|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 70000050201
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.79
|
| Rate for Payer: BCN Commercial |
$3.79
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
OP
|
$9.52
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna Commercial |
$8.09
|
| Rate for Payer: Aetna Medicare |
$2.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.98
|
| Rate for Payer: BCBS Complete |
$1.76
|
| Rate for Payer: BCBS MAPPO |
$2.38
|
| Rate for Payer: BCBS Trust/PPO |
$7.83
|
| Rate for Payer: BCN Commercial |
$7.83
|
| Rate for Payer: BCN Medicare Advantage |
$2.38
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.38
|
| Rate for Payer: Healthscope Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.14
|
| Rate for Payer: Mclaren Medicaid |
$1.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.50
|
| Rate for Payer: Meridian Medicaid |
$1.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.09
|
| Rate for Payer: Nomi Health Commercial |
$7.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.14
|
| Rate for Payer: PACE Senior Care Partners |
$2.26
|
| Rate for Payer: PACE SWMI |
$2.38
|
| Rate for Payer: PHP Commercial |
$8.09
|
| Rate for Payer: PHP Medicare Advantage |
$2.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.28
|
| Rate for Payer: Priority Health Medicare |
$2.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC Core |
$7.95
|
| Rate for Payer: UHC Exchange |
$2.38
|
| Rate for Payer: UHC Medicaid |
$1.68
|
| Rate for Payer: UHC Medicare Advantage |
$2.38
|
| Rate for Payer: UHCCP Medicaid |
$1.68
|
| Rate for Payer: VA VA |
$2.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.14
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
IP
|
$11.41
|
|
|
Service Code
|
NDC 96295013764
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$10.27 |
| Rate for Payer: Aetna Commercial |
$9.70
|
| Rate for Payer: BCBS Trust/PPO |
$9.42
|
| Rate for Payer: BCN Commercial |
$9.42
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cofinity Commercial |
$9.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.13
|
| Rate for Payer: Healthscope Commercial |
$10.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.70
|
| Rate for Payer: Nomi Health Commercial |
$9.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.56
|
| Rate for Payer: PHP Commercial |
$9.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.04
|
| Rate for Payer: UHC Core |
$9.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.56
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
OP
|
$29.04
|
|
|
Service Code
|
NDC 42002020705
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$26.14 |
| Rate for Payer: Aetna Commercial |
$24.68
|
| Rate for Payer: Aetna Medicare |
$7.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.07
|
| Rate for Payer: BCBS Complete |
$5.38
|
| Rate for Payer: BCBS MAPPO |
$7.26
|
| Rate for Payer: BCBS Trust/PPO |
$23.87
|
| Rate for Payer: BCN Commercial |
$23.87
|
| Rate for Payer: BCN Medicare Advantage |
$7.26
|
| Rate for Payer: Cash Price |
$23.23
|
| Rate for Payer: Cofinity Commercial |
$24.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.26
|
| Rate for Payer: Healthscope Commercial |
$26.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.78
|
| Rate for Payer: Mclaren Medicaid |
$5.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.62
|
| Rate for Payer: Meridian Medicaid |
$5.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.68
|
| Rate for Payer: Nomi Health Commercial |
$23.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.78
|
| Rate for Payer: PACE Senior Care Partners |
$6.90
|
| Rate for Payer: PACE SWMI |
$7.26
|
| Rate for Payer: PHP Commercial |
$24.68
|
| Rate for Payer: PHP Medicare Advantage |
$7.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.26
|
| Rate for Payer: Priority Health Medicare |
$7.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.21
|
| Rate for Payer: Railroad Medicare Medicare |
$7.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.56
|
| Rate for Payer: UHC Core |
$24.25
|
| Rate for Payer: UHC Exchange |
$7.26
|
| Rate for Payer: UHC Medicaid |
$5.12
|
| Rate for Payer: UHC Medicare Advantage |
$7.26
|
| Rate for Payer: UHCCP Medicaid |
$5.12
|
| Rate for Payer: VA VA |
$7.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.78
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
IP
|
$29.04
|
|
|
Service Code
|
NDC 42002020705
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$26.14 |
| Rate for Payer: Aetna Commercial |
$24.68
|
| Rate for Payer: BCBS Trust/PPO |
$23.98
|
| Rate for Payer: BCN Commercial |
$23.98
|
| Rate for Payer: Cash Price |
$23.23
|
| Rate for Payer: Cofinity Commercial |
$24.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.23
|
| Rate for Payer: Healthscope Commercial |
$26.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.68
|
| Rate for Payer: Nomi Health Commercial |
$23.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.78
|
| Rate for Payer: PHP Commercial |
$24.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.56
|
| Rate for Payer: UHC Core |
$24.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.78
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
IP
|
$9.52
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna Commercial |
$8.09
|
| Rate for Payer: BCBS Trust/PPO |
$7.86
|
| Rate for Payer: BCN Commercial |
$7.86
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.62
|
| Rate for Payer: Healthscope Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.09
|
| Rate for Payer: Nomi Health Commercial |
$7.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.14
|
| Rate for Payer: PHP Commercial |
$8.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC Core |
$7.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.14
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 70000050201
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$1.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.43
|
| Rate for Payer: BCBS Complete |
$0.85
|
| Rate for Payer: BCBS MAPPO |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.77
|
| Rate for Payer: BCN Commercial |
$3.77
|
| Rate for Payer: BCN Medicare Advantage |
$1.15
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.15
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Mclaren Medicaid |
$0.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.20
|
| Rate for Payer: Meridian Medicaid |
$0.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PACE Senior Care Partners |
$1.09
|
| Rate for Payer: PACE SWMI |
$1.15
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: PHP Medicare Advantage |
$1.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Medicare |
$1.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: UHC Exchange |
$1.15
|
| Rate for Payer: UHC Medicaid |
$0.81
|
| Rate for Payer: UHC Medicare Advantage |
$1.15
|
| Rate for Payer: UHCCP Medicaid |
$0.81
|
| Rate for Payer: VA VA |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$16,067.54
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
32267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,832.71 |
| Max. Negotiated Rate |
$14,460.79 |
| Rate for Payer: Aetna Commercial |
$13,657.41
|
| Rate for Payer: Aetna Medicare |
$4,177.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,021.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,021.11
|
| Rate for Payer: BCBS Complete |
$2,974.10
|
| Rate for Payer: BCBS MAPPO |
$4,016.89
|
| Rate for Payer: BCBS Trust/PPO |
$13,209.12
|
| Rate for Payer: BCN Commercial |
$13,209.12
|
| Rate for Payer: BCN Medicare Advantage |
$4,016.89
|
| Rate for Payer: Cash Price |
$12,854.03
|
| Rate for Payer: Cofinity Commercial |
$13,818.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,854.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,016.89
|
| Rate for Payer: Healthscope Commercial |
$14,460.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,050.66
|
| Rate for Payer: Mclaren Medicaid |
$2,832.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,217.73
|
| Rate for Payer: Meridian Medicaid |
$2,974.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,619.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,418.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,657.41
|
| Rate for Payer: Nomi Health Commercial |
$13,175.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,050.66
|
| Rate for Payer: PACE Senior Care Partners |
$3,816.04
|
| Rate for Payer: PACE SWMI |
$4,016.89
|
| Rate for Payer: PHP Commercial |
$13,657.41
|
| Rate for Payer: PHP Medicare Advantage |
$4,016.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,832.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13,978.76
|
| Rate for Payer: Priority Health Medicare |
$4,057.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,183.01
|
| Rate for Payer: Railroad Medicare Medicare |
$4,016.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,139.44
|
| Rate for Payer: UHC Core |
$13,416.40
|
| Rate for Payer: UHC Exchange |
$4,016.89
|
| Rate for Payer: UHC Medicaid |
$2,832.71
|
| Rate for Payer: UHC Medicare Advantage |
$4,016.89
|
| Rate for Payer: UHCCP Medicaid |
$2,832.71
|
| Rate for Payer: VA VA |
$4,016.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,050.66
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$16,067.54
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
32267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,183.01 |
| Max. Negotiated Rate |
$14,460.79 |
| Rate for Payer: Aetna Commercial |
$13,657.41
|
| Rate for Payer: BCBS Trust/PPO |
$13,270.18
|
| Rate for Payer: BCN Commercial |
$13,270.18
|
| Rate for Payer: Cash Price |
$12,854.03
|
| Rate for Payer: Cofinity Commercial |
$13,818.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,854.03
|
| Rate for Payer: Healthscope Commercial |
$14,460.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,050.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,657.41
|
| Rate for Payer: Nomi Health Commercial |
$13,175.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,050.66
|
| Rate for Payer: PHP Commercial |
$13,657.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13,978.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,183.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,139.44
|
| Rate for Payer: UHC Core |
$13,416.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,050.66
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$1,208.01
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
112201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$212.97 |
| Max. Negotiated Rate |
$1,087.21 |
| Rate for Payer: Aetna Commercial |
$1,026.81
|
| Rate for Payer: Aetna Medicare |
$314.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$377.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$377.50
|
| Rate for Payer: BCBS Complete |
$223.60
|
| Rate for Payer: BCBS MAPPO |
$302.00
|
| Rate for Payer: BCBS Trust/PPO |
$993.11
|
| Rate for Payer: BCN Commercial |
$993.11
|
| Rate for Payer: BCN Medicare Advantage |
$302.00
|
| Rate for Payer: Cash Price |
$966.41
|
| Rate for Payer: Cofinity Commercial |
$1,038.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.00
|
| Rate for Payer: Healthscope Commercial |
$1,087.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.01
|
| Rate for Payer: Mclaren Medicaid |
$212.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$317.10
|
| Rate for Payer: Meridian Medicaid |
$223.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$347.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$332.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.81
|
| Rate for Payer: Nomi Health Commercial |
$990.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.01
|
| Rate for Payer: PACE Senior Care Partners |
$286.90
|
| Rate for Payer: PACE SWMI |
$302.00
|
| Rate for Payer: PHP Commercial |
$1,026.81
|
| Rate for Payer: PHP Medicare Advantage |
$302.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,050.97
|
| Rate for Payer: Priority Health Medicare |
$305.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$840.77
|
| Rate for Payer: Railroad Medicare Medicare |
$302.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,063.05
|
| Rate for Payer: UHC Core |
$1,008.69
|
| Rate for Payer: UHC Exchange |
$302.00
|
| Rate for Payer: UHC Medicaid |
$212.97
|
| Rate for Payer: UHC Medicare Advantage |
$302.00
|
| Rate for Payer: UHCCP Medicaid |
$212.97
|
| Rate for Payer: VA VA |
$302.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.01
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$1,208.01
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
112201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$840.77 |
| Max. Negotiated Rate |
$1,087.21 |
| Rate for Payer: Aetna Commercial |
$1,026.81
|
| Rate for Payer: BCBS Trust/PPO |
$997.70
|
| Rate for Payer: BCN Commercial |
$997.70
|
| Rate for Payer: Cash Price |
$966.41
|
| Rate for Payer: Cofinity Commercial |
$1,038.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.41
|
| Rate for Payer: Healthscope Commercial |
$1,087.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.81
|
| Rate for Payer: Nomi Health Commercial |
$990.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.01
|
| Rate for Payer: PHP Commercial |
$1,026.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,050.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$840.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,063.05
|
| Rate for Payer: UHC Core |
$1,008.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.01
|
|
|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$19.82
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$17.84 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: BCBS Trust/PPO |
$16.37
|
| Rate for Payer: BCBS Trust/PPO |
$24.45
|
| Rate for Payer: BCN Commercial |
$16.37
|
| Rate for Payer: BCN Commercial |
$24.45
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$17.84
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.16
|
| Rate for Payer: Nomi Health Commercial |
$16.25
|
| Rate for Payer: Nomi Health Commercial |
$24.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.20
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: PHP Commercial |
$16.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.05
|
| Rate for Payer: UHC Core |
$16.55
|
| Rate for Payer: UHC Core |
$24.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
|
|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$19.82
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$17.84 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna Medicare |
$7.70
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.25
|
| Rate for Payer: BCBS Complete |
$3.67
|
| Rate for Payer: BCBS Complete |
$5.48
|
| Rate for Payer: BCBS MAPPO |
$4.96
|
| Rate for Payer: BCBS MAPPO |
$7.40
|
| Rate for Payer: BCBS Trust/PPO |
$16.29
|
| Rate for Payer: BCBS Trust/PPO |
$24.33
|
| Rate for Payer: BCN Commercial |
$24.33
|
| Rate for Payer: BCN Commercial |
$16.29
|
| Rate for Payer: BCN Medicare Advantage |
$7.40
|
| Rate for Payer: BCN Medicare Advantage |
$4.96
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.96
|
| Rate for Payer: Healthscope Commercial |
$17.84
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicaid |
$3.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Medicaid |
$3.67
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.85
|
| Rate for Payer: Nomi Health Commercial |
$24.27
|
| Rate for Payer: Nomi Health Commercial |
$16.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.20
|
| Rate for Payer: PACE Senior Care Partners |
$7.03
|
| Rate for Payer: PACE Senior Care Partners |
$4.71
|
| Rate for Payer: PACE SWMI |
$7.40
|
| Rate for Payer: PACE SWMI |
$4.96
|
| Rate for Payer: PHP Commercial |
$16.85
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: PHP Medicare Advantage |
$4.96
|
| Rate for Payer: PHP Medicare Advantage |
$7.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.24
|
| Rate for Payer: Priority Health Medicare |
$7.47
|
| Rate for Payer: Priority Health Medicare |
$5.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.60
|
| Rate for Payer: Railroad Medicare Medicare |
$4.96
|
| Rate for Payer: Railroad Medicare Medicare |
$7.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.05
|
| Rate for Payer: UHC Core |
$24.72
|
| Rate for Payer: UHC Core |
$16.55
|
| Rate for Payer: UHC Exchange |
$7.40
|
| Rate for Payer: UHC Exchange |
$4.96
|
| Rate for Payer: UHC Medicaid |
$5.22
|
| Rate for Payer: UHC Medicaid |
$3.49
|
| Rate for Payer: UHC Medicare Advantage |
$4.96
|
| Rate for Payer: UHC Medicare Advantage |
$7.40
|
| Rate for Payer: UHCCP Medicaid |
$3.49
|
| Rate for Payer: UHCCP Medicaid |
$5.22
|
| Rate for Payer: VA VA |
$4.96
|
| Rate for Payer: VA VA |
$7.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.87
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$253.80
|
|
|
Service Code
|
NDC 00093412774
|
| Hospital Charge Code |
6091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.74 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna Medicare |
$65.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.31
|
| Rate for Payer: BCBS Complete |
$46.98
|
| Rate for Payer: BCBS MAPPO |
$63.45
|
| Rate for Payer: BCBS Trust/PPO |
$208.65
|
| Rate for Payer: BCN Commercial |
$208.65
|
| Rate for Payer: BCN Medicare Advantage |
$63.45
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.45
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.35
|
| Rate for Payer: Mclaren Medicaid |
$44.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.62
|
| Rate for Payer: Meridian Medicaid |
$46.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$69.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Nomi Health Commercial |
$208.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.35
|
| Rate for Payer: PACE Senior Care Partners |
$60.28
|
| Rate for Payer: PACE SWMI |
$63.45
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: PHP Medicare Advantage |
$63.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$220.81
|
| Rate for Payer: Priority Health Medicare |
$64.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.64
|
| Rate for Payer: Railroad Medicare Medicare |
$63.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.34
|
| Rate for Payer: UHC Core |
$211.92
|
| Rate for Payer: UHC Exchange |
$63.45
|
| Rate for Payer: UHC Medicaid |
$44.74
|
| Rate for Payer: UHC Medicare Advantage |
$63.45
|
| Rate for Payer: UHCCP Medicaid |
$44.74
|
| Rate for Payer: VA VA |
$63.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.35
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$253.80
|
|
|
Service Code
|
NDC 00093412774
|
| Hospital Charge Code |
6091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.64 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: BCBS Trust/PPO |
$209.61
|
| Rate for Payer: BCN Commercial |
$209.61
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Nomi Health Commercial |
$208.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.35
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$220.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.34
|
| Rate for Payer: UHC Core |
$211.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.35
|
|
|
PENICILLIN V POTASSIUM 500 MG TABLET
|
Facility
|
IP
|
$239.70
|
|
|
Service Code
|
NDC 65862017601
|
| Hospital Charge Code |
6093
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.83 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$203.75
|
| Rate for Payer: BCBS Trust/PPO |
$197.97
|
| Rate for Payer: BCN Commercial |
$197.97
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.75
|
| Rate for Payer: Nomi Health Commercial |
$196.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.78
|
| Rate for Payer: PHP Commercial |
$203.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$208.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.94
|
| Rate for Payer: UHC Core |
$200.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
|
PENICILLIN V POTASSIUM 500 MG TABLET
|
Facility
|
OP
|
$239.70
|
|
|
Service Code
|
NDC 65862017601
|
| Hospital Charge Code |
6093
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.26 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$203.75
|
| Rate for Payer: Aetna Medicare |
$62.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.91
|
| Rate for Payer: BCBS Complete |
$44.37
|
| Rate for Payer: BCBS MAPPO |
$59.92
|
| Rate for Payer: BCBS Trust/PPO |
$197.06
|
| Rate for Payer: BCN Commercial |
$197.06
|
| Rate for Payer: BCN Medicare Advantage |
$59.92
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.92
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: Mclaren Medicaid |
$42.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.92
|
| Rate for Payer: Meridian Medicaid |
$44.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.75
|
| Rate for Payer: Nomi Health Commercial |
$196.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.78
|
| Rate for Payer: PACE Senior Care Partners |
$56.93
|
| Rate for Payer: PACE SWMI |
$59.92
|
| Rate for Payer: PHP Commercial |
$203.75
|
| Rate for Payer: PHP Medicare Advantage |
$59.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$208.54
|
| Rate for Payer: Priority Health Medicare |
$60.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.83
|
| Rate for Payer: Railroad Medicare Medicare |
$59.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.94
|
| Rate for Payer: UHC Core |
$200.15
|
| Rate for Payer: UHC Exchange |
$59.92
|
| Rate for Payer: UHC Medicaid |
$42.26
|
| Rate for Payer: UHC Medicare Advantage |
$59.92
|
| Rate for Payer: UHCCP Medicaid |
$42.26
|
| Rate for Payer: VA VA |
$59.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$8,370.85
|
|
|
Service Code
|
APR-DRG 4832
|
| Min. Negotiated Rate |
$7,972.24 |
| Max. Negotiated Rate |
$8,370.85 |
| Rate for Payer: BCBS Complete |
$8,370.85
|
| Rate for Payer: Mclaren Medicaid |
$7,972.24
|
| Rate for Payer: Meridian Medicaid |
$8,370.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,972.24
|
| Rate for Payer: UHC Medicaid |
$7,972.24
|
| Rate for Payer: UHCCP Medicaid |
$7,972.24
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$12,128.50
|
|
|
Service Code
|
APR-DRG 4833
|
| Min. Negotiated Rate |
$11,550.95 |
| Max. Negotiated Rate |
$12,128.50 |
| Rate for Payer: BCBS Complete |
$12,128.50
|
| Rate for Payer: Mclaren Medicaid |
$11,550.95
|
| Rate for Payer: Meridian Medicaid |
$12,128.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,550.95
|
| Rate for Payer: UHC Medicaid |
$11,550.95
|
| Rate for Payer: UHCCP Medicaid |
$11,550.95
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$22,429.18
|
|
|
Service Code
|
APR-DRG 4834
|
| Min. Negotiated Rate |
$21,361.12 |
| Max. Negotiated Rate |
$22,429.18 |
| Rate for Payer: BCBS Complete |
$22,429.18
|
| Rate for Payer: Mclaren Medicaid |
$21,361.12
|
| Rate for Payer: Meridian Medicaid |
$22,429.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,361.12
|
| Rate for Payer: UHC Medicaid |
$21,361.12
|
| Rate for Payer: UHCCP Medicaid |
$21,361.12
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$5,832.09
|
|
|
Service Code
|
APR-DRG 4831
|
| Min. Negotiated Rate |
$5,554.37 |
| Max. Negotiated Rate |
$5,832.09 |
| Rate for Payer: BCBS Complete |
$5,832.09
|
| Rate for Payer: Mclaren Medicaid |
$5,554.37
|
| Rate for Payer: Meridian Medicaid |
$5,832.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,554.37
|
| Rate for Payer: UHC Medicaid |
$5,554.37
|
| Rate for Payer: UHCCP Medicaid |
$5,554.37
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$374.30
|
|
|
Service Code
|
NDC 60505003306
|
| Hospital Charge Code |
10911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.99 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna Commercial |
$318.15
|
| Rate for Payer: Aetna Medicare |
$97.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.97
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS MAPPO |
$93.58
|
| Rate for Payer: BCBS Trust/PPO |
$307.71
|
| Rate for Payer: BCN Commercial |
$307.71
|
| Rate for Payer: BCN Medicare Advantage |
$93.58
|
| Rate for Payer: Cash Price |
$299.44
|
| Rate for Payer: Cofinity Commercial |
$321.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.58
|
| Rate for Payer: Healthscope Commercial |
$336.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.73
|
| Rate for Payer: Mclaren Medicaid |
$65.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.25
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.15
|
| Rate for Payer: Nomi Health Commercial |
$306.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.73
|
| Rate for Payer: PACE Senior Care Partners |
$88.90
|
| Rate for Payer: PACE SWMI |
$93.58
|
| Rate for Payer: PHP Commercial |
$318.15
|
| Rate for Payer: PHP Medicare Advantage |
$93.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$325.64
|
| Rate for Payer: Priority Health Medicare |
$94.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.51
|
| Rate for Payer: Railroad Medicare Medicare |
$93.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.38
|
| Rate for Payer: UHC Core |
$312.54
|
| Rate for Payer: UHC Exchange |
$93.58
|
| Rate for Payer: UHC Medicaid |
$65.99
|
| Rate for Payer: UHC Medicare Advantage |
$93.58
|
| Rate for Payer: UHCCP Medicaid |
$65.99
|
| Rate for Payer: VA VA |
$93.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.73
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$218.50
|
|
|
Service Code
|
NDC 00904544861
|
| Hospital Charge Code |
10911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.52 |
| Max. Negotiated Rate |
$196.65 |
| Rate for Payer: Aetna Commercial |
$185.72
|
| Rate for Payer: Aetna Medicare |
$56.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.28
|
| Rate for Payer: BCBS Complete |
$40.44
|
| Rate for Payer: BCBS MAPPO |
$54.62
|
| Rate for Payer: BCBS Trust/PPO |
$179.63
|
| Rate for Payer: BCN Commercial |
$179.63
|
| Rate for Payer: BCN Medicare Advantage |
$54.62
|
| Rate for Payer: Cash Price |
$174.80
|
| Rate for Payer: Cofinity Commercial |
$187.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.62
|
| Rate for Payer: Healthscope Commercial |
$196.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.88
|
| Rate for Payer: Mclaren Medicaid |
$38.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.36
|
| Rate for Payer: Meridian Medicaid |
$40.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.72
|
| Rate for Payer: Nomi Health Commercial |
$179.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.88
|
| Rate for Payer: PACE Senior Care Partners |
$51.89
|
| Rate for Payer: PACE SWMI |
$54.62
|
| Rate for Payer: PHP Commercial |
$185.72
|
| Rate for Payer: PHP Medicare Advantage |
$54.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$55.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.08
|
| Rate for Payer: Railroad Medicare Medicare |
$54.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.28
|
| Rate for Payer: UHC Core |
$182.45
|
| Rate for Payer: UHC Exchange |
$54.62
|
| Rate for Payer: UHC Medicaid |
$38.52
|
| Rate for Payer: UHC Medicare Advantage |
$54.62
|
| Rate for Payer: UHCCP Medicaid |
$38.52
|
| Rate for Payer: VA VA |
$54.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.88
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$374.30
|
|
|
Service Code
|
NDC 60505003306
|
| Hospital Charge Code |
10911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.51 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna Commercial |
$318.15
|
| Rate for Payer: BCBS Trust/PPO |
$309.13
|
| Rate for Payer: BCN Commercial |
$309.13
|
| Rate for Payer: Cash Price |
$299.44
|
| 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: Lakeland Regional Health Systems Commercial |
$280.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.15
|
| Rate for Payer: Nomi Health Commercial |
$306.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.73
|
| Rate for Payer: PHP Commercial |
$318.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$325.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.38
|
| Rate for Payer: UHC Core |
$312.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.73
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$218.50
|
|
|
Service Code
|
NDC 00904544861
|
| Hospital Charge Code |
10911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.08 |
| Max. Negotiated Rate |
$196.65 |
| Rate for Payer: Aetna Commercial |
$185.72
|
| Rate for Payer: BCBS Trust/PPO |
$180.46
|
| Rate for Payer: BCN Commercial |
$180.46
|
| Rate for Payer: Cash Price |
$174.80
|
| Rate for Payer: Cofinity Commercial |
$187.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.80
|
| Rate for Payer: Healthscope Commercial |
$196.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.72
|
| Rate for Payer: Nomi Health Commercial |
$179.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.88
|
| Rate for Payer: PHP Commercial |
$185.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$190.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.28
|
| Rate for Payer: UHC Core |
$182.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.88
|
|
