|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
OP
|
$11.28
|
|
|
Service Code
|
NDC 00168000615
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$10.15 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: Aetna Medicare |
$2.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.52
|
| Rate for Payer: BCBS Complete |
$2.09
|
| Rate for Payer: BCBS MAPPO |
$2.82
|
| Rate for Payer: BCBS Trust/PPO |
$9.27
|
| Rate for Payer: BCN Commercial |
$9.27
|
| Rate for Payer: BCN Medicare Advantage |
$2.82
|
| Rate for Payer: Cash Price |
$9.02
|
| Rate for Payer: Cofinity Commercial |
$9.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$10.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.46
|
| Rate for Payer: Mclaren Medicaid |
$1.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.96
|
| Rate for Payer: Meridian Medicaid |
$2.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.59
|
| Rate for Payer: Nomi Health Commercial |
$9.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.46
|
| Rate for Payer: PACE Senior Care Partners |
$2.68
|
| Rate for Payer: PACE SWMI |
$2.82
|
| Rate for Payer: PHP Commercial |
$9.59
|
| Rate for Payer: PHP Medicare Advantage |
$2.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.81
|
| Rate for Payer: Priority Health Medicare |
$2.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.85
|
| Rate for Payer: Railroad Medicare Medicare |
$2.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.93
|
| Rate for Payer: UHC Core |
$9.42
|
| Rate for Payer: UHC Exchange |
$2.82
|
| Rate for Payer: UHC Medicaid |
$1.99
|
| Rate for Payer: UHC Medicare Advantage |
$2.82
|
| Rate for Payer: UHCCP Medicaid |
$1.99
|
| Rate for Payer: VA VA |
$2.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.46
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$38.72
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
8120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: Aetna Commercial |
$21.77
|
| Rate for Payer: Aetna Commercial |
$13.84
|
| Rate for Payer: Aetna Commercial |
$28.45
|
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Commercial |
$167.12
|
| Rate for Payer: Aetna Medicare |
$6.66
|
| Rate for Payer: Aetna Medicare |
$51.12
|
| Rate for Payer: Aetna Medicare |
$4.23
|
| Rate for Payer: Aetna Medicare |
$10.07
|
| Rate for Payer: Aetna Medicare |
$5.37
|
| Rate for Payer: Aetna Medicare |
$8.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.00
|
| Rate for Payer: BCBS Complete |
$3.82
|
| Rate for Payer: BCBS Complete |
$6.20
|
| Rate for Payer: BCBS Complete |
$36.39
|
| Rate for Payer: BCBS Complete |
$3.01
|
| Rate for Payer: BCBS Complete |
$7.17
|
| Rate for Payer: BCBS Complete |
$4.74
|
| Rate for Payer: BCBS MAPPO |
$6.40
|
| Rate for Payer: BCBS MAPPO |
$9.68
|
| Rate for Payer: BCBS MAPPO |
$8.37
|
| Rate for Payer: BCBS MAPPO |
$49.15
|
| Rate for Payer: BCBS MAPPO |
$4.07
|
| Rate for Payer: BCBS MAPPO |
$5.16
|
| Rate for Payer: BCBS Trust/PPO |
$13.38
|
| Rate for Payer: BCBS Trust/PPO |
$27.52
|
| Rate for Payer: BCBS Trust/PPO |
$161.63
|
| Rate for Payer: BCBS Trust/PPO |
$16.98
|
| Rate for Payer: BCBS Trust/PPO |
$21.05
|
| Rate for Payer: BCBS Trust/PPO |
$31.83
|
| Rate for Payer: BCN Commercial |
$16.98
|
| Rate for Payer: BCN Commercial |
$21.05
|
| Rate for Payer: BCN Commercial |
$13.38
|
| Rate for Payer: BCN Commercial |
$161.63
|
| Rate for Payer: BCN Commercial |
$27.52
|
| Rate for Payer: BCN Commercial |
$31.83
|
| Rate for Payer: BCN Medicare Advantage |
$8.37
|
| Rate for Payer: BCN Medicare Advantage |
$9.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.16
|
| Rate for Payer: BCN Medicare Advantage |
$4.07
|
| Rate for Payer: BCN Medicare Advantage |
$6.40
|
| Rate for Payer: BCN Medicare Advantage |
$49.15
|
| Rate for Payer: Cash Price |
$20.49
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cash Price |
$157.29
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Cash Price |
$26.78
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$22.02
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$169.08
|
| Rate for Payer: Cofinity Commercial |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$28.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.15
|
| Rate for Payer: Healthscope Commercial |
$23.05
|
| Rate for Payer: Healthscope Commercial |
$34.85
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Healthscope Commercial |
$176.95
|
| Rate for Payer: Healthscope Commercial |
$14.65
|
| Rate for Payer: Healthscope Commercial |
$30.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Mclaren Medicaid |
$34.66
|
| Rate for Payer: Mclaren Medicaid |
$2.87
|
| Rate for Payer: Mclaren Medicaid |
$3.64
|
| Rate for Payer: Mclaren Medicaid |
$4.52
|
| Rate for Payer: Mclaren Medicaid |
$5.90
|
| Rate for Payer: Mclaren Medicaid |
$6.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.42
|
| Rate for Payer: Meridian Medicaid |
$6.20
|
| Rate for Payer: Meridian Medicaid |
$7.17
|
| Rate for Payer: Meridian Medicaid |
$36.39
|
| Rate for Payer: Meridian Medicaid |
$3.01
|
| Rate for Payer: Meridian Medicaid |
$3.82
|
| Rate for Payer: Meridian Medicaid |
$4.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.91
|
| Rate for Payer: Nomi Health Commercial |
$16.93
|
| Rate for Payer: Nomi Health Commercial |
$21.00
|
| Rate for Payer: Nomi Health Commercial |
$13.35
|
| Rate for Payer: Nomi Health Commercial |
$27.45
|
| Rate for Payer: Nomi Health Commercial |
$31.75
|
| Rate for Payer: Nomi Health Commercial |
$161.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.46
|
| Rate for Payer: PACE Senior Care Partners |
$4.90
|
| Rate for Payer: PACE Senior Care Partners |
$46.69
|
| Rate for Payer: PACE Senior Care Partners |
$6.08
|
| Rate for Payer: PACE Senior Care Partners |
$7.95
|
| Rate for Payer: PACE Senior Care Partners |
$3.87
|
| Rate for Payer: PACE Senior Care Partners |
$9.20
|
| Rate for Payer: PACE SWMI |
$49.15
|
| Rate for Payer: PACE SWMI |
$6.40
|
| Rate for Payer: PACE SWMI |
$9.68
|
| Rate for Payer: PACE SWMI |
$4.07
|
| Rate for Payer: PACE SWMI |
$8.37
|
| Rate for Payer: PACE SWMI |
$5.16
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: PHP Commercial |
$167.12
|
| Rate for Payer: PHP Commercial |
$21.77
|
| Rate for Payer: PHP Commercial |
$28.45
|
| Rate for Payer: PHP Commercial |
$32.91
|
| Rate for Payer: PHP Commercial |
$13.84
|
| Rate for Payer: PHP Medicare Advantage |
$9.68
|
| Rate for Payer: PHP Medicare Advantage |
$49.15
|
| Rate for Payer: PHP Medicare Advantage |
$8.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.07
|
| Rate for Payer: PHP Medicare Advantage |
$6.40
|
| Rate for Payer: PHP Medicare Advantage |
$5.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$171.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.69
|
| Rate for Payer: Priority Health Medicare |
$4.11
|
| Rate for Payer: Priority Health Medicare |
$9.78
|
| Rate for Payer: Priority Health Medicare |
$49.64
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health Medicare |
$5.21
|
| Rate for Payer: Priority Health Medicare |
$8.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.82
|
| Rate for Payer: Railroad Medicare Medicare |
$4.07
|
| Rate for Payer: Railroad Medicare Medicare |
$8.37
|
| Rate for Payer: Railroad Medicare Medicare |
$6.40
|
| Rate for Payer: Railroad Medicare Medicare |
$49.15
|
| Rate for Payer: Railroad Medicare Medicare |
$5.16
|
| Rate for Payer: Railroad Medicare Medicare |
$9.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.33
|
| Rate for Payer: UHC Core |
$17.24
|
| Rate for Payer: UHC Core |
$27.95
|
| Rate for Payer: UHC Core |
$21.38
|
| Rate for Payer: UHC Core |
$32.33
|
| Rate for Payer: UHC Core |
$13.59
|
| Rate for Payer: UHC Core |
$164.17
|
| Rate for Payer: UHC Exchange |
$49.15
|
| Rate for Payer: UHC Exchange |
$4.07
|
| Rate for Payer: UHC Exchange |
$6.40
|
| Rate for Payer: UHC Exchange |
$5.16
|
| Rate for Payer: UHC Exchange |
$8.37
|
| Rate for Payer: UHC Exchange |
$9.68
|
| Rate for Payer: UHC Medicaid |
$5.90
|
| Rate for Payer: UHC Medicaid |
$4.52
|
| Rate for Payer: UHC Medicaid |
$34.66
|
| Rate for Payer: UHC Medicaid |
$3.64
|
| Rate for Payer: UHC Medicaid |
$2.87
|
| Rate for Payer: UHC Medicaid |
$6.83
|
| Rate for Payer: UHC Medicare Advantage |
$49.15
|
| Rate for Payer: UHC Medicare Advantage |
$8.37
|
| Rate for Payer: UHC Medicare Advantage |
$6.40
|
| Rate for Payer: UHC Medicare Advantage |
$5.16
|
| Rate for Payer: UHC Medicare Advantage |
$4.07
|
| Rate for Payer: UHC Medicare Advantage |
$9.68
|
| Rate for Payer: UHCCP Medicaid |
$5.90
|
| Rate for Payer: UHCCP Medicaid |
$4.52
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: UHCCP Medicaid |
$34.66
|
| Rate for Payer: UHCCP Medicaid |
$2.87
|
| Rate for Payer: UHCCP Medicaid |
$6.83
|
| Rate for Payer: VA VA |
$5.16
|
| Rate for Payer: VA VA |
$49.15
|
| Rate for Payer: VA VA |
$8.37
|
| Rate for Payer: VA VA |
$6.40
|
| Rate for Payer: VA VA |
$4.07
|
| Rate for Payer: VA VA |
$9.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$38.72
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
8120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: Aetna Commercial |
$13.84
|
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Commercial |
$167.12
|
| Rate for Payer: Aetna Commercial |
$21.77
|
| Rate for Payer: Aetna Commercial |
$28.45
|
| Rate for Payer: BCBS Trust/PPO |
$31.98
|
| Rate for Payer: BCBS Trust/PPO |
$21.15
|
| Rate for Payer: BCBS Trust/PPO |
$27.64
|
| Rate for Payer: BCBS Trust/PPO |
$162.38
|
| Rate for Payer: BCBS Trust/PPO |
$13.45
|
| Rate for Payer: BCBS Trust/PPO |
$17.05
|
| Rate for Payer: BCN Commercial |
$27.64
|
| Rate for Payer: BCN Commercial |
$21.15
|
| Rate for Payer: BCN Commercial |
$13.45
|
| Rate for Payer: BCN Commercial |
$17.05
|
| Rate for Payer: BCN Commercial |
$31.98
|
| Rate for Payer: BCN Commercial |
$162.38
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Cash Price |
$157.29
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cash Price |
$20.49
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cash Price |
$26.78
|
| Rate for Payer: Cofinity Commercial |
$28.78
|
| Rate for Payer: Cofinity Commercial |
$169.08
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$22.02
|
| Rate for Payer: Cofinity Commercial |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$33.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.98
|
| Rate for Payer: Healthscope Commercial |
$14.65
|
| Rate for Payer: Healthscope Commercial |
$176.95
|
| Rate for Payer: Healthscope Commercial |
$30.12
|
| Rate for Payer: Healthscope Commercial |
$34.85
|
| Rate for Payer: Healthscope Commercial |
$23.05
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Nomi Health Commercial |
$27.45
|
| Rate for Payer: Nomi Health Commercial |
$13.35
|
| Rate for Payer: Nomi Health Commercial |
$161.22
|
| Rate for Payer: Nomi Health Commercial |
$21.00
|
| Rate for Payer: Nomi Health Commercial |
$16.93
|
| Rate for Payer: Nomi Health Commercial |
$31.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.21
|
| Rate for Payer: PHP Commercial |
$28.45
|
| Rate for Payer: PHP Commercial |
$32.91
|
| Rate for Payer: PHP Commercial |
$21.77
|
| Rate for Payer: PHP Commercial |
$13.84
|
| Rate for Payer: PHP Commercial |
$167.12
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$171.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.07
|
| Rate for Payer: UHC Core |
$32.33
|
| Rate for Payer: UHC Core |
$164.17
|
| Rate for Payer: UHC Core |
$17.24
|
| Rate for Payer: UHC Core |
$27.95
|
| Rate for Payer: UHC Core |
$21.38
|
| Rate for Payer: UHC Core |
$13.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.21
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$121.83
|
|
|
Service Code
|
NDC 68084075025
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.48 |
| Max. Negotiated Rate |
$109.65 |
| Rate for Payer: Aetna Commercial |
$103.56
|
| Rate for Payer: Aetna Medicare |
$31.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.07
|
| Rate for Payer: BCBS Complete |
$22.55
|
| Rate for Payer: BCBS MAPPO |
$30.46
|
| Rate for Payer: BCBS Trust/PPO |
$100.16
|
| Rate for Payer: BCN Commercial |
$100.16
|
| Rate for Payer: BCN Medicare Advantage |
$30.46
|
| Rate for Payer: Cash Price |
$97.46
|
| Rate for Payer: Cofinity Commercial |
$104.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.46
|
| Rate for Payer: Healthscope Commercial |
$109.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.37
|
| Rate for Payer: Mclaren Medicaid |
$21.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.98
|
| Rate for Payer: Meridian Medicaid |
$22.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.56
|
| Rate for Payer: Nomi Health Commercial |
$99.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.37
|
| Rate for Payer: PACE Senior Care Partners |
$28.93
|
| Rate for Payer: PACE SWMI |
$30.46
|
| Rate for Payer: PHP Commercial |
$103.56
|
| Rate for Payer: PHP Medicare Advantage |
$30.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$105.99
|
| Rate for Payer: Priority Health Medicare |
$30.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.79
|
| Rate for Payer: Railroad Medicare Medicare |
$30.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.21
|
| Rate for Payer: UHC Core |
$101.73
|
| Rate for Payer: UHC Exchange |
$30.46
|
| Rate for Payer: UHC Medicaid |
$21.48
|
| Rate for Payer: UHC Medicare Advantage |
$30.46
|
| Rate for Payer: UHCCP Medicaid |
$21.48
|
| Rate for Payer: VA VA |
$30.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.37
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$243.20
|
|
|
Service Code
|
NDC 60505265601
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.88 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: Aetna Medicare |
$63.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.00
|
| Rate for Payer: BCBS Complete |
$45.02
|
| Rate for Payer: BCBS MAPPO |
$60.80
|
| Rate for Payer: BCBS Trust/PPO |
$199.93
|
| Rate for Payer: BCN Commercial |
$199.93
|
| Rate for Payer: BCN Medicare Advantage |
$60.80
|
| 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: Health Alliance Plan Medicare Advantage |
$60.80
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Mclaren Medicaid |
$42.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.84
|
| Rate for Payer: Meridian Medicaid |
$45.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.72
|
| Rate for Payer: Nomi Health Commercial |
$199.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.40
|
| Rate for Payer: PACE Senior Care Partners |
$57.76
|
| Rate for Payer: PACE SWMI |
$60.80
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: PHP Medicare Advantage |
$60.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$211.58
|
| Rate for Payer: Priority Health Medicare |
$61.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.27
|
| Rate for Payer: Railroad Medicare Medicare |
$60.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.02
|
| Rate for Payer: UHC Core |
$203.07
|
| Rate for Payer: UHC Exchange |
$60.80
|
| Rate for Payer: UHC Medicaid |
$42.88
|
| Rate for Payer: UHC Medicare Advantage |
$60.80
|
| Rate for Payer: UHCCP Medicaid |
$42.88
|
| Rate for Payer: VA VA |
$60.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$243.20
|
|
|
Service Code
|
NDC 00591042401
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.27 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: BCBS Trust/PPO |
$200.86
|
| Rate for Payer: BCN Commercial |
$200.86
|
| 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 Commercial |
$206.72
|
| Rate for Payer: Nomi Health Commercial |
$199.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.40
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$211.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.27
|
| 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
|
OP
|
$4.07
|
|
|
Service Code
|
NDC 68084075095
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.27
|
| Rate for Payer: BCBS Complete |
$0.75
|
| Rate for Payer: BCBS MAPPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$3.35
|
| Rate for Payer: BCN Commercial |
$3.35
|
| Rate for Payer: BCN Medicare Advantage |
$1.02
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$3.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.05
|
| Rate for Payer: Mclaren Medicaid |
$0.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.07
|
| Rate for Payer: Meridian Medicaid |
$0.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.46
|
| Rate for Payer: Nomi Health Commercial |
$3.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.05
|
| Rate for Payer: PACE Senior Care Partners |
$0.97
|
| Rate for Payer: PACE SWMI |
$1.02
|
| Rate for Payer: PHP Commercial |
$3.46
|
| Rate for Payer: PHP Medicare Advantage |
$1.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.54
|
| Rate for Payer: Priority Health Medicare |
$1.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.83
|
| Rate for Payer: Railroad Medicare Medicare |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.58
|
| Rate for Payer: UHC Core |
$3.40
|
| Rate for Payer: UHC Exchange |
$1.02
|
| Rate for Payer: UHC Medicaid |
$0.72
|
| Rate for Payer: UHC Medicare Advantage |
$1.02
|
| Rate for Payer: UHCCP Medicaid |
$0.72
|
| Rate for Payer: VA VA |
$1.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.05
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$121.83
|
|
|
Service Code
|
NDC 68084075025
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.79 |
| Max. Negotiated Rate |
$109.65 |
| Rate for Payer: Aetna Commercial |
$103.56
|
| Rate for Payer: BCBS Trust/PPO |
$100.62
|
| Rate for Payer: BCN Commercial |
$100.62
|
| Rate for Payer: Cash Price |
$97.46
|
| Rate for Payer: Cofinity Commercial |
$104.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.46
|
| Rate for Payer: Healthscope Commercial |
$109.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.56
|
| Rate for Payer: Nomi Health Commercial |
$99.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.37
|
| Rate for Payer: PHP Commercial |
$103.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$105.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.21
|
| Rate for Payer: UHC Core |
$101.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.37
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$243.20
|
|
|
Service Code
|
NDC 00591042401
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.88 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: Aetna Medicare |
$63.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.00
|
| Rate for Payer: BCBS Complete |
$45.02
|
| Rate for Payer: BCBS MAPPO |
$60.80
|
| Rate for Payer: BCBS Trust/PPO |
$199.93
|
| Rate for Payer: BCN Commercial |
$199.93
|
| Rate for Payer: BCN Medicare Advantage |
$60.80
|
| 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: Health Alliance Plan Medicare Advantage |
$60.80
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Mclaren Medicaid |
$42.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.84
|
| Rate for Payer: Meridian Medicaid |
$45.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.72
|
| Rate for Payer: Nomi Health Commercial |
$199.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.40
|
| Rate for Payer: PACE Senior Care Partners |
$57.76
|
| Rate for Payer: PACE SWMI |
$60.80
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: PHP Medicare Advantage |
$60.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$211.58
|
| Rate for Payer: Priority Health Medicare |
$61.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.27
|
| Rate for Payer: Railroad Medicare Medicare |
$60.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.02
|
| Rate for Payer: UHC Core |
$203.07
|
| Rate for Payer: UHC Exchange |
$60.80
|
| Rate for Payer: UHC Medicaid |
$42.88
|
| Rate for Payer: UHC Medicare Advantage |
$60.80
|
| Rate for Payer: UHCCP Medicaid |
$42.88
|
| Rate for Payer: VA VA |
$60.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$243.20
|
|
|
Service Code
|
NDC 60505265601
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.27 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: BCBS Trust/PPO |
$200.86
|
| Rate for Payer: BCN Commercial |
$200.86
|
| 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 Commercial |
$206.72
|
| Rate for Payer: Nomi Health Commercial |
$199.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.40
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$211.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.27
|
| 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
|
$4.07
|
|
|
Service Code
|
NDC 68084075095
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: BCBS Trust/PPO |
$3.36
|
| Rate for Payer: BCN Commercial |
$3.36
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$3.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.46
|
| Rate for Payer: Nomi Health Commercial |
$3.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.05
|
| Rate for Payer: PHP Commercial |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.58
|
| Rate for Payer: UHC Core |
$3.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.05
|
|
|
TRIFLUOPERAZINE 2 MG TABLET
|
Facility
|
IP
|
$346.56
|
|
|
Service Code
|
NDC 00378240201
|
| Hospital Charge Code |
8163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.21 |
| Max. Negotiated Rate |
$311.90 |
| Rate for Payer: Aetna Commercial |
$294.58
|
| Rate for Payer: BCBS Trust/PPO |
$286.22
|
| Rate for Payer: BCN Commercial |
$286.22
|
| Rate for Payer: Cash Price |
$277.25
|
| Rate for Payer: Cofinity Commercial |
$298.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.25
|
| Rate for Payer: Healthscope Commercial |
$311.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.58
|
| Rate for Payer: Nomi Health Commercial |
$284.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.92
|
| Rate for Payer: PHP Commercial |
$294.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$301.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.97
|
| Rate for Payer: UHC Core |
$289.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.92
|
|
|
TRIFLUOPERAZINE 2 MG TABLET
|
Facility
|
OP
|
$346.56
|
|
|
Service Code
|
NDC 00378240201
|
| Hospital Charge Code |
8163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$311.90 |
| Rate for Payer: Aetna Commercial |
$294.58
|
| Rate for Payer: Aetna Medicare |
$90.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.30
|
| Rate for Payer: BCBS Complete |
$64.15
|
| Rate for Payer: BCBS MAPPO |
$86.64
|
| Rate for Payer: BCBS Trust/PPO |
$284.91
|
| Rate for Payer: BCN Commercial |
$284.91
|
| Rate for Payer: BCN Medicare Advantage |
$86.64
|
| Rate for Payer: Cash Price |
$277.25
|
| Rate for Payer: Cofinity Commercial |
$298.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.64
|
| Rate for Payer: Healthscope Commercial |
$311.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.92
|
| Rate for Payer: Mclaren Medicaid |
$61.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.97
|
| Rate for Payer: Meridian Medicaid |
$64.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.58
|
| Rate for Payer: Nomi Health Commercial |
$284.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.92
|
| Rate for Payer: PACE Senior Care Partners |
$82.31
|
| Rate for Payer: PACE SWMI |
$86.64
|
| Rate for Payer: PHP Commercial |
$294.58
|
| Rate for Payer: PHP Medicare Advantage |
$86.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$301.51
|
| Rate for Payer: Priority Health Medicare |
$87.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.21
|
| Rate for Payer: Railroad Medicare Medicare |
$86.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.97
|
| Rate for Payer: UHC Core |
$289.38
|
| Rate for Payer: UHC Exchange |
$86.64
|
| Rate for Payer: UHC Medicaid |
$61.10
|
| Rate for Payer: UHC Medicare Advantage |
$86.64
|
| Rate for Payer: UHCCP Medicaid |
$61.10
|
| Rate for Payer: VA VA |
$86.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.92
|
|
|
TRIMETHOBENZAMIDE 100 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$200.51
|
|
|
Service Code
|
HCPCS J3250
|
| Hospital Charge Code |
108755
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$139.55 |
| Max. Negotiated Rate |
$180.46 |
| Rate for Payer: Aetna Commercial |
$170.43
|
| Rate for Payer: BCBS Trust/PPO |
$165.60
|
| Rate for Payer: BCN Commercial |
$165.60
|
| Rate for Payer: Cash Price |
$160.41
|
| Rate for Payer: Cofinity Commercial |
$172.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.41
|
| Rate for Payer: Healthscope Commercial |
$180.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.43
|
| Rate for Payer: Nomi Health Commercial |
$164.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.38
|
| Rate for Payer: PHP Commercial |
$170.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.45
|
| Rate for Payer: UHC Core |
$167.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.38
|
|
|
TRIMETHOBENZAMIDE 100 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$200.51
|
|
|
Service Code
|
HCPCS J3250
|
| Hospital Charge Code |
108755
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$180.46 |
| Rate for Payer: Aetna Commercial |
$170.43
|
| Rate for Payer: Aetna Medicare |
$52.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.66
|
| Rate for Payer: BCBS Complete |
$37.11
|
| Rate for Payer: BCBS MAPPO |
$50.13
|
| Rate for Payer: BCBS Trust/PPO |
$164.84
|
| Rate for Payer: BCN Commercial |
$164.84
|
| Rate for Payer: BCN Medicare Advantage |
$50.13
|
| Rate for Payer: Cash Price |
$160.41
|
| Rate for Payer: Cofinity Commercial |
$172.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.13
|
| Rate for Payer: Healthscope Commercial |
$180.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.38
|
| Rate for Payer: Mclaren Medicaid |
$35.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.63
|
| Rate for Payer: Meridian Medicaid |
$37.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$55.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.43
|
| Rate for Payer: Nomi Health Commercial |
$164.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.38
|
| Rate for Payer: PACE Senior Care Partners |
$47.62
|
| Rate for Payer: PACE SWMI |
$50.13
|
| Rate for Payer: PHP Commercial |
$170.43
|
| Rate for Payer: PHP Medicare Advantage |
$50.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.44
|
| Rate for Payer: Priority Health Medicare |
$50.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.55
|
| Rate for Payer: Railroad Medicare Medicare |
$50.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.45
|
| Rate for Payer: UHC Core |
$167.43
|
| Rate for Payer: UHC Exchange |
$50.13
|
| Rate for Payer: UHC Medicaid |
$35.35
|
| Rate for Payer: UHC Medicare Advantage |
$50.13
|
| Rate for Payer: UHCCP Medicaid |
$35.35
|
| Rate for Payer: VA VA |
$50.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.38
|
|
|
TRIMETHOPRIM 100 MG TABLET
|
Facility
|
IP
|
$595.68
|
|
|
Service Code
|
NDC 51862048601
|
| Hospital Charge Code |
8182
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$414.59 |
| Max. Negotiated Rate |
$536.11 |
| Rate for Payer: Aetna Commercial |
$506.33
|
| Rate for Payer: BCBS Trust/PPO |
$491.97
|
| Rate for Payer: BCN Commercial |
$491.97
|
| Rate for Payer: Cash Price |
$476.54
|
| Rate for Payer: Cofinity Commercial |
$512.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.54
|
| Rate for Payer: Healthscope Commercial |
$536.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.33
|
| Rate for Payer: Nomi Health Commercial |
$488.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.76
|
| Rate for Payer: PHP Commercial |
$506.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$518.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$414.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$524.20
|
| Rate for Payer: UHC Core |
$497.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.76
|
|
|
TRIMETHOPRIM 100 MG TABLET
|
Facility
|
OP
|
$630.72
|
|
|
Service Code
|
NDC 75907004301
|
| Hospital Charge Code |
8182
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$567.65 |
| Rate for Payer: Aetna Commercial |
$536.11
|
| Rate for Payer: Aetna Medicare |
$163.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$197.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$197.10
|
| Rate for Payer: BCBS Complete |
$116.75
|
| Rate for Payer: BCBS MAPPO |
$157.68
|
| Rate for Payer: BCBS Trust/PPO |
$518.51
|
| Rate for Payer: BCN Commercial |
$518.51
|
| Rate for Payer: BCN Medicare Advantage |
$157.68
|
| Rate for Payer: Cash Price |
$504.58
|
| Rate for Payer: Cofinity Commercial |
$542.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.68
|
| Rate for Payer: Healthscope Commercial |
$567.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.04
|
| Rate for Payer: Mclaren Medicaid |
$111.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.56
|
| Rate for Payer: Meridian Medicaid |
$116.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$173.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.11
|
| Rate for Payer: Nomi Health Commercial |
$517.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$473.04
|
| Rate for Payer: PACE Senior Care Partners |
$149.80
|
| Rate for Payer: PACE SWMI |
$157.68
|
| Rate for Payer: PHP Commercial |
$536.11
|
| Rate for Payer: PHP Medicare Advantage |
$157.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$548.73
|
| Rate for Payer: Priority Health Medicare |
$159.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$438.98
|
| Rate for Payer: Railroad Medicare Medicare |
$157.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$555.03
|
| Rate for Payer: UHC Core |
$526.65
|
| Rate for Payer: UHC Exchange |
$157.68
|
| Rate for Payer: UHC Medicaid |
$111.20
|
| Rate for Payer: UHC Medicare Advantage |
$157.68
|
| Rate for Payer: UHCCP Medicaid |
$111.20
|
| Rate for Payer: VA VA |
$157.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.04
|
|
|
TRIMETHOPRIM 100 MG TABLET
|
Facility
|
OP
|
$595.68
|
|
|
Service Code
|
NDC 51862048601
|
| Hospital Charge Code |
8182
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.02 |
| Max. Negotiated Rate |
$536.11 |
| Rate for Payer: Aetna Commercial |
$506.33
|
| Rate for Payer: Aetna Medicare |
$154.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.15
|
| Rate for Payer: BCBS Complete |
$110.26
|
| Rate for Payer: BCBS MAPPO |
$148.92
|
| Rate for Payer: BCBS Trust/PPO |
$489.71
|
| Rate for Payer: BCN Commercial |
$489.71
|
| Rate for Payer: BCN Medicare Advantage |
$148.92
|
| Rate for Payer: Cash Price |
$476.54
|
| Rate for Payer: Cofinity Commercial |
$512.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.92
|
| Rate for Payer: Healthscope Commercial |
$536.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.76
|
| Rate for Payer: Mclaren Medicaid |
$105.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.37
|
| Rate for Payer: Meridian Medicaid |
$110.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$163.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.33
|
| Rate for Payer: Nomi Health Commercial |
$488.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.76
|
| Rate for Payer: PACE Senior Care Partners |
$141.47
|
| Rate for Payer: PACE SWMI |
$148.92
|
| Rate for Payer: PHP Commercial |
$506.33
|
| Rate for Payer: PHP Medicare Advantage |
$148.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$518.24
|
| Rate for Payer: Priority Health Medicare |
$150.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$414.59
|
| Rate for Payer: Railroad Medicare Medicare |
$148.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$524.20
|
| Rate for Payer: UHC Core |
$497.39
|
| Rate for Payer: UHC Exchange |
$148.92
|
| Rate for Payer: UHC Medicaid |
$105.02
|
| Rate for Payer: UHC Medicare Advantage |
$148.92
|
| Rate for Payer: UHCCP Medicaid |
$105.02
|
| Rate for Payer: VA VA |
$148.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.76
|
|
|
TRIMETHOPRIM 100 MG TABLET
|
Facility
|
IP
|
$630.72
|
|
|
Service Code
|
NDC 75907004301
|
| Hospital Charge Code |
8182
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$438.98 |
| Max. Negotiated Rate |
$567.65 |
| Rate for Payer: Aetna Commercial |
$536.11
|
| Rate for Payer: BCBS Trust/PPO |
$520.91
|
| Rate for Payer: BCN Commercial |
$520.91
|
| Rate for Payer: Cash Price |
$504.58
|
| Rate for Payer: Cofinity Commercial |
$542.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.58
|
| Rate for Payer: Healthscope Commercial |
$567.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.11
|
| Rate for Payer: Nomi Health Commercial |
$517.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$473.04
|
| Rate for Payer: PHP Commercial |
$536.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$548.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$438.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$555.03
|
| Rate for Payer: UHC Core |
$526.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.04
|
|
|
TROLAMINE SALICYLATE 10 % TOPICAL CREAM
|
Facility
|
IP
|
$11.86
|
|
|
Service Code
|
NDC 096295129854
|
| Hospital Charge Code |
27680
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Aetna Commercial |
$10.08
|
| Rate for Payer: BCBS Trust/PPO |
$9.80
|
| Rate for Payer: BCN Commercial |
$9.80
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.49
|
| Rate for Payer: Healthscope Commercial |
$10.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.08
|
| Rate for Payer: Nomi Health Commercial |
$9.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.89
|
| Rate for Payer: PHP Commercial |
$10.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.44
|
| Rate for Payer: UHC Core |
$9.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.89
|
|
|
TROLAMINE SALICYLATE 10 % TOPICAL CREAM
|
Facility
|
OP
|
$13.39
|
|
|
Service Code
|
NDC 96295012985
|
| Hospital Charge Code |
27680
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$12.05 |
| Rate for Payer: Aetna Commercial |
$11.38
|
| Rate for Payer: Aetna Medicare |
$3.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.18
|
| Rate for Payer: BCBS Complete |
$2.48
|
| Rate for Payer: BCBS MAPPO |
$3.35
|
| Rate for Payer: BCBS Trust/PPO |
$11.01
|
| Rate for Payer: BCN Commercial |
$11.01
|
| Rate for Payer: BCN Medicare Advantage |
$3.35
|
| Rate for Payer: Cash Price |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$11.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.35
|
| Rate for Payer: Healthscope Commercial |
$12.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.04
|
| Rate for Payer: Mclaren Medicaid |
$2.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.51
|
| Rate for Payer: Meridian Medicaid |
$2.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.38
|
| Rate for Payer: Nomi Health Commercial |
$10.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.04
|
| Rate for Payer: PACE Senior Care Partners |
$3.18
|
| Rate for Payer: PACE SWMI |
$3.35
|
| Rate for Payer: PHP Commercial |
$11.38
|
| Rate for Payer: PHP Medicare Advantage |
$3.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.65
|
| Rate for Payer: Priority Health Medicare |
$3.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.32
|
| Rate for Payer: Railroad Medicare Medicare |
$3.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.78
|
| Rate for Payer: UHC Core |
$11.18
|
| Rate for Payer: UHC Exchange |
$3.35
|
| Rate for Payer: UHC Medicaid |
$2.36
|
| Rate for Payer: UHC Medicare Advantage |
$3.35
|
| Rate for Payer: UHCCP Medicaid |
$2.36
|
| Rate for Payer: VA VA |
$3.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.04
|
|
|
TROLAMINE SALICYLATE 10 % TOPICAL CREAM
|
Facility
|
IP
|
$13.39
|
|
|
Service Code
|
NDC 96295012985
|
| Hospital Charge Code |
27680
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$12.05 |
| Rate for Payer: Aetna Commercial |
$11.38
|
| Rate for Payer: BCBS Trust/PPO |
$11.06
|
| Rate for Payer: BCN Commercial |
$11.06
|
| Rate for Payer: Cash Price |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$11.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.71
|
| Rate for Payer: Healthscope Commercial |
$12.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.38
|
| Rate for Payer: Nomi Health Commercial |
$10.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.04
|
| Rate for Payer: PHP Commercial |
$11.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.78
|
| Rate for Payer: UHC Core |
$11.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.04
|
|
|
TROLAMINE SALICYLATE 10 % TOPICAL CREAM
|
Facility
|
OP
|
$11.86
|
|
|
Service Code
|
NDC 096295129854
|
| Hospital Charge Code |
27680
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Aetna Commercial |
$10.08
|
| Rate for Payer: Aetna Medicare |
$3.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: BCBS Complete |
$2.20
|
| Rate for Payer: BCBS MAPPO |
$2.96
|
| Rate for Payer: BCBS Trust/PPO |
$9.75
|
| Rate for Payer: BCN Commercial |
$9.75
|
| Rate for Payer: BCN Medicare Advantage |
$2.96
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$10.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.89
|
| Rate for Payer: Mclaren Medicaid |
$2.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.11
|
| Rate for Payer: Meridian Medicaid |
$2.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.08
|
| Rate for Payer: Nomi Health Commercial |
$9.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.89
|
| Rate for Payer: PACE Senior Care Partners |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.96
|
| Rate for Payer: PHP Commercial |
$10.08
|
| Rate for Payer: PHP Medicare Advantage |
$2.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.32
|
| Rate for Payer: Priority Health Medicare |
$2.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.25
|
| Rate for Payer: Railroad Medicare Medicare |
$2.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.44
|
| Rate for Payer: UHC Core |
$9.90
|
| Rate for Payer: UHC Exchange |
$2.96
|
| Rate for Payer: UHC Medicaid |
$2.09
|
| Rate for Payer: UHC Medicare Advantage |
$2.96
|
| Rate for Payer: UHCCP Medicaid |
$2.09
|
| Rate for Payer: VA VA |
$2.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.89
|
|
|
TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$182.04
|
|
|
Service Code
|
NDC 68803061210
|
| Hospital Charge Code |
88317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$163.84 |
| Rate for Payer: Aetna Commercial |
$154.73
|
| Rate for Payer: BCBS Trust/PPO |
$150.35
|
| Rate for Payer: BCN Commercial |
$150.35
|
| Rate for Payer: Cash Price |
$145.63
|
| Rate for Payer: Cofinity Commercial |
$156.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.63
|
| Rate for Payer: Healthscope Commercial |
$163.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.73
|
| Rate for Payer: Nomi Health Commercial |
$149.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.53
|
| Rate for Payer: PHP Commercial |
$154.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$158.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.20
|
| Rate for Payer: UHC Core |
$152.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.53
|
|
|
TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE
|
Facility
|
OP
|
$182.04
|
|
|
Service Code
|
NDC 68803061210
|
| Hospital Charge Code |
88317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$163.84 |
| Rate for Payer: Aetna Commercial |
$154.73
|
| Rate for Payer: Aetna Medicare |
$47.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.89
|
| Rate for Payer: BCBS Complete |
$33.70
|
| Rate for Payer: BCBS MAPPO |
$45.51
|
| Rate for Payer: BCBS Trust/PPO |
$149.66
|
| Rate for Payer: BCN Commercial |
$149.66
|
| Rate for Payer: BCN Medicare Advantage |
$45.51
|
| Rate for Payer: Cash Price |
$145.63
|
| Rate for Payer: Cofinity Commercial |
$156.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.51
|
| Rate for Payer: Healthscope Commercial |
$163.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.53
|
| Rate for Payer: Mclaren Medicaid |
$32.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.79
|
| Rate for Payer: Meridian Medicaid |
$33.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.73
|
| Rate for Payer: Nomi Health Commercial |
$149.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.53
|
| Rate for Payer: PACE Senior Care Partners |
$43.23
|
| Rate for Payer: PACE SWMI |
$45.51
|
| Rate for Payer: PHP Commercial |
$154.73
|
| Rate for Payer: PHP Medicare Advantage |
$45.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$158.37
|
| Rate for Payer: Priority Health Medicare |
$45.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.70
|
| Rate for Payer: Railroad Medicare Medicare |
$45.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.20
|
| Rate for Payer: UHC Core |
$152.00
|
| Rate for Payer: UHC Exchange |
$45.51
|
| Rate for Payer: UHC Medicaid |
$32.09
|
| Rate for Payer: UHC Medicare Advantage |
$45.51
|
| Rate for Payer: UHCCP Medicaid |
$32.09
|
| Rate for Payer: VA VA |
$45.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.53
|
|
