|
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 |
$22.74 |
| 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 |
$29.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.92
|
| Rate for Payer: BCBS Complete |
$38.30
|
| Rate for Payer: BCBS MAPPO |
$23.94
|
| Rate for Payer: BCBS Trust/PPO |
$78.72
|
| Rate for Payer: BCN Commercial |
$74.45
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: Nomi Health Commercial |
$78.52
|
| 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 Cigna Priority Health |
$62.24
|
| Rate for Payer: Priority Health HMO/PPO |
$83.31
|
| Rate for Payer: Priority Health Medicare |
$24.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.16
|
| 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 Dual Complete DSNP |
$23.94
|
| Rate for Payer: UHC Exchange |
$23.94
|
| Rate for Payer: UHC Medicare Advantage |
$23.94
|
| 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
|
$95.76
|
|
|
Service Code
|
NDC 68462031435
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.74 |
| 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 |
$29.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.92
|
| Rate for Payer: BCBS Complete |
$38.30
|
| Rate for Payer: BCBS MAPPO |
$23.94
|
| Rate for Payer: BCBS Trust/PPO |
$78.72
|
| Rate for Payer: BCN Commercial |
$74.45
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: Nomi Health Commercial |
$78.52
|
| 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 Cigna Priority Health |
$62.24
|
| Rate for Payer: Priority Health HMO/PPO |
$83.31
|
| Rate for Payer: Priority Health Medicare |
$24.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.16
|
| 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 Dual Complete DSNP |
$23.94
|
| Rate for Payer: UHC Exchange |
$23.94
|
| Rate for Payer: UHC Medicare Advantage |
$23.94
|
| 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
|
$41.79
|
|
|
Service Code
|
NDC 45802088094
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$37.61 |
| Rate for Payer: Aetna Commercial |
$35.52
|
| Rate for Payer: Aetna Medicare |
$10.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.06
|
| Rate for Payer: BCBS Complete |
$16.72
|
| Rate for Payer: BCBS MAPPO |
$10.45
|
| Rate for Payer: BCBS Trust/PPO |
$34.36
|
| Rate for Payer: BCN Commercial |
$32.49
|
| Rate for Payer: BCN Medicare Advantage |
$10.45
|
| Rate for Payer: Cash Price |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$35.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.45
|
| Rate for Payer: Healthscope Commercial |
$37.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.52
|
| Rate for Payer: Nomi Health Commercial |
$34.27
|
| Rate for Payer: PACE Senior Care Partners |
$9.93
|
| Rate for Payer: PACE SWMI |
$10.45
|
| Rate for Payer: PHP Commercial |
$35.52
|
| Rate for Payer: PHP Medicare Advantage |
$10.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.16
|
| Rate for Payer: Priority Health HMO/PPO |
$36.36
|
| Rate for Payer: Priority Health Medicare |
$10.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.00
|
| Rate for Payer: Railroad Medicare Medicare |
$10.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.78
|
| Rate for Payer: UHC Core |
$34.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.45
|
| Rate for Payer: UHC Exchange |
$10.45
|
| Rate for Payer: UHC Medicare Advantage |
$10.45
|
| Rate for Payer: VA VA |
$10.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.34
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$41.79
|
|
|
Service Code
|
NDC 45802088094
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.16 |
| Max. Negotiated Rate |
$37.61 |
| Rate for Payer: Aetna Commercial |
$35.52
|
| Rate for Payer: BCBS Trust/PPO |
$34.11
|
| Rate for Payer: BCN Commercial |
$32.30
|
| Rate for Payer: Cash Price |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$35.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.43
|
| Rate for Payer: Healthscope Commercial |
$37.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.52
|
| Rate for Payer: Nomi Health Commercial |
$34.27
|
| Rate for Payer: PHP Commercial |
$35.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.16
|
| Rate for Payer: Priority Health HMO/PPO |
$36.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.78
|
| Rate for Payer: UHC Core |
$34.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.34
|
|
|
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 |
$62.24 |
| Max. Negotiated Rate |
$86.18 |
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: BCBS Trust/PPO |
$78.17
|
| Rate for Payer: BCN Commercial |
$74.00
|
| 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: PHP Commercial |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.24
|
| Rate for Payer: Priority Health HMO/PPO |
$83.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.16
|
| 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 |
$62.24 |
| Max. Negotiated Rate |
$86.18 |
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: BCBS Trust/PPO |
$78.17
|
| Rate for Payer: BCN Commercial |
$74.00
|
| 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: PHP Commercial |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.24
|
| Rate for Payer: Priority Health HMO/PPO |
$83.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.16
|
| 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/GRAM-0.1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$170.94
|
|
|
Service Code
|
NDC 00168008930
|
| Hospital Charge Code |
5755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$153.85 |
| Rate for Payer: Aetna Commercial |
$145.30
|
| Rate for Payer: BCBS Trust/PPO |
$139.54
|
| Rate for Payer: BCN Commercial |
$132.10
|
| Rate for Payer: Cash Price |
$136.75
|
| Rate for Payer: Cofinity Commercial |
$147.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.75
|
| Rate for Payer: Healthscope Commercial |
$153.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.30
|
| Rate for Payer: Nomi Health Commercial |
$140.17
|
| Rate for Payer: PHP Commercial |
$145.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.11
|
| Rate for Payer: Priority Health HMO/PPO |
$148.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.43
|
| Rate for Payer: UHC Core |
$142.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.20
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/GRAM-0.1 % TOPICAL OINTMENT
|
Facility
|
OP
|
$170.94
|
|
|
Service Code
|
NDC 00168008930
|
| Hospital Charge Code |
5755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$153.85 |
| Rate for Payer: Aetna Commercial |
$145.30
|
| Rate for Payer: Aetna Medicare |
$44.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.42
|
| Rate for Payer: BCBS Complete |
$68.38
|
| Rate for Payer: BCBS MAPPO |
$42.74
|
| Rate for Payer: BCBS Trust/PPO |
$140.53
|
| Rate for Payer: BCN Commercial |
$132.91
|
| Rate for Payer: BCN Medicare Advantage |
$42.74
|
| Rate for Payer: Cash Price |
$136.75
|
| Rate for Payer: Cofinity Commercial |
$147.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.74
|
| Rate for Payer: Healthscope Commercial |
$153.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.30
|
| Rate for Payer: Nomi Health Commercial |
$140.17
|
| Rate for Payer: PACE Senior Care Partners |
$40.60
|
| Rate for Payer: PACE SWMI |
$42.74
|
| Rate for Payer: PHP Commercial |
$145.30
|
| Rate for Payer: PHP Medicare Advantage |
$42.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.11
|
| Rate for Payer: Priority Health HMO/PPO |
$148.72
|
| Rate for Payer: Priority Health Medicare |
$43.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.53
|
| Rate for Payer: Railroad Medicare Medicare |
$42.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.43
|
| Rate for Payer: UHC Core |
$142.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.74
|
| Rate for Payer: UHC Exchange |
$42.74
|
| Rate for Payer: UHC Medicare Advantage |
$42.74
|
| Rate for Payer: VA VA |
$42.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.20
|
|
|
OB/GYN SPEC KZOO ONLY - NITROUS OXIDE ADMIN
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 00563
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
|
|
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 |
$11.19 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna Commercial |
$20.39
|
| Rate for Payer: BCBS Trust/PPO |
$18.17
|
| Rate for Payer: BCBS Trust/PPO |
$14.05
|
| Rate for Payer: BCBS Trust/PPO |
$19.58
|
| Rate for Payer: BCN Commercial |
$17.20
|
| Rate for Payer: BCN Commercial |
$13.30
|
| Rate for Payer: BCN Commercial |
$18.54
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$19.19
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cofinity Commercial |
$20.63
|
| 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 |
$19.19
|
| Rate for Payer: Healthscope Commercial |
$20.03
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$21.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.99
|
| 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 |
$20.39
|
| Rate for Payer: Nomi Health Commercial |
$14.11
|
| Rate for Payer: Nomi Health Commercial |
$18.25
|
| Rate for Payer: Nomi Health Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$18.92
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$20.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.47
|
| Rate for Payer: Priority Health HMO/PPO |
$20.87
|
| Rate for Payer: Priority Health HMO/PPO |
$19.37
|
| Rate for Payer: Priority Health HMO/PPO |
$14.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.11
|
| 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 |
$20.03
|
| Rate for Payer: UHC Core |
$18.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.99
|
| 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 |
$4.09 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$20.39
|
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: Aetna Medicare |
$4.47
|
| Rate for Payer: Aetna Medicare |
$5.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.50
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$4.30
|
| Rate for Payer: BCBS MAPPO |
$5.56
|
| Rate for Payer: BCBS Trust/PPO |
$18.30
|
| Rate for Payer: BCBS Trust/PPO |
$14.15
|
| Rate for Payer: BCBS Trust/PPO |
$19.72
|
| Rate for Payer: BCN Commercial |
$17.31
|
| Rate for Payer: BCN Commercial |
$18.65
|
| Rate for Payer: BCN Commercial |
$13.38
|
| Rate for Payer: BCN Medicare Advantage |
$4.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.56
|
| Rate for Payer: BCN Medicare Advantage |
$6.00
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cash Price |
$19.19
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Commercial |
$20.63
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.00
|
| 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 |
$21.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| 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 |
$6.30
|
| 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 |
$6.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Nomi Health Commercial |
$19.67
|
| Rate for Payer: Nomi Health Commercial |
$14.11
|
| Rate for Payer: Nomi Health Commercial |
$18.25
|
| Rate for Payer: PACE Senior Care Partners |
$5.70
|
| Rate for Payer: PACE Senior Care Partners |
$4.09
|
| Rate for Payer: PACE Senior Care Partners |
$5.29
|
| Rate for Payer: PACE SWMI |
$5.56
|
| Rate for Payer: PACE SWMI |
$4.30
|
| Rate for Payer: PACE SWMI |
$6.00
|
| Rate for Payer: PHP Commercial |
$20.39
|
| Rate for Payer: PHP Commercial |
$18.92
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Medicare Advantage |
$5.56
|
| Rate for Payer: PHP Medicare Advantage |
$6.00
|
| Rate for Payer: PHP Medicare Advantage |
$4.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.47
|
| Rate for Payer: Priority Health HMO/PPO |
$20.87
|
| Rate for Payer: Priority Health HMO/PPO |
$14.97
|
| Rate for Payer: Priority Health HMO/PPO |
$19.37
|
| Rate for Payer: Priority Health Medicare |
$4.35
|
| Rate for Payer: Priority Health Medicare |
$6.06
|
| Rate for Payer: Priority Health Medicare |
$5.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.53
|
| Rate for Payer: Railroad Medicare Medicare |
$5.56
|
| Rate for Payer: Railroad Medicare Medicare |
$6.00
|
| 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) |
$21.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.14
|
| Rate for Payer: UHC Core |
$20.03
|
| Rate for Payer: UHC Core |
$18.59
|
| Rate for Payer: UHC Core |
$14.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.56
|
| Rate for Payer: UHC Exchange |
$5.56
|
| Rate for Payer: UHC Exchange |
$4.30
|
| Rate for Payer: UHC Exchange |
$6.00
|
| Rate for Payer: UHC Medicare Advantage |
$4.30
|
| Rate for Payer: UHC Medicare Advantage |
$5.56
|
| Rate for Payer: UHC Medicare Advantage |
$6.00
|
| Rate for Payer: VA VA |
$5.56
|
| Rate for Payer: VA VA |
$6.00
|
| Rate for Payer: VA VA |
$4.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.70
|
|
|
OFLOXACIN 0.3 % EAR DROPS
|
Facility
|
OP
|
$58.24
|
|
|
Service Code
|
NDC 60505036301
|
| Hospital Charge Code |
22257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$52.42 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Medicare |
$15.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.20
|
| Rate for Payer: BCBS Complete |
$23.30
|
| Rate for Payer: BCBS MAPPO |
$14.56
|
| Rate for Payer: BCBS Trust/PPO |
$47.88
|
| Rate for Payer: BCN Commercial |
$45.28
|
| Rate for Payer: BCN Medicare Advantage |
$14.56
|
| Rate for Payer: Cash Price |
$46.59
|
| Rate for Payer: Cofinity Commercial |
$50.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$52.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$47.76
|
| Rate for Payer: PACE Senior Care Partners |
$13.83
|
| Rate for Payer: PACE SWMI |
$14.56
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: PHP Medicare Advantage |
$14.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.86
|
| Rate for Payer: Priority Health HMO/PPO |
$50.67
|
| Rate for Payer: Priority Health Medicare |
$14.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.02
|
| Rate for Payer: Railroad Medicare Medicare |
$14.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.25
|
| Rate for Payer: UHC Core |
$48.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.56
|
| Rate for Payer: UHC Exchange |
$14.56
|
| Rate for Payer: UHC Medicare Advantage |
$14.56
|
| Rate for Payer: VA VA |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.68
|
|
|
OFLOXACIN 0.3 % EAR DROPS
|
Facility
|
IP
|
$58.24
|
|
|
Service Code
|
NDC 60505036301
|
| Hospital Charge Code |
22257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.86 |
| Max. Negotiated Rate |
$52.42 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: BCBS Trust/PPO |
$47.54
|
| Rate for Payer: BCN Commercial |
$45.01
|
| Rate for Payer: Cash Price |
$46.59
|
| Rate for Payer: Cofinity Commercial |
$50.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.59
|
| Rate for Payer: Healthscope Commercial |
$52.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$47.76
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.86
|
| Rate for Payer: Priority Health HMO/PPO |
$50.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.25
|
| Rate for Payer: UHC Core |
$48.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.68
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$25.34
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Aetna Commercial |
$21.54
|
| Rate for Payer: Aetna Medicare |
$6.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.92
|
| Rate for Payer: BCBS Complete |
$10.14
|
| Rate for Payer: BCBS MAPPO |
$6.34
|
| Rate for Payer: BCBS Trust/PPO |
$20.83
|
| Rate for Payer: BCN Commercial |
$19.70
|
| Rate for Payer: BCN Medicare Advantage |
$6.34
|
| Rate for Payer: Cash Price |
$20.27
|
| Rate for Payer: Cofinity Commercial |
$21.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.34
|
| Rate for Payer: Healthscope Commercial |
$22.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.54
|
| Rate for Payer: Nomi Health Commercial |
$20.78
|
| Rate for Payer: PACE Senior Care Partners |
$6.02
|
| Rate for Payer: PACE SWMI |
$6.34
|
| Rate for Payer: PHP Commercial |
$21.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.47
|
| Rate for Payer: Priority Health HMO/PPO |
$22.05
|
| Rate for Payer: Priority Health Medicare |
$6.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.98
|
| Rate for Payer: Railroad Medicare Medicare |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.30
|
| Rate for Payer: UHC Core |
$21.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Medicare Advantage |
$6.34
|
| Rate for Payer: VA VA |
$6.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.00
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$31.75
|
|
|
Service Code
|
NDC 17478071310
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$28.58 |
| 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 |
$12.70
|
| Rate for Payer: BCBS MAPPO |
$7.94
|
| Rate for Payer: BCBS Trust/PPO |
$26.10
|
| Rate for Payer: BCN Commercial |
$24.69
|
| 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 |
$28.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.99
|
| Rate for Payer: Nomi Health Commercial |
$26.04
|
| 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 Cigna Priority Health |
$20.64
|
| Rate for Payer: Priority Health HMO/PPO |
$27.62
|
| Rate for Payer: Priority Health Medicare |
$8.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.27
|
| 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 Dual Complete DSNP |
$7.94
|
| Rate for Payer: UHC Exchange |
$7.94
|
| Rate for Payer: UHC Medicare Advantage |
$7.94
|
| 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
|
$126.42
|
|
|
Service Code
|
NDC 24208043410
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$113.78 |
| Rate for Payer: Aetna Commercial |
$107.46
|
| Rate for Payer: BCBS Trust/PPO |
$103.20
|
| Rate for Payer: BCN Commercial |
$97.70
|
| 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: Healthscope Commercial |
$113.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.46
|
| Rate for Payer: Nomi Health Commercial |
$103.66
|
| Rate for Payer: PHP Commercial |
$107.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.17
|
| Rate for Payer: Priority Health HMO/PPO |
$109.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.25
|
| Rate for Payer: UHC Core |
$105.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.82
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$25.34
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Aetna Commercial |
$21.54
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.58
|
| Rate for Payer: Cash Price |
$20.27
|
| Rate for Payer: Cofinity Commercial |
$21.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.27
|
| Rate for Payer: Healthscope Commercial |
$22.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.54
|
| Rate for Payer: Nomi Health Commercial |
$20.78
|
| Rate for Payer: PHP Commercial |
$21.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.47
|
| Rate for Payer: Priority Health HMO/PPO |
$22.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.30
|
| Rate for Payer: UHC Core |
$21.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.00
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$26.04
|
|
|
Service Code
|
NDC 70756060730
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$23.44 |
| Rate for Payer: Aetna Commercial |
$22.13
|
| Rate for Payer: BCBS Trust/PPO |
$21.26
|
| Rate for Payer: BCN Commercial |
$20.12
|
| Rate for Payer: Cash Price |
$20.83
|
| Rate for Payer: Cofinity Commercial |
$22.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.83
|
| Rate for Payer: Healthscope Commercial |
$23.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: Nomi Health Commercial |
$21.35
|
| Rate for Payer: PHP Commercial |
$22.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.93
|
| Rate for Payer: Priority Health HMO/PPO |
$22.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.92
|
| Rate for Payer: UHC Core |
$21.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.53
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$66.54
|
|
|
Service Code
|
NDC 24208043405
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.80 |
| 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 |
$26.62
|
| Rate for Payer: BCBS MAPPO |
$16.64
|
| Rate for Payer: BCBS Trust/PPO |
$54.70
|
| Rate for Payer: BCN Commercial |
$51.73
|
| 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 |
$49.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.56
|
| Rate for Payer: Nomi Health Commercial |
$54.56
|
| 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 Cigna Priority Health |
$43.25
|
| Rate for Payer: Priority Health HMO/PPO |
$57.89
|
| Rate for Payer: Priority Health Medicare |
$16.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.58
|
| 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 Dual Complete DSNP |
$16.64
|
| Rate for Payer: UHC Exchange |
$16.64
|
| Rate for Payer: UHC Medicare Advantage |
$16.64
|
| Rate for Payer: VA VA |
$16.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.90
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$26.04
|
|
|
Service Code
|
NDC 70756060730
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$23.44 |
| Rate for Payer: Aetna Commercial |
$22.13
|
| Rate for Payer: Aetna Medicare |
$6.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.14
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$6.51
|
| Rate for Payer: BCBS Trust/PPO |
$21.41
|
| Rate for Payer: BCN Commercial |
$20.25
|
| Rate for Payer: BCN Medicare Advantage |
$6.51
|
| Rate for Payer: Cash Price |
$20.83
|
| Rate for Payer: Cofinity Commercial |
$22.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.51
|
| Rate for Payer: Healthscope Commercial |
$23.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: Nomi Health Commercial |
$21.35
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.51
|
| Rate for Payer: PHP Commercial |
$22.13
|
| Rate for Payer: PHP Medicare Advantage |
$6.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.93
|
| Rate for Payer: Priority Health HMO/PPO |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$6.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.45
|
| Rate for Payer: Railroad Medicare Medicare |
$6.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.92
|
| Rate for Payer: UHC Core |
$21.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.51
|
| Rate for Payer: UHC Exchange |
$6.51
|
| Rate for Payer: UHC Medicare Advantage |
$6.51
|
| Rate for Payer: VA VA |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.53
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$31.75
|
|
|
Service Code
|
NDC 17478071310
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$28.58 |
| Rate for Payer: Aetna Commercial |
$26.99
|
| Rate for Payer: BCBS Trust/PPO |
$25.92
|
| Rate for Payer: BCN Commercial |
$24.54
|
| 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: Healthscope Commercial |
$28.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.99
|
| Rate for Payer: Nomi Health Commercial |
$26.04
|
| Rate for Payer: PHP Commercial |
$26.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.64
|
| Rate for Payer: Priority Health HMO/PPO |
$27.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.94
|
| Rate for Payer: UHC Core |
$26.51
|
| 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 |
$43.25 |
| Max. Negotiated Rate |
$59.89 |
| Rate for Payer: Aetna Commercial |
$56.56
|
| Rate for Payer: BCBS Trust/PPO |
$54.32
|
| Rate for Payer: BCN Commercial |
$51.42
|
| 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 |
$49.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.56
|
| Rate for Payer: Nomi Health Commercial |
$54.56
|
| Rate for Payer: PHP Commercial |
$56.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.25
|
| Rate for Payer: Priority Health HMO/PPO |
$57.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.58
|
| 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 |
$49.90
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$126.42
|
|
|
Service Code
|
NDC 24208043410
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.02 |
| 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 |
$50.57
|
| Rate for Payer: BCBS MAPPO |
$31.60
|
| Rate for Payer: BCBS Trust/PPO |
$103.93
|
| Rate for Payer: BCN Commercial |
$98.29
|
| Rate for Payer: BCN Medicare Advantage |
$31.60
|
| 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 |
$31.60
|
| Rate for Payer: Healthscope Commercial |
$113.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.46
|
| Rate for Payer: Nomi Health Commercial |
$103.66
|
| Rate for Payer: PACE Senior Care Partners |
$30.02
|
| Rate for Payer: PACE SWMI |
$31.60
|
| Rate for Payer: PHP Commercial |
$107.46
|
| Rate for Payer: PHP Medicare Advantage |
$31.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.17
|
| Rate for Payer: Priority Health HMO/PPO |
$109.99
|
| Rate for Payer: Priority Health Medicare |
$31.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.70
|
| Rate for Payer: Railroad Medicare Medicare |
$31.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.25
|
| Rate for Payer: UHC Core |
$105.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.60
|
| Rate for Payer: UHC Exchange |
$31.60
|
| Rate for Payer: UHC Medicare Advantage |
$31.60
|
| Rate for Payer: VA VA |
$31.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.82
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$118.56
|
|
|
Service Code
|
NDC 33342008407
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.06 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: Aetna Commercial |
$100.78
|
| Rate for Payer: BCBS Trust/PPO |
$96.78
|
| Rate for Payer: BCN Commercial |
$91.62
|
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Cofinity Commercial |
$101.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.85
|
| Rate for Payer: Healthscope Commercial |
$106.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.78
|
| Rate for Payer: Nomi Health Commercial |
$97.22
|
| Rate for Payer: PHP Commercial |
$100.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.06
|
| Rate for Payer: Priority Health HMO/PPO |
$103.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.33
|
| Rate for Payer: UHC Core |
$99.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.92
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$118.56
|
|
|
Service Code
|
NDC 33342008407
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.16 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: Aetna Commercial |
$100.78
|
| Rate for Payer: Aetna Medicare |
$30.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.05
|
| Rate for Payer: BCBS Complete |
$47.42
|
| Rate for Payer: BCBS MAPPO |
$29.64
|
| Rate for Payer: BCBS Trust/PPO |
$97.47
|
| Rate for Payer: BCN Commercial |
$92.18
|
| Rate for Payer: BCN Medicare Advantage |
$29.64
|
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Cofinity Commercial |
$101.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.64
|
| Rate for Payer: Healthscope Commercial |
$106.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.78
|
| Rate for Payer: Nomi Health Commercial |
$97.22
|
| Rate for Payer: PACE Senior Care Partners |
$28.16
|
| Rate for Payer: PACE SWMI |
$29.64
|
| Rate for Payer: PHP Commercial |
$100.78
|
| Rate for Payer: PHP Medicare Advantage |
$29.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.06
|
| Rate for Payer: Priority Health HMO/PPO |
$103.15
|
| Rate for Payer: Priority Health Medicare |
$29.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.44
|
| Rate for Payer: Railroad Medicare Medicare |
$29.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.33
|
| Rate for Payer: UHC Core |
$99.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.64
|
| Rate for Payer: UHC Exchange |
$29.64
|
| Rate for Payer: UHC Medicare Advantage |
$29.64
|
| Rate for Payer: VA VA |
$29.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.92
|
|
