|
THERMAGE KNEES - BILATERAL
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 00151
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$489.60 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: Aetna Medicare |
$612.00
|
| Rate for Payer: BCBS Complete |
$489.60
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$795.60
|
|
|
THERMAGE NECK
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 00141
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$489.60 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: Aetna Medicare |
$612.00
|
| Rate for Payer: BCBS Complete |
$489.60
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$795.60
|
|
|
THERMAGE THIGH - 1 THIGH
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 00147
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$775.20 |
| Max. Negotiated Rate |
$1,259.70 |
| Rate for Payer: Aetna Medicare |
$969.00
|
| Rate for Payer: BCBS Complete |
$775.20
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
|
|
THERMAGE THIGH - BILATERAL
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 00148
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,264.80 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Medicare |
$1,581.00
|
| Rate for Payer: BCBS Complete |
$1,264.80
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.04
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
7876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: Aetna Commercial |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$19.62
|
| Rate for Payer: BCBS Trust/PPO |
$23.04
|
| Rate for Payer: BCN Commercial |
$18.58
|
| Rate for Payer: BCN Commercial |
$21.82
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cash Price |
$22.58
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.23
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$25.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.00
|
| Rate for Payer: Nomi Health Commercial |
$19.71
|
| Rate for Payer: Nomi Health Commercial |
$23.15
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: PHP Commercial |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health HMO/PPO |
$24.56
|
| Rate for Payer: Priority Health HMO/PPO |
$20.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.84
|
| Rate for Payer: UHC Core |
$20.07
|
| Rate for Payer: UHC Core |
$23.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.17
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$28.23
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
7876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$25.41 |
| Rate for Payer: Aetna Commercial |
$24.00
|
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: Aetna Medicare |
$7.34
|
| Rate for Payer: Aetna Medicare |
$6.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.51
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Complete |
$11.29
|
| Rate for Payer: BCBS MAPPO |
$6.01
|
| Rate for Payer: BCBS MAPPO |
$7.06
|
| Rate for Payer: BCBS Trust/PPO |
$23.21
|
| Rate for Payer: BCBS Trust/PPO |
$19.76
|
| Rate for Payer: BCN Commercial |
$21.95
|
| Rate for Payer: BCN Commercial |
$18.69
|
| Rate for Payer: BCN Medicare Advantage |
$7.06
|
| Rate for Payer: BCN Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$22.58
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.06
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$25.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Nomi Health Commercial |
$23.15
|
| Rate for Payer: Nomi Health Commercial |
$19.71
|
| Rate for Payer: PACE Senior Care Partners |
$6.70
|
| Rate for Payer: PACE Senior Care Partners |
$5.71
|
| Rate for Payer: PACE SWMI |
$7.06
|
| Rate for Payer: PACE SWMI |
$6.01
|
| Rate for Payer: PHP Commercial |
$24.00
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: PHP Medicare Advantage |
$6.01
|
| Rate for Payer: PHP Medicare Advantage |
$7.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health HMO/PPO |
$20.91
|
| Rate for Payer: Priority Health HMO/PPO |
$24.56
|
| Rate for Payer: Priority Health Medicare |
$7.13
|
| Rate for Payer: Priority Health Medicare |
$6.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.11
|
| Rate for Payer: Railroad Medicare Medicare |
$6.01
|
| Rate for Payer: Railroad Medicare Medicare |
$7.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.84
|
| Rate for Payer: UHC Core |
$23.57
|
| Rate for Payer: UHC Core |
$20.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.01
|
| Rate for Payer: UHC Exchange |
$6.01
|
| Rate for Payer: UHC Exchange |
$7.06
|
| Rate for Payer: UHC Medicare Advantage |
$6.01
|
| Rate for Payer: UHC Medicare Advantage |
$7.06
|
| Rate for Payer: VA VA |
$6.01
|
| Rate for Payer: VA VA |
$7.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.03
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$387.75
|
|
|
Service Code
|
NDC 77333093410
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.09 |
| Max. Negotiated Rate |
$348.98 |
| Rate for Payer: Aetna Commercial |
$329.59
|
| Rate for Payer: Aetna Medicare |
$100.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.17
|
| Rate for Payer: BCBS Complete |
$155.10
|
| Rate for Payer: BCBS MAPPO |
$96.94
|
| Rate for Payer: BCBS Trust/PPO |
$318.77
|
| Rate for Payer: BCN Commercial |
$301.48
|
| Rate for Payer: BCN Medicare Advantage |
$96.94
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$333.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.94
|
| Rate for Payer: Healthscope Commercial |
$348.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.59
|
| Rate for Payer: Nomi Health Commercial |
$317.96
|
| Rate for Payer: PACE Senior Care Partners |
$92.09
|
| Rate for Payer: PACE SWMI |
$96.94
|
| Rate for Payer: PHP Commercial |
$329.59
|
| Rate for Payer: PHP Medicare Advantage |
$96.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.04
|
| Rate for Payer: Priority Health HMO/PPO |
$337.34
|
| Rate for Payer: Priority Health Medicare |
$97.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.79
|
| Rate for Payer: Railroad Medicare Medicare |
$96.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.22
|
| Rate for Payer: UHC Core |
$323.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.94
|
| Rate for Payer: UHC Exchange |
$96.94
|
| Rate for Payer: UHC Medicare Advantage |
$96.94
|
| Rate for Payer: VA VA |
$96.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.81
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
IP
|
$387.75
|
|
|
Service Code
|
NDC 77333093410
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.04 |
| Max. Negotiated Rate |
$348.98 |
| Rate for Payer: Aetna Commercial |
$329.59
|
| Rate for Payer: BCBS Trust/PPO |
$316.52
|
| Rate for Payer: BCN Commercial |
$299.65
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$333.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$348.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.59
|
| Rate for Payer: Nomi Health Commercial |
$317.96
|
| Rate for Payer: PHP Commercial |
$329.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.04
|
| Rate for Payer: Priority Health HMO/PPO |
$337.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.22
|
| Rate for Payer: UHC Core |
$323.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.81
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
IP
|
$3.88
|
|
|
Service Code
|
NDC 77333093425
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: BCBS Trust/PPO |
$3.17
|
| Rate for Payer: BCN Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Nomi Health Commercial |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health HMO/PPO |
$3.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.91
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 77333093425
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.21
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: BCBS MAPPO |
$0.97
|
| Rate for Payer: BCBS Trust/PPO |
$3.19
|
| Rate for Payer: BCN Commercial |
$3.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.97
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.97
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Nomi Health Commercial |
$3.18
|
| Rate for Payer: PACE Senior Care Partners |
$0.92
|
| Rate for Payer: PACE SWMI |
$0.97
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health HMO/PPO |
$3.38
|
| Rate for Payer: Priority Health Medicare |
$0.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.60
|
| Rate for Payer: Railroad Medicare Medicare |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Medicare Advantage |
$0.97
|
| Rate for Payer: VA VA |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.91
|
|
|
THIORIDAZINE 50 MG TABLET
|
Facility
|
OP
|
$366.24
|
|
|
Service Code
|
NDC 00378061601
|
| Hospital Charge Code |
7900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.98 |
| Max. Negotiated Rate |
$329.62 |
| Rate for Payer: Aetna Commercial |
$311.30
|
| Rate for Payer: Aetna Medicare |
$95.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.45
|
| Rate for Payer: BCBS Complete |
$146.50
|
| Rate for Payer: BCBS MAPPO |
$91.56
|
| Rate for Payer: BCBS Trust/PPO |
$301.09
|
| Rate for Payer: BCN Commercial |
$284.75
|
| Rate for Payer: BCN Medicare Advantage |
$91.56
|
| Rate for Payer: Cash Price |
$292.99
|
| Rate for Payer: Cofinity Commercial |
$314.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.56
|
| Rate for Payer: Healthscope Commercial |
$329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.30
|
| Rate for Payer: Nomi Health Commercial |
$300.32
|
| Rate for Payer: PACE Senior Care Partners |
$86.98
|
| Rate for Payer: PACE SWMI |
$91.56
|
| Rate for Payer: PHP Commercial |
$311.30
|
| Rate for Payer: PHP Medicare Advantage |
$91.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.06
|
| Rate for Payer: Priority Health HMO/PPO |
$318.63
|
| Rate for Payer: Priority Health Medicare |
$92.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.38
|
| Rate for Payer: Railroad Medicare Medicare |
$91.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.29
|
| Rate for Payer: UHC Core |
$305.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.56
|
| Rate for Payer: UHC Exchange |
$91.56
|
| Rate for Payer: UHC Medicare Advantage |
$91.56
|
| Rate for Payer: VA VA |
$91.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.68
|
|
|
THIORIDAZINE 50 MG TABLET
|
Facility
|
IP
|
$366.24
|
|
|
Service Code
|
NDC 00378061601
|
| Hospital Charge Code |
7900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.06 |
| Max. Negotiated Rate |
$329.62 |
| Rate for Payer: Aetna Commercial |
$311.30
|
| Rate for Payer: BCBS Trust/PPO |
$298.96
|
| Rate for Payer: BCN Commercial |
$283.03
|
| Rate for Payer: Cash Price |
$292.99
|
| Rate for Payer: Cofinity Commercial |
$314.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.99
|
| Rate for Payer: Healthscope Commercial |
$329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.30
|
| Rate for Payer: Nomi Health Commercial |
$300.32
|
| Rate for Payer: PHP Commercial |
$311.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.06
|
| Rate for Payer: Priority Health HMO/PPO |
$318.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.29
|
| Rate for Payer: UHC Core |
$305.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.68
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY
|
Facility
|
OP
|
$854.74
|
|
|
Service Code
|
NDC 60793021721
|
| Hospital Charge Code |
108841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$769.27 |
| Rate for Payer: Aetna Commercial |
$726.53
|
| Rate for Payer: Aetna Medicare |
$222.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$267.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$267.11
|
| Rate for Payer: BCBS Complete |
$341.90
|
| Rate for Payer: BCBS MAPPO |
$213.68
|
| Rate for Payer: BCBS Trust/PPO |
$702.68
|
| Rate for Payer: BCN Commercial |
$664.56
|
| Rate for Payer: BCN Medicare Advantage |
$213.68
|
| Rate for Payer: Cash Price |
$683.79
|
| Rate for Payer: Cofinity Commercial |
$735.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.68
|
| Rate for Payer: Healthscope Commercial |
$769.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$641.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$245.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.53
|
| Rate for Payer: Nomi Health Commercial |
$700.89
|
| Rate for Payer: PACE Senior Care Partners |
$203.00
|
| Rate for Payer: PACE SWMI |
$213.68
|
| Rate for Payer: PHP Commercial |
$726.53
|
| Rate for Payer: PHP Medicare Advantage |
$213.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.58
|
| Rate for Payer: Priority Health HMO/PPO |
$743.62
|
| Rate for Payer: Priority Health Medicare |
$215.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$572.68
|
| Rate for Payer: Railroad Medicare Medicare |
$213.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$752.17
|
| Rate for Payer: UHC Core |
$713.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$213.68
|
| Rate for Payer: UHC Exchange |
$213.68
|
| Rate for Payer: UHC Medicare Advantage |
$213.68
|
| Rate for Payer: VA VA |
$213.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$641.06
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY
|
Facility
|
IP
|
$854.74
|
|
|
Service Code
|
NDC 60793021721
|
| Hospital Charge Code |
108841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$555.58 |
| Max. Negotiated Rate |
$769.27 |
| Rate for Payer: Aetna Commercial |
$726.53
|
| Rate for Payer: BCBS Trust/PPO |
$697.72
|
| Rate for Payer: BCN Commercial |
$660.54
|
| Rate for Payer: Cash Price |
$683.79
|
| Rate for Payer: Cofinity Commercial |
$735.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.79
|
| Rate for Payer: Healthscope Commercial |
$769.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$641.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.53
|
| Rate for Payer: Nomi Health Commercial |
$700.89
|
| Rate for Payer: PHP Commercial |
$726.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.58
|
| Rate for Payer: Priority Health HMO/PPO |
$743.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$572.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$752.17
|
| Rate for Payer: UHC Core |
$713.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$641.06
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SPRAY SYRINGE
|
Facility
|
OP
|
$202.04
|
|
|
Service Code
|
NDC 60793070505
|
| Hospital Charge Code |
87798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.98 |
| Max. Negotiated Rate |
$181.84 |
| Rate for Payer: Aetna Commercial |
$171.73
|
| Rate for Payer: Aetna Medicare |
$52.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.14
|
| Rate for Payer: BCBS Complete |
$80.82
|
| Rate for Payer: BCBS MAPPO |
$50.51
|
| Rate for Payer: BCBS Trust/PPO |
$166.10
|
| Rate for Payer: BCN Commercial |
$157.09
|
| Rate for Payer: BCN Medicare Advantage |
$50.51
|
| Rate for Payer: Cash Price |
$161.63
|
| Rate for Payer: Cofinity Commercial |
$173.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.51
|
| Rate for Payer: Healthscope Commercial |
$181.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.73
|
| Rate for Payer: Nomi Health Commercial |
$165.67
|
| Rate for Payer: PACE Senior Care Partners |
$47.98
|
| Rate for Payer: PACE SWMI |
$50.51
|
| Rate for Payer: PHP Commercial |
$171.73
|
| Rate for Payer: PHP Medicare Advantage |
$50.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.33
|
| Rate for Payer: Priority Health HMO/PPO |
$175.77
|
| Rate for Payer: Priority Health Medicare |
$51.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.37
|
| Rate for Payer: Railroad Medicare Medicare |
$50.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.80
|
| Rate for Payer: UHC Core |
$168.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.51
|
| Rate for Payer: UHC Exchange |
$50.51
|
| Rate for Payer: UHC Medicare Advantage |
$50.51
|
| Rate for Payer: VA VA |
$50.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.53
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SPRAY SYRINGE
|
Facility
|
IP
|
$202.04
|
|
|
Service Code
|
NDC 60793070505
|
| Hospital Charge Code |
87798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$131.33 |
| Max. Negotiated Rate |
$181.84 |
| Rate for Payer: Aetna Commercial |
$171.73
|
| Rate for Payer: BCBS Trust/PPO |
$164.93
|
| Rate for Payer: BCN Commercial |
$156.14
|
| Rate for Payer: Cash Price |
$161.63
|
| Rate for Payer: Cofinity Commercial |
$173.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.63
|
| Rate for Payer: Healthscope Commercial |
$181.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.73
|
| Rate for Payer: Nomi Health Commercial |
$165.67
|
| Rate for Payer: PHP Commercial |
$171.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.33
|
| Rate for Payer: Priority Health HMO/PPO |
$175.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.80
|
| Rate for Payer: UHC Core |
$168.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.53
|
|
|
THYROID (PORK) 60 MG TABLET
|
Facility
|
IP
|
$366.72
|
|
|
Service Code
|
NDC 42192033001
|
| Hospital Charge Code |
119105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.37 |
| Max. Negotiated Rate |
$330.05 |
| Rate for Payer: Aetna Commercial |
$311.71
|
| Rate for Payer: BCBS Trust/PPO |
$299.35
|
| Rate for Payer: BCN Commercial |
$283.40
|
| Rate for Payer: Cash Price |
$293.38
|
| Rate for Payer: Cofinity Commercial |
$315.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.38
|
| Rate for Payer: Healthscope Commercial |
$330.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.71
|
| Rate for Payer: Nomi Health Commercial |
$300.71
|
| Rate for Payer: PHP Commercial |
$311.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.37
|
| Rate for Payer: Priority Health HMO/PPO |
$319.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.71
|
| Rate for Payer: UHC Core |
$306.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.04
|
|
|
THYROID (PORK) 60 MG TABLET
|
Facility
|
OP
|
$366.72
|
|
|
Service Code
|
NDC 42192033001
|
| Hospital Charge Code |
119105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$330.05 |
| Rate for Payer: Aetna Commercial |
$311.71
|
| Rate for Payer: Aetna Medicare |
$95.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.60
|
| Rate for Payer: BCBS Complete |
$146.69
|
| Rate for Payer: BCBS MAPPO |
$91.68
|
| Rate for Payer: BCBS Trust/PPO |
$301.48
|
| Rate for Payer: BCN Commercial |
$285.12
|
| Rate for Payer: BCN Medicare Advantage |
$91.68
|
| Rate for Payer: Cash Price |
$293.38
|
| Rate for Payer: Cofinity Commercial |
$315.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.68
|
| Rate for Payer: Healthscope Commercial |
$330.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.71
|
| Rate for Payer: Nomi Health Commercial |
$300.71
|
| Rate for Payer: PACE Senior Care Partners |
$87.10
|
| Rate for Payer: PACE SWMI |
$91.68
|
| Rate for Payer: PHP Commercial |
$311.71
|
| Rate for Payer: PHP Medicare Advantage |
$91.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.37
|
| Rate for Payer: Priority Health HMO/PPO |
$319.05
|
| Rate for Payer: Priority Health Medicare |
$92.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.70
|
| Rate for Payer: Railroad Medicare Medicare |
$91.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.71
|
| Rate for Payer: UHC Core |
$306.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.68
|
| Rate for Payer: UHC Exchange |
$91.68
|
| Rate for Payer: UHC Medicare Advantage |
$91.68
|
| Rate for Payer: VA VA |
$91.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.04
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
IP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077760
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,084.41 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna Commercial |
$1,418.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,361.86
|
| Rate for Payer: BCN Commercial |
$1,289.29
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Commercial |
$1,434.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Healthscope Commercial |
$1,501.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,251.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: Nomi Health Commercial |
$1,368.03
|
| Rate for Payer: PHP Commercial |
$1,418.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,084.41
|
| Rate for Payer: Priority Health HMO/PPO |
$1,451.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,117.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,468.13
|
| Rate for Payer: UHC Core |
$1,393.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,251.25
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
OP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077760
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$396.23 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna Commercial |
$1,418.08
|
| Rate for Payer: Aetna Medicare |
$433.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$521.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$521.35
|
| Rate for Payer: BCBS Complete |
$667.33
|
| Rate for Payer: BCBS MAPPO |
$417.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,371.53
|
| Rate for Payer: BCN Commercial |
$1,297.13
|
| Rate for Payer: BCN Medicare Advantage |
$417.08
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Commercial |
$1,434.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$417.08
|
| Rate for Payer: Healthscope Commercial |
$1,501.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,251.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: Nomi Health Commercial |
$1,368.03
|
| Rate for Payer: PACE Senior Care Partners |
$396.23
|
| Rate for Payer: PACE SWMI |
$417.08
|
| Rate for Payer: PHP Commercial |
$1,418.08
|
| Rate for Payer: PHP Medicare Advantage |
$417.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,084.41
|
| Rate for Payer: Priority Health HMO/PPO |
$1,451.45
|
| Rate for Payer: Priority Health Medicare |
$421.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,117.78
|
| Rate for Payer: Railroad Medicare Medicare |
$417.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,468.13
|
| Rate for Payer: UHC Core |
$1,393.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$417.08
|
| Rate for Payer: UHC Exchange |
$417.08
|
| Rate for Payer: UHC Medicare Advantage |
$417.08
|
| Rate for Payer: VA VA |
$417.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,251.25
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$30.77
|
|
|
Service Code
|
NDC 61314022710
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$27.69 |
| Rate for Payer: Aetna Commercial |
$26.15
|
| Rate for Payer: Aetna Medicare |
$8.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.62
|
| Rate for Payer: BCBS Complete |
$12.31
|
| Rate for Payer: BCBS MAPPO |
$7.69
|
| Rate for Payer: BCBS Trust/PPO |
$25.30
|
| Rate for Payer: BCN Commercial |
$23.92
|
| Rate for Payer: BCN Medicare Advantage |
$7.69
|
| Rate for Payer: Cash Price |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$26.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.69
|
| Rate for Payer: Healthscope Commercial |
$27.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.15
|
| Rate for Payer: Nomi Health Commercial |
$25.23
|
| Rate for Payer: PACE Senior Care Partners |
$7.31
|
| Rate for Payer: PACE SWMI |
$7.69
|
| Rate for Payer: PHP Commercial |
$26.15
|
| Rate for Payer: PHP Medicare Advantage |
$7.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.00
|
| Rate for Payer: Priority Health HMO/PPO |
$26.77
|
| Rate for Payer: Priority Health Medicare |
$7.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.62
|
| Rate for Payer: Railroad Medicare Medicare |
$7.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.08
|
| Rate for Payer: UHC Core |
$25.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.69
|
| Rate for Payer: UHC Exchange |
$7.69
|
| Rate for Payer: UHC Medicare Advantage |
$7.69
|
| Rate for Payer: VA VA |
$7.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.08
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$30.77
|
|
|
Service Code
|
NDC 61314022710
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$27.69 |
| Rate for Payer: Aetna Commercial |
$26.15
|
| Rate for Payer: BCBS Trust/PPO |
$25.12
|
| Rate for Payer: BCN Commercial |
$23.78
|
| Rate for Payer: Cash Price |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$26.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.62
|
| Rate for Payer: Healthscope Commercial |
$27.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.15
|
| Rate for Payer: Nomi Health Commercial |
$25.23
|
| Rate for Payer: PHP Commercial |
$26.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.00
|
| Rate for Payer: Priority Health HMO/PPO |
$26.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.08
|
| Rate for Payer: UHC Core |
$25.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.08
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$20.21
|
|
|
Service Code
|
NDC 61314022705
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.14 |
| Max. Negotiated Rate |
$18.19 |
| Rate for Payer: Aetna Commercial |
$17.18
|
| Rate for Payer: BCBS Trust/PPO |
$16.50
|
| Rate for Payer: BCN Commercial |
$15.62
|
| Rate for Payer: Cash Price |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$17.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.17
|
| Rate for Payer: Healthscope Commercial |
$18.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.18
|
| Rate for Payer: Nomi Health Commercial |
$16.57
|
| Rate for Payer: PHP Commercial |
$17.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.14
|
| Rate for Payer: Priority Health HMO/PPO |
$17.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.78
|
| Rate for Payer: UHC Core |
$16.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.16
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$28.25
|
|
|
Service Code
|
NDC 17478028810
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$25.42 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: BCBS Trust/PPO |
$23.06
|
| Rate for Payer: BCN Commercial |
$21.83
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$25.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Nomi Health Commercial |
$23.16
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.36
|
| Rate for Payer: Priority Health HMO/PPO |
$24.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.86
|
| Rate for Payer: UHC Core |
$23.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.19
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$22.91
|
|
|
Service Code
|
NDC 60758080105
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$19.47
|
| Rate for Payer: BCBS Trust/PPO |
$18.70
|
| Rate for Payer: BCN Commercial |
$17.70
|
| Rate for Payer: Cash Price |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$19.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.33
|
| Rate for Payer: Healthscope Commercial |
$20.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.47
|
| Rate for Payer: Nomi Health Commercial |
$18.79
|
| Rate for Payer: PHP Commercial |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.89
|
| Rate for Payer: Priority Health HMO/PPO |
$19.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.16
|
| Rate for Payer: UHC Core |
$19.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.18
|
|
