|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$5.80
|
|
|
Service Code
|
NDC 60687067911
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna Commercial |
$4.93
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.81
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: BCBS MAPPO |
$1.45
|
| Rate for Payer: BCBS Trust/PPO |
$4.77
|
| Rate for Payer: BCN Commercial |
$4.51
|
| Rate for Payer: BCN Medicare Advantage |
$1.45
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$4.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.45
|
| Rate for Payer: Healthscope Commercial |
$5.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: PACE Senior Care Partners |
$1.38
|
| Rate for Payer: PACE SWMI |
$1.45
|
| Rate for Payer: PHP Commercial |
$4.93
|
| Rate for Payer: PHP Medicare Advantage |
$1.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.77
|
| Rate for Payer: Priority Health HMO/PPO |
$5.05
|
| Rate for Payer: Priority Health Medicare |
$1.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.10
|
| Rate for Payer: UHC Core |
$4.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.45
|
| Rate for Payer: UHC Exchange |
$1.45
|
| Rate for Payer: UHC Medicare Advantage |
$1.45
|
| Rate for Payer: VA VA |
$1.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.35
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$75.81
|
|
|
Service Code
|
NDC 29300012613
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$68.23 |
| Rate for Payer: Aetna Commercial |
$64.44
|
| Rate for Payer: Aetna Medicare |
$19.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.69
|
| Rate for Payer: BCBS Complete |
$30.32
|
| Rate for Payer: BCBS MAPPO |
$18.95
|
| Rate for Payer: BCBS Trust/PPO |
$62.32
|
| Rate for Payer: BCN Commercial |
$58.94
|
| Rate for Payer: BCN Medicare Advantage |
$18.95
|
| Rate for Payer: Cash Price |
$60.65
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.95
|
| Rate for Payer: Healthscope Commercial |
$68.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.44
|
| Rate for Payer: Nomi Health Commercial |
$62.16
|
| Rate for Payer: PACE Senior Care Partners |
$18.00
|
| Rate for Payer: PACE SWMI |
$18.95
|
| Rate for Payer: PHP Commercial |
$64.44
|
| Rate for Payer: PHP Medicare Advantage |
$18.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.28
|
| Rate for Payer: Priority Health HMO/PPO |
$65.95
|
| Rate for Payer: Priority Health Medicare |
$19.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.79
|
| Rate for Payer: Railroad Medicare Medicare |
$18.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.71
|
| Rate for Payer: UHC Core |
$63.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.95
|
| Rate for Payer: UHC Exchange |
$18.95
|
| Rate for Payer: UHC Medicare Advantage |
$18.95
|
| Rate for Payer: VA VA |
$18.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.86
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$173.96
|
|
|
Service Code
|
NDC 60687067921
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.07 |
| Max. Negotiated Rate |
$156.56 |
| Rate for Payer: Aetna Commercial |
$147.87
|
| Rate for Payer: BCBS Trust/PPO |
$142.00
|
| Rate for Payer: BCN Commercial |
$134.44
|
| Rate for Payer: Cash Price |
$139.17
|
| Rate for Payer: Cofinity Commercial |
$149.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.17
|
| Rate for Payer: Healthscope Commercial |
$156.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.87
|
| Rate for Payer: Nomi Health Commercial |
$142.65
|
| Rate for Payer: PHP Commercial |
$147.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.07
|
| Rate for Payer: Priority Health HMO/PPO |
$151.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.08
|
| Rate for Payer: UHC Core |
$145.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.47
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$75.81
|
|
|
Service Code
|
NDC 29300012613
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.28 |
| Max. Negotiated Rate |
$68.23 |
| Rate for Payer: Aetna Commercial |
$64.44
|
| Rate for Payer: BCBS Trust/PPO |
$61.88
|
| Rate for Payer: BCN Commercial |
$58.59
|
| Rate for Payer: Cash Price |
$60.65
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.65
|
| Rate for Payer: Healthscope Commercial |
$68.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.44
|
| Rate for Payer: Nomi Health Commercial |
$62.16
|
| Rate for Payer: PHP Commercial |
$64.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.28
|
| Rate for Payer: Priority Health HMO/PPO |
$65.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.71
|
| Rate for Payer: UHC Core |
$63.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.86
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$173.96
|
|
|
Service Code
|
NDC 60687067921
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$156.56 |
| Rate for Payer: Aetna Commercial |
$147.87
|
| Rate for Payer: Aetna Medicare |
$45.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.36
|
| Rate for Payer: BCBS Complete |
$69.58
|
| Rate for Payer: BCBS MAPPO |
$43.49
|
| Rate for Payer: BCBS Trust/PPO |
$143.01
|
| Rate for Payer: BCN Commercial |
$135.25
|
| Rate for Payer: BCN Medicare Advantage |
$43.49
|
| Rate for Payer: Cash Price |
$139.17
|
| Rate for Payer: Cofinity Commercial |
$149.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.49
|
| Rate for Payer: Healthscope Commercial |
$156.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.87
|
| Rate for Payer: Nomi Health Commercial |
$142.65
|
| Rate for Payer: PACE Senior Care Partners |
$41.32
|
| Rate for Payer: PACE SWMI |
$43.49
|
| Rate for Payer: PHP Commercial |
$147.87
|
| Rate for Payer: PHP Medicare Advantage |
$43.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.07
|
| Rate for Payer: Priority Health HMO/PPO |
$151.35
|
| Rate for Payer: Priority Health Medicare |
$43.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.55
|
| Rate for Payer: Railroad Medicare Medicare |
$43.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.08
|
| Rate for Payer: UHC Core |
$145.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.49
|
| Rate for Payer: UHC Exchange |
$43.49
|
| Rate for Payer: UHC Medicare Advantage |
$43.49
|
| Rate for Payer: VA VA |
$43.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.47
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$124.79
|
|
|
Service Code
|
NDC 52817027030
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.11 |
| Max. Negotiated Rate |
$112.31 |
| Rate for Payer: Aetna Commercial |
$106.07
|
| Rate for Payer: BCBS Trust/PPO |
$101.87
|
| Rate for Payer: BCN Commercial |
$96.44
|
| Rate for Payer: Cash Price |
$99.83
|
| Rate for Payer: Cofinity Commercial |
$107.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.83
|
| Rate for Payer: Healthscope Commercial |
$112.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.07
|
| Rate for Payer: Nomi Health Commercial |
$102.33
|
| Rate for Payer: PHP Commercial |
$106.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.11
|
| Rate for Payer: Priority Health HMO/PPO |
$108.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.82
|
| Rate for Payer: UHC Core |
$104.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.59
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$5.80
|
|
|
Service Code
|
NDC 60687067911
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna Commercial |
$4.93
|
| Rate for Payer: BCBS Trust/PPO |
$4.73
|
| Rate for Payer: BCN Commercial |
$4.48
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$4.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: PHP Commercial |
$4.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.77
|
| Rate for Payer: Priority Health HMO/PPO |
$5.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.10
|
| Rate for Payer: UHC Core |
$4.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.35
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$124.79
|
|
|
Service Code
|
NDC 52817027030
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$112.31 |
| Rate for Payer: Aetna Commercial |
$106.07
|
| Rate for Payer: Aetna Medicare |
$32.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.00
|
| Rate for Payer: BCBS Complete |
$49.92
|
| Rate for Payer: BCBS MAPPO |
$31.20
|
| Rate for Payer: BCBS Trust/PPO |
$102.59
|
| Rate for Payer: BCN Commercial |
$97.02
|
| Rate for Payer: BCN Medicare Advantage |
$31.20
|
| Rate for Payer: Cash Price |
$99.83
|
| Rate for Payer: Cofinity Commercial |
$107.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.20
|
| Rate for Payer: Healthscope Commercial |
$112.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.07
|
| Rate for Payer: Nomi Health Commercial |
$102.33
|
| Rate for Payer: PACE Senior Care Partners |
$29.64
|
| Rate for Payer: PACE SWMI |
$31.20
|
| Rate for Payer: PHP Commercial |
$106.07
|
| Rate for Payer: PHP Medicare Advantage |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.11
|
| Rate for Payer: Priority Health HMO/PPO |
$108.57
|
| Rate for Payer: Priority Health Medicare |
$31.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.61
|
| Rate for Payer: Railroad Medicare Medicare |
$31.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.82
|
| Rate for Payer: UHC Core |
$104.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.20
|
| Rate for Payer: UHC Exchange |
$31.20
|
| Rate for Payer: UHC Medicare Advantage |
$31.20
|
| Rate for Payer: VA VA |
$31.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.59
|
|
|
BREAST REDUCTION
|
Facility
|
OP
|
$4,850.98
|
|
|
Service Code
|
CPT 19318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,619.68 |
| Max. Negotiated Rate |
$4,850.98 |
| Rate for Payer: BCBS Complete |
$4,850.98
|
| Rate for Payer: Mclaren Medicaid |
$4,619.68
|
| Rate for Payer: Meridian Medicaid |
$4,850.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,619.68
|
| Rate for Payer: UHCCP Medicaid |
$4,619.68
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$632.59
|
|
|
Service Code
|
NDC 00023932105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.24 |
| Max. Negotiated Rate |
$569.33 |
| Rate for Payer: Aetna Commercial |
$537.70
|
| Rate for Payer: Aetna Medicare |
$164.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$197.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$197.68
|
| Rate for Payer: BCBS Complete |
$253.04
|
| Rate for Payer: BCBS MAPPO |
$158.15
|
| Rate for Payer: BCBS Trust/PPO |
$520.05
|
| Rate for Payer: BCN Commercial |
$491.84
|
| Rate for Payer: BCN Medicare Advantage |
$158.15
|
| Rate for Payer: Cash Price |
$506.07
|
| Rate for Payer: Cofinity Commercial |
$544.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$158.15
|
| Rate for Payer: Healthscope Commercial |
$569.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$474.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$166.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.70
|
| Rate for Payer: Nomi Health Commercial |
$518.72
|
| Rate for Payer: PACE Senior Care Partners |
$150.24
|
| Rate for Payer: PACE SWMI |
$158.15
|
| Rate for Payer: PHP Commercial |
$537.70
|
| Rate for Payer: PHP Medicare Advantage |
$158.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$411.18
|
| Rate for Payer: Priority Health HMO/PPO |
$550.35
|
| Rate for Payer: Priority Health Medicare |
$159.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$423.84
|
| Rate for Payer: Railroad Medicare Medicare |
$158.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$556.68
|
| Rate for Payer: UHC Core |
$528.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$158.15
|
| Rate for Payer: UHC Exchange |
$158.15
|
| Rate for Payer: UHC Medicare Advantage |
$158.15
|
| Rate for Payer: VA VA |
$158.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$474.44
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$632.59
|
|
|
Service Code
|
NDC 00023932105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$411.18 |
| Max. Negotiated Rate |
$569.33 |
| Rate for Payer: Aetna Commercial |
$537.70
|
| Rate for Payer: BCBS Trust/PPO |
$516.38
|
| Rate for Payer: BCN Commercial |
$488.87
|
| Rate for Payer: Cash Price |
$506.07
|
| Rate for Payer: Cofinity Commercial |
$544.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.07
|
| Rate for Payer: Healthscope Commercial |
$569.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$474.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.70
|
| Rate for Payer: Nomi Health Commercial |
$518.72
|
| Rate for Payer: PHP Commercial |
$537.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$411.18
|
| Rate for Payer: Priority Health HMO/PPO |
$550.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$423.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$556.68
|
| Rate for Payer: UHC Core |
$528.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$474.44
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$26.42
|
|
|
Service Code
|
NDC 61314014315
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$23.78 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Medicare |
$6.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.26
|
| Rate for Payer: BCBS Complete |
$10.57
|
| Rate for Payer: BCBS MAPPO |
$6.60
|
| Rate for Payer: BCBS Trust/PPO |
$21.72
|
| Rate for Payer: BCN Commercial |
$20.54
|
| Rate for Payer: BCN Medicare Advantage |
$6.60
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: Cofinity Commercial |
$22.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.60
|
| Rate for Payer: Healthscope Commercial |
$23.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.46
|
| Rate for Payer: Nomi Health Commercial |
$21.66
|
| Rate for Payer: PACE Senior Care Partners |
$6.27
|
| Rate for Payer: PACE SWMI |
$6.60
|
| Rate for Payer: PHP Commercial |
$22.46
|
| Rate for Payer: PHP Medicare Advantage |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.17
|
| Rate for Payer: Priority Health HMO/PPO |
$22.99
|
| Rate for Payer: Priority Health Medicare |
$6.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.70
|
| Rate for Payer: Railroad Medicare Medicare |
$6.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.25
|
| Rate for Payer: UHC Core |
$22.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.60
|
| Rate for Payer: UHC Exchange |
$6.60
|
| Rate for Payer: UHC Medicare Advantage |
$6.60
|
| Rate for Payer: VA VA |
$6.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.82
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$19.93
|
|
|
Service Code
|
NDC 70069023301
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.23
|
| Rate for Payer: BCBS Complete |
$7.97
|
| Rate for Payer: BCBS MAPPO |
$4.98
|
| Rate for Payer: BCBS Trust/PPO |
$16.38
|
| Rate for Payer: BCN Commercial |
$15.50
|
| Rate for Payer: BCN Medicare Advantage |
$4.98
|
| Rate for Payer: Cash Price |
$15.94
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.98
|
| Rate for Payer: Healthscope Commercial |
$17.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.94
|
| Rate for Payer: Nomi Health Commercial |
$16.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.73
|
| Rate for Payer: PACE SWMI |
$4.98
|
| Rate for Payer: PHP Commercial |
$16.94
|
| Rate for Payer: PHP Medicare Advantage |
$4.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.95
|
| Rate for Payer: Priority Health HMO/PPO |
$17.34
|
| Rate for Payer: Priority Health Medicare |
$5.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.35
|
| Rate for Payer: Railroad Medicare Medicare |
$4.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.54
|
| Rate for Payer: UHC Core |
$16.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.98
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicare Advantage |
$4.98
|
| Rate for Payer: VA VA |
$4.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.95
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$19.93
|
|
|
Service Code
|
NDC 70069023301
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$16.27
|
| Rate for Payer: BCN Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$15.94
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.94
|
| Rate for Payer: Healthscope Commercial |
$17.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.94
|
| Rate for Payer: Nomi Health Commercial |
$16.34
|
| Rate for Payer: PHP Commercial |
$16.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.95
|
| Rate for Payer: Priority Health HMO/PPO |
$17.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.54
|
| Rate for Payer: UHC Core |
$16.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.95
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$26.42
|
|
|
Service Code
|
NDC 61314014315
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.17 |
| Max. Negotiated Rate |
$23.78 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: BCBS Trust/PPO |
$21.57
|
| Rate for Payer: BCN Commercial |
$20.42
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: Cofinity Commercial |
$22.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.14
|
| Rate for Payer: Healthscope Commercial |
$23.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.46
|
| Rate for Payer: Nomi Health Commercial |
$21.66
|
| Rate for Payer: PHP Commercial |
$22.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.17
|
| Rate for Payer: Priority Health HMO/PPO |
$22.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.25
|
| Rate for Payer: UHC Core |
$22.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.82
|
|
|
BRIMONIDINE-TIMOLOL 0.2 %-0.5 % EYE DROPS
|
Facility
|
OP
|
$664.13
|
|
|
Service Code
|
NDC 00023921105
|
| Hospital Charge Code |
87834
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.73 |
| Max. Negotiated Rate |
$597.72 |
| Rate for Payer: Aetna Commercial |
$564.51
|
| Rate for Payer: Aetna Medicare |
$172.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$207.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$207.54
|
| Rate for Payer: BCBS Complete |
$265.65
|
| Rate for Payer: BCBS MAPPO |
$166.03
|
| Rate for Payer: BCBS Trust/PPO |
$545.98
|
| Rate for Payer: BCN Commercial |
$516.36
|
| Rate for Payer: BCN Medicare Advantage |
$166.03
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Cofinity Commercial |
$571.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.03
|
| Rate for Payer: Healthscope Commercial |
$597.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$498.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$564.51
|
| Rate for Payer: Nomi Health Commercial |
$544.59
|
| Rate for Payer: PACE Senior Care Partners |
$157.73
|
| Rate for Payer: PACE SWMI |
$166.03
|
| Rate for Payer: PHP Commercial |
$564.51
|
| Rate for Payer: PHP Medicare Advantage |
$166.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.68
|
| Rate for Payer: Priority Health HMO/PPO |
$577.79
|
| Rate for Payer: Priority Health Medicare |
$167.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$444.97
|
| Rate for Payer: Railroad Medicare Medicare |
$166.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$584.43
|
| Rate for Payer: UHC Core |
$554.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.03
|
| Rate for Payer: UHC Exchange |
$166.03
|
| Rate for Payer: UHC Medicare Advantage |
$166.03
|
| Rate for Payer: VA VA |
$166.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$498.10
|
|
|
BRIMONIDINE-TIMOLOL 0.2 %-0.5 % EYE DROPS
|
Facility
|
IP
|
$664.13
|
|
|
Service Code
|
NDC 00023921105
|
| Hospital Charge Code |
87834
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$431.68 |
| Max. Negotiated Rate |
$597.72 |
| Rate for Payer: Aetna Commercial |
$564.51
|
| Rate for Payer: BCBS Trust/PPO |
$542.13
|
| Rate for Payer: BCN Commercial |
$513.24
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Cofinity Commercial |
$571.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.30
|
| Rate for Payer: Healthscope Commercial |
$597.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$498.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$564.51
|
| Rate for Payer: Nomi Health Commercial |
$544.59
|
| Rate for Payer: PHP Commercial |
$564.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.68
|
| Rate for Payer: Priority Health HMO/PPO |
$577.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$444.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$584.43
|
| Rate for Payer: UHC Core |
$554.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$498.10
|
|
|
BRINZOLAMIDE 1 %-BRIMONIDINE 0.2 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$668.03
|
|
|
Service Code
|
NDC 00065414727
|
| Hospital Charge Code |
166167
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$434.22 |
| Max. Negotiated Rate |
$601.23 |
| Rate for Payer: Aetna Commercial |
$567.83
|
| Rate for Payer: BCBS Trust/PPO |
$545.31
|
| Rate for Payer: BCN Commercial |
$516.25
|
| Rate for Payer: Cash Price |
$534.42
|
| Rate for Payer: Cofinity Commercial |
$574.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$534.42
|
| Rate for Payer: Healthscope Commercial |
$601.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$567.83
|
| Rate for Payer: Nomi Health Commercial |
$547.78
|
| Rate for Payer: PHP Commercial |
$567.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.22
|
| Rate for Payer: Priority Health HMO/PPO |
$581.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$447.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$587.87
|
| Rate for Payer: UHC Core |
$557.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.02
|
|
|
BRINZOLAMIDE 1 %-BRIMONIDINE 0.2 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$668.03
|
|
|
Service Code
|
NDC 00065414727
|
| Hospital Charge Code |
166167
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.66 |
| Max. Negotiated Rate |
$601.23 |
| Rate for Payer: Aetna Commercial |
$567.83
|
| Rate for Payer: Aetna Medicare |
$173.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.76
|
| Rate for Payer: BCBS Complete |
$267.21
|
| Rate for Payer: BCBS MAPPO |
$167.01
|
| Rate for Payer: BCBS Trust/PPO |
$549.19
|
| Rate for Payer: BCN Commercial |
$519.39
|
| Rate for Payer: BCN Medicare Advantage |
$167.01
|
| Rate for Payer: Cash Price |
$534.42
|
| Rate for Payer: Cofinity Commercial |
$574.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$534.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.01
|
| Rate for Payer: Healthscope Commercial |
$601.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$567.83
|
| Rate for Payer: Nomi Health Commercial |
$547.78
|
| Rate for Payer: PACE Senior Care Partners |
$158.66
|
| Rate for Payer: PACE SWMI |
$167.01
|
| Rate for Payer: PHP Commercial |
$567.83
|
| Rate for Payer: PHP Medicare Advantage |
$167.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.22
|
| Rate for Payer: Priority Health HMO/PPO |
$581.19
|
| Rate for Payer: Priority Health Medicare |
$168.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$447.58
|
| Rate for Payer: Railroad Medicare Medicare |
$167.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$587.87
|
| Rate for Payer: UHC Core |
$557.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.01
|
| Rate for Payer: UHC Exchange |
$167.01
|
| Rate for Payer: UHC Medicare Advantage |
$167.01
|
| Rate for Payer: VA VA |
$167.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.02
|
|
|
BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$965.27
|
|
|
Service Code
|
NDC 00591212779
|
| Hospital Charge Code |
22953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.25 |
| Max. Negotiated Rate |
$868.74 |
| Rate for Payer: Aetna Commercial |
$820.48
|
| Rate for Payer: Aetna Medicare |
$250.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$301.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$301.65
|
| Rate for Payer: BCBS Complete |
$386.11
|
| Rate for Payer: BCBS MAPPO |
$241.32
|
| Rate for Payer: BCBS Trust/PPO |
$793.55
|
| Rate for Payer: BCN Commercial |
$750.50
|
| Rate for Payer: BCN Medicare Advantage |
$241.32
|
| Rate for Payer: Cash Price |
$772.22
|
| Rate for Payer: Cofinity Commercial |
$830.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.32
|
| Rate for Payer: Healthscope Commercial |
$868.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.48
|
| Rate for Payer: Nomi Health Commercial |
$791.52
|
| Rate for Payer: PACE Senior Care Partners |
$229.25
|
| Rate for Payer: PACE SWMI |
$241.32
|
| Rate for Payer: PHP Commercial |
$820.48
|
| Rate for Payer: PHP Medicare Advantage |
$241.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.43
|
| Rate for Payer: Priority Health HMO/PPO |
$839.78
|
| Rate for Payer: Priority Health Medicare |
$243.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$646.73
|
| Rate for Payer: Railroad Medicare Medicare |
$241.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$849.44
|
| Rate for Payer: UHC Core |
$806.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$241.32
|
| Rate for Payer: UHC Exchange |
$241.32
|
| Rate for Payer: UHC Medicare Advantage |
$241.32
|
| Rate for Payer: VA VA |
$241.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.95
|
|
|
BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$965.27
|
|
|
Service Code
|
NDC 00591212779
|
| Hospital Charge Code |
22953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$627.43 |
| Max. Negotiated Rate |
$868.74 |
| Rate for Payer: Aetna Commercial |
$820.48
|
| Rate for Payer: BCBS Trust/PPO |
$787.95
|
| Rate for Payer: BCN Commercial |
$745.96
|
| Rate for Payer: Cash Price |
$772.22
|
| Rate for Payer: Cofinity Commercial |
$830.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.22
|
| Rate for Payer: Healthscope Commercial |
$868.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.48
|
| Rate for Payer: Nomi Health Commercial |
$791.52
|
| Rate for Payer: PHP Commercial |
$820.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.43
|
| Rate for Payer: Priority Health HMO/PPO |
$839.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$646.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$849.44
|
| Rate for Payer: UHC Core |
$806.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.95
|
|
|
BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$1,114.61
|
|
|
Service Code
|
NDC 00065027510
|
| Hospital Charge Code |
22953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$724.50 |
| Max. Negotiated Rate |
$1,003.15 |
| Rate for Payer: Aetna Commercial |
$947.42
|
| Rate for Payer: BCBS Trust/PPO |
$909.86
|
| Rate for Payer: BCN Commercial |
$861.37
|
| Rate for Payer: Cash Price |
$891.69
|
| Rate for Payer: Cofinity Commercial |
$958.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.69
|
| Rate for Payer: Healthscope Commercial |
$1,003.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$835.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.42
|
| Rate for Payer: Nomi Health Commercial |
$913.98
|
| Rate for Payer: PHP Commercial |
$947.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.50
|
| Rate for Payer: Priority Health HMO/PPO |
$969.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$746.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.86
|
| Rate for Payer: UHC Core |
$930.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$835.96
|
|
|
BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$1,114.61
|
|
|
Service Code
|
NDC 00065027510
|
| Hospital Charge Code |
22953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$264.72 |
| Max. Negotiated Rate |
$1,003.15 |
| Rate for Payer: Aetna Commercial |
$947.42
|
| Rate for Payer: Aetna Medicare |
$289.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.32
|
| Rate for Payer: BCBS Complete |
$445.84
|
| Rate for Payer: BCBS MAPPO |
$278.65
|
| Rate for Payer: BCBS Trust/PPO |
$916.32
|
| Rate for Payer: BCN Commercial |
$866.61
|
| Rate for Payer: BCN Medicare Advantage |
$278.65
|
| Rate for Payer: Cash Price |
$891.69
|
| Rate for Payer: Cofinity Commercial |
$958.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.65
|
| Rate for Payer: Healthscope Commercial |
$1,003.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$835.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$292.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.42
|
| Rate for Payer: Nomi Health Commercial |
$913.98
|
| Rate for Payer: PACE Senior Care Partners |
$264.72
|
| Rate for Payer: PACE SWMI |
$278.65
|
| Rate for Payer: PHP Commercial |
$947.42
|
| Rate for Payer: PHP Medicare Advantage |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.50
|
| Rate for Payer: Priority Health HMO/PPO |
$969.71
|
| Rate for Payer: Priority Health Medicare |
$281.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$746.79
|
| Rate for Payer: Railroad Medicare Medicare |
$278.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.86
|
| Rate for Payer: UHC Core |
$930.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.65
|
| Rate for Payer: UHC Exchange |
$278.65
|
| Rate for Payer: UHC Medicare Advantage |
$278.65
|
| Rate for Payer: VA VA |
$278.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$835.96
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
OP
|
$27.36
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$24.62 |
| Rate for Payer: Aetna Commercial |
$23.26
|
| Rate for Payer: Aetna Commercial |
$7.51
|
| Rate for Payer: Aetna Commercial |
$6.37
|
| Rate for Payer: Aetna Medicare |
$2.30
|
| Rate for Payer: Aetna Medicare |
$7.11
|
| Rate for Payer: Aetna Medicare |
$1.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.76
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS Complete |
$10.94
|
| Rate for Payer: BCBS Complete |
$3.53
|
| Rate for Payer: BCBS MAPPO |
$2.21
|
| Rate for Payer: BCBS MAPPO |
$6.84
|
| Rate for Payer: BCBS MAPPO |
$1.87
|
| Rate for Payer: BCBS Trust/PPO |
$6.16
|
| Rate for Payer: BCBS Trust/PPO |
$22.49
|
| Rate for Payer: BCBS Trust/PPO |
$7.26
|
| Rate for Payer: BCN Commercial |
$5.82
|
| Rate for Payer: BCN Commercial |
$6.87
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: BCN Medicare Advantage |
$6.84
|
| Rate for Payer: BCN Medicare Advantage |
$1.87
|
| Rate for Payer: BCN Medicare Advantage |
$2.21
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Cofinity Commercial |
$7.59
|
| Rate for Payer: Cofinity Commercial |
$23.53
|
| Rate for Payer: Cofinity Commercial |
$6.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.84
|
| Rate for Payer: Healthscope Commercial |
$6.74
|
| Rate for Payer: Healthscope Commercial |
$24.62
|
| Rate for Payer: Healthscope Commercial |
$7.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.26
|
| Rate for Payer: Nomi Health Commercial |
$7.24
|
| Rate for Payer: Nomi Health Commercial |
$22.44
|
| Rate for Payer: Nomi Health Commercial |
$6.14
|
| Rate for Payer: PACE Senior Care Partners |
$2.10
|
| Rate for Payer: PACE Senior Care Partners |
$6.50
|
| Rate for Payer: PACE Senior Care Partners |
$1.78
|
| Rate for Payer: PACE SWMI |
$1.87
|
| Rate for Payer: PACE SWMI |
$6.84
|
| Rate for Payer: PACE SWMI |
$2.21
|
| Rate for Payer: PHP Commercial |
$7.51
|
| Rate for Payer: PHP Commercial |
$6.37
|
| Rate for Payer: PHP Commercial |
$23.26
|
| Rate for Payer: PHP Medicare Advantage |
$1.87
|
| Rate for Payer: PHP Medicare Advantage |
$2.21
|
| Rate for Payer: PHP Medicare Advantage |
$6.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.87
|
| Rate for Payer: Priority Health HMO/PPO |
$7.68
|
| Rate for Payer: Priority Health HMO/PPO |
$23.80
|
| Rate for Payer: Priority Health HMO/PPO |
$6.52
|
| Rate for Payer: Priority Health Medicare |
$6.91
|
| Rate for Payer: Priority Health Medicare |
$2.23
|
| Rate for Payer: Priority Health Medicare |
$1.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.87
|
| Rate for Payer: Railroad Medicare Medicare |
$2.21
|
| Rate for Payer: Railroad Medicare Medicare |
$6.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.08
|
| Rate for Payer: UHC Core |
$7.37
|
| Rate for Payer: UHC Core |
$6.25
|
| Rate for Payer: UHC Core |
$22.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.87
|
| Rate for Payer: UHC Exchange |
$1.87
|
| Rate for Payer: UHC Exchange |
$6.84
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Medicare Advantage |
$6.84
|
| Rate for Payer: UHC Medicare Advantage |
$1.87
|
| Rate for Payer: UHC Medicare Advantage |
$2.21
|
| Rate for Payer: VA VA |
$1.87
|
| Rate for Payer: VA VA |
$2.21
|
| Rate for Payer: VA VA |
$6.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.62
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$27.36
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$24.62 |
| Rate for Payer: Aetna Commercial |
$23.26
|
| Rate for Payer: Aetna Commercial |
$6.37
|
| Rate for Payer: Aetna Commercial |
$7.51
|
| Rate for Payer: BCBS Trust/PPO |
$6.11
|
| Rate for Payer: BCBS Trust/PPO |
$22.33
|
| Rate for Payer: BCBS Trust/PPO |
$7.21
|
| Rate for Payer: BCN Commercial |
$5.79
|
| Rate for Payer: BCN Commercial |
$21.14
|
| Rate for Payer: BCN Commercial |
$6.82
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cofinity Commercial |
$7.59
|
| Rate for Payer: Cofinity Commercial |
$6.44
|
| Rate for Payer: Cofinity Commercial |
$23.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.06
|
| Rate for Payer: Healthscope Commercial |
$6.74
|
| Rate for Payer: Healthscope Commercial |
$24.62
|
| Rate for Payer: Healthscope Commercial |
$7.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.51
|
| Rate for Payer: Nomi Health Commercial |
$22.44
|
| Rate for Payer: Nomi Health Commercial |
$6.14
|
| Rate for Payer: Nomi Health Commercial |
$7.24
|
| Rate for Payer: PHP Commercial |
$6.37
|
| Rate for Payer: PHP Commercial |
$23.26
|
| Rate for Payer: PHP Commercial |
$7.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.87
|
| Rate for Payer: Priority Health HMO/PPO |
$7.68
|
| Rate for Payer: Priority Health HMO/PPO |
$6.52
|
| Rate for Payer: Priority Health HMO/PPO |
$23.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.08
|
| Rate for Payer: UHC Core |
$22.85
|
| Rate for Payer: UHC Core |
$7.37
|
| Rate for Payer: UHC Core |
$6.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.62
|
|
