC Core |
$28.98
|
| Rate for Payer: UHC Core |
$35.17
|
| Rate for Payer: UHC Core |
$18.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.59
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$19.24
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
3037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Commercial |
$8.62
|
| Rate for Payer: Aetna Commercial |
$19.31
|
| Rate for Payer: Aetna Commercial |
$29.50
|
| Rate for Payer: Aetna Commercial |
$8.34
|
| Rate for Payer: BCBS Trust/PPO |
$7.84
|
| Rate for Payer: BCBS Trust/PPO |
$26.82
|
| Rate for Payer: BCBS Trust/PPO |
$18.16
|
| Rate for Payer: BCBS Trust/PPO |
$14.87
|
| Rate for Payer: BCBS Trust/PPO |
$17.56
|
| Rate for Payer: BCBS Trust/PPO |
$7.58
|
| Rate for Payer: BCBS Trust/PPO |
$19.10
|
| Rate for Payer: BCN Commercial |
$14.87
|
| Rate for Payer: BCN Commercial |
$7.84
|
| Rate for Payer: BCN Commercial |
$7.58
|
| Rate for Payer: BCN Commercial |
$26.82
|
| Rate for Payer: BCN Commercial |
$19.10
|
| Rate for Payer: BCN Commercial |
$17.56
|
| Rate for Payer: BCN Commercial |
$18.16
|
| Rate for Payer: Cash Price |
$7.85
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cash Price |
$8.11
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cash Price |
$27.77
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Cofinity Commercial |
$8.44
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$8.72
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Cofinity Commercial |
$29.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$31.24
|
| Rate for Payer: Healthscope Commercial |
$9.13
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Healthscope Commercial |
$22.25
|
| Rate for Payer: Healthscope Commercial |
$8.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.34
|
| Rate for Payer: PHP Commercial |
$19.31
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: PHP Commercial |
$8.62
|
| Rate for Payer: PHP Commercial |
$29.50
|
| Rate for Payer: PHP Commercial |
$8.34
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: PHP Commercial |
$21.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.99
|
| Rate for Payer: UHC Core |
$18.97
|
| Rate for Payer: UHC Core |
$19.62
|
| Rate for Payer: UHC Core |
$16.07
|
| Rate for Payer: UHC Core |
$20.64
|
| Rate for Payer: UHC Core |
$8.47
|
| Rate for Payer: UHC Core |
$28.98
|
| Rate for Payer: UHC Core |
$8.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.36
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,978.84
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
167398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,816.79 |
| Max. Negotiated Rate |
$2,680.96 |
| Rate for Payer: Aetna Commercial |
$2,532.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,302.05
|
| Rate for Payer: BCN Commercial |
$2,302.05
|
| Rate for Payer: Cash Price |
$2,383.07
|
| Rate for Payer: Cofinity Commercial |
$2,561.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,383.07
|
| Rate for Payer: Healthscope Commercial |
$2,680.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,234.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,532.01
|
| Rate for Payer: PHP Commercial |
$2,532.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,085.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,591.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,816.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,621.38
|
| Rate for Payer: UHC Core |
$2,487.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,234.13
|
|
|
FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL ELIXIR
|
Facility
|
IP
|
$73.79
|
|
|
Service Code
|
NDC 5038377816
|
| Hospital Charge Code |
179529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Aetna Commercial |
$62.72
|
| Rate for Payer: BCBS Trust/PPO |
$57.02
|
| Rate for Payer: BCN Commercial |
$57.02
|
| Rate for Payer: Cash Price |
$59.03
|
| Rate for Payer: Cofinity Commercial |
$63.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.03
|
| Rate for Payer: Healthscope Commercial |
$66.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.72
|
| Rate for Payer: PHP Commercial |
$62.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.94
|
| Rate for Payer: UHC Core |
$61.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.34
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
IP
|
$11.68
|
|
|
Service Code
|
NDC 121053005
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Commercial |
$9.03
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.93
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.28
|
| Rate for Payer: UHC Core |
$9.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
IP
|
$11.68
|
|
|
Service Code
|
NDC 5026833624
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Commercial |
$9.03
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.93
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.28
|
| Rate for Payer: UHC Core |
$9.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
IP
|
$11.68
|
|
|
Service Code
|
NDC 5026833611
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Commercial |
$9.03
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.93
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.28
|
| Rate for Payer: UHC Core |
$9.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
IP
|
$58.75
|
|
|
Service Code
|
NDC 904759161
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.83 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: BCBS Trust/PPO |
$45.40
|
| Rate for Payer: BCN Commercial |
$45.40
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.94
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.70
|
| Rate for Payer: UHC Core |
$49.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.06
|
|
|
FIBERSOURCE HN CYCLIC FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 4390018588
|
| Hospital Charge Code |
200077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$7.42
|
| Rate for Payer: BCN Commercial |
$7.42
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.45
|
| Rate for Payer: UHC Core |
$8.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$53.58
|
|
|
Service Code
|
NDC 16729-090-10
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.68 |
| Max. Negotiated Rate |
$48.22 |
| Rate for Payer: Aetna Commercial |
$45.54
|
| Rate for Payer: BCBS Trust/PPO |
$41.41
|
| Rate for Payer: BCN Commercial |
$41.41
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Commercial |
$46.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Healthscope Commercial |
$48.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.54
|
| Rate for Payer: PHP Commercial |
$45.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.15
|
| Rate for Payer: UHC Core |
$44.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.18
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$82.49
|
|
|
Service Code
|
NDC 65862-149-30
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.31 |
| Max. Negotiated Rate |
$74.24 |
| Rate for Payer: Aetna Commercial |
$70.12
|
| Rate for Payer: BCBS Trust/PPO |
$63.75
|
| Rate for Payer: BCN Commercial |
$63.75
|
| Rate for Payer: Cash Price |
$65.99
|
| Rate for Payer: Cofinity Commercial |
$70.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.99
|
| Rate for Payer: Healthscope Commercial |
$74.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.12
|
| Rate for Payer: PHP Commercial |
$70.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.59
|
| Rate for Payer: UHC Core |
$68.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.87
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$251.04
|
|
|
Service Code
|
NDC 0904-6830-61
|
| Hospital Charge Code |
10037
|
|
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
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$193.80
|
|
|
Service Code
|
NDC 0904-6830-06
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: BCBS Trust/PPO |
$149.77
|
| Rate for Payer: BCN Commercial |
$149.77
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.73
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.54
|
| Rate for Payer: UHC Core |
$161.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.35
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$250.08
|
|
|
Service Code
|
NDC 0054-0010-20
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.52 |
| Max. Negotiated Rate |
$225.07 |
| Rate for Payer: Aetna Commercial |
$212.57
|
| Rate for Payer: BCBS Trust/PPO |
$193.26
|
| Rate for Payer: BCN Commercial |
$193.26
|
| Rate for Payer: Cash Price |
$200.06
|
| Rate for Payer: Cofinity Commercial |
$215.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.06
|
| Rate for Payer: Healthscope Commercial |
$225.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.57
|
| Rate for Payer: PHP Commercial |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.07
|
| Rate for Payer: UHC Core |
$208.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.56
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$153.80
|
|
|
Service Code
|
NDC 0054-0010-21
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$138.42 |
| Rate for Payer: Aetna Commercial |
$130.73
|
| Rate for Payer: BCBS Trust/PPO |
$118.86
|
| Rate for Payer: BCN Commercial |
$118.86
|
| Rate for Payer: Cash Price |
$123.04
|
| Rate for Payer: Cofinity Commercial |
$132.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.04
|
| Rate for Payer: Healthscope Commercial |
$138.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.73
|
| Rate for Payer: PHP Commercial |
$130.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.34
|
| Rate for Payer: UHC Core |
$128.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.35
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$5.69
|
|
|
Service Code
|
NDC 68084-728-11
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: BCBS Trust/PPO |
$4.40
|
| Rate for Payer: BCN Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cofinity Commercial |
$4.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$5.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.84
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.01
|
| Rate for Payer: UHC Core |
$4.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.27
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$114.20
|
|
|
Service Code
|
NDC 55111-144-30
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.65 |
| Max. Negotiated Rate |
$102.78 |
| Rate for Payer: Aetna Commercial |
$97.07
|
| Rate for Payer: BCBS Trust/PPO |
$88.25
|
| Rate for Payer: BCN Commercial |
$88.25
|
| Rate for Payer: Cash Price |
$91.36
|
| Rate for Payer: Cofinity Commercial |
$98.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.36
|
| Rate for Payer: Healthscope Commercial |
$102.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.07
|
| Rate for Payer: PHP Commercial |
$97.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.50
|
| Rate for Payer: UHC Core |
$95.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.65
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$568.32
|
|
|
Service Code
|
NDC 68084-728-01
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$346.62 |
| Max. Negotiated Rate |
$511.49 |
| Rate for Payer: Aetna Commercial |
$483.07
|
| Rate for Payer: BCBS Trust/PPO |
$439.20
|
| Rate for Payer: BCN Commercial |
$439.20
|
| Rate for Payer: Cash Price |
$454.66
|
| Rate for Payer: Cofinity Commercial |
$488.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.66
|
| Rate for Payer: Healthscope Commercial |
$511.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$426.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$483.07
|
| Rate for Payer: PHP Commercial |
$483.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$494.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$346.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$500.12
|
| Rate for Payer: UHC Core |
$474.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$426.24
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$115.71
|
|
|
Service Code
|
NDC 68462-102-30
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.57 |
| Max. Negotiated Rate |
$104.14 |
| Rate for Payer: Aetna Commercial |
$98.35
|
| Rate for Payer: BCBS Trust/PPO |
$89.42
|
| Rate for Payer: BCN Commercial |
$89.42
|
| Rate for Payer: Cash Price |
$92.57
|
| Rate for Payer: Cofinity Commercial |
$99.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.57
|
| Rate for Payer: Healthscope Commercial |
$104.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.35
|
| Rate for Payer: PHP Commercial |
$98.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.82
|
| Rate for Payer: UHC Core |
$96.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.78
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$251.28
|
|
|
Service Code
|
NDC 0904-6500-06
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.26 |
| Max. Negotiated Rate |
$226.15 |
| Rate for Payer: Aetna Commercial |
$213.59
|
| Rate for Payer: BCBS Trust/PPO |
$194.19
|
| Rate for Payer: BCN Commercial |
$194.19
|
| Rate for Payer: Cash Price |
$201.02
|
| Rate for Payer: Cofinity Commercial |
$216.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.02
|
| Rate for Payer: Healthscope Commercial |
$226.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.59
|
| Rate for Payer: PHP Commercial |
$213.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.13
|
| Rate for Payer: UHC Core |
$209.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.46
|
|
|
FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$89.32
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
10049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$80.39 |
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: BCBS Trust/PPO |
$69.03
|
| Rate for Payer: BCN Commercial |
$69.03
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.46
|
| Rate for Payer: Healthscope Commercial |
$80.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.92
|
| Rate for Payer: PHP Commercial |
$75.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.60
|
| Rate for Payer: UHC Core |
$74.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.99
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$263.04
|
|
|
Service Code
|
NDC 0115-7033-01
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.43 |
| Max. Negotiated Rate |
$236.74 |
| Rate for Payer: Aetna Commercial |
$223.58
|
| Rate for Payer: BCBS Trust/PPO |
$203.28
|
| Rate for Payer: BCN Commercial |
$203.28
|
| Rate for Payer: Cash Price |
$210.43
|
| Rate for Payer: Cofinity Commercial |
$226.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.43
|
| Rate for Payer: Healthscope Commercial |
$236.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.58
|
| Rate for Payer: PHP Commercial |
$223.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.48
|
| Rate for Payer: UHC Core |
$219.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.28
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$2.41
|
|
|
Service Code
|
NDC 50268-330-11
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna Commercial |
$2.05
|
| Rate for Payer: BCBS Trust/PPO |
$1.86
|
| Rate for Payer: BCN Commercial |
$1.86
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cofinity Commercial |
$2.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$2.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.12
|
| Rate for Payer: UHC Core |
$2.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.81
|
|
