|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
OP
|
$374.30
|
|
|
Service Code
|
NDC 00904657561
|
| Hospital Charge Code |
6217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.10 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna Commercial |
$318.15
|
| Rate for Payer: Aetna Medicare |
$187.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.29
|
| Rate for Payer: BCBS Complete |
$149.72
|
| Rate for Payer: Cash Price |
$299.44
|
| Rate for Payer: Cofinity Advantage |
$262.01
|
| Rate for Payer: Cofinity Commercial |
$321.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.44
|
| Rate for Payer: Healthscope Commercial |
$336.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.73
|
| Rate for Payer: PHP Commercial |
$318.15
|
| Rate for Payer: Priority Health SBD |
$235.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.29
|
| Rate for Payer: UHC Core |
$195.01
|
| Rate for Payer: UHC Exchange |
$147.10
|
|
|
PHENOBARBITAL 97.2 MG TABLET
|
Facility
|
OP
|
$425.28
|
|
|
Service Code
|
NDC 00603516821
|
| Hospital Charge Code |
6220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.14 |
| Max. Negotiated Rate |
$382.75 |
| Rate for Payer: Aetna Commercial |
$361.49
|
| Rate for Payer: Aetna Medicare |
$212.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.43
|
| Rate for Payer: BCBS Complete |
$170.11
|
| Rate for Payer: Cash Price |
$340.22
|
| Rate for Payer: Cofinity Advantage |
$297.70
|
| Rate for Payer: Cofinity Commercial |
$365.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.22
|
| Rate for Payer: Healthscope Commercial |
$382.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.96
|
| Rate for Payer: PHP Commercial |
$361.49
|
| Rate for Payer: Priority Health SBD |
$267.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.43
|
| Rate for Payer: UHC Core |
$221.57
|
| Rate for Payer: UHC Exchange |
$167.14
|
|
|
PHENOBARBITAL 97.2 MG TABLET
|
Facility
|
IP
|
$202.35
|
|
|
Service Code
|
NDC 16571066801
|
| Hospital Charge Code |
6220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.48 |
| Max. Negotiated Rate |
$182.12 |
| Rate for Payer: Aetna Commercial |
$172.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.53
|
| Rate for Payer: Cash Price |
$161.88
|
| Rate for Payer: Cofinity Advantage |
$141.65
|
| Rate for Payer: Cofinity Commercial |
$174.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.88
|
| Rate for Payer: Healthscope Commercial |
$182.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.76
|
| Rate for Payer: PHP Commercial |
$172.00
|
| Rate for Payer: Priority Health SBD |
$127.48
|
|
|
PHENOBARBITAL 97.2 MG TABLET
|
Facility
|
OP
|
$202.35
|
|
|
Service Code
|
NDC 16571066801
|
| Hospital Charge Code |
6220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.52 |
| Max. Negotiated Rate |
$182.12 |
| Rate for Payer: Aetna Commercial |
$172.00
|
| Rate for Payer: Aetna Medicare |
$101.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.53
|
| Rate for Payer: BCBS Complete |
$80.94
|
| Rate for Payer: Cash Price |
$161.88
|
| Rate for Payer: Cofinity Advantage |
$141.65
|
| Rate for Payer: Cofinity Commercial |
$174.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.88
|
| Rate for Payer: Healthscope Commercial |
$182.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.76
|
| Rate for Payer: PHP Commercial |
$172.00
|
| Rate for Payer: Priority Health SBD |
$127.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.53
|
| Rate for Payer: UHC Core |
$105.42
|
| Rate for Payer: UHC Exchange |
$79.52
|
|
|
PHENOBARBITAL 97.2 MG TABLET
|
Facility
|
IP
|
$425.28
|
|
|
Service Code
|
NDC 00603516821
|
| Hospital Charge Code |
6220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$267.93 |
| Max. Negotiated Rate |
$382.75 |
| Rate for Payer: Aetna Commercial |
$361.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.43
|
| Rate for Payer: Cash Price |
$340.22
|
| Rate for Payer: Cofinity Advantage |
$297.70
|
| Rate for Payer: Cofinity Commercial |
$365.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.22
|
| Rate for Payer: Healthscope Commercial |
$382.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.96
|
| Rate for Payer: PHP Commercial |
$361.49
|
| Rate for Payer: Priority Health SBD |
$267.93
|
|
|
PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$180.42
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
6221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.98 |
| Max. Negotiated Rate |
$162.38 |
| Rate for Payer: Aetna Commercial |
$153.36
|
| Rate for Payer: Aetna Commercial |
$107.19
|
| Rate for Payer: Aetna Medicare |
$90.21
|
| Rate for Payer: Aetna Medicare |
$63.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.27
|
| Rate for Payer: BCBS Complete |
$72.17
|
| Rate for Payer: BCBS Complete |
$50.44
|
| Rate for Payer: BCBS Trust/PPO |
$72.94
|
| Rate for Payer: BCBS Trust/PPO |
$72.94
|
| Rate for Payer: BCN Commercial |
$72.94
|
| Rate for Payer: BCN Commercial |
$72.94
|
| Rate for Payer: Cash Price |
$100.89
|
| Rate for Payer: Cash Price |
$100.89
|
| Rate for Payer: Cash Price |
$144.34
|
| Rate for Payer: Cash Price |
$144.34
|
| Rate for Payer: Cofinity Advantage |
$88.28
|
| Rate for Payer: Cofinity Advantage |
$126.29
|
| Rate for Payer: Cofinity Commercial |
$155.16
|
| Rate for Payer: Cofinity Commercial |
$108.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.89
|
| Rate for Payer: Healthscope Commercial |
$113.50
|
| Rate for Payer: Healthscope Commercial |
$162.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.31
|
| Rate for Payer: PHP Commercial |
$153.36
|
| Rate for Payer: PHP Commercial |
$107.19
|
| Rate for Payer: Priority Health SBD |
$79.45
|
| Rate for Payer: Priority Health SBD |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.98
|
| Rate for Payer: UHC Core |
$47.98
|
| Rate for Payer: UHC Core |
$47.98
|
| Rate for Payer: UHC Exchange |
$47.98
|
| Rate for Payer: UHC Exchange |
$47.98
|
|
|
PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$126.11
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
6221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.45 |
| Max. Negotiated Rate |
$113.50 |
| Rate for Payer: Aetna Commercial |
$107.19
|
| Rate for Payer: Aetna Commercial |
$153.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.27
|
| Rate for Payer: Cash Price |
$100.89
|
| Rate for Payer: Cash Price |
$144.34
|
| Rate for Payer: Cofinity Advantage |
$88.28
|
| Rate for Payer: Cofinity Advantage |
$126.29
|
| Rate for Payer: Cofinity Commercial |
$108.45
|
| Rate for Payer: Cofinity Commercial |
$155.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.89
|
| Rate for Payer: Healthscope Commercial |
$162.38
|
| Rate for Payer: Healthscope Commercial |
$113.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.31
|
| Rate for Payer: PHP Commercial |
$107.19
|
| Rate for Payer: PHP Commercial |
$153.36
|
| Rate for Payer: Priority Health SBD |
$79.45
|
| Rate for Payer: Priority Health SBD |
$113.66
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$9.56
|
|
|
Service Code
|
NDC 96295013644
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$8.60 |
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.21
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cofinity Advantage |
$6.69
|
| Rate for Payer: Cofinity Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.65
|
| Rate for Payer: Healthscope Commercial |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.17
|
| Rate for Payer: PHP Commercial |
$8.13
|
| Rate for Payer: Priority Health SBD |
$6.02
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
OP
|
$25.49
|
|
|
Service Code
|
NDC 78112001103
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.02 |
| Max. Negotiated Rate |
$22.94 |
| Rate for Payer: Aetna Commercial |
$21.67
|
| Rate for Payer: Aetna Medicare |
$12.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: Cash Price |
$20.39
|
| Rate for Payer: Cofinity Advantage |
$17.84
|
| Rate for Payer: Cofinity Commercial |
$21.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.39
|
| Rate for Payer: Healthscope Commercial |
$22.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.12
|
| Rate for Payer: PHP Commercial |
$21.67
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.57
|
| Rate for Payer: UHC Core |
$13.28
|
| Rate for Payer: UHC Exchange |
$10.02
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$10.62
|
|
|
Service Code
|
NDC 70000045801
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Aetna Commercial |
$9.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.90
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cofinity Advantage |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$9.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$9.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PHP Commercial |
$9.03
|
| Rate for Payer: Priority Health SBD |
$6.69
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
OP
|
$10.62
|
|
|
Service Code
|
NDC 70000045801
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Aetna Commercial |
$9.03
|
| Rate for Payer: Aetna Medicare |
$5.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.90
|
| Rate for Payer: BCBS Complete |
$4.25
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cofinity Advantage |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$9.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$9.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PHP Commercial |
$9.03
|
| Rate for Payer: Priority Health SBD |
$6.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.90
|
| Rate for Payer: UHC Core |
$5.53
|
| Rate for Payer: UHC Exchange |
$4.17
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$25.49
|
|
|
Service Code
|
NDC 78112001103
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$22.94 |
| Rate for Payer: Aetna Commercial |
$21.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: Cash Price |
$20.39
|
| Rate for Payer: Cofinity Advantage |
$17.84
|
| Rate for Payer: Cofinity Commercial |
$21.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.39
|
| Rate for Payer: Healthscope Commercial |
$22.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.12
|
| Rate for Payer: PHP Commercial |
$21.67
|
| Rate for Payer: Priority Health SBD |
$16.06
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
OP
|
$9.56
|
|
|
Service Code
|
NDC 96295013644
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$8.60 |
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: Aetna Medicare |
$4.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.21
|
| Rate for Payer: BCBS Complete |
$3.82
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cofinity Advantage |
$6.69
|
| Rate for Payer: Cofinity Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.65
|
| Rate for Payer: Healthscope Commercial |
$8.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.17
|
| Rate for Payer: PHP Commercial |
$8.13
|
| Rate for Payer: Priority Health SBD |
$6.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.21
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Exchange |
$3.76
|
|
|
PHENOL 89 % TOPICAL SWAB
|
Facility
|
OP
|
$656.35
|
|
|
Service Code
|
NDC 00884629730
|
| Hospital Charge Code |
115851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.95 |
| Max. Negotiated Rate |
$590.72 |
| Rate for Payer: Aetna Commercial |
$557.90
|
| Rate for Payer: Aetna Medicare |
$328.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.63
|
| Rate for Payer: BCBS Complete |
$262.54
|
| Rate for Payer: Cash Price |
$525.08
|
| Rate for Payer: Cofinity Advantage |
$459.44
|
| Rate for Payer: Cofinity Commercial |
$564.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.08
|
| Rate for Payer: Healthscope Commercial |
$590.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$525.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$557.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.26
|
| Rate for Payer: PHP Commercial |
$557.90
|
| Rate for Payer: Priority Health SBD |
$413.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.63
|
| Rate for Payer: UHC Core |
$341.96
|
| Rate for Payer: UHC Exchange |
$257.95
|
|
|
PHENOL 89 % TOPICAL SWAB
|
Facility
|
IP
|
$656.35
|
|
|
Service Code
|
NDC 00884629730
|
| Hospital Charge Code |
115851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$413.50 |
| Max. Negotiated Rate |
$590.72 |
| Rate for Payer: Aetna Commercial |
$557.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.63
|
| Rate for Payer: Cash Price |
$525.08
|
| Rate for Payer: Cofinity Advantage |
$459.44
|
| Rate for Payer: Cofinity Commercial |
$564.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.08
|
| Rate for Payer: Healthscope Commercial |
$590.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$557.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.26
|
| Rate for Payer: PHP Commercial |
$557.90
|
| Rate for Payer: Priority Health SBD |
$413.50
|
|
|
PHENTOLAMINE 0.5 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
IP
|
$309.10
|
|
|
Service Code
|
NDC 09900001943
|
| Hospital Charge Code |
150967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$194.73 |
| Max. Negotiated Rate |
$278.19 |
| Rate for Payer: Aetna Commercial |
$262.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.91
|
| Rate for Payer: Cash Price |
$247.28
|
| Rate for Payer: Cofinity Advantage |
$216.37
|
| Rate for Payer: Cofinity Commercial |
$265.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.28
|
| Rate for Payer: Healthscope Commercial |
$278.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.82
|
| Rate for Payer: PHP Commercial |
$262.74
|
| Rate for Payer: Priority Health SBD |
$194.73
|
|
|
PHENTOLAMINE 0.5 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
OP
|
$309.10
|
|
|
Service Code
|
NDC 09900001943
|
| Hospital Charge Code |
150967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$121.48 |
| Max. Negotiated Rate |
$278.19 |
| Rate for Payer: Aetna Commercial |
$262.74
|
| Rate for Payer: Aetna Medicare |
$154.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.91
|
| Rate for Payer: BCBS Complete |
$123.64
|
| Rate for Payer: Cash Price |
$247.28
|
| Rate for Payer: Cofinity Advantage |
$216.37
|
| Rate for Payer: Cofinity Commercial |
$265.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.28
|
| Rate for Payer: Healthscope Commercial |
$278.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.82
|
| Rate for Payer: PHP Commercial |
$262.74
|
| Rate for Payer: Priority Health SBD |
$194.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.91
|
| Rate for Payer: UHC Core |
$161.04
|
| Rate for Payer: UHC Exchange |
$121.48
|
|
|
PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
IP
|
$1,671.75
|
|
|
Service Code
|
NDC 09900001945
|
| Hospital Charge Code |
301530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,053.20 |
| Max. Negotiated Rate |
$1,504.58 |
| Rate for Payer: Aetna Commercial |
$1,420.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,086.64
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cofinity Advantage |
$1,170.22
|
| Rate for Payer: Cofinity Commercial |
$1,437.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.40
|
| Rate for Payer: Healthscope Commercial |
$1,504.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,420.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,253.81
|
| Rate for Payer: PHP Commercial |
$1,420.99
|
| Rate for Payer: Priority Health SBD |
$1,053.20
|
|
|
PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
IP
|
$618.20
|
|
|
Service Code
|
NDC 09900001944
|
| Hospital Charge Code |
301530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$389.47 |
| Max. Negotiated Rate |
$556.38 |
| Rate for Payer: Aetna Commercial |
$525.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.83
|
| Rate for Payer: Cash Price |
$494.56
|
| Rate for Payer: Cofinity Advantage |
$432.74
|
| Rate for Payer: Cofinity Commercial |
$531.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.56
|
| Rate for Payer: Healthscope Commercial |
$556.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$463.65
|
| Rate for Payer: PHP Commercial |
$525.47
|
| Rate for Payer: Priority Health SBD |
$389.47
|
|
|
PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
OP
|
$618.20
|
|
|
Service Code
|
NDC 09900001944
|
| Hospital Charge Code |
301530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$242.95 |
| Max. Negotiated Rate |
$556.38 |
| Rate for Payer: Aetna Commercial |
$525.47
|
| Rate for Payer: Aetna Medicare |
$309.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.83
|
| Rate for Payer: BCBS Complete |
$247.28
|
| Rate for Payer: Cash Price |
$494.56
|
| Rate for Payer: Cofinity Advantage |
$432.74
|
| Rate for Payer: Cofinity Commercial |
$531.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.56
|
| Rate for Payer: Healthscope Commercial |
$556.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$494.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$463.65
|
| Rate for Payer: PHP Commercial |
$525.47
|
| Rate for Payer: Priority Health SBD |
$389.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$401.83
|
| Rate for Payer: UHC Core |
$322.08
|
| Rate for Payer: UHC Exchange |
$242.95
|
|
|
PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
OP
|
$1,671.75
|
|
|
Service Code
|
NDC 09900001945
|
| Hospital Charge Code |
301530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$657.00 |
| Max. Negotiated Rate |
$1,504.58 |
| Rate for Payer: Aetna Commercial |
$1,420.99
|
| Rate for Payer: Aetna Medicare |
$835.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,086.64
|
| Rate for Payer: BCBS Complete |
$668.70
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cofinity Advantage |
$1,170.22
|
| Rate for Payer: Cofinity Commercial |
$1,437.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.40
|
| Rate for Payer: Healthscope Commercial |
$1,504.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,337.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,420.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,253.81
|
| Rate for Payer: PHP Commercial |
$1,420.99
|
| Rate for Payer: Priority Health SBD |
$1,053.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,086.64
|
| Rate for Payer: UHC Core |
$870.98
|
| Rate for Payer: UHC Exchange |
$657.00
|
|
|
PHENTOLAMINE 5 MG INJECTION SOLUTION
|
Facility
|
IP
|
$1,385.23
|
|
|
Service Code
|
HCPCS J2760
|
| Hospital Charge Code |
10947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$872.69 |
| Max. Negotiated Rate |
$1,246.71 |
| Rate for Payer: Aetna Commercial |
$1,177.45
|
| Rate for Payer: Aetna Commercial |
$825.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$900.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.92
|
| Rate for Payer: Cash Price |
$1,108.18
|
| Rate for Payer: Cash Price |
$776.52
|
| Rate for Payer: Cofinity Advantage |
$969.66
|
| Rate for Payer: Cofinity Advantage |
$679.46
|
| Rate for Payer: Cofinity Commercial |
$1,191.30
|
| Rate for Payer: Cofinity Commercial |
$834.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.18
|
| Rate for Payer: Healthscope Commercial |
$873.59
|
| Rate for Payer: Healthscope Commercial |
$1,246.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,177.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,038.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$727.99
|
| Rate for Payer: PHP Commercial |
$1,177.45
|
| Rate for Payer: PHP Commercial |
$825.05
|
| Rate for Payer: Priority Health SBD |
$872.69
|
| Rate for Payer: Priority Health SBD |
$611.51
|
|
|
PHENTOLAMINE 5 MG INJECTION SOLUTION
|
Facility
|
OP
|
$1,385.23
|
|
|
Service Code
|
HCPCS J2760
|
| Hospital Charge Code |
10947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.65 |
| Max. Negotiated Rate |
$1,362.57 |
| Rate for Payer: Aetna Commercial |
$1,177.45
|
| Rate for Payer: Aetna Commercial |
$825.05
|
| Rate for Payer: Aetna Medicare |
$267.75
|
| Rate for Payer: Aetna Medicare |
$267.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$900.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$321.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$321.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$321.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$321.81
|
| Rate for Payer: BCBS Complete |
$141.39
|
| Rate for Payer: BCBS Complete |
$141.39
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.11
|
| Rate for Payer: BCN Commercial |
$1,055.11
|
| Rate for Payer: BCN Commercial |
$1,055.11
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$1,108.18
|
| Rate for Payer: Cash Price |
$776.52
|
| Rate for Payer: Cash Price |
$776.52
|
| Rate for Payer: Cash Price |
$1,108.18
|
| Rate for Payer: Cofinity Advantage |
$679.46
|
| Rate for Payer: Cofinity Advantage |
$969.66
|
| Rate for Payer: Cofinity Commercial |
$834.76
|
| Rate for Payer: Cofinity Commercial |
$1,191.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Healthscope Commercial |
$1,246.71
|
| Rate for Payer: Healthscope Commercial |
$873.59
|
| Rate for Payer: Mclaren Medicaid |
$134.65
|
| Rate for Payer: Mclaren Medicaid |
$134.65
|
| Rate for Payer: Mclaren Medicare |
$257.45
|
| Rate for Payer: Mclaren Medicare |
$257.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: Meridian Medicaid |
$270.32
|
| Rate for Payer: Meridian Medicaid |
$270.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$283.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$283.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,177.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.05
|
| Rate for Payer: Nomi Health Commercial |
$772.35
|
| Rate for Payer: Nomi Health Commercial |
$772.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,038.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$727.99
|
| Rate for Payer: PACE Medicare |
$244.58
|
| Rate for Payer: PACE Medicare |
$244.58
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PHP Commercial |
$825.05
|
| Rate for Payer: PHP Commercial |
$1,177.45
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,362.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,362.57
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: Priority Health SBD |
$611.51
|
| Rate for Payer: Priority Health SBD |
$872.69
|
| Rate for Payer: Priority Health Tiered Network |
$1,090.06
|
| Rate for Payer: Priority Health Tiered Network |
$1,090.06
|
| Rate for Payer: Railroad Medicare Medicare |
$257.45
|
| Rate for Payer: Railroad Medicare Medicare |
$257.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.92
|
| Rate for Payer: UHC Core |
$693.92
|
| Rate for Payer: UHC Core |
$693.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$257.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$257.45
|
| Rate for Payer: UHC Exchange |
$693.92
|
| Rate for Payer: UHC Exchange |
$693.92
|
| Rate for Payer: UHC Medicaid |
$134.65
|
| Rate for Payer: UHC Medicaid |
$134.65
|
| Rate for Payer: UHCCP Medicaid |
$134.65
|
| Rate for Payer: UHCCP Medicaid |
$134.65
|
| Rate for Payer: VA VA |
$257.45
|
| Rate for Payer: VA VA |
$257.45
|
|
|
PHENYLEPHRINE 0.25 %-PRAMOXINE 1 %-GLYCERIN-WH.PETROLATUM RECTAL CREAM
|
Facility
|
IP
|
$25.94
|
|
|
Service Code
|
NDC 00573286893
|
| Hospital Charge Code |
77868
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.86
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Advantage |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$23.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.45
|
| Rate for Payer: PHP Commercial |
$22.05
|
| Rate for Payer: Priority Health SBD |
$16.34
|
|
|
PHENYLEPHRINE 0.25 %-PRAMOXINE 1 %-GLYCERIN-WH.PETROLATUM RECTAL CREAM
|
Facility
|
OP
|
$25.94
|
|
|
Service Code
|
NDC 00573286893
|
| Hospital Charge Code |
77868
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna Medicare |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.86
|
| Rate for Payer: BCBS Complete |
$10.38
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Advantage |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$23.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.45
|
| Rate for Payer: PHP Commercial |
$22.05
|
| Rate for Payer: Priority Health SBD |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.86
|
| Rate for Payer: UHC Core |
$13.51
|
| Rate for Payer: UHC Exchange |
$10.19
|
|
