|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) NEBULIZED SOLUTION CUSTOM
|
Facility
|
IP
|
$27.38
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
301846
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: BCBS Trust/PPO |
$22.35
|
| Rate for Payer: BCN Commercial |
$21.16
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$23.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.90
|
| Rate for Payer: Healthscope Commercial |
$24.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.27
|
| Rate for Payer: Nomi Health Commercial |
$22.45
|
| Rate for Payer: PHP Commercial |
$23.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.80
|
| Rate for Payer: Priority Health HMO/PPO |
$23.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.09
|
| Rate for Payer: UHC Core |
$22.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.54
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) SOLUTION CUSTOM
|
Facility
|
OP
|
$16.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
300870
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$15.19 |
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Aetna Medicare |
$4.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.28
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS MAPPO |
$4.22
|
| Rate for Payer: BCBS Trust/PPO |
$13.88
|
| Rate for Payer: BCN Commercial |
$13.12
|
| Rate for Payer: BCN Medicare Advantage |
$4.22
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cofinity Commercial |
$14.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.22
|
| Rate for Payer: Healthscope Commercial |
$15.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.35
|
| Rate for Payer: Nomi Health Commercial |
$13.84
|
| Rate for Payer: PACE Senior Care Partners |
$4.01
|
| Rate for Payer: PACE SWMI |
$4.22
|
| Rate for Payer: PHP Commercial |
$14.35
|
| Rate for Payer: PHP Medicare Advantage |
$4.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.97
|
| Rate for Payer: Priority Health HMO/PPO |
$14.69
|
| Rate for Payer: Priority Health Medicare |
$4.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.31
|
| Rate for Payer: Railroad Medicare Medicare |
$4.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.85
|
| Rate for Payer: UHC Core |
$14.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.22
|
| Rate for Payer: UHC Exchange |
$4.22
|
| Rate for Payer: UHC Medicare Advantage |
$4.22
|
| Rate for Payer: VA VA |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.66
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) SOLUTION CUSTOM
|
Facility
|
IP
|
$16.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
300870
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$15.19 |
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: BCBS Trust/PPO |
$13.78
|
| Rate for Payer: BCN Commercial |
$13.04
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cofinity Commercial |
$14.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Healthscope Commercial |
$15.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.35
|
| Rate for Payer: Nomi Health Commercial |
$13.84
|
| Rate for Payer: PHP Commercial |
$14.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.97
|
| Rate for Payer: Priority Health HMO/PPO |
$14.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.85
|
| Rate for Payer: UHC Core |
$14.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.66
|
|
|
TRAVOPROST 0.004 % EYE DROPS
|
Facility
|
OP
|
$430.89
|
|
|
Service Code
|
NDC 00781618556
|
| Hospital Charge Code |
108556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.34 |
| Max. Negotiated Rate |
$387.80 |
| Rate for Payer: Aetna Commercial |
$366.26
|
| Rate for Payer: Aetna Medicare |
$112.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.65
|
| Rate for Payer: BCBS Complete |
$172.36
|
| Rate for Payer: BCBS MAPPO |
$107.72
|
| Rate for Payer: BCBS Trust/PPO |
$354.23
|
| Rate for Payer: BCN Commercial |
$335.02
|
| Rate for Payer: BCN Medicare Advantage |
$107.72
|
| Rate for Payer: Cash Price |
$344.71
|
| Rate for Payer: Cofinity Commercial |
$370.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.72
|
| Rate for Payer: Healthscope Commercial |
$387.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.26
|
| Rate for Payer: Nomi Health Commercial |
$353.33
|
| Rate for Payer: PACE Senior Care Partners |
$102.34
|
| Rate for Payer: PACE SWMI |
$107.72
|
| Rate for Payer: PHP Commercial |
$366.26
|
| Rate for Payer: PHP Medicare Advantage |
$107.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.08
|
| Rate for Payer: Priority Health HMO/PPO |
$374.87
|
| Rate for Payer: Priority Health Medicare |
$108.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.70
|
| Rate for Payer: Railroad Medicare Medicare |
$107.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.18
|
| Rate for Payer: UHC Core |
$359.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.72
|
| Rate for Payer: UHC Exchange |
$107.72
|
| Rate for Payer: UHC Medicare Advantage |
$107.72
|
| Rate for Payer: VA VA |
$107.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.17
|
|
|
TRAVOPROST 0.004 % EYE DROPS
|
Facility
|
OP
|
$190.33
|
|
|
Service Code
|
NDC 42571013027
|
| Hospital Charge Code |
108556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$171.30 |
| Rate for Payer: Aetna Commercial |
$161.78
|
| Rate for Payer: Aetna Medicare |
$49.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.48
|
| Rate for Payer: BCBS Complete |
$76.13
|
| Rate for Payer: BCBS MAPPO |
$47.58
|
| Rate for Payer: BCBS Trust/PPO |
$156.47
|
| Rate for Payer: BCN Commercial |
$147.98
|
| Rate for Payer: BCN Medicare Advantage |
$47.58
|
| Rate for Payer: Cash Price |
$152.26
|
| Rate for Payer: Cofinity Commercial |
$163.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.58
|
| Rate for Payer: Healthscope Commercial |
$171.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.78
|
| Rate for Payer: Nomi Health Commercial |
$156.07
|
| Rate for Payer: PACE Senior Care Partners |
$45.20
|
| Rate for Payer: PACE SWMI |
$47.58
|
| Rate for Payer: PHP Commercial |
$161.78
|
| Rate for Payer: PHP Medicare Advantage |
$47.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.71
|
| Rate for Payer: Priority Health HMO/PPO |
$165.59
|
| Rate for Payer: Priority Health Medicare |
$48.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.52
|
| Rate for Payer: Railroad Medicare Medicare |
$47.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.49
|
| Rate for Payer: UHC Core |
$158.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.58
|
| Rate for Payer: UHC Exchange |
$47.58
|
| Rate for Payer: UHC Medicare Advantage |
$47.58
|
| Rate for Payer: VA VA |
$47.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.75
|
|
|
TRAVOPROST 0.004 % EYE DROPS
|
Facility
|
IP
|
$190.33
|
|
|
Service Code
|
NDC 42571013027
|
| Hospital Charge Code |
108556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.71 |
| Max. Negotiated Rate |
$171.30 |
| Rate for Payer: Aetna Commercial |
$161.78
|
| Rate for Payer: BCBS Trust/PPO |
$155.37
|
| Rate for Payer: BCN Commercial |
$147.09
|
| Rate for Payer: Cash Price |
$152.26
|
| Rate for Payer: Cofinity Commercial |
$163.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.26
|
| Rate for Payer: Healthscope Commercial |
$171.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.78
|
| Rate for Payer: Nomi Health Commercial |
$156.07
|
| Rate for Payer: PHP Commercial |
$161.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.71
|
| Rate for Payer: Priority Health HMO/PPO |
$165.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.49
|
| Rate for Payer: UHC Core |
$158.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.75
|
|
|
TRAVOPROST 0.004 % EYE DROPS
|
Facility
|
IP
|
$430.89
|
|
|
Service Code
|
NDC 00781618556
|
| Hospital Charge Code |
108556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.08 |
| Max. Negotiated Rate |
$387.80 |
| Rate for Payer: Aetna Commercial |
$366.26
|
| Rate for Payer: BCBS Trust/PPO |
$351.74
|
| Rate for Payer: BCN Commercial |
$332.99
|
| Rate for Payer: Cash Price |
$344.71
|
| Rate for Payer: Cofinity Commercial |
$370.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.71
|
| Rate for Payer: Healthscope Commercial |
$387.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.26
|
| Rate for Payer: Nomi Health Commercial |
$353.33
|
| Rate for Payer: PHP Commercial |
$366.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.08
|
| Rate for Payer: Priority Health HMO/PPO |
$374.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.18
|
| Rate for Payer: UHC Core |
$359.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.17
|
|
|
TRAZODONE 100 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 00904686961
|
| Hospital Charge Code |
8083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.96 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: BCBS Trust/PPO |
$276.24
|
| Rate for Payer: BCN Commercial |
$261.52
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Nomi Health Commercial |
$277.49
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.96
|
| Rate for Payer: Priority Health HMO/PPO |
$294.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.79
|
| Rate for Payer: UHC Core |
$282.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
TRAZODONE 100 MG TABLET
|
Facility
|
OP
|
$338.40
|
|
|
Service Code
|
NDC 00904686961
|
| Hospital Charge Code |
8083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.37 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna Medicare |
$87.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.75
|
| Rate for Payer: BCBS Complete |
$135.36
|
| Rate for Payer: BCBS MAPPO |
$84.60
|
| Rate for Payer: BCBS Trust/PPO |
$278.20
|
| Rate for Payer: BCN Commercial |
$263.11
|
| Rate for Payer: BCN Medicare Advantage |
$84.60
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Nomi Health Commercial |
$277.49
|
| Rate for Payer: PACE Senior Care Partners |
$80.37
|
| Rate for Payer: PACE SWMI |
$84.60
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: PHP Medicare Advantage |
$84.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.96
|
| Rate for Payer: Priority Health HMO/PPO |
$294.41
|
| Rate for Payer: Priority Health Medicare |
$85.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.73
|
| Rate for Payer: Railroad Medicare Medicare |
$84.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.79
|
| Rate for Payer: UHC Core |
$282.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.60
|
| Rate for Payer: UHC Exchange |
$84.60
|
| Rate for Payer: UHC Medicare Advantage |
$84.60
|
| Rate for Payer: VA VA |
$84.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
TRAZODONE 25 MG CUSTOM TAB
|
Facility
|
OP
|
$0.92
|
|
|
Service Code
|
NDC 09900000314
|
| Hospital Charge Code |
155125
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Aetna Commercial |
$0.78
|
| Rate for Payer: Aetna Medicare |
$0.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.29
|
| Rate for Payer: BCBS Complete |
$0.37
|
| Rate for Payer: BCBS MAPPO |
$0.23
|
| Rate for Payer: BCBS Trust/PPO |
$0.76
|
| Rate for Payer: BCN Commercial |
$0.72
|
| Rate for Payer: BCN Medicare Advantage |
$0.23
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.23
|
| Rate for Payer: Healthscope Commercial |
$0.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.78
|
| Rate for Payer: Nomi Health Commercial |
$0.75
|
| Rate for Payer: PACE Senior Care Partners |
$0.22
|
| Rate for Payer: PACE SWMI |
$0.23
|
| Rate for Payer: PHP Commercial |
$0.78
|
| Rate for Payer: PHP Medicare Advantage |
$0.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.60
|
| Rate for Payer: Priority Health HMO/PPO |
$0.80
|
| Rate for Payer: Priority Health Medicare |
$0.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.62
|
| Rate for Payer: Railroad Medicare Medicare |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.81
|
| Rate for Payer: UHC Core |
$0.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Medicare Advantage |
$0.23
|
| Rate for Payer: VA VA |
$0.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.69
|
|
|
TRAZODONE 25 MG CUSTOM TAB
|
Facility
|
IP
|
$0.92
|
|
|
Service Code
|
NDC 09900000314
|
| Hospital Charge Code |
155125
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Aetna Commercial |
$0.78
|
| Rate for Payer: BCBS Trust/PPO |
$0.75
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$0.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.78
|
| Rate for Payer: Nomi Health Commercial |
$0.75
|
| Rate for Payer: PHP Commercial |
$0.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.60
|
| Rate for Payer: Priority Health HMO/PPO |
$0.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.81
|
| Rate for Payer: UHC Core |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.69
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$270.25
|
|
|
Service Code
|
NDC 60687044301
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna Medicare |
$70.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.45
|
| Rate for Payer: BCBS Complete |
$108.10
|
| Rate for Payer: BCBS MAPPO |
$67.56
|
| Rate for Payer: BCBS Trust/PPO |
$222.17
|
| Rate for Payer: BCN Commercial |
$210.12
|
| Rate for Payer: BCN Medicare Advantage |
$67.56
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$232.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.56
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: Nomi Health Commercial |
$221.60
|
| Rate for Payer: PACE Senior Care Partners |
$64.18
|
| Rate for Payer: PACE SWMI |
$67.56
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: PHP Medicare Advantage |
$67.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.66
|
| Rate for Payer: Priority Health HMO/PPO |
$235.12
|
| Rate for Payer: Priority Health Medicare |
$68.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.07
|
| Rate for Payer: Railroad Medicare Medicare |
$67.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.82
|
| Rate for Payer: UHC Core |
$225.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.56
|
| Rate for Payer: UHC Exchange |
$67.56
|
| Rate for Payer: UHC Medicare Advantage |
$67.56
|
| Rate for Payer: VA VA |
$67.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$2.71
|
|
|
Service Code
|
NDC 60687044311
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: BCBS Trust/PPO |
$2.21
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cofinity Commercial |
$2.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$2.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.30
|
| Rate for Payer: Nomi Health Commercial |
$2.22
|
| Rate for Payer: PHP Commercial |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.76
|
| Rate for Payer: Priority Health HMO/PPO |
$2.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.38
|
| Rate for Payer: UHC Core |
$2.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.03
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$2.71
|
|
|
Service Code
|
NDC 60687044311
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: Aetna Medicare |
$0.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.85
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: BCBS MAPPO |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$2.23
|
| Rate for Payer: BCN Commercial |
$2.11
|
| Rate for Payer: BCN Medicare Advantage |
$0.68
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cofinity Commercial |
$2.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.68
|
| Rate for Payer: Healthscope Commercial |
$2.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.30
|
| Rate for Payer: Nomi Health Commercial |
$2.22
|
| Rate for Payer: PACE Senior Care Partners |
$0.64
|
| Rate for Payer: PACE SWMI |
$0.68
|
| Rate for Payer: PHP Commercial |
$2.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.76
|
| Rate for Payer: Priority Health HMO/PPO |
$2.36
|
| Rate for Payer: Priority Health Medicare |
$0.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.82
|
| Rate for Payer: Railroad Medicare Medicare |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.38
|
| Rate for Payer: UHC Core |
$2.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Medicare Advantage |
$0.68
|
| Rate for Payer: VA VA |
$0.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.03
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$145.70
|
|
|
Service Code
|
NDC 60505265301
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.70 |
| Max. Negotiated Rate |
$131.13 |
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: BCBS Trust/PPO |
$118.93
|
| Rate for Payer: BCN Commercial |
$112.60
|
| Rate for Payer: Cash Price |
$116.56
|
| Rate for Payer: Cofinity Commercial |
$125.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.56
|
| Rate for Payer: Healthscope Commercial |
$131.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Nomi Health Commercial |
$119.47
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.70
|
| Rate for Payer: Priority Health HMO/PPO |
$126.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.22
|
| Rate for Payer: UHC Core |
$121.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.28
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$145.70
|
|
|
Service Code
|
NDC 60505265301
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$131.13 |
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna Medicare |
$37.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.53
|
| Rate for Payer: BCBS Complete |
$58.28
|
| Rate for Payer: BCBS MAPPO |
$36.42
|
| Rate for Payer: BCBS Trust/PPO |
$119.78
|
| Rate for Payer: BCN Commercial |
$113.28
|
| Rate for Payer: BCN Medicare Advantage |
$36.42
|
| Rate for Payer: Cash Price |
$116.56
|
| Rate for Payer: Cofinity Commercial |
$125.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.42
|
| Rate for Payer: Healthscope Commercial |
$131.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Nomi Health Commercial |
$119.47
|
| Rate for Payer: PACE Senior Care Partners |
$34.60
|
| Rate for Payer: PACE SWMI |
$36.42
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: PHP Medicare Advantage |
$36.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.70
|
| Rate for Payer: Priority Health HMO/PPO |
$126.76
|
| Rate for Payer: Priority Health Medicare |
$36.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.62
|
| Rate for Payer: Railroad Medicare Medicare |
$36.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.22
|
| Rate for Payer: UHC Core |
$121.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.42
|
| Rate for Payer: UHC Exchange |
$36.42
|
| Rate for Payer: UHC Medicare Advantage |
$36.42
|
| Rate for Payer: VA VA |
$36.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.28
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$270.25
|
|
|
Service Code
|
NDC 60687044301
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.66 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: BCBS Trust/PPO |
$220.61
|
| Rate for Payer: BCN Commercial |
$208.85
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$232.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: Nomi Health Commercial |
$221.60
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.66
|
| Rate for Payer: Priority Health HMO/PPO |
$235.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.82
|
| Rate for Payer: UHC Core |
$225.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$244.40
|
|
|
Service Code
|
NDC 00904686861
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.86 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: BCBS Trust/PPO |
$199.50
|
| Rate for Payer: BCN Commercial |
$188.87
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.74
|
| Rate for Payer: Nomi Health Commercial |
$200.41
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.86
|
| Rate for Payer: Priority Health HMO/PPO |
$212.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.07
|
| Rate for Payer: UHC Core |
$204.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$244.40
|
|
|
Service Code
|
NDC 00904686861
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.05 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: Aetna Medicare |
$63.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.38
|
| Rate for Payer: BCBS Complete |
$97.76
|
| Rate for Payer: BCBS MAPPO |
$61.10
|
| Rate for Payer: BCBS Trust/PPO |
$200.92
|
| Rate for Payer: BCN Commercial |
$190.02
|
| Rate for Payer: BCN Medicare Advantage |
$61.10
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.10
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.74
|
| Rate for Payer: Nomi Health Commercial |
$200.41
|
| Rate for Payer: PACE Senior Care Partners |
$58.05
|
| Rate for Payer: PACE SWMI |
$61.10
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: PHP Medicare Advantage |
$61.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.86
|
| Rate for Payer: Priority Health HMO/PPO |
$212.63
|
| Rate for Payer: Priority Health Medicare |
$61.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.75
|
| Rate for Payer: Railroad Medicare Medicare |
$61.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.07
|
| Rate for Payer: UHC Core |
$204.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.10
|
| Rate for Payer: UHC Exchange |
$61.10
|
| Rate for Payer: UHC Medicare Advantage |
$61.10
|
| Rate for Payer: VA VA |
$61.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE
|
Facility
|
OP
|
$464.73
|
|
|
Service Code
|
CPT 12020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$442.57 |
| Max. Negotiated Rate |
$464.73 |
| Rate for Payer: BCBS Complete |
$464.73
|
| Rate for Payer: Mclaren Medicaid |
$442.57
|
| Rate for Payer: Meridian Medicaid |
$464.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.57
|
| Rate for Payer: UHCCP Medicaid |
$442.57
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$10.33
|
|
|
Service Code
|
NDC 67877025115
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$9.30 |
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: BCBS Trust/PPO |
$8.43
|
| Rate for Payer: BCN Commercial |
$7.98
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$9.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.78
|
| Rate for Payer: Nomi Health Commercial |
$8.47
|
| Rate for Payer: PHP Commercial |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.71
|
| Rate for Payer: Priority Health HMO/PPO |
$8.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.09
|
| Rate for Payer: UHC Core |
$8.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.75
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$10.33
|
|
|
Service Code
|
NDC 67877025115
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$9.30 |
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: Aetna Medicare |
$2.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.23
|
| Rate for Payer: BCBS Complete |
$4.13
|
| Rate for Payer: BCBS MAPPO |
$2.58
|
| Rate for Payer: BCBS Trust/PPO |
$8.49
|
| Rate for Payer: BCN Commercial |
$8.03
|
| Rate for Payer: BCN Medicare Advantage |
$2.58
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$9.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.78
|
| Rate for Payer: Nomi Health Commercial |
$8.47
|
| Rate for Payer: PACE Senior Care Partners |
$2.45
|
| Rate for Payer: PACE SWMI |
$2.58
|
| Rate for Payer: PHP Commercial |
$8.78
|
| Rate for Payer: PHP Medicare Advantage |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.71
|
| Rate for Payer: Priority Health HMO/PPO |
$8.99
|
| Rate for Payer: Priority Health Medicare |
$2.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.92
|
| Rate for Payer: Railroad Medicare Medicare |
$2.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.09
|
| Rate for Payer: UHC Core |
$8.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.58
|
| Rate for Payer: UHC Exchange |
$2.58
|
| Rate for Payer: UHC Medicare Advantage |
$2.58
|
| Rate for Payer: VA VA |
$2.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.75
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$11.28
|
|
|
Service Code
|
NDC 00168000615
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$10.15 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: BCBS Trust/PPO |
$9.21
|
| Rate for Payer: BCN Commercial |
$8.72
|
| 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: Healthscope Commercial |
$10.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.59
|
| Rate for Payer: Nomi Health Commercial |
$9.25
|
| Rate for Payer: PHP Commercial |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.33
|
| Rate for Payer: Priority Health HMO/PPO |
$9.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.93
|
| Rate for Payer: UHC Core |
$9.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.46
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$11.61
|
|
|
Service Code
|
NDC 33342033315
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna Commercial |
$9.87
|
| Rate for Payer: BCBS Trust/PPO |
$9.48
|
| Rate for Payer: BCN Commercial |
$8.97
|
| Rate for Payer: Cash Price |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.29
|
| Rate for Payer: Healthscope Commercial |
$10.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.87
|
| Rate for Payer: Nomi Health Commercial |
$9.52
|
| Rate for Payer: PHP Commercial |
$9.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: Priority Health HMO/PPO |
$10.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.22
|
| Rate for Payer: UHC Core |
$9.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.71
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
OP
|
$11.61
|
|
|
Service Code
|
NDC 33342033315
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna Commercial |
$9.87
|
| Rate for Payer: Aetna Medicare |
$3.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.63
|
| Rate for Payer: BCBS Complete |
$4.64
|
| Rate for Payer: BCBS MAPPO |
$2.90
|
| Rate for Payer: BCBS Trust/PPO |
$9.54
|
| Rate for Payer: BCN Commercial |
$9.03
|
| Rate for Payer: BCN Medicare Advantage |
$2.90
|
| Rate for Payer: Cash Price |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$10.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.87
|
| Rate for Payer: Nomi Health Commercial |
$9.52
|
| Rate for Payer: PACE Senior Care Partners |
$2.76
|
| Rate for Payer: PACE SWMI |
$2.90
|
| Rate for Payer: PHP Commercial |
$9.87
|
| Rate for Payer: PHP Medicare Advantage |
$2.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: Priority Health HMO/PPO |
$10.10
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.78
|
| Rate for Payer: Railroad Medicare Medicare |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.22
|
| Rate for Payer: UHC Core |
$9.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.90
|
| Rate for Payer: UHC Exchange |
$2.90
|
| Rate for Payer: UHC Medicare Advantage |
$2.90
|
| Rate for Payer: VA VA |
$2.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.71
|
|
