|
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 |
$315.61
|
| 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 |
$315.61
|
| Rate for Payer: Nomi Health Commercial |
$304.47
|
| Rate for Payer: PHP Commercial |
$315.61
|
| 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
|
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
|
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 |
$315.61
|
| 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 |
$92.83
|
| Rate for Payer: BCBS Trust/PPO |
$305.25
|
| Rate for Payer: BCN Commercial |
$288.69
|
| Rate for Payer: BCN Medicare Advantage |
$92.83
|
| 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 |
$92.83
|
| 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 |
$315.61
|
| Rate for Payer: Nomi Health Commercial |
$304.47
|
| Rate for Payer: PACE Senior Care Partners |
$88.18
|
| Rate for Payer: PACE SWMI |
$92.83
|
| Rate for Payer: PHP Commercial |
$315.61
|
| Rate for Payer: PHP Medicare Advantage |
$92.83
|
| 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 |
$92.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.74
|
| Rate for Payer: UHC Core |
$310.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.83
|
| Rate for Payer: UHC Exchange |
$92.83
|
| Rate for Payer: UHC Medicare Advantage |
$92.83
|
| Rate for Payer: VA VA |
$92.83
|
| 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
|
$302.10
|
|
|
Service Code
|
NDC 00904656461
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.37 |
| Max. Negotiated Rate |
$271.89 |
| Rate for Payer: Aetna Commercial |
$256.79
|
| 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 |
$226.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.79
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: PHP Commercial |
$256.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.37
|
| 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 |
$226.57
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$309.70
|
|
|
Service Code
|
NDC 00904715361
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.31 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna Commercial |
$263.25
|
| 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 |
$263.25
|
| Rate for Payer: Nomi Health Commercial |
$253.95
|
| Rate for Payer: PHP Commercial |
$263.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.31
|
| 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
|
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
|
IP
|
$3.65
|
|
|
Service Code
|
NDC 68084021411
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$3.29 |
| 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 |
$3.29
|
| 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 |
$3.29 |
| 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 |
$3.29
|
| 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
|
|
|
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 |
$256.79
|
| 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 |
$75.53
|
| Rate for Payer: BCBS Trust/PPO |
$248.36
|
| Rate for Payer: BCN Commercial |
$234.88
|
| Rate for Payer: BCN Medicare Advantage |
$75.53
|
| 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 |
$75.53
|
| Rate for Payer: Healthscope Commercial |
$271.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.57
|
| 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 |
$256.79
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: PACE Senior Care Partners |
$71.75
|
| Rate for Payer: PACE SWMI |
$75.53
|
| Rate for Payer: PHP Commercial |
$256.79
|
| Rate for Payer: PHP Medicare Advantage |
$75.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.37
|
| 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 |
$75.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.85
|
| Rate for Payer: UHC Core |
$252.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.53
|
| Rate for Payer: UHC Exchange |
$75.53
|
| Rate for Payer: UHC Medicare Advantage |
$75.53
|
| Rate for Payer: VA VA |
$75.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.57
|
|
|
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
|
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 |
$263.25
|
| 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 |
$263.25
|
| 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 |
$263.25
|
| Rate for Payer: PHP Medicare Advantage |
$77.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.31
|
| 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
|
|
|
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
|
OP
|
$183.30
|
|
|
Service Code
|
NDC 69315013601
|
| Hospital Charge Code |
998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.53 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna Medicare |
$47.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.28
|
| Rate for Payer: BCBS Complete |
$73.32
|
| Rate for Payer: BCBS MAPPO |
$45.83
|
| Rate for Payer: BCBS Trust/PPO |
$150.69
|
| Rate for Payer: BCN Commercial |
$142.52
|
| Rate for Payer: BCN Medicare Advantage |
$45.83
|
| 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: Health Alliance Plan Medicare Advantage |
$45.83
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: PACE Senior Care Partners |
$43.53
|
| Rate for Payer: PACE SWMI |
$45.83
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: PHP Medicare Advantage |
$45.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.14
|
| Rate for Payer: Priority Health HMO/PPO |
$159.47
|
| Rate for Payer: Priority Health Medicare |
$46.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.81
|
| Rate for Payer: Railroad Medicare Medicare |
$45.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$153.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.83
|
| Rate for Payer: UHC Exchange |
$45.83
|
| Rate for Payer: UHC Medicare Advantage |
$45.83
|
| Rate for Payer: VA VA |
$45.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
BENZTROPINE 0.5 MG TABLET
|
Facility
|
IP
|
$307.80
|
|
|
Service Code
|
NDC 00904728861
|
| Hospital Charge Code |
998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.07 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: BCBS Trust/PPO |
$251.26
|
| Rate for Payer: BCN Commercial |
$237.87
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Commercial |
$264.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.24
|
| Rate for Payer: Healthscope Commercial |
$277.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: Nomi Health Commercial |
$252.40
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.07
|
| Rate for Payer: Priority Health HMO/PPO |
$267.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.86
|
| Rate for Payer: UHC Core |
$257.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
|
|
BENZTROPINE 0.5 MG TABLET
|
Facility
|
IP
|
$216.20
|
|
|
Service Code
|
NDC 76385010301
|
| Hospital Charge Code |
998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.53 |
| Max. Negotiated Rate |
$194.58 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: BCBS Trust/PPO |
$176.48
|
| Rate for Payer: BCN Commercial |
$167.08
|
| Rate for Payer: Cash Price |
$172.96
|
| Rate for Payer: Cofinity Commercial |
$185.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.96
|
| Rate for Payer: Healthscope Commercial |
$194.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.77
|
| Rate for Payer: Nomi Health Commercial |
$177.28
|
| Rate for Payer: PHP Commercial |
$183.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.53
|
| Rate for Payer: Priority Health HMO/PPO |
$188.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.26
|
| Rate for Payer: UHC Core |
$180.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.15
|
|
|
BENZTROPINE 0.5 MG TABLET
|
Facility
|
OP
|
$284.35
|
|
|
Service Code
|
NDC 69097082607
|
| Hospital Charge Code |
998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.53 |
| Max. Negotiated Rate |
$255.91 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna Medicare |
$73.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.86
|
| Rate for Payer: BCBS Complete |
$113.74
|
| Rate for Payer: BCBS MAPPO |
$71.09
|
| Rate for Payer: BCBS Trust/PPO |
$233.76
|
| Rate for Payer: BCN Commercial |
$221.08
|
| Rate for Payer: BCN Medicare Advantage |
$71.09
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.09
|
| Rate for Payer: Healthscope Commercial |
$255.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: PACE Senior Care Partners |
$67.53
|
| Rate for Payer: PACE SWMI |
$71.09
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: PHP Medicare Advantage |
$71.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: Priority Health HMO/PPO |
$247.38
|
| Rate for Payer: Priority Health Medicare |
$71.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.51
|
| Rate for Payer: Railroad Medicare Medicare |
$71.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.23
|
| Rate for Payer: UHC Core |
$237.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.09
|
| Rate for Payer: UHC Exchange |
$71.09
|
| Rate for Payer: UHC Medicare Advantage |
$71.09
|
| Rate for Payer: VA VA |
$71.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
|
BENZTROPINE 0.5 MG TABLET
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
NDC 00904678861
|
| Hospital Charge Code |
998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.25 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: BCBS Trust/PPO |
$232.65
|
| Rate for Payer: BCN Commercial |
$220.25
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.25
|
| Rate for Payer: Nomi Health Commercial |
$233.70
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.25
|
| Rate for Payer: Priority Health HMO/PPO |
$247.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.80
|
| Rate for Payer: UHC Core |
$237.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.75
|
|
|
BENZTROPINE 0.5 MG TABLET
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
NDC 00904678861
|
| Hospital Charge Code |
998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna Medicare |
$74.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.06
|
| Rate for Payer: BCBS Complete |
$114.00
|
| Rate for Payer: BCBS MAPPO |
$71.25
|
| Rate for Payer: BCBS Trust/PPO |
$234.30
|
| Rate for Payer: BCN Commercial |
$221.59
|
| Rate for Payer: BCN Medicare Advantage |
$71.25
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.25
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.25
|
| Rate for Payer: Nomi Health Commercial |
$233.70
|
| Rate for Payer: PACE Senior Care Partners |
$67.69
|
| Rate for Payer: PACE SWMI |
$71.25
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: PHP Medicare Advantage |
$71.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.25
|
| Rate for Payer: Priority Health HMO/PPO |
$247.95
|
| Rate for Payer: Priority Health Medicare |
$71.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.95
|
| Rate for Payer: Railroad Medicare Medicare |
$71.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.80
|
| Rate for Payer: UHC Core |
$237.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.25
|
| Rate for Payer: UHC Exchange |
$71.25
|
| Rate for Payer: UHC Medicare Advantage |
$71.25
|
| Rate for Payer: VA VA |
$71.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.75
|
|
|
BENZTROPINE 0.5 MG TABLET
|
Facility
|
OP
|
$307.80
|
|
|
Service Code
|
NDC 00904728861
|
| Hospital Charge Code |
998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.10 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna Medicare |
$80.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.19
|
| Rate for Payer: BCBS Complete |
$123.12
|
| Rate for Payer: BCBS MAPPO |
$76.95
|
| Rate for Payer: BCBS Trust/PPO |
$253.04
|
| Rate for Payer: BCN Commercial |
$239.31
|
| Rate for Payer: BCN Medicare Advantage |
$76.95
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Commercial |
$264.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.95
|
| Rate for Payer: Healthscope Commercial |
$277.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: Nomi Health Commercial |
$252.40
|
| Rate for Payer: PACE Senior Care Partners |
$73.10
|
| Rate for Payer: PACE SWMI |
$76.95
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: PHP Medicare Advantage |
$76.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.07
|
| Rate for Payer: Priority Health HMO/PPO |
$267.79
|
| Rate for Payer: Priority Health Medicare |
$77.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.23
|
| Rate for Payer: Railroad Medicare Medicare |
$76.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.86
|
| Rate for Payer: UHC Core |
$257.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.95
|
| Rate for Payer: UHC Exchange |
$76.95
|
| Rate for Payer: UHC Medicare Advantage |
$76.95
|
| Rate for Payer: VA VA |
$76.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
|
|
BENZTROPINE 0.5 MG TABLET
|
Facility
|
OP
|
$216.20
|
|
|
Service Code
|
NDC 76385010301
|
| Hospital Charge Code |
998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$194.58 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna Medicare |
$56.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.56
|
| Rate for Payer: BCBS Complete |
$86.48
|
| Rate for Payer: BCBS MAPPO |
$54.05
|
| Rate for Payer: BCBS Trust/PPO |
$177.74
|
| Rate for Payer: BCN Commercial |
$168.10
|
| Rate for Payer: BCN Medicare Advantage |
$54.05
|
| Rate for Payer: Cash Price |
$172.96
|
| Rate for Payer: Cofinity Commercial |
$185.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.05
|
| Rate for Payer: Healthscope Commercial |
$194.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.77
|
| Rate for Payer: Nomi Health Commercial |
$177.28
|
| Rate for Payer: PACE Senior Care Partners |
$51.35
|
| Rate for Payer: PACE SWMI |
$54.05
|
| Rate for Payer: PHP Commercial |
$183.77
|
| Rate for Payer: PHP Medicare Advantage |
$54.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.53
|
| Rate for Payer: Priority Health HMO/PPO |
$188.09
|
| Rate for Payer: Priority Health Medicare |
$54.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.85
|
| Rate for Payer: Railroad Medicare Medicare |
$54.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.26
|
| Rate for Payer: UHC Core |
$180.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.05
|
| Rate for Payer: UHC Exchange |
$54.05
|
| Rate for Payer: UHC Medicare Advantage |
$54.05
|
| Rate for Payer: VA VA |
$54.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.15
|
|
|
BENZTROPINE 0.5 MG TABLET
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 69097082607
|
| Hospital Charge Code |
998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.83 |
| Max. Negotiated Rate |
$255.91 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: BCBS Trust/PPO |
$232.11
|
| Rate for Payer: BCN Commercial |
$219.75
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: Priority Health HMO/PPO |
$247.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.23
|
| Rate for Payer: UHC Core |
$237.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
|
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 |
$155.81
|
| 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 |
$137.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: PHP Commercial |
$155.81
|
| 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 |
$137.47
|
|
