|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 00904738361
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.35 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: BCBS Trust/PPO |
$157.42
|
| Rate for Payer: BCN Commercial |
$149.03
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Nomi Health Commercial |
$158.14
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: Priority Health HMO/PPO |
$167.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Core |
$161.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$2.31
|
|
|
Service Code
|
NDC 68084029911
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.08 |
| Rate for Payer: Aetna Commercial |
$1.96
|
| Rate for Payer: Aetna Medicare |
$0.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.72
|
| Rate for Payer: BCBS Complete |
$0.92
|
| Rate for Payer: BCBS MAPPO |
$0.58
|
| Rate for Payer: BCBS Trust/PPO |
$1.90
|
| Rate for Payer: BCN Commercial |
$1.80
|
| Rate for Payer: BCN Medicare Advantage |
$0.58
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cofinity Commercial |
$1.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.58
|
| Rate for Payer: Healthscope Commercial |
$2.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.96
|
| Rate for Payer: Nomi Health Commercial |
$1.89
|
| Rate for Payer: PACE Senior Care Partners |
$0.55
|
| Rate for Payer: PACE SWMI |
$0.58
|
| Rate for Payer: PHP Commercial |
$1.96
|
| Rate for Payer: PHP Medicare Advantage |
$0.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.50
|
| Rate for Payer: Priority Health HMO/PPO |
$2.01
|
| Rate for Payer: Priority Health Medicare |
$0.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.55
|
| Rate for Payer: Railroad Medicare Medicare |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.03
|
| Rate for Payer: UHC Core |
$1.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Medicare Advantage |
$0.58
|
| Rate for Payer: VA VA |
$0.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.73
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$230.85
|
|
|
Service Code
|
NDC 68084029901
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.05 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: BCBS Trust/PPO |
$188.44
|
| Rate for Payer: BCN Commercial |
$178.40
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: Priority Health HMO/PPO |
$200.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.15
|
| Rate for Payer: UHC Core |
$192.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$1.49
|
|
|
Service Code
|
NDC 51079041801
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna Medicare |
$0.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.47
|
| Rate for Payer: BCBS Complete |
$0.60
|
| Rate for Payer: BCBS MAPPO |
$0.37
|
| Rate for Payer: BCBS Trust/PPO |
$1.22
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: BCN Medicare Advantage |
$0.37
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.37
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.27
|
| Rate for Payer: Nomi Health Commercial |
$1.22
|
| Rate for Payer: PACE Senior Care Partners |
$0.35
|
| Rate for Payer: PACE SWMI |
$0.37
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: PHP Medicare Advantage |
$0.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.97
|
| Rate for Payer: Priority Health HMO/PPO |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.00
|
| Rate for Payer: Railroad Medicare Medicare |
$0.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.31
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.37
|
| Rate for Payer: UHC Exchange |
$0.37
|
| Rate for Payer: UHC Medicare Advantage |
$0.37
|
| Rate for Payer: VA VA |
$0.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$136.50
|
|
|
Service Code
|
NDC 00228207610
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$122.85 |
| Rate for Payer: Aetna Commercial |
$116.02
|
| Rate for Payer: Aetna Medicare |
$35.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.66
|
| Rate for Payer: BCBS Complete |
$54.60
|
| Rate for Payer: BCBS MAPPO |
$34.12
|
| Rate for Payer: BCBS Trust/PPO |
$112.22
|
| Rate for Payer: BCN Commercial |
$106.13
|
| Rate for Payer: BCN Medicare Advantage |
$34.12
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cofinity Commercial |
$117.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.12
|
| Rate for Payer: Healthscope Commercial |
$122.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.02
|
| Rate for Payer: Nomi Health Commercial |
$111.93
|
| Rate for Payer: PACE Senior Care Partners |
$32.42
|
| Rate for Payer: PACE SWMI |
$34.12
|
| Rate for Payer: PHP Commercial |
$116.02
|
| Rate for Payer: PHP Medicare Advantage |
$34.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.72
|
| Rate for Payer: Priority Health HMO/PPO |
$118.76
|
| Rate for Payer: Priority Health Medicare |
$34.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.46
|
| Rate for Payer: Railroad Medicare Medicare |
$34.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.12
|
| Rate for Payer: UHC Core |
$113.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.12
|
| Rate for Payer: UHC Exchange |
$34.12
|
| Rate for Payer: UHC Medicare Advantage |
$34.12
|
| Rate for Payer: VA VA |
$34.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.38
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$136.50
|
|
|
Service Code
|
NDC 00228207610
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.72 |
| Max. Negotiated Rate |
$122.85 |
| Rate for Payer: Aetna Commercial |
$116.02
|
| Rate for Payer: BCBS Trust/PPO |
$111.42
|
| Rate for Payer: BCN Commercial |
$105.49
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cofinity Commercial |
$117.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.20
|
| Rate for Payer: Healthscope Commercial |
$122.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.02
|
| Rate for Payer: Nomi Health Commercial |
$111.93
|
| Rate for Payer: PHP Commercial |
$116.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.72
|
| Rate for Payer: Priority Health HMO/PPO |
$118.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.12
|
| Rate for Payer: UHC Core |
$113.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.38
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$152.25
|
|
|
Service Code
|
NDC 00378401001
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$137.02 |
| Rate for Payer: Aetna Commercial |
$129.41
|
| Rate for Payer: BCBS Trust/PPO |
$124.28
|
| Rate for Payer: BCN Commercial |
$117.66
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cofinity Commercial |
$130.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.80
|
| Rate for Payer: Healthscope Commercial |
$137.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.41
|
| Rate for Payer: Nomi Health Commercial |
$124.84
|
| Rate for Payer: PHP Commercial |
$129.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.96
|
| Rate for Payer: Priority Health HMO/PPO |
$132.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.98
|
| Rate for Payer: UHC Core |
$127.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.19
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$152.25
|
|
|
Service Code
|
NDC 00378401001
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.16 |
| Max. Negotiated Rate |
$137.02 |
| Rate for Payer: Aetna Commercial |
$129.41
|
| Rate for Payer: Aetna Medicare |
$39.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.58
|
| Rate for Payer: BCBS Complete |
$60.90
|
| Rate for Payer: BCBS MAPPO |
$38.06
|
| Rate for Payer: BCBS Trust/PPO |
$125.16
|
| Rate for Payer: BCN Commercial |
$118.37
|
| Rate for Payer: BCN Medicare Advantage |
$38.06
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cofinity Commercial |
$130.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.06
|
| Rate for Payer: Healthscope Commercial |
$137.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.41
|
| Rate for Payer: Nomi Health Commercial |
$124.84
|
| Rate for Payer: PACE Senior Care Partners |
$36.16
|
| Rate for Payer: PACE SWMI |
$38.06
|
| Rate for Payer: PHP Commercial |
$129.41
|
| Rate for Payer: PHP Medicare Advantage |
$38.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.96
|
| Rate for Payer: Priority Health HMO/PPO |
$132.46
|
| Rate for Payer: Priority Health Medicare |
$38.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.01
|
| Rate for Payer: Railroad Medicare Medicare |
$38.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.98
|
| Rate for Payer: UHC Core |
$127.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.06
|
| Rate for Payer: UHC Exchange |
$38.06
|
| Rate for Payer: UHC Medicare Advantage |
$38.06
|
| Rate for Payer: VA VA |
$38.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.19
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$1.49
|
|
|
Service Code
|
NDC 51079041801
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: BCBS Trust/PPO |
$1.22
|
| Rate for Payer: BCN Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.27
|
| Rate for Payer: Nomi Health Commercial |
$1.22
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.97
|
| Rate for Payer: Priority Health HMO/PPO |
$1.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.31
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$338.95
|
|
|
Service Code
|
NDC 68084054921
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$305.06 |
| Rate for Payer: Aetna Commercial |
$288.11
|
| Rate for Payer: Aetna Medicare |
$88.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.92
|
| Rate for Payer: BCBS Complete |
$135.58
|
| Rate for Payer: BCBS MAPPO |
$84.74
|
| Rate for Payer: BCBS Trust/PPO |
$278.65
|
| Rate for Payer: BCN Commercial |
$263.53
|
| Rate for Payer: BCN Medicare Advantage |
$84.74
|
| Rate for Payer: Cash Price |
$271.16
|
| Rate for Payer: Cofinity Commercial |
$291.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.74
|
| Rate for Payer: Healthscope Commercial |
$305.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.11
|
| Rate for Payer: Nomi Health Commercial |
$277.94
|
| Rate for Payer: PACE Senior Care Partners |
$80.50
|
| Rate for Payer: PACE SWMI |
$84.74
|
| Rate for Payer: PHP Commercial |
$288.11
|
| Rate for Payer: PHP Medicare Advantage |
$84.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.32
|
| Rate for Payer: Priority Health HMO/PPO |
$294.89
|
| Rate for Payer: Priority Health Medicare |
$85.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.10
|
| Rate for Payer: Railroad Medicare Medicare |
$84.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.28
|
| Rate for Payer: UHC Core |
$283.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.74
|
| Rate for Payer: UHC Exchange |
$84.74
|
| Rate for Payer: UHC Medicare Advantage |
$84.74
|
| Rate for Payer: VA VA |
$84.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.21
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$308.18
|
|
|
Service Code
|
NDC 00904643604
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.32 |
| Max. Negotiated Rate |
$277.36 |
| Rate for Payer: Aetna Commercial |
$261.95
|
| Rate for Payer: BCBS Trust/PPO |
$251.57
|
| Rate for Payer: BCN Commercial |
$238.16
|
| Rate for Payer: Cash Price |
$246.54
|
| Rate for Payer: Cofinity Commercial |
$265.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.54
|
| Rate for Payer: Healthscope Commercial |
$277.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.95
|
| Rate for Payer: Nomi Health Commercial |
$252.71
|
| Rate for Payer: PHP Commercial |
$261.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.32
|
| Rate for Payer: Priority Health HMO/PPO |
$268.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.20
|
| Rate for Payer: UHC Core |
$257.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.14
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$2,127.84
|
|
|
Service Code
|
NDC 00378311001
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,383.10 |
| Max. Negotiated Rate |
$1,915.06 |
| Rate for Payer: Aetna Commercial |
$1,808.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,736.96
|
| Rate for Payer: BCN Commercial |
$1,644.39
|
| Rate for Payer: Cash Price |
$1,702.27
|
| Rate for Payer: Cofinity Commercial |
$1,829.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.27
|
| Rate for Payer: Healthscope Commercial |
$1,915.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,595.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,808.66
|
| Rate for Payer: Nomi Health Commercial |
$1,744.83
|
| Rate for Payer: PHP Commercial |
$1,808.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,383.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,851.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,425.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,872.50
|
| Rate for Payer: UHC Core |
$1,776.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,595.88
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$1,169.61
|
|
|
Service Code
|
NDC 53489064801
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$760.25 |
| Max. Negotiated Rate |
$1,052.65 |
| Rate for Payer: Aetna Commercial |
$994.17
|
| Rate for Payer: BCBS Trust/PPO |
$954.75
|
| Rate for Payer: BCN Commercial |
$903.87
|
| Rate for Payer: Cash Price |
$935.69
|
| Rate for Payer: Cofinity Commercial |
$1,005.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$935.69
|
| Rate for Payer: Healthscope Commercial |
$1,052.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$877.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$994.17
|
| Rate for Payer: Nomi Health Commercial |
$959.08
|
| Rate for Payer: PHP Commercial |
$994.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,017.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$783.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,029.26
|
| Rate for Payer: UHC Core |
$976.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$877.21
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$2,127.84
|
|
|
Service Code
|
NDC 00378311001
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$505.36 |
| Max. Negotiated Rate |
$1,915.06 |
| Rate for Payer: Aetna Commercial |
$1,808.66
|
| Rate for Payer: Aetna Medicare |
$553.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$664.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$664.95
|
| Rate for Payer: BCBS Complete |
$851.14
|
| Rate for Payer: BCBS MAPPO |
$531.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,749.30
|
| Rate for Payer: BCN Commercial |
$1,654.40
|
| Rate for Payer: BCN Medicare Advantage |
$531.96
|
| Rate for Payer: Cash Price |
$1,702.27
|
| Rate for Payer: Cofinity Commercial |
$1,829.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$531.96
|
| Rate for Payer: Healthscope Commercial |
$1,915.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,595.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$558.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$611.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,808.66
|
| Rate for Payer: Nomi Health Commercial |
$1,744.83
|
| Rate for Payer: PACE Senior Care Partners |
$505.36
|
| Rate for Payer: PACE SWMI |
$531.96
|
| Rate for Payer: PHP Commercial |
$1,808.66
|
| Rate for Payer: PHP Medicare Advantage |
$531.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,383.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,851.22
|
| Rate for Payer: Priority Health Medicare |
$537.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,425.65
|
| Rate for Payer: Railroad Medicare Medicare |
$531.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,872.50
|
| Rate for Payer: UHC Core |
$1,776.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$531.96
|
| Rate for Payer: UHC Exchange |
$531.96
|
| Rate for Payer: UHC Medicare Advantage |
$531.96
|
| Rate for Payer: VA VA |
$531.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,595.88
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$338.95
|
|
|
Service Code
|
NDC 68084054921
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.32 |
| Max. Negotiated Rate |
$305.06 |
| Rate for Payer: Aetna Commercial |
$288.11
|
| Rate for Payer: BCBS Trust/PPO |
$276.68
|
| Rate for Payer: BCN Commercial |
$261.94
|
| Rate for Payer: Cash Price |
$271.16
|
| Rate for Payer: Cofinity Commercial |
$291.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.16
|
| Rate for Payer: Healthscope Commercial |
$305.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.11
|
| Rate for Payer: Nomi Health Commercial |
$277.94
|
| Rate for Payer: PHP Commercial |
$288.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.32
|
| Rate for Payer: Priority Health HMO/PPO |
$294.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.28
|
| Rate for Payer: UHC Core |
$283.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.21
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$308.18
|
|
|
Service Code
|
NDC 00904643604
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.19 |
| Max. Negotiated Rate |
$277.36 |
| Rate for Payer: Aetna Commercial |
$261.95
|
| Rate for Payer: Aetna Medicare |
$80.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.31
|
| Rate for Payer: BCBS Complete |
$123.27
|
| Rate for Payer: BCBS MAPPO |
$77.04
|
| Rate for Payer: BCBS Trust/PPO |
$253.35
|
| Rate for Payer: BCN Commercial |
$239.61
|
| Rate for Payer: BCN Medicare Advantage |
$77.04
|
| Rate for Payer: Cash Price |
$246.54
|
| Rate for Payer: Cofinity Commercial |
$265.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.04
|
| Rate for Payer: Healthscope Commercial |
$277.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.95
|
| Rate for Payer: Nomi Health Commercial |
$252.71
|
| Rate for Payer: PACE Senior Care Partners |
$73.19
|
| Rate for Payer: PACE SWMI |
$77.04
|
| Rate for Payer: PHP Commercial |
$261.95
|
| Rate for Payer: PHP Medicare Advantage |
$77.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.32
|
| Rate for Payer: Priority Health HMO/PPO |
$268.12
|
| Rate for Payer: Priority Health Medicare |
$77.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.48
|
| Rate for Payer: Railroad Medicare Medicare |
$77.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.20
|
| Rate for Payer: UHC Core |
$257.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.04
|
| Rate for Payer: UHC Exchange |
$77.04
|
| Rate for Payer: UHC Medicare Advantage |
$77.04
|
| Rate for Payer: VA VA |
$77.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.14
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$11.30
|
|
|
Service Code
|
NDC 68084054911
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Aetna Commercial |
$9.60
|
| Rate for Payer: Aetna Medicare |
$2.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.53
|
| Rate for Payer: BCBS Complete |
$4.52
|
| Rate for Payer: BCBS MAPPO |
$2.82
|
| Rate for Payer: BCBS Trust/PPO |
$9.29
|
| Rate for Payer: BCN Commercial |
$8.79
|
| Rate for Payer: BCN Medicare Advantage |
$2.82
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.60
|
| Rate for Payer: Nomi Health Commercial |
$9.27
|
| Rate for Payer: PACE Senior Care Partners |
$2.68
|
| Rate for Payer: PACE SWMI |
$2.82
|
| Rate for Payer: PHP Commercial |
$9.60
|
| Rate for Payer: PHP Medicare Advantage |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.34
|
| Rate for Payer: Priority Health HMO/PPO |
$9.83
|
| Rate for Payer: Priority Health Medicare |
$2.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.57
|
| Rate for Payer: Railroad Medicare Medicare |
$2.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.94
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.82
|
| Rate for Payer: UHC Exchange |
$2.82
|
| Rate for Payer: UHC Medicare Advantage |
$2.82
|
| Rate for Payer: VA VA |
$2.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.48
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$11.30
|
|
|
Service Code
|
NDC 68084054911
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Aetna Commercial |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$9.22
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.04
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.60
|
| Rate for Payer: Nomi Health Commercial |
$9.27
|
| Rate for Payer: PHP Commercial |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.34
|
| Rate for Payer: Priority Health HMO/PPO |
$9.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.94
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.48
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$1,169.61
|
|
|
Service Code
|
NDC 53489064801
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.78 |
| Max. Negotiated Rate |
$1,052.65 |
| Rate for Payer: Aetna Commercial |
$994.17
|
| Rate for Payer: Aetna Medicare |
$304.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$365.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$365.50
|
| Rate for Payer: BCBS Complete |
$467.84
|
| Rate for Payer: BCBS MAPPO |
$292.40
|
| Rate for Payer: BCBS Trust/PPO |
$961.54
|
| Rate for Payer: BCN Commercial |
$909.37
|
| Rate for Payer: BCN Medicare Advantage |
$292.40
|
| Rate for Payer: Cash Price |
$935.69
|
| Rate for Payer: Cofinity Commercial |
$1,005.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$935.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.40
|
| Rate for Payer: Healthscope Commercial |
$1,052.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$877.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$307.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$994.17
|
| Rate for Payer: Nomi Health Commercial |
$959.08
|
| Rate for Payer: PACE Senior Care Partners |
$277.78
|
| Rate for Payer: PACE SWMI |
$292.40
|
| Rate for Payer: PHP Commercial |
$994.17
|
| Rate for Payer: PHP Medicare Advantage |
$292.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,017.56
|
| Rate for Payer: Priority Health Medicare |
$295.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$783.64
|
| Rate for Payer: Railroad Medicare Medicare |
$292.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,029.26
|
| Rate for Payer: UHC Core |
$976.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$292.40
|
| Rate for Payer: UHC Exchange |
$292.40
|
| Rate for Payer: UHC Medicare Advantage |
$292.40
|
| Rate for Payer: VA VA |
$292.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$877.21
|
|
|
TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
|
Facility
|
OP
|
$1,190.46
|
|
|
Service Code
|
CPT 26055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,133.70 |
| Max. Negotiated Rate |
$1,190.46 |
| Rate for Payer: BCBS Complete |
$1,190.46
|
| Rate for Payer: Mclaren Medicaid |
$1,133.70
|
| Rate for Payer: Meridian Medicaid |
$1,190.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,133.70
|
| Rate for Payer: UHCCP Medicaid |
$1,133.70
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29,932.38
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
186094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.44 |
| Max. Negotiated Rate |
$26,939.14 |
| Rate for Payer: Aetna Commercial |
$25,442.52
|
| Rate for Payer: Aetna Medicare |
$7,782.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,353.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,353.87
|
| Rate for Payer: BCBS Complete |
$123.32
|
| Rate for Payer: BCBS MAPPO |
$7,483.10
|
| Rate for Payer: BCBS Trust/PPO |
$24,607.41
|
| Rate for Payer: BCN Commercial |
$23,272.43
|
| Rate for Payer: BCN Medicare Advantage |
$7,483.10
|
| Rate for Payer: Cash Price |
$23,945.90
|
| Rate for Payer: Cash Price |
$23,945.90
|
| Rate for Payer: Cofinity Commercial |
$25,741.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,945.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,483.10
|
| Rate for Payer: Healthscope Commercial |
$26,939.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,449.28
|
| Rate for Payer: Mclaren Medicaid |
$117.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,857.25
|
| Rate for Payer: Meridian Medicaid |
$123.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,605.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,442.52
|
| Rate for Payer: Nomi Health Commercial |
$24,544.55
|
| Rate for Payer: PACE Senior Care Partners |
$7,108.94
|
| Rate for Payer: PACE SWMI |
$7,483.10
|
| Rate for Payer: PHP Commercial |
$25,442.52
|
| Rate for Payer: PHP Medicare Advantage |
$7,483.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,456.05
|
| Rate for Payer: Priority Health HMO/PPO |
$26,041.17
|
| Rate for Payer: Priority Health Medicare |
$7,557.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,054.69
|
| Rate for Payer: Railroad Medicare Medicare |
$7,483.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,340.49
|
| Rate for Payer: UHC Core |
$24,993.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,483.10
|
| Rate for Payer: UHC Exchange |
$7,483.10
|
| Rate for Payer: UHC Medicare Advantage |
$7,483.10
|
| Rate for Payer: UHCCP Medicaid |
$117.44
|
| Rate for Payer: VA VA |
$7,483.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,449.28
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29,932.38
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
186094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19,456.05 |
| Max. Negotiated Rate |
$26,939.14 |
| Rate for Payer: Aetna Commercial |
$25,442.52
|
| Rate for Payer: BCBS Trust/PPO |
$24,433.80
|
| Rate for Payer: BCN Commercial |
$23,131.74
|
| Rate for Payer: Cash Price |
$23,945.90
|
| Rate for Payer: Cofinity Commercial |
$25,741.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,945.90
|
| Rate for Payer: Healthscope Commercial |
$26,939.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,449.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,442.52
|
| Rate for Payer: Nomi Health Commercial |
$24,544.55
|
| Rate for Payer: PHP Commercial |
$25,442.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,456.05
|
| Rate for Payer: Priority Health HMO/PPO |
$26,041.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,054.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,340.49
|
| Rate for Payer: UHC Core |
$24,993.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,449.28
|
|
|
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON
|
Facility
|
OP
|
$2,413.50
|
|
|
Service Code
|
CPT 25295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,298.42 |
| Max. Negotiated Rate |
$2,413.50 |
| Rate for Payer: BCBS Complete |
$2,413.50
|
| Rate for Payer: Mclaren Medicaid |
$2,298.42
|
| Rate for Payer: Meridian Medicaid |
$2,413.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.42
|
| Rate for Payer: UHCCP Medicaid |
$2,298.42
|
|
|
TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); DEBRIDEMENT, SOFT TISSUE AND/OR BONE, OPEN
|
Facility
|
OP
|
$2,413.50
|
|
|
Service Code
|
CPT 24358
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,298.42 |
| Max. Negotiated Rate |
$2,413.50 |
| Rate for Payer: BCBS Complete |
$2,413.50
|
| Rate for Payer: Mclaren Medicaid |
$2,298.42
|
| Rate for Payer: Meridian Medicaid |
$2,413.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.42
|
| Rate for Payer: UHCCP Medicaid |
$2,298.42
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$23.90
|
|
|
Service Code
|
NDC 51672208001
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$21.51 |
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: BCBS Trust/PPO |
$19.51
|
| Rate for Payer: BCN Commercial |
$18.47
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cofinity Commercial |
$20.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$21.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.32
|
| Rate for Payer: Nomi Health Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$20.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health HMO/PPO |
$20.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.03
|
| Rate for Payer: UHC Core |
$19.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.92
|
|
