|
PSYLLIUM ORAL PACKET
|
Facility
|
IP
|
$72.66
|
|
|
Service Code
|
NDC 38485080857
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.78 |
| Max. Negotiated Rate |
$65.39 |
| Rate for Payer: Aetna Commercial |
$61.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.23
|
| Rate for Payer: Cash Price |
$58.13
|
| Rate for Payer: Cofinity Advantage |
$50.86
|
| Rate for Payer: Cofinity Commercial |
$62.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.13
|
| Rate for Payer: Healthscope Commercial |
$65.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.49
|
| Rate for Payer: PHP Commercial |
$61.76
|
| Rate for Payer: Priority Health SBD |
$45.78
|
|
|
PULMONARY EDEMA AND RESPIRATORY FAILURE
|
Facility
|
IP
|
$20,137.02
|
|
|
Service Code
|
MSDRG 189
|
| Min. Negotiated Rate |
$9,620.13 |
| Max. Negotiated Rate |
$20,137.02 |
| Rate for Payer: Aetna Medicare |
$10,531.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,658.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,658.06
|
| Rate for Payer: BCBS MAPPO |
$10,126.45
|
| Rate for Payer: BCBS Trust/PPO |
$19,440.34
|
| Rate for Payer: BCN Commercial |
$19,440.34
|
| Rate for Payer: BCN Medicare Advantage |
$10,126.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,126.45
|
| Rate for Payer: Mclaren Medicare |
$10,126.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,632.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,645.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,139.09
|
| Rate for Payer: Nomi Health Commercial |
$15,936.66
|
| Rate for Payer: PACE Medicare |
$9,620.13
|
| Rate for Payer: PACE SWMI |
$10,126.45
|
| Rate for Payer: PHP Medicare Advantage |
$10,126.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,917.29
|
| Rate for Payer: Priority Health Medicare |
$10,126.45
|
| Rate for Payer: Priority Health Tiered Network |
$15,933.83
|
| Rate for Payer: Railroad Medicare Medicare |
$10,126.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,137.02
|
| Rate for Payer: UHC Core |
$16,847.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,126.45
|
| Rate for Payer: UHC Exchange |
$13,758.65
|
| Rate for Payer: VA VA |
$10,126.45
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$6,818.83
|
|
|
Service Code
|
APR-DRG 1343
|
| Min. Negotiated Rate |
$6,494.12 |
| Max. Negotiated Rate |
$6,818.83 |
| Rate for Payer: BCBS Complete |
$6,818.83
|
| Rate for Payer: Mclaren Medicaid |
$6,494.12
|
| Rate for Payer: Meridian Medicaid |
$6,818.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,494.12
|
| Rate for Payer: UHC Medicaid |
$6,494.12
|
| Rate for Payer: UHCCP Medicaid |
$6,494.12
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$4,315.23
|
|
|
Service Code
|
APR-DRG 1342
|
| Min. Negotiated Rate |
$4,109.74 |
| Max. Negotiated Rate |
$4,315.23 |
| Rate for Payer: BCBS Complete |
$4,315.23
|
| Rate for Payer: Mclaren Medicaid |
$4,109.74
|
| Rate for Payer: Meridian Medicaid |
$4,315.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,109.74
|
| Rate for Payer: UHC Medicaid |
$4,109.74
|
| Rate for Payer: UHCCP Medicaid |
$4,109.74
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$11,310.06
|
|
|
Service Code
|
APR-DRG 1344
|
| Min. Negotiated Rate |
$10,771.49 |
| Max. Negotiated Rate |
$11,310.06 |
| Rate for Payer: BCBS Complete |
$11,310.06
|
| Rate for Payer: Mclaren Medicaid |
$10,771.49
|
| Rate for Payer: Meridian Medicaid |
$11,310.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,771.49
|
| Rate for Payer: UHC Medicaid |
$10,771.49
|
| Rate for Payer: UHCCP Medicaid |
$10,771.49
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$3,412.85
|
|
|
Service Code
|
APR-DRG 1341
|
| Min. Negotiated Rate |
$3,250.34 |
| Max. Negotiated Rate |
$3,412.85 |
| Rate for Payer: BCBS Complete |
$3,412.85
|
| Rate for Payer: Mclaren Medicaid |
$3,250.34
|
| Rate for Payer: Meridian Medicaid |
$3,412.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,250.34
|
| Rate for Payer: UHC Medicaid |
$3,250.34
|
| Rate for Payer: UHCCP Medicaid |
$3,250.34
|
|
|
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE
|
Facility
|
IP
|
$24,470.72
|
|
|
Service Code
|
MSDRG 175
|
| Min. Negotiated Rate |
$10,634.77 |
| Max. Negotiated Rate |
$24,470.72 |
| Rate for Payer: Aetna Medicare |
$11,642.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,993.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,993.11
|
| Rate for Payer: BCBS MAPPO |
$11,194.49
|
| Rate for Payer: BCBS Trust/PPO |
$24,470.72
|
| Rate for Payer: BCN Commercial |
$24,470.72
|
| Rate for Payer: BCN Medicare Advantage |
$11,194.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,194.49
|
| Rate for Payer: Mclaren Medicare |
$11,194.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,754.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,873.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,313.94
|
| Rate for Payer: Nomi Health Commercial |
$17,719.44
|
| Rate for Payer: PACE Medicare |
$10,634.77
|
| Rate for Payer: PACE SWMI |
$11,194.49
|
| Rate for Payer: PHP Medicare Advantage |
$11,194.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,145.37
|
| Rate for Payer: Priority Health Medicare |
$11,194.49
|
| Rate for Payer: Priority Health Tiered Network |
$17,716.29
|
| Rate for Payer: Railroad Medicare Medicare |
$11,194.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,389.68
|
| Rate for Payer: UHC Core |
$18,731.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,194.49
|
| Rate for Payer: UHC Exchange |
$15,297.78
|
| Rate for Payer: VA VA |
$11,194.49
|
|
|
PULMONARY EMBOLISM WITHOUT MCC
|
Facility
|
IP
|
$14,021.39
|
|
|
Service Code
|
MSDRG 176
|
| Min. Negotiated Rate |
$6,460.22 |
| Max. Negotiated Rate |
$14,021.39 |
| Rate for Payer: Aetna Medicare |
$7,072.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,500.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,500.29
|
| Rate for Payer: BCBS MAPPO |
$6,800.23
|
| Rate for Payer: BCBS Trust/PPO |
$14,021.39
|
| Rate for Payer: BCN Commercial |
$14,021.39
|
| Rate for Payer: BCN Medicare Advantage |
$6,800.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,800.23
|
| Rate for Payer: Mclaren Medicare |
$6,800.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,140.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,820.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,480.25
|
| Rate for Payer: Nomi Health Commercial |
$10,384.50
|
| Rate for Payer: PACE Medicare |
$6,460.22
|
| Rate for Payer: PACE SWMI |
$6,800.23
|
| Rate for Payer: PHP Medicare Advantage |
$6,800.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,978.32
|
| Rate for Payer: Priority Health Medicare |
$6,800.23
|
| Rate for Payer: Priority Health Tiered Network |
$10,382.66
|
| Rate for Payer: Railroad Medicare Medicare |
$6,800.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,121.50
|
| Rate for Payer: UHC Core |
$10,977.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,800.23
|
| Rate for Payer: UHC Exchange |
$8,965.28
|
| Rate for Payer: VA VA |
$6,800.23
|
|
|
PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST
|
Facility
|
OP
|
$1,309.90
|
|
|
Service Code
|
CPT 10160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$214.05
|
| Rate for Payer: BCN Commercial |
$214.05
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
PUNCTURE ASPIRATION OF CYST OF BREAST;
|
Facility
|
OP
|
$2,281.79
|
|
|
Service Code
|
CPT 19000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$535.08
|
| Rate for Payer: BCCCP Commercial |
$92.31
|
| Rate for Payer: BCN Commercial |
$535.08
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Mclaren Medicaid |
$369.02
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$948.17
|
|
|
Service Code
|
NDC 61748001206
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$597.35 |
| Max. Negotiated Rate |
$853.35 |
| Rate for Payer: Aetna Commercial |
$805.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.31
|
| Rate for Payer: Cash Price |
$758.54
|
| Rate for Payer: Cofinity Advantage |
$663.72
|
| Rate for Payer: Cofinity Commercial |
$815.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.54
|
| Rate for Payer: Healthscope Commercial |
$853.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$805.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$711.13
|
| Rate for Payer: PHP Commercial |
$805.94
|
| Rate for Payer: Priority Health SBD |
$597.35
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$969.03
|
|
|
Service Code
|
NDC 70954048430
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$610.49 |
| Max. Negotiated Rate |
$872.13 |
| Rate for Payer: Aetna Commercial |
$823.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.87
|
| Rate for Payer: Cash Price |
$775.22
|
| Rate for Payer: Cofinity Advantage |
$678.32
|
| Rate for Payer: Cofinity Commercial |
$833.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.22
|
| Rate for Payer: Healthscope Commercial |
$872.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$726.77
|
| Rate for Payer: PHP Commercial |
$823.68
|
| Rate for Payer: Priority Health SBD |
$610.49
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
OP
|
$969.03
|
|
|
Service Code
|
NDC 70954048430
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$380.83 |
| Max. Negotiated Rate |
$872.13 |
| Rate for Payer: Aetna Commercial |
$823.68
|
| Rate for Payer: Aetna Medicare |
$484.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.87
|
| Rate for Payer: BCBS Complete |
$387.61
|
| Rate for Payer: Cash Price |
$775.22
|
| Rate for Payer: Cofinity Advantage |
$678.32
|
| Rate for Payer: Cofinity Commercial |
$833.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.22
|
| Rate for Payer: Healthscope Commercial |
$872.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$775.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$726.77
|
| Rate for Payer: PHP Commercial |
$823.68
|
| Rate for Payer: Priority Health SBD |
$610.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$629.87
|
| Rate for Payer: UHC Core |
$504.86
|
| Rate for Payer: UHC Exchange |
$380.83
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$1,540.31
|
|
|
Service Code
|
NDC 61748001201
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$970.40 |
| Max. Negotiated Rate |
$1,386.28 |
| Rate for Payer: Aetna Commercial |
$1,309.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,001.20
|
| Rate for Payer: Cash Price |
$1,232.25
|
| Rate for Payer: Cofinity Advantage |
$1,078.22
|
| Rate for Payer: Cofinity Commercial |
$1,324.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,232.25
|
| Rate for Payer: Healthscope Commercial |
$1,386.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,309.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,155.23
|
| Rate for Payer: PHP Commercial |
$1,309.26
|
| Rate for Payer: Priority Health SBD |
$970.40
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
OP
|
$1,540.31
|
|
|
Service Code
|
NDC 61748001201
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$605.34 |
| Max. Negotiated Rate |
$1,386.28 |
| Rate for Payer: Aetna Commercial |
$1,309.26
|
| Rate for Payer: Aetna Medicare |
$770.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,001.20
|
| Rate for Payer: BCBS Complete |
$616.12
|
| Rate for Payer: Cash Price |
$1,232.25
|
| Rate for Payer: Cofinity Advantage |
$1,078.22
|
| Rate for Payer: Cofinity Commercial |
$1,324.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,232.25
|
| Rate for Payer: Healthscope Commercial |
$1,386.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,232.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,309.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,155.23
|
| Rate for Payer: PHP Commercial |
$1,309.26
|
| Rate for Payer: Priority Health SBD |
$970.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,001.20
|
| Rate for Payer: UHC Core |
$802.50
|
| Rate for Payer: UHC Exchange |
$605.34
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
OP
|
$948.17
|
|
|
Service Code
|
NDC 61748001206
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$372.63 |
| Max. Negotiated Rate |
$853.35 |
| Rate for Payer: Aetna Commercial |
$805.94
|
| Rate for Payer: Aetna Medicare |
$474.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.31
|
| Rate for Payer: BCBS Complete |
$379.27
|
| Rate for Payer: Cash Price |
$758.54
|
| Rate for Payer: Cofinity Advantage |
$663.72
|
| Rate for Payer: Cofinity Commercial |
$815.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.54
|
| Rate for Payer: Healthscope Commercial |
$853.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$758.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$805.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$711.13
|
| Rate for Payer: PHP Commercial |
$805.94
|
| Rate for Payer: Priority Health SBD |
$597.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$616.31
|
| Rate for Payer: UHC Core |
$494.00
|
| Rate for Payer: UHC Exchange |
$372.63
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$124.60
|
|
|
Service Code
|
NDC 00781304072
|
| Hospital Charge Code |
11237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.50 |
| Max. Negotiated Rate |
$112.14 |
| Rate for Payer: Aetna Commercial |
$105.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.99
|
| Rate for Payer: Cash Price |
$99.68
|
| Rate for Payer: Cofinity Advantage |
$87.22
|
| Rate for Payer: Cofinity Commercial |
$107.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.68
|
| Rate for Payer: Healthscope Commercial |
$112.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.45
|
| Rate for Payer: PHP Commercial |
$105.91
|
| Rate for Payer: Priority Health SBD |
$78.50
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$124.60
|
|
|
Service Code
|
NDC 00781304072
|
| Hospital Charge Code |
11237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.97 |
| Max. Negotiated Rate |
$112.14 |
| Rate for Payer: Aetna Commercial |
$105.91
|
| Rate for Payer: Aetna Medicare |
$62.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.99
|
| Rate for Payer: BCBS Complete |
$49.84
|
| Rate for Payer: Cash Price |
$99.68
|
| Rate for Payer: Cofinity Advantage |
$87.22
|
| Rate for Payer: Cofinity Commercial |
$107.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.68
|
| Rate for Payer: Healthscope Commercial |
$112.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.45
|
| Rate for Payer: PHP Commercial |
$105.91
|
| Rate for Payer: Priority Health SBD |
$78.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.99
|
| Rate for Payer: UHC Core |
$64.92
|
| Rate for Payer: UHC Exchange |
$48.97
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$124.60
|
|
|
Service Code
|
NDC 00781304095
|
| Hospital Charge Code |
11237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.50 |
| Max. Negotiated Rate |
$112.14 |
| Rate for Payer: Aetna Commercial |
$105.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.99
|
| Rate for Payer: Cash Price |
$99.68
|
| Rate for Payer: Cofinity Advantage |
$87.22
|
| Rate for Payer: Cofinity Commercial |
$107.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.68
|
| Rate for Payer: Healthscope Commercial |
$112.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.45
|
| Rate for Payer: PHP Commercial |
$105.91
|
| Rate for Payer: Priority Health SBD |
$78.50
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$124.60
|
|
|
Service Code
|
NDC 00781304095
|
| Hospital Charge Code |
11237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.97 |
| Max. Negotiated Rate |
$112.14 |
| Rate for Payer: Aetna Commercial |
$105.91
|
| Rate for Payer: Aetna Medicare |
$62.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.99
|
| Rate for Payer: BCBS Complete |
$49.84
|
| Rate for Payer: Cash Price |
$99.68
|
| Rate for Payer: Cofinity Advantage |
$87.22
|
| Rate for Payer: Cofinity Commercial |
$107.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.68
|
| Rate for Payer: Healthscope Commercial |
$112.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.45
|
| Rate for Payer: PHP Commercial |
$105.91
|
| Rate for Payer: Priority Health SBD |
$78.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.99
|
| Rate for Payer: UHC Core |
$64.92
|
| Rate for Payer: UHC Exchange |
$48.97
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
IP
|
$494.88
|
|
|
Service Code
|
NDC 00904662261
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$311.77 |
| Max. Negotiated Rate |
$445.39 |
| Rate for Payer: Aetna Commercial |
$420.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.67
|
| Rate for Payer: Cash Price |
$395.90
|
| Rate for Payer: Cofinity Advantage |
$346.42
|
| Rate for Payer: Cofinity Commercial |
$425.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.90
|
| Rate for Payer: Healthscope Commercial |
$445.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.16
|
| Rate for Payer: PHP Commercial |
$420.65
|
| Rate for Payer: Priority Health SBD |
$311.77
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
OP
|
$544.80
|
|
|
Service Code
|
NDC 68084049401
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.11 |
| Max. Negotiated Rate |
$490.32 |
| Rate for Payer: Aetna Commercial |
$463.08
|
| Rate for Payer: Aetna Medicare |
$272.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.12
|
| Rate for Payer: BCBS Complete |
$217.92
|
| Rate for Payer: Cash Price |
$435.84
|
| Rate for Payer: Cofinity Advantage |
$381.36
|
| Rate for Payer: Cofinity Commercial |
$468.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.84
|
| Rate for Payer: Healthscope Commercial |
$490.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$435.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$408.60
|
| Rate for Payer: PHP Commercial |
$463.08
|
| Rate for Payer: Priority Health SBD |
$343.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.12
|
| Rate for Payer: UHC Core |
$283.84
|
| Rate for Payer: UHC Exchange |
$214.11
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
OP
|
$433.20
|
|
|
Service Code
|
NDC 68682030210
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.25 |
| Max. Negotiated Rate |
$389.88 |
| Rate for Payer: Aetna Commercial |
$368.22
|
| Rate for Payer: Aetna Medicare |
$216.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.58
|
| Rate for Payer: BCBS Complete |
$173.28
|
| Rate for Payer: Cash Price |
$346.56
|
| Rate for Payer: Cofinity Advantage |
$303.24
|
| Rate for Payer: Cofinity Commercial |
$372.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.56
|
| Rate for Payer: Healthscope Commercial |
$389.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.90
|
| Rate for Payer: PHP Commercial |
$368.22
|
| Rate for Payer: Priority Health SBD |
$272.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.58
|
| Rate for Payer: UHC Core |
$225.70
|
| Rate for Payer: UHC Exchange |
$170.25
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
OP
|
$364.32
|
|
|
Service Code
|
NDC 00115351101
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.18 |
| Max. Negotiated Rate |
$327.89 |
| Rate for Payer: Aetna Commercial |
$309.67
|
| Rate for Payer: Aetna Medicare |
$182.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.81
|
| Rate for Payer: BCBS Complete |
$145.73
|
| Rate for Payer: Cash Price |
$291.46
|
| Rate for Payer: Cofinity Advantage |
$255.02
|
| Rate for Payer: Cofinity Commercial |
$313.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.46
|
| Rate for Payer: Healthscope Commercial |
$327.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.24
|
| Rate for Payer: PHP Commercial |
$309.67
|
| Rate for Payer: Priority Health SBD |
$229.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.81
|
| Rate for Payer: UHC Core |
$189.81
|
| Rate for Payer: UHC Exchange |
$143.18
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
IP
|
$544.80
|
|
|
Service Code
|
NDC 68084049401
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$343.22 |
| Max. Negotiated Rate |
$490.32 |
| Rate for Payer: Aetna Commercial |
$463.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.12
|
| Rate for Payer: Cash Price |
$435.84
|
| Rate for Payer: Cofinity Advantage |
$381.36
|
| Rate for Payer: Cofinity Commercial |
$468.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.84
|
| Rate for Payer: Healthscope Commercial |
$490.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$408.60
|
| Rate for Payer: PHP Commercial |
$463.08
|
| Rate for Payer: Priority Health SBD |
$343.22
|
|
