|
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
|
|
|
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 |
$255.92 |
| 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 |
$255.92
|
| 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
|
$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
|
$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
|
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
|
$284.35
|
|
|
Service Code
|
NDC 69097082607
|
| Hospital Charge Code |
998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.53 |
| Max. Negotiated Rate |
$255.92 |
| 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 |
$255.92
|
| 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
|
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 |
$155.80
|
| 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 |
$45.82
|
| Rate for Payer: BCBS Trust/PPO |
$150.69
|
| Rate for Payer: BCN Commercial |
$142.52
|
| Rate for Payer: BCN Medicare Advantage |
$45.82
|
| 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 |
$45.82
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.48
|
| 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 |
$155.80
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: PACE Senior Care Partners |
$43.53
|
| Rate for Payer: PACE SWMI |
$45.82
|
| Rate for Payer: PHP Commercial |
$155.80
|
| Rate for Payer: PHP Medicare Advantage |
$45.82
|
| 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 |
$45.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$153.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.82
|
| Rate for Payer: UHC Exchange |
$45.82
|
| Rate for Payer: UHC Medicare Advantage |
$45.82
|
| Rate for Payer: VA VA |
$45.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.48
|
|
|
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
|
$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 |
$237.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.75
|
|
|
BENZTROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$103.47
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
9259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.26 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: BCBS Trust/PPO |
$84.46
|
| Rate for Payer: BCN Commercial |
$79.96
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: Nomi Health Commercial |
$84.85
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.26
|
| Rate for Payer: Priority Health HMO/PPO |
$90.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.05
|
| Rate for Payer: UHC Core |
$86.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.60
|
|
|
BENZTROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$103.47
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
9259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: Aetna Medicare |
$26.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.33
|
| Rate for Payer: BCBS Complete |
$41.39
|
| Rate for Payer: BCBS MAPPO |
$25.87
|
| Rate for Payer: BCBS Trust/PPO |
$85.06
|
| Rate for Payer: BCN Commercial |
$80.45
|
| Rate for Payer: BCN Medicare Advantage |
$25.87
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.87
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: Nomi Health Commercial |
$84.85
|
| Rate for Payer: PACE Senior Care Partners |
$24.57
|
| Rate for Payer: PACE SWMI |
$25.87
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: PHP Medicare Advantage |
$25.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.26
|
| Rate for Payer: Priority Health HMO/PPO |
$90.02
|
| Rate for Payer: Priority Health Medicare |
$26.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.32
|
| Rate for Payer: Railroad Medicare Medicare |
$25.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.05
|
| Rate for Payer: UHC Core |
$86.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.87
|
| Rate for Payer: UHC Exchange |
$25.87
|
| Rate for Payer: UHC Medicare Advantage |
$25.87
|
| Rate for Payer: VA VA |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.60
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$153.53
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.79 |
| Max. Negotiated Rate |
$138.18 |
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: BCBS Trust/PPO |
$125.33
|
| Rate for Payer: BCN Commercial |
$118.65
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cofinity Commercial |
$132.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Healthscope Commercial |
$138.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.50
|
| Rate for Payer: Nomi Health Commercial |
$125.89
|
| Rate for Payer: PHP Commercial |
$130.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| Rate for Payer: Priority Health HMO/PPO |
$133.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.11
|
| Rate for Payer: UHC Core |
$128.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.15
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$153.53
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.46 |
| Max. Negotiated Rate |
$138.18 |
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna Medicare |
$39.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.98
|
| Rate for Payer: BCBS Complete |
$61.41
|
| Rate for Payer: BCBS MAPPO |
$38.38
|
| Rate for Payer: BCBS Trust/PPO |
$126.22
|
| Rate for Payer: BCN Commercial |
$119.37
|
| Rate for Payer: BCN Medicare Advantage |
$38.38
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cofinity Commercial |
$132.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.38
|
| Rate for Payer: Healthscope Commercial |
$138.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.50
|
| Rate for Payer: Nomi Health Commercial |
$125.89
|
| Rate for Payer: PACE Senior Care Partners |
$36.46
|
| Rate for Payer: PACE SWMI |
$38.38
|
| Rate for Payer: PHP Commercial |
$130.50
|
| Rate for Payer: PHP Medicare Advantage |
$38.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| Rate for Payer: Priority Health HMO/PPO |
$133.57
|
| Rate for Payer: Priority Health Medicare |
$38.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.87
|
| Rate for Payer: Railroad Medicare Medicare |
$38.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.11
|
| Rate for Payer: UHC Core |
$128.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.38
|
| Rate for Payer: UHC Exchange |
$38.38
|
| Rate for Payer: UHC Medicare Advantage |
$38.38
|
| Rate for Payer: VA VA |
$38.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.15
|
|
|
BIOPSY, MUSCLE; SUPERFICIAL
|
Facility
|
OP
|
$1,205.21
|
|
|
Service Code
|
CPT 20200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,147.75 |
| Max. Negotiated Rate |
$1,205.21 |
| Rate for Payer: BCBS Complete |
$1,205.21
|
| Rate for Payer: Mclaren Medicaid |
$1,147.75
|
| Rate for Payer: Meridian Medicaid |
$1,205.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,147.75
|
| Rate for Payer: UHCCP Medicaid |
$1,147.75
|
|
|
BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); 1 LESION
|
Facility
|
OP
|
$647.70
|
|
|
Service Code
|
CPT 56605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$616.81 |
| Max. Negotiated Rate |
$647.70 |
| Rate for Payer: BCBS Complete |
$647.70
|
| Rate for Payer: Mclaren Medicaid |
$616.81
|
| Rate for Payer: Meridian Medicaid |
$647.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.81
|
| Rate for Payer: UHCCP Medicaid |
$616.81
|
|
|
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S)
|
Facility
|
OP
|
$2,848.40
|
|
|
Service Code
|
CPT 38510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,712.59 |
| Max. Negotiated Rate |
$2,848.40 |
| Rate for Payer: BCBS Complete |
$2,848.40
|
| Rate for Payer: Mclaren Medicaid |
$2,712.59
|
| Rate for Payer: Meridian Medicaid |
$2,848.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,712.59
|
| Rate for Payer: UHCCP Medicaid |
$2,712.59
|
|
|
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, SUPERFICIAL
|
Facility
|
OP
|
$2,848.40
|
|
|
Service Code
|
CPT 38500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,712.59 |
| Max. Negotiated Rate |
$2,848.40 |
| Rate for Payer: BCBS Complete |
$2,848.40
|
| Rate for Payer: Mclaren Medicaid |
$2,712.59
|
| Rate for Payer: Meridian Medicaid |
$2,848.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,712.59
|
| Rate for Payer: UHCCP Medicaid |
$2,712.59
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$124.06
|
|
|
Service Code
|
NDC 81421002105
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.64 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: BCBS Trust/PPO |
$101.27
|
| Rate for Payer: BCN Commercial |
$95.87
|
| Rate for Payer: Cash Price |
$99.25
|
| Rate for Payer: Cofinity Commercial |
$106.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.25
|
| Rate for Payer: Healthscope Commercial |
$111.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.45
|
| Rate for Payer: Nomi Health Commercial |
$101.73
|
| Rate for Payer: PHP Commercial |
$105.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.64
|
| Rate for Payer: Priority Health HMO/PPO |
$107.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.17
|
| Rate for Payer: UHC Core |
$103.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.04
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$25.88
|
|
|
Service Code
|
NDC 00574705012
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.82 |
| Max. Negotiated Rate |
$23.29 |
| Rate for Payer: Aetna Commercial |
$22.00
|
| Rate for Payer: BCBS Trust/PPO |
$21.13
|
| Rate for Payer: BCN Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cofinity Commercial |
$22.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.70
|
| Rate for Payer: Healthscope Commercial |
$23.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.00
|
| Rate for Payer: Nomi Health Commercial |
$21.22
|
| Rate for Payer: PHP Commercial |
$22.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.82
|
| Rate for Payer: Priority Health HMO/PPO |
$22.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.77
|
| Rate for Payer: UHC Core |
$21.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.41
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$38.42
|
|
|
Service Code
|
NDC 00904714212
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$34.58 |
| Rate for Payer: Aetna Commercial |
$32.66
|
| Rate for Payer: BCBS Trust/PPO |
$31.36
|
| Rate for Payer: BCN Commercial |
$29.69
|
| Rate for Payer: Cash Price |
$30.74
|
| Rate for Payer: Cofinity Commercial |
$33.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.74
|
| Rate for Payer: Healthscope Commercial |
$34.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.66
|
| Rate for Payer: Nomi Health Commercial |
$31.50
|
| Rate for Payer: PHP Commercial |
$32.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.97
|
| Rate for Payer: Priority Health HMO/PPO |
$33.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.81
|
| Rate for Payer: UHC Core |
$32.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.82
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$38.42
|
|
|
Service Code
|
NDC 00904714212
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$34.58 |
| Rate for Payer: Aetna Commercial |
$32.66
|
| Rate for Payer: Aetna Medicare |
$9.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.01
|
| Rate for Payer: BCBS Complete |
$15.37
|
| Rate for Payer: BCBS MAPPO |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$31.59
|
| Rate for Payer: BCN Commercial |
$29.87
|
| Rate for Payer: BCN Medicare Advantage |
$9.60
|
| Rate for Payer: Cash Price |
$30.74
|
| Rate for Payer: Cofinity Commercial |
$33.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$34.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.66
|
| Rate for Payer: Nomi Health Commercial |
$31.50
|
| Rate for Payer: PACE Senior Care Partners |
$9.12
|
| Rate for Payer: PACE SWMI |
$9.60
|
| Rate for Payer: PHP Commercial |
$32.66
|
| Rate for Payer: PHP Medicare Advantage |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.97
|
| Rate for Payer: Priority Health HMO/PPO |
$33.43
|
| Rate for Payer: Priority Health Medicare |
$9.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.74
|
| Rate for Payer: Railroad Medicare Medicare |
$9.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.81
|
| Rate for Payer: UHC Core |
$32.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.60
|
| Rate for Payer: UHC Exchange |
$9.60
|
| Rate for Payer: UHC Medicare Advantage |
$9.60
|
| Rate for Payer: VA VA |
$9.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.82
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$25.88
|
|
|
Service Code
|
NDC 00574705012
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$23.29 |
| Rate for Payer: Aetna Commercial |
$22.00
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$10.35
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.28
|
| Rate for Payer: BCN Commercial |
$20.12
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cofinity Commercial |
$22.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.00
|
| Rate for Payer: Nomi Health Commercial |
$21.22
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.00
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.82
|
| Rate for Payer: Priority Health HMO/PPO |
$22.52
|
| Rate for Payer: Priority Health Medicare |
$6.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.34
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.77
|
| Rate for Payer: UHC Core |
$21.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.41
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$124.06
|
|
|
Service Code
|
NDC 81421002105
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.46 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: Aetna Medicare |
$32.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.77
|
| Rate for Payer: BCBS Complete |
$49.62
|
| Rate for Payer: BCBS MAPPO |
$31.02
|
| Rate for Payer: BCBS Trust/PPO |
$101.99
|
| Rate for Payer: BCN Commercial |
$96.46
|
| Rate for Payer: BCN Medicare Advantage |
$31.02
|
| Rate for Payer: Cash Price |
$99.25
|
| Rate for Payer: Cofinity Commercial |
$106.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.02
|
| Rate for Payer: Healthscope Commercial |
$111.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.45
|
| Rate for Payer: Nomi Health Commercial |
$101.73
|
| Rate for Payer: PACE Senior Care Partners |
$29.46
|
| Rate for Payer: PACE SWMI |
$31.02
|
| Rate for Payer: PHP Commercial |
$105.45
|
| Rate for Payer: PHP Medicare Advantage |
$31.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.64
|
| Rate for Payer: Priority Health HMO/PPO |
$107.93
|
| Rate for Payer: Priority Health Medicare |
$31.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.12
|
| Rate for Payer: Railroad Medicare Medicare |
$31.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.17
|
| Rate for Payer: UHC Core |
$103.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.02
|
| Rate for Payer: UHC Exchange |
$31.02
|
| Rate for Payer: UHC Medicare Advantage |
$31.02
|
| Rate for Payer: VA VA |
$31.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.04
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$5.88
|
|
|
Service Code
|
NDC 00904640761
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna Commercial |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$4.80
|
| Rate for Payer: BCN Commercial |
$4.54
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cofinity Commercial |
$5.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.70
|
| Rate for Payer: Healthscope Commercial |
$5.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.00
|
| Rate for Payer: Nomi Health Commercial |
$4.82
|
| Rate for Payer: PHP Commercial |
$5.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.82
|
| Rate for Payer: Priority Health HMO/PPO |
$5.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.17
|
| Rate for Payer: UHC Core |
$4.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.41
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$5.88
|
|
|
Service Code
|
NDC 00904640761
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna Commercial |
$5.00
|
| Rate for Payer: Aetna Medicare |
$1.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.84
|
| Rate for Payer: BCBS Complete |
$2.35
|
| Rate for Payer: BCBS MAPPO |
$1.47
|
| Rate for Payer: BCBS Trust/PPO |
$4.83
|
| Rate for Payer: BCN Commercial |
$4.57
|
| Rate for Payer: BCN Medicare Advantage |
$1.47
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cofinity Commercial |
$5.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.47
|
| Rate for Payer: Healthscope Commercial |
$5.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.00
|
| Rate for Payer: Nomi Health Commercial |
$4.82
|
| Rate for Payer: PACE Senior Care Partners |
$1.40
|
| Rate for Payer: PACE SWMI |
$1.47
|
| Rate for Payer: PHP Commercial |
$5.00
|
| Rate for Payer: PHP Medicare Advantage |
$1.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.82
|
| Rate for Payer: Priority Health HMO/PPO |
$5.12
|
| Rate for Payer: Priority Health Medicare |
$1.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.17
|
| Rate for Payer: UHC Core |
$4.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.47
|
| Rate for Payer: UHC Exchange |
$1.47
|
| Rate for Payer: UHC Medicare Advantage |
$1.47
|
| Rate for Payer: VA VA |
$1.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.41
|
|
