|
PR XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 93224
|
| Min. Negotiated Rate |
$68.33 |
| Max. Negotiated Rate |
$1,872.30 |
| Rate for Payer: Aetna Commercial |
$91.56
|
| Rate for Payer: Aetna Medicare |
$71.06
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: BCBS MAPPO |
$68.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,872.30
|
| Rate for Payer: BCN Commercial |
$106.04
|
| Rate for Payer: BCN Medicare Advantage |
$68.33
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$91.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.75
|
| Rate for Payer: PACE SWMI |
$68.33
|
| Rate for Payer: PHP Medicare Advantage |
$68.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.62
|
| Rate for Payer: Priority Health Medicare |
$68.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.33
|
| Rate for Payer: UHC Medicare Advantage |
$70.38
|
|
|
PR XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 93227
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$2,081.50 |
| Rate for Payer: Aetna Commercial |
$23.99
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,081.50
|
| Rate for Payer: BCN Commercial |
$26.39
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Cofinity Commercial |
$25.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Mclaren Medicaid |
$11.50
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.54
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Medicare Advantage |
$18.44
|
|
|
PR XTRNL FIXJ W/STRTCTC ADJUSTMENT EXCHANGE STRUT
|
Professional
|
Both
|
$3,819.00
|
|
|
Service Code
|
HCPCS 20697
|
| Min. Negotiated Rate |
$578.50 |
| Max. Negotiated Rate |
$2,803.47 |
| Rate for Payer: Aetna Commercial |
$2,271.37
|
| Rate for Payer: Aetna Medicare |
$1,762.85
|
| Rate for Payer: BCBS Complete |
$1,527.60
|
| Rate for Payer: BCBS MAPPO |
$1,695.05
|
| Rate for Payer: BCBS Trust/PPO |
$578.50
|
| Rate for Payer: BCN Commercial |
$2,682.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,695.05
|
| Rate for Payer: Cash Price |
$3,055.20
|
| Rate for Payer: Cash Price |
$3,055.20
|
| Rate for Payer: Cofinity Commercial |
$2,440.87
|
| Rate for Payer: Cofinity Commercial |
$2,271.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,695.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,779.80
|
| Rate for Payer: PACE SWMI |
$1,695.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,695.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,673.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,803.47
|
| Rate for Payer: Priority Health Medicare |
$1,695.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,803.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,695.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,695.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,745.90
|
|
|
PR XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 93228
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$454.34 |
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Aetna Medicare |
$25.81
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS MAPPO |
$24.82
|
| Rate for Payer: BCBS Trust/PPO |
$454.34
|
| Rate for Payer: BCN Commercial |
$36.65
|
| Rate for Payer: BCN Medicare Advantage |
$24.82
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Cofinity Commercial |
$35.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.82
|
| Rate for Payer: Mclaren Medicaid |
$15.76
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.06
|
| Rate for Payer: PACE SWMI |
$24.82
|
| Rate for Payer: PHP Medicare Advantage |
$24.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.47
|
| Rate for Payer: Priority Health Medicare |
$24.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.82
|
| Rate for Payer: UHC Medicare Advantage |
$25.56
|
|
|
PR XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
HCPCS 93271
|
| Min. Negotiated Rate |
$134.96 |
| Max. Negotiated Rate |
$867.47 |
| Rate for Payer: Aetna Commercial |
$180.85
|
| Rate for Payer: Aetna Medicare |
$140.36
|
| Rate for Payer: BCBS Complete |
$256.40
|
| Rate for Payer: BCBS MAPPO |
$134.96
|
| Rate for Payer: BCBS Trust/PPO |
$867.47
|
| Rate for Payer: BCN Commercial |
$213.55
|
| Rate for Payer: BCN Medicare Advantage |
$134.96
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cofinity Commercial |
$180.85
|
| Rate for Payer: Cofinity Commercial |
$194.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$141.71
|
| Rate for Payer: PACE SWMI |
$134.96
|
| Rate for Payer: PHP Medicare Advantage |
$134.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.65
|
| Rate for Payer: Priority Health Medicare |
$134.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.96
|
| Rate for Payer: UHC Medicare Advantage |
$139.01
|
|
|
PR XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 93270
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$1,098.86 |
| Rate for Payer: Aetna Commercial |
$10.41
|
| Rate for Payer: Aetna Medicare |
$8.08
|
| Rate for Payer: BCBS Complete |
$48.40
|
| Rate for Payer: BCBS MAPPO |
$7.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.86
|
| Rate for Payer: BCN Commercial |
$12.22
|
| Rate for Payer: BCN Medicare Advantage |
$7.77
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$11.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.16
|
| Rate for Payer: PACE SWMI |
$7.77
|
| Rate for Payer: PHP Medicare Advantage |
$7.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.82
|
| Rate for Payer: Priority Health Medicare |
$7.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.77
|
| Rate for Payer: UHC Medicare Advantage |
$8.00
|
|
|
PR XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS
|
Professional
|
Both
|
$854.00
|
|
|
Service Code
|
HCPCS 93268
|
| Min. Negotiated Rate |
$166.34 |
| Max. Negotiated Rate |
$869.58 |
| Rate for Payer: Aetna Commercial |
$222.90
|
| Rate for Payer: Aetna Medicare |
$172.99
|
| Rate for Payer: BCBS Complete |
$341.60
|
| Rate for Payer: BCBS MAPPO |
$166.34
|
| Rate for Payer: BCBS Trust/PPO |
$869.58
|
| Rate for Payer: BCN Commercial |
$260.46
|
| Rate for Payer: BCN Medicare Advantage |
$166.34
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Cofinity Commercial |
$222.90
|
| Rate for Payer: Cofinity Commercial |
$239.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$174.66
|
| Rate for Payer: PACE SWMI |
$166.34
|
| Rate for Payer: PHP Medicare Advantage |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.04
|
| Rate for Payer: Priority Health Medicare |
$166.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.34
|
| Rate for Payer: UHC Medicare Advantage |
$171.33
|
|
|
PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 93272
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$934.03 |
| Rate for Payer: Aetna Commercial |
$31.62
|
| Rate for Payer: Aetna Medicare |
$24.54
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS MAPPO |
$23.60
|
| Rate for Payer: BCBS Trust/PPO |
$934.03
|
| Rate for Payer: BCN Commercial |
$34.70
|
| Rate for Payer: BCN Medicare Advantage |
$23.60
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$33.98
|
| Rate for Payer: Cofinity Commercial |
$31.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.60
|
| Rate for Payer: Mclaren Medicaid |
$15.12
|
| Rate for Payer: Meridian Medicaid |
$15.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.78
|
| Rate for Payer: PACE SWMI |
$23.60
|
| Rate for Payer: PHP Medicare Advantage |
$23.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.57
|
| Rate for Payer: Priority Health Medicare |
$23.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.60
|
| Rate for Payer: UHC Medicare Advantage |
$24.31
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 41015
|
| Min. Negotiated Rate |
$191.27 |
| Max. Negotiated Rate |
$1,058.71 |
| Rate for Payer: Aetna Commercial |
$387.43
|
| Rate for Payer: Aetna Medicare |
$300.70
|
| Rate for Payer: BCBS Complete |
$200.83
|
| Rate for Payer: BCBS MAPPO |
$289.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.71
|
| Rate for Payer: BCN Commercial |
$583.48
|
| Rate for Payer: BCN Medicare Advantage |
$289.13
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cofinity Commercial |
$416.35
|
| Rate for Payer: Cofinity Commercial |
$387.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.13
|
| Rate for Payer: Mclaren Medicaid |
$191.27
|
| Rate for Payer: Meridian Medicaid |
$200.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$303.59
|
| Rate for Payer: PACE SWMI |
$289.13
|
| Rate for Payer: PHP Medicare Advantage |
$289.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$523.30
|
| Rate for Payer: Priority Health Medicare |
$289.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$523.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.13
|
| Rate for Payer: UHC Medicare Advantage |
$297.80
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 41017
|
| Min. Negotiated Rate |
$219.39 |
| Max. Negotiated Rate |
$686.10 |
| Rate for Payer: Aetna Commercial |
$445.48
|
| Rate for Payer: Aetna Medicare |
$345.75
|
| Rate for Payer: BCBS Complete |
$230.36
|
| Rate for Payer: BCBS MAPPO |
$332.45
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: BCN Commercial |
$686.10
|
| Rate for Payer: BCN Medicare Advantage |
$332.45
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cofinity Commercial |
$478.73
|
| Rate for Payer: Cofinity Commercial |
$445.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$332.45
|
| Rate for Payer: Mclaren Medicaid |
$219.39
|
| Rate for Payer: Meridian Medicaid |
$230.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$349.07
|
| Rate for Payer: PACE SWMI |
$332.45
|
| Rate for Payer: PHP Medicare Advantage |
$332.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$604.44
|
| Rate for Payer: Priority Health Medicare |
$332.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$604.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$332.45
|
| Rate for Payer: UHC Medicare Advantage |
$342.42
|
|
|
PR ZINC PASTE BAND W >=3<5/YD
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS A6456
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna Commercial |
$1.18
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: BCN Commercial |
$1.39
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
|
|
PR ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 90736
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$221.01 |
| Rate for Payer: Aetna Commercial |
$216.92
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: BCBS Trust/PPO |
$221.01
|
| Rate for Payer: BCN Commercial |
$216.92
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.40
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
IP
|
$22.56
|
|
|
Service Code
|
NDC 0904-6337-24
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$20.30 |
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: BCBS Trust/PPO |
$17.43
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$19.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$20.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.18
|
| Rate for Payer: PHP Commercial |
$19.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.85
|
| Rate for Payer: UHC Core |
$18.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.92
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
NDC 0904-5053-59
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.67 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: BCBS Trust/PPO |
$36.32
|
| Rate for Payer: BCN Commercial |
$36.32
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.95
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.36
|
| Rate for Payer: UHC Core |
$39.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.25
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$26.41
|
|
|
Service Code
|
NDC 45802-107-52
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$23.77 |
| Rate for Payer: Aetna Commercial |
$22.45
|
| Rate for Payer: BCBS Trust/PPO |
$20.41
|
| Rate for Payer: BCN Commercial |
$20.41
|
| Rate for Payer: Cash Price |
$21.13
|
| Rate for Payer: Cofinity Commercial |
$22.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.13
|
| Rate for Payer: Healthscope Commercial |
$23.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.45
|
| Rate for Payer: PHP Commercial |
$22.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.24
|
| Rate for Payer: UHC Core |
$22.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.81
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
NDC 0904-6754-15
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: BCBS Trust/PPO |
$24.60
|
| Rate for Payer: BCN Commercial |
$24.60
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.06
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.01
|
| Rate for Payer: UHC Core |
$26.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.87
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
IP
|
$8.85
|
|
|
Service Code
|
NDC 37000-024-10
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: BCBS Trust/PPO |
$6.84
|
| Rate for Payer: BCN Commercial |
$6.84
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Healthscope Commercial |
$7.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.52
|
| Rate for Payer: PHP Commercial |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.79
|
| Rate for Payer: UHC Core |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$1.25
|
|
|
Service Code
|
NDC 7733394025
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna Commercial |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.97
|
| Rate for Payer: BCN Commercial |
$0.97
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cofinity Commercial |
$1.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.00
|
| Rate for Payer: Healthscope Commercial |
$1.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.06
|
| Rate for Payer: PHP Commercial |
$1.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.10
|
| Rate for Payer: UHC Core |
$1.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.94
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$124.30
|
|
|
Service Code
|
NDC 7733394010
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.81 |
| Max. Negotiated Rate |
$111.87 |
| Rate for Payer: Aetna Commercial |
$105.66
|
| Rate for Payer: BCBS Trust/PPO |
$96.06
|
| Rate for Payer: BCN Commercial |
$96.06
|
| Rate for Payer: Cash Price |
$99.44
|
| Rate for Payer: Cofinity Commercial |
$106.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.44
|
| Rate for Payer: Healthscope Commercial |
$111.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.66
|
| Rate for Payer: PHP Commercial |
$105.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.38
|
| Rate for Payer: UHC Core |
$103.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.22
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$157.50
|
|
|
Service Code
|
NDC 5789685301
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.06 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: BCBS Trust/PPO |
$121.72
|
| Rate for Payer: BCN Commercial |
$121.72
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$141.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.88
|
| Rate for Payer: PHP Commercial |
$133.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.60
|
| Rate for Payer: UHC Core |
$131.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.12
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 16729-147-01
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: BCBS Trust/PPO |
$107.15
|
| Rate for Payer: BCN Commercial |
$107.15
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.85
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.01
|
| Rate for Payer: UHC Core |
$115.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$442.70
|
|
|
Service Code
|
NDC 63739-665-10
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: BCBS Trust/PPO |
$342.12
|
| Rate for Payer: BCN Commercial |
$342.12
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$398.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.30
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$385.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.58
|
| Rate for Payer: UHC Core |
$369.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.02
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$314.90
|
|
|
Service Code
|
NDC 0904-6640-61
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.06 |
| Max. Negotiated Rate |
$283.41 |
| Rate for Payer: Aetna Commercial |
$267.66
|
| Rate for Payer: BCBS Trust/PPO |
$243.35
|
| Rate for Payer: BCN Commercial |
$243.35
|
| Rate for Payer: Cash Price |
$251.92
|
| Rate for Payer: Cofinity Commercial |
$270.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.92
|
| Rate for Payer: Healthscope Commercial |
$283.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.66
|
| Rate for Payer: PHP Commercial |
$267.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.11
|
| Rate for Payer: UHC Core |
$262.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.18
|
|
|
QUETIAPINE 12.5 MG CUSTOM TAB
|
Facility
|
IP
|
$2.44
|
|
|
Service Code
|
NDC 9900-0003-11
|
| Hospital Charge Code |
155122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: BCBS Trust/PPO |
$1.89
|
| Rate for Payer: BCN Commercial |
$1.89
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.95
|
| Rate for Payer: Healthscope Commercial |
$2.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.07
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.15
|
| Rate for Payer: UHC Core |
$2.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.83
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$54.05
|
|
|
Service Code
|
NDC 67877-242-01
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.97 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Aetna Commercial |
$45.94
|
| Rate for Payer: BCBS Trust/PPO |
$41.77
|
| Rate for Payer: BCN Commercial |
$41.77
|
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Cofinity Commercial |
$46.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.24
|
| Rate for Payer: Healthscope Commercial |
$48.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.94
|
| Rate for Payer: PHP Commercial |
$45.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.56
|
| Rate for Payer: UHC Core |
$45.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.54
|
|
