|
FLURAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$409.45
|
|
|
Service Code
|
NDC 0378-4415-01
|
| Hospital Charge Code |
3223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.72 |
| Max. Negotiated Rate |
$368.50 |
| Rate for Payer: Aetna Commercial |
$348.03
|
| Rate for Payer: BCBS Trust/PPO |
$316.42
|
| Rate for Payer: BCN Commercial |
$316.42
|
| Rate for Payer: Cash Price |
$327.56
|
| Rate for Payer: Cofinity Commercial |
$352.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.56
|
| Rate for Payer: Healthscope Commercial |
$368.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$348.03
|
| Rate for Payer: PHP Commercial |
$348.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$356.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.32
|
| Rate for Payer: UHC Core |
$341.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.09
|
|
|
FLUTAMIDE 125 MG CAPSULE
|
Facility
|
IP
|
$19,026.96
|
|
|
Service Code
|
NDC 80725-600-18
|
| Hospital Charge Code |
10081
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11,604.54 |
| Max. Negotiated Rate |
$17,124.26 |
| Rate for Payer: Aetna Commercial |
$16,172.92
|
| Rate for Payer: BCBS Trust/PPO |
$14,704.03
|
| Rate for Payer: BCN Commercial |
$14,704.03
|
| Rate for Payer: Cash Price |
$15,221.57
|
| Rate for Payer: Cofinity Commercial |
$16,363.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,221.57
|
| Rate for Payer: Healthscope Commercial |
$17,124.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,270.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,172.92
|
| Rate for Payer: PHP Commercial |
$16,172.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,318.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,553.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,604.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,743.72
|
| Rate for Payer: UHC Core |
$15,887.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,270.22
|
|
|
FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$226.14
|
|
|
Service Code
|
NDC 0173-0874-14
|
| Hospital Charge Code |
173282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.92 |
| Max. Negotiated Rate |
$203.53 |
| Rate for Payer: Aetna Commercial |
$192.22
|
| Rate for Payer: BCBS Trust/PPO |
$174.76
|
| Rate for Payer: BCN Commercial |
$174.76
|
| Rate for Payer: Cash Price |
$180.91
|
| Rate for Payer: Cofinity Commercial |
$194.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.91
|
| Rate for Payer: Healthscope Commercial |
$203.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.22
|
| Rate for Payer: PHP Commercial |
$192.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.00
|
| Rate for Payer: UHC Core |
$188.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.60
|
|
|
FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$302.75
|
|
|
Service Code
|
NDC 0173-0876-14
|
| Hospital Charge Code |
173283
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.65 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna Commercial |
$257.34
|
| Rate for Payer: BCBS Trust/PPO |
$233.97
|
| Rate for Payer: BCN Commercial |
$233.97
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cofinity Commercial |
$260.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.20
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.34
|
| Rate for Payer: PHP Commercial |
$257.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.42
|
| Rate for Payer: UHC Core |
$252.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.06
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$19.80
|
|
|
Service Code
|
NDC 60505-0829-1
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.08 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Aetna Commercial |
$16.83
|
| Rate for Payer: BCBS Trust/PPO |
$15.30
|
| Rate for Payer: BCN Commercial |
$15.30
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.84
|
| Rate for Payer: Healthscope Commercial |
$17.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.83
|
| Rate for Payer: PHP Commercial |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.42
|
| Rate for Payer: UHC Core |
$16.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.85
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$14.55
|
|
|
Service Code
|
NDC 60432-264-15
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Aetna Commercial |
$12.37
|
| Rate for Payer: BCBS Trust/PPO |
$11.24
|
| Rate for Payer: BCN Commercial |
$11.24
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cofinity Commercial |
$12.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.64
|
| Rate for Payer: Healthscope Commercial |
$13.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.37
|
| Rate for Payer: PHP Commercial |
$12.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.80
|
| Rate for Payer: UHC Core |
$12.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.91
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$36.57
|
|
|
Service Code
|
NDC 0054-3270-99
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.30 |
| Max. Negotiated Rate |
$32.91 |
| Rate for Payer: Aetna Commercial |
$31.08
|
| Rate for Payer: BCBS Trust/PPO |
$28.26
|
| Rate for Payer: BCN Commercial |
$28.26
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cofinity Commercial |
$31.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Healthscope Commercial |
$32.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.08
|
| Rate for Payer: PHP Commercial |
$31.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.18
|
| Rate for Payer: UHC Core |
$30.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.43
|
|
|
FLU VACCINE QS2023-24(65YR UP)(PF)240 MCG/0.7 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$222.09
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
204599
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.45 |
| Max. Negotiated Rate |
$199.88 |
| Rate for Payer: Aetna Commercial |
$188.78
|
| Rate for Payer: BCBS Trust/PPO |
$171.63
|
| Rate for Payer: BCN Commercial |
$171.63
|
| Rate for Payer: Cash Price |
$177.67
|
| Rate for Payer: Cofinity Commercial |
$191.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.67
|
| Rate for Payer: Healthscope Commercial |
$199.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.78
|
| Rate for Payer: PHP Commercial |
$188.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.44
|
| Rate for Payer: UHC Core |
$185.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.57
|
|
|
FLU VACCINE QS 2023-24(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE
|
Facility
|
IP
|
$83.74
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
204598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$75.37 |
| Rate for Payer: Aetna Commercial |
$71.18
|
| Rate for Payer: BCBS Trust/PPO |
$64.71
|
| Rate for Payer: BCN Commercial |
$64.71
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$72.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Healthscope Commercial |
$75.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.18
|
| Rate for Payer: PHP Commercial |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.69
|
| Rate for Payer: UHC Core |
$69.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.80
|
|
|
FLUVOXAMINE 50 MG TABLET
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 62559-159-01
|
| Hospital Charge Code |
10085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.22 |
| Max. Negotiated Rate |
$293.98 |
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: BCBS Trust/PPO |
$252.44
|
| Rate for Payer: BCN Commercial |
$252.44
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.65
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.45
|
| Rate for Payer: UHC Core |
$272.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
NDC 69315-127-01
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.58 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: BCBS Trust/PPO |
$123.65
|
| Rate for Payer: BCN Commercial |
$123.65
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$135.30
|
|
|
Service Code
|
NDC 0904-7224-61
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.52 |
| Max. Negotiated Rate |
$121.77 |
| Rate for Payer: Aetna Commercial |
$115.00
|
| Rate for Payer: BCBS Trust/PPO |
$104.56
|
| Rate for Payer: BCN Commercial |
$104.56
|
| Rate for Payer: Cash Price |
$108.24
|
| Rate for Payer: Cofinity Commercial |
$116.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.24
|
| Rate for Payer: Healthscope Commercial |
$121.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.00
|
| Rate for Payer: PHP Commercial |
$115.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.06
|
| Rate for Payer: UHC Core |
$112.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.48
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$149.60
|
|
|
Service Code
|
NDC 62584-897-01
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.24 |
| Max. Negotiated Rate |
$134.64 |
| Rate for Payer: Aetna Commercial |
$127.16
|
| Rate for Payer: BCBS Trust/PPO |
$115.61
|
| Rate for Payer: BCN Commercial |
$115.61
|
| Rate for Payer: Cash Price |
$119.68
|
| Rate for Payer: Cofinity Commercial |
$128.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.68
|
| Rate for Payer: Healthscope Commercial |
$134.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.16
|
| Rate for Payer: PHP Commercial |
$127.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.65
|
| Rate for Payer: UHC Core |
$124.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.20
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 62584-897-11
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna Commercial |
$1.28
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cofinity Commercial |
$1.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.20
|
| Rate for Payer: Healthscope Commercial |
$1.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.28
|
| Rate for Payer: PHP Commercial |
$1.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.32
|
| Rate for Payer: UHC Core |
$1.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
NDC 60687-681-11
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna Commercial |
$1.33
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.21
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cofinity Commercial |
$1.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.25
|
| Rate for Payer: Healthscope Commercial |
$1.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.33
|
| Rate for Payer: PHP Commercial |
$1.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC Core |
$1.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.17
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$155.10
|
|
|
Service Code
|
NDC 60687-681-01
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.60 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: BCBS Trust/PPO |
$119.86
|
| Rate for Payer: BCN Commercial |
$119.86
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.84
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.49
|
| Rate for Payer: UHC Core |
$129.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.32
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
NDC 63739-537-10
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.21 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna Commercial |
$241.40
|
| Rate for Payer: BCBS Trust/PPO |
$219.48
|
| Rate for Payer: BCN Commercial |
$219.48
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cofinity Commercial |
$244.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.20
|
| Rate for Payer: Healthscope Commercial |
$255.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$241.40
|
| Rate for Payer: PHP Commercial |
$241.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.92
|
| Rate for Payer: UHC Core |
$237.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.00
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
NDC 11534-165-01
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.62 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: BCBS Trust/PPO |
$173.11
|
| Rate for Payer: BCN Commercial |
$173.11
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.20
|
| Rate for Payer: Healthscope Commercial |
$201.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$190.40
|
| Rate for Payer: PHP Commercial |
$190.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$194.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.12
|
| Rate for Payer: UHC Core |
$187.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.00
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$283.19
|
|
|
Service Code
|
NDC 39822-1100-1
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$172.72 |
| Max. Negotiated Rate |
$254.87 |
| Rate for Payer: Aetna Commercial |
$240.71
|
| Rate for Payer: BCBS Trust/PPO |
$218.85
|
| Rate for Payer: BCN Commercial |
$218.85
|
| Rate for Payer: Cash Price |
$226.55
|
| Rate for Payer: Cofinity Commercial |
$243.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.55
|
| Rate for Payer: Healthscope Commercial |
$254.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$240.71
|
| Rate for Payer: PHP Commercial |
$240.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$246.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.21
|
| Rate for Payer: UHC Core |
$236.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.39
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$5.69
|
|
|
Service Code
|
NDC 63323-184-11
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$203.55
|
|
|
Service Code
|
NDC 63323-184-10
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$124.15 |
| Max. Negotiated Rate |
$183.20 |
| Rate for Payer: Aetna Commercial |
$173.02
|
| Rate for Payer: BCBS Trust/PPO |
$157.30
|
| Rate for Payer: BCN Commercial |
$157.30
|
| Rate for Payer: Cash Price |
$162.84
|
| Rate for Payer: Cofinity Commercial |
$175.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.84
|
| Rate for Payer: Healthscope Commercial |
$183.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.02
|
| Rate for Payer: PHP Commercial |
$173.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.12
|
| Rate for Payer: UHC Core |
$169.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.66
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,676.55
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
22185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,022.53 |
| Max. Negotiated Rate |
$1,508.90 |
| Rate for Payer: Aetna Commercial |
$1,425.07
|
| Rate for Payer: Aetna Commercial |
$2,494.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,267.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,295.64
|
| Rate for Payer: BCN Commercial |
$2,267.63
|
| Rate for Payer: BCN Commercial |
$1,295.64
|
| Rate for Payer: Cash Price |
$1,341.24
|
| Rate for Payer: Cash Price |
$2,347.45
|
| Rate for Payer: Cofinity Commercial |
$1,441.83
|
| Rate for Payer: Cofinity Commercial |
$2,523.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,347.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,341.24
|
| Rate for Payer: Healthscope Commercial |
$1,508.90
|
| Rate for Payer: Healthscope Commercial |
$2,640.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,200.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,257.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,494.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,425.07
|
| Rate for Payer: PHP Commercial |
$1,425.07
|
| Rate for Payer: PHP Commercial |
$2,494.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,054.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,173.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,552.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,458.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,789.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,022.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,582.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,475.36
|
| Rate for Payer: UHC Core |
$1,399.92
|
| Rate for Payer: UHC Core |
$2,450.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,257.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,200.73
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$33.67
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
32215
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$30.30 |
| Rate for Payer: Aetna Commercial |
$28.62
|
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Aetna Commercial |
$35.34
|
| Rate for Payer: BCBS Trust/PPO |
$32.05
|
| Rate for Payer: BCBS Trust/PPO |
$26.02
|
| Rate for Payer: BCBS Trust/PPO |
$32.13
|
| Rate for Payer: BCN Commercial |
$26.02
|
| Rate for Payer: BCN Commercial |
$32.13
|
| Rate for Payer: BCN Commercial |
$32.05
|
| Rate for Payer: Cash Price |
$26.94
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.26
|
| Rate for Payer: Cofinity Commercial |
$35.76
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$28.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.26
|
| Rate for Payer: Healthscope Commercial |
$37.32
|
| Rate for Payer: Healthscope Commercial |
$30.30
|
| Rate for Payer: Healthscope Commercial |
$37.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.62
|
| Rate for Payer: PHP Commercial |
$35.34
|
| Rate for Payer: PHP Commercial |
$28.62
|
| Rate for Payer: PHP Commercial |
$35.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.49
|
| Rate for Payer: UHC Core |
$34.72
|
| Rate for Payer: UHC Core |
$34.63
|
| Rate for Payer: UHC Core |
$28.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.18
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$190.41
|
|
|
Service Code
|
NDC 70700-268-94
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.13 |
| Max. Negotiated Rate |
$171.37 |
| Rate for Payer: Aetna Commercial |
$161.85
|
| Rate for Payer: BCBS Trust/PPO |
$147.15
|
| Rate for Payer: BCN Commercial |
$147.15
|
| Rate for Payer: Cash Price |
$152.33
|
| Rate for Payer: Cofinity Commercial |
$163.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.33
|
| Rate for Payer: Healthscope Commercial |
$171.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.85
|
| Rate for Payer: PHP Commercial |
$161.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.56
|
| Rate for Payer: UHC Core |
$158.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.81
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
NDC 69097-579-67
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.92 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: BCBS Trust/PPO |
$159.55
|
| Rate for Payer: BCN Commercial |
$159.55
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.49
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.68
|
| Rate for Payer: UHC Core |
$172.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
