|
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
|
|
|
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
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$19.87
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
17764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$17.88 |
| Rate for Payer: Aetna Commercial |
$16.89
|
| Rate for Payer: BCBS Trust/PPO |
$15.36
|
| Rate for Payer: BCN Commercial |
$15.36
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.90
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.89
|
| Rate for Payer: PHP Commercial |
$16.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.49
|
| Rate for Payer: UHC Core |
$16.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.90
|
|
|
FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION
|
Facility
|
IP
|
$53.14
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
88010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.41 |
| Max. Negotiated Rate |
$47.83 |
| Rate for Payer: Aetna Commercial |
$45.17
|
| Rate for Payer: BCBS Trust/PPO |
$41.07
|
| Rate for Payer: BCN Commercial |
$41.07
|
| Rate for Payer: Cash Price |
$42.51
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.51
|
| Rate for Payer: Healthscope Commercial |
$47.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.17
|
| Rate for Payer: PHP Commercial |
$45.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.76
|
| Rate for Payer: UHC Core |
$44.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.86
|
|
|
FRAXEL ARMS - BILATERAL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 00166
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Complete |
$400.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.00
|
|
|
FRAXEL CHEST
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 00155
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: BCBS Complete |
$320.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.00
|
|
|
FRAXEL FACE & NECK
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 00162
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Complete |
$400.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.00
|
|
|
FRAXEL FULL FACE
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 00152
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: BCBS Complete |
$240.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
|
|
FRAXEL HANDS
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 00154
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
|
|
FRAXEL LARGE SCAR
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 00161
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: BCBS Complete |
$320.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.00
|
|
|
FRAXEL MEDIUM SCAR
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 00160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
|
|
FRAXEL NECK
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 00153
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: BCBS Complete |
$160.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
|
|
FRAXEL NECK & CHEST
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 00163
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: BCBS Complete |
$480.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.00
|
|
|
FRAXEL PARTIAL TREATMENT - BILATERAL EYES
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 00157
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
|
|
FRAXEL PARTIAL TREATMENT - PERI-ORAL
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 00156
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.00
|
|
|
FRAXEL PARTIAL TREATMENT - UPPER LIP
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 00158
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
|
|
FRAXEL RESTORE
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 00168
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
|
|
FRAXEL SMALL SCAR
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 00159
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
|
|
FRAXEL STRETCH MARKS - ENTIRE ABDOMEN
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 00165
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: BCBS Complete |
$320.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.00
|
|
|
FRAXEL STRETCH MARKS - PERI-UMBILICAL
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 00164
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: BCBS Complete |
$240.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
|
|
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS, AND/OR FEET; 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,256.10
|
|
|
Service Code
|
CPT 15240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,196.28 |
| Max. Negotiated Rate |
$1,256.10 |
| Rate for Payer: BCBS Complete |
$1,256.10
|
| Rate for Payer: Mclaren Medicaid |
$1,196.28
|
| Rate for Payer: Meridian Medicaid |
$1,256.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,196.28
|
|
|
FUROSEMIDE 10 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$10.94
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
163713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$9.85 |
| Rate for Payer: Aetna Commercial |
$9.30
|
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: BCBS Trust/PPO |
$12.21
|
| Rate for Payer: BCBS Trust/PPO |
$12.91
|
| Rate for Payer: BCBS Trust/PPO |
$8.45
|
| Rate for Payer: BCBS Trust/PPO |
$19.68
|
| Rate for Payer: BCN Commercial |
$12.91
|
| Rate for Payer: BCN Commercial |
$12.21
|
| Rate for Payer: BCN Commercial |
$8.45
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$14.36
|
| Rate for Payer: Cofinity Commercial |
$9.41
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Healthscope Commercial |
$9.85
|
| Rate for Payer: Healthscope Commercial |
$15.03
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.43
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: PHP Commercial |
$14.20
|
| Rate for Payer: PHP Commercial |
$9.30
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.70
|
| Rate for Payer: UHC Core |
$13.94
|
| Rate for Payer: UHC Core |
$13.19
|
| Rate for Payer: UHC Core |
$9.13
|
| Rate for Payer: UHC Core |
$21.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.10
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$15.15
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
3291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$13.64 |
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Commercial |
$9.30
|
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: Aetna Commercial |
$23.96
|
| Rate for Payer: Aetna Commercial |
$9.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.68
|
| Rate for Payer: BCBS Trust/PPO |
$10.63
|
| Rate for Payer: BCBS Trust/PPO |
$11.71
|
| Rate for Payer: BCBS Trust/PPO |
$7.91
|
| Rate for Payer: BCBS Trust/PPO |
$12.21
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCBS Trust/PPO |
$12.91
|
| Rate for Payer: BCBS Trust/PPO |
$8.76
|
| Rate for Payer: BCBS Trust/PPO |
$8.45
|
| Rate for Payer: BCN Commercial |
$12.91
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Commercial |
$12.21
|
| Rate for Payer: BCN Commercial |
$8.45
|
| Rate for Payer: BCN Commercial |
$11.71
|
| Rate for Payer: BCN Commercial |
$10.63
|
| Rate for Payer: BCN Commercial |
$8.76
|
| Rate for Payer: BCN Commercial |
$7.91
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Cash Price |
$9.07
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$9.75
|
| Rate for Payer: Cofinity Commercial |
$9.41
|
| Rate for Payer: Cofinity Commercial |
$14.36
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$24.24
|
| Rate for Payer: Cofinity Commercial |
$8.81
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$25.37
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$9.85
|
| Rate for Payer: Healthscope Commercial |
$13.64
|
| Rate for Payer: Healthscope Commercial |
$15.03
|
| Rate for Payer: Healthscope Commercial |
$9.22
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Healthscope Commercial |
$10.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.64
|
| Rate for Payer: PHP Commercial |
$11.69
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: PHP Commercial |
$23.96
|
| Rate for Payer: PHP Commercial |
$14.20
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: PHP Commercial |
$9.64
|
| Rate for Payer: PHP Commercial |
$8.70
|
| Rate for Payer: PHP Commercial |
$9.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.81
|
| Rate for Payer: UHC Core |
$11.48
|
| Rate for Payer: UHC Core |
$8.55
|
| Rate for Payer: UHC Core |
$13.19
|
| Rate for Payer: UHC Core |
$9.13
|
| Rate for Payer: UHC Core |
$9.47
|
| Rate for Payer: UHC Core |
$12.65
|
| Rate for Payer: UHC Core |
$23.54
|
| Rate for Payer: UHC Core |
$13.94
|
| Rate for Payer: UHC Core |
$21.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.14
|
|
|
FUROSEMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$2.21
|
|
|
Service Code
|
NDC 9900-0003-35
|
| Hospital Charge Code |
3292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna Commercial |
$1.88
|
| Rate for Payer: BCBS Trust/PPO |
$1.71
|
| Rate for Payer: BCN Commercial |
$1.71
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.77
|
| Rate for Payer: Healthscope Commercial |
$1.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.88
|
| Rate for Payer: PHP Commercial |
$1.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.94
|
| Rate for Payer: UHC Core |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.66
|
|
|
FUROSEMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$124.08
|
|
|
Service Code
|
NDC 0054-3294-46
|
| Hospital Charge Code |
3292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.68 |
| Max. Negotiated Rate |
$111.67 |
| Rate for Payer: Aetna Commercial |
$105.47
|
| Rate for Payer: BCBS Trust/PPO |
$95.89
|
| Rate for Payer: BCN Commercial |
$95.89
|
| Rate for Payer: Cash Price |
$99.26
|
| Rate for Payer: Cofinity Commercial |
$106.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.26
|
| Rate for Payer: Healthscope Commercial |
$111.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.47
|
| Rate for Payer: PHP Commercial |
$105.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.19
|
| Rate for Payer: UHC Core |
$103.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.06
|
|
