|
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 |
$6.61
|
| Rate for Payer: BCBS Trust/PPO |
$21.72
|
| Rate for Payer: BCN Commercial |
$20.54
|
| Rate for Payer: BCN Medicare Advantage |
$6.61
|
| 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 |
$6.61
|
| 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 |
$6.61
|
| Rate for Payer: PHP Commercial |
$22.46
|
| Rate for Payer: PHP Medicare Advantage |
$6.61
|
| 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 |
$6.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.25
|
| Rate for Payer: UHC Core |
$22.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.61
|
| Rate for Payer: UHC Exchange |
$6.61
|
| Rate for Payer: UHC Medicare Advantage |
$6.61
|
| Rate for Payer: VA VA |
$6.61
|
| 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
|
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
|
|
|
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
|
|
|
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
|
$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
|
|
|
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
|
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
|
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
|
|
|
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
|
|
|
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 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
OP
|
$12.10
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna Medicare |
$2.05
|
| Rate for Payer: Aetna Medicare |
$3.15
|
| Rate for Payer: Aetna Medicare |
$8.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.47
|
| Rate for Payer: BCBS Complete |
$12.79
|
| Rate for Payer: BCBS Complete |
$4.84
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: BCBS MAPPO |
$1.97
|
| Rate for Payer: BCBS MAPPO |
$3.02
|
| Rate for Payer: BCBS MAPPO |
$7.99
|
| Rate for Payer: BCBS Trust/PPO |
$26.28
|
| Rate for Payer: BCBS Trust/PPO |
$9.95
|
| Rate for Payer: BCBS Trust/PPO |
$6.49
|
| Rate for Payer: BCN Commercial |
$24.86
|
| Rate for Payer: BCN Commercial |
$6.13
|
| Rate for Payer: BCN Commercial |
$9.41
|
| Rate for Payer: BCN Medicare Advantage |
$3.02
|
| Rate for Payer: BCN Medicare Advantage |
$7.99
|
| Rate for Payer: BCN Medicare Advantage |
$1.97
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Healthscope Commercial |
$10.89
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Nomi Health Commercial |
$6.47
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: Nomi Health Commercial |
$26.22
|
| Rate for Payer: PACE Senior Care Partners |
$1.87
|
| Rate for Payer: PACE Senior Care Partners |
$2.87
|
| Rate for Payer: PACE Senior Care Partners |
$7.59
|
| Rate for Payer: PACE SWMI |
$7.99
|
| Rate for Payer: PACE SWMI |
$3.02
|
| Rate for Payer: PACE SWMI |
$1.97
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: PHP Commercial |
$10.29
|
| Rate for Payer: PHP Medicare Advantage |
$7.99
|
| Rate for Payer: PHP Medicare Advantage |
$1.97
|
| Rate for Payer: PHP Medicare Advantage |
$3.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.78
|
| Rate for Payer: Priority Health HMO/PPO |
$6.86
|
| Rate for Payer: Priority Health HMO/PPO |
$10.53
|
| Rate for Payer: Priority Health HMO/PPO |
$27.81
|
| Rate for Payer: Priority Health Medicare |
$3.06
|
| Rate for Payer: Priority Health Medicare |
$1.99
|
| Rate for Payer: Priority Health Medicare |
$8.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.11
|
| Rate for Payer: Railroad Medicare Medicare |
$7.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1.97
|
| Rate for Payer: Railroad Medicare Medicare |
$3.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.65
|
| Rate for Payer: UHC Core |
$6.59
|
| Rate for Payer: UHC Core |
$26.69
|
| Rate for Payer: UHC Core |
$10.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.99
|
| Rate for Payer: UHC Exchange |
$7.99
|
| Rate for Payer: UHC Exchange |
$3.02
|
| Rate for Payer: UHC Exchange |
$1.97
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: UHC Medicare Advantage |
$7.99
|
| Rate for Payer: UHC Medicare Advantage |
$1.97
|
| Rate for Payer: VA VA |
$7.99
|
| Rate for Payer: VA VA |
$1.97
|
| Rate for Payer: VA VA |
$3.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.98
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$12.10
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: BCBS Trust/PPO |
$26.10
|
| Rate for Payer: BCBS Trust/PPO |
$9.88
|
| Rate for Payer: BCBS Trust/PPO |
$6.44
|
| Rate for Payer: BCN Commercial |
$24.71
|
| Rate for Payer: BCN Commercial |
$9.35
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Healthscope Commercial |
$10.89
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: Nomi Health Commercial |
$26.22
|
| Rate for Payer: Nomi Health Commercial |
$6.47
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: PHP Commercial |
$10.29
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.78
|
| Rate for Payer: Priority Health HMO/PPO |
$6.86
|
| Rate for Payer: Priority Health HMO/PPO |
$27.81
|
| Rate for Payer: Priority Health HMO/PPO |
$10.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.65
|
| Rate for Payer: UHC Core |
$10.10
|
| Rate for Payer: UHC Core |
$6.59
|
| Rate for Payer: UHC Core |
$26.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.98
|
|
|
BUDESONIDE 1 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$10.28
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
88223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$9.25 |
| Rate for Payer: Aetna Commercial |
$8.74
|
| Rate for Payer: Aetna Commercial |
$26.89
|
| Rate for Payer: Aetna Commercial |
$62.88
|
| Rate for Payer: BCBS Trust/PPO |
$25.82
|
| Rate for Payer: BCBS Trust/PPO |
$8.39
|
| Rate for Payer: BCBS Trust/PPO |
$60.39
|
| Rate for Payer: BCN Commercial |
$24.44
|
| Rate for Payer: BCN Commercial |
$7.94
|
| Rate for Payer: BCN Commercial |
$57.17
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$59.18
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$63.62
|
| Rate for Payer: Cofinity Commercial |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$8.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.18
|
| Rate for Payer: Healthscope Commercial |
$28.47
|
| Rate for Payer: Healthscope Commercial |
$9.25
|
| Rate for Payer: Healthscope Commercial |
$66.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.88
|
| Rate for Payer: Nomi Health Commercial |
$8.43
|
| Rate for Payer: Nomi Health Commercial |
$25.94
|
| Rate for Payer: Nomi Health Commercial |
$60.66
|
| Rate for Payer: PHP Commercial |
$26.89
|
| Rate for Payer: PHP Commercial |
$8.74
|
| Rate for Payer: PHP Commercial |
$62.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.56
|
| Rate for Payer: Priority Health HMO/PPO |
$64.36
|
| Rate for Payer: Priority Health HMO/PPO |
$27.52
|
| Rate for Payer: Priority Health HMO/PPO |
$8.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.05
|
| Rate for Payer: UHC Core |
$8.58
|
| Rate for Payer: UHC Core |
$61.77
|
| Rate for Payer: UHC Core |
$26.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.72
|
|
|
BUDESONIDE 1 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
OP
|
$10.28
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
88223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$9.25 |
| Rate for Payer: Aetna Commercial |
$8.74
|
| Rate for Payer: Aetna Commercial |
$62.88
|
| Rate for Payer: Aetna Commercial |
$26.89
|
| Rate for Payer: Aetna Medicare |
$19.23
|
| Rate for Payer: Aetna Medicare |
$2.67
|
| Rate for Payer: Aetna Medicare |
$8.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.12
|
| Rate for Payer: BCBS Complete |
$12.65
|
| Rate for Payer: BCBS Complete |
$4.11
|
| Rate for Payer: BCBS Complete |
$29.59
|
| Rate for Payer: BCBS MAPPO |
$18.50
|
| Rate for Payer: BCBS MAPPO |
$2.57
|
| Rate for Payer: BCBS MAPPO |
$7.91
|
| Rate for Payer: BCBS Trust/PPO |
$26.00
|
| Rate for Payer: BCBS Trust/PPO |
$8.45
|
| Rate for Payer: BCBS Trust/PPO |
$60.82
|
| Rate for Payer: BCN Commercial |
$24.59
|
| Rate for Payer: BCN Commercial |
$57.52
|
| Rate for Payer: BCN Commercial |
$7.99
|
| Rate for Payer: BCN Medicare Advantage |
$2.57
|
| Rate for Payer: BCN Medicare Advantage |
$7.91
|
| Rate for Payer: BCN Medicare Advantage |
$18.50
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$59.18
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cofinity Commercial |
$63.62
|
| Rate for Payer: Cofinity Commercial |
$8.84
|
| Rate for Payer: Cofinity Commercial |
$27.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.57
|
| Rate for Payer: Healthscope Commercial |
$28.47
|
| Rate for Payer: Healthscope Commercial |
$9.25
|
| Rate for Payer: Healthscope Commercial |
$66.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.74
|
| Rate for Payer: Nomi Health Commercial |
$60.66
|
| Rate for Payer: Nomi Health Commercial |
$8.43
|
| Rate for Payer: Nomi Health Commercial |
$25.94
|
| Rate for Payer: PACE Senior Care Partners |
$17.57
|
| Rate for Payer: PACE Senior Care Partners |
$2.44
|
| Rate for Payer: PACE Senior Care Partners |
$7.51
|
| Rate for Payer: PACE SWMI |
$7.91
|
| Rate for Payer: PACE SWMI |
$2.57
|
| Rate for Payer: PACE SWMI |
$18.50
|
| Rate for Payer: PHP Commercial |
$62.88
|
| Rate for Payer: PHP Commercial |
$26.89
|
| Rate for Payer: PHP Commercial |
$8.74
|
| Rate for Payer: PHP Medicare Advantage |
$7.91
|
| Rate for Payer: PHP Medicare Advantage |
$18.50
|
| Rate for Payer: PHP Medicare Advantage |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.56
|
| Rate for Payer: Priority Health HMO/PPO |
$64.36
|
| Rate for Payer: Priority Health HMO/PPO |
$8.94
|
| Rate for Payer: Priority Health HMO/PPO |
$27.52
|
| Rate for Payer: Priority Health Medicare |
$2.60
|
| Rate for Payer: Priority Health Medicare |
$18.68
|
| Rate for Payer: Priority Health Medicare |
$7.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.89
|
| Rate for Payer: Railroad Medicare Medicare |
$7.91
|
| Rate for Payer: Railroad Medicare Medicare |
$18.50
|
| Rate for Payer: Railroad Medicare Medicare |
$2.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.05
|
| Rate for Payer: UHC Core |
$61.77
|
| Rate for Payer: UHC Core |
$26.41
|
| Rate for Payer: UHC Core |
$8.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.91
|
| Rate for Payer: UHC Exchange |
$7.91
|
| Rate for Payer: UHC Exchange |
$2.57
|
| Rate for Payer: UHC Exchange |
$18.50
|
| Rate for Payer: UHC Medicare Advantage |
$2.57
|
| Rate for Payer: UHC Medicare Advantage |
$7.91
|
| Rate for Payer: UHC Medicare Advantage |
$18.50
|
| Rate for Payer: VA VA |
$7.91
|
| Rate for Payer: VA VA |
$18.50
|
| Rate for Payer: VA VA |
$2.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.72
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$185.64
|
|
|
Service Code
|
NDC 00186037028
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: BCBS Trust/PPO |
$151.54
|
| Rate for Payer: BCN Commercial |
$143.46
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: Nomi Health Commercial |
$152.22
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO |
$161.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.36
|
| Rate for Payer: UHC Core |
$155.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$185.64
|
|
|
Service Code
|
NDC 00186037028
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: Aetna Medicare |
$48.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.01
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$152.61
|
| Rate for Payer: BCN Commercial |
$144.34
|
| Rate for Payer: BCN Medicare Advantage |
$46.41
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.41
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: Nomi Health Commercial |
$152.22
|
| Rate for Payer: PACE Senior Care Partners |
$44.09
|
| Rate for Payer: PACE SWMI |
$46.41
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: PHP Medicare Advantage |
$46.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO |
$161.51
|
| Rate for Payer: Priority Health Medicare |
$46.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.38
|
| Rate for Payer: Railroad Medicare Medicare |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.36
|
| Rate for Payer: UHC Core |
$155.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.41
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
| Rate for Payer: VA VA |
$46.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$185.64
|
|
|
Service Code
|
NDC 00186037228
|
| Hospital Charge Code |
81453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: Aetna Medicare |
$48.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.01
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$152.61
|
| Rate for Payer: BCN Commercial |
$144.34
|
| Rate for Payer: BCN Medicare Advantage |
$46.41
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.41
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: Nomi Health Commercial |
$152.22
|
| Rate for Payer: PACE Senior Care Partners |
$44.09
|
| Rate for Payer: PACE SWMI |
$46.41
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: PHP Medicare Advantage |
$46.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO |
$161.51
|
| Rate for Payer: Priority Health Medicare |
$46.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.38
|
| Rate for Payer: Railroad Medicare Medicare |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.36
|
| Rate for Payer: UHC Core |
$155.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.41
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
| Rate for Payer: VA VA |
$46.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$185.64
|
|
|
Service Code
|
NDC 00186037228
|
| Hospital Charge Code |
81453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: BCBS Trust/PPO |
$151.54
|
| Rate for Payer: BCN Commercial |
$143.46
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: Nomi Health Commercial |
$152.22
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO |
$161.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.36
|
| Rate for Payer: UHC Core |
$155.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$25.52
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$22.97 |
| Rate for Payer: Aetna Commercial |
$21.69
|
| Rate for Payer: Aetna Commercial |
$24.45
|
| Rate for Payer: Aetna Medicare |
$6.64
|
| Rate for Payer: Aetna Medicare |
$7.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.99
|
| Rate for Payer: BCBS Complete |
$0.28
|
| Rate for Payer: BCBS Complete |
$0.28
|
| Rate for Payer: BCBS MAPPO |
$7.19
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$20.98
|
| Rate for Payer: BCBS Trust/PPO |
$23.65
|
| Rate for Payer: BCN Commercial |
$19.84
|
| Rate for Payer: BCN Commercial |
$22.37
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: BCN Medicare Advantage |
$7.19
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cofinity Commercial |
$21.95
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.19
|
| Rate for Payer: Healthscope Commercial |
$25.89
|
| Rate for Payer: Healthscope Commercial |
$22.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.58
|
| Rate for Payer: Mclaren Medicaid |
$0.27
|
| Rate for Payer: Mclaren Medicaid |
$0.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.70
|
| Rate for Payer: Meridian Medicaid |
$0.28
|
| Rate for Payer: Meridian Medicaid |
$0.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.45
|
| Rate for Payer: Nomi Health Commercial |
$20.93
|
| Rate for Payer: Nomi Health Commercial |
$23.59
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE Senior Care Partners |
$6.83
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PACE SWMI |
$7.19
|
| Rate for Payer: PHP Commercial |
$24.45
|
| Rate for Payer: PHP Commercial |
$21.69
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: PHP Medicare Advantage |
$7.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.70
|
| Rate for Payer: Priority Health HMO/PPO |
$25.03
|
| Rate for Payer: Priority Health HMO/PPO |
$22.20
|
| Rate for Payer: Priority Health Medicare |
$6.44
|
| Rate for Payer: Priority Health Medicare |
$7.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.28
|
| Rate for Payer: Railroad Medicare Medicare |
$7.19
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.46
|
| Rate for Payer: UHC Core |
$24.02
|
| Rate for Payer: UHC Core |
$21.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.19
|
| Rate for Payer: UHC Exchange |
$7.19
|
| Rate for Payer: UHC Exchange |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$7.19
|
| Rate for Payer: UHC Medicare Advantage |
$6.38
|
| Rate for Payer: UHCCP Medicaid |
$0.27
|
| Rate for Payer: UHCCP Medicaid |
$0.27
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: VA VA |
$7.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.58
|
|
