|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$8.70
|
|
|
Service Code
|
NDC 00121086805
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Aetna Commercial |
$7.39
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.72
|
| Rate for Payer: BCBS Complete |
$1.61
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$7.15
|
| Rate for Payer: BCN Commercial |
$7.15
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$6.96
|
| Rate for Payer: Cofinity Commercial |
$7.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$7.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.53
|
| Rate for Payer: Mclaren Medicaid |
$1.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: Meridian Medicaid |
$1.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.39
|
| Rate for Payer: Nomi Health Commercial |
$7.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.53
|
| Rate for Payer: PACE Senior Care Partners |
$2.07
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$7.39
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.57
|
| Rate for Payer: Priority Health Medicare |
$2.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.06
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.66
|
| Rate for Payer: UHC Core |
$7.26
|
| Rate for Payer: UHC Exchange |
$2.17
|
| Rate for Payer: UHC Medicaid |
$1.53
|
| Rate for Payer: UHC Medicare Advantage |
$2.17
|
| Rate for Payer: UHCCP Medicaid |
$1.53
|
| Rate for Payer: VA VA |
$2.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.53
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.70
|
|
|
Service Code
|
NDC 00121086805
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Aetna Commercial |
$7.39
|
| Rate for Payer: BCBS Trust/PPO |
$7.19
|
| Rate for Payer: BCN Commercial |
$7.19
|
| Rate for Payer: Cash Price |
$6.96
|
| Rate for Payer: Cofinity Commercial |
$7.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.96
|
| Rate for Payer: Healthscope Commercial |
$7.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.39
|
| Rate for Payer: Nomi Health Commercial |
$7.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.53
|
| Rate for Payer: PHP Commercial |
$7.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.66
|
| Rate for Payer: UHC Core |
$7.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.53
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$7.17
|
|
|
Service Code
|
NDC 00904727670
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$6.45 |
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.24
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.79
|
| Rate for Payer: BCBS Trust/PPO |
$5.89
|
| Rate for Payer: BCN Commercial |
$5.89
|
| Rate for Payer: BCN Medicare Advantage |
$1.79
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cofinity Commercial |
$6.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.79
|
| Rate for Payer: Healthscope Commercial |
$6.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.38
|
| Rate for Payer: Mclaren Medicaid |
$1.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.88
|
| Rate for Payer: Meridian Medicaid |
$1.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Nomi Health Commercial |
$5.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.38
|
| Rate for Payer: PACE Senior Care Partners |
$1.70
|
| Rate for Payer: PACE SWMI |
$1.79
|
| Rate for Payer: PHP Commercial |
$6.09
|
| Rate for Payer: PHP Medicare Advantage |
$1.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.24
|
| Rate for Payer: Priority Health Medicare |
$1.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.31
|
| Rate for Payer: UHC Core |
$5.99
|
| Rate for Payer: UHC Exchange |
$1.79
|
| Rate for Payer: UHC Medicaid |
$1.26
|
| Rate for Payer: UHC Medicare Advantage |
$1.79
|
| Rate for Payer: UHCCP Medicaid |
$1.26
|
| Rate for Payer: VA VA |
$1.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.38
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$95.76
|
|
|
Service Code
|
NDC 51672126302
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.65 |
| Max. Negotiated Rate |
$86.18 |
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: BCBS Trust/PPO |
$79.09
|
| Rate for Payer: BCN Commercial |
$79.09
|
| Rate for Payer: Cash Price |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$82.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.61
|
| Rate for Payer: Healthscope Commercial |
$86.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: Nomi Health Commercial |
$78.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.82
|
| Rate for Payer: PHP Commercial |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.27
|
| Rate for Payer: UHC Core |
$79.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.82
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$95.76
|
|
|
Service Code
|
NDC 68462031435
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.65 |
| Max. Negotiated Rate |
$86.18 |
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: BCBS Trust/PPO |
$79.09
|
| Rate for Payer: BCN Commercial |
$79.09
|
| Rate for Payer: Cash Price |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$82.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.61
|
| Rate for Payer: Healthscope Commercial |
$86.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: Nomi Health Commercial |
$78.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.82
|
| Rate for Payer: PHP Commercial |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.27
|
| Rate for Payer: UHC Core |
$79.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.82
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$95.76
|
|
|
Service Code
|
NDC 68462031435
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.88 |
| Max. Negotiated Rate |
$86.18 |
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: Aetna Medicare |
$24.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.93
|
| Rate for Payer: BCBS Complete |
$17.73
|
| Rate for Payer: BCBS MAPPO |
$23.94
|
| Rate for Payer: BCBS Trust/PPO |
$78.72
|
| Rate for Payer: BCN Commercial |
$78.72
|
| Rate for Payer: BCN Medicare Advantage |
$23.94
|
| Rate for Payer: Cash Price |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$82.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.94
|
| Rate for Payer: Healthscope Commercial |
$86.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.82
|
| Rate for Payer: Mclaren Medicaid |
$16.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.14
|
| Rate for Payer: Meridian Medicaid |
$17.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: Nomi Health Commercial |
$78.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.82
|
| Rate for Payer: PACE Senior Care Partners |
$22.74
|
| Rate for Payer: PACE SWMI |
$23.94
|
| Rate for Payer: PHP Commercial |
$81.40
|
| Rate for Payer: PHP Medicare Advantage |
$23.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.31
|
| Rate for Payer: Priority Health Medicare |
$24.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.65
|
| Rate for Payer: Railroad Medicare Medicare |
$23.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.27
|
| Rate for Payer: UHC Core |
$79.96
|
| Rate for Payer: UHC Exchange |
$23.94
|
| Rate for Payer: UHC Medicaid |
$16.88
|
| Rate for Payer: UHC Medicare Advantage |
$23.94
|
| Rate for Payer: UHCCP Medicaid |
$16.88
|
| Rate for Payer: VA VA |
$23.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.82
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$33.71
|
|
|
Service Code
|
NDC 45802088094
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$30.34 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Medicare |
$8.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.53
|
| Rate for Payer: BCBS Complete |
$6.24
|
| Rate for Payer: BCBS MAPPO |
$8.43
|
| Rate for Payer: BCBS Trust/PPO |
$27.71
|
| Rate for Payer: BCN Commercial |
$27.71
|
| Rate for Payer: BCN Medicare Advantage |
$8.43
|
| Rate for Payer: Cash Price |
$26.97
|
| Rate for Payer: Cofinity Commercial |
$28.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.43
|
| Rate for Payer: Healthscope Commercial |
$30.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.28
|
| Rate for Payer: Mclaren Medicaid |
$5.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.85
|
| Rate for Payer: Meridian Medicaid |
$6.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.65
|
| Rate for Payer: Nomi Health Commercial |
$27.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.28
|
| Rate for Payer: PACE Senior Care Partners |
$8.01
|
| Rate for Payer: PACE SWMI |
$8.43
|
| Rate for Payer: PHP Commercial |
$28.65
|
| Rate for Payer: PHP Medicare Advantage |
$8.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.33
|
| Rate for Payer: Priority Health Medicare |
$8.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.46
|
| Rate for Payer: Railroad Medicare Medicare |
$8.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.66
|
| Rate for Payer: UHC Core |
$28.15
|
| Rate for Payer: UHC Exchange |
$8.43
|
| Rate for Payer: UHC Medicaid |
$5.94
|
| Rate for Payer: UHC Medicare Advantage |
$8.43
|
| Rate for Payer: UHCCP Medicaid |
$5.94
|
| Rate for Payer: VA VA |
$8.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.28
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$33.71
|
|
|
Service Code
|
NDC 45802088094
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$30.34 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: BCBS Trust/PPO |
$27.84
|
| Rate for Payer: BCN Commercial |
$27.84
|
| Rate for Payer: Cash Price |
$26.97
|
| Rate for Payer: Cofinity Commercial |
$28.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.97
|
| Rate for Payer: Healthscope Commercial |
$30.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.65
|
| Rate for Payer: Nomi Health Commercial |
$27.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.28
|
| Rate for Payer: PHP Commercial |
$28.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.66
|
| Rate for Payer: UHC Core |
$28.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.28
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$95.76
|
|
|
Service Code
|
NDC 51672126302
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.88 |
| Max. Negotiated Rate |
$86.18 |
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: Aetna Medicare |
$24.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.93
|
| Rate for Payer: BCBS Complete |
$17.73
|
| Rate for Payer: BCBS MAPPO |
$23.94
|
| Rate for Payer: BCBS Trust/PPO |
$78.72
|
| Rate for Payer: BCN Commercial |
$78.72
|
| Rate for Payer: BCN Medicare Advantage |
$23.94
|
| Rate for Payer: Cash Price |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$82.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.94
|
| Rate for Payer: Healthscope Commercial |
$86.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.82
|
| Rate for Payer: Mclaren Medicaid |
$16.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.14
|
| Rate for Payer: Meridian Medicaid |
$17.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: Nomi Health Commercial |
$78.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.82
|
| Rate for Payer: PACE Senior Care Partners |
$22.74
|
| Rate for Payer: PACE SWMI |
$23.94
|
| Rate for Payer: PHP Commercial |
$81.40
|
| Rate for Payer: PHP Medicare Advantage |
$23.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.31
|
| Rate for Payer: Priority Health Medicare |
$24.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.65
|
| Rate for Payer: Railroad Medicare Medicare |
$23.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.27
|
| Rate for Payer: UHC Core |
$79.96
|
| Rate for Payer: UHC Exchange |
$23.94
|
| Rate for Payer: UHC Medicaid |
$16.88
|
| Rate for Payer: UHC Medicare Advantage |
$23.94
|
| Rate for Payer: UHCCP Medicaid |
$16.88
|
| Rate for Payer: VA VA |
$23.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.82
|
|
|
OB/GYN SPEC KZOO ONLY - NITROUS OXIDE ADMIN
|
Professional
|
Both
|
$63.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Aetna Medicare |
$31.50
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.25
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$2,746.46
|
|
|
Service Code
|
APR-DRG 7621
|
| Min. Negotiated Rate |
$2,615.68 |
| Max. Negotiated Rate |
$2,746.46 |
| Rate for Payer: BCBS Complete |
$2,746.46
|
| Rate for Payer: Mclaren Medicaid |
$2,615.68
|
| Rate for Payer: Meridian Medicaid |
$2,746.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,615.68
|
| Rate for Payer: UHC Medicaid |
$2,615.68
|
| Rate for Payer: UHCCP Medicaid |
$2,615.68
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$6,319.55
|
|
|
Service Code
|
APR-DRG 7624
|
| Min. Negotiated Rate |
$6,018.61 |
| Max. Negotiated Rate |
$6,319.55 |
| Rate for Payer: BCBS Complete |
$6,319.55
|
| Rate for Payer: Mclaren Medicaid |
$6,018.61
|
| Rate for Payer: Meridian Medicaid |
$6,319.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,018.61
|
| Rate for Payer: UHC Medicaid |
$6,018.61
|
| Rate for Payer: UHCCP Medicaid |
$6,018.61
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$3,435.31
|
|
|
Service Code
|
APR-DRG 7622
|
| Min. Negotiated Rate |
$3,271.73 |
| Max. Negotiated Rate |
$3,435.31 |
| Rate for Payer: BCBS Complete |
$3,435.31
|
| Rate for Payer: Mclaren Medicaid |
$3,271.73
|
| Rate for Payer: Meridian Medicaid |
$3,435.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,271.73
|
| Rate for Payer: UHC Medicaid |
$3,271.73
|
| Rate for Payer: UHCCP Medicaid |
$3,271.73
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$5,053.85
|
|
|
Service Code
|
APR-DRG 7623
|
| Min. Negotiated Rate |
$4,813.19 |
| Max. Negotiated Rate |
$5,053.85 |
| Rate for Payer: BCBS Complete |
$5,053.85
|
| Rate for Payer: Mclaren Medicaid |
$4,813.19
|
| Rate for Payer: Meridian Medicaid |
$5,053.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,813.19
|
| Rate for Payer: UHC Medicaid |
$4,813.19
|
| Rate for Payer: UHCCP Medicaid |
$4,813.19
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$17.21
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$18.38
|
| Rate for Payer: BCBS Trust/PPO |
$14.21
|
| Rate for Payer: BCBS Trust/PPO |
$20.22
|
| Rate for Payer: BCN Commercial |
$18.38
|
| Rate for Payer: BCN Commercial |
$14.21
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$20.03
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Nomi Health Commercial |
$14.11
|
| Rate for Payer: Nomi Health Commercial |
$18.25
|
| Rate for Payer: Nomi Health Commercial |
$20.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.36
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: PHP Commercial |
$18.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.14
|
| Rate for Payer: UHC Core |
$14.37
|
| Rate for Payer: UHC Core |
$20.44
|
| Rate for Payer: UHC Core |
$18.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.70
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$17.21
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Aetna Medicare |
$4.47
|
| Rate for Payer: Aetna Medicare |
$5.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.65
|
| Rate for Payer: BCBS Complete |
$4.12
|
| Rate for Payer: BCBS Complete |
$3.19
|
| Rate for Payer: BCBS Complete |
$4.53
|
| Rate for Payer: BCBS MAPPO |
$6.12
|
| Rate for Payer: BCBS MAPPO |
$4.30
|
| Rate for Payer: BCBS MAPPO |
$5.57
|
| Rate for Payer: BCBS Trust/PPO |
$14.15
|
| Rate for Payer: BCBS Trust/PPO |
$18.30
|
| Rate for Payer: BCBS Trust/PPO |
$20.13
|
| Rate for Payer: BCN Commercial |
$18.30
|
| Rate for Payer: BCN Commercial |
$20.13
|
| Rate for Payer: BCN Commercial |
$14.15
|
| Rate for Payer: BCN Medicare Advantage |
$6.12
|
| Rate for Payer: BCN Medicare Advantage |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$4.30
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.30
|
| Rate for Payer: Healthscope Commercial |
$20.03
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.70
|
| Rate for Payer: Mclaren Medicaid |
$3.03
|
| Rate for Payer: Mclaren Medicaid |
$4.32
|
| Rate for Payer: Mclaren Medicaid |
$3.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.43
|
| Rate for Payer: Meridian Medicaid |
$4.53
|
| Rate for Payer: Meridian Medicaid |
$3.19
|
| Rate for Payer: Meridian Medicaid |
$4.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.92
|
| Rate for Payer: Nomi Health Commercial |
$20.07
|
| Rate for Payer: Nomi Health Commercial |
$18.25
|
| Rate for Payer: Nomi Health Commercial |
$14.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: PACE Senior Care Partners |
$5.29
|
| Rate for Payer: PACE Senior Care Partners |
$4.09
|
| Rate for Payer: PACE Senior Care Partners |
$5.81
|
| Rate for Payer: PACE SWMI |
$6.12
|
| Rate for Payer: PACE SWMI |
$5.57
|
| Rate for Payer: PACE SWMI |
$4.30
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: PHP Commercial |
$18.92
|
| Rate for Payer: PHP Medicare Advantage |
$5.57
|
| Rate for Payer: PHP Medicare Advantage |
$4.30
|
| Rate for Payer: PHP Medicare Advantage |
$6.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.30
|
| Rate for Payer: Priority Health Medicare |
$6.18
|
| Rate for Payer: Priority Health Medicare |
$5.62
|
| Rate for Payer: Priority Health Medicare |
$4.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.98
|
| Rate for Payer: Railroad Medicare Medicare |
$5.57
|
| Rate for Payer: Railroad Medicare Medicare |
$6.12
|
| Rate for Payer: Railroad Medicare Medicare |
$4.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.14
|
| Rate for Payer: UHC Core |
$14.37
|
| Rate for Payer: UHC Core |
$20.44
|
| Rate for Payer: UHC Core |
$18.59
|
| Rate for Payer: UHC Exchange |
$6.12
|
| Rate for Payer: UHC Exchange |
$5.57
|
| Rate for Payer: UHC Exchange |
$4.30
|
| Rate for Payer: UHC Medicaid |
$3.03
|
| Rate for Payer: UHC Medicaid |
$4.32
|
| Rate for Payer: UHC Medicaid |
$3.92
|
| Rate for Payer: UHC Medicare Advantage |
$5.57
|
| Rate for Payer: UHC Medicare Advantage |
$4.30
|
| Rate for Payer: UHC Medicare Advantage |
$6.12
|
| Rate for Payer: UHCCP Medicaid |
$3.92
|
| Rate for Payer: UHCCP Medicaid |
$3.03
|
| Rate for Payer: UHCCP Medicaid |
$4.32
|
| Rate for Payer: VA VA |
$4.30
|
| Rate for Payer: VA VA |
$6.12
|
| Rate for Payer: VA VA |
$5.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
OFLOXACIN 0.3 % EAR DROPS
|
Facility
|
OP
|
$211.58
|
|
|
Service Code
|
NDC 60505036301
|
| Hospital Charge Code |
22257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.30 |
| Max. Negotiated Rate |
$190.42 |
| Rate for Payer: Aetna Commercial |
$179.84
|
| Rate for Payer: Aetna Medicare |
$55.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.12
|
| Rate for Payer: BCBS Complete |
$39.16
|
| Rate for Payer: BCBS MAPPO |
$52.90
|
| Rate for Payer: BCBS Trust/PPO |
$173.94
|
| Rate for Payer: BCN Commercial |
$173.94
|
| Rate for Payer: BCN Medicare Advantage |
$52.90
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Cofinity Commercial |
$181.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.90
|
| Rate for Payer: Healthscope Commercial |
$190.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.69
|
| Rate for Payer: Mclaren Medicaid |
$37.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.54
|
| Rate for Payer: Meridian Medicaid |
$39.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.84
|
| Rate for Payer: Nomi Health Commercial |
$173.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.69
|
| Rate for Payer: PACE Senior Care Partners |
$50.25
|
| Rate for Payer: PACE SWMI |
$52.90
|
| Rate for Payer: PHP Commercial |
$179.84
|
| Rate for Payer: PHP Medicare Advantage |
$52.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.07
|
| Rate for Payer: Priority Health Medicare |
$53.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.26
|
| Rate for Payer: Railroad Medicare Medicare |
$52.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.19
|
| Rate for Payer: UHC Core |
$176.67
|
| Rate for Payer: UHC Exchange |
$52.90
|
| Rate for Payer: UHC Medicaid |
$37.30
|
| Rate for Payer: UHC Medicare Advantage |
$52.90
|
| Rate for Payer: UHCCP Medicaid |
$37.30
|
| Rate for Payer: VA VA |
$52.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.69
|
|
|
OFLOXACIN 0.3 % EAR DROPS
|
Facility
|
IP
|
$211.58
|
|
|
Service Code
|
NDC 60505036301
|
| Hospital Charge Code |
22257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.26 |
| Max. Negotiated Rate |
$190.42 |
| Rate for Payer: Aetna Commercial |
$179.84
|
| Rate for Payer: BCBS Trust/PPO |
$174.74
|
| Rate for Payer: BCN Commercial |
$174.74
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Cofinity Commercial |
$181.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.26
|
| Rate for Payer: Healthscope Commercial |
$190.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.84
|
| Rate for Payer: Nomi Health Commercial |
$173.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.69
|
| Rate for Payer: PHP Commercial |
$179.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.19
|
| Rate for Payer: UHC Core |
$176.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.69
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$66.54
|
|
|
Service Code
|
NDC 24208043405
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$59.89 |
| Rate for Payer: Aetna Commercial |
$56.56
|
| Rate for Payer: Aetna Medicare |
$17.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.79
|
| Rate for Payer: BCBS Complete |
$12.32
|
| Rate for Payer: BCBS MAPPO |
$16.64
|
| Rate for Payer: BCBS Trust/PPO |
$54.70
|
| Rate for Payer: BCN Commercial |
$54.70
|
| Rate for Payer: BCN Medicare Advantage |
$16.64
|
| Rate for Payer: Cash Price |
$53.23
|
| Rate for Payer: Cofinity Commercial |
$57.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.64
|
| Rate for Payer: Healthscope Commercial |
$59.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.91
|
| Rate for Payer: Mclaren Medicaid |
$11.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.47
|
| Rate for Payer: Meridian Medicaid |
$12.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.56
|
| Rate for Payer: Nomi Health Commercial |
$54.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.91
|
| Rate for Payer: PACE Senior Care Partners |
$15.80
|
| Rate for Payer: PACE SWMI |
$16.64
|
| Rate for Payer: PHP Commercial |
$56.56
|
| Rate for Payer: PHP Medicare Advantage |
$16.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.89
|
| Rate for Payer: Priority Health Medicare |
$16.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.31
|
| Rate for Payer: Railroad Medicare Medicare |
$16.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.56
|
| Rate for Payer: UHC Core |
$55.56
|
| Rate for Payer: UHC Exchange |
$16.64
|
| Rate for Payer: UHC Medicaid |
$11.73
|
| Rate for Payer: UHC Medicare Advantage |
$16.64
|
| Rate for Payer: UHCCP Medicaid |
$11.73
|
| Rate for Payer: VA VA |
$16.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.91
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$48.83
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$43.95 |
| Rate for Payer: Aetna Commercial |
$41.51
|
| Rate for Payer: BCBS Trust/PPO |
$40.33
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$43.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.51
|
| Rate for Payer: Nomi Health Commercial |
$40.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: PHP Commercial |
$41.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.97
|
| Rate for Payer: UHC Core |
$40.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.62
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$31.75
|
|
|
Service Code
|
NDC 17478071310
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$28.57 |
| Rate for Payer: Aetna Commercial |
$26.99
|
| Rate for Payer: Aetna Medicare |
$8.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.92
|
| Rate for Payer: BCBS Complete |
$5.88
|
| Rate for Payer: BCBS MAPPO |
$7.94
|
| Rate for Payer: BCBS Trust/PPO |
$26.10
|
| Rate for Payer: BCN Commercial |
$26.10
|
| Rate for Payer: BCN Medicare Advantage |
$7.94
|
| Rate for Payer: Cash Price |
$25.40
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.94
|
| Rate for Payer: Healthscope Commercial |
$28.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.81
|
| Rate for Payer: Mclaren Medicaid |
$5.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.33
|
| Rate for Payer: Meridian Medicaid |
$5.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.99
|
| Rate for Payer: Nomi Health Commercial |
$26.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.81
|
| Rate for Payer: PACE Senior Care Partners |
$7.54
|
| Rate for Payer: PACE SWMI |
$7.94
|
| Rate for Payer: PHP Commercial |
$26.99
|
| Rate for Payer: PHP Medicare Advantage |
$7.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.62
|
| Rate for Payer: Priority Health Medicare |
$8.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.10
|
| Rate for Payer: Railroad Medicare Medicare |
$7.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.94
|
| Rate for Payer: UHC Core |
$26.51
|
| Rate for Payer: UHC Exchange |
$7.94
|
| Rate for Payer: UHC Medicaid |
$5.60
|
| Rate for Payer: UHC Medicare Advantage |
$7.94
|
| Rate for Payer: UHCCP Medicaid |
$5.60
|
| Rate for Payer: VA VA |
$7.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.81
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$66.54
|
|
|
Service Code
|
NDC 24208043405
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.31 |
| Max. Negotiated Rate |
$59.89 |
| Rate for Payer: Aetna Commercial |
$56.56
|
| Rate for Payer: BCBS Trust/PPO |
$54.96
|
| Rate for Payer: BCN Commercial |
$54.96
|
| Rate for Payer: Cash Price |
$53.23
|
| Rate for Payer: Cofinity Commercial |
$57.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.23
|
| Rate for Payer: Healthscope Commercial |
$59.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.56
|
| Rate for Payer: Nomi Health Commercial |
$54.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.91
|
| Rate for Payer: PHP Commercial |
$56.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.56
|
| Rate for Payer: UHC Core |
$55.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.91
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$31.29
|
|
|
Service Code
|
NDC 70756060730
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$28.16 |
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna Medicare |
$8.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.78
|
| Rate for Payer: BCBS Complete |
$5.79
|
| Rate for Payer: BCBS MAPPO |
$7.82
|
| Rate for Payer: BCBS Trust/PPO |
$25.72
|
| Rate for Payer: BCN Commercial |
$25.72
|
| Rate for Payer: BCN Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cofinity Commercial |
$26.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$28.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.47
|
| Rate for Payer: Mclaren Medicaid |
$5.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.21
|
| Rate for Payer: Meridian Medicaid |
$5.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.60
|
| Rate for Payer: Nomi Health Commercial |
$25.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.47
|
| Rate for Payer: PACE Senior Care Partners |
$7.43
|
| Rate for Payer: PACE SWMI |
$7.82
|
| Rate for Payer: PHP Commercial |
$26.60
|
| Rate for Payer: PHP Medicare Advantage |
$7.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.22
|
| Rate for Payer: Priority Health Medicare |
$7.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.78
|
| Rate for Payer: Railroad Medicare Medicare |
$7.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.54
|
| Rate for Payer: UHC Core |
$26.13
|
| Rate for Payer: UHC Exchange |
$7.82
|
| Rate for Payer: UHC Medicaid |
$5.52
|
| Rate for Payer: UHC Medicare Advantage |
$7.82
|
| Rate for Payer: UHCCP Medicaid |
$5.52
|
| Rate for Payer: VA VA |
$7.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.47
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$48.83
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$43.95 |
| Rate for Payer: Aetna Commercial |
$41.51
|
| Rate for Payer: Aetna Medicare |
$12.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.26
|
| Rate for Payer: BCBS Complete |
$9.04
|
| Rate for Payer: BCBS MAPPO |
$12.21
|
| Rate for Payer: BCBS Trust/PPO |
$40.14
|
| Rate for Payer: BCN Commercial |
$40.14
|
| Rate for Payer: BCN Medicare Advantage |
$12.21
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.21
|
| Rate for Payer: Healthscope Commercial |
$43.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.62
|
| Rate for Payer: Mclaren Medicaid |
$8.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.82
|
| Rate for Payer: Meridian Medicaid |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.51
|
| Rate for Payer: Nomi Health Commercial |
$40.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: PACE Senior Care Partners |
$11.60
|
| Rate for Payer: PACE SWMI |
$12.21
|
| Rate for Payer: PHP Commercial |
$41.51
|
| Rate for Payer: PHP Medicare Advantage |
$12.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.48
|
| Rate for Payer: Priority Health Medicare |
$12.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.99
|
| Rate for Payer: Railroad Medicare Medicare |
$12.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.97
|
| Rate for Payer: UHC Core |
$40.77
|
| Rate for Payer: UHC Exchange |
$12.21
|
| Rate for Payer: UHC Medicaid |
$8.61
|
| Rate for Payer: UHC Medicare Advantage |
$12.21
|
| Rate for Payer: UHCCP Medicaid |
$8.61
|
| Rate for Payer: VA VA |
$12.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.62
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$126.42
|
|
|
Service Code
|
NDC 24208043410
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.29 |
| Max. Negotiated Rate |
$113.78 |
| Rate for Payer: Aetna Commercial |
$107.46
|
| Rate for Payer: Aetna Medicare |
$32.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.51
|
| Rate for Payer: BCBS Complete |
$23.40
|
| Rate for Payer: BCBS MAPPO |
$31.61
|
| Rate for Payer: BCBS Trust/PPO |
$103.93
|
| Rate for Payer: BCN Commercial |
$103.93
|
| Rate for Payer: BCN Medicare Advantage |
$31.61
|
| Rate for Payer: Cash Price |
$101.14
|
| Rate for Payer: Cofinity Commercial |
$108.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.61
|
| Rate for Payer: Healthscope Commercial |
$113.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.81
|
| Rate for Payer: Mclaren Medicaid |
$22.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.19
|
| Rate for Payer: Meridian Medicaid |
$23.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.46
|
| Rate for Payer: Nomi Health Commercial |
$103.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.81
|
| Rate for Payer: PACE Senior Care Partners |
$30.02
|
| Rate for Payer: PACE SWMI |
$31.61
|
| Rate for Payer: PHP Commercial |
$107.46
|
| Rate for Payer: PHP Medicare Advantage |
$31.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$109.99
|
| Rate for Payer: Priority Health Medicare |
$31.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.99
|
| Rate for Payer: Railroad Medicare Medicare |
$31.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.25
|
| Rate for Payer: UHC Core |
$105.56
|
| Rate for Payer: UHC Exchange |
$31.61
|
| Rate for Payer: UHC Medicaid |
$22.29
|
| Rate for Payer: UHC Medicare Advantage |
$31.61
|
| Rate for Payer: UHCCP Medicaid |
$22.29
|
| Rate for Payer: VA VA |
$31.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.81
|
|
