|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM
|
Facility
|
IP
|
$26.36
|
|
|
Service Code
|
NDC 45802006578
|
| Hospital Charge Code |
8114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$23.72 |
| Rate for Payer: Aetna American Axle |
$17.13
|
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.13
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cofinity Commercial |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$23.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health SBD |
$16.61
|
| Rate for Payer: UMR Bronson Commercial |
$11.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.77
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$17.89
|
|
|
Service Code
|
NDC 45802004935
|
| Hospital Charge Code |
8119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna American Axle |
$11.63
|
| Rate for Payer: Aetna Commercial |
$15.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.63
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cofinity Commercial |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$16.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: PHP Commercial |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.63
|
| Rate for Payer: Priority Health SBD |
$11.27
|
| Rate for Payer: UMR Bronson Commercial |
$7.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.42
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL OINTMENT
|
Facility
|
OP
|
$17.89
|
|
|
Service Code
|
NDC 45802004935
|
| Hospital Charge Code |
8119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna American Axle |
$11.63
|
| Rate for Payer: Aetna Commercial |
$15.21
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.63
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cofinity Commercial |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$16.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: PHP Commercial |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.63
|
| Rate for Payer: Priority Health SBD |
$11.27
|
| Rate for Payer: UMR Bronson Commercial |
$6.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.42
|
|
|
TRIAMCINOLONE ACETONIDE 10 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$83.18
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
11584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$74.86 |
| Rate for Payer: Aetna American Axle |
$54.07
|
| Rate for Payer: Aetna Commercial |
$70.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.07
|
| Rate for Payer: Cash Price |
$66.54
|
| Rate for Payer: Cofinity Commercial |
$58.23
|
| Rate for Payer: Cofinity Commercial |
$71.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.54
|
| Rate for Payer: Healthscope Commercial |
$74.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.70
|
| Rate for Payer: PHP Commercial |
$70.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.07
|
| Rate for Payer: Priority Health SBD |
$52.40
|
| Rate for Payer: UMR Bronson Commercial |
$36.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.38
|
|
|
TRIAMCINOLONE ACETONIDE 10 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$83.18
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
11584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.78 |
| Max. Negotiated Rate |
$74.86 |
| Rate for Payer: Aetna American Axle |
$54.07
|
| Rate for Payer: Aetna Commercial |
$70.70
|
| Rate for Payer: Aetna Medicare |
$41.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.07
|
| Rate for Payer: BCBS Complete |
$33.27
|
| Rate for Payer: Cash Price |
$66.54
|
| Rate for Payer: Cofinity Commercial |
$58.23
|
| Rate for Payer: Cofinity Commercial |
$71.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.54
|
| Rate for Payer: Healthscope Commercial |
$74.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.70
|
| Rate for Payer: PHP Commercial |
$70.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.07
|
| Rate for Payer: Priority Health SBD |
$52.40
|
| Rate for Payer: UMR Bronson Commercial |
$30.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.38
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$23.77
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
8120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$21.39 |
| Rate for Payer: Aetna American Axle |
$15.45
|
| Rate for Payer: Aetna American Axle |
$25.17
|
| Rate for Payer: Aetna American Axle |
$12.30
|
| Rate for Payer: Aetna American Axle |
$15.59
|
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: Aetna Commercial |
$20.38
|
| Rate for Payer: Aetna Commercial |
$16.09
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna Medicare |
$9.46
|
| Rate for Payer: Aetna Medicare |
$19.36
|
| Rate for Payer: Aetna Medicare |
$11.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.30
|
| Rate for Payer: BCBS Complete |
$7.57
|
| Rate for Payer: BCBS Complete |
$15.49
|
| Rate for Payer: BCBS Complete |
$9.59
|
| Rate for Payer: BCBS Complete |
$9.51
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Cofinity Commercial |
$20.44
|
| Rate for Payer: Cofinity Commercial |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$13.25
|
| Rate for Payer: Cofinity Commercial |
$20.62
|
| Rate for Payer: Cofinity Commercial |
$16.79
|
| Rate for Payer: Cofinity Commercial |
$27.10
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Cofinity Commercial |
$16.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.02
|
| Rate for Payer: Healthscope Commercial |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$17.04
|
| Rate for Payer: Healthscope Commercial |
$21.39
|
| Rate for Payer: Healthscope Commercial |
$34.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.38
|
| Rate for Payer: PHP Commercial |
$20.38
|
| Rate for Payer: PHP Commercial |
$20.20
|
| Rate for Payer: PHP Commercial |
$32.91
|
| Rate for Payer: PHP Commercial |
$16.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.30
|
| Rate for Payer: Priority Health SBD |
$15.11
|
| Rate for Payer: Priority Health SBD |
$24.39
|
| Rate for Payer: Priority Health SBD |
$14.98
|
| Rate for Payer: Priority Health SBD |
$11.93
|
| Rate for Payer: UMR Bronson Commercial |
$8.87
|
| Rate for Payer: UMR Bronson Commercial |
$8.79
|
| Rate for Payer: UMR Bronson Commercial |
$14.33
|
| Rate for Payer: UMR Bronson Commercial |
$7.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.83
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$23.98
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
8120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$21.58 |
| Rate for Payer: Aetna American Axle |
$15.59
|
| Rate for Payer: Aetna American Axle |
$15.45
|
| Rate for Payer: Aetna American Axle |
$12.30
|
| Rate for Payer: Aetna American Axle |
$25.17
|
| Rate for Payer: Aetna Commercial |
$20.38
|
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: Aetna Commercial |
$16.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.59
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Cofinity Commercial |
$13.25
|
| Rate for Payer: Cofinity Commercial |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$27.10
|
| Rate for Payer: Cofinity Commercial |
$16.79
|
| Rate for Payer: Cofinity Commercial |
$16.64
|
| Rate for Payer: Cofinity Commercial |
$20.44
|
| Rate for Payer: Cofinity Commercial |
$20.62
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.02
|
| Rate for Payer: Healthscope Commercial |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$17.04
|
| Rate for Payer: Healthscope Commercial |
$21.39
|
| Rate for Payer: Healthscope Commercial |
$34.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.38
|
| Rate for Payer: PHP Commercial |
$20.38
|
| Rate for Payer: PHP Commercial |
$32.91
|
| Rate for Payer: PHP Commercial |
$16.09
|
| Rate for Payer: PHP Commercial |
$20.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.30
|
| Rate for Payer: Priority Health SBD |
$24.39
|
| Rate for Payer: Priority Health SBD |
$11.93
|
| Rate for Payer: Priority Health SBD |
$14.98
|
| Rate for Payer: Priority Health SBD |
$15.11
|
| Rate for Payer: UMR Bronson Commercial |
$10.55
|
| Rate for Payer: UMR Bronson Commercial |
$17.04
|
| Rate for Payer: UMR Bronson Commercial |
$10.46
|
| Rate for Payer: UMR Bronson Commercial |
$8.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.98
|
|
|
TRIAMCINOLONE ACETONIDE 80 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$77.48
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
190715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.09 |
| Max. Negotiated Rate |
$69.73 |
| Rate for Payer: Aetna American Axle |
$50.36
|
| Rate for Payer: Aetna Commercial |
$65.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$69.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.86
|
| Rate for Payer: PHP Commercial |
$65.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.36
|
| Rate for Payer: Priority Health SBD |
$48.81
|
| Rate for Payer: UMR Bronson Commercial |
$34.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.11
|
|
|
TRIAMCINOLONE ACETONIDE 80 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$77.48
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
190715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.67 |
| Max. Negotiated Rate |
$69.73 |
| Rate for Payer: Aetna American Axle |
$50.36
|
| Rate for Payer: Aetna Commercial |
$65.86
|
| Rate for Payer: Aetna Medicare |
$38.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: BCBS Complete |
$30.99
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$69.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.86
|
| Rate for Payer: PHP Commercial |
$65.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.36
|
| Rate for Payer: Priority Health SBD |
$48.81
|
| Rate for Payer: UMR Bronson Commercial |
$28.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.11
|
|
|
TRIAMCINOLONE ACETONIDE (PF) 40 MG/ML INTRAOCULAR SUSPENSION
|
Facility
|
OP
|
$3,072.72
|
|
|
Service Code
|
HCPCS J3300
|
| Hospital Charge Code |
89128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.13 |
| Max. Negotiated Rate |
$2,765.45 |
| Rate for Payer: Aetna American Axle |
$1,997.27
|
| Rate for Payer: Aetna Commercial |
$2,611.81
|
| Rate for Payer: Aetna Medicare |
$25.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,997.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.62
|
| Rate for Payer: BCBS Complete |
$13.79
|
| Rate for Payer: BCBS MAPPO |
$24.50
|
| Rate for Payer: BCN Medicare Advantage |
$24.50
|
| Rate for Payer: Cash Price |
$2,458.18
|
| Rate for Payer: Cash Price |
$2,458.18
|
| Rate for Payer: Cofinity Commercial |
$2,642.54
|
| Rate for Payer: Cofinity Commercial |
$2,150.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,150.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,458.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.50
|
| Rate for Payer: Healthscope Commercial |
$2,765.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,150.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,304.54
|
| Rate for Payer: Mclaren Medicaid |
$13.13
|
| Rate for Payer: Mclaren Medicare |
$24.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.73
|
| Rate for Payer: Meridian Medicaid |
$13.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,611.81
|
| Rate for Payer: PACE Medicare |
$23.27
|
| Rate for Payer: PACE SWMI |
$24.50
|
| Rate for Payer: PHP Commercial |
$2,611.81
|
| Rate for Payer: PHP Medicare Advantage |
$24.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,997.27
|
| Rate for Payer: Priority Health Medicare |
$24.50
|
| Rate for Payer: Priority Health SBD |
$1,935.81
|
| Rate for Payer: Railroad Medicare Medicare |
$24.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.50
|
| Rate for Payer: UHC Exchange |
$46.82
|
| Rate for Payer: UHC Medicare Advantage |
$24.50
|
| Rate for Payer: UHCCP Medicaid |
$13.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,136.91
|
| Rate for Payer: VA VA |
$24.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,304.54
|
|
|
TRIAMCINOLONE ACETONIDE (PF) 40 MG/ML INTRAOCULAR SUSPENSION
|
Facility
|
IP
|
$3,072.72
|
|
|
Service Code
|
HCPCS J3300
|
| Hospital Charge Code |
89128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,352.00 |
| Max. Negotiated Rate |
$2,765.45 |
| Rate for Payer: Aetna American Axle |
$1,997.27
|
| Rate for Payer: Aetna Commercial |
$2,611.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,997.27
|
| Rate for Payer: Cash Price |
$2,458.18
|
| Rate for Payer: Cofinity Commercial |
$2,150.90
|
| Rate for Payer: Cofinity Commercial |
$2,642.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,150.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,458.18
|
| Rate for Payer: Healthscope Commercial |
$2,765.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,150.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,304.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,611.81
|
| Rate for Payer: PHP Commercial |
$2,611.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,997.27
|
| Rate for Payer: Priority Health SBD |
$1,935.81
|
| Rate for Payer: UMR Bronson Commercial |
$1,352.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,304.54
|
|
|
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 |
$107.01 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna American Axle |
$158.08
|
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.08
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$170.24
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.56
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.72
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.08
|
| Rate for Payer: Priority Health SBD |
$153.22
|
| Rate for Payer: UMR Bronson Commercial |
$107.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$117.50
|
|
|
Service Code
|
NDC 72888009401
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna American Axle |
$76.38
|
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.38
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Cofinity Commercial |
$82.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.88
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.38
|
| Rate for Payer: Priority Health SBD |
$74.03
|
| Rate for Payer: UMR Bronson Commercial |
$51.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.12
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$117.50
|
|
|
Service Code
|
NDC 72888009401
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.48 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna American Axle |
$76.38
|
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: Aetna Medicare |
$58.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.38
|
| Rate for Payer: BCBS Complete |
$47.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Cofinity Commercial |
$82.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.88
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.38
|
| Rate for Payer: Priority Health SBD |
$74.03
|
| Rate for Payer: UMR Bronson Commercial |
$43.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.12
|
|
|
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 |
$89.98 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna American Axle |
$158.08
|
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: Aetna Medicare |
$121.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.08
|
| Rate for Payer: BCBS Complete |
$97.28
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$170.24
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.56
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.72
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.08
|
| Rate for Payer: Priority Health SBD |
$153.22
|
| Rate for Payer: UMR Bronson Commercial |
$89.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
TRICHLOROACETIC ACID 100 % TOPICAL POWDER FOR SOLUTION
|
Facility
|
OP
|
$1,866.00
|
|
|
Service Code
|
NDC 51552027406
|
| Hospital Charge Code |
161607
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$690.42 |
| Max. Negotiated Rate |
$1,679.40 |
| Rate for Payer: Aetna American Axle |
$1,212.90
|
| Rate for Payer: Aetna Commercial |
$1,586.10
|
| Rate for Payer: Aetna Medicare |
$933.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,212.90
|
| Rate for Payer: BCBS Complete |
$746.40
|
| Rate for Payer: Cash Price |
$1,492.80
|
| Rate for Payer: Cofinity Commercial |
$1,306.20
|
| Rate for Payer: Cofinity Commercial |
$1,604.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,306.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,492.80
|
| Rate for Payer: Healthscope Commercial |
$1,679.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,306.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,399.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,586.10
|
| Rate for Payer: PHP Commercial |
$1,586.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,212.90
|
| Rate for Payer: Priority Health SBD |
$1,175.58
|
| Rate for Payer: UMR Bronson Commercial |
$690.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,399.50
|
|
|
TRICHLOROACETIC ACID 100 % TOPICAL POWDER FOR SOLUTION
|
Facility
|
IP
|
$1,866.00
|
|
|
Service Code
|
NDC 51552027406
|
| Hospital Charge Code |
161607
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$821.04 |
| Max. Negotiated Rate |
$1,679.40 |
| Rate for Payer: Aetna American Axle |
$1,212.90
|
| Rate for Payer: Aetna Commercial |
$1,586.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,212.90
|
| Rate for Payer: Cash Price |
$1,492.80
|
| Rate for Payer: Cofinity Commercial |
$1,306.20
|
| Rate for Payer: Cofinity Commercial |
$1,604.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,306.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,492.80
|
| Rate for Payer: Healthscope Commercial |
$1,679.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,306.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,399.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,586.10
|
| Rate for Payer: PHP Commercial |
$1,586.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,212.90
|
| Rate for Payer: Priority Health SBD |
$1,175.58
|
| Rate for Payer: UMR Bronson Commercial |
$821.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,399.50
|
|
|
TRICLOSAN TOPICAL BAR
|
Facility
|
OP
|
$9.09
|
|
|
Service Code
|
NDC 72140085700
|
| Hospital Charge Code |
169208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$8.18 |
| Rate for Payer: Aetna American Axle |
$5.91
|
| Rate for Payer: Aetna Commercial |
$7.73
|
| Rate for Payer: Aetna Medicare |
$4.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.91
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: Cash Price |
$7.27
|
| Rate for Payer: Cofinity Commercial |
$6.36
|
| Rate for Payer: Cofinity Commercial |
$7.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.27
|
| Rate for Payer: Healthscope Commercial |
$8.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.73
|
| Rate for Payer: PHP Commercial |
$7.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.91
|
| Rate for Payer: Priority Health SBD |
$5.73
|
| Rate for Payer: UMR Bronson Commercial |
$3.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.82
|
|
|
TRICLOSAN TOPICAL BAR
|
Facility
|
IP
|
$9.09
|
|
|
Service Code
|
NDC 72140085700
|
| Hospital Charge Code |
169208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$8.18 |
| Rate for Payer: Aetna American Axle |
$5.91
|
| Rate for Payer: Aetna Commercial |
$7.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.91
|
| Rate for Payer: Cash Price |
$7.27
|
| Rate for Payer: Cofinity Commercial |
$6.36
|
| Rate for Payer: Cofinity Commercial |
$7.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.27
|
| Rate for Payer: Healthscope Commercial |
$8.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.73
|
| Rate for Payer: PHP Commercial |
$7.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.91
|
| Rate for Payer: Priority Health SBD |
$5.73
|
| Rate for Payer: UMR Bronson Commercial |
$4.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.82
|
|
|
TRICLOSAN TOPICAL BAR
|
Facility
|
IP
|
$11.64
|
|
|
Service Code
|
NDC 09900000607
|
| Hospital Charge Code |
169208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$10.48 |
| Rate for Payer: Aetna American Axle |
$7.57
|
| Rate for Payer: Aetna Commercial |
$9.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.57
|
| Rate for Payer: Cash Price |
$9.31
|
| Rate for Payer: Cofinity Commercial |
$10.01
|
| Rate for Payer: Cofinity Commercial |
$8.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.31
|
| Rate for Payer: Healthscope Commercial |
$10.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.89
|
| Rate for Payer: PHP Commercial |
$9.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.57
|
| Rate for Payer: Priority Health SBD |
$7.33
|
| Rate for Payer: UMR Bronson Commercial |
$5.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.73
|
|
|
TRICLOSAN TOPICAL BAR
|
Facility
|
OP
|
$11.64
|
|
|
Service Code
|
NDC 09900000607
|
| Hospital Charge Code |
169208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$10.48 |
| Rate for Payer: Aetna American Axle |
$7.57
|
| Rate for Payer: Aetna Commercial |
$9.89
|
| Rate for Payer: Aetna Medicare |
$5.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.57
|
| Rate for Payer: BCBS Complete |
$4.66
|
| Rate for Payer: Cash Price |
$9.31
|
| Rate for Payer: Cofinity Commercial |
$10.01
|
| Rate for Payer: Cofinity Commercial |
$8.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.31
|
| Rate for Payer: Healthscope Commercial |
$10.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.89
|
| Rate for Payer: PHP Commercial |
$9.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.57
|
| Rate for Payer: Priority Health SBD |
$7.33
|
| Rate for Payer: UMR Bronson Commercial |
$4.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.73
|
|
|
TRIFLUOPERAZINE 10 MG TABLET
|
Facility
|
IP
|
$882.82
|
|
|
Service Code
|
NDC 51079057520
|
| Hospital Charge Code |
8162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$388.44 |
| Max. Negotiated Rate |
$794.54 |
| Rate for Payer: Aetna American Axle |
$573.83
|
| Rate for Payer: Aetna Commercial |
$750.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.83
|
| Rate for Payer: Cash Price |
$706.26
|
| Rate for Payer: Cofinity Commercial |
$617.97
|
| Rate for Payer: Cofinity Commercial |
$759.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$617.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$706.26
|
| Rate for Payer: Healthscope Commercial |
$794.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$617.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$662.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$750.40
|
| Rate for Payer: PHP Commercial |
$750.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.83
|
| Rate for Payer: Priority Health SBD |
$556.18
|
| Rate for Payer: UMR Bronson Commercial |
$388.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$662.12
|
|
|
TRIFLUOPERAZINE 10 MG TABLET
|
Facility
|
OP
|
$882.82
|
|
|
Service Code
|
NDC 51079057520
|
| Hospital Charge Code |
8162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$326.64 |
| Max. Negotiated Rate |
$794.54 |
| Rate for Payer: Aetna American Axle |
$573.83
|
| Rate for Payer: Aetna Commercial |
$750.40
|
| Rate for Payer: Aetna Medicare |
$441.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.83
|
| Rate for Payer: BCBS Complete |
$353.13
|
| Rate for Payer: Cash Price |
$706.26
|
| Rate for Payer: Cofinity Commercial |
$617.97
|
| Rate for Payer: Cofinity Commercial |
$759.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$617.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$706.26
|
| Rate for Payer: Healthscope Commercial |
$794.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$617.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$662.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$750.40
|
| Rate for Payer: PHP Commercial |
$750.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.83
|
| Rate for Payer: Priority Health SBD |
$556.18
|
| Rate for Payer: UMR Bronson Commercial |
$326.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$662.12
|
|
|
TRIFLUOPERAZINE 10 MG TABLET
|
Facility
|
OP
|
$8.83
|
|
|
Service Code
|
NDC 51079057501
|
| Hospital Charge Code |
8162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$7.95 |
| Rate for Payer: Aetna American Axle |
$5.74
|
| Rate for Payer: Aetna Commercial |
$7.51
|
| Rate for Payer: Aetna Medicare |
$4.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.74
|
| Rate for Payer: BCBS Complete |
$3.53
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cofinity Commercial |
$6.18
|
| Rate for Payer: Cofinity Commercial |
$7.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.06
|
| Rate for Payer: Healthscope Commercial |
$7.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.51
|
| Rate for Payer: PHP Commercial |
$7.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.74
|
| Rate for Payer: Priority Health SBD |
$5.56
|
| Rate for Payer: UMR Bronson Commercial |
$3.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.62
|
|
|
TRIFLUOPERAZINE 10 MG TABLET
|
Facility
|
IP
|
$8.83
|
|
|
Service Code
|
NDC 51079057501
|
| Hospital Charge Code |
8162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$7.95 |
| Rate for Payer: Aetna American Axle |
$5.74
|
| Rate for Payer: Aetna Commercial |
$7.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.74
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cofinity Commercial |
$6.18
|
| Rate for Payer: Cofinity Commercial |
$7.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.06
|
| Rate for Payer: Healthscope Commercial |
$7.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.51
|
| Rate for Payer: PHP Commercial |
$7.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.74
|
| Rate for Payer: Priority Health SBD |
$5.56
|
| Rate for Payer: UMR Bronson Commercial |
$3.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.62
|
|
