|
ATORVASTATIN 40 MG TABLET
|
Facility
IP
|
$215.65
|
|
|
Service Code
|
NDC 0904-6292-61
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.52 |
| Max. Negotiated Rate |
$194.08 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: BCBS Trust/PPO |
$166.65
|
| Rate for Payer: BCN Commercial |
$166.65
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.77
|
| Rate for Payer: UHC Core |
$180.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
IP
|
$1,198.50
|
|
|
Service Code
|
NDC 60505-2580-8
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$730.97 |
| Max. Negotiated Rate |
$1,078.65 |
| Rate for Payer: Aetna Commercial |
$1,018.72
|
| Rate for Payer: BCBS Trust/PPO |
$926.20
|
| Rate for Payer: BCN Commercial |
$926.20
|
| Rate for Payer: Cash Price |
$958.80
|
| Rate for Payer: Cofinity Commercial |
$1,030.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$958.80
|
| Rate for Payer: Healthscope Commercial |
$1,078.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$898.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,018.72
|
| Rate for Payer: PHP Commercial |
$1,018.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$838.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,042.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$730.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,054.68
|
| Rate for Payer: UHC Core |
$1,000.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$898.88
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
IP
|
$28.22
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$25.40 |
| Rate for Payer: Aetna Commercial |
$23.99
|
| Rate for Payer: Aetna Commercial |
$30.46
|
| Rate for Payer: Aetna Commercial |
$48.35
|
| Rate for Payer: Aetna Commercial |
$33.25
|
| Rate for Payer: BCBS Trust/PPO |
$27.69
|
| Rate for Payer: BCBS Trust/PPO |
$21.81
|
| Rate for Payer: BCBS Trust/PPO |
$43.96
|
| Rate for Payer: BCBS Trust/PPO |
$30.23
|
| Rate for Payer: BCN Commercial |
$43.96
|
| Rate for Payer: BCN Commercial |
$30.23
|
| Rate for Payer: BCN Commercial |
$27.69
|
| Rate for Payer: BCN Commercial |
$21.81
|
| Rate for Payer: Cash Price |
$28.66
|
| Rate for Payer: Cash Price |
$22.58
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Cofinity Commercial |
$24.27
|
| Rate for Payer: Cofinity Commercial |
$48.92
|
| Rate for Payer: Cofinity Commercial |
$30.81
|
| Rate for Payer: Cofinity Commercial |
$33.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.66
|
| Rate for Payer: Healthscope Commercial |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$32.25
|
| Rate for Payer: Healthscope Commercial |
$25.40
|
| Rate for Payer: Healthscope Commercial |
$35.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.35
|
| Rate for Payer: PHP Commercial |
$48.35
|
| Rate for Payer: PHP Commercial |
$30.46
|
| Rate for Payer: PHP Commercial |
$23.99
|
| Rate for Payer: PHP Commercial |
$33.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.83
|
| Rate for Payer: UHC Core |
$23.56
|
| Rate for Payer: UHC Core |
$47.49
|
| Rate for Payer: UHC Core |
$32.67
|
| Rate for Payer: UHC Core |
$29.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.66
|
|
|
ATROPINE 0.1 MG/ML SYRINGE (CODE)
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
163701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.69 |
| Max. Negotiated Rate |
$51.19 |
| Rate for Payer: Aetna Commercial |
$48.35
|
| Rate for Payer: Aetna Commercial |
$30.46
|
| Rate for Payer: BCBS Trust/PPO |
$27.69
|
| Rate for Payer: BCBS Trust/PPO |
$43.96
|
| Rate for Payer: BCN Commercial |
$27.69
|
| Rate for Payer: BCN Commercial |
$43.96
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$28.66
|
| Rate for Payer: Cofinity Commercial |
$48.92
|
| Rate for Payer: Cofinity Commercial |
$30.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.50
|
| Rate for Payer: Healthscope Commercial |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$32.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.35
|
| Rate for Payer: PHP Commercial |
$30.46
|
| Rate for Payer: PHP Commercial |
$48.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.05
|
| Rate for Payer: UHC Core |
$29.92
|
| Rate for Payer: UHC Core |
$47.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.87
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
IP
|
$161.25
|
|
|
Service Code
|
NDC 0065-0303-55
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.35 |
| Max. Negotiated Rate |
$145.12 |
| Rate for Payer: Aetna Commercial |
$137.06
|
| Rate for Payer: BCBS Trust/PPO |
$124.61
|
| Rate for Payer: BCN Commercial |
$124.61
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cofinity Commercial |
$138.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.00
|
| Rate for Payer: Healthscope Commercial |
$145.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.06
|
| Rate for Payer: PHP Commercial |
$137.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.90
|
| Rate for Payer: UHC Core |
$134.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.94
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
IP
|
$122.08
|
|
|
Service Code
|
NDC 17478-215-05
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.46 |
| Max. Negotiated Rate |
$109.87 |
| Rate for Payer: Aetna Commercial |
$103.77
|
| Rate for Payer: BCBS Trust/PPO |
$94.34
|
| Rate for Payer: BCN Commercial |
$94.34
|
| Rate for Payer: Cash Price |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$104.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.66
|
| Rate for Payer: Healthscope Commercial |
$109.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.77
|
| Rate for Payer: PHP Commercial |
$103.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.43
|
| Rate for Payer: UHC Core |
$101.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.56
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
IP
|
$30.29
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$27.26 |
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna Commercial |
$25.80
|
| Rate for Payer: BCBS Trust/PPO |
$23.41
|
| Rate for Payer: BCBS Trust/PPO |
$23.45
|
| Rate for Payer: BCN Commercial |
$23.45
|
| Rate for Payer: BCN Commercial |
$23.41
|
| Rate for Payer: Cash Price |
$24.28
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cofinity Commercial |
$26.10
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.28
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Healthscope Commercial |
$27.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.80
|
| Rate for Payer: PHP Commercial |
$25.80
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.71
|
| Rate for Payer: UHC Core |
$25.34
|
| Rate for Payer: UHC Core |
$25.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.72
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$116.79
|
|
|
Service Code
|
NDC 0093-2026-31
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.23 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna Commercial |
$99.27
|
| Rate for Payer: BCBS Trust/PPO |
$90.26
|
| Rate for Payer: BCN Commercial |
$90.26
|
| Rate for Payer: Cash Price |
$93.43
|
| Rate for Payer: Cofinity Commercial |
$100.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.43
|
| Rate for Payer: Healthscope Commercial |
$105.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.27
|
| Rate for Payer: PHP Commercial |
$99.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.78
|
| Rate for Payer: UHC Core |
$97.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.59
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$19.08
|
|
|
Service Code
|
NDC 9900-0003-33
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.64 |
| Max. Negotiated Rate |
$17.17 |
| Rate for Payer: Aetna Commercial |
$16.22
|
| Rate for Payer: BCBS Trust/PPO |
$14.75
|
| Rate for Payer: BCN Commercial |
$14.75
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cofinity Commercial |
$16.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.26
|
| Rate for Payer: Healthscope Commercial |
$17.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.22
|
| Rate for Payer: PHP Commercial |
$16.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.79
|
| Rate for Payer: UHC Core |
$15.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.31
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$94.05
|
|
|
Service Code
|
NDC 42806-151-34
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.36 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: BCBS Trust/PPO |
$72.68
|
| Rate for Payer: BCN Commercial |
$72.68
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Commercial |
$80.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.94
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.76
|
| Rate for Payer: UHC Core |
$78.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.54
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$3.12
|
|
|
Service Code
|
NDC 50268-098-11
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.41
|
| Rate for Payer: BCN Commercial |
$2.41
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.65
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.75
|
| Rate for Payer: UHC Core |
$2.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$7.76
|
|
|
Service Code
|
NDC 60687-282-11
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$6.98 |
| Rate for Payer: Aetna Commercial |
$6.60
|
| Rate for Payer: BCBS Trust/PPO |
$6.00
|
| Rate for Payer: BCN Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cofinity Commercial |
$6.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.21
|
| Rate for Payer: Healthscope Commercial |
$6.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.60
|
| Rate for Payer: PHP Commercial |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.83
|
| Rate for Payer: UHC Core |
$6.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.82
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$384.80
|
|
|
Service Code
|
NDC 59762-3060-3
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.69 |
| Max. Negotiated Rate |
$346.32 |
| Rate for Payer: Aetna Commercial |
$327.08
|
| Rate for Payer: BCBS Trust/PPO |
$297.37
|
| Rate for Payer: BCN Commercial |
$297.37
|
| Rate for Payer: Cash Price |
$307.84
|
| Rate for Payer: Cofinity Commercial |
$330.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.84
|
| Rate for Payer: Healthscope Commercial |
$346.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$327.08
|
| Rate for Payer: PHP Commercial |
$327.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$334.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$234.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.62
|
| Rate for Payer: UHC Core |
$321.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.60
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$231.12
|
|
|
Service Code
|
NDC 50268-098-15
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.96 |
| Max. Negotiated Rate |
$208.01 |
| Rate for Payer: Aetna Commercial |
$196.45
|
| Rate for Payer: BCBS Trust/PPO |
$178.61
|
| Rate for Payer: BCN Commercial |
$178.61
|
| Rate for Payer: Cash Price |
$184.90
|
| Rate for Payer: Cofinity Commercial |
$198.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.90
|
| Rate for Payer: Healthscope Commercial |
$208.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.45
|
| Rate for Payer: PHP Commercial |
$196.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.39
|
| Rate for Payer: UHC Core |
$192.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.34
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$51.62
|
|
|
Service Code
|
NDC 50111-787-51
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.48 |
| Max. Negotiated Rate |
$46.46 |
| Rate for Payer: Aetna Commercial |
$43.88
|
| Rate for Payer: BCBS Trust/PPO |
$39.89
|
| Rate for Payer: BCN Commercial |
$39.89
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$44.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.30
|
| Rate for Payer: Healthscope Commercial |
$46.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.88
|
| Rate for Payer: PHP Commercial |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.43
|
| Rate for Payer: UHC Core |
$43.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.72
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$775.20
|
|
|
Service Code
|
NDC 60687-282-01
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$472.79 |
| Max. Negotiated Rate |
$697.68 |
| Rate for Payer: Aetna Commercial |
$658.92
|
| Rate for Payer: BCBS Trust/PPO |
$599.07
|
| Rate for Payer: BCN Commercial |
$599.07
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cofinity Commercial |
$666.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.16
|
| Rate for Payer: Healthscope Commercial |
$697.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$658.92
|
| Rate for Payer: PHP Commercial |
$658.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$674.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$472.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$682.18
|
| Rate for Payer: UHC Core |
$647.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.40
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$40.50
|
|
|
Service Code
|
NDC 50111-787-66
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: BCBS Trust/PPO |
$31.30
|
| Rate for Payer: BCN Commercial |
$31.30
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.42
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.64
|
| Rate for Payer: UHC Core |
$33.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$409.92
|
|
|
Service Code
|
NDC 0904-6708-61
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.01 |
| Max. Negotiated Rate |
$368.93 |
| Rate for Payer: Aetna Commercial |
$348.43
|
| Rate for Payer: BCBS Trust/PPO |
$316.79
|
| Rate for Payer: BCN Commercial |
$316.79
|
| Rate for Payer: Cash Price |
$327.94
|
| Rate for Payer: Cofinity Commercial |
$352.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.94
|
| Rate for Payer: Healthscope Commercial |
$368.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$348.43
|
| Rate for Payer: PHP Commercial |
$348.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$356.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.73
|
| Rate for Payer: UHC Core |
$342.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.44
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$17.47
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna Commercial |
$19.79
|
| Rate for Payer: Aetna Commercial |
$24.27
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$17.08
|
| Rate for Payer: BCBS Trust/PPO |
$20.22
|
| Rate for Payer: BCBS Trust/PPO |
$13.50
|
| Rate for Payer: BCBS Trust/PPO |
$15.53
|
| Rate for Payer: BCBS Trust/PPO |
$23.73
|
| Rate for Payer: BCBS Trust/PPO |
$16.04
|
| Rate for Payer: BCBS Trust/PPO |
$22.06
|
| Rate for Payer: BCBS Trust/PPO |
$17.99
|
| Rate for Payer: BCN Commercial |
$22.06
|
| Rate for Payer: BCN Commercial |
$16.04
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Commercial |
$23.73
|
| Rate for Payer: BCN Commercial |
$15.53
|
| Rate for Payer: BCN Commercial |
$17.99
|
| Rate for Payer: BCN Commercial |
$13.50
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$22.84
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Commercial |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Cofinity Commercial |
$24.55
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$20.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.84
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Healthscope Commercial |
$18.09
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Healthscope Commercial |
$20.95
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.27
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: PHP Commercial |
$19.79
|
| Rate for Payer: PHP Commercial |
$17.08
|
| Rate for Payer: PHP Commercial |
$24.27
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.02
|
| Rate for Payer: UHC Core |
$16.78
|
| Rate for Payer: UHC Core |
$19.44
|
| Rate for Payer: UHC Core |
$17.33
|
| Rate for Payer: UHC Core |
$14.59
|
| Rate for Payer: UHC Core |
$25.64
|
| Rate for Payer: UHC Core |
$23.84
|
| Rate for Payer: UHC Core |
$21.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.41
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$99.33
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.58 |
| Max. Negotiated Rate |
$89.40 |
| Rate for Payer: Aetna Commercial |
$84.43
|
| Rate for Payer: Aetna Commercial |
$84.40
|
| Rate for Payer: BCBS Trust/PPO |
$76.73
|
| Rate for Payer: BCBS Trust/PPO |
$76.76
|
| Rate for Payer: BCN Commercial |
$76.73
|
| Rate for Payer: BCN Commercial |
$76.76
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cash Price |
$79.43
|
| Rate for Payer: Cofinity Commercial |
$85.39
|
| Rate for Payer: Cofinity Commercial |
$85.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.43
|
| Rate for Payer: Healthscope Commercial |
$89.36
|
| Rate for Payer: Healthscope Commercial |
$89.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.43
|
| Rate for Payer: PHP Commercial |
$84.43
|
| Rate for Payer: PHP Commercial |
$84.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.41
|
| Rate for Payer: UHC Core |
$82.94
|
| Rate for Payer: UHC Core |
$82.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.50
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$202.79
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.68 |
| Max. Negotiated Rate |
$182.51 |
| Rate for Payer: Aetna Commercial |
$172.37
|
| Rate for Payer: Aetna Commercial |
$172.34
|
| Rate for Payer: BCBS Trust/PPO |
$156.72
|
| Rate for Payer: BCBS Trust/PPO |
$156.69
|
| Rate for Payer: BCN Commercial |
$156.72
|
| Rate for Payer: BCN Commercial |
$156.69
|
| Rate for Payer: Cash Price |
$162.20
|
| Rate for Payer: Cash Price |
$162.23
|
| Rate for Payer: Cofinity Commercial |
$174.36
|
| Rate for Payer: Cofinity Commercial |
$174.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.23
|
| Rate for Payer: Healthscope Commercial |
$182.51
|
| Rate for Payer: Healthscope Commercial |
$182.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.34
|
| Rate for Payer: PHP Commercial |
$172.34
|
| Rate for Payer: PHP Commercial |
$172.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.46
|
| Rate for Payer: UHC Core |
$169.30
|
| Rate for Payer: UHC Core |
$169.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.09
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
IP
|
$9.85
|
|
|
Service Code
|
NDC 51672-2075-2
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: BCBS Trust/PPO |
$7.61
|
| Rate for Payer: BCN Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$8.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.37
|
| Rate for Payer: PHP Commercial |
$8.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.67
|
| Rate for Payer: UHC Core |
$8.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.39
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
IP
|
$63.97
|
|
|
Service Code
|
NDC 1678411761
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.02 |
| Max. Negotiated Rate |
$57.57 |
| Rate for Payer: Aetna Commercial |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$49.44
|
| Rate for Payer: BCN Commercial |
$49.44
|
| Rate for Payer: Cash Price |
$51.18
|
| Rate for Payer: Cofinity Commercial |
$55.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.18
|
| Rate for Payer: Healthscope Commercial |
$57.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.37
|
| Rate for Payer: PHP Commercial |
$54.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.29
|
| Rate for Payer: UHC Core |
$53.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.98
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
IP
|
$10.26
|
|
|
Service Code
|
NDC 1442800944
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: BCBS Trust/PPO |
$7.93
|
| Rate for Payer: BCN Commercial |
$7.93
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.72
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.03
|
| Rate for Payer: UHC Core |
$8.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
IP
|
$10.46
|
|
|
Service Code
|
NDC 0536-1263-28
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: BCBS Trust/PPO |
$8.08
|
| Rate for Payer: BCN Commercial |
$8.08
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.20
|
| Rate for Payer: UHC Core |
$8.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
|
