|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$19.39
|
|
|
Service Code
|
NDC 61990-0611-2
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$17.45 |
| Rate for Payer: Aetna Commercial |
$16.48
|
| Rate for Payer: BCBS Trust/PPO |
$14.98
|
| Rate for Payer: BCN Commercial |
$14.98
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$16.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.51
|
| Rate for Payer: Healthscope Commercial |
$17.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.48
|
| Rate for Payer: PHP Commercial |
$16.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.06
|
| Rate for Payer: UHC Core |
$16.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.54
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$22.20
|
|
|
Service Code
|
NDC 43066-008-01
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: BCBS Trust/PPO |
$17.16
|
| Rate for Payer: BCN Commercial |
$17.16
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.87
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.54
|
| Rate for Payer: UHC Core |
$18.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$24.05
|
|
|
Service Code
|
NDC 72485-107-01
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.67 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: BCBS Trust/PPO |
$18.59
|
| Rate for Payer: BCN Commercial |
$18.59
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.44
|
| Rate for Payer: PHP Commercial |
$20.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.16
|
| Rate for Payer: UHC Core |
$20.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.04
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$24.05
|
|
|
Service Code
|
NDC 72485-107-10
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.67 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: BCBS Trust/PPO |
$18.59
|
| Rate for Payer: BCN Commercial |
$18.59
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.44
|
| Rate for Payer: PHP Commercial |
$20.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.16
|
| Rate for Payer: UHC Core |
$20.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.04
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$27.38
|
|
|
Service Code
|
NDC 70860-400-41
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: BCBS Trust/PPO |
$21.16
|
| Rate for Payer: BCN Commercial |
$21.16
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$23.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.90
|
| Rate for Payer: Healthscope Commercial |
$24.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.27
|
| Rate for Payer: PHP Commercial |
$23.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.09
|
| Rate for Payer: UHC Core |
$22.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.54
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$25.90
|
|
|
Service Code
|
NDC 60505-6169-1
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$20.02
|
| Rate for Payer: BCN Commercial |
$20.02
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.02
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$19.39
|
|
|
Service Code
|
NDC 61990-0611-0
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$17.45 |
| Rate for Payer: Aetna Commercial |
$16.48
|
| Rate for Payer: BCBS Trust/PPO |
$14.98
|
| Rate for Payer: BCN Commercial |
$14.98
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$16.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.51
|
| Rate for Payer: Healthscope Commercial |
$17.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.48
|
| Rate for Payer: PHP Commercial |
$16.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.06
|
| Rate for Payer: UHC Core |
$16.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.54
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) SOLUTION CUSTOM
|
Facility
IP
|
$43.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
300870
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.33 |
| Max. Negotiated Rate |
$38.85 |
| Rate for Payer: Aetna Commercial |
$36.69
|
| Rate for Payer: BCBS Trust/PPO |
$33.36
|
| Rate for Payer: BCN Commercial |
$33.36
|
| Rate for Payer: Cash Price |
$34.54
|
| Rate for Payer: Cofinity Commercial |
$37.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.54
|
| Rate for Payer: Healthscope Commercial |
$38.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.69
|
| Rate for Payer: PHP Commercial |
$36.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.99
|
| Rate for Payer: UHC Core |
$36.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.38
|
|
|
TRAVOPROST 0.004 % EYE DROPS
|
Facility
IP
|
$538.65
|
|
|
Service Code
|
NDC 0781-6185-56
|
| Hospital Charge Code |
108556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$328.52 |
| Max. Negotiated Rate |
$484.78 |
| Rate for Payer: Aetna Commercial |
$457.85
|
| Rate for Payer: BCBS Trust/PPO |
$416.27
|
| Rate for Payer: BCN Commercial |
$416.27
|
| Rate for Payer: Cash Price |
$430.92
|
| Rate for Payer: Cofinity Commercial |
$463.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.92
|
| Rate for Payer: Healthscope Commercial |
$484.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$457.85
|
| Rate for Payer: PHP Commercial |
$457.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$377.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$468.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$328.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$474.01
|
| Rate for Payer: UHC Core |
$449.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.99
|
|
|
TRAVOPROST 0.004 % EYE DROPS
|
Facility
IP
|
$635.53
|
|
|
Service Code
|
NDC 0065-0260-25
|
| Hospital Charge Code |
108556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$387.61 |
| Max. Negotiated Rate |
$571.98 |
| Rate for Payer: Aetna Commercial |
$540.20
|
| Rate for Payer: BCBS Trust/PPO |
$491.14
|
| Rate for Payer: BCN Commercial |
$491.14
|
| Rate for Payer: Cash Price |
$508.42
|
| Rate for Payer: Cofinity Commercial |
$546.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.42
|
| Rate for Payer: Healthscope Commercial |
$571.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$476.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$540.20
|
| Rate for Payer: PHP Commercial |
$540.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$552.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$387.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$559.27
|
| Rate for Payer: UHC Core |
$530.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$476.65
|
|
|
TRAZODONE 100 MG TABLET
|
Facility
IP
|
$333.70
|
|
|
Service Code
|
NDC 0904-6869-61
|
| Hospital Charge Code |
8083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: BCBS Trust/PPO |
$257.88
|
| Rate for Payer: BCN Commercial |
$257.88
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.64
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.66
|
| Rate for Payer: UHC Core |
$278.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.28
|
|
|
TRAZODONE 100 MG TABLET
|
Facility
IP
|
$136.30
|
|
|
Service Code
|
NDC 50111-434-01
|
| Hospital Charge Code |
8083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.13 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: BCBS Trust/PPO |
$105.33
|
| Rate for Payer: BCN Commercial |
$105.33
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.86
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.94
|
| Rate for Payer: UHC Core |
$113.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
TRAZODONE 25 MG CUSTOM TAB
|
Facility
IP
|
$0.92
|
|
|
Service Code
|
NDC 9900-0003-14
|
| Hospital Charge Code |
155125
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Aetna Commercial |
$0.78
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$0.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.78
|
| Rate for Payer: PHP Commercial |
$0.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.81
|
| Rate for Payer: UHC Core |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.69
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
IP
|
$260.85
|
|
|
Service Code
|
NDC 60687-443-01
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.09 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: BCBS Trust/PPO |
$201.58
|
| Rate for Payer: BCN Commercial |
$201.58
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.72
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.55
|
| Rate for Payer: UHC Core |
$217.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
IP
|
$2.61
|
|
|
Service Code
|
NDC 60687-443-11
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.09
|
| Rate for Payer: Healthscope Commercial |
$2.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.22
|
| Rate for Payer: PHP Commercial |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.30
|
| Rate for Payer: UHC Core |
$2.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.96
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
IP
|
$242.05
|
|
|
Service Code
|
NDC 0904-6868-61
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.63 |
| Max. Negotiated Rate |
$217.84 |
| Rate for Payer: Aetna Commercial |
$205.74
|
| Rate for Payer: BCBS Trust/PPO |
$187.06
|
| Rate for Payer: BCN Commercial |
$187.06
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cofinity Commercial |
$208.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.64
|
| Rate for Payer: Healthscope Commercial |
$217.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.74
|
| Rate for Payer: PHP Commercial |
$205.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.00
|
| Rate for Payer: UHC Core |
$202.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.54
|
|
|
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE
|
Facility
OP
|
$432.60
|
|
|
Service Code
|
CPT 12020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$412.00 |
| Max. Negotiated Rate |
$432.60 |
| Rate for Payer: BCBS Complete |
$432.60
|
| Rate for Payer: Mclaren Medicaid |
$412.00
|
| Rate for Payer: Meridian Medicaid |
$432.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$412.00
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
IP
|
$10.08
|
|
|
Service Code
|
NDC 67877-251-15
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$9.07 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: BCBS Trust/PPO |
$7.79
|
| Rate for Payer: BCN Commercial |
$7.79
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cofinity Commercial |
$8.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.06
|
| Rate for Payer: Healthscope Commercial |
$9.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.57
|
| Rate for Payer: PHP Commercial |
$8.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.87
|
| Rate for Payer: UHC Core |
$8.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.56
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
IP
|
$11.34
|
|
|
Service Code
|
NDC 33342-333-15
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$10.21 |
| Rate for Payer: Aetna Commercial |
$9.64
|
| Rate for Payer: BCBS Trust/PPO |
$8.76
|
| Rate for Payer: BCN Commercial |
$8.76
|
| Rate for Payer: Cash Price |
$9.07
|
| Rate for Payer: Cofinity Commercial |
$9.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.07
|
| Rate for Payer: Healthscope Commercial |
$10.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.64
|
| Rate for Payer: PHP Commercial |
$9.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.98
|
| Rate for Payer: UHC Core |
$9.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.50
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
IP
|
$19.24
|
|
|
Service Code
|
NDC 45802-055-35
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: BCBS Trust/PPO |
$14.87
|
| Rate for Payer: BCN Commercial |
$14.87
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.39
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.35
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.93
|
| Rate for Payer: UHC Core |
$16.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.43
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
IP
|
$19.44
|
|
|
Service Code
|
NDC 0168-0006-15
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.86 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: BCBS Trust/PPO |
$15.02
|
| Rate for Payer: BCN Commercial |
$15.02
|
| Rate for Payer: Cash Price |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$16.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.55
|
| Rate for Payer: Healthscope Commercial |
$17.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.52
|
| Rate for Payer: PHP Commercial |
$16.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.11
|
| Rate for Payer: UHC Core |
$16.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.58
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
IP
|
$196.61
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
8120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.91 |
| Max. Negotiated Rate |
$176.95 |
| Rate for Payer: Aetna Commercial |
$167.12
|
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: Aetna Commercial |
$20.38
|
| Rate for Payer: BCBS Trust/PPO |
$17.05
|
| Rate for Payer: BCBS Trust/PPO |
$18.53
|
| Rate for Payer: BCBS Trust/PPO |
$29.92
|
| Rate for Payer: BCBS Trust/PPO |
$151.94
|
| Rate for Payer: BCBS Trust/PPO |
$18.37
|
| Rate for Payer: BCN Commercial |
$151.94
|
| Rate for Payer: BCN Commercial |
$18.37
|
| Rate for Payer: BCN Commercial |
$18.53
|
| Rate for Payer: BCN Commercial |
$29.92
|
| Rate for Payer: BCN Commercial |
$17.05
|
| Rate for Payer: Cash Price |
$157.29
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Cofinity Commercial |
$20.44
|
| Rate for Payer: Cofinity Commercial |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$20.62
|
| Rate for Payer: Cofinity Commercial |
$18.97
|
| Rate for Payer: Cofinity Commercial |
$169.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.18
|
| Rate for Payer: Healthscope Commercial |
$34.85
|
| Rate for Payer: Healthscope Commercial |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$176.95
|
| Rate for Payer: Healthscope Commercial |
$19.85
|
| Rate for Payer: Healthscope Commercial |
$21.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$167.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.38
|
| Rate for Payer: PHP Commercial |
$32.91
|
| Rate for Payer: PHP Commercial |
$167.12
|
| Rate for Payer: PHP Commercial |
$20.20
|
| Rate for Payer: PHP Commercial |
$18.75
|
| Rate for Payer: PHP Commercial |
$20.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.10
|
| Rate for Payer: UHC Core |
$19.85
|
| Rate for Payer: UHC Core |
$164.17
|
| Rate for Payer: UHC Core |
$20.02
|
| Rate for Payer: UHC Core |
$32.33
|
| Rate for Payer: UHC Core |
$18.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.04
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
IP
|
$243.20
|
|
|
Service Code
|
NDC 0591-0424-01
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.33 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: BCBS Trust/PPO |
$187.94
|
| Rate for Payer: BCN Commercial |
$187.94
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.56
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$206.72
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.02
|
| Rate for Payer: UHC Core |
$203.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
IP
|
$3.05
|
|
|
Service Code
|
NDC 68084-750-95
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Aetna Commercial |
$2.59
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.44
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.59
|
| Rate for Payer: PHP Commercial |
$2.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.68
|
| Rate for Payer: UHC Core |
$2.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.29
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
IP
|
$243.20
|
|
|
Service Code
|
NDC 60505-2656-1
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.33 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: BCBS Trust/PPO |
$187.94
|
| Rate for Payer: BCN Commercial |
$187.94
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.56
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$206.72
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.02
|
| Rate for Payer: UHC Core |
$203.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
