|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$4.58
|
|
|
Service Code
|
NDC 17238-900-99
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: ASR ASR |
$4.44
|
| Rate for Payer: BCBS Trust/PPO |
$3.55
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.66
|
| Rate for Payer: Healthscope Commercial |
$4.58
|
| Rate for Payer: Healthscope Whirlpool |
$4.44
|
| Rate for Payer: Mclaren Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.03
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$548.20
|
|
|
Service Code
|
NDC 11980-211-05
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$383.74 |
| Max. Negotiated Rate |
$548.20 |
| Rate for Payer: Aetna Commercial |
$493.38
|
| Rate for Payer: ASR ASR |
$531.75
|
| Rate for Payer: BCBS Trust/PPO |
$425.02
|
| Rate for Payer: BCN Commercial |
$425.02
|
| Rate for Payer: Cash Price |
$438.56
|
| Rate for Payer: Cofinity Commercial |
$515.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.56
|
| Rate for Payer: Healthscope Commercial |
$548.20
|
| Rate for Payer: Healthscope Whirlpool |
$531.75
|
| Rate for Payer: Mclaren Commercial |
$493.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$465.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$482.42
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$19.04
|
|
|
Service Code
|
NDC 0904-5784-61
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Aetna Commercial |
$17.14
|
| Rate for Payer: ASR ASR |
$18.47
|
| Rate for Payer: BCBS Trust/PPO |
$14.76
|
| Rate for Payer: BCN Commercial |
$14.76
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: Healthscope Whirlpool |
$18.47
|
| Rate for Payer: Mclaren Commercial |
$17.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.76
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$20.68
|
|
|
Service Code
|
NDC 0904-5785-61
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: Aetna Commercial |
$18.61
|
| Rate for Payer: ASR ASR |
$20.06
|
| Rate for Payer: BCBS Trust/PPO |
$16.03
|
| Rate for Payer: BCN Commercial |
$16.03
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cofinity Commercial |
$19.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$20.68
|
| Rate for Payer: Healthscope Whirlpool |
$20.06
|
| Rate for Payer: Mclaren Commercial |
$18.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.20
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
IP
|
$1,080.40
|
|
|
Service Code
|
NDC 0527-1790-01
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$756.28 |
| Max. Negotiated Rate |
$1,080.40 |
| Rate for Payer: Aetna Commercial |
$972.36
|
| Rate for Payer: ASR ASR |
$1,047.99
|
| Rate for Payer: BCBS Trust/PPO |
$837.63
|
| Rate for Payer: BCN Commercial |
$837.63
|
| Rate for Payer: Cash Price |
$864.32
|
| Rate for Payer: Cofinity Commercial |
$1,015.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$864.32
|
| Rate for Payer: Healthscope Commercial |
$1,080.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,047.99
|
| Rate for Payer: Mclaren Commercial |
$972.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$918.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$950.75
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
3215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$292.50
|
| Rate for Payer: ASR ASR |
$315.25
|
| Rate for Payer: BCBS Trust/PPO |
$251.97
|
| Rate for Payer: BCN Commercial |
$251.97
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$305.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.00
|
| Rate for Payer: Healthscope Commercial |
$325.00
|
| Rate for Payer: Healthscope Whirlpool |
$315.25
|
| Rate for Payer: Mclaren Commercial |
$292.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$286.00
|
|
|
FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$316.68
|
|
|
Service Code
|
NDC 0173-0874-14
|
| Hospital Charge Code |
173282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.68 |
| Max. Negotiated Rate |
$316.68 |
| Rate for Payer: Aetna Commercial |
$285.01
|
| Rate for Payer: ASR ASR |
$307.18
|
| Rate for Payer: BCBS Trust/PPO |
$245.52
|
| Rate for Payer: BCN Commercial |
$245.52
|
| Rate for Payer: Cash Price |
$253.34
|
| Rate for Payer: Cofinity Commercial |
$297.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.34
|
| Rate for Payer: Healthscope Commercial |
$316.68
|
| Rate for Payer: Healthscope Whirlpool |
$307.18
|
| Rate for Payer: Mclaren Commercial |
$285.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$269.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$278.68
|
|
|
FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$423.99
|
|
|
Service Code
|
NDC 0173-0876-14
|
| Hospital Charge Code |
173283
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.79 |
| Max. Negotiated Rate |
$423.99 |
| Rate for Payer: Aetna Commercial |
$381.59
|
| Rate for Payer: ASR ASR |
$411.27
|
| Rate for Payer: BCBS Trust/PPO |
$328.72
|
| Rate for Payer: BCN Commercial |
$328.72
|
| Rate for Payer: Cash Price |
$339.19
|
| Rate for Payer: Cofinity Commercial |
$398.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.19
|
| Rate for Payer: Healthscope Commercial |
$423.99
|
| Rate for Payer: Healthscope Whirlpool |
$411.27
|
| Rate for Payer: Mclaren Commercial |
$381.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$360.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.11
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$36.57
|
|
|
Service Code
|
NDC 0054-3270-99
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.60 |
| 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 |
$28.35
|
| Rate for Payer: BCN Commercial |
$28.35
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cofinity Commercial |
$34.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Healthscope Commercial |
$36.57
|
| Rate for Payer: Healthscope Whirlpool |
$35.47
|
| Rate for Payer: Mclaren Commercial |
$32.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.18
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
NDC 50383-700-16
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.72 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$32.91
|
| Rate for Payer: BCN Commercial |
$32.91
|
| 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 |
$42.45
|
| Rate for Payer: Healthscope Whirlpool |
$41.18
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$36.01
|
|
|
Service Code
|
NDC 60432-264-15
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.21 |
| 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 |
$27.92
|
| Rate for Payer: BCN Commercial |
$27.92
|
| 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 |
$36.01
|
| Rate for Payer: Healthscope Whirlpool |
$34.93
|
| Rate for Payer: Mclaren Commercial |
$32.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.69
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$19.80
|
|
|
Service Code
|
NDC 60505-0829-1
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Aetna Commercial |
$17.82
|
| Rate for Payer: ASR ASR |
$19.21
|
| Rate for Payer: BCBS Trust/PPO |
$15.35
|
| Rate for Payer: BCN Commercial |
$15.35
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.84
|
| Rate for Payer: Healthscope Commercial |
$19.80
|
| Rate for Payer: Healthscope Whirlpool |
$19.21
|
| Rate for Payer: Mclaren Commercial |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.42
|
|
|
FLU VACCINE QS2023-24(65YR UP)(PF)240 MCG/0.7 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$222.08
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
204599
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.46 |
| Max. Negotiated Rate |
$222.08 |
| Rate for Payer: Aetna Commercial |
$199.87
|
| Rate for Payer: ASR ASR |
$215.42
|
| Rate for Payer: BCBS Trust/PPO |
$172.18
|
| Rate for Payer: BCN Commercial |
$172.18
|
| Rate for Payer: Cash Price |
$177.67
|
| Rate for Payer: Cofinity Commercial |
$208.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.66
|
| Rate for Payer: Healthscope Commercial |
$222.08
|
| Rate for Payer: Healthscope Whirlpool |
$215.42
|
| Rate for Payer: Mclaren Commercial |
$199.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.43
|
|
|
FLU VACCINE QS 2023-24(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE
|
Facility
|
IP
|
$83.74
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
204598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.62 |
| Max. Negotiated Rate |
$83.74 |
| Rate for Payer: Aetna Commercial |
$75.37
|
| Rate for Payer: ASR ASR |
$81.23
|
| Rate for Payer: BCBS Trust/PPO |
$64.92
|
| Rate for Payer: BCN Commercial |
$64.92
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$78.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Healthscope Commercial |
$83.74
|
| Rate for Payer: Healthscope Whirlpool |
$81.23
|
| Rate for Payer: Mclaren Commercial |
$75.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.69
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
NDC 50268-345-11
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$2.34
|
| Rate for Payer: ASR ASR |
$2.52
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Healthscope Whirlpool |
$2.52
|
| Rate for Payer: Mclaren Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.29
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$135.30
|
|
|
Service Code
|
NDC 0904-7224-61
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.71 |
| Max. Negotiated Rate |
$135.30 |
| Rate for Payer: Aetna Commercial |
$121.77
|
| Rate for Payer: ASR ASR |
$131.24
|
| Rate for Payer: BCBS Trust/PPO |
$104.90
|
| Rate for Payer: BCN Commercial |
$104.90
|
| Rate for Payer: Cash Price |
$108.24
|
| Rate for Payer: Cofinity Commercial |
$127.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.24
|
| Rate for Payer: Healthscope Commercial |
$135.30
|
| Rate for Payer: Healthscope Whirlpool |
$131.24
|
| Rate for Payer: Mclaren Commercial |
$121.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.06
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
NDC 69315-127-01
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Trust/PPO |
$124.05
|
| Rate for Payer: BCN Commercial |
$124.05
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$160.00
|
| Rate for Payer: Healthscope Whirlpool |
$155.20
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 65162-361-10
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.60 |
| 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 |
$145.76
|
| Rate for Payer: BCN Commercial |
$145.76
|
| 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 |
$188.00
|
| Rate for Payer: Healthscope Whirlpool |
$182.36
|
| Rate for Payer: Mclaren Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.44
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
NDC 50268-345-15
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: ASR ASR |
$126.10
|
| Rate for Payer: BCBS Trust/PPO |
$100.79
|
| Rate for Payer: BCN Commercial |
$100.79
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cofinity Commercial |
$122.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.00
|
| Rate for Payer: Healthscope Commercial |
$130.00
|
| Rate for Payer: Healthscope Whirlpool |
$126.10
|
| Rate for Payer: Mclaren Commercial |
$117.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.40
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 62584-897-11
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$1.35
|
| Rate for Payer: ASR ASR |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.20
|
| Rate for Payer: Healthscope Commercial |
$1.50
|
| Rate for Payer: Healthscope Whirlpool |
$1.46
|
| Rate for Payer: Mclaren Commercial |
$1.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.32
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$203.54
|
|
|
Service Code
|
NDC 63323-184-10
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$203.54 |
| Rate for Payer: Aetna Commercial |
$183.19
|
| Rate for Payer: ASR ASR |
$197.43
|
| Rate for Payer: BCBS Trust/PPO |
$157.80
|
| Rate for Payer: BCN Commercial |
$157.80
|
| Rate for Payer: Cash Price |
$162.83
|
| Rate for Payer: Cofinity Commercial |
$191.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.83
|
| Rate for Payer: Healthscope Commercial |
$203.54
|
| Rate for Payer: Healthscope Whirlpool |
$197.43
|
| Rate for Payer: Mclaren Commercial |
$183.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.12
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$283.18
|
|
|
Service Code
|
NDC 39822-1100-1
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$198.23 |
| Max. Negotiated Rate |
$283.18 |
| Rate for Payer: Aetna Commercial |
$254.86
|
| Rate for Payer: ASR ASR |
$274.68
|
| Rate for Payer: BCBS Trust/PPO |
$219.55
|
| Rate for Payer: BCN Commercial |
$219.55
|
| Rate for Payer: Cash Price |
$226.55
|
| Rate for Payer: Cofinity Commercial |
$266.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.54
|
| Rate for Payer: Healthscope Commercial |
$283.18
|
| Rate for Payer: Healthscope Whirlpool |
$274.68
|
| Rate for Payer: Mclaren Commercial |
$254.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$240.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.20
|
|
|
FOOT PROCEDURES WITH CC
|
Facility
|
IP
|
$22,175.96
|
|
|
Service Code
|
MS-DRG 504
|
| Min. Negotiated Rate |
$15,488.10 |
| Max. Negotiated Rate |
$22,175.96 |
| Rate for Payer: Aetna Medicare |
$16,303.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,379.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,379.08
|
| Rate for Payer: BCBS MAPPO |
$16,303.26
|
| Rate for Payer: BCN Medicare Advantage |
$16,303.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,303.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,303.26
|
| Rate for Payer: Mclaren Medicare |
$16,303.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,118.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,748.75
|
| Rate for Payer: PACE Medicare |
$15,488.10
|
| Rate for Payer: PACE SWMI |
$16,303.26
|
| Rate for Payer: PHP Commercial |
$17,933.59
|
| Rate for Payer: PHP Medicare Advantage |
$16,303.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,175.96
|
| Rate for Payer: Priority Health Medicare |
$16,303.26
|
| Rate for Payer: Priority Health Narrow Network |
$17,740.77
|
| Rate for Payer: Railroad Medicare Medicare |
$16,303.26
|
| Rate for Payer: UHC Medicare Advantage |
$16,792.36
|
| Rate for Payer: VA VA |
$16,303.26
|
|
|
FOOT PROCEDURES WITH MCC
|
Facility
|
IP
|
$34,435.60
|
|
|
Service Code
|
MS-DRG 503
|
| Min. Negotiated Rate |
$23,167.61 |
| Max. Negotiated Rate |
$34,435.60 |
| Rate for Payer: Aetna Medicare |
$24,386.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,483.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,483.70
|
| Rate for Payer: BCBS MAPPO |
$24,386.96
|
| Rate for Payer: BCN Medicare Advantage |
$24,386.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,386.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,386.96
|
| Rate for Payer: Mclaren Medicare |
$24,386.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,606.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,045.00
|
| Rate for Payer: PACE Medicare |
$23,167.61
|
| Rate for Payer: PACE SWMI |
$24,386.96
|
| Rate for Payer: PHP Commercial |
$26,825.66
|
| Rate for Payer: PHP Medicare Advantage |
$24,386.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,435.60
|
| Rate for Payer: Priority Health Medicare |
$24,386.96
|
| Rate for Payer: Priority Health Narrow Network |
$27,548.48
|
| Rate for Payer: Railroad Medicare Medicare |
$24,386.96
|
| Rate for Payer: UHC Medicare Advantage |
$25,118.57
|
| Rate for Payer: VA VA |
$24,386.96
|
|
|
FOOT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$21,901.19
|
|
|
Service Code
|
MS-DRG 505
|
| Min. Negotiated Rate |
$15,315.98 |
| Max. Negotiated Rate |
$21,901.19 |
| Rate for Payer: Aetna Medicare |
$16,122.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,152.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,152.60
|
| Rate for Payer: BCBS MAPPO |
$16,122.08
|
| Rate for Payer: BCN Medicare Advantage |
$16,122.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,122.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,122.08
|
| Rate for Payer: Mclaren Medicare |
$16,122.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,928.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,540.39
|
| Rate for Payer: PACE Medicare |
$15,315.98
|
| Rate for Payer: PACE SWMI |
$16,122.08
|
| Rate for Payer: PHP Commercial |
$17,734.29
|
| Rate for Payer: PHP Medicare Advantage |
$16,122.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,901.19
|
| Rate for Payer: Priority Health Medicare |
$16,122.08
|
| Rate for Payer: Priority Health Narrow Network |
$17,520.95
|
| Rate for Payer: Railroad Medicare Medicare |
$16,122.08
|
| Rate for Payer: UHC Medicare Advantage |
$16,605.74
|
| Rate for Payer: VA VA |
$16,122.08
|
|
