|
IPL FACE SECOND
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 00131
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
|
|
IPL HANDS & ARMS FIRST
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 00136
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
|
|
IPL HANDS & ARMS SECOND
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 00137
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Aetna Medicare |
$115.00
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
|
|
IPL NECK
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 00138
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
|
|
IPL NOSE & CHEEKS FIRST
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00127
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN
|
Facility
|
OP
|
$2.43
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
30510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Medicare |
$0.75
|
| Rate for Payer: Aetna Medicare |
$0.63
|
| Rate for Payer: Aetna Medicare |
$0.76
|
| Rate for Payer: Aetna Medicare |
$1.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.76
|
| Rate for Payer: BCBS Complete |
$0.97
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS Complete |
$1.77
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$0.61
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS MAPPO |
$1.10
|
| Rate for Payer: BCBS MAPPO |
$0.74
|
| Rate for Payer: BCBS Trust/PPO |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCBS Trust/PPO |
$2.38
|
| Rate for Payer: BCBS Trust/PPO |
$2.42
|
| Rate for Payer: BCN Commercial |
$1.89
|
| Rate for Payer: BCN Commercial |
$2.29
|
| Rate for Payer: BCN Commercial |
$2.25
|
| Rate for Payer: BCN Commercial |
$3.44
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| Rate for Payer: BCN Medicare Advantage |
$1.10
|
| Rate for Payer: BCN Medicare Advantage |
$0.61
|
| Rate for Payer: BCN Medicare Advantage |
$0.74
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$3.98
|
| Rate for Payer: Healthscope Commercial |
$2.65
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.50
|
| Rate for Payer: Nomi Health Commercial |
$2.41
|
| Rate for Payer: Nomi Health Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$1.99
|
| Rate for Payer: Nomi Health Commercial |
$2.38
|
| Rate for Payer: PACE Senior Care Partners |
$0.58
|
| Rate for Payer: PACE Senior Care Partners |
$0.70
|
| Rate for Payer: PACE Senior Care Partners |
$1.05
|
| Rate for Payer: PACE Senior Care Partners |
$0.69
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PACE SWMI |
$0.61
|
| Rate for Payer: PACE SWMI |
$0.74
|
| Rate for Payer: PACE SWMI |
$1.10
|
| Rate for Payer: PHP Commercial |
$2.50
|
| Rate for Payer: PHP Commercial |
$3.76
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: PHP Medicare Advantage |
$0.61
|
| Rate for Payer: PHP Medicare Advantage |
$1.10
|
| Rate for Payer: PHP Medicare Advantage |
$0.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.58
|
| Rate for Payer: Priority Health HMO/PPO |
$2.52
|
| Rate for Payer: Priority Health HMO/PPO |
$3.85
|
| Rate for Payer: Priority Health HMO/PPO |
$2.56
|
| Rate for Payer: Priority Health HMO/PPO |
$2.11
|
| Rate for Payer: Priority Health Medicare |
$0.74
|
| Rate for Payer: Priority Health Medicare |
$0.61
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: Priority Health Medicare |
$1.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.63
|
| Rate for Payer: Railroad Medicare Medicare |
$0.73
|
| Rate for Payer: Railroad Medicare Medicare |
$0.74
|
| Rate for Payer: Railroad Medicare Medicare |
$0.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.55
|
| Rate for Payer: UHC Core |
$2.03
|
| Rate for Payer: UHC Core |
$3.69
|
| Rate for Payer: UHC Core |
$2.42
|
| Rate for Payer: UHC Core |
$2.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.73
|
| Rate for Payer: UHC Exchange |
$1.10
|
| Rate for Payer: UHC Exchange |
$0.73
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.74
|
| Rate for Payer: UHC Medicare Advantage |
$1.10
|
| Rate for Payer: UHC Medicare Advantage |
$0.61
|
| Rate for Payer: UHC Medicare Advantage |
$0.74
|
| Rate for Payer: UHC Medicare Advantage |
$0.73
|
| Rate for Payer: VA VA |
$0.73
|
| Rate for Payer: VA VA |
$1.10
|
| Rate for Payer: VA VA |
$0.74
|
| Rate for Payer: VA VA |
$0.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.21
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN
|
Facility
|
IP
|
$2.94
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
30510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$3.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCBS Trust/PPO |
$1.98
|
| Rate for Payer: BCN Commercial |
$2.27
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: BCN Commercial |
$3.42
|
| Rate for Payer: BCN Commercial |
$2.24
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$3.98
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: Healthscope Commercial |
$2.65
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.76
|
| Rate for Payer: Nomi Health Commercial |
$1.99
|
| Rate for Payer: Nomi Health Commercial |
$2.38
|
| Rate for Payer: Nomi Health Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$2.41
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: PHP Commercial |
$2.50
|
| Rate for Payer: PHP Commercial |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.91
|
| Rate for Payer: Priority Health HMO/PPO |
$2.56
|
| Rate for Payer: Priority Health HMO/PPO |
$3.85
|
| Rate for Payer: Priority Health HMO/PPO |
$2.11
|
| Rate for Payer: Priority Health HMO/PPO |
$2.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.59
|
| Rate for Payer: UHC Core |
$2.45
|
| Rate for Payer: UHC Core |
$3.69
|
| Rate for Payer: UHC Core |
$2.42
|
| Rate for Payer: UHC Core |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.21
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
12580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Aetna Commercial |
$5.10
|
| Rate for Payer: Aetna Medicare |
$2.28
|
| Rate for Payer: Aetna Medicare |
$1.19
|
| Rate for Payer: Aetna Medicare |
$1.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.74
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS Complete |
$3.50
|
| Rate for Payer: BCBS MAPPO |
$2.19
|
| Rate for Payer: BCBS MAPPO |
$1.15
|
| Rate for Payer: BCBS MAPPO |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$4.93
|
| Rate for Payer: BCBS Trust/PPO |
$3.77
|
| Rate for Payer: BCBS Trust/PPO |
$7.20
|
| Rate for Payer: BCN Commercial |
$4.67
|
| Rate for Payer: BCN Commercial |
$6.81
|
| Rate for Payer: BCN Commercial |
$3.57
|
| Rate for Payer: BCN Medicare Advantage |
$1.15
|
| Rate for Payer: BCN Medicare Advantage |
$1.50
|
| Rate for Payer: BCN Medicare Advantage |
$2.19
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$7.53
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Cofinity Commercial |
$5.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.15
|
| Rate for Payer: Healthscope Commercial |
$5.40
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Healthscope Commercial |
$7.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$7.18
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Nomi Health Commercial |
$4.92
|
| Rate for Payer: PACE Senior Care Partners |
$2.08
|
| Rate for Payer: PACE Senior Care Partners |
$1.09
|
| Rate for Payer: PACE Senior Care Partners |
$1.43
|
| Rate for Payer: PACE SWMI |
$1.50
|
| Rate for Payer: PACE SWMI |
$1.15
|
| Rate for Payer: PACE SWMI |
$2.19
|
| Rate for Payer: PHP Commercial |
$7.45
|
| Rate for Payer: PHP Commercial |
$5.10
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: PHP Medicare Advantage |
$1.50
|
| Rate for Payer: PHP Medicare Advantage |
$2.19
|
| Rate for Payer: PHP Medicare Advantage |
$1.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: Priority Health HMO/PPO |
$7.62
|
| Rate for Payer: Priority Health HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health HMO/PPO |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$1.16
|
| Rate for Payer: Priority Health Medicare |
$2.21
|
| Rate for Payer: Priority Health Medicare |
$1.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1.50
|
| Rate for Payer: Railroad Medicare Medicare |
$2.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$7.31
|
| Rate for Payer: UHC Core |
$5.01
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.50
|
| Rate for Payer: UHC Exchange |
$1.50
|
| Rate for Payer: UHC Exchange |
$1.15
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Medicare Advantage |
$1.15
|
| Rate for Payer: UHC Medicare Advantage |
$1.50
|
| Rate for Payer: UHC Medicare Advantage |
$2.19
|
| Rate for Payer: VA VA |
$1.50
|
| Rate for Payer: VA VA |
$2.19
|
| Rate for Payer: VA VA |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.50
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
12580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Commercial |
$5.10
|
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.75
|
| Rate for Payer: BCBS Trust/PPO |
$7.15
|
| Rate for Payer: BCN Commercial |
$4.64
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: BCN Commercial |
$6.77
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$7.53
|
| Rate for Payer: Cofinity Commercial |
$5.16
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.01
|
| Rate for Payer: Healthscope Commercial |
$5.40
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Healthscope Commercial |
$7.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.45
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Nomi Health Commercial |
$4.92
|
| Rate for Payer: Nomi Health Commercial |
$7.18
|
| Rate for Payer: PHP Commercial |
$5.10
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$7.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: Priority Health HMO/PPO |
$7.62
|
| Rate for Payer: Priority Health HMO/PPO |
$5.22
|
| Rate for Payer: Priority Health HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: UHC Core |
$7.31
|
| Rate for Payer: UHC Core |
$5.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.50
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY
|
Facility
|
OP
|
$61.95
|
|
|
Service Code
|
NDC 69238201603
|
| Hospital Charge Code |
16070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$55.76 |
| Rate for Payer: Aetna Commercial |
$52.66
|
| Rate for Payer: Aetna Medicare |
$16.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.36
|
| Rate for Payer: BCBS Complete |
$24.78
|
| Rate for Payer: BCBS MAPPO |
$15.49
|
| Rate for Payer: BCBS Trust/PPO |
$50.93
|
| Rate for Payer: BCN Commercial |
$48.17
|
| Rate for Payer: BCN Medicare Advantage |
$15.49
|
| Rate for Payer: Cash Price |
$49.56
|
| Rate for Payer: Cofinity Commercial |
$53.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$55.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.66
|
| Rate for Payer: Nomi Health Commercial |
$50.80
|
| Rate for Payer: PACE Senior Care Partners |
$14.71
|
| Rate for Payer: PACE SWMI |
$15.49
|
| Rate for Payer: PHP Commercial |
$52.66
|
| Rate for Payer: PHP Medicare Advantage |
$15.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.27
|
| Rate for Payer: Priority Health HMO/PPO |
$53.90
|
| Rate for Payer: Priority Health Medicare |
$15.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.51
|
| Rate for Payer: Railroad Medicare Medicare |
$15.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.52
|
| Rate for Payer: UHC Core |
$51.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.49
|
| Rate for Payer: UHC Exchange |
$15.49
|
| Rate for Payer: UHC Medicare Advantage |
$15.49
|
| Rate for Payer: VA VA |
$15.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.46
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
NDC 00054004544
|
| Hospital Charge Code |
16070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.93 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Medicare |
$32.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.38
|
| Rate for Payer: BCBS Complete |
$50.40
|
| Rate for Payer: BCBS MAPPO |
$31.50
|
| Rate for Payer: BCBS Trust/PPO |
$103.58
|
| Rate for Payer: BCN Commercial |
$97.97
|
| Rate for Payer: BCN Medicare Advantage |
$31.50
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$108.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.50
|
| Rate for Payer: Healthscope Commercial |
$113.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.10
|
| Rate for Payer: Nomi Health Commercial |
$103.32
|
| Rate for Payer: PACE Senior Care Partners |
$29.93
|
| Rate for Payer: PACE SWMI |
$31.50
|
| Rate for Payer: PHP Commercial |
$107.10
|
| Rate for Payer: PHP Medicare Advantage |
$31.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health HMO/PPO |
$109.62
|
| Rate for Payer: Priority Health Medicare |
$31.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.42
|
| Rate for Payer: Railroad Medicare Medicare |
$31.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.88
|
| Rate for Payer: UHC Core |
$105.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.50
|
| Rate for Payer: UHC Exchange |
$31.50
|
| Rate for Payer: UHC Medicare Advantage |
$31.50
|
| Rate for Payer: VA VA |
$31.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.50
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
NDC 00054004544
|
| Hospital Charge Code |
16070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: BCBS Trust/PPO |
$102.85
|
| Rate for Payer: BCN Commercial |
$97.37
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$108.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.80
|
| Rate for Payer: Healthscope Commercial |
$113.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.10
|
| Rate for Payer: Nomi Health Commercial |
$103.32
|
| Rate for Payer: PHP Commercial |
$107.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health HMO/PPO |
$109.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.88
|
| Rate for Payer: UHC Core |
$105.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.50
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY
|
Facility
|
IP
|
$61.95
|
|
|
Service Code
|
NDC 69238201603
|
| Hospital Charge Code |
16070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.27 |
| Max. Negotiated Rate |
$55.76 |
| Rate for Payer: Aetna Commercial |
$52.66
|
| Rate for Payer: BCBS Trust/PPO |
$50.57
|
| Rate for Payer: BCN Commercial |
$47.87
|
| Rate for Payer: Cash Price |
$49.56
|
| Rate for Payer: Cofinity Commercial |
$53.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.56
|
| Rate for Payer: Healthscope Commercial |
$55.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.66
|
| Rate for Payer: Nomi Health Commercial |
$50.80
|
| Rate for Payer: PHP Commercial |
$52.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.27
|
| Rate for Payer: Priority Health HMO/PPO |
$53.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.52
|
| Rate for Payer: UHC Core |
$51.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.46
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$161.68
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$145.51 |
| Rate for Payer: Aetna Commercial |
$137.43
|
| Rate for Payer: Aetna Medicare |
$42.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.52
|
| Rate for Payer: BCBS Complete |
$13.75
|
| Rate for Payer: BCBS MAPPO |
$40.42
|
| Rate for Payer: BCBS Trust/PPO |
$132.92
|
| Rate for Payer: BCN Commercial |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$40.42
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cofinity Commercial |
$139.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.42
|
| Rate for Payer: Healthscope Commercial |
$145.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.26
|
| Rate for Payer: Mclaren Medicaid |
$13.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.44
|
| Rate for Payer: Meridian Medicaid |
$13.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.43
|
| Rate for Payer: Nomi Health Commercial |
$132.58
|
| Rate for Payer: PACE Senior Care Partners |
$38.40
|
| Rate for Payer: PACE SWMI |
$40.42
|
| Rate for Payer: PHP Commercial |
$137.43
|
| Rate for Payer: PHP Medicare Advantage |
$40.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.09
|
| Rate for Payer: Priority Health HMO/PPO |
$140.66
|
| Rate for Payer: Priority Health Medicare |
$40.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.33
|
| Rate for Payer: Railroad Medicare Medicare |
$40.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.28
|
| Rate for Payer: UHC Core |
$135.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.42
|
| Rate for Payer: UHC Exchange |
$40.42
|
| Rate for Payer: UHC Medicare Advantage |
$40.42
|
| Rate for Payer: UHCCP Medicaid |
$13.09
|
| Rate for Payer: VA VA |
$40.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.26
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$161.68
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$145.51 |
| Rate for Payer: Aetna Commercial |
$137.43
|
| Rate for Payer: BCBS Trust/PPO |
$131.98
|
| Rate for Payer: BCN Commercial |
$124.95
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cofinity Commercial |
$139.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.34
|
| Rate for Payer: Healthscope Commercial |
$145.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.43
|
| Rate for Payer: Nomi Health Commercial |
$132.58
|
| Rate for Payer: PHP Commercial |
$137.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.09
|
| Rate for Payer: Priority Health HMO/PPO |
$140.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.28
|
| Rate for Payer: UHC Core |
$135.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.26
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$154.04
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.58 |
| Max. Negotiated Rate |
$138.64 |
| Rate for Payer: Aetna Commercial |
$130.93
|
| Rate for Payer: Aetna Medicare |
$40.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.14
|
| Rate for Payer: BCBS Complete |
$61.62
|
| Rate for Payer: BCBS MAPPO |
$38.51
|
| Rate for Payer: BCBS Trust/PPO |
$126.64
|
| Rate for Payer: BCN Commercial |
$119.77
|
| Rate for Payer: BCN Medicare Advantage |
$38.51
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cofinity Commercial |
$132.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.51
|
| Rate for Payer: Healthscope Commercial |
$138.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.93
|
| Rate for Payer: Nomi Health Commercial |
$126.31
|
| Rate for Payer: PACE Senior Care Partners |
$36.58
|
| Rate for Payer: PACE SWMI |
$38.51
|
| Rate for Payer: PHP Commercial |
$130.93
|
| Rate for Payer: PHP Medicare Advantage |
$38.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.13
|
| Rate for Payer: Priority Health HMO/PPO |
$134.01
|
| Rate for Payer: Priority Health Medicare |
$38.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.21
|
| Rate for Payer: Railroad Medicare Medicare |
$38.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.56
|
| Rate for Payer: UHC Core |
$128.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.51
|
| Rate for Payer: UHC Exchange |
$38.51
|
| Rate for Payer: UHC Medicare Advantage |
$38.51
|
| Rate for Payer: VA VA |
$38.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.53
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$154.04
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.13 |
| Max. Negotiated Rate |
$138.64 |
| Rate for Payer: Aetna Commercial |
$130.93
|
| Rate for Payer: BCBS Trust/PPO |
$125.74
|
| Rate for Payer: BCN Commercial |
$119.04
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cofinity Commercial |
$132.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.23
|
| Rate for Payer: Healthscope Commercial |
$138.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.93
|
| Rate for Payer: Nomi Health Commercial |
$126.31
|
| Rate for Payer: PHP Commercial |
$130.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.13
|
| Rate for Payer: Priority Health HMO/PPO |
$134.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.56
|
| Rate for Payer: UHC Core |
$128.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.53
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
OP
|
$79.55
|
|
|
Service Code
|
NDC 10019036040
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.89 |
| Max. Negotiated Rate |
$71.59 |
| Rate for Payer: Aetna Commercial |
$67.62
|
| Rate for Payer: Aetna Medicare |
$20.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.86
|
| Rate for Payer: BCBS Complete |
$31.82
|
| Rate for Payer: BCBS MAPPO |
$19.89
|
| Rate for Payer: BCBS Trust/PPO |
$65.40
|
| Rate for Payer: BCN Commercial |
$61.85
|
| Rate for Payer: BCN Medicare Advantage |
$19.89
|
| Rate for Payer: Cash Price |
$63.64
|
| Rate for Payer: Cofinity Commercial |
$68.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.89
|
| Rate for Payer: Healthscope Commercial |
$71.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.62
|
| Rate for Payer: Nomi Health Commercial |
$65.23
|
| Rate for Payer: PACE Senior Care Partners |
$18.89
|
| Rate for Payer: PACE SWMI |
$19.89
|
| Rate for Payer: PHP Commercial |
$67.62
|
| Rate for Payer: PHP Medicare Advantage |
$19.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health HMO/PPO |
$69.21
|
| Rate for Payer: Priority Health Medicare |
$20.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.30
|
| Rate for Payer: Railroad Medicare Medicare |
$19.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.00
|
| Rate for Payer: UHC Core |
$66.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.89
|
| Rate for Payer: UHC Exchange |
$19.89
|
| Rate for Payer: UHC Medicare Advantage |
$19.89
|
| Rate for Payer: VA VA |
$19.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.66
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$52.91
|
|
|
Service Code
|
NDC 66794001910
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.39 |
| Max. Negotiated Rate |
$47.62 |
| Rate for Payer: Aetna Commercial |
$44.97
|
| Rate for Payer: BCBS Trust/PPO |
$43.19
|
| Rate for Payer: BCN Commercial |
$40.89
|
| Rate for Payer: Cash Price |
$42.33
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.33
|
| Rate for Payer: Healthscope Commercial |
$47.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.97
|
| Rate for Payer: Nomi Health Commercial |
$43.39
|
| Rate for Payer: PHP Commercial |
$44.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.39
|
| Rate for Payer: Priority Health HMO/PPO |
$46.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.56
|
| Rate for Payer: UHC Core |
$44.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.68
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$79.55
|
|
|
Service Code
|
NDC 10019036040
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.71 |
| Max. Negotiated Rate |
$71.59 |
| Rate for Payer: Aetna Commercial |
$67.62
|
| Rate for Payer: BCBS Trust/PPO |
$64.94
|
| Rate for Payer: BCN Commercial |
$61.48
|
| Rate for Payer: Cash Price |
$63.64
|
| Rate for Payer: Cofinity Commercial |
$68.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.64
|
| Rate for Payer: Healthscope Commercial |
$71.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.62
|
| Rate for Payer: Nomi Health Commercial |
$65.23
|
| Rate for Payer: PHP Commercial |
$67.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health HMO/PPO |
$69.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.00
|
| Rate for Payer: UHC Core |
$66.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.66
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$106.38
|
|
|
Service Code
|
NDC 66794001925
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.15 |
| Max. Negotiated Rate |
$95.74 |
| Rate for Payer: Aetna Commercial |
$90.42
|
| Rate for Payer: BCBS Trust/PPO |
$86.84
|
| Rate for Payer: BCN Commercial |
$82.21
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Cofinity Commercial |
$91.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.10
|
| Rate for Payer: Healthscope Commercial |
$95.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.42
|
| Rate for Payer: Nomi Health Commercial |
$87.23
|
| Rate for Payer: PHP Commercial |
$90.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.15
|
| Rate for Payer: Priority Health HMO/PPO |
$92.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.61
|
| Rate for Payer: UHC Core |
$88.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.78
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
OP
|
$52.91
|
|
|
Service Code
|
NDC 66794001910
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$47.62 |
| Rate for Payer: Aetna Commercial |
$44.97
|
| Rate for Payer: Aetna Medicare |
$13.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.53
|
| Rate for Payer: BCBS Complete |
$21.16
|
| Rate for Payer: BCBS MAPPO |
$13.23
|
| Rate for Payer: BCBS Trust/PPO |
$43.50
|
| Rate for Payer: BCN Commercial |
$41.14
|
| Rate for Payer: BCN Medicare Advantage |
$13.23
|
| Rate for Payer: Cash Price |
$42.33
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.23
|
| Rate for Payer: Healthscope Commercial |
$47.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.97
|
| Rate for Payer: Nomi Health Commercial |
$43.39
|
| Rate for Payer: PACE Senior Care Partners |
$12.57
|
| Rate for Payer: PACE SWMI |
$13.23
|
| Rate for Payer: PHP Commercial |
$44.97
|
| Rate for Payer: PHP Medicare Advantage |
$13.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.39
|
| Rate for Payer: Priority Health HMO/PPO |
$46.03
|
| Rate for Payer: Priority Health Medicare |
$13.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.45
|
| Rate for Payer: Railroad Medicare Medicare |
$13.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.56
|
| Rate for Payer: UHC Core |
$44.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.23
|
| Rate for Payer: UHC Exchange |
$13.23
|
| Rate for Payer: UHC Medicare Advantage |
$13.23
|
| Rate for Payer: VA VA |
$13.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.68
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
OP
|
$106.38
|
|
|
Service Code
|
NDC 66794001925
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$95.74 |
| Rate for Payer: Aetna Commercial |
$90.42
|
| Rate for Payer: Aetna Medicare |
$27.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.24
|
| Rate for Payer: BCBS Complete |
$42.55
|
| Rate for Payer: BCBS MAPPO |
$26.59
|
| Rate for Payer: BCBS Trust/PPO |
$87.45
|
| Rate for Payer: BCN Commercial |
$82.71
|
| Rate for Payer: BCN Medicare Advantage |
$26.59
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Cofinity Commercial |
$91.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.59
|
| Rate for Payer: Healthscope Commercial |
$95.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.42
|
| Rate for Payer: Nomi Health Commercial |
$87.23
|
| Rate for Payer: PACE Senior Care Partners |
$25.27
|
| Rate for Payer: PACE SWMI |
$26.59
|
| Rate for Payer: PHP Commercial |
$90.42
|
| Rate for Payer: PHP Medicare Advantage |
$26.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.15
|
| Rate for Payer: Priority Health HMO/PPO |
$92.55
|
| Rate for Payer: Priority Health Medicare |
$26.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.27
|
| Rate for Payer: Railroad Medicare Medicare |
$26.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.61
|
| Rate for Payer: UHC Core |
$88.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.59
|
| Rate for Payer: UHC Exchange |
$26.59
|
| Rate for Payer: UHC Medicare Advantage |
$26.59
|
| Rate for Payer: VA VA |
$26.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.78
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$428.45
|
|
|
Service Code
|
NDC 00904661961
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.76 |
| Max. Negotiated Rate |
$385.61 |
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna Medicare |
$111.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.89
|
| Rate for Payer: BCBS Complete |
$171.38
|
| Rate for Payer: BCBS MAPPO |
$107.11
|
| Rate for Payer: BCBS Trust/PPO |
$352.23
|
| Rate for Payer: BCN Commercial |
$333.12
|
| Rate for Payer: BCN Medicare Advantage |
$107.11
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.11
|
| Rate for Payer: Healthscope Commercial |
$385.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Nomi Health Commercial |
$351.33
|
| Rate for Payer: PACE Senior Care Partners |
$101.76
|
| Rate for Payer: PACE SWMI |
$107.11
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: PHP Medicare Advantage |
$107.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: Priority Health HMO/PPO |
$372.75
|
| Rate for Payer: Priority Health Medicare |
$108.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.06
|
| Rate for Payer: Railroad Medicare Medicare |
$107.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.04
|
| Rate for Payer: UHC Core |
$357.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.11
|
| Rate for Payer: UHC Exchange |
$107.11
|
| Rate for Payer: UHC Medicare Advantage |
$107.11
|
| Rate for Payer: VA VA |
$107.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$262.08
|
|
|
Service Code
|
NDC 63739056910
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.35 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Aetna Commercial |
$222.77
|
| Rate for Payer: BCBS Trust/PPO |
$213.94
|
| Rate for Payer: BCN Commercial |
$202.54
|
| Rate for Payer: Cash Price |
$209.66
|
| Rate for Payer: Cofinity Commercial |
$225.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.66
|
| Rate for Payer: Healthscope Commercial |
$235.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.77
|
| Rate for Payer: Nomi Health Commercial |
$214.91
|
| Rate for Payer: PHP Commercial |
$222.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.35
|
| Rate for Payer: Priority Health HMO/PPO |
$228.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.63
|
| Rate for Payer: UHC Core |
$218.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.56
|
|
