|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
OP
|
$19.24
|
|
|
Service Code
|
NDC 45802005535
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.01
|
| Rate for Payer: BCBS Complete |
$7.70
|
| Rate for Payer: BCBS MAPPO |
$4.81
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$14.96
|
| Rate for Payer: BCN Medicare Advantage |
$4.81
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.81
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.35
|
| Rate for Payer: Nomi Health Commercial |
$15.78
|
| Rate for Payer: PACE Senior Care Partners |
$4.57
|
| Rate for Payer: PACE SWMI |
$4.81
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: PHP Medicare Advantage |
$4.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.51
|
| Rate for Payer: Priority Health HMO/PPO |
$16.74
|
| Rate for Payer: Priority Health Medicare |
$4.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.89
|
| Rate for Payer: Railroad Medicare Medicare |
$4.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.93
|
| Rate for Payer: UHC Core |
$16.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.81
|
| Rate for Payer: UHC Exchange |
$4.81
|
| Rate for Payer: UHC Medicare Advantage |
$4.81
|
| Rate for Payer: VA VA |
$4.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.43
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
OP
|
$11.28
|
|
|
Service Code
|
NDC 00168000615
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$10.15 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: Aetna Medicare |
$2.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.52
|
| Rate for Payer: BCBS Complete |
$4.51
|
| Rate for Payer: BCBS MAPPO |
$2.82
|
| Rate for Payer: BCBS Trust/PPO |
$9.27
|
| Rate for Payer: BCN Commercial |
$8.77
|
| Rate for Payer: BCN Medicare Advantage |
$2.82
|
| Rate for Payer: Cash Price |
$9.02
|
| Rate for Payer: Cofinity Commercial |
$9.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$10.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.59
|
| Rate for Payer: Nomi Health Commercial |
$9.25
|
| Rate for Payer: PACE Senior Care Partners |
$2.68
|
| Rate for Payer: PACE SWMI |
$2.82
|
| Rate for Payer: PHP Commercial |
$9.59
|
| Rate for Payer: PHP Medicare Advantage |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.33
|
| Rate for Payer: Priority Health HMO/PPO |
$9.81
|
| Rate for Payer: Priority Health Medicare |
$2.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.56
|
| Rate for Payer: Railroad Medicare Medicare |
$2.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.93
|
| Rate for Payer: UHC Core |
$9.42
|
| Rate for Payer: UHC 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 |
$8.46
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$19.24
|
|
|
Service Code
|
NDC 45802005535
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.51 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: BCBS Trust/PPO |
$15.71
|
| Rate for Payer: BCN Commercial |
$14.87
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.39
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.35
|
| Rate for Payer: Nomi Health Commercial |
$15.78
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.51
|
| Rate for Payer: Priority Health HMO/PPO |
$16.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.93
|
| Rate for Payer: UHC Core |
$16.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.43
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$38.72
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
8120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: Aetna Commercial |
$20.38
|
| Rate for Payer: Aetna Commercial |
$167.12
|
| Rate for Payer: BCBS Trust/PPO |
$19.57
|
| Rate for Payer: BCBS Trust/PPO |
$31.61
|
| Rate for Payer: BCBS Trust/PPO |
$19.40
|
| Rate for Payer: BCBS Trust/PPO |
$18.01
|
| Rate for Payer: BCBS Trust/PPO |
$160.49
|
| Rate for Payer: BCN Commercial |
$18.53
|
| Rate for Payer: BCN Commercial |
$18.37
|
| Rate for Payer: BCN Commercial |
$151.94
|
| Rate for Payer: BCN Commercial |
$17.05
|
| Rate for Payer: BCN Commercial |
$29.92
|
| Rate for Payer: Cash Price |
$157.29
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cofinity Commercial |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$169.08
|
| Rate for Payer: Cofinity Commercial |
$20.62
|
| Rate for Payer: Cofinity Commercial |
$20.44
|
| Rate for Payer: Cofinity Commercial |
$18.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.98
|
| Rate for Payer: Healthscope Commercial |
$19.85
|
| Rate for Payer: Healthscope Commercial |
$21.39
|
| Rate for Payer: Healthscope Commercial |
$176.95
|
| Rate for Payer: Healthscope Commercial |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$34.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.38
|
| Rate for Payer: Nomi Health Commercial |
$161.22
|
| Rate for Payer: Nomi Health Commercial |
$18.09
|
| Rate for Payer: Nomi Health Commercial |
$19.49
|
| Rate for Payer: Nomi Health Commercial |
$19.66
|
| Rate for Payer: Nomi Health Commercial |
$31.75
|
| Rate for Payer: PHP Commercial |
$20.20
|
| Rate for Payer: PHP Commercial |
$18.75
|
| Rate for Payer: PHP Commercial |
$167.12
|
| Rate for Payer: PHP Commercial |
$20.38
|
| Rate for Payer: PHP Commercial |
$32.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.80
|
| Rate for Payer: Priority Health HMO/PPO |
$171.05
|
| Rate for Payer: Priority Health HMO/PPO |
$33.69
|
| Rate for Payer: Priority Health HMO/PPO |
$20.68
|
| Rate for Payer: Priority Health HMO/PPO |
$20.86
|
| Rate for Payer: Priority Health HMO/PPO |
$19.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.10
|
| Rate for Payer: UHC Core |
$164.17
|
| Rate for Payer: UHC Core |
$18.42
|
| Rate for Payer: UHC Core |
$20.02
|
| Rate for Payer: UHC Core |
$32.33
|
| Rate for Payer: UHC Core |
$19.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.98
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$22.06
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
8120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$19.85 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: Aetna Commercial |
$20.38
|
| Rate for Payer: Aetna Commercial |
$167.12
|
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: Aetna Medicare |
$6.18
|
| Rate for Payer: Aetna Medicare |
$51.12
|
| Rate for Payer: Aetna Medicare |
$5.74
|
| Rate for Payer: Aetna Medicare |
$6.23
|
| Rate for Payer: Aetna Medicare |
$10.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.49
|
| Rate for Payer: BCBS Complete |
$9.59
|
| Rate for Payer: BCBS Complete |
$78.64
|
| Rate for Payer: BCBS Complete |
$8.82
|
| Rate for Payer: BCBS Complete |
$9.51
|
| Rate for Payer: BCBS Complete |
$15.49
|
| Rate for Payer: BCBS MAPPO |
$5.94
|
| Rate for Payer: BCBS MAPPO |
$49.15
|
| Rate for Payer: BCBS MAPPO |
$5.51
|
| Rate for Payer: BCBS MAPPO |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$9.68
|
| Rate for Payer: BCBS Trust/PPO |
$161.63
|
| Rate for Payer: BCBS Trust/PPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.54
|
| Rate for Payer: BCBS Trust/PPO |
$31.83
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$30.10
|
| Rate for Payer: BCN Commercial |
$152.86
|
| Rate for Payer: BCN Commercial |
$17.15
|
| Rate for Payer: BCN Commercial |
$18.48
|
| Rate for Payer: BCN Commercial |
$18.64
|
| Rate for Payer: BCN Medicare Advantage |
$9.68
|
| Rate for Payer: BCN Medicare Advantage |
$6.00
|
| Rate for Payer: BCN Medicare Advantage |
$49.15
|
| Rate for Payer: BCN Medicare Advantage |
$5.51
|
| Rate for Payer: BCN Medicare Advantage |
$5.94
|
| Rate for Payer: Cash Price |
$157.29
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cofinity Commercial |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$169.08
|
| Rate for Payer: Cofinity Commercial |
$18.97
|
| Rate for Payer: Cofinity Commercial |
$20.62
|
| Rate for Payer: Cofinity Commercial |
$20.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.94
|
| Rate for Payer: Healthscope Commercial |
$19.85
|
| Rate for Payer: Healthscope Commercial |
$176.95
|
| Rate for Payer: Healthscope Commercial |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$21.39
|
| Rate for Payer: Healthscope Commercial |
$34.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.91
|
| Rate for Payer: Nomi Health Commercial |
$18.09
|
| Rate for Payer: Nomi Health Commercial |
$19.66
|
| Rate for Payer: Nomi Health Commercial |
$19.49
|
| Rate for Payer: Nomi Health Commercial |
$31.75
|
| Rate for Payer: Nomi Health Commercial |
$161.22
|
| Rate for Payer: PACE Senior Care Partners |
$46.69
|
| Rate for Payer: PACE Senior Care Partners |
$5.70
|
| Rate for Payer: PACE Senior Care Partners |
$5.24
|
| Rate for Payer: PACE Senior Care Partners |
$5.65
|
| Rate for Payer: PACE Senior Care Partners |
$9.20
|
| Rate for Payer: PACE SWMI |
$49.15
|
| Rate for Payer: PACE SWMI |
$6.00
|
| Rate for Payer: PACE SWMI |
$5.94
|
| Rate for Payer: PACE SWMI |
$5.51
|
| Rate for Payer: PACE SWMI |
$9.68
|
| Rate for Payer: PHP Commercial |
$32.91
|
| Rate for Payer: PHP Commercial |
$20.20
|
| Rate for Payer: PHP Commercial |
$20.38
|
| Rate for Payer: PHP Commercial |
$18.75
|
| Rate for Payer: PHP Commercial |
$167.12
|
| Rate for Payer: PHP Medicare Advantage |
$5.94
|
| Rate for Payer: PHP Medicare Advantage |
$6.00
|
| Rate for Payer: PHP Medicare Advantage |
$9.68
|
| Rate for Payer: PHP Medicare Advantage |
$49.15
|
| Rate for Payer: PHP Medicare Advantage |
$5.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.80
|
| Rate for Payer: Priority Health HMO/PPO |
$171.05
|
| Rate for Payer: Priority Health HMO/PPO |
$20.68
|
| Rate for Payer: Priority Health HMO/PPO |
$33.69
|
| Rate for Payer: Priority Health HMO/PPO |
$20.86
|
| Rate for Payer: Priority Health HMO/PPO |
$19.19
|
| Rate for Payer: Priority Health Medicare |
$9.78
|
| Rate for Payer: Priority Health Medicare |
$6.00
|
| Rate for Payer: Priority Health Medicare |
$5.57
|
| Rate for Payer: Priority Health Medicare |
$6.05
|
| Rate for Payer: Priority Health Medicare |
$49.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.94
|
| Rate for Payer: Railroad Medicare Medicare |
$6.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.94
|
| Rate for Payer: Railroad Medicare Medicare |
$49.15
|
| Rate for Payer: Railroad Medicare Medicare |
$5.51
|
| Rate for Payer: Railroad Medicare Medicare |
$9.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.92
|
| Rate for Payer: UHC Core |
$18.42
|
| Rate for Payer: UHC Core |
$32.33
|
| Rate for Payer: UHC Core |
$19.85
|
| Rate for Payer: UHC Core |
$20.02
|
| Rate for Payer: UHC Core |
$164.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.94
|
| Rate for Payer: UHC Exchange |
$5.94
|
| Rate for Payer: UHC Exchange |
$9.68
|
| Rate for Payer: UHC Exchange |
$49.15
|
| Rate for Payer: UHC Exchange |
$6.00
|
| Rate for Payer: UHC Exchange |
$5.51
|
| Rate for Payer: UHC Medicare Advantage |
$5.51
|
| Rate for Payer: UHC Medicare Advantage |
$9.68
|
| Rate for Payer: UHC Medicare Advantage |
$5.94
|
| Rate for Payer: UHC Medicare Advantage |
$49.15
|
| Rate for Payer: UHC Medicare Advantage |
$6.00
|
| Rate for Payer: VA VA |
$49.15
|
| Rate for Payer: VA VA |
$6.00
|
| Rate for Payer: VA VA |
$5.51
|
| Rate for Payer: VA VA |
$9.68
|
| Rate for Payer: VA VA |
$5.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.83
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$109.01
|
|
|
Service Code
|
NDC 68084075025
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.86 |
| Max. Negotiated Rate |
$98.11 |
| Rate for Payer: Aetna Commercial |
$92.66
|
| Rate for Payer: BCBS Trust/PPO |
$88.98
|
| Rate for Payer: BCN Commercial |
$84.24
|
| Rate for Payer: Cash Price |
$87.21
|
| Rate for Payer: Cofinity Commercial |
$93.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.21
|
| Rate for Payer: Healthscope Commercial |
$98.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.66
|
| Rate for Payer: Nomi Health Commercial |
$89.39
|
| Rate for Payer: PHP Commercial |
$92.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.86
|
| Rate for Payer: Priority Health HMO/PPO |
$94.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.93
|
| Rate for Payer: UHC Core |
$91.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.76
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$3.64
|
|
|
Service Code
|
NDC 68084075095
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.97
|
| Rate for Payer: BCN Commercial |
$2.81
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.91
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Nomi Health Commercial |
$2.98
|
| Rate for Payer: PHP Commercial |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health HMO/PPO |
$3.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC Core |
$3.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.73
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$243.20
|
|
|
Service Code
|
NDC 60505265601
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.76 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: Aetna Medicare |
$63.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.00
|
| Rate for Payer: BCBS Complete |
$97.28
|
| Rate for Payer: BCBS MAPPO |
$60.80
|
| Rate for Payer: BCBS Trust/PPO |
$199.93
|
| Rate for Payer: BCN Commercial |
$189.09
|
| Rate for Payer: BCN Medicare Advantage |
$60.80
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.80
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.72
|
| Rate for Payer: Nomi Health Commercial |
$199.42
|
| Rate for Payer: PACE Senior Care Partners |
$57.76
|
| Rate for Payer: PACE SWMI |
$60.80
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: PHP Medicare Advantage |
$60.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.08
|
| Rate for Payer: Priority Health HMO/PPO |
$211.58
|
| Rate for Payer: Priority Health Medicare |
$61.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.94
|
| Rate for Payer: Railroad Medicare Medicare |
$60.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.02
|
| Rate for Payer: UHC Core |
$203.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.80
|
| Rate for Payer: UHC Exchange |
$60.80
|
| Rate for Payer: UHC Medicare Advantage |
$60.80
|
| Rate for Payer: VA VA |
$60.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$109.01
|
|
|
Service Code
|
NDC 68084075025
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$98.11 |
| Rate for Payer: Aetna Commercial |
$92.66
|
| Rate for Payer: Aetna Medicare |
$28.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.07
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS MAPPO |
$27.25
|
| Rate for Payer: BCBS Trust/PPO |
$89.62
|
| Rate for Payer: BCN Commercial |
$84.76
|
| Rate for Payer: BCN Medicare Advantage |
$27.25
|
| Rate for Payer: Cash Price |
$87.21
|
| Rate for Payer: Cofinity Commercial |
$93.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.25
|
| Rate for Payer: Healthscope Commercial |
$98.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.66
|
| Rate for Payer: Nomi Health Commercial |
$89.39
|
| Rate for Payer: PACE Senior Care Partners |
$25.89
|
| Rate for Payer: PACE SWMI |
$27.25
|
| Rate for Payer: PHP Commercial |
$92.66
|
| Rate for Payer: PHP Medicare Advantage |
$27.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.86
|
| Rate for Payer: Priority Health HMO/PPO |
$94.84
|
| Rate for Payer: Priority Health Medicare |
$27.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.04
|
| Rate for Payer: Railroad Medicare Medicare |
$27.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.93
|
| Rate for Payer: UHC Core |
$91.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.25
|
| Rate for Payer: UHC Exchange |
$27.25
|
| Rate for Payer: UHC Medicare Advantage |
$27.25
|
| Rate for Payer: VA VA |
$27.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.76
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$243.20
|
|
|
Service Code
|
NDC 00591042401
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.08 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: BCBS Trust/PPO |
$198.52
|
| Rate for Payer: BCN Commercial |
$187.94
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.56
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.72
|
| Rate for Payer: Nomi Health Commercial |
$199.42
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.08
|
| Rate for Payer: Priority Health HMO/PPO |
$211.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.02
|
| Rate for Payer: UHC Core |
$203.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$243.20
|
|
|
Service Code
|
NDC 00591042401
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.76 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: Aetna Medicare |
$63.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.00
|
| Rate for Payer: BCBS Complete |
$97.28
|
| Rate for Payer: BCBS MAPPO |
$60.80
|
| Rate for Payer: BCBS Trust/PPO |
$199.93
|
| Rate for Payer: BCN Commercial |
$189.09
|
| Rate for Payer: BCN Medicare Advantage |
$60.80
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.80
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.72
|
| Rate for Payer: Nomi Health Commercial |
$199.42
|
| Rate for Payer: PACE Senior Care Partners |
$57.76
|
| Rate for Payer: PACE SWMI |
$60.80
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: PHP Medicare Advantage |
$60.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.08
|
| Rate for Payer: Priority Health HMO/PPO |
$211.58
|
| Rate for Payer: Priority Health Medicare |
$61.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.94
|
| Rate for Payer: Railroad Medicare Medicare |
$60.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.02
|
| Rate for Payer: UHC Core |
$203.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.80
|
| Rate for Payer: UHC Exchange |
$60.80
|
| Rate for Payer: UHC Medicare Advantage |
$60.80
|
| Rate for Payer: VA VA |
$60.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$243.20
|
|
|
Service Code
|
NDC 60505265601
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.08 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: BCBS Trust/PPO |
$198.52
|
| Rate for Payer: BCN Commercial |
$187.94
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.56
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.72
|
| Rate for Payer: Nomi Health Commercial |
$199.42
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.08
|
| Rate for Payer: Priority Health HMO/PPO |
$211.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.02
|
| Rate for Payer: UHC Core |
$203.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$3.64
|
|
|
Service Code
|
NDC 68084075095
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: Aetna Medicare |
$0.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.14
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: BCBS MAPPO |
$0.91
|
| Rate for Payer: BCBS Trust/PPO |
$2.99
|
| Rate for Payer: BCN Commercial |
$2.83
|
| Rate for Payer: BCN Medicare Advantage |
$0.91
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.91
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Nomi Health Commercial |
$2.98
|
| Rate for Payer: PACE Senior Care Partners |
$0.86
|
| Rate for Payer: PACE SWMI |
$0.91
|
| Rate for Payer: PHP Commercial |
$3.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health HMO/PPO |
$3.17
|
| Rate for Payer: Priority Health Medicare |
$0.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.44
|
| Rate for Payer: Railroad Medicare Medicare |
$0.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC Core |
$3.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.91
|
| Rate for Payer: UHC Exchange |
$0.91
|
| Rate for Payer: UHC Medicare Advantage |
$0.91
|
| Rate for Payer: VA VA |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.73
|
|
|
TRIFLUOPERAZINE 2 MG TABLET
|
Facility
|
IP
|
$327.84
|
|
|
Service Code
|
NDC 00378240201
|
| Hospital Charge Code |
8163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.10 |
| Max. Negotiated Rate |
$295.06 |
| Rate for Payer: Aetna Commercial |
$278.66
|
| Rate for Payer: BCBS Trust/PPO |
$267.62
|
| Rate for Payer: BCN Commercial |
$253.35
|
| Rate for Payer: Cash Price |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$281.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.27
|
| Rate for Payer: Healthscope Commercial |
$295.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.66
|
| Rate for Payer: Nomi Health Commercial |
$268.83
|
| Rate for Payer: PHP Commercial |
$278.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.10
|
| Rate for Payer: Priority Health HMO/PPO |
$285.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.50
|
| Rate for Payer: UHC Core |
$273.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.88
|
|
|
TRIFLUOPERAZINE 2 MG TABLET
|
Facility
|
OP
|
$327.84
|
|
|
Service Code
|
NDC 00378240201
|
| Hospital Charge Code |
8163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.86 |
| Max. Negotiated Rate |
$295.06 |
| Rate for Payer: Aetna Commercial |
$278.66
|
| Rate for Payer: Aetna Medicare |
$85.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.45
|
| Rate for Payer: BCBS Complete |
$131.14
|
| Rate for Payer: BCBS MAPPO |
$81.96
|
| Rate for Payer: BCBS Trust/PPO |
$269.52
|
| Rate for Payer: BCN Commercial |
$254.90
|
| Rate for Payer: BCN Medicare Advantage |
$81.96
|
| Rate for Payer: Cash Price |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$281.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.96
|
| Rate for Payer: Healthscope Commercial |
$295.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.66
|
| Rate for Payer: Nomi Health Commercial |
$268.83
|
| Rate for Payer: PACE Senior Care Partners |
$77.86
|
| Rate for Payer: PACE SWMI |
$81.96
|
| Rate for Payer: PHP Commercial |
$278.66
|
| Rate for Payer: PHP Medicare Advantage |
$81.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.10
|
| Rate for Payer: Priority Health HMO/PPO |
$285.22
|
| Rate for Payer: Priority Health Medicare |
$82.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.65
|
| Rate for Payer: Railroad Medicare Medicare |
$81.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.50
|
| Rate for Payer: UHC Core |
$273.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.96
|
| Rate for Payer: UHC Exchange |
$81.96
|
| Rate for Payer: UHC Medicare Advantage |
$81.96
|
| Rate for Payer: VA VA |
$81.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.88
|
|
|
TRIMETHOBENZAMIDE 100 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$200.51
|
|
|
Service Code
|
HCPCS J3250
|
| Hospital Charge Code |
108755
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.33 |
| Max. Negotiated Rate |
$180.46 |
| Rate for Payer: Aetna Commercial |
$170.43
|
| Rate for Payer: BCBS Trust/PPO |
$163.68
|
| Rate for Payer: BCN Commercial |
$154.95
|
| Rate for Payer: Cash Price |
$160.41
|
| Rate for Payer: Cofinity Commercial |
$172.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.41
|
| Rate for Payer: Healthscope Commercial |
$180.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.43
|
| Rate for Payer: Nomi Health Commercial |
$164.42
|
| Rate for Payer: PHP Commercial |
$170.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.33
|
| Rate for Payer: Priority Health HMO/PPO |
$174.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.45
|
| Rate for Payer: UHC Core |
$167.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.38
|
|
|
TRIMETHOBENZAMIDE 100 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$200.51
|
|
|
Service Code
|
HCPCS J3250
|
| Hospital Charge Code |
108755
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.62 |
| Max. Negotiated Rate |
$180.46 |
| Rate for Payer: Aetna Commercial |
$170.43
|
| Rate for Payer: Aetna Medicare |
$52.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.66
|
| Rate for Payer: BCBS Complete |
$80.20
|
| Rate for Payer: BCBS MAPPO |
$50.13
|
| Rate for Payer: BCBS Trust/PPO |
$164.84
|
| Rate for Payer: BCN Commercial |
$155.90
|
| Rate for Payer: BCN Medicare Advantage |
$50.13
|
| Rate for Payer: Cash Price |
$160.41
|
| Rate for Payer: Cofinity Commercial |
$172.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.13
|
| Rate for Payer: Healthscope Commercial |
$180.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.43
|
| Rate for Payer: Nomi Health Commercial |
$164.42
|
| Rate for Payer: PACE Senior Care Partners |
$47.62
|
| Rate for Payer: PACE SWMI |
$50.13
|
| Rate for Payer: PHP Commercial |
$170.43
|
| Rate for Payer: PHP Medicare Advantage |
$50.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.33
|
| Rate for Payer: Priority Health HMO/PPO |
$174.44
|
| Rate for Payer: Priority Health Medicare |
$50.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.34
|
| Rate for Payer: Railroad Medicare Medicare |
$50.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.45
|
| Rate for Payer: UHC Core |
$167.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.13
|
| Rate for Payer: UHC Exchange |
$50.13
|
| Rate for Payer: UHC Medicare Advantage |
$50.13
|
| Rate for Payer: VA VA |
$50.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.38
|
|
|
TRIMETHOPRIM 100 MG TABLET
|
Facility
|
OP
|
$595.68
|
|
|
Service Code
|
NDC 51862048601
|
| Hospital Charge Code |
8182
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.47 |
| Max. Negotiated Rate |
$536.11 |
| Rate for Payer: Aetna Commercial |
$506.33
|
| Rate for Payer: Aetna Medicare |
$154.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.15
|
| Rate for Payer: BCBS Complete |
$238.27
|
| Rate for Payer: BCBS MAPPO |
$148.92
|
| Rate for Payer: BCBS Trust/PPO |
$489.71
|
| Rate for Payer: BCN Commercial |
$463.14
|
| Rate for Payer: BCN Medicare Advantage |
$148.92
|
| Rate for Payer: Cash Price |
$476.54
|
| Rate for Payer: Cofinity Commercial |
$512.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.92
|
| Rate for Payer: Healthscope Commercial |
$536.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.33
|
| Rate for Payer: Nomi Health Commercial |
$488.46
|
| Rate for Payer: PACE Senior Care Partners |
$141.47
|
| Rate for Payer: PACE SWMI |
$148.92
|
| Rate for Payer: PHP Commercial |
$506.33
|
| Rate for Payer: PHP Medicare Advantage |
$148.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.19
|
| Rate for Payer: Priority Health HMO/PPO |
$518.24
|
| Rate for Payer: Priority Health Medicare |
$150.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$399.11
|
| Rate for Payer: Railroad Medicare Medicare |
$148.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$524.20
|
| Rate for Payer: UHC Core |
$497.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.92
|
| Rate for Payer: UHC Exchange |
$148.92
|
| Rate for Payer: UHC Medicare Advantage |
$148.92
|
| Rate for Payer: VA VA |
$148.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.76
|
|
|
TRIMETHOPRIM 100 MG TABLET
|
Facility
|
IP
|
$595.68
|
|
|
Service Code
|
NDC 51862048601
|
| Hospital Charge Code |
8182
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$387.19 |
| Max. Negotiated Rate |
$536.11 |
| Rate for Payer: Aetna Commercial |
$506.33
|
| Rate for Payer: BCBS Trust/PPO |
$486.25
|
| Rate for Payer: BCN Commercial |
$460.34
|
| Rate for Payer: Cash Price |
$476.54
|
| Rate for Payer: Cofinity Commercial |
$512.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.54
|
| Rate for Payer: Healthscope Commercial |
$536.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.33
|
| Rate for Payer: Nomi Health Commercial |
$488.46
|
| Rate for Payer: PHP Commercial |
$506.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.19
|
| Rate for Payer: Priority Health HMO/PPO |
$518.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$399.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$524.20
|
| Rate for Payer: UHC Core |
$497.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.76
|
|
|
TROLAMINE SALICYLATE 10 % TOPICAL CREAM
|
Facility
|
IP
|
$11.86
|
|
|
Service Code
|
NDC 96295129854
|
| Hospital Charge Code |
27680
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Aetna Commercial |
$10.08
|
| Rate for Payer: BCBS Trust/PPO |
$9.68
|
| Rate for Payer: BCN Commercial |
$9.17
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.49
|
| Rate for Payer: Healthscope Commercial |
$10.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.08
|
| Rate for Payer: Nomi Health Commercial |
$9.73
|
| Rate for Payer: PHP Commercial |
$10.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.71
|
| Rate for Payer: Priority Health HMO/PPO |
$10.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.44
|
| Rate for Payer: UHC Core |
$9.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.89
|
|
|
TROLAMINE SALICYLATE 10 % TOPICAL CREAM
|
Facility
|
IP
|
$13.39
|
|
|
Service Code
|
NDC 96295012985
|
| Hospital Charge Code |
27680
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$12.05 |
| Rate for Payer: Aetna Commercial |
$11.38
|
| Rate for Payer: BCBS Trust/PPO |
$10.93
|
| Rate for Payer: BCN Commercial |
$10.35
|
| Rate for Payer: Cash Price |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$11.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.71
|
| Rate for Payer: Healthscope Commercial |
$12.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.38
|
| Rate for Payer: Nomi Health Commercial |
$10.98
|
| Rate for Payer: PHP Commercial |
$11.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.70
|
| Rate for Payer: Priority Health HMO/PPO |
$11.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.78
|
| Rate for Payer: UHC Core |
$11.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.04
|
|
|
TROLAMINE SALICYLATE 10 % TOPICAL CREAM
|
Facility
|
OP
|
$11.86
|
|
|
Service Code
|
NDC 96295129854
|
| Hospital Charge Code |
27680
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Aetna Commercial |
$10.08
|
| Rate for Payer: Aetna Medicare |
$3.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: BCBS Complete |
$4.74
|
| Rate for Payer: BCBS MAPPO |
$2.96
|
| Rate for Payer: BCBS Trust/PPO |
$9.75
|
| Rate for Payer: BCN Commercial |
$9.22
|
| Rate for Payer: BCN Medicare Advantage |
$2.96
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$10.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.08
|
| Rate for Payer: Nomi Health Commercial |
$9.73
|
| Rate for Payer: PACE Senior Care Partners |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.96
|
| Rate for Payer: PHP Commercial |
$10.08
|
| Rate for Payer: PHP Medicare Advantage |
$2.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.71
|
| Rate for Payer: Priority Health HMO/PPO |
$10.32
|
| Rate for Payer: Priority Health Medicare |
$2.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.95
|
| Rate for Payer: Railroad Medicare Medicare |
$2.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.44
|
| Rate for Payer: UHC Core |
$9.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.96
|
| Rate for Payer: UHC Exchange |
$2.96
|
| Rate for Payer: UHC Medicare Advantage |
$2.96
|
| Rate for Payer: VA VA |
$2.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.89
|
|
|
TROLAMINE SALICYLATE 10 % TOPICAL CREAM
|
Facility
|
OP
|
$13.39
|
|
|
Service Code
|
NDC 96295012985
|
| Hospital Charge Code |
27680
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$12.05 |
| Rate for Payer: Aetna Commercial |
$11.38
|
| Rate for Payer: Aetna Medicare |
$3.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.18
|
| Rate for Payer: BCBS Complete |
$5.36
|
| Rate for Payer: BCBS MAPPO |
$3.35
|
| Rate for Payer: BCBS Trust/PPO |
$11.01
|
| Rate for Payer: BCN Commercial |
$10.41
|
| Rate for Payer: BCN Medicare Advantage |
$3.35
|
| Rate for Payer: Cash Price |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$11.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.35
|
| Rate for Payer: Healthscope Commercial |
$12.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.38
|
| Rate for Payer: Nomi Health Commercial |
$10.98
|
| Rate for Payer: PACE Senior Care Partners |
$3.18
|
| Rate for Payer: PACE SWMI |
$3.35
|
| Rate for Payer: PHP Commercial |
$11.38
|
| Rate for Payer: PHP Medicare Advantage |
$3.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.70
|
| Rate for Payer: Priority Health HMO/PPO |
$11.65
|
| Rate for Payer: Priority Health Medicare |
$3.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.97
|
| Rate for Payer: Railroad Medicare Medicare |
$3.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.78
|
| Rate for Payer: UHC Core |
$11.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.35
|
| Rate for Payer: UHC Exchange |
$3.35
|
| Rate for Payer: UHC Medicare Advantage |
$3.35
|
| Rate for Payer: VA VA |
$3.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.04
|
|
|
TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$182.04
|
|
|
Service Code
|
NDC 68803061210
|
| Hospital Charge Code |
88317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$118.33 |
| Max. Negotiated Rate |
$163.84 |
| Rate for Payer: Aetna Commercial |
$154.73
|
| Rate for Payer: BCBS Trust/PPO |
$148.60
|
| Rate for Payer: BCN Commercial |
$140.68
|
| Rate for Payer: Cash Price |
$145.63
|
| Rate for Payer: Cofinity Commercial |
$156.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.63
|
| Rate for Payer: Healthscope Commercial |
$163.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.73
|
| Rate for Payer: Nomi Health Commercial |
$149.27
|
| Rate for Payer: PHP Commercial |
$154.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.33
|
| Rate for Payer: Priority Health HMO/PPO |
$158.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.20
|
| Rate for Payer: UHC Core |
$152.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.53
|
|
|
TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE
|
Facility
|
OP
|
$182.04
|
|
|
Service Code
|
NDC 68803061210
|
| Hospital Charge Code |
88317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$163.84 |
| Rate for Payer: Aetna Commercial |
$154.73
|
| Rate for Payer: Aetna Medicare |
$47.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.89
|
| Rate for Payer: BCBS Complete |
$72.82
|
| Rate for Payer: BCBS MAPPO |
$45.51
|
| Rate for Payer: BCBS Trust/PPO |
$149.66
|
| Rate for Payer: BCN Commercial |
$141.54
|
| Rate for Payer: BCN Medicare Advantage |
$45.51
|
| Rate for Payer: Cash Price |
$145.63
|
| Rate for Payer: Cofinity Commercial |
$156.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.51
|
| Rate for Payer: Healthscope Commercial |
$163.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.73
|
| Rate for Payer: Nomi Health Commercial |
$149.27
|
| Rate for Payer: PACE Senior Care Partners |
$43.23
|
| Rate for Payer: PACE SWMI |
$45.51
|
| Rate for Payer: PHP Commercial |
$154.73
|
| Rate for Payer: PHP Medicare Advantage |
$45.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.33
|
| Rate for Payer: Priority Health HMO/PPO |
$158.37
|
| Rate for Payer: Priority Health Medicare |
$45.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.97
|
| Rate for Payer: Railroad Medicare Medicare |
$45.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.20
|
| Rate for Payer: UHC Core |
$152.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.51
|
| Rate for Payer: UHC Exchange |
$45.51
|
| Rate for Payer: UHC Medicare Advantage |
$45.51
|
| Rate for Payer: VA VA |
$45.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.53
|
|
