|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
OP
|
$213.75
|
|
|
Service Code
|
NDC 51672411101
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$192.38 |
| Rate for Payer: Aetna Commercial |
$181.69
|
| Rate for Payer: Aetna Medicare |
$106.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.94
|
| Rate for Payer: BCBS Complete |
$85.50
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cofinity Advantage |
$149.62
|
| Rate for Payer: Cofinity Commercial |
$183.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.00
|
| Rate for Payer: Healthscope Commercial |
$192.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.31
|
| Rate for Payer: PHP Commercial |
$181.69
|
| Rate for Payer: Priority Health SBD |
$134.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.94
|
| Rate for Payer: UHC Core |
$111.36
|
| Rate for Payer: UHC Exchange |
$84.00
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$828.96
|
|
|
Service Code
|
NDC 00071036940
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$522.24 |
| Max. Negotiated Rate |
$746.06 |
| Rate for Payer: Aetna Commercial |
$704.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$538.82
|
| Rate for Payer: Cash Price |
$663.17
|
| Rate for Payer: Cofinity Advantage |
$580.27
|
| Rate for Payer: Cofinity Commercial |
$712.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$663.17
|
| Rate for Payer: Healthscope Commercial |
$746.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$704.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$621.72
|
| Rate for Payer: PHP Commercial |
$704.62
|
| Rate for Payer: Priority Health SBD |
$522.24
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
OP
|
$253.44
|
|
|
Service Code
|
NDC 51079090520
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.60 |
| Max. Negotiated Rate |
$228.10 |
| Rate for Payer: Aetna Commercial |
$215.42
|
| Rate for Payer: Aetna Medicare |
$126.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.74
|
| Rate for Payer: BCBS Complete |
$101.38
|
| Rate for Payer: Cash Price |
$202.75
|
| Rate for Payer: Cofinity Advantage |
$177.41
|
| Rate for Payer: Cofinity Commercial |
$217.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.75
|
| Rate for Payer: Healthscope Commercial |
$228.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.08
|
| Rate for Payer: PHP Commercial |
$215.42
|
| Rate for Payer: Priority Health SBD |
$159.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.74
|
| Rate for Payer: UHC Core |
$132.04
|
| Rate for Payer: UHC Exchange |
$99.60
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$253.44
|
|
|
Service Code
|
NDC 51079090520
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.67 |
| Max. Negotiated Rate |
$228.10 |
| Rate for Payer: Aetna Commercial |
$215.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.74
|
| Rate for Payer: Cash Price |
$202.75
|
| Rate for Payer: Cofinity Advantage |
$177.41
|
| Rate for Payer: Cofinity Commercial |
$217.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.75
|
| Rate for Payer: Healthscope Commercial |
$228.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.08
|
| Rate for Payer: PHP Commercial |
$215.42
|
| Rate for Payer: Priority Health SBD |
$159.67
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
OP
|
$382.85
|
|
|
Service Code
|
NDC 00904618761
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.46 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: Aetna Medicare |
$191.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.85
|
| Rate for Payer: BCBS Complete |
$153.14
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Advantage |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$306.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.14
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health SBD |
$241.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.85
|
| Rate for Payer: UHC Core |
$199.46
|
| Rate for Payer: UHC Exchange |
$150.46
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$213.75
|
|
|
Service Code
|
NDC 51672411101
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.66 |
| Max. Negotiated Rate |
$192.38 |
| Rate for Payer: Aetna Commercial |
$181.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.94
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cofinity Advantage |
$149.62
|
| Rate for Payer: Cofinity Commercial |
$183.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.00
|
| Rate for Payer: Healthscope Commercial |
$192.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.31
|
| Rate for Payer: PHP Commercial |
$181.69
|
| Rate for Payer: Priority Health SBD |
$134.66
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$382.85
|
|
|
Service Code
|
NDC 00904618761
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.20 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.85
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Advantage |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.14
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health SBD |
$241.20
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
OP
|
$828.96
|
|
|
Service Code
|
NDC 00071036940
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$325.78 |
| Max. Negotiated Rate |
$746.06 |
| Rate for Payer: Aetna Commercial |
$704.62
|
| Rate for Payer: Aetna Medicare |
$414.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$538.82
|
| Rate for Payer: BCBS Complete |
$331.58
|
| Rate for Payer: Cash Price |
$663.17
|
| Rate for Payer: Cofinity Advantage |
$580.27
|
| Rate for Payer: Cofinity Commercial |
$712.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$663.17
|
| Rate for Payer: Healthscope Commercial |
$746.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$663.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$704.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$621.72
|
| Rate for Payer: PHP Commercial |
$704.62
|
| Rate for Payer: Priority Health SBD |
$522.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$538.82
|
| Rate for Payer: UHC Core |
$431.89
|
| Rate for Payer: UHC Exchange |
$325.78
|
|
|
PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE
|
Facility
|
IP
|
$700.32
|
|
|
Service Code
|
NDC 58151011801
|
| Hospital Charge Code |
11019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$441.20 |
| Max. Negotiated Rate |
$630.29 |
| Rate for Payer: Aetna Commercial |
$595.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.21
|
| Rate for Payer: Cash Price |
$560.26
|
| Rate for Payer: Cofinity Advantage |
$490.22
|
| Rate for Payer: Cofinity Commercial |
$602.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.26
|
| Rate for Payer: Healthscope Commercial |
$630.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$525.24
|
| Rate for Payer: PHP Commercial |
$595.27
|
| Rate for Payer: Priority Health SBD |
$441.20
|
|
|
PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE
|
Facility
|
OP
|
$700.32
|
|
|
Service Code
|
NDC 58151011801
|
| Hospital Charge Code |
11019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.23 |
| Max. Negotiated Rate |
$630.29 |
| Rate for Payer: Aetna Commercial |
$595.27
|
| Rate for Payer: Aetna Medicare |
$350.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.21
|
| Rate for Payer: BCBS Complete |
$280.13
|
| Rate for Payer: Cash Price |
$560.26
|
| Rate for Payer: Cofinity Advantage |
$490.22
|
| Rate for Payer: Cofinity Commercial |
$602.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.26
|
| Rate for Payer: Healthscope Commercial |
$630.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$560.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$525.24
|
| Rate for Payer: PHP Commercial |
$595.27
|
| Rate for Payer: Priority Health SBD |
$441.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$455.21
|
| Rate for Payer: UHC Core |
$364.87
|
| Rate for Payer: UHC Exchange |
$275.23
|
|
|
PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE
|
Facility
|
IP
|
$647.52
|
|
|
Service Code
|
NDC 00071374066
|
| Hospital Charge Code |
11019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$407.94 |
| Max. Negotiated Rate |
$582.77 |
| Rate for Payer: Aetna Commercial |
$550.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.89
|
| Rate for Payer: Cash Price |
$518.02
|
| Rate for Payer: Cofinity Advantage |
$453.26
|
| Rate for Payer: Cofinity Commercial |
$556.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.02
|
| Rate for Payer: Healthscope Commercial |
$582.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$485.64
|
| Rate for Payer: PHP Commercial |
$550.39
|
| Rate for Payer: Priority Health SBD |
$407.94
|
|
|
PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE
|
Facility
|
OP
|
$647.52
|
|
|
Service Code
|
NDC 00071374066
|
| Hospital Charge Code |
11019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.48 |
| Max. Negotiated Rate |
$582.77 |
| Rate for Payer: Aetna Commercial |
$550.39
|
| Rate for Payer: Aetna Medicare |
$323.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.89
|
| Rate for Payer: BCBS Complete |
$259.01
|
| Rate for Payer: Cash Price |
$518.02
|
| Rate for Payer: Cofinity Advantage |
$453.26
|
| Rate for Payer: Cofinity Commercial |
$556.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.02
|
| Rate for Payer: Healthscope Commercial |
$582.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$518.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$485.64
|
| Rate for Payer: PHP Commercial |
$550.39
|
| Rate for Payer: Priority Health SBD |
$407.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$420.89
|
| Rate for Payer: UHC Core |
$337.36
|
| Rate for Payer: UHC Exchange |
$254.48
|
|
|
PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$258.47
|
|
|
Service Code
|
NDC 17478051002
|
| Hospital Charge Code |
6270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$162.84 |
| Max. Negotiated Rate |
$232.62 |
| Rate for Payer: Aetna Commercial |
$219.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.01
|
| Rate for Payer: Cash Price |
$206.78
|
| Rate for Payer: Cofinity Advantage |
$180.93
|
| Rate for Payer: Cofinity Commercial |
$222.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.78
|
| Rate for Payer: Healthscope Commercial |
$232.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.85
|
| Rate for Payer: PHP Commercial |
$219.70
|
| Rate for Payer: Priority Health SBD |
$162.84
|
|
|
PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$258.47
|
|
|
Service Code
|
NDC 17478051002
|
| Hospital Charge Code |
6270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$101.58 |
| Max. Negotiated Rate |
$232.62 |
| Rate for Payer: Aetna Commercial |
$219.70
|
| Rate for Payer: Aetna Medicare |
$129.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.01
|
| Rate for Payer: BCBS Complete |
$103.39
|
| Rate for Payer: Cash Price |
$206.78
|
| Rate for Payer: Cofinity Advantage |
$180.93
|
| Rate for Payer: Cofinity Commercial |
$222.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.78
|
| Rate for Payer: Healthscope Commercial |
$232.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.85
|
| Rate for Payer: PHP Commercial |
$219.70
|
| Rate for Payer: Priority Health SBD |
$162.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.01
|
| Rate for Payer: UHC Core |
$134.66
|
| Rate for Payer: UHC Exchange |
$101.58
|
|
|
PHYTONADIONE ORAL SOLUTION 10 MG/ML
|
Facility
|
IP
|
$71.58
|
|
|
Service Code
|
NDC 00409915801
|
| Hospital Charge Code |
150708
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.10 |
| Max. Negotiated Rate |
$64.42 |
| Rate for Payer: Aetna Commercial |
$60.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.53
|
| Rate for Payer: Cash Price |
$57.26
|
| Rate for Payer: Cofinity Advantage |
$50.11
|
| Rate for Payer: Cofinity Commercial |
$61.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.26
|
| Rate for Payer: Healthscope Commercial |
$64.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.69
|
| Rate for Payer: PHP Commercial |
$60.84
|
| Rate for Payer: Priority Health SBD |
$45.10
|
|
|
PHYTONADIONE ORAL SOLUTION 10 MG/ML
|
Facility
|
OP
|
$71.58
|
|
|
Service Code
|
NDC 00409915801
|
| Hospital Charge Code |
150708
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$64.42 |
| Rate for Payer: Aetna Commercial |
$60.84
|
| Rate for Payer: Aetna Medicare |
$35.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.53
|
| Rate for Payer: BCBS Complete |
$28.63
|
| Rate for Payer: Cash Price |
$57.26
|
| Rate for Payer: Cofinity Advantage |
$50.11
|
| Rate for Payer: Cofinity Commercial |
$61.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.26
|
| Rate for Payer: Healthscope Commercial |
$64.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.69
|
| Rate for Payer: PHP Commercial |
$60.84
|
| Rate for Payer: Priority Health SBD |
$45.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.53
|
| Rate for Payer: UHC Core |
$37.29
|
| Rate for Payer: UHC Exchange |
$28.13
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$78.61
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
11023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$70.75 |
| Rate for Payer: Aetna Commercial |
$66.82
|
| Rate for Payer: Aetna Commercial |
$67.57
|
| Rate for Payer: Aetna Commercial |
$73.18
|
| Rate for Payer: Aetna Commercial |
$57.92
|
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.82
|
| Rate for Payer: Cash Price |
$68.87
|
| Rate for Payer: Cash Price |
$54.51
|
| Rate for Payer: Cash Price |
$62.89
|
| Rate for Payer: Cash Price |
$63.59
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cofinity Advantage |
$47.70
|
| Rate for Payer: Cofinity Advantage |
$55.03
|
| Rate for Payer: Cofinity Advantage |
$57.96
|
| Rate for Payer: Cofinity Advantage |
$55.64
|
| Rate for Payer: Cofinity Advantage |
$60.26
|
| Rate for Payer: Cofinity Commercial |
$67.60
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Cofinity Commercial |
$58.60
|
| Rate for Payer: Cofinity Commercial |
$68.36
|
| Rate for Payer: Cofinity Commercial |
$74.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.87
|
| Rate for Payer: Healthscope Commercial |
$70.75
|
| Rate for Payer: Healthscope Commercial |
$61.33
|
| Rate for Payer: Healthscope Commercial |
$77.48
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Healthscope Commercial |
$71.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.10
|
| Rate for Payer: PHP Commercial |
$73.18
|
| Rate for Payer: PHP Commercial |
$70.38
|
| Rate for Payer: PHP Commercial |
$67.57
|
| Rate for Payer: PHP Commercial |
$66.82
|
| Rate for Payer: PHP Commercial |
$57.92
|
| Rate for Payer: Priority Health SBD |
$49.52
|
| Rate for Payer: Priority Health SBD |
$54.24
|
| Rate for Payer: Priority Health SBD |
$52.16
|
| Rate for Payer: Priority Health SBD |
$42.93
|
| Rate for Payer: Priority Health SBD |
$50.08
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$86.09
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
11023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$77.48 |
| Rate for Payer: Aetna Commercial |
$73.18
|
| Rate for Payer: Aetna Commercial |
$67.57
|
| Rate for Payer: Aetna Commercial |
$66.82
|
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: Aetna Commercial |
$57.92
|
| Rate for Payer: Aetna Medicare |
$34.07
|
| Rate for Payer: Aetna Medicare |
$39.30
|
| Rate for Payer: Aetna Medicare |
$39.74
|
| Rate for Payer: Aetna Medicare |
$43.05
|
| Rate for Payer: Aetna Medicare |
$41.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.29
|
| Rate for Payer: BCBS Complete |
$34.44
|
| Rate for Payer: BCBS Complete |
$31.44
|
| Rate for Payer: BCBS Complete |
$31.80
|
| Rate for Payer: BCBS Complete |
$27.26
|
| Rate for Payer: BCBS Complete |
$33.12
|
| Rate for Payer: BCBS Trust/PPO |
$7.04
|
| Rate for Payer: BCBS Trust/PPO |
$7.04
|
| Rate for Payer: BCBS Trust/PPO |
$7.04
|
| Rate for Payer: BCBS Trust/PPO |
$7.04
|
| Rate for Payer: BCBS Trust/PPO |
$7.04
|
| Rate for Payer: BCN Commercial |
$7.04
|
| Rate for Payer: BCN Commercial |
$7.04
|
| Rate for Payer: BCN Commercial |
$7.04
|
| Rate for Payer: BCN Commercial |
$7.04
|
| Rate for Payer: BCN Commercial |
$7.04
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cash Price |
$62.89
|
| Rate for Payer: Cash Price |
$54.51
|
| Rate for Payer: Cash Price |
$54.51
|
| Rate for Payer: Cash Price |
$63.59
|
| Rate for Payer: Cash Price |
$62.89
|
| Rate for Payer: Cash Price |
$63.59
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cash Price |
$68.87
|
| Rate for Payer: Cash Price |
$68.87
|
| Rate for Payer: Cofinity Advantage |
$60.26
|
| Rate for Payer: Cofinity Advantage |
$57.96
|
| Rate for Payer: Cofinity Advantage |
$55.03
|
| Rate for Payer: Cofinity Advantage |
$47.70
|
| Rate for Payer: Cofinity Advantage |
$55.64
|
| Rate for Payer: Cofinity Commercial |
$68.36
|
| Rate for Payer: Cofinity Commercial |
$67.60
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Cofinity Commercial |
$74.04
|
| Rate for Payer: Cofinity Commercial |
$58.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.89
|
| Rate for Payer: Healthscope Commercial |
$70.75
|
| Rate for Payer: Healthscope Commercial |
$77.48
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Healthscope Commercial |
$71.54
|
| Rate for Payer: Healthscope Commercial |
$61.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.10
|
| Rate for Payer: PHP Commercial |
$67.57
|
| Rate for Payer: PHP Commercial |
$66.82
|
| Rate for Payer: PHP Commercial |
$57.92
|
| Rate for Payer: PHP Commercial |
$73.18
|
| Rate for Payer: PHP Commercial |
$70.38
|
| Rate for Payer: Priority Health SBD |
$50.08
|
| Rate for Payer: Priority Health SBD |
$52.16
|
| Rate for Payer: Priority Health SBD |
$54.24
|
| Rate for Payer: Priority Health SBD |
$49.52
|
| Rate for Payer: Priority Health SBD |
$42.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.64
|
| Rate for Payer: UHC Core |
$4.64
|
| Rate for Payer: UHC Core |
$4.64
|
| Rate for Payer: UHC Core |
$4.64
|
| Rate for Payer: UHC Core |
$4.64
|
| Rate for Payer: UHC Core |
$4.64
|
| Rate for Payer: UHC Exchange |
$4.64
|
| Rate for Payer: UHC Exchange |
$4.64
|
| Rate for Payer: UHC Exchange |
$4.64
|
| Rate for Payer: UHC Exchange |
$4.64
|
| Rate for Payer: UHC Exchange |
$4.64
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION
|
Facility
|
IP
|
$28.84
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
108266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.17 |
| Max. Negotiated Rate |
$25.96 |
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cofinity Advantage |
$20.19
|
| Rate for Payer: Cofinity Advantage |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.63
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: Priority Health SBD |
$15.18
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION
|
Facility
|
OP
|
$28.84
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
108266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$25.96 |
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: Aetna Medicare |
$14.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Trust/PPO |
$7.04
|
| Rate for Payer: BCBS Trust/PPO |
$7.04
|
| Rate for Payer: BCN Commercial |
$7.04
|
| Rate for Payer: BCN Commercial |
$7.04
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Advantage |
$20.19
|
| Rate for Payer: Cofinity Advantage |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.07
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: Priority Health SBD |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.64
|
| Rate for Payer: UHC Core |
$4.64
|
| Rate for Payer: UHC Core |
$4.64
|
| Rate for Payer: UHC Exchange |
$4.64
|
| Rate for Payer: UHC Exchange |
$4.64
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$88.16
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
6271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$79.34 |
| Rate for Payer: Aetna Commercial |
$74.94
|
| Rate for Payer: Aetna Medicare |
$44.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.30
|
| Rate for Payer: BCBS Complete |
$35.26
|
| Rate for Payer: BCBS Trust/PPO |
$7.04
|
| Rate for Payer: BCN Commercial |
$7.04
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cofinity Advantage |
$61.71
|
| Rate for Payer: Cofinity Commercial |
$75.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.53
|
| Rate for Payer: Healthscope Commercial |
$79.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.12
|
| Rate for Payer: PHP Commercial |
$74.94
|
| Rate for Payer: Priority Health SBD |
$55.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.64
|
| Rate for Payer: UHC Core |
$4.64
|
| Rate for Payer: UHC Exchange |
$4.64
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$88.16
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
6271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.54 |
| Max. Negotiated Rate |
$79.34 |
| Rate for Payer: Aetna Commercial |
$74.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.30
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cofinity Advantage |
$61.71
|
| Rate for Payer: Cofinity Commercial |
$75.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.53
|
| Rate for Payer: Healthscope Commercial |
$79.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.12
|
| Rate for Payer: PHP Commercial |
$74.94
|
| Rate for Payer: Priority Health SBD |
$55.54
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET
|
Facility
|
OP
|
$3,747.70
|
|
|
Service Code
|
NDC 69238105103
|
| Hospital Charge Code |
11024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,472.85 |
| Max. Negotiated Rate |
$3,372.93 |
| Rate for Payer: Aetna Commercial |
$3,185.55
|
| Rate for Payer: Aetna Medicare |
$1,873.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,436.01
|
| Rate for Payer: BCBS Complete |
$1,499.08
|
| Rate for Payer: Cash Price |
$2,998.16
|
| Rate for Payer: Cofinity Advantage |
$2,623.39
|
| Rate for Payer: Cofinity Commercial |
$3,223.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,998.16
|
| Rate for Payer: Healthscope Commercial |
$3,372.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,998.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,185.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,810.78
|
| Rate for Payer: PHP Commercial |
$3,185.55
|
| Rate for Payer: Priority Health SBD |
$2,361.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,436.01
|
| Rate for Payer: UHC Core |
$1,952.55
|
| Rate for Payer: UHC Exchange |
$1,472.85
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET
|
Facility
|
IP
|
$3,747.70
|
|
|
Service Code
|
NDC 69238105103
|
| Hospital Charge Code |
11024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,361.05 |
| Max. Negotiated Rate |
$3,372.93 |
| Rate for Payer: Aetna Commercial |
$3,185.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,436.01
|
| Rate for Payer: Cash Price |
$2,998.16
|
| Rate for Payer: Cofinity Advantage |
$2,623.39
|
| Rate for Payer: Cofinity Commercial |
$3,223.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,998.16
|
| Rate for Payer: Healthscope Commercial |
$3,372.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,185.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,810.78
|
| Rate for Payer: PHP Commercial |
$3,185.55
|
| Rate for Payer: Priority Health SBD |
$2,361.05
|
|
|
PILOCARPINE 1 % EYE DROPS
|
Facility
|
OP
|
$138.87
|
|
|
Service Code
|
NDC 61314020315
|
| Hospital Charge Code |
6279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.58 |
| Max. Negotiated Rate |
$124.98 |
| Rate for Payer: Aetna Commercial |
$118.04
|
| Rate for Payer: Aetna Medicare |
$69.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.27
|
| Rate for Payer: BCBS Complete |
$55.55
|
| Rate for Payer: Cash Price |
$111.10
|
| Rate for Payer: Cofinity Advantage |
$97.21
|
| Rate for Payer: Cofinity Commercial |
$119.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.10
|
| Rate for Payer: Healthscope Commercial |
$124.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.15
|
| Rate for Payer: PHP Commercial |
$118.04
|
| Rate for Payer: Priority Health SBD |
$87.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.27
|
| Rate for Payer: UHC Core |
$72.35
|
| Rate for Payer: UHC Exchange |
$54.58
|
|
