|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
IP
|
$155.67
|
|
|
Service Code
|
NDC 60687-156-25
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.94 |
| Max. Negotiated Rate |
$140.10 |
| Rate for Payer: Aetna Commercial |
$132.32
|
| Rate for Payer: BCBS Trust/PPO |
$120.30
|
| Rate for Payer: BCN Commercial |
$120.30
|
| Rate for Payer: Cash Price |
$124.54
|
| Rate for Payer: Cofinity Commercial |
$133.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.54
|
| Rate for Payer: Healthscope Commercial |
$140.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.32
|
| Rate for Payer: PHP Commercial |
$132.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.99
|
| Rate for Payer: UHC Core |
$129.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.75
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
IP
|
$5.19
|
|
|
Service Code
|
NDC 60687-156-95
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial |
$4.41
|
| Rate for Payer: BCBS Trust/PPO |
$4.01
|
| Rate for Payer: BCN Commercial |
$4.01
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.15
|
| Rate for Payer: Healthscope Commercial |
$4.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.41
|
| Rate for Payer: PHP Commercial |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.57
|
| Rate for Payer: UHC Core |
$4.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.89
|
|
|
PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14.97
|
|
|
Service Code
|
HCPCS J1165
|
| Hospital Charge Code |
6256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$13.47 |
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: Aetna Commercial |
$18.31
|
| Rate for Payer: BCBS Trust/PPO |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$11.57
|
| Rate for Payer: BCN Commercial |
$11.57
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$17.23
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$18.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.23
|
| Rate for Payer: Healthscope Commercial |
$19.39
|
| Rate for Payer: Healthscope Commercial |
$13.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.31
|
| Rate for Payer: PHP Commercial |
$12.72
|
| Rate for Payer: PHP Commercial |
$18.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.17
|
| Rate for Payer: UHC Core |
$17.99
|
| Rate for Payer: UHC Core |
$12.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.16
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$452.20
|
|
|
Service Code
|
NDC 68084-376-11
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.80 |
| Max. Negotiated Rate |
$406.98 |
| Rate for Payer: Aetna Commercial |
$384.37
|
| Rate for Payer: BCBS Trust/PPO |
$349.46
|
| Rate for Payer: BCN Commercial |
$349.46
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Cofinity Commercial |
$388.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.76
|
| Rate for Payer: Healthscope Commercial |
$406.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$384.37
|
| Rate for Payer: PHP Commercial |
$384.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$393.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.94
|
| Rate for Payer: UHC Core |
$377.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.15
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$452.20
|
|
|
Service Code
|
NDC 68084-376-01
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.80 |
| Max. Negotiated Rate |
$406.98 |
| Rate for Payer: Aetna Commercial |
$384.37
|
| Rate for Payer: BCBS Trust/PPO |
$349.46
|
| Rate for Payer: BCN Commercial |
$349.46
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Cofinity Commercial |
$388.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.76
|
| Rate for Payer: Healthscope Commercial |
$406.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$384.37
|
| Rate for Payer: PHP Commercial |
$384.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$393.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.94
|
| Rate for Payer: UHC Core |
$377.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.15
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$382.85
|
|
|
Service Code
|
NDC 0904-6187-61
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.50 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: BCBS Trust/PPO |
$295.87
|
| Rate for Payer: BCN Commercial |
$295.87
|
| Rate for Payer: Cash Price |
$306.28
|
| 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: Lakeland Regional Health Systems Commercial |
$287.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.42
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$333.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.91
|
| Rate for Payer: UHC Core |
$319.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.14
|
|
|
PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$258.47
|
|
|
Service Code
|
NDC 17478-510-02
|
| Hospital Charge Code |
6270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$157.64 |
| Max. Negotiated Rate |
$232.62 |
| Rate for Payer: Aetna Commercial |
$219.70
|
| Rate for Payer: BCBS Trust/PPO |
$199.75
|
| Rate for Payer: BCN Commercial |
$199.75
|
| Rate for Payer: Cash Price |
$206.78
|
| 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: Lakeland Regional Health Systems Commercial |
$193.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.70
|
| Rate for Payer: PHP Commercial |
$219.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.45
|
| Rate for Payer: UHC Core |
$215.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.85
|
|
|
PHYTONADIONE (VITAMIN K1) 1,000 MCG CAPSULE
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 510501050
|
| Hospital Charge Code |
196288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.39 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: BCBS Trust/PPO |
$207.03
|
| Rate for Payer: BCN Commercial |
$207.03
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.75
|
| Rate for Payer: UHC Core |
$223.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.92
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$82.80
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
11023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: BCBS Trust/PPO |
$81.91
|
| Rate for Payer: BCBS Trust/PPO |
$63.99
|
| Rate for Payer: BCN Commercial |
$81.91
|
| Rate for Payer: BCN Commercial |
$63.99
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cash Price |
$84.79
|
| Rate for Payer: Cofinity Commercial |
$91.15
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.24
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Healthscope Commercial |
$95.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.38
|
| Rate for Payer: PHP Commercial |
$70.38
|
| Rate for Payer: PHP Commercial |
$90.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.86
|
| Rate for Payer: UHC Core |
$69.14
|
| Rate for Payer: UHC Core |
$88.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.49
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION
|
Facility
|
IP
|
$20.70
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
108266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: BCBS Trust/PPO |
$16.00
|
| Rate for Payer: BCN Commercial |
$16.00
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.60
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.22
|
| Rate for Payer: UHC Core |
$17.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.52
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET
|
Facility
|
IP
|
$4,525.10
|
|
|
Service Code
|
NDC 0904-6882-10
|
| Hospital Charge Code |
11024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,759.86 |
| Max. Negotiated Rate |
$4,072.59 |
| Rate for Payer: Aetna Commercial |
$3,846.34
|
| Rate for Payer: BCBS Trust/PPO |
$3,497.00
|
| Rate for Payer: BCN Commercial |
$3,497.00
|
| Rate for Payer: Cash Price |
$3,620.08
|
| Rate for Payer: Cofinity Commercial |
$3,891.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,620.08
|
| Rate for Payer: Healthscope Commercial |
$4,072.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,393.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,846.34
|
| Rate for Payer: PHP Commercial |
$3,846.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,167.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,936.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,759.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,982.09
|
| Rate for Payer: UHC Core |
$3,778.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,393.82
|
|
|
PILOCARPINE 1 % EYE DROPS
|
Facility
|
IP
|
$134.35
|
|
|
Service Code
|
NDC 61314-203-15
|
| Hospital Charge Code |
6279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$120.92 |
| Rate for Payer: Aetna Commercial |
$114.20
|
| Rate for Payer: BCBS Trust/PPO |
$103.83
|
| Rate for Payer: BCN Commercial |
$103.83
|
| Rate for Payer: Cash Price |
$107.48
|
| Rate for Payer: Cofinity Commercial |
$115.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.48
|
| Rate for Payer: Healthscope Commercial |
$120.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.20
|
| Rate for Payer: PHP Commercial |
$114.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.23
|
| Rate for Payer: UHC Core |
$112.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.76
|
|
|
PILOCARPINE 2 % EYE DROPS
|
Facility
|
IP
|
$311.54
|
|
|
Service Code
|
NDC 0998-0204-15
|
| Hospital Charge Code |
6280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.01 |
| Max. Negotiated Rate |
$280.39 |
| Rate for Payer: Aetna Commercial |
$264.81
|
| Rate for Payer: BCBS Trust/PPO |
$240.76
|
| Rate for Payer: BCN Commercial |
$240.76
|
| Rate for Payer: Cash Price |
$249.23
|
| Rate for Payer: Cofinity Commercial |
$267.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.23
|
| Rate for Payer: Healthscope Commercial |
$280.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$264.81
|
| Rate for Payer: PHP Commercial |
$264.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.16
|
| Rate for Payer: UHC Core |
$260.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.66
|
|
|
PILOCARPINE 4 % EYE DROPS
|
Facility
|
IP
|
$138.92
|
|
|
Service Code
|
NDC 70069-201-01
|
| Hospital Charge Code |
6282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.73 |
| Max. Negotiated Rate |
$125.03 |
| Rate for Payer: Aetna Commercial |
$118.08
|
| Rate for Payer: BCBS Trust/PPO |
$107.36
|
| Rate for Payer: BCN Commercial |
$107.36
|
| Rate for Payer: Cash Price |
$111.14
|
| Rate for Payer: Cofinity Commercial |
$119.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.14
|
| Rate for Payer: Healthscope Commercial |
$125.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$118.08
|
| Rate for Payer: PHP Commercial |
$118.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.25
|
| Rate for Payer: UHC Core |
$116.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.19
|
|
|
PILOCARPINE 4 % EYE DROPS
|
Facility
|
IP
|
$149.37
|
|
|
Service Code
|
NDC 61314-206-15
|
| Hospital Charge Code |
6282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.10 |
| Max. Negotiated Rate |
$134.43 |
| Rate for Payer: Aetna Commercial |
$126.96
|
| Rate for Payer: BCBS Trust/PPO |
$115.43
|
| Rate for Payer: BCN Commercial |
$115.43
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cofinity Commercial |
$128.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.50
|
| Rate for Payer: Healthscope Commercial |
$134.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.96
|
| Rate for Payer: PHP Commercial |
$126.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.45
|
| Rate for Payer: UHC Core |
$124.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.03
|
|
|
PILOCARPINE 5 MG TABLET
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
NDC 0527-1313-01
|
| Hospital Charge Code |
12803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.17 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: BCBS Trust/PPO |
$278.98
|
| Rate for Payer: BCN Commercial |
$278.98
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$310.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.80
|
| Rate for Payer: Healthscope Commercial |
$324.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.85
|
| Rate for Payer: PHP Commercial |
$306.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$314.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.68
|
| Rate for Payer: UHC Core |
$301.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.75
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$1,337.11
|
|
|
Service Code
|
NDC 64764-151-04
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$815.50 |
| Max. Negotiated Rate |
$1,203.40 |
| Rate for Payer: Aetna Commercial |
$1,136.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,033.32
|
| Rate for Payer: BCN Commercial |
$1,033.32
|
| Rate for Payer: Cash Price |
$1,069.69
|
| Rate for Payer: Cofinity Commercial |
$1,149.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,069.69
|
| Rate for Payer: Healthscope Commercial |
$1,203.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,002.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,136.54
|
| Rate for Payer: PHP Commercial |
$1,136.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$935.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,163.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$815.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,176.66
|
| Rate for Payer: UHC Core |
$1,116.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,002.83
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$81.78
|
|
|
Service Code
|
NDC 57237-219-30
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.88 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$69.51
|
| Rate for Payer: BCBS Trust/PPO |
$63.20
|
| Rate for Payer: BCN Commercial |
$63.20
|
| Rate for Payer: Cash Price |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$70.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.42
|
| Rate for Payer: Healthscope Commercial |
$73.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.51
|
| Rate for Payer: PHP Commercial |
$69.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.97
|
| Rate for Payer: UHC Core |
$68.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.34
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$438.24
|
|
|
Service Code
|
NDC 0904-7090-61
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$267.28 |
| Max. Negotiated Rate |
$394.42 |
| Rate for Payer: Aetna Commercial |
$372.50
|
| Rate for Payer: BCBS Trust/PPO |
$338.67
|
| Rate for Payer: BCN Commercial |
$338.67
|
| Rate for Payer: Cash Price |
$350.59
|
| Rate for Payer: Cofinity Commercial |
$376.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.59
|
| Rate for Payer: Healthscope Commercial |
$394.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$372.50
|
| Rate for Payer: PHP Commercial |
$372.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$306.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$381.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.65
|
| Rate for Payer: UHC Core |
$365.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.68
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$58.52
|
|
|
Service Code
|
NDC 16729-020-10
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.69 |
| Max. Negotiated Rate |
$52.67 |
| Rate for Payer: Aetna Commercial |
$49.74
|
| Rate for Payer: BCBS Trust/PPO |
$45.22
|
| Rate for Payer: BCN Commercial |
$45.22
|
| Rate for Payer: Cash Price |
$46.82
|
| Rate for Payer: Cofinity Commercial |
$50.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.82
|
| Rate for Payer: Healthscope Commercial |
$52.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.74
|
| Rate for Payer: PHP Commercial |
$49.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.50
|
| Rate for Payer: UHC Core |
$48.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.89
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.14
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$16.33 |
| Rate for Payer: Aetna Commercial |
$15.42
|
| Rate for Payer: Aetna Commercial |
$24.45
|
| Rate for Payer: Aetna Commercial |
$21.19
|
| Rate for Payer: Aetna Commercial |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$19.27
|
| Rate for Payer: BCBS Trust/PPO |
$22.23
|
| Rate for Payer: BCBS Trust/PPO |
$15.63
|
| Rate for Payer: BCBS Trust/PPO |
$14.02
|
| Rate for Payer: BCN Commercial |
$15.63
|
| Rate for Payer: BCN Commercial |
$19.27
|
| Rate for Payer: BCN Commercial |
$14.02
|
| Rate for Payer: BCN Commercial |
$22.23
|
| Rate for Payer: Cash Price |
$14.51
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cofinity Commercial |
$15.60
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$17.40
|
| Rate for Payer: Cofinity Commercial |
$21.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Healthscope Commercial |
$22.44
|
| Rate for Payer: Healthscope Commercial |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$16.33
|
| Rate for Payer: Healthscope Commercial |
$25.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.19
|
| Rate for Payer: PHP Commercial |
$17.20
|
| Rate for Payer: PHP Commercial |
$21.19
|
| Rate for Payer: PHP Commercial |
$24.45
|
| Rate for Payer: PHP Commercial |
$15.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.80
|
| Rate for Payer: UHC Core |
$20.82
|
| Rate for Payer: UHC Core |
$15.15
|
| Rate for Payer: UHC Core |
$16.89
|
| Rate for Payer: UHC Core |
$24.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.17
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375GM IVPB (IV PREMIX)
|
Facility
|
IP
|
$26.26
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
180352
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: BCBS Trust/PPO |
$20.29
|
| Rate for Payer: BCN Commercial |
$20.29
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.32
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.11
|
| Rate for Payer: UHC Core |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.76
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.71 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Aetna Commercial |
$21.90
|
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna Commercial |
$18.01
|
| Rate for Payer: Aetna Commercial |
$14.75
|
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: Aetna Commercial |
$15.56
|
| Rate for Payer: BCBS Trust/PPO |
$15.07
|
| Rate for Payer: BCBS Trust/PPO |
$13.41
|
| Rate for Payer: BCBS Trust/PPO |
$16.38
|
| Rate for Payer: BCBS Trust/PPO |
$19.29
|
| Rate for Payer: BCBS Trust/PPO |
$12.65
|
| Rate for Payer: BCBS Trust/PPO |
$14.09
|
| Rate for Payer: BCBS Trust/PPO |
$14.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.91
|
| Rate for Payer: BCN Commercial |
$16.38
|
| Rate for Payer: BCN Commercial |
$14.09
|
| Rate for Payer: BCN Commercial |
$19.29
|
| Rate for Payer: BCN Commercial |
$13.41
|
| Rate for Payer: BCN Commercial |
$15.07
|
| Rate for Payer: BCN Commercial |
$14.14
|
| Rate for Payer: BCN Commercial |
$19.91
|
| Rate for Payer: BCN Commercial |
$12.65
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$19.97
|
| Rate for Payer: Cash Price |
$16.95
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: Cash Price |
$13.88
|
| Rate for Payer: Cash Price |
$20.61
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cofinity Commercial |
$16.77
|
| Rate for Payer: Cofinity Commercial |
$15.74
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Cofinity Commercial |
$15.68
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Cofinity Commercial |
$14.92
|
| Rate for Payer: Cofinity Commercial |
$14.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.95
|
| Rate for Payer: Healthscope Commercial |
$22.46
|
| Rate for Payer: Healthscope Commercial |
$15.62
|
| Rate for Payer: Healthscope Commercial |
$16.41
|
| Rate for Payer: Healthscope Commercial |
$16.47
|
| Rate for Payer: Healthscope Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$19.07
|
| Rate for Payer: Healthscope Commercial |
$17.55
|
| Rate for Payer: Healthscope Commercial |
$14.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.50
|
| Rate for Payer: PHP Commercial |
$15.50
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: PHP Commercial |
$18.01
|
| Rate for Payer: PHP Commercial |
$15.56
|
| Rate for Payer: PHP Commercial |
$21.90
|
| Rate for Payer: PHP Commercial |
$13.91
|
| Rate for Payer: PHP Commercial |
$14.75
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.10
|
| Rate for Payer: UHC Core |
$15.28
|
| Rate for Payer: UHC Core |
$13.67
|
| Rate for Payer: UHC Core |
$16.28
|
| Rate for Payer: UHC Core |
$14.49
|
| Rate for Payer: UHC Core |
$20.84
|
| Rate for Payer: UHC Core |
$15.22
|
| Rate for Payer: UHC Core |
$17.69
|
| Rate for Payer: UHC Core |
$21.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.32
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.85
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$16.96 |
| Rate for Payer: Aetna Commercial |
$16.02
|
| Rate for Payer: Aetna Commercial |
$23.07
|
| Rate for Payer: Aetna Commercial |
$22.70
|
| Rate for Payer: Aetna Commercial |
$16.06
|
| Rate for Payer: BCBS Trust/PPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$20.97
|
| Rate for Payer: BCBS Trust/PPO |
$14.61
|
| Rate for Payer: BCBS Trust/PPO |
$20.63
|
| Rate for Payer: BCN Commercial |
$20.63
|
| Rate for Payer: BCN Commercial |
$20.97
|
| Rate for Payer: BCN Commercial |
$14.57
|
| Rate for Payer: BCN Commercial |
$14.61
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cash Price |
$21.71
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cofinity Commercial |
$23.34
|
| Rate for Payer: Cofinity Commercial |
$22.96
|
| Rate for Payer: Cofinity Commercial |
$16.21
|
| Rate for Payer: Cofinity Commercial |
$16.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$24.43
|
| Rate for Payer: Healthscope Commercial |
$17.01
|
| Rate for Payer: Healthscope Commercial |
$24.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.70
|
| Rate for Payer: PHP Commercial |
$22.70
|
| Rate for Payer: PHP Commercial |
$23.07
|
| Rate for Payer: PHP Commercial |
$16.02
|
| Rate for Payer: PHP Commercial |
$16.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.88
|
| Rate for Payer: UHC Core |
$15.78
|
| Rate for Payer: UHC Core |
$22.66
|
| Rate for Payer: UHC Core |
$22.29
|
| Rate for Payer: UHC Core |
$15.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.02
|
|
|
PIPER.BUT-PYRETHRINS-PERMETHRN 4 %-0.33 %-0.5 % TOPICAL KIT
|
Facility
|
IP
|
$62.62
|
|
|
Service Code
|
NDC 1650050492
|
| Hospital Charge Code |
10920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$56.36 |
| Rate for Payer: Aetna Commercial |
$53.23
|
| Rate for Payer: BCBS Trust/PPO |
$48.39
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cofinity Commercial |
$53.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.10
|
| Rate for Payer: Healthscope Commercial |
$56.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.23
|
| Rate for Payer: PHP Commercial |
$53.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.11
|
| Rate for Payer: UHC Core |
$52.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.96
|
|
