|
BECLOMETHASONE DIPROP 40 MCG/ACTUATION HFA BREATH ACTIVATED AEROSOL
|
Facility
|
IP
|
$747.20
|
|
|
Service Code
|
NDC 59310030240
|
| Hospital Charge Code |
184684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$485.68 |
| Max. Negotiated Rate |
$672.48 |
| Rate for Payer: Aetna Commercial |
$635.12
|
| Rate for Payer: BCBS Trust/PPO |
$609.94
|
| Rate for Payer: BCN Commercial |
$577.44
|
| Rate for Payer: Cash Price |
$597.76
|
| Rate for Payer: Cofinity Commercial |
$642.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$597.76
|
| Rate for Payer: Healthscope Commercial |
$672.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$560.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$635.12
|
| Rate for Payer: Nomi Health Commercial |
$612.70
|
| Rate for Payer: PHP Commercial |
$635.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.68
|
| Rate for Payer: Priority Health HMO/PPO |
$650.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$500.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$657.54
|
| Rate for Payer: UHC Core |
$623.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$560.40
|
|
|
BECLOMETHASONE DIPROP 40 MCG/ACTUATION HFA BREATH ACTIVATED AEROSOL
|
Facility
|
OP
|
$747.20
|
|
|
Service Code
|
NDC 59310030240
|
| Hospital Charge Code |
184684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.46 |
| Max. Negotiated Rate |
$672.48 |
| Rate for Payer: Aetna Commercial |
$635.12
|
| Rate for Payer: Aetna Medicare |
$194.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$233.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$233.50
|
| Rate for Payer: BCBS Complete |
$298.88
|
| Rate for Payer: BCBS MAPPO |
$186.80
|
| Rate for Payer: BCBS Trust/PPO |
$614.27
|
| Rate for Payer: BCN Commercial |
$580.95
|
| Rate for Payer: BCN Medicare Advantage |
$186.80
|
| Rate for Payer: Cash Price |
$597.76
|
| Rate for Payer: Cofinity Commercial |
$642.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$597.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.80
|
| Rate for Payer: Healthscope Commercial |
$672.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$560.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$635.12
|
| Rate for Payer: Nomi Health Commercial |
$612.70
|
| Rate for Payer: PACE Senior Care Partners |
$177.46
|
| Rate for Payer: PACE SWMI |
$186.80
|
| Rate for Payer: PHP Commercial |
$635.12
|
| Rate for Payer: PHP Medicare Advantage |
$186.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.68
|
| Rate for Payer: Priority Health HMO/PPO |
$650.06
|
| Rate for Payer: Priority Health Medicare |
$188.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$500.62
|
| Rate for Payer: Railroad Medicare Medicare |
$186.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$657.54
|
| Rate for Payer: UHC Core |
$623.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.80
|
| Rate for Payer: UHC Exchange |
$186.80
|
| Rate for Payer: UHC Medicare Advantage |
$186.80
|
| Rate for Payer: VA VA |
$186.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$560.40
|
|
|
BENZOCAINE 20 %-MENTHOL 0.26 % MOUTH MUCOSAL GEL
|
Facility
|
OP
|
$22.24
|
|
|
Service Code
|
NDC 10310043028
|
| Hospital Charge Code |
190719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Medicare |
$5.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.95
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS MAPPO |
$5.56
|
| Rate for Payer: BCBS Trust/PPO |
$18.28
|
| Rate for Payer: BCN Commercial |
$17.29
|
| Rate for Payer: BCN Medicare Advantage |
$5.56
|
| Rate for Payer: Cash Price |
$17.79
|
| Rate for Payer: Cofinity Commercial |
$19.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.56
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.90
|
| Rate for Payer: Nomi Health Commercial |
$18.24
|
| Rate for Payer: PACE Senior Care Partners |
$5.28
|
| Rate for Payer: PACE SWMI |
$5.56
|
| Rate for Payer: PHP Commercial |
$18.90
|
| Rate for Payer: PHP Medicare Advantage |
$5.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health HMO/PPO |
$19.35
|
| Rate for Payer: Priority Health Medicare |
$5.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.90
|
| Rate for Payer: Railroad Medicare Medicare |
$5.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.57
|
| Rate for Payer: UHC Core |
$18.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.56
|
| Rate for Payer: UHC Exchange |
$5.56
|
| Rate for Payer: UHC Medicare Advantage |
$5.56
|
| Rate for Payer: VA VA |
$5.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.68
|
|
|
BENZOCAINE 20 %-MENTHOL 0.26 % MOUTH MUCOSAL GEL
|
Facility
|
IP
|
$22.24
|
|
|
Service Code
|
NDC 10310043028
|
| Hospital Charge Code |
190719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: BCBS Trust/PPO |
$18.15
|
| Rate for Payer: BCN Commercial |
$17.19
|
| Rate for Payer: Cash Price |
$17.79
|
| Rate for Payer: Cofinity Commercial |
$19.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.79
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.90
|
| Rate for Payer: Nomi Health Commercial |
$18.24
|
| Rate for Payer: PHP Commercial |
$18.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health HMO/PPO |
$19.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.57
|
| Rate for Payer: UHC Core |
$18.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.68
|
|
|
BENZOCAINE 20 % MUCOSAL GEL
|
Facility
|
OP
|
$10.38
|
|
|
Service Code
|
NDC 10310028340
|
| Hospital Charge Code |
19691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$9.34 |
| Rate for Payer: Aetna Commercial |
$8.82
|
| Rate for Payer: Aetna Medicare |
$2.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.24
|
| Rate for Payer: BCBS Complete |
$4.15
|
| Rate for Payer: BCBS MAPPO |
$2.60
|
| Rate for Payer: BCBS Trust/PPO |
$8.53
|
| Rate for Payer: BCN Commercial |
$8.07
|
| Rate for Payer: BCN Medicare Advantage |
$2.60
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$9.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.82
|
| Rate for Payer: Nomi Health Commercial |
$8.51
|
| Rate for Payer: PACE Senior Care Partners |
$2.47
|
| Rate for Payer: PACE SWMI |
$2.60
|
| Rate for Payer: PHP Commercial |
$8.82
|
| Rate for Payer: PHP Medicare Advantage |
$2.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.75
|
| Rate for Payer: Priority Health HMO/PPO |
$9.03
|
| Rate for Payer: Priority Health Medicare |
$2.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.95
|
| Rate for Payer: Railroad Medicare Medicare |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.13
|
| Rate for Payer: UHC Core |
$8.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.60
|
| Rate for Payer: UHC Exchange |
$2.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.60
|
| Rate for Payer: VA VA |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.78
|
|
|
BENZOCAINE 20 % MUCOSAL GEL
|
Facility
|
IP
|
$10.38
|
|
|
Service Code
|
NDC 10310028340
|
| Hospital Charge Code |
19691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$9.34 |
| Rate for Payer: Aetna Commercial |
$8.82
|
| Rate for Payer: BCBS Trust/PPO |
$8.47
|
| Rate for Payer: BCN Commercial |
$8.02
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.30
|
| Rate for Payer: Healthscope Commercial |
$9.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.82
|
| Rate for Payer: Nomi Health Commercial |
$8.51
|
| Rate for Payer: PHP Commercial |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.75
|
| Rate for Payer: Priority Health HMO/PPO |
$9.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.13
|
| Rate for Payer: UHC Core |
$8.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.78
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
OP
|
$37.17
|
|
|
Service Code
|
NDC 00283061043
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$33.45 |
| Rate for Payer: Aetna Commercial |
$31.59
|
| Rate for Payer: Aetna Medicare |
$9.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: BCBS Complete |
$14.87
|
| Rate for Payer: BCBS MAPPO |
$9.29
|
| Rate for Payer: BCBS Trust/PPO |
$30.56
|
| Rate for Payer: BCN Commercial |
$28.90
|
| Rate for Payer: BCN Medicare Advantage |
$9.29
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cofinity Commercial |
$31.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.29
|
| Rate for Payer: Healthscope Commercial |
$33.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.59
|
| Rate for Payer: Nomi Health Commercial |
$30.48
|
| Rate for Payer: PACE Senior Care Partners |
$8.83
|
| Rate for Payer: PACE SWMI |
$9.29
|
| Rate for Payer: PHP Commercial |
$31.59
|
| Rate for Payer: PHP Medicare Advantage |
$9.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.16
|
| Rate for Payer: Priority Health HMO/PPO |
$32.34
|
| Rate for Payer: Priority Health Medicare |
$9.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.90
|
| Rate for Payer: Railroad Medicare Medicare |
$9.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.71
|
| Rate for Payer: UHC Core |
$31.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.29
|
| Rate for Payer: UHC Exchange |
$9.29
|
| Rate for Payer: UHC Medicare Advantage |
$9.29
|
| Rate for Payer: VA VA |
$9.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.88
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
IP
|
$37.17
|
|
|
Service Code
|
NDC 00283061043
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.16 |
| Max. Negotiated Rate |
$33.45 |
| Rate for Payer: Aetna Commercial |
$31.59
|
| Rate for Payer: BCBS Trust/PPO |
$30.34
|
| Rate for Payer: BCN Commercial |
$28.72
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cofinity Commercial |
$31.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.74
|
| Rate for Payer: Healthscope Commercial |
$33.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.59
|
| Rate for Payer: Nomi Health Commercial |
$30.48
|
| Rate for Payer: PHP Commercial |
$31.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.16
|
| Rate for Payer: Priority Health HMO/PPO |
$32.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.71
|
| Rate for Payer: UHC Core |
$31.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.88
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
OP
|
$34.86
|
|
|
Service Code
|
NDC 00283061026
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$31.37 |
| Rate for Payer: Aetna Commercial |
$29.63
|
| Rate for Payer: Aetna Medicare |
$9.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.89
|
| Rate for Payer: BCBS Complete |
$13.94
|
| Rate for Payer: BCBS MAPPO |
$8.72
|
| Rate for Payer: BCBS Trust/PPO |
$28.66
|
| Rate for Payer: BCN Commercial |
$27.10
|
| Rate for Payer: BCN Medicare Advantage |
$8.72
|
| Rate for Payer: Cash Price |
$27.89
|
| Rate for Payer: Cofinity Commercial |
$29.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.72
|
| Rate for Payer: Healthscope Commercial |
$31.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.63
|
| Rate for Payer: Nomi Health Commercial |
$28.59
|
| Rate for Payer: PACE Senior Care Partners |
$8.28
|
| Rate for Payer: PACE SWMI |
$8.72
|
| Rate for Payer: PHP Commercial |
$29.63
|
| Rate for Payer: PHP Medicare Advantage |
$8.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.66
|
| Rate for Payer: Priority Health HMO/PPO |
$30.33
|
| Rate for Payer: Priority Health Medicare |
$8.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.36
|
| Rate for Payer: Railroad Medicare Medicare |
$8.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.68
|
| Rate for Payer: UHC Core |
$29.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.72
|
| Rate for Payer: UHC Exchange |
$8.72
|
| Rate for Payer: UHC Medicare Advantage |
$8.72
|
| Rate for Payer: VA VA |
$8.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.14
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
IP
|
$34.86
|
|
|
Service Code
|
NDC 00283061026
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$31.37 |
| Rate for Payer: Aetna Commercial |
$29.63
|
| Rate for Payer: BCBS Trust/PPO |
$28.46
|
| Rate for Payer: BCN Commercial |
$26.94
|
| Rate for Payer: Cash Price |
$27.89
|
| Rate for Payer: Cofinity Commercial |
$29.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.89
|
| Rate for Payer: Healthscope Commercial |
$31.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.63
|
| Rate for Payer: Nomi Health Commercial |
$28.59
|
| Rate for Payer: PHP Commercial |
$29.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.66
|
| Rate for Payer: Priority Health HMO/PPO |
$30.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.68
|
| Rate for Payer: UHC Core |
$29.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.14
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$371.30
|
|
|
Service Code
|
NDC 67877057301
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.34 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna Commercial |
$315.60
|
| Rate for Payer: BCBS Trust/PPO |
$303.09
|
| Rate for Payer: BCN Commercial |
$286.94
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.60
|
| Rate for Payer: Nomi Health Commercial |
$304.47
|
| Rate for Payer: PHP Commercial |
$315.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.34
|
| Rate for Payer: Priority Health HMO/PPO |
$323.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.74
|
| Rate for Payer: UHC Core |
$310.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$309.70
|
|
|
Service Code
|
NDC 00904715361
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.55 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna Commercial |
$263.24
|
| Rate for Payer: Aetna Medicare |
$80.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.78
|
| Rate for Payer: BCBS Complete |
$123.88
|
| Rate for Payer: BCBS MAPPO |
$77.42
|
| Rate for Payer: BCBS Trust/PPO |
$254.60
|
| Rate for Payer: BCN Commercial |
$240.79
|
| Rate for Payer: BCN Medicare Advantage |
$77.42
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.42
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.24
|
| Rate for Payer: Nomi Health Commercial |
$253.95
|
| Rate for Payer: PACE Senior Care Partners |
$73.55
|
| Rate for Payer: PACE SWMI |
$77.42
|
| Rate for Payer: PHP Commercial |
$263.24
|
| Rate for Payer: PHP Medicare Advantage |
$77.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.30
|
| Rate for Payer: Priority Health HMO/PPO |
$269.44
|
| Rate for Payer: Priority Health Medicare |
$78.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.50
|
| Rate for Payer: Railroad Medicare Medicare |
$77.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.54
|
| Rate for Payer: UHC Core |
$258.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.42
|
| Rate for Payer: UHC Exchange |
$77.42
|
| Rate for Payer: UHC Medicare Advantage |
$77.42
|
| Rate for Payer: VA VA |
$77.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$371.30
|
|
|
Service Code
|
NDC 67877057301
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.18 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna Commercial |
$315.60
|
| Rate for Payer: Aetna Medicare |
$96.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.03
|
| Rate for Payer: BCBS Complete |
$148.52
|
| Rate for Payer: BCBS MAPPO |
$92.82
|
| Rate for Payer: BCBS Trust/PPO |
$305.25
|
| Rate for Payer: BCN Commercial |
$288.69
|
| Rate for Payer: BCN Medicare Advantage |
$92.82
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.82
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.60
|
| Rate for Payer: Nomi Health Commercial |
$304.47
|
| Rate for Payer: PACE Senior Care Partners |
$88.18
|
| Rate for Payer: PACE SWMI |
$92.82
|
| Rate for Payer: PHP Commercial |
$315.60
|
| Rate for Payer: PHP Medicare Advantage |
$92.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.34
|
| Rate for Payer: Priority Health HMO/PPO |
$323.03
|
| Rate for Payer: Priority Health Medicare |
$93.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.77
|
| Rate for Payer: Railroad Medicare Medicare |
$92.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.74
|
| Rate for Payer: UHC Core |
$310.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.82
|
| Rate for Payer: UHC Exchange |
$92.82
|
| Rate for Payer: UHC Medicare Advantage |
$92.82
|
| Rate for Payer: VA VA |
$92.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$195.05
|
|
|
Service Code
|
NDC 42806071401
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.32 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$50.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.95
|
| Rate for Payer: BCBS Complete |
$78.02
|
| Rate for Payer: BCBS MAPPO |
$48.76
|
| Rate for Payer: BCBS Trust/PPO |
$160.35
|
| Rate for Payer: BCN Commercial |
$151.65
|
| Rate for Payer: BCN Medicare Advantage |
$48.76
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.76
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Nomi Health Commercial |
$159.94
|
| Rate for Payer: PACE Senior Care Partners |
$46.32
|
| Rate for Payer: PACE SWMI |
$48.76
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: PHP Medicare Advantage |
$48.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.78
|
| Rate for Payer: Priority Health HMO/PPO |
$169.69
|
| Rate for Payer: Priority Health Medicare |
$49.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.68
|
| Rate for Payer: Railroad Medicare Medicare |
$48.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.64
|
| Rate for Payer: UHC Core |
$162.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.76
|
| Rate for Payer: UHC Exchange |
$48.76
|
| Rate for Payer: UHC Medicare Advantage |
$48.76
|
| Rate for Payer: VA VA |
$48.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
NDC 42806071401
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.78 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: BCBS Trust/PPO |
$159.22
|
| Rate for Payer: BCN Commercial |
$150.73
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Nomi Health Commercial |
$159.94
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.78
|
| Rate for Payer: Priority Health HMO/PPO |
$169.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.64
|
| Rate for Payer: UHC Core |
$162.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$302.10
|
|
|
Service Code
|
NDC 00904656461
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.36 |
| Max. Negotiated Rate |
$271.89 |
| Rate for Payer: Aetna Commercial |
$256.78
|
| Rate for Payer: BCBS Trust/PPO |
$246.60
|
| Rate for Payer: BCN Commercial |
$233.46
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$259.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Healthscope Commercial |
$271.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.78
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: PHP Commercial |
$256.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.36
|
| Rate for Payer: Priority Health HMO/PPO |
$262.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.85
|
| Rate for Payer: UHC Core |
$252.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.58
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$364.80
|
|
|
Service Code
|
NDC 68084021401
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.64 |
| Max. Negotiated Rate |
$328.32 |
| Rate for Payer: Aetna Commercial |
$310.08
|
| Rate for Payer: Aetna Medicare |
$94.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.00
|
| Rate for Payer: BCBS Complete |
$145.92
|
| Rate for Payer: BCBS MAPPO |
$91.20
|
| Rate for Payer: BCBS Trust/PPO |
$299.90
|
| Rate for Payer: BCN Commercial |
$283.63
|
| Rate for Payer: BCN Medicare Advantage |
$91.20
|
| Rate for Payer: Cash Price |
$291.84
|
| Rate for Payer: Cofinity Commercial |
$313.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.20
|
| Rate for Payer: Healthscope Commercial |
$328.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.08
|
| Rate for Payer: Nomi Health Commercial |
$299.14
|
| Rate for Payer: PACE Senior Care Partners |
$86.64
|
| Rate for Payer: PACE SWMI |
$91.20
|
| Rate for Payer: PHP Commercial |
$310.08
|
| Rate for Payer: PHP Medicare Advantage |
$91.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.12
|
| Rate for Payer: Priority Health HMO/PPO |
$317.38
|
| Rate for Payer: Priority Health Medicare |
$92.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.42
|
| Rate for Payer: Railroad Medicare Medicare |
$91.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.02
|
| Rate for Payer: UHC Core |
$304.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.20
|
| Rate for Payer: UHC Exchange |
$91.20
|
| Rate for Payer: UHC Medicare Advantage |
$91.20
|
| Rate for Payer: VA VA |
$91.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.60
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$302.10
|
|
|
Service Code
|
NDC 00904656461
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.75 |
| Max. Negotiated Rate |
$271.89 |
| Rate for Payer: Aetna Commercial |
$256.78
|
| Rate for Payer: Aetna Medicare |
$78.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.41
|
| Rate for Payer: BCBS Complete |
$120.84
|
| Rate for Payer: BCBS MAPPO |
$75.52
|
| Rate for Payer: BCBS Trust/PPO |
$248.36
|
| Rate for Payer: BCN Commercial |
$234.88
|
| Rate for Payer: BCN Medicare Advantage |
$75.52
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$259.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.52
|
| Rate for Payer: Healthscope Commercial |
$271.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.78
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: PACE Senior Care Partners |
$71.75
|
| Rate for Payer: PACE SWMI |
$75.52
|
| Rate for Payer: PHP Commercial |
$256.78
|
| Rate for Payer: PHP Medicare Advantage |
$75.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.36
|
| Rate for Payer: Priority Health HMO/PPO |
$262.83
|
| Rate for Payer: Priority Health Medicare |
$76.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.41
|
| Rate for Payer: Railroad Medicare Medicare |
$75.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.85
|
| Rate for Payer: UHC Core |
$252.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.52
|
| Rate for Payer: UHC Exchange |
$75.52
|
| Rate for Payer: UHC Medicare Advantage |
$75.52
|
| Rate for Payer: VA VA |
$75.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.58
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$364.80
|
|
|
Service Code
|
NDC 68084021401
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.12 |
| Max. Negotiated Rate |
$328.32 |
| Rate for Payer: Aetna Commercial |
$310.08
|
| Rate for Payer: BCBS Trust/PPO |
$297.79
|
| Rate for Payer: BCN Commercial |
$281.92
|
| Rate for Payer: Cash Price |
$291.84
|
| Rate for Payer: Cofinity Commercial |
$313.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.84
|
| Rate for Payer: Healthscope Commercial |
$328.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.08
|
| Rate for Payer: Nomi Health Commercial |
$299.14
|
| Rate for Payer: PHP Commercial |
$310.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.12
|
| Rate for Payer: Priority Health HMO/PPO |
$317.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.02
|
| Rate for Payer: UHC Core |
$304.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.60
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$309.70
|
|
|
Service Code
|
NDC 00904715361
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.30 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna Commercial |
$263.24
|
| Rate for Payer: BCBS Trust/PPO |
$252.81
|
| Rate for Payer: BCN Commercial |
$239.34
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.24
|
| Rate for Payer: Nomi Health Commercial |
$253.95
|
| Rate for Payer: PHP Commercial |
$263.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.30
|
| Rate for Payer: Priority Health HMO/PPO |
$269.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.54
|
| Rate for Payer: UHC Core |
$258.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$3.65
|
|
|
Service Code
|
NDC 68084021411
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna Commercial |
$3.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.82
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cofinity Commercial |
$3.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.92
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.10
|
| Rate for Payer: Nomi Health Commercial |
$2.99
|
| Rate for Payer: PHP Commercial |
$3.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| 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) |
$3.21
|
| Rate for Payer: UHC Core |
$3.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.74
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$3.65
|
|
|
Service Code
|
NDC 68084021411
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna Commercial |
$3.10
|
| 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 |
$0.91
|
| Rate for Payer: BCBS Trust/PPO |
$3.00
|
| Rate for Payer: BCN Commercial |
$2.84
|
| Rate for Payer: BCN Medicare Advantage |
$0.91
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cofinity Commercial |
$3.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.91
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.74
|
| 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 |
$3.10
|
| Rate for Payer: Nomi Health Commercial |
$2.99
|
| Rate for Payer: PACE Senior Care Partners |
$0.87
|
| Rate for Payer: PACE SWMI |
$0.91
|
| Rate for Payer: PHP Commercial |
$3.10
|
| Rate for Payer: PHP Medicare Advantage |
$0.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| 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 |
$0.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.21
|
| Rate for Payer: UHC Core |
$3.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.91
|
| Rate for Payer: UHC Exchange |
$0.91
|
| Rate for Payer: UHC Medicare Advantage |
$0.91
|
| Rate for Payer: VA VA |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.74
|
|
|
BENZOYL PEROXIDE 5 % TOPICAL CLEANSER
|
Facility
|
OP
|
$21.48
|
|
|
Service Code
|
NDC 00536125919
|
| Hospital Charge Code |
993
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$19.33 |
| Rate for Payer: Aetna Commercial |
$18.26
|
| Rate for Payer: Aetna Medicare |
$5.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.71
|
| Rate for Payer: BCBS Complete |
$8.59
|
| Rate for Payer: BCBS MAPPO |
$5.37
|
| Rate for Payer: BCBS Trust/PPO |
$17.66
|
| Rate for Payer: BCN Commercial |
$16.70
|
| Rate for Payer: BCN Medicare Advantage |
$5.37
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Commercial |
$18.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.37
|
| Rate for Payer: Healthscope Commercial |
$19.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.26
|
| Rate for Payer: Nomi Health Commercial |
$17.61
|
| Rate for Payer: PACE Senior Care Partners |
$5.10
|
| Rate for Payer: PACE SWMI |
$5.37
|
| Rate for Payer: PHP Commercial |
$18.26
|
| Rate for Payer: PHP Medicare Advantage |
$5.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.96
|
| Rate for Payer: Priority Health HMO/PPO |
$18.69
|
| Rate for Payer: Priority Health Medicare |
$5.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.39
|
| Rate for Payer: Railroad Medicare Medicare |
$5.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.90
|
| Rate for Payer: UHC Core |
$17.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.37
|
| Rate for Payer: UHC Exchange |
$5.37
|
| Rate for Payer: UHC Medicare Advantage |
$5.37
|
| Rate for Payer: VA VA |
$5.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.11
|
|
|
BENZOYL PEROXIDE 5 % TOPICAL CLEANSER
|
Facility
|
IP
|
$21.48
|
|
|
Service Code
|
NDC 00536125919
|
| Hospital Charge Code |
993
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$19.33 |
| Rate for Payer: Aetna Commercial |
$18.26
|
| Rate for Payer: BCBS Trust/PPO |
$17.53
|
| Rate for Payer: BCN Commercial |
$16.60
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Commercial |
$18.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$19.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.26
|
| Rate for Payer: Nomi Health Commercial |
$17.61
|
| Rate for Payer: PHP Commercial |
$18.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.96
|
| Rate for Payer: Priority Health HMO/PPO |
$18.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.90
|
| Rate for Payer: UHC Core |
$17.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.11
|
|
|
BENZTROPINE 0.5 MG TABLET
|
Facility
|
IP
|
$183.30
|
|
|
Service Code
|
NDC 69315013601
|
| Hospital Charge Code |
998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.80
|
| Rate for Payer: BCBS Trust/PPO |
$149.63
|
| Rate for Payer: BCN Commercial |
$141.65
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.80
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: PHP Commercial |
$155.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.14
|
| Rate for Payer: Priority Health HMO/PPO |
$159.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$153.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.48
|
|
