|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.11
|
|
|
Service Code
|
NDC 51991098317
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: Aetna Medicare |
$6.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.85
|
| Rate for Payer: BCBS Complete |
$10.04
|
| Rate for Payer: BCBS MAPPO |
$6.28
|
| Rate for Payer: BCBS Trust/PPO |
$20.64
|
| Rate for Payer: BCN Commercial |
$19.52
|
| Rate for Payer: BCN Medicare Advantage |
$6.28
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Cofinity Commercial |
$21.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.28
|
| Rate for Payer: Healthscope Commercial |
$22.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.34
|
| Rate for Payer: Nomi Health Commercial |
$20.59
|
| Rate for Payer: PACE Senior Care Partners |
$5.96
|
| Rate for Payer: PACE SWMI |
$6.28
|
| Rate for Payer: PHP Commercial |
$21.34
|
| Rate for Payer: PHP Medicare Advantage |
$6.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.32
|
| Rate for Payer: Priority Health HMO/PPO |
$21.85
|
| Rate for Payer: Priority Health Medicare |
$6.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.10
|
| Rate for Payer: UHC Core |
$20.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.28
|
| Rate for Payer: UHC Exchange |
$6.28
|
| Rate for Payer: UHC Medicare Advantage |
$6.28
|
| Rate for Payer: VA VA |
$6.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.83
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.11
|
|
|
Service Code
|
NDC 51991098317
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: BCBS Trust/PPO |
$20.50
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Cofinity Commercial |
$21.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.09
|
| Rate for Payer: Healthscope Commercial |
$22.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.34
|
| Rate for Payer: Nomi Health Commercial |
$20.59
|
| Rate for Payer: PHP Commercial |
$21.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.32
|
| Rate for Payer: Priority Health HMO/PPO |
$21.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.10
|
| Rate for Payer: UHC Core |
$20.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.83
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.59
|
|
|
Service Code
|
NDC 00703115303
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.48 |
| Max. Negotiated Rate |
$67.13 |
| Rate for Payer: Aetna Commercial |
$63.40
|
| Rate for Payer: BCBS Trust/PPO |
$60.89
|
| Rate for Payer: BCN Commercial |
$57.64
|
| Rate for Payer: Cash Price |
$59.67
|
| Rate for Payer: Cofinity Commercial |
$64.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.67
|
| Rate for Payer: Healthscope Commercial |
$67.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.40
|
| Rate for Payer: Nomi Health Commercial |
$61.16
|
| Rate for Payer: PHP Commercial |
$63.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.48
|
| Rate for Payer: Priority Health HMO/PPO |
$64.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.64
|
| Rate for Payer: UHC Core |
$62.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.94
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.59
|
|
|
Service Code
|
NDC 00703115301
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.72 |
| Max. Negotiated Rate |
$67.13 |
| Rate for Payer: Aetna Commercial |
$63.40
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.31
|
| Rate for Payer: BCBS Complete |
$29.84
|
| Rate for Payer: BCBS MAPPO |
$18.65
|
| Rate for Payer: BCBS Trust/PPO |
$61.32
|
| Rate for Payer: BCN Commercial |
$57.99
|
| Rate for Payer: BCN Medicare Advantage |
$18.65
|
| Rate for Payer: Cash Price |
$59.67
|
| Rate for Payer: Cofinity Commercial |
$64.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.65
|
| Rate for Payer: Healthscope Commercial |
$67.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.40
|
| Rate for Payer: Nomi Health Commercial |
$61.16
|
| Rate for Payer: PACE Senior Care Partners |
$17.72
|
| Rate for Payer: PACE SWMI |
$18.65
|
| Rate for Payer: PHP Commercial |
$63.40
|
| Rate for Payer: PHP Medicare Advantage |
$18.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.48
|
| Rate for Payer: Priority Health HMO/PPO |
$64.89
|
| Rate for Payer: Priority Health Medicare |
$18.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.98
|
| Rate for Payer: Railroad Medicare Medicare |
$18.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.64
|
| Rate for Payer: UHC Core |
$62.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.65
|
| Rate for Payer: UHC Exchange |
$18.65
|
| Rate for Payer: UHC Medicare Advantage |
$18.65
|
| Rate for Payer: VA VA |
$18.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.94
|
|
|
NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) INFUSION
|
Facility
|
OP
|
$28.25
|
|
|
Service Code
|
NDC 44567064110
|
| Hospital Charge Code |
119763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$25.43 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna Medicare |
$7.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.83
|
| Rate for Payer: BCBS Complete |
$11.30
|
| Rate for Payer: BCBS MAPPO |
$7.06
|
| Rate for Payer: BCBS Trust/PPO |
$23.22
|
| Rate for Payer: BCN Commercial |
$21.96
|
| Rate for Payer: BCN Medicare Advantage |
$7.06
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.06
|
| Rate for Payer: Healthscope Commercial |
$25.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Nomi Health Commercial |
$23.16
|
| Rate for Payer: PACE Senior Care Partners |
$6.71
|
| Rate for Payer: PACE SWMI |
$7.06
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: PHP Medicare Advantage |
$7.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.36
|
| Rate for Payer: Priority Health HMO/PPO |
$24.58
|
| Rate for Payer: Priority Health Medicare |
$7.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.93
|
| Rate for Payer: Railroad Medicare Medicare |
$7.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.86
|
| Rate for Payer: UHC Core |
$23.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.06
|
| Rate for Payer: UHC Exchange |
$7.06
|
| Rate for Payer: UHC Medicare Advantage |
$7.06
|
| Rate for Payer: VA VA |
$7.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.19
|
|
|
NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) INFUSION
|
Facility
|
IP
|
$28.25
|
|
|
Service Code
|
NDC 44567064101
|
| Hospital Charge Code |
119763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$25.43 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: BCBS Trust/PPO |
$23.06
|
| Rate for Payer: BCN Commercial |
$21.83
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$25.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Nomi Health Commercial |
$23.16
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.36
|
| Rate for Payer: Priority Health HMO/PPO |
$24.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.86
|
| Rate for Payer: UHC Core |
$23.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.19
|
|
|
NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) INFUSION
|
Facility
|
OP
|
$28.25
|
|
|
Service Code
|
NDC 44567064101
|
| Hospital Charge Code |
119763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$25.43 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna Medicare |
$7.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.83
|
| Rate for Payer: BCBS Complete |
$11.30
|
| Rate for Payer: BCBS MAPPO |
$7.06
|
| Rate for Payer: BCBS Trust/PPO |
$23.22
|
| Rate for Payer: BCN Commercial |
$21.96
|
| Rate for Payer: BCN Medicare Advantage |
$7.06
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.06
|
| Rate for Payer: Healthscope Commercial |
$25.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Nomi Health Commercial |
$23.16
|
| Rate for Payer: PACE Senior Care Partners |
$6.71
|
| Rate for Payer: PACE SWMI |
$7.06
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: PHP Medicare Advantage |
$7.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.36
|
| Rate for Payer: Priority Health HMO/PPO |
$24.58
|
| Rate for Payer: Priority Health Medicare |
$7.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.93
|
| Rate for Payer: Railroad Medicare Medicare |
$7.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.86
|
| Rate for Payer: UHC Core |
$23.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.06
|
| Rate for Payer: UHC Exchange |
$7.06
|
| Rate for Payer: UHC Medicare Advantage |
$7.06
|
| Rate for Payer: VA VA |
$7.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.19
|
|
|
NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) INFUSION
|
Facility
|
IP
|
$28.25
|
|
|
Service Code
|
NDC 44567064110
|
| Hospital Charge Code |
119763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$25.43 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: BCBS Trust/PPO |
$23.06
|
| Rate for Payer: BCN Commercial |
$21.83
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$25.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Nomi Health Commercial |
$23.16
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.36
|
| Rate for Payer: Priority Health HMO/PPO |
$24.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.86
|
| Rate for Payer: UHC Core |
$23.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.19
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$3.66
|
|
|
Service Code
|
NDC 50268060411
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna Commercial |
$3.11
|
| Rate for Payer: BCBS Trust/PPO |
$2.99
|
| Rate for Payer: BCN Commercial |
$2.83
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$3.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.11
|
| Rate for Payer: Nomi Health Commercial |
$3.00
|
| Rate for Payer: PHP Commercial |
$3.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.38
|
| Rate for Payer: Priority Health HMO/PPO |
$3.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.22
|
| Rate for Payer: UHC Core |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
OP
|
$3.57
|
|
|
Service Code
|
NDC 60687029311
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna Medicare |
$0.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.12
|
| Rate for Payer: BCBS Complete |
$1.43
|
| Rate for Payer: BCBS MAPPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$2.93
|
| Rate for Payer: BCN Commercial |
$2.78
|
| Rate for Payer: BCN Medicare Advantage |
$0.89
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.89
|
| Rate for Payer: Healthscope Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: Nomi Health Commercial |
$2.93
|
| Rate for Payer: PACE Senior Care Partners |
$0.85
|
| Rate for Payer: PACE SWMI |
$0.89
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: PHP Medicare Advantage |
$0.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.32
|
| Rate for Payer: Priority Health HMO/PPO |
$3.11
|
| Rate for Payer: Priority Health Medicare |
$0.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.39
|
| Rate for Payer: Railroad Medicare Medicare |
$0.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.14
|
| Rate for Payer: UHC Core |
$2.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.89
|
| Rate for Payer: UHC Exchange |
$0.89
|
| Rate for Payer: UHC Medicare Advantage |
$0.89
|
| Rate for Payer: VA VA |
$0.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.68
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$3.57
|
|
|
Service Code
|
NDC 60687029311
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: BCBS Trust/PPO |
$2.91
|
| Rate for Payer: BCN Commercial |
$2.76
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.86
|
| Rate for Payer: Healthscope Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: Nomi Health Commercial |
$2.93
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.32
|
| Rate for Payer: Priority Health HMO/PPO |
$3.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.14
|
| Rate for Payer: UHC Core |
$2.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.68
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
OP
|
$356.25
|
|
|
Service Code
|
NDC 60687029301
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.61 |
| Max. Negotiated Rate |
$320.62 |
| Rate for Payer: Aetna Commercial |
$302.81
|
| Rate for Payer: Aetna Medicare |
$92.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.33
|
| Rate for Payer: BCBS Complete |
$142.50
|
| Rate for Payer: BCBS MAPPO |
$89.06
|
| Rate for Payer: BCBS Trust/PPO |
$292.87
|
| Rate for Payer: BCN Commercial |
$276.98
|
| Rate for Payer: BCN Medicare Advantage |
$89.06
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cofinity Commercial |
$306.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.06
|
| Rate for Payer: Healthscope Commercial |
$320.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.81
|
| Rate for Payer: Nomi Health Commercial |
$292.12
|
| Rate for Payer: PACE Senior Care Partners |
$84.61
|
| Rate for Payer: PACE SWMI |
$89.06
|
| Rate for Payer: PHP Commercial |
$302.81
|
| Rate for Payer: PHP Medicare Advantage |
$89.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.56
|
| Rate for Payer: Priority Health HMO/PPO |
$309.94
|
| Rate for Payer: Priority Health Medicare |
$89.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.69
|
| Rate for Payer: Railroad Medicare Medicare |
$89.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.50
|
| Rate for Payer: UHC Core |
$297.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.06
|
| Rate for Payer: UHC Exchange |
$89.06
|
| Rate for Payer: UHC Medicare Advantage |
$89.06
|
| Rate for Payer: VA VA |
$89.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.19
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$356.25
|
|
|
Service Code
|
NDC 60687029301
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.56 |
| Max. Negotiated Rate |
$320.62 |
| Rate for Payer: Aetna Commercial |
$302.81
|
| Rate for Payer: BCBS Trust/PPO |
$290.81
|
| Rate for Payer: BCN Commercial |
$275.31
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cofinity Commercial |
$306.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.00
|
| Rate for Payer: Healthscope Commercial |
$320.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.81
|
| Rate for Payer: Nomi Health Commercial |
$292.12
|
| Rate for Payer: PHP Commercial |
$302.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.56
|
| Rate for Payer: Priority Health HMO/PPO |
$309.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.50
|
| Rate for Payer: UHC Core |
$297.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.19
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$182.88
|
|
|
Service Code
|
NDC 50268060415
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.87 |
| Max. Negotiated Rate |
$164.59 |
| Rate for Payer: Aetna Commercial |
$155.45
|
| Rate for Payer: BCBS Trust/PPO |
$149.28
|
| Rate for Payer: BCN Commercial |
$141.33
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$157.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.30
|
| Rate for Payer: Healthscope Commercial |
$164.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.45
|
| Rate for Payer: Nomi Health Commercial |
$149.96
|
| Rate for Payer: PHP Commercial |
$155.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.87
|
| Rate for Payer: Priority Health HMO/PPO |
$159.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.93
|
| Rate for Payer: UHC Core |
$152.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.16
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
NDC 51672400201
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: BCBS Trust/PPO |
$168.81
|
| Rate for Payer: BCN Commercial |
$159.82
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: Nomi Health Commercial |
$169.58
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| Rate for Payer: Priority Health HMO/PPO |
$179.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.98
|
| Rate for Payer: UHC Core |
$172.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
OP
|
$206.80
|
|
|
Service Code
|
NDC 51672400201
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.12 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: Aetna Medicare |
$53.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.62
|
| Rate for Payer: BCBS Complete |
$82.72
|
| Rate for Payer: BCBS MAPPO |
$51.70
|
| Rate for Payer: BCBS Trust/PPO |
$170.01
|
| Rate for Payer: BCN Commercial |
$160.79
|
| Rate for Payer: BCN Medicare Advantage |
$51.70
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.70
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: Nomi Health Commercial |
$169.58
|
| Rate for Payer: PACE Senior Care Partners |
$49.12
|
| Rate for Payer: PACE SWMI |
$51.70
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: PHP Medicare Advantage |
$51.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| Rate for Payer: Priority Health HMO/PPO |
$179.92
|
| Rate for Payer: Priority Health Medicare |
$52.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.56
|
| Rate for Payer: Railroad Medicare Medicare |
$51.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.98
|
| Rate for Payer: UHC Core |
$172.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.70
|
| Rate for Payer: UHC Exchange |
$51.70
|
| Rate for Payer: UHC Medicare Advantage |
$51.70
|
| Rate for Payer: VA VA |
$51.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
OP
|
$3.66
|
|
|
Service Code
|
NDC 50268060411
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna Commercial |
$3.11
|
| Rate for Payer: Aetna Medicare |
$0.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.14
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: BCBS MAPPO |
$0.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.01
|
| Rate for Payer: BCN Commercial |
$2.85
|
| Rate for Payer: BCN Medicare Advantage |
$0.92
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.92
|
| Rate for Payer: Healthscope Commercial |
$3.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.11
|
| Rate for Payer: Nomi Health Commercial |
$3.00
|
| Rate for Payer: PACE Senior Care Partners |
$0.87
|
| Rate for Payer: PACE SWMI |
$0.92
|
| Rate for Payer: PHP Commercial |
$3.11
|
| Rate for Payer: PHP Medicare Advantage |
$0.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.38
|
| Rate for Payer: Priority Health HMO/PPO |
$3.18
|
| Rate for Payer: Priority Health Medicare |
$0.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.45
|
| Rate for Payer: Railroad Medicare Medicare |
$0.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.22
|
| Rate for Payer: UHC Core |
$3.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.92
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UHC Medicare Advantage |
$0.92
|
| Rate for Payer: VA VA |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
OP
|
$182.88
|
|
|
Service Code
|
NDC 50268060415
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.43 |
| Max. Negotiated Rate |
$164.59 |
| Rate for Payer: Aetna Commercial |
$155.45
|
| Rate for Payer: Aetna Medicare |
$47.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.15
|
| Rate for Payer: BCBS Complete |
$73.15
|
| Rate for Payer: BCBS MAPPO |
$45.72
|
| Rate for Payer: BCBS Trust/PPO |
$150.35
|
| Rate for Payer: BCN Commercial |
$142.19
|
| Rate for Payer: BCN Medicare Advantage |
$45.72
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$157.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.72
|
| Rate for Payer: Healthscope Commercial |
$164.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.45
|
| Rate for Payer: Nomi Health Commercial |
$149.96
|
| Rate for Payer: PACE Senior Care Partners |
$43.43
|
| Rate for Payer: PACE SWMI |
$45.72
|
| Rate for Payer: PHP Commercial |
$155.45
|
| Rate for Payer: PHP Medicare Advantage |
$45.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.87
|
| Rate for Payer: Priority Health HMO/PPO |
$159.11
|
| Rate for Payer: Priority Health Medicare |
$46.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.53
|
| Rate for Payer: Railroad Medicare Medicare |
$45.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.93
|
| Rate for Payer: UHC Core |
$152.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.72
|
| Rate for Payer: UHC Exchange |
$45.72
|
| Rate for Payer: UHC Medicare Advantage |
$45.72
|
| Rate for Payer: VA VA |
$45.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.16
|
|
|
NOVASOURCE RENAL CONTINUOUS FEED
|
Facility
|
OP
|
$6.83
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
168945
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: Aetna Medicare |
$1.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.13
|
| Rate for Payer: BCBS Complete |
$2.73
|
| Rate for Payer: BCBS MAPPO |
$1.71
|
| Rate for Payer: BCBS Trust/PPO |
$5.61
|
| Rate for Payer: BCN Commercial |
$5.31
|
| Rate for Payer: BCN Medicare Advantage |
$1.71
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.71
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.81
|
| Rate for Payer: Nomi Health Commercial |
$5.60
|
| Rate for Payer: PACE Senior Care Partners |
$1.62
|
| Rate for Payer: PACE SWMI |
$1.71
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: PHP Medicare Advantage |
$1.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.44
|
| Rate for Payer: Priority Health HMO/PPO |
$5.94
|
| Rate for Payer: Priority Health Medicare |
$1.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.01
|
| Rate for Payer: UHC Core |
$5.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.71
|
| Rate for Payer: UHC Exchange |
$1.71
|
| Rate for Payer: UHC Medicare Advantage |
$1.71
|
| Rate for Payer: VA VA |
$1.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
NOVASOURCE RENAL CONTINUOUS FEED
|
Facility
|
IP
|
$6.83
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
168945
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: BCBS Trust/PPO |
$5.58
|
| Rate for Payer: BCN Commercial |
$5.28
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.81
|
| Rate for Payer: Nomi Health Commercial |
$5.60
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.44
|
| Rate for Payer: Priority Health HMO/PPO |
$5.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.01
|
| Rate for Payer: UHC Core |
$5.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
NOVASOURCE RENAL INTERMITTENT FEED
|
Facility
|
OP
|
$6.83
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
200086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: Aetna Medicare |
$1.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.13
|
| Rate for Payer: BCBS Complete |
$2.73
|
| Rate for Payer: BCBS MAPPO |
$1.71
|
| Rate for Payer: BCBS Trust/PPO |
$5.61
|
| Rate for Payer: BCN Commercial |
$5.31
|
| Rate for Payer: BCN Medicare Advantage |
$1.71
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.71
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.81
|
| Rate for Payer: Nomi Health Commercial |
$5.60
|
| Rate for Payer: PACE Senior Care Partners |
$1.62
|
| Rate for Payer: PACE SWMI |
$1.71
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: PHP Medicare Advantage |
$1.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.44
|
| Rate for Payer: Priority Health HMO/PPO |
$5.94
|
| Rate for Payer: Priority Health Medicare |
$1.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.01
|
| Rate for Payer: UHC Core |
$5.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.71
|
| Rate for Payer: UHC Exchange |
$1.71
|
| Rate for Payer: UHC Medicare Advantage |
$1.71
|
| Rate for Payer: VA VA |
$1.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
NOVASOURCE RENAL INTERMITTENT FEED
|
Facility
|
IP
|
$6.83
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
200086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: BCBS Trust/PPO |
$5.58
|
| Rate for Payer: BCN Commercial |
$5.28
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.81
|
| Rate for Payer: Nomi Health Commercial |
$5.60
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.44
|
| Rate for Payer: Priority Health HMO/PPO |
$5.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.01
|
| Rate for Payer: UHC Core |
$5.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
NURSING CASE MANAGEMENT
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS RN001
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM
|
Facility
|
IP
|
$24.99
|
|
|
Service Code
|
NDC 45802005911
|
| Hospital Charge Code |
5749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.24 |
| Max. Negotiated Rate |
$22.49 |
| Rate for Payer: Aetna Commercial |
$21.24
|
| Rate for Payer: BCBS Trust/PPO |
$20.40
|
| Rate for Payer: BCN Commercial |
$19.31
|
| Rate for Payer: Cash Price |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$21.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.99
|
| Rate for Payer: Healthscope Commercial |
$22.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.24
|
| Rate for Payer: Nomi Health Commercial |
$20.49
|
| Rate for Payer: PHP Commercial |
$21.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.24
|
| Rate for Payer: Priority Health HMO/PPO |
$21.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.99
|
| Rate for Payer: UHC Core |
$20.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.74
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM
|
Facility
|
OP
|
$24.99
|
|
|
Service Code
|
NDC 45802005911
|
| Hospital Charge Code |
5749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$22.49 |
| Rate for Payer: Aetna Commercial |
$21.24
|
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.81
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS MAPPO |
$6.25
|
| Rate for Payer: BCBS Trust/PPO |
$20.54
|
| Rate for Payer: BCN Commercial |
$19.43
|
| Rate for Payer: BCN Medicare Advantage |
$6.25
|
| Rate for Payer: Cash Price |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$21.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$22.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.24
|
| Rate for Payer: Nomi Health Commercial |
$20.49
|
| Rate for Payer: PACE Senior Care Partners |
$5.94
|
| Rate for Payer: PACE SWMI |
$6.25
|
| Rate for Payer: PHP Commercial |
$21.24
|
| Rate for Payer: PHP Medicare Advantage |
$6.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.24
|
| Rate for Payer: Priority Health HMO/PPO |
$21.74
|
| Rate for Payer: Priority Health Medicare |
$6.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.99
|
| Rate for Payer: UHC Core |
$20.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.25
|
| Rate for Payer: UHC Exchange |
$6.25
|
| Rate for Payer: UHC Medicare Advantage |
$6.25
|
| Rate for Payer: VA VA |
$6.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.74
|
|
