|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
IP
|
$232.75
|
|
|
Service Code
|
NDC 68084-299-01
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.95 |
| Max. Negotiated Rate |
$209.48 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: BCBS Trust/PPO |
$179.87
|
| Rate for Payer: BCN Commercial |
$179.87
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.84
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.82
|
| Rate for Payer: UHC Core |
$194.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
IP
|
$192.85
|
|
|
Service Code
|
NDC 0904-6401-61
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.62 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: BCBS Trust/PPO |
$149.03
|
| Rate for Payer: BCN Commercial |
$149.03
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.92
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Core |
$161.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
IP
|
$441.75
|
|
|
Service Code
|
NDC 0781-2076-01
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.42 |
| Max. Negotiated Rate |
$397.58 |
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: BCBS Trust/PPO |
$341.38
|
| Rate for Payer: BCN Commercial |
$341.38
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$375.49
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$384.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.74
|
| Rate for Payer: UHC Core |
$368.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
IP
|
$147.00
|
|
|
Service Code
|
NDC 63739-877-10
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.66 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna Commercial |
$124.95
|
| Rate for Payer: BCBS Trust/PPO |
$113.60
|
| Rate for Payer: BCN Commercial |
$113.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$126.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.60
|
| Rate for Payer: Healthscope Commercial |
$132.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.95
|
| Rate for Payer: PHP Commercial |
$124.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.36
|
| Rate for Payer: UHC Core |
$122.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.25
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
IP
|
$152.25
|
|
|
Service Code
|
NDC 0378-4010-01
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.86 |
| Max. Negotiated Rate |
$137.02 |
| Rate for Payer: Aetna Commercial |
$129.41
|
| Rate for Payer: BCBS Trust/PPO |
$117.66
|
| Rate for Payer: BCN Commercial |
$117.66
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cofinity Commercial |
$130.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.80
|
| Rate for Payer: Healthscope Commercial |
$137.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.41
|
| Rate for Payer: PHP Commercial |
$129.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.98
|
| Rate for Payer: UHC Core |
$127.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.19
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
IP
|
$1.49
|
|
|
Service Code
|
NDC 51079-418-01
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: BCBS Trust/PPO |
$1.15
|
| Rate for Payer: BCN Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.27
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.31
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
IP
|
$10.36
|
|
|
Service Code
|
NDC 68084-549-11
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$9.32 |
| Rate for Payer: Aetna Commercial |
$8.81
|
| Rate for Payer: BCBS Trust/PPO |
$8.01
|
| Rate for Payer: BCN Commercial |
$8.01
|
| Rate for Payer: Cash Price |
$8.29
|
| Rate for Payer: Cofinity Commercial |
$8.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.29
|
| Rate for Payer: Healthscope Commercial |
$9.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.81
|
| Rate for Payer: PHP Commercial |
$8.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.12
|
| Rate for Payer: UHC Core |
$8.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.77
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
IP
|
$1,169.61
|
|
|
Service Code
|
NDC 53489-648-01
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$713.35 |
| Max. Negotiated Rate |
$1,052.65 |
| Rate for Payer: Aetna Commercial |
$994.17
|
| Rate for Payer: BCBS Trust/PPO |
$903.87
|
| Rate for Payer: BCN Commercial |
$903.87
|
| Rate for Payer: Cash Price |
$935.69
|
| Rate for Payer: Cofinity Commercial |
$1,005.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$935.69
|
| Rate for Payer: Healthscope Commercial |
$1,052.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$877.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$994.17
|
| Rate for Payer: PHP Commercial |
$994.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,017.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$713.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,029.26
|
| Rate for Payer: UHC Core |
$976.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$877.21
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
IP
|
$298.59
|
|
|
Service Code
|
NDC 0904-6436-04
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.11 |
| Max. Negotiated Rate |
$268.73 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: BCBS Trust/PPO |
$230.75
|
| Rate for Payer: BCN Commercial |
$230.75
|
| Rate for Payer: Cash Price |
$238.87
|
| Rate for Payer: Cofinity Commercial |
$256.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.87
|
| Rate for Payer: Healthscope Commercial |
$268.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.80
|
| Rate for Payer: PHP Commercial |
$253.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.76
|
| Rate for Payer: UHC Core |
$249.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.94
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
IP
|
$310.76
|
|
|
Service Code
|
NDC 68084-549-21
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.53 |
| Max. Negotiated Rate |
$279.68 |
| Rate for Payer: Aetna Commercial |
$264.15
|
| Rate for Payer: BCBS Trust/PPO |
$240.16
|
| Rate for Payer: BCN Commercial |
$240.16
|
| Rate for Payer: Cash Price |
$248.61
|
| Rate for Payer: Cofinity Commercial |
$267.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.61
|
| Rate for Payer: Healthscope Commercial |
$279.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$264.15
|
| Rate for Payer: PHP Commercial |
$264.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.47
|
| Rate for Payer: UHC Core |
$259.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.07
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
IP
|
$2,127.84
|
|
|
Service Code
|
NDC 0378-3110-01
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,297.77 |
| Max. Negotiated Rate |
$1,915.06 |
| Rate for Payer: Aetna Commercial |
$1,808.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.39
|
| Rate for Payer: BCN Commercial |
$1,644.39
|
| Rate for Payer: Cash Price |
$1,702.27
|
| Rate for Payer: Cofinity Commercial |
$1,829.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.27
|
| Rate for Payer: Healthscope Commercial |
$1,915.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,595.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,808.66
|
| Rate for Payer: PHP Commercial |
$1,808.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,489.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,851.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,297.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,872.50
|
| Rate for Payer: UHC Core |
$1,776.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,595.88
|
|
|
TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
|
Facility
OP
|
$1,107.03
|
|
|
Service Code
|
CPT 26055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,054.31 |
| Max. Negotiated Rate |
$1,107.03 |
| Rate for Payer: BCBS Complete |
$1,107.03
|
| Rate for Payer: Mclaren Medicaid |
$1,054.31
|
| Rate for Payer: Meridian Medicaid |
$1,107.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,054.31
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$26,150.27
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
186094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15,949.05 |
| Max. Negotiated Rate |
$23,535.24 |
| Rate for Payer: Aetna Commercial |
$22,227.73
|
| Rate for Payer: BCBS Trust/PPO |
$20,208.93
|
| Rate for Payer: BCN Commercial |
$20,208.93
|
| Rate for Payer: Cash Price |
$20,920.22
|
| Rate for Payer: Cofinity Commercial |
$22,489.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,920.22
|
| Rate for Payer: Healthscope Commercial |
$23,535.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,612.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22,227.73
|
| Rate for Payer: PHP Commercial |
$22,227.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,305.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,750.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15,949.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,012.24
|
| Rate for Payer: UHC Core |
$21,835.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,612.70
|
|
|
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON
|
Facility
OP
|
$2,229.50
|
|
|
Service Code
|
CPT 25295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,123.34 |
| Max. Negotiated Rate |
$2,229.50 |
| Rate for Payer: BCBS Complete |
$2,229.50
|
| Rate for Payer: Mclaren Medicaid |
$2,123.34
|
| Rate for Payer: Meridian Medicaid |
$2,229.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,123.34
|
|
|
TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); DEBRIDEMENT, SOFT TISSUE AND/OR BONE, OPEN
|
Facility
OP
|
$2,229.50
|
|
|
Service Code
|
CPT 24358
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,123.34 |
| Max. Negotiated Rate |
$2,229.50 |
| Rate for Payer: BCBS Complete |
$2,229.50
|
| Rate for Payer: Mclaren Medicaid |
$2,123.34
|
| Rate for Payer: Meridian Medicaid |
$2,229.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,123.34
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
IP
|
$30.03
|
|
|
Service Code
|
NDC 0067-3998-42
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Aetna Commercial |
$25.53
|
| Rate for Payer: BCBS Trust/PPO |
$23.21
|
| Rate for Payer: BCN Commercial |
$23.21
|
| Rate for Payer: Cash Price |
$24.02
|
| Rate for Payer: Cofinity Commercial |
$25.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.02
|
| Rate for Payer: Healthscope Commercial |
$27.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.53
|
| Rate for Payer: PHP Commercial |
$25.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.43
|
| Rate for Payer: UHC Core |
$25.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.52
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
IP
|
$23.22
|
|
|
Service Code
|
NDC 51672-2080-1
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.16 |
| Max. Negotiated Rate |
$20.90 |
| Rate for Payer: Aetna Commercial |
$19.74
|
| Rate for Payer: BCBS Trust/PPO |
$17.94
|
| Rate for Payer: BCN Commercial |
$17.94
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$19.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.58
|
| Rate for Payer: Healthscope Commercial |
$20.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.74
|
| Rate for Payer: PHP Commercial |
$19.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.43
|
| Rate for Payer: UHC Core |
$19.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.42
|
|
|
TERCONAZOLE 0.4 % VAGINAL CREAM
|
Facility
IP
|
$71.98
|
|
|
Service Code
|
NDC 51672-1304-6
|
| Hospital Charge Code |
11510
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.90 |
| Max. Negotiated Rate |
$64.78 |
| Rate for Payer: Aetna Commercial |
$61.18
|
| Rate for Payer: BCBS Trust/PPO |
$55.63
|
| Rate for Payer: BCN Commercial |
$55.63
|
| Rate for Payer: Cash Price |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$61.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.58
|
| Rate for Payer: Healthscope Commercial |
$64.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.18
|
| Rate for Payer: PHP Commercial |
$61.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.34
|
| Rate for Payer: UHC Core |
$60.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.98
|
|
|
TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL
|
Facility
IP
|
$34.35
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
7784
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$30.92 |
| Rate for Payer: Aetna Commercial |
$29.20
|
| Rate for Payer: BCBS Trust/PPO |
$26.55
|
| Rate for Payer: BCN Commercial |
$26.55
|
| Rate for Payer: Cash Price |
$27.48
|
| Rate for Payer: Cofinity Commercial |
$29.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.48
|
| Rate for Payer: Healthscope Commercial |
$30.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.20
|
| Rate for Payer: PHP Commercial |
$29.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.23
|
| Rate for Payer: UHC Core |
$28.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.76
|
|
|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE
|
Facility
IP
|
$1,676.77
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
118208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,022.66 |
| Max. Negotiated Rate |
$1,509.09 |
| Rate for Payer: Aetna Commercial |
$1,425.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,295.81
|
| Rate for Payer: BCN Commercial |
$1,295.81
|
| Rate for Payer: Cash Price |
$1,341.42
|
| Rate for Payer: Cofinity Commercial |
$1,442.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,341.42
|
| Rate for Payer: Healthscope Commercial |
$1,509.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,257.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,425.25
|
| Rate for Payer: PHP Commercial |
$1,425.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,173.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,458.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,022.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,475.56
|
| Rate for Payer: UHC Core |
$1,400.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,257.58
|
|
|
TETRACAINE HCL (PF) 0.5 % EYE DROPS
|
Facility
IP
|
$36.43
|
|
|
Service Code
|
NDC 0065-0741-14
|
| Hospital Charge Code |
151946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.22 |
| Max. Negotiated Rate |
$32.79 |
| Rate for Payer: Aetna Commercial |
$30.97
|
| Rate for Payer: BCBS Trust/PPO |
$28.15
|
| Rate for Payer: BCN Commercial |
$28.15
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cofinity Commercial |
$31.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.14
|
| Rate for Payer: Healthscope Commercial |
$32.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.97
|
| Rate for Payer: PHP Commercial |
$30.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.06
|
| Rate for Payer: UHC Core |
$30.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.32
|
|
|
THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
IP
|
$882.45
|
|
|
Service Code
|
NDC 62332-025-31
|
| Hospital Charge Code |
12098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$538.21 |
| Max. Negotiated Rate |
$794.20 |
| Rate for Payer: Aetna Commercial |
$750.08
|
| Rate for Payer: BCBS Trust/PPO |
$681.96
|
| Rate for Payer: BCN Commercial |
$681.96
|
| Rate for Payer: Cash Price |
$705.96
|
| Rate for Payer: Cofinity Commercial |
$758.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.96
|
| Rate for Payer: Healthscope Commercial |
$794.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$750.08
|
| Rate for Payer: PHP Commercial |
$750.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$767.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$538.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$776.56
|
| Rate for Payer: UHC Core |
$736.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.84
|
|
|
THERMAGE
|
Professional
|
$1,000.00
|
|
|
Service Code
|
HCPCS 00167
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Complete |
$400.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.00
|
|
|
THERMAGE ABDOMEN - ENTIRE
|
Professional
|
$3,100.00
|
|
|
Service Code
|
HCPCS 00150
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,240.00 |
| Max. Negotiated Rate |
$2,170.00 |
| Rate for Payer: BCBS Complete |
$1,240.00
|
| Rate for Payer: Cash Price |
$2,480.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,170.00
|
|
|
THERMAGE ABDOMEN - LOWER
|
Professional
|
$2,000.00
|
|
|
Service Code
|
HCPCS 00149
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: BCBS Complete |
$800.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.00
|
|
