|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$244.40
|
|
|
Service Code
|
NDC 0904-6638-61
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.06 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: BCBS Trust/PPO |
$188.87
|
| Rate for Payer: BCN Commercial |
$188.87
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.74
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.07
|
| Rate for Payer: UHC Core |
$204.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
IP
|
$194.75
|
|
|
Service Code
|
NDC 0904-6639-61
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.78 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna Commercial |
$165.54
|
| Rate for Payer: BCBS Trust/PPO |
$150.50
|
| Rate for Payer: BCN Commercial |
$150.50
|
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Cofinity Commercial |
$167.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.80
|
| Rate for Payer: Healthscope Commercial |
$175.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.54
|
| Rate for Payer: PHP Commercial |
$165.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.38
|
| Rate for Payer: UHC Core |
$162.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.06
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
NDC 50268-631-11
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.76
|
| Rate for Payer: BCBS Trust/PPO |
$1.60
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.76
|
| Rate for Payer: PHP Commercial |
$1.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.82
|
| Rate for Payer: UHC Core |
$1.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.55
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
IP
|
$259.35
|
|
|
Service Code
|
NDC 60687-338-01
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.18 |
| Max. Negotiated Rate |
$233.42 |
| Rate for Payer: Aetna Commercial |
$220.45
|
| Rate for Payer: BCBS Trust/PPO |
$200.43
|
| Rate for Payer: BCN Commercial |
$200.43
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Commercial |
$223.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$233.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$220.45
|
| Rate for Payer: PHP Commercial |
$220.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.23
|
| Rate for Payer: UHC Core |
$216.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.51
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
IP
|
$103.08
|
|
|
Service Code
|
NDC 50268-631-15
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.87 |
| Max. Negotiated Rate |
$92.77 |
| Rate for Payer: Aetna Commercial |
$87.62
|
| Rate for Payer: BCBS Trust/PPO |
$79.66
|
| Rate for Payer: BCN Commercial |
$79.66
|
| Rate for Payer: Cash Price |
$82.46
|
| Rate for Payer: Cofinity Commercial |
$88.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.46
|
| Rate for Payer: Healthscope Commercial |
$92.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.62
|
| Rate for Payer: PHP Commercial |
$87.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.71
|
| Rate for Payer: UHC Core |
$86.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.31
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
NDC 60687-338-11
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: BCBS Trust/PPO |
$2.01
|
| Rate for Payer: BCN Commercial |
$2.01
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.21
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.29
|
| Rate for Payer: UHC Core |
$2.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.95
|
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2,861.81
|
|
|
Service Code
|
NDC 0310-0281-60
|
| Hospital Charge Code |
96233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,745.42 |
| Max. Negotiated Rate |
$2,575.63 |
| Rate for Payer: Aetna Commercial |
$2,432.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,211.61
|
| Rate for Payer: BCN Commercial |
$2,211.61
|
| Rate for Payer: Cash Price |
$2,289.45
|
| Rate for Payer: Cofinity Commercial |
$2,461.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,289.45
|
| Rate for Payer: Healthscope Commercial |
$2,575.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,146.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,432.54
|
| Rate for Payer: PHP Commercial |
$2,432.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,003.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,489.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,745.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,518.39
|
| Rate for Payer: UHC Core |
$2,389.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,146.36
|
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$310.08
|
|
|
Service Code
|
NDC 0904-6802-61
|
| Hospital Charge Code |
96233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.12 |
| Max. Negotiated Rate |
$279.07 |
| Rate for Payer: Aetna Commercial |
$263.57
|
| Rate for Payer: BCBS Trust/PPO |
$239.63
|
| Rate for Payer: BCN Commercial |
$239.63
|
| Rate for Payer: Cash Price |
$248.06
|
| Rate for Payer: Cofinity Commercial |
$266.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.06
|
| Rate for Payer: Healthscope Commercial |
$279.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.57
|
| Rate for Payer: PHP Commercial |
$263.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.87
|
| Rate for Payer: UHC Core |
$258.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.56
|
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$128.25
|
|
|
Service Code
|
NDC 68180-613-07
|
| Hospital Charge Code |
96233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.22 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: BCBS Trust/PPO |
$99.11
|
| Rate for Payer: BCN Commercial |
$99.11
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.60
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.01
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.86
|
| Rate for Payer: UHC Core |
$107.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.19
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$295.20
|
|
|
Service Code
|
NDC 0904-6801-61
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.04 |
| Max. Negotiated Rate |
$265.68 |
| Rate for Payer: Aetna Commercial |
$250.92
|
| Rate for Payer: BCBS Trust/PPO |
$228.13
|
| Rate for Payer: BCN Commercial |
$228.13
|
| Rate for Payer: Cash Price |
$236.16
|
| Rate for Payer: Cofinity Commercial |
$253.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.16
|
| Rate for Payer: Healthscope Commercial |
$265.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.92
|
| Rate for Payer: PHP Commercial |
$250.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$256.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.78
|
| Rate for Payer: UHC Core |
$246.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.40
|
|
|
QUINIDINE SULFATE 200 MG TABLET
|
Facility
|
IP
|
$408.90
|
|
|
Service Code
|
NDC 0185-4346-01
|
| Hospital Charge Code |
6777
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.39 |
| Max. Negotiated Rate |
$368.01 |
| Rate for Payer: Aetna Commercial |
$347.56
|
| Rate for Payer: BCBS Trust/PPO |
$316.00
|
| Rate for Payer: BCN Commercial |
$316.00
|
| Rate for Payer: Cash Price |
$327.12
|
| Rate for Payer: Cofinity Commercial |
$351.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.12
|
| Rate for Payer: Healthscope Commercial |
$368.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$347.56
|
| Rate for Payer: PHP Commercial |
$347.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$355.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.83
|
| Rate for Payer: UHC Core |
$341.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.68
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$2,014.85
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,228.86 |
| Max. Negotiated Rate |
$1,813.36 |
| Rate for Payer: Aetna Commercial |
$1,712.62
|
| Rate for Payer: Aetna Commercial |
$6,957.48
|
| Rate for Payer: BCBS Trust/PPO |
$6,325.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,557.08
|
| Rate for Payer: BCN Commercial |
$6,325.58
|
| Rate for Payer: BCN Commercial |
$1,557.08
|
| Rate for Payer: Cash Price |
$1,611.88
|
| Rate for Payer: Cash Price |
$6,548.22
|
| Rate for Payer: Cofinity Commercial |
$1,732.77
|
| Rate for Payer: Cofinity Commercial |
$7,039.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,611.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,548.22
|
| Rate for Payer: Healthscope Commercial |
$7,366.74
|
| Rate for Payer: Healthscope Commercial |
$1,813.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,138.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,511.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,957.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,712.62
|
| Rate for Payer: PHP Commercial |
$1,712.62
|
| Rate for Payer: PHP Commercial |
$6,957.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,410.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,729.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,752.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,121.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,992.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,228.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,773.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,203.04
|
| Rate for Payer: UHC Core |
$1,682.40
|
| Rate for Payer: UHC Core |
$6,834.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,511.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,138.95
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
IP
|
$1,212.93
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$739.77 |
| Max. Negotiated Rate |
$1,091.64 |
| Rate for Payer: Aetna Commercial |
$1,030.99
|
| Rate for Payer: Aetna Commercial |
$864.36
|
| Rate for Payer: BCBS Trust/PPO |
$785.86
|
| Rate for Payer: BCBS Trust/PPO |
$937.35
|
| Rate for Payer: BCN Commercial |
$785.86
|
| Rate for Payer: BCN Commercial |
$937.35
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cash Price |
$813.52
|
| Rate for Payer: Cofinity Commercial |
$874.53
|
| Rate for Payer: Cofinity Commercial |
$1,043.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.52
|
| Rate for Payer: Healthscope Commercial |
$1,091.64
|
| Rate for Payer: Healthscope Commercial |
$915.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$909.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,030.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$864.36
|
| Rate for Payer: PHP Commercial |
$864.36
|
| Rate for Payer: PHP Commercial |
$1,030.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$711.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$884.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,055.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$739.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$620.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,067.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$894.87
|
| Rate for Payer: UHC Core |
$849.11
|
| Rate for Payer: UHC Core |
$1,012.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$909.70
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$6.69
|
|
|
Service Code
|
NDC 0487-5901-99
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna Commercial |
$5.69
|
| Rate for Payer: BCBS Trust/PPO |
$5.17
|
| Rate for Payer: BCN Commercial |
$5.17
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cofinity Commercial |
$5.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.35
|
| Rate for Payer: Healthscope Commercial |
$6.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.69
|
| Rate for Payer: PHP Commercial |
$5.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.89
|
| Rate for Payer: UHC Core |
$5.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.02
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 0487-2784-01
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: BCBS Trust/PPO |
$2.87
|
| Rate for Payer: BCN Commercial |
$2.87
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.16
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.27
|
| Rate for Payer: UHC Core |
$3.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
IP
|
$7,203.46
|
|
|
Service Code
|
NDC 0006-0227-61
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,393.39 |
| Max. Negotiated Rate |
$6,483.11 |
| Rate for Payer: Aetna Commercial |
$6,122.94
|
| Rate for Payer: BCBS Trust/PPO |
$5,566.83
|
| Rate for Payer: BCN Commercial |
$5,566.83
|
| Rate for Payer: Cash Price |
$5,762.77
|
| Rate for Payer: Cofinity Commercial |
$6,194.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,762.77
|
| Rate for Payer: Healthscope Commercial |
$6,483.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,402.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,122.94
|
| Rate for Payer: PHP Commercial |
$6,122.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,042.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,267.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,393.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,339.04
|
| Rate for Payer: UHC Core |
$6,014.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,402.60
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
IP
|
$82.08
|
|
|
Service Code
|
NDC 68382-144-06
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.06 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna Commercial |
$69.77
|
| Rate for Payer: BCBS Trust/PPO |
$63.43
|
| Rate for Payer: BCN Commercial |
$63.43
|
| Rate for Payer: Cash Price |
$65.66
|
| Rate for Payer: Cofinity Commercial |
$70.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.66
|
| Rate for Payer: Healthscope Commercial |
$73.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.77
|
| Rate for Payer: PHP Commercial |
$69.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.23
|
| Rate for Payer: UHC Core |
$68.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.56
|
|
|
RAMIPRIL 2.5 MG CAPSULE
|
Facility
|
IP
|
$79.90
|
|
|
Service Code
|
NDC 65862-475-01
|
| Hospital Charge Code |
11260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.73 |
| Max. Negotiated Rate |
$71.91 |
| Rate for Payer: Aetna Commercial |
$67.92
|
| Rate for Payer: BCBS Trust/PPO |
$61.75
|
| Rate for Payer: BCN Commercial |
$61.75
|
| Rate for Payer: Cash Price |
$63.92
|
| Rate for Payer: Cofinity Commercial |
$68.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.92
|
| Rate for Payer: Healthscope Commercial |
$71.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.92
|
| Rate for Payer: PHP Commercial |
$67.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.31
|
| Rate for Payer: UHC Core |
$66.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.92
|
|
|
RAMIPRIL 5 MG CAPSULE
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 65862-476-01
|
| Hospital Charge Code |
11261
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: BCBS Trust/PPO |
$81.72
|
| Rate for Payer: BCN Commercial |
$81.72
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.06
|
| Rate for Payer: UHC Core |
$88.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$154.47
|
|
|
Service Code
|
NDC 70756-703-60
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.21 |
| Max. Negotiated Rate |
$139.02 |
| Rate for Payer: Aetna Commercial |
$131.30
|
| Rate for Payer: BCBS Trust/PPO |
$119.37
|
| Rate for Payer: BCN Commercial |
$119.37
|
| Rate for Payer: Cash Price |
$123.58
|
| Rate for Payer: Cofinity Commercial |
$132.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.58
|
| Rate for Payer: Healthscope Commercial |
$139.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.30
|
| Rate for Payer: PHP Commercial |
$131.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.93
|
| Rate for Payer: UHC Core |
$128.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.85
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$5.78
|
|
|
Service Code
|
NDC 60687-549-11
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna Commercial |
$4.91
|
| Rate for Payer: BCBS Trust/PPO |
$4.47
|
| Rate for Payer: BCN Commercial |
$4.47
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cofinity Commercial |
$4.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.62
|
| Rate for Payer: Healthscope Commercial |
$5.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.91
|
| Rate for Payer: PHP Commercial |
$4.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.09
|
| Rate for Payer: UHC Core |
$4.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.34
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$1,414.81
|
|
|
Service Code
|
NDC 61958-1003-1
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$862.89 |
| Max. Negotiated Rate |
$1,273.33 |
| Rate for Payer: Aetna Commercial |
$1,202.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,093.37
|
| Rate for Payer: BCN Commercial |
$1,093.37
|
| Rate for Payer: Cash Price |
$1,131.85
|
| Rate for Payer: Cofinity Commercial |
$1,216.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.85
|
| Rate for Payer: Healthscope Commercial |
$1,273.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,061.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,202.59
|
| Rate for Payer: PHP Commercial |
$1,202.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$862.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,245.03
|
| Rate for Payer: UHC Core |
$1,181.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,061.11
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$173.38
|
|
|
Service Code
|
NDC 60687-549-21
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.74 |
| Max. Negotiated Rate |
$156.04 |
| Rate for Payer: Aetna Commercial |
$147.37
|
| Rate for Payer: BCBS Trust/PPO |
$133.99
|
| Rate for Payer: BCN Commercial |
$133.99
|
| Rate for Payer: Cash Price |
$138.70
|
| Rate for Payer: Cofinity Commercial |
$149.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.70
|
| Rate for Payer: Healthscope Commercial |
$156.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.37
|
| Rate for Payer: PHP Commercial |
$147.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.57
|
| Rate for Payer: UHC Core |
$144.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.04
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$381.03
|
|
|
Service Code
|
NDC 45963-418-06
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.39 |
| Max. Negotiated Rate |
$342.93 |
| Rate for Payer: Aetna Commercial |
$323.88
|
| Rate for Payer: BCBS Trust/PPO |
$294.46
|
| Rate for Payer: BCN Commercial |
$294.46
|
| Rate for Payer: Cash Price |
$304.82
|
| Rate for Payer: Cofinity Commercial |
$327.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.82
|
| Rate for Payer: Healthscope Commercial |
$342.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.88
|
| Rate for Payer: PHP Commercial |
$323.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.31
|
| Rate for Payer: UHC Core |
$318.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.77
|
|
|
RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE ADVANCEMENT OR RELEASE (EG, CAMPBELL, GOLDWAITE TYPE PROCEDURE)
|
Facility
|
OP
|
$4,927.66
|
|
|
Service Code
|
CPT 27422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,693.01 |
| Max. Negotiated Rate |
$4,927.66 |
| Rate for Payer: BCBS Complete |
$4,927.66
|
| Rate for Payer: Mclaren Medicaid |
$4,693.01
|
| Rate for Payer: Meridian Medicaid |
$4,927.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,693.01
|
|
