|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$45.49
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$40.94 |
| Rate for Payer: Aetna Commercial |
$38.67
|
| Rate for Payer: Aetna Commercial |
$15.11
|
| Rate for Payer: BCBS Trust/PPO |
$35.15
|
| Rate for Payer: BCBS Trust/PPO |
$13.74
|
| Rate for Payer: BCN Commercial |
$35.15
|
| Rate for Payer: BCN Commercial |
$13.74
|
| Rate for Payer: Cash Price |
$36.39
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$40.94
|
| Rate for Payer: Healthscope Commercial |
$16.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.11
|
| Rate for Payer: PHP Commercial |
$15.11
|
| Rate for Payer: PHP Commercial |
$38.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.03
|
| Rate for Payer: UHC Core |
$14.85
|
| Rate for Payer: UHC Core |
$37.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.34
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$27.70
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$24.93 |
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Commercial |
$24.42
|
| Rate for Payer: BCBS Trust/PPO |
$22.20
|
| Rate for Payer: BCBS Trust/PPO |
$21.41
|
| Rate for Payer: BCBS Trust/PPO |
$22.46
|
| Rate for Payer: BCN Commercial |
$22.46
|
| Rate for Payer: BCN Commercial |
$21.41
|
| Rate for Payer: BCN Commercial |
$22.20
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Commercial |
$24.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.98
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Healthscope Commercial |
$25.86
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.70
|
| Rate for Payer: PHP Commercial |
$24.70
|
| Rate for Payer: PHP Commercial |
$23.54
|
| Rate for Payer: PHP Commercial |
$24.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.57
|
| Rate for Payer: UHC Core |
$23.13
|
| Rate for Payer: UHC Core |
$24.27
|
| Rate for Payer: UHC Core |
$23.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$25.05
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$22.54 |
| Rate for Payer: Aetna Commercial |
$21.29
|
| Rate for Payer: Aetna Commercial |
$30.96
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Commercial |
$30.91
|
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: Aetna Commercial |
$28.54
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: BCBS Trust/PPO |
$19.68
|
| Rate for Payer: BCBS Trust/PPO |
$19.45
|
| Rate for Payer: BCBS Trust/PPO |
$25.95
|
| Rate for Payer: BCBS Trust/PPO |
$28.10
|
| Rate for Payer: BCBS Trust/PPO |
$20.83
|
| Rate for Payer: BCBS Trust/PPO |
$19.36
|
| Rate for Payer: BCBS Trust/PPO |
$28.15
|
| Rate for Payer: BCN Commercial |
$28.10
|
| Rate for Payer: BCN Commercial |
$28.15
|
| Rate for Payer: BCN Commercial |
$25.95
|
| Rate for Payer: BCN Commercial |
$19.45
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Commercial |
$20.83
|
| Rate for Payer: BCN Commercial |
$19.36
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cash Price |
$20.04
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Cofinity Commercial |
$31.27
|
| Rate for Payer: Cofinity Commercial |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$28.88
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.57
|
| Rate for Payer: Healthscope Commercial |
$24.26
|
| Rate for Payer: Healthscope Commercial |
$32.72
|
| Rate for Payer: Healthscope Commercial |
$32.78
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Healthscope Commercial |
$22.54
|
| Rate for Payer: Healthscope Commercial |
$30.22
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.65
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$30.96
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: PHP Commercial |
$28.54
|
| Rate for Payer: PHP Commercial |
$21.29
|
| Rate for Payer: PHP Commercial |
$30.91
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.05
|
| Rate for Payer: UHC Core |
$21.27
|
| Rate for Payer: UHC Core |
$28.04
|
| Rate for Payer: UHC Core |
$30.41
|
| Rate for Payer: UHC Core |
$30.36
|
| Rate for Payer: UHC Core |
$21.02
|
| Rate for Payer: UHC Core |
$20.92
|
| Rate for Payer: UHC Core |
$22.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.10
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
IP
|
$29.06
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.72 |
| Max. Negotiated Rate |
$26.15 |
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: BCBS Trust/PPO |
$22.46
|
| Rate for Payer: BCN Commercial |
$22.46
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.25
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.70
|
| Rate for Payer: PHP Commercial |
$24.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.57
|
| Rate for Payer: UHC Core |
$24.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
|
|
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
|
Facility
OP
|
$2,229.50
|
|
|
Service Code
|
CPT 28820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,123.34 |
| Max. Negotiated Rate |
$2,229.50 |
| Rate for Payer: BCBS Complete |
$2,229.50
|
| Rate for Payer: Mclaren Medicaid |
$2,123.34
|
| Rate for Payer: Meridian Medicaid |
$2,229.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,123.34
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
IP
|
$81.78
|
|
|
Service Code
|
NDC 16729-035-10
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.88 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$69.51
|
| Rate for Payer: BCBS Trust/PPO |
$63.20
|
| Rate for Payer: BCN Commercial |
$63.20
|
| Rate for Payer: Cash Price |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$70.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.42
|
| Rate for Payer: Healthscope Commercial |
$73.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.51
|
| Rate for Payer: PHP Commercial |
$69.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.97
|
| Rate for Payer: UHC Core |
$68.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.34
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
IP
|
$4.05
|
|
|
Service Code
|
NDC 60687-112-11
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: BCBS Trust/PPO |
$3.13
|
| Rate for Payer: BCN Commercial |
$3.13
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$3.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.56
|
| Rate for Payer: UHC Core |
$3.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
IP
|
$121.40
|
|
|
Service Code
|
NDC 60687-112-21
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.04 |
| Max. Negotiated Rate |
$109.26 |
| Rate for Payer: Aetna Commercial |
$103.19
|
| Rate for Payer: BCBS Trust/PPO |
$93.82
|
| Rate for Payer: BCN Commercial |
$93.82
|
| Rate for Payer: Cash Price |
$97.12
|
| Rate for Payer: Cofinity Commercial |
$104.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.12
|
| Rate for Payer: Healthscope Commercial |
$109.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.19
|
| Rate for Payer: PHP Commercial |
$103.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.83
|
| Rate for Payer: UHC Core |
$101.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.05
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$140.31
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
88093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.58 |
| Max. Negotiated Rate |
$126.28 |
| Rate for Payer: Aetna Commercial |
$119.26
|
| Rate for Payer: BCBS Trust/PPO |
$108.43
|
| Rate for Payer: BCN Commercial |
$108.43
|
| Rate for Payer: Cash Price |
$112.25
|
| Rate for Payer: Cofinity Commercial |
$120.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.25
|
| Rate for Payer: Healthscope Commercial |
$126.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.26
|
| Rate for Payer: PHP Commercial |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.47
|
| Rate for Payer: UHC Core |
$117.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.23
|
|
|
ANORECTAL EXAM, SURGICAL, REQUIRING ANESTHESIA (GENERAL, SPINAL, OR EPIDURAL), DIAGNOSTIC
|
Facility
OP
|
$1,933.98
|
|
|
Service Code
|
CPT 45990
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,841.89 |
| Max. Negotiated Rate |
$1,933.98 |
| Rate for Payer: BCBS Complete |
$1,933.98
|
| Rate for Payer: Mclaren Medicaid |
$1,841.89
|
| Rate for Payer: Meridian Medicaid |
$1,933.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,841.89
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,200 UNIT INTRAVENOUS SOLUTION
|
Facility
IP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.31
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.39
|
| Rate for Payer: UHC Core |
$2.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 2,400 UNIT INTRAVENOUS SOLUTION
|
Facility
IP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.31
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.39
|
| Rate for Payer: UHC Core |
$2.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
IP
|
$669.60
|
|
|
Service Code
|
NDC 0003-0893-31
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$408.39 |
| Max. Negotiated Rate |
$602.64 |
| Rate for Payer: Aetna Commercial |
$569.16
|
| Rate for Payer: BCBS Trust/PPO |
$517.47
|
| Rate for Payer: BCN Commercial |
$517.47
|
| Rate for Payer: Cash Price |
$535.68
|
| Rate for Payer: Cofinity Commercial |
$575.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.68
|
| Rate for Payer: Healthscope Commercial |
$602.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$569.16
|
| Rate for Payer: PHP Commercial |
$569.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$582.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$408.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$589.25
|
| Rate for Payer: UHC Core |
$559.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.20
|
|
|
APIXABAN 5 MG TABLET
|
Facility
IP
|
$669.60
|
|
|
Service Code
|
NDC 0003-0894-31
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$408.39 |
| Max. Negotiated Rate |
$602.64 |
| Rate for Payer: Aetna Commercial |
$569.16
|
| Rate for Payer: BCBS Trust/PPO |
$517.47
|
| Rate for Payer: BCN Commercial |
$517.47
|
| Rate for Payer: Cash Price |
$535.68
|
| Rate for Payer: Cofinity Commercial |
$575.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.68
|
| Rate for Payer: Healthscope Commercial |
$602.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$569.16
|
| Rate for Payer: PHP Commercial |
$569.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$582.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$408.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$589.25
|
| Rate for Payer: UHC Core |
$559.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.20
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
IP
|
$169.69
|
|
|
Service Code
|
NDC 13668-591-80
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.49 |
| Max. Negotiated Rate |
$152.72 |
| Rate for Payer: Aetna Commercial |
$144.24
|
| Rate for Payer: BCBS Trust/PPO |
$131.14
|
| Rate for Payer: BCN Commercial |
$131.14
|
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: Cofinity Commercial |
$145.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.75
|
| Rate for Payer: Healthscope Commercial |
$152.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.24
|
| Rate for Payer: PHP Commercial |
$144.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.33
|
| Rate for Payer: UHC Core |
$141.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.27
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
IP
|
$169.69
|
|
|
Service Code
|
NDC 13668-591-81
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.49 |
| Max. Negotiated Rate |
$152.72 |
| Rate for Payer: Aetna Commercial |
$144.24
|
| Rate for Payer: BCBS Trust/PPO |
$131.14
|
| Rate for Payer: BCN Commercial |
$131.14
|
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: Cofinity Commercial |
$145.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.75
|
| Rate for Payer: Healthscope Commercial |
$152.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.24
|
| Rate for Payer: PHP Commercial |
$144.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.33
|
| Rate for Payer: UHC Core |
$141.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.27
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
IP
|
$907.84
|
|
|
Service Code
|
NDC 13668-591-82
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$553.69 |
| Max. Negotiated Rate |
$817.06 |
| Rate for Payer: Aetna Commercial |
$771.66
|
| Rate for Payer: BCBS Trust/PPO |
$701.58
|
| Rate for Payer: BCN Commercial |
$701.58
|
| Rate for Payer: Cash Price |
$726.27
|
| Rate for Payer: Cofinity Commercial |
$780.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$726.27
|
| Rate for Payer: Healthscope Commercial |
$817.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$680.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$771.66
|
| Rate for Payer: PHP Commercial |
$771.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$789.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$553.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$798.90
|
| Rate for Payer: UHC Core |
$758.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$680.88
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
IP
|
$255.38
|
|
|
Service Code
|
NDC 0781-2321-06
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.76 |
| Max. Negotiated Rate |
$229.84 |
| Rate for Payer: Aetna Commercial |
$217.07
|
| Rate for Payer: BCBS Trust/PPO |
$197.36
|
| Rate for Payer: BCN Commercial |
$197.36
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cofinity Commercial |
$219.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.30
|
| Rate for Payer: Healthscope Commercial |
$229.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.07
|
| Rate for Payer: PHP Commercial |
$217.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.73
|
| Rate for Payer: UHC Core |
$213.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.54
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
IP
|
$1,276.73
|
|
|
Service Code
|
NDC 0781-2321-51
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$778.68 |
| Max. Negotiated Rate |
$1,149.06 |
| Rate for Payer: Aetna Commercial |
$1,085.22
|
| Rate for Payer: BCBS Trust/PPO |
$986.66
|
| Rate for Payer: BCN Commercial |
$986.66
|
| Rate for Payer: Cash Price |
$1,021.38
|
| Rate for Payer: Cofinity Commercial |
$1,097.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.38
|
| Rate for Payer: Healthscope Commercial |
$1,149.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,085.22
|
| Rate for Payer: PHP Commercial |
$1,085.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$893.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,110.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$778.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.52
|
| Rate for Payer: UHC Core |
$1,066.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.55
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
IP
|
$199.16
|
|
|
Service Code
|
NDC 60505-3075-3
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.47 |
| Max. Negotiated Rate |
$179.24 |
| Rate for Payer: Aetna Commercial |
$169.29
|
| Rate for Payer: BCBS Trust/PPO |
$153.91
|
| Rate for Payer: BCN Commercial |
$153.91
|
| Rate for Payer: Cash Price |
$159.33
|
| Rate for Payer: Cofinity Commercial |
$171.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.33
|
| Rate for Payer: Healthscope Commercial |
$179.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.29
|
| Rate for Payer: PHP Commercial |
$169.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.26
|
| Rate for Payer: UHC Core |
$166.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.37
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
IP
|
$627.60
|
|
|
Service Code
|
NDC 0904-6509-04
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$382.77 |
| Max. Negotiated Rate |
$564.84 |
| Rate for Payer: Aetna Commercial |
$533.46
|
| Rate for Payer: BCBS Trust/PPO |
$485.01
|
| Rate for Payer: BCN Commercial |
$485.01
|
| Rate for Payer: Cash Price |
$502.08
|
| Rate for Payer: Cofinity Commercial |
$539.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$502.08
|
| Rate for Payer: Healthscope Commercial |
$564.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$470.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$533.46
|
| Rate for Payer: PHP Commercial |
$533.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$382.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.29
|
| Rate for Payer: UHC Core |
$524.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$470.70
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
IP
|
$103.64
|
|
|
Service Code
|
NDC 65162-896-03
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.21 |
| Max. Negotiated Rate |
$93.28 |
| Rate for Payer: Aetna Commercial |
$88.09
|
| Rate for Payer: BCBS Trust/PPO |
$80.09
|
| Rate for Payer: BCN Commercial |
$80.09
|
| Rate for Payer: Cash Price |
$82.91
|
| Rate for Payer: Cofinity Commercial |
$89.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.91
|
| Rate for Payer: Healthscope Commercial |
$93.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.09
|
| Rate for Payer: PHP Commercial |
$88.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.20
|
| Rate for Payer: UHC Core |
$86.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.73
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
IP
|
$2,008.88
|
|
|
Service Code
|
NDC 59148-006-13
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,225.22 |
| Max. Negotiated Rate |
$1,807.99 |
| Rate for Payer: Aetna Commercial |
$1,707.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,552.46
|
| Rate for Payer: BCN Commercial |
$1,552.46
|
| Rate for Payer: Cash Price |
$1,607.10
|
| Rate for Payer: Cofinity Commercial |
$1,727.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,607.10
|
| Rate for Payer: Healthscope Commercial |
$1,807.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,506.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,707.55
|
| Rate for Payer: PHP Commercial |
$1,707.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,406.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,747.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,225.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,767.81
|
| Rate for Payer: UHC Core |
$1,677.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.66
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
IP
|
$225.72
|
|
|
Service Code
|
NDC 65162-897-09
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.67 |
| Max. Negotiated Rate |
$203.15 |
| Rate for Payer: Aetna Commercial |
$191.86
|
| Rate for Payer: BCBS Trust/PPO |
$174.44
|
| Rate for Payer: BCN Commercial |
$174.44
|
| Rate for Payer: Cash Price |
$180.58
|
| Rate for Payer: Cofinity Commercial |
$194.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.58
|
| Rate for Payer: Healthscope Commercial |
$203.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.86
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.63
|
| Rate for Payer: UHC Core |
$188.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.29
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
IP
|
$93.75
|
|
|
Service Code
|
NDC 27241-052-03
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.18 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Aetna Commercial |
$79.69
|
| Rate for Payer: BCBS Trust/PPO |
$72.45
|
| Rate for Payer: BCN Commercial |
$72.45
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cofinity Commercial |
$80.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$84.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.69
|
| Rate for Payer: PHP Commercial |
$79.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.50
|
| Rate for Payer: UHC Core |
$78.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.31
|
|
