|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$26.06
|
|
|
Service Code
|
NDC 60505082901
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$26.06 |
| Rate for Payer: Aetna Commercial |
$23.46
|
| Rate for Payer: Aetna Medicare |
$9.64
|
| Rate for Payer: ASR ASR |
$25.28
|
| Rate for Payer: BCBS Complete |
$10.43
|
| Rate for Payer: BCBS Trust/PPO |
$21.49
|
| Rate for Payer: BCN Commercial |
$21.49
|
| Rate for Payer: Cash Price |
$20.85
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.85
|
| Rate for Payer: Healthscope Commercial |
$25.28
|
| Rate for Payer: Healthscope Whirlpool |
$26.06
|
| Rate for Payer: Mclaren Commercial |
$23.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.15
|
| Rate for Payer: Nomi Health Commercial |
$21.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.84
|
| Rate for Payer: Priority Health Narrow Network |
$18.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.94
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$26.06
|
|
|
Service Code
|
NDC 60505082901
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$26.06 |
| Rate for Payer: Aetna Commercial |
$23.46
|
| Rate for Payer: ASR ASR |
$25.28
|
| Rate for Payer: BCBS Trust/PPO |
$21.40
|
| Rate for Payer: BCN Commercial |
$21.40
|
| Rate for Payer: Cash Price |
$20.85
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.85
|
| Rate for Payer: Healthscope Commercial |
$25.28
|
| Rate for Payer: Healthscope Whirlpool |
$26.06
|
| Rate for Payer: Mclaren Commercial |
$23.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.15
|
| Rate for Payer: Nomi Health Commercial |
$21.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.94
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$36.57
|
|
|
Service Code
|
NDC 54327099
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$36.57 |
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: ASR ASR |
$35.47
|
| Rate for Payer: BCBS Complete |
$14.63
|
| Rate for Payer: BCBS Trust/PPO |
$30.15
|
| Rate for Payer: BCN Commercial |
$30.15
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cofinity Commercial |
$34.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.25
|
| Rate for Payer: Healthscope Commercial |
$35.47
|
| Rate for Payer: Healthscope Whirlpool |
$36.57
|
| Rate for Payer: Mclaren Commercial |
$32.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.08
|
| Rate for Payer: Nomi Health Commercial |
$29.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$32.04
|
| Rate for Payer: Priority Health Narrow Network |
$25.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.18
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$36.57
|
|
|
Service Code
|
NDC 54327099
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.43 |
| Max. Negotiated Rate |
$36.57 |
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: ASR ASR |
$35.47
|
| Rate for Payer: BCBS Trust/PPO |
$30.03
|
| Rate for Payer: BCN Commercial |
$30.03
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cofinity Commercial |
$34.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.25
|
| Rate for Payer: Healthscope Commercial |
$35.47
|
| Rate for Payer: Healthscope Whirlpool |
$36.57
|
| Rate for Payer: Mclaren Commercial |
$32.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.08
|
| Rate for Payer: Nomi Health Commercial |
$29.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.18
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$36.01
|
|
|
Service Code
|
NDC 60432026415
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$36.01 |
| Rate for Payer: Aetna Commercial |
$32.41
|
| Rate for Payer: Aetna Medicare |
$13.32
|
| Rate for Payer: ASR ASR |
$34.93
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Trust/PPO |
$29.69
|
| Rate for Payer: BCN Commercial |
$29.69
|
| Rate for Payer: Cash Price |
$28.81
|
| Rate for Payer: Cofinity Commercial |
$33.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.81
|
| Rate for Payer: Healthscope Commercial |
$34.93
|
| Rate for Payer: Healthscope Whirlpool |
$36.01
|
| Rate for Payer: Mclaren Commercial |
$32.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.61
|
| Rate for Payer: Nomi Health Commercial |
$29.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31.55
|
| Rate for Payer: Priority Health Narrow Network |
$25.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.69
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
NDC 50383070016
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.17
|
| Rate for Payer: BCBS Trust/PPO |
$34.86
|
| Rate for Payer: BCN Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.17
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.35
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
NDC 50383070016
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.71 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Medicare |
$15.71
|
| Rate for Payer: ASR ASR |
$41.17
|
| Rate for Payer: BCBS Complete |
$16.98
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.17
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.19
|
| Rate for Payer: Priority Health Narrow Network |
$29.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.35
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$36.01
|
|
|
Service Code
|
NDC 60432026415
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$36.01 |
| Rate for Payer: Aetna Commercial |
$32.41
|
| Rate for Payer: ASR ASR |
$34.93
|
| Rate for Payer: BCBS Trust/PPO |
$29.57
|
| Rate for Payer: BCN Commercial |
$29.57
|
| Rate for Payer: Cash Price |
$28.81
|
| Rate for Payer: Cofinity Commercial |
$33.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.81
|
| Rate for Payer: Healthscope Commercial |
$34.93
|
| Rate for Payer: Healthscope Whirlpool |
$36.01
|
| Rate for Payer: Mclaren Commercial |
$32.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.61
|
| Rate for Payer: Nomi Health Commercial |
$29.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.69
|
|
|
FLU VACCINE TS2025-26(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$234.60
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
212355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.95 |
| Max. Negotiated Rate |
$234.59 |
| Rate for Payer: Aetna Commercial |
$211.14
|
| Rate for Payer: ASR ASR |
$227.56
|
| Rate for Payer: BCBS Trust/PPO |
$192.65
|
| Rate for Payer: BCN Commercial |
$192.65
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$220.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.68
|
| Rate for Payer: Healthscope Commercial |
$227.56
|
| Rate for Payer: Healthscope Whirlpool |
$234.59
|
| Rate for Payer: Mclaren Commercial |
$211.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.41
|
| Rate for Payer: Nomi Health Commercial |
$192.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.44
|
|
|
FLU VACCINE TS2025-26(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$234.60
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
212355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.53 |
| Max. Negotiated Rate |
$234.59 |
| Rate for Payer: Aetna Commercial |
$211.14
|
| Rate for Payer: Aetna Medicare |
$86.80
|
| Rate for Payer: ASR ASR |
$227.56
|
| Rate for Payer: BCBS Complete |
$93.84
|
| Rate for Payer: BCBS Trust/PPO |
$193.42
|
| Rate for Payer: BCN Commercial |
$193.42
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$220.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.68
|
| Rate for Payer: Healthscope Commercial |
$227.56
|
| Rate for Payer: Healthscope Whirlpool |
$234.59
|
| Rate for Payer: Mclaren Commercial |
$211.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.41
|
| Rate for Payer: Nomi Health Commercial |
$192.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$98.16
|
| Rate for Payer: Priority Health Narrow Network |
$78.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.44
|
|
|
FLU VACCINE TS 2025-26(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE
|
Facility
|
OP
|
$82.13
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
212359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.58 |
| Max. Negotiated Rate |
$82.12 |
| Rate for Payer: Aetna Commercial |
$73.91
|
| Rate for Payer: Aetna Medicare |
$30.39
|
| Rate for Payer: ASR ASR |
$79.66
|
| Rate for Payer: BCBS Complete |
$32.85
|
| Rate for Payer: BCBS Trust/PPO |
$67.71
|
| Rate for Payer: BCN Commercial |
$67.71
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cofinity Commercial |
$77.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.70
|
| Rate for Payer: Healthscope Commercial |
$79.66
|
| Rate for Payer: Healthscope Whirlpool |
$82.12
|
| Rate for Payer: Mclaren Commercial |
$73.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.81
|
| Rate for Payer: Nomi Health Commercial |
$67.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.27
|
|
|
FLU VACCINE TS 2025-26(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE
|
Facility
|
IP
|
$82.13
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
212359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.59 |
| Max. Negotiated Rate |
$82.12 |
| Rate for Payer: Aetna Commercial |
$73.91
|
| Rate for Payer: ASR ASR |
$79.66
|
| Rate for Payer: BCBS Trust/PPO |
$67.44
|
| Rate for Payer: BCN Commercial |
$67.44
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cofinity Commercial |
$77.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.70
|
| Rate for Payer: Healthscope Commercial |
$79.66
|
| Rate for Payer: Healthscope Whirlpool |
$82.12
|
| Rate for Payer: Mclaren Commercial |
$73.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.81
|
| Rate for Payer: Nomi Health Commercial |
$67.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.27
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$149.60
|
|
|
Service Code
|
NDC 904722461
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.35 |
| Max. Negotiated Rate |
$149.60 |
| Rate for Payer: Aetna Commercial |
$134.64
|
| Rate for Payer: Aetna Medicare |
$55.35
|
| Rate for Payer: ASR ASR |
$145.11
|
| Rate for Payer: BCBS Complete |
$59.84
|
| Rate for Payer: BCBS Trust/PPO |
$123.35
|
| Rate for Payer: BCN Commercial |
$123.35
|
| Rate for Payer: Cash Price |
$119.68
|
| Rate for Payer: Cofinity Commercial |
$140.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.68
|
| Rate for Payer: Healthscope Commercial |
$145.11
|
| Rate for Payer: Healthscope Whirlpool |
$149.60
|
| Rate for Payer: Mclaren Commercial |
$134.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.16
|
| Rate for Payer: Nomi Health Commercial |
$122.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.08
|
| Rate for Payer: Priority Health Narrow Network |
$104.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.65
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 65162036110
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: ASR ASR |
$182.36
|
| Rate for Payer: BCBS Trust/PPO |
$154.39
|
| Rate for Payer: BCN Commercial |
$154.39
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$176.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$182.36
|
| Rate for Payer: Healthscope Whirlpool |
$188.00
|
| Rate for Payer: Mclaren Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.44
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
NDC 69315012701
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: ASR ASR |
$162.96
|
| Rate for Payer: BCBS Trust/PPO |
$137.96
|
| Rate for Payer: BCN Commercial |
$137.96
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$157.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Healthscope Commercial |
$162.96
|
| Rate for Payer: Healthscope Whirlpool |
$168.00
|
| Rate for Payer: Mclaren Commercial |
$151.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.80
|
| Rate for Payer: Nomi Health Commercial |
$137.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.84
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
NDC 69315012701
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.16 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Medicare |
$62.16
|
| Rate for Payer: ASR ASR |
$162.96
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS Trust/PPO |
$138.52
|
| Rate for Payer: BCN Commercial |
$138.52
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$157.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Healthscope Commercial |
$162.96
|
| Rate for Payer: Healthscope Whirlpool |
$168.00
|
| Rate for Payer: Mclaren Commercial |
$151.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.80
|
| Rate for Payer: Nomi Health Commercial |
$137.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$147.20
|
| Rate for Payer: Priority Health Narrow Network |
$117.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.84
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 65162036110
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.56 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Medicare |
$69.56
|
| Rate for Payer: ASR ASR |
$182.36
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS Trust/PPO |
$155.01
|
| Rate for Payer: BCN Commercial |
$155.01
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$176.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$182.36
|
| Rate for Payer: Healthscope Whirlpool |
$188.00
|
| Rate for Payer: Mclaren Commercial |
$169.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$164.73
|
| Rate for Payer: Priority Health Narrow Network |
$131.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.44
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$149.60
|
|
|
Service Code
|
NDC 904722461
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$149.60 |
| Rate for Payer: Aetna Commercial |
$134.64
|
| Rate for Payer: ASR ASR |
$145.11
|
| Rate for Payer: BCBS Trust/PPO |
$122.85
|
| Rate for Payer: BCN Commercial |
$122.85
|
| Rate for Payer: Cash Price |
$119.68
|
| Rate for Payer: Cofinity Commercial |
$140.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.68
|
| Rate for Payer: Healthscope Commercial |
$145.11
|
| Rate for Payer: Healthscope Whirlpool |
$149.60
|
| Rate for Payer: Mclaren Commercial |
$134.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.16
|
| Rate for Payer: Nomi Health Commercial |
$122.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.65
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
HCPCS J1808
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.84 |
| Max. Negotiated Rate |
$206.46 |
| Rate for Payer: Aetna Commercial |
$185.81
|
| Rate for Payer: Aetna Commercial |
$142.72
|
| Rate for Payer: ASR ASR |
$153.82
|
| Rate for Payer: ASR ASR |
$200.27
|
| Rate for Payer: BCBS Trust/PPO |
$130.23
|
| Rate for Payer: BCBS Trust/PPO |
$169.54
|
| Rate for Payer: BCN Commercial |
$130.23
|
| Rate for Payer: BCN Commercial |
$169.54
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cash Price |
$126.87
|
| Rate for Payer: Cofinity Commercial |
$194.07
|
| Rate for Payer: Cofinity Commercial |
$149.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$153.82
|
| Rate for Payer: Healthscope Commercial |
$200.27
|
| Rate for Payer: Healthscope Whirlpool |
$206.46
|
| Rate for Payer: Healthscope Whirlpool |
$158.58
|
| Rate for Payer: Mclaren Commercial |
$185.81
|
| Rate for Payer: Mclaren Commercial |
$142.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.79
|
| Rate for Payer: Nomi Health Commercial |
$169.30
|
| Rate for Payer: Nomi Health Commercial |
$130.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.55
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$206.46
|
|
|
Service Code
|
HCPCS J1808
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.39 |
| Max. Negotiated Rate |
$206.46 |
| Rate for Payer: Aetna Commercial |
$185.81
|
| Rate for Payer: Aetna Commercial |
$142.72
|
| Rate for Payer: Aetna Medicare |
$58.68
|
| Rate for Payer: Aetna Medicare |
$76.39
|
| Rate for Payer: ASR ASR |
$153.82
|
| Rate for Payer: ASR ASR |
$200.27
|
| Rate for Payer: BCBS Complete |
$63.43
|
| Rate for Payer: BCBS Complete |
$82.58
|
| Rate for Payer: BCBS Trust/PPO |
$130.75
|
| Rate for Payer: BCBS Trust/PPO |
$170.23
|
| Rate for Payer: BCN Commercial |
$130.75
|
| Rate for Payer: BCN Commercial |
$170.23
|
| Rate for Payer: Cash Price |
$126.87
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$149.07
|
| Rate for Payer: Cofinity Commercial |
$194.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.87
|
| Rate for Payer: Healthscope Commercial |
$200.27
|
| Rate for Payer: Healthscope Commercial |
$153.82
|
| Rate for Payer: Healthscope Whirlpool |
$158.58
|
| Rate for Payer: Healthscope Whirlpool |
$206.46
|
| Rate for Payer: Mclaren Commercial |
$142.72
|
| Rate for Payer: Mclaren Commercial |
$185.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.79
|
| Rate for Payer: Nomi Health Commercial |
$169.30
|
| Rate for Payer: Nomi Health Commercial |
$130.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$138.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$180.90
|
| Rate for Payer: Priority Health Narrow Network |
$111.17
|
| Rate for Payer: Priority Health Narrow Network |
$144.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.68
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$8,540.46
|
|
|
Service Code
|
APR-DRG 3142
|
| Min. Negotiated Rate |
$7,721.59 |
| Max. Negotiated Rate |
$8,540.46 |
| Rate for Payer: BCBS Complete |
$8,540.46
|
| Rate for Payer: Mclaren Medicaid |
$8,133.77
|
| Rate for Payer: Meridian Medicaid |
$8,540.46
|
| Rate for Payer: PHP Medicaid |
$7,721.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,133.77
|
| Rate for Payer: UHC Medicaid |
$8,133.77
|
| Rate for Payer: UHCCP Medicaid |
$8,133.77
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$11,833.59
|
|
|
Service Code
|
APR-DRG 3143
|
| Min. Negotiated Rate |
$10,698.98 |
| Max. Negotiated Rate |
$11,833.59 |
| Rate for Payer: BCBS Complete |
$11,833.59
|
| Rate for Payer: Mclaren Medicaid |
$11,270.08
|
| Rate for Payer: Meridian Medicaid |
$11,833.59
|
| Rate for Payer: PHP Medicaid |
$10,698.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,270.08
|
| Rate for Payer: UHC Medicaid |
$11,270.08
|
| Rate for Payer: UHCCP Medicaid |
$11,270.08
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$6,023.33
|
|
|
Service Code
|
APR-DRG 3141
|
| Min. Negotiated Rate |
$5,445.81 |
| Max. Negotiated Rate |
$6,023.33 |
| Rate for Payer: BCBS Complete |
$6,023.33
|
| Rate for Payer: Mclaren Medicaid |
$5,736.51
|
| Rate for Payer: Meridian Medicaid |
$6,023.33
|
| Rate for Payer: PHP Medicaid |
$5,445.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,736.51
|
| Rate for Payer: UHC Medicaid |
$5,736.51
|
| Rate for Payer: UHCCP Medicaid |
$5,736.51
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$15,943.06
|
|
|
Service Code
|
APR-DRG 3144
|
| Min. Negotiated Rate |
$14,414.43 |
| Max. Negotiated Rate |
$15,943.06 |
| Rate for Payer: BCBS Complete |
$15,943.06
|
| Rate for Payer: Mclaren Medicaid |
$15,183.86
|
| Rate for Payer: Meridian Medicaid |
$15,943.06
|
| Rate for Payer: PHP Medicaid |
$14,414.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,183.86
|
| Rate for Payer: UHC Medicaid |
$15,183.86
|
| Rate for Payer: UHCCP Medicaid |
$15,183.86
|
|
|
FOOT PROCEDURES WITH CC
|
Facility
|
IP
|
$25,680.56
|
|
|
Service Code
|
MSDRG 504
|
| Min. Negotiated Rate |
$14,454.27 |
| Max. Negotiated Rate |
$25,680.56 |
| Rate for Payer: Aetna Medicare |
$15,215.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,018.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,018.78
|
| Rate for Payer: BCBS MAPPO |
$15,215.02
|
| Rate for Payer: BCN Medicare Advantage |
$15,215.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,215.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,215.02
|
| Rate for Payer: Mclaren Medicare |
$15,215.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,975.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,497.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,736.52
|
| Rate for Payer: PACE Medicare |
$14,454.27
|
| Rate for Payer: PACE SWMI |
$15,215.02
|
| Rate for Payer: PHP Commercial |
$16,736.52
|
| Rate for Payer: PHP Medicare Advantage |
$15,215.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25,680.56
|
| Rate for Payer: Priority Health Medicare |
$15,215.02
|
| Rate for Payer: Priority Health Narrow Network |
$20,544.45
|
| Rate for Payer: Railroad Medicare Medicare |
$15,215.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,215.02
|
| Rate for Payer: UHC Exchange |
$23,583.28
|
| Rate for Payer: UHCCP DNSP |
$15,215.02
|
| Rate for Payer: VA VA |
$15,215.02
|
|
