|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$249.10
|
|
|
Service Code
|
NDC 00093412774
|
| Hospital Charge Code |
6091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: Aetna Medicare |
$64.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.84
|
| Rate for Payer: BCBS Complete |
$99.64
|
| Rate for Payer: BCBS MAPPO |
$62.27
|
| Rate for Payer: BCBS Trust/PPO |
$204.79
|
| Rate for Payer: BCN Commercial |
$193.68
|
| Rate for Payer: BCN Medicare Advantage |
$62.27
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.27
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.74
|
| Rate for Payer: Nomi Health Commercial |
$204.26
|
| Rate for Payer: PACE Senior Care Partners |
$59.16
|
| Rate for Payer: PACE SWMI |
$62.27
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: PHP Medicare Advantage |
$62.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.91
|
| Rate for Payer: Priority Health HMO/PPO |
$216.72
|
| Rate for Payer: Priority Health Medicare |
$62.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.90
|
| Rate for Payer: Railroad Medicare Medicare |
$62.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.21
|
| Rate for Payer: UHC Core |
$208.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.27
|
| Rate for Payer: UHC Exchange |
$62.27
|
| Rate for Payer: UHC Medicare Advantage |
$62.27
|
| Rate for Payer: VA VA |
$62.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$249.10
|
|
|
Service Code
|
NDC 00093412774
|
| Hospital Charge Code |
6091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.91 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: BCBS Trust/PPO |
$203.34
|
| Rate for Payer: BCN Commercial |
$192.50
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.74
|
| Rate for Payer: Nomi Health Commercial |
$204.26
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.91
|
| Rate for Payer: Priority Health HMO/PPO |
$216.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.21
|
| Rate for Payer: UHC Core |
$208.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
|
PENICILLIN V POTASSIUM 500 MG TABLET
|
Facility
|
IP
|
$227.95
|
|
|
Service Code
|
NDC 65862017601
|
| Hospital Charge Code |
6093
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.17 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$193.76
|
| Rate for Payer: BCBS Trust/PPO |
$186.08
|
| Rate for Payer: BCN Commercial |
$176.16
|
| Rate for Payer: Cash Price |
$182.36
|
| Rate for Payer: Cofinity Commercial |
$196.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.36
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.76
|
| Rate for Payer: Nomi Health Commercial |
$186.92
|
| Rate for Payer: PHP Commercial |
$193.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.17
|
| Rate for Payer: Priority Health HMO/PPO |
$198.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.60
|
| Rate for Payer: UHC Core |
$190.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.96
|
|
|
PENICILLIN V POTASSIUM 500 MG TABLET
|
Facility
|
IP
|
$416.64
|
|
|
Service Code
|
NDC 00781165501
|
| Hospital Charge Code |
6093
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.82 |
| Max. Negotiated Rate |
$374.98 |
| Rate for Payer: Aetna Commercial |
$354.14
|
| Rate for Payer: BCBS Trust/PPO |
$340.10
|
| Rate for Payer: BCN Commercial |
$321.98
|
| Rate for Payer: Cash Price |
$333.31
|
| Rate for Payer: Cofinity Commercial |
$358.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.31
|
| Rate for Payer: Healthscope Commercial |
$374.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.14
|
| Rate for Payer: Nomi Health Commercial |
$341.64
|
| Rate for Payer: PHP Commercial |
$354.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.82
|
| Rate for Payer: Priority Health HMO/PPO |
$362.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$279.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.64
|
| Rate for Payer: UHC Core |
$347.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.48
|
|
|
PENICILLIN V POTASSIUM 500 MG TABLET
|
Facility
|
OP
|
$227.95
|
|
|
Service Code
|
NDC 65862017601
|
| Hospital Charge Code |
6093
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.14 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$193.76
|
| Rate for Payer: Aetna Medicare |
$59.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.23
|
| Rate for Payer: BCBS Complete |
$91.18
|
| Rate for Payer: BCBS MAPPO |
$56.99
|
| Rate for Payer: BCBS Trust/PPO |
$187.40
|
| Rate for Payer: BCN Commercial |
$177.23
|
| Rate for Payer: BCN Medicare Advantage |
$56.99
|
| Rate for Payer: Cash Price |
$182.36
|
| Rate for Payer: Cofinity Commercial |
$196.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.99
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.76
|
| Rate for Payer: Nomi Health Commercial |
$186.92
|
| Rate for Payer: PACE Senior Care Partners |
$54.14
|
| Rate for Payer: PACE SWMI |
$56.99
|
| Rate for Payer: PHP Commercial |
$193.76
|
| Rate for Payer: PHP Medicare Advantage |
$56.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.17
|
| Rate for Payer: Priority Health HMO/PPO |
$198.32
|
| Rate for Payer: Priority Health Medicare |
$57.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.73
|
| Rate for Payer: Railroad Medicare Medicare |
$56.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.60
|
| Rate for Payer: UHC Core |
$190.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.99
|
| Rate for Payer: UHC Exchange |
$56.99
|
| Rate for Payer: UHC Medicare Advantage |
$56.99
|
| Rate for Payer: VA VA |
$56.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.96
|
|
|
PENICILLIN V POTASSIUM 500 MG TABLET
|
Facility
|
OP
|
$416.64
|
|
|
Service Code
|
NDC 00781165501
|
| Hospital Charge Code |
6093
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.95 |
| Max. Negotiated Rate |
$374.98 |
| Rate for Payer: Aetna Commercial |
$354.14
|
| Rate for Payer: Aetna Medicare |
$108.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.20
|
| Rate for Payer: BCBS Complete |
$166.66
|
| Rate for Payer: BCBS MAPPO |
$104.16
|
| Rate for Payer: BCBS Trust/PPO |
$342.52
|
| Rate for Payer: BCN Commercial |
$323.94
|
| Rate for Payer: BCN Medicare Advantage |
$104.16
|
| Rate for Payer: Cash Price |
$333.31
|
| Rate for Payer: Cofinity Commercial |
$358.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.16
|
| Rate for Payer: Healthscope Commercial |
$374.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.14
|
| Rate for Payer: Nomi Health Commercial |
$341.64
|
| Rate for Payer: PACE Senior Care Partners |
$98.95
|
| Rate for Payer: PACE SWMI |
$104.16
|
| Rate for Payer: PHP Commercial |
$354.14
|
| Rate for Payer: PHP Medicare Advantage |
$104.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.82
|
| Rate for Payer: Priority Health HMO/PPO |
$362.48
|
| Rate for Payer: Priority Health Medicare |
$105.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$279.15
|
| Rate for Payer: Railroad Medicare Medicare |
$104.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.64
|
| Rate for Payer: UHC Core |
$347.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.16
|
| Rate for Payer: UHC Exchange |
$104.16
|
| Rate for Payer: UHC Medicare Advantage |
$104.16
|
| Rate for Payer: VA VA |
$104.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.48
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$222.30
|
|
|
Service Code
|
NDC 00904544861
|
| Hospital Charge Code |
10911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.50 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: BCBS Trust/PPO |
$181.46
|
| Rate for Payer: BCN Commercial |
$171.79
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: Nomi Health Commercial |
$182.29
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: Priority Health HMO/PPO |
$193.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.62
|
| Rate for Payer: UHC Core |
$185.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.72
|
|
|
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 |
$88.90 |
| 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 |
$149.72
|
| Rate for Payer: BCBS MAPPO |
$93.58
|
| Rate for Payer: BCBS Trust/PPO |
$307.71
|
| Rate for Payer: BCN Commercial |
$291.02
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.15
|
| Rate for Payer: Nomi Health Commercial |
$306.93
|
| 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 Cigna Priority Health |
$243.29
|
| Rate for Payer: Priority Health HMO/PPO |
$325.64
|
| Rate for Payer: Priority Health Medicare |
$94.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.78
|
| 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 Dual Complete DSNP |
$93.58
|
| Rate for Payer: UHC Exchange |
$93.58
|
| Rate for Payer: UHC Medicare Advantage |
$93.58
|
| 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
|
IP
|
$374.30
|
|
|
Service Code
|
NDC 60505003306
|
| Hospital Charge Code |
10911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.29 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna Commercial |
$318.15
|
| Rate for Payer: BCBS Trust/PPO |
$305.54
|
| Rate for Payer: BCN Commercial |
$289.26
|
| 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: PHP Commercial |
$318.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.29
|
| Rate for Payer: Priority Health HMO/PPO |
$325.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.78
|
| 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
|
OP
|
$222.30
|
|
|
Service Code
|
NDC 00904544861
|
| Hospital Charge Code |
10911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna Medicare |
$57.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.47
|
| Rate for Payer: BCBS Complete |
$88.92
|
| Rate for Payer: BCBS MAPPO |
$55.58
|
| Rate for Payer: BCBS Trust/PPO |
$182.75
|
| Rate for Payer: BCN Commercial |
$172.84
|
| Rate for Payer: BCN Medicare Advantage |
$55.58
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.58
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: Nomi Health Commercial |
$182.29
|
| Rate for Payer: PACE Senior Care Partners |
$52.80
|
| Rate for Payer: PACE SWMI |
$55.58
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: PHP Medicare Advantage |
$55.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: Priority Health HMO/PPO |
$193.40
|
| Rate for Payer: Priority Health Medicare |
$56.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.94
|
| Rate for Payer: Railroad Medicare Medicare |
$55.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.62
|
| Rate for Payer: UHC Core |
$185.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.58
|
| Rate for Payer: UHC Exchange |
$55.58
|
| Rate for Payer: UHC Medicare Advantage |
$55.58
|
| Rate for Payer: VA VA |
$55.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.72
|
|
|
PEPTAMEN AF INTERMITTENT FEED
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 98716066360
|
| Hospital Charge Code |
200078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Medicare |
$3.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.62
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: BCBS MAPPO |
$3.70
|
| Rate for Payer: BCBS Trust/PPO |
$12.17
|
| Rate for Payer: BCN Commercial |
$11.51
|
| Rate for Payer: BCN Medicare Advantage |
$3.70
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.70
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: PACE Senior Care Partners |
$3.52
|
| Rate for Payer: PACE SWMI |
$3.70
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: PHP Medicare Advantage |
$3.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health HMO/PPO |
$12.88
|
| Rate for Payer: Priority Health Medicare |
$3.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.92
|
| Rate for Payer: Railroad Medicare Medicare |
$3.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.02
|
| Rate for Payer: UHC Core |
$12.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.70
|
| Rate for Payer: UHC Exchange |
$3.70
|
| Rate for Payer: UHC Medicare Advantage |
$3.70
|
| Rate for Payer: VA VA |
$3.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
PEPTAMEN AF INTERMITTENT FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 98716066360
|
| Hospital Charge Code |
200078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: BCBS Trust/PPO |
$12.08
|
| Rate for Payer: BCN Commercial |
$11.44
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health HMO/PPO |
$12.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.02
|
| Rate for Payer: UHC Core |
$12.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
PERMETHRIN 1 % TOPICAL LIQUID
|
Facility
|
OP
|
$39.65
|
|
|
Service Code
|
NDC 63736012002
|
| Hospital Charge Code |
10918
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$35.69 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Medicare |
$10.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.39
|
| Rate for Payer: BCBS Complete |
$15.86
|
| Rate for Payer: BCBS MAPPO |
$9.91
|
| Rate for Payer: BCBS Trust/PPO |
$32.60
|
| Rate for Payer: BCN Commercial |
$30.83
|
| Rate for Payer: BCN Medicare Advantage |
$9.91
|
| Rate for Payer: Cash Price |
$31.72
|
| Rate for Payer: Cofinity Commercial |
$34.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.91
|
| Rate for Payer: Healthscope Commercial |
$35.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.70
|
| Rate for Payer: Nomi Health Commercial |
$32.51
|
| Rate for Payer: PACE Senior Care Partners |
$9.42
|
| Rate for Payer: PACE SWMI |
$9.91
|
| Rate for Payer: PHP Commercial |
$33.70
|
| Rate for Payer: PHP Medicare Advantage |
$9.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.77
|
| Rate for Payer: Priority Health HMO/PPO |
$34.50
|
| Rate for Payer: Priority Health Medicare |
$10.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.57
|
| Rate for Payer: Railroad Medicare Medicare |
$9.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.89
|
| Rate for Payer: UHC Core |
$33.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.91
|
| Rate for Payer: UHC Exchange |
$9.91
|
| Rate for Payer: UHC Medicare Advantage |
$9.91
|
| Rate for Payer: VA VA |
$9.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.74
|
|
|
PERMETHRIN 1 % TOPICAL LIQUID
|
Facility
|
IP
|
$39.65
|
|
|
Service Code
|
NDC 63736012002
|
| Hospital Charge Code |
10918
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$35.69 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: BCBS Trust/PPO |
$32.37
|
| Rate for Payer: BCN Commercial |
$30.64
|
| Rate for Payer: Cash Price |
$31.72
|
| Rate for Payer: Cofinity Commercial |
$34.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.72
|
| Rate for Payer: Healthscope Commercial |
$35.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.70
|
| Rate for Payer: Nomi Health Commercial |
$32.51
|
| Rate for Payer: PHP Commercial |
$33.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.77
|
| Rate for Payer: Priority Health HMO/PPO |
$34.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.89
|
| Rate for Payer: UHC Core |
$33.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.74
|
|
|
PERPHENAZINE 2 MG TABLET
|
Facility
|
IP
|
$366.24
|
|
|
Service Code
|
NDC 00904659961
|
| Hospital Charge Code |
6157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.06 |
| Max. Negotiated Rate |
$329.62 |
| Rate for Payer: Aetna Commercial |
$311.30
|
| Rate for Payer: BCBS Trust/PPO |
$298.96
|
| Rate for Payer: BCN Commercial |
$283.03
|
| Rate for Payer: Cash Price |
$292.99
|
| Rate for Payer: Cofinity Commercial |
$314.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.99
|
| Rate for Payer: Healthscope Commercial |
$329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.30
|
| Rate for Payer: Nomi Health Commercial |
$300.32
|
| Rate for Payer: PHP Commercial |
$311.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.06
|
| Rate for Payer: Priority Health HMO/PPO |
$318.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.29
|
| Rate for Payer: UHC Core |
$305.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.68
|
|
|
PERPHENAZINE 2 MG TABLET
|
Facility
|
OP
|
$366.24
|
|
|
Service Code
|
NDC 00904659961
|
| Hospital Charge Code |
6157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.98 |
| Max. Negotiated Rate |
$329.62 |
| Rate for Payer: Aetna Commercial |
$311.30
|
| Rate for Payer: Aetna Medicare |
$95.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.45
|
| Rate for Payer: BCBS Complete |
$146.50
|
| Rate for Payer: BCBS MAPPO |
$91.56
|
| Rate for Payer: BCBS Trust/PPO |
$301.09
|
| Rate for Payer: BCN Commercial |
$284.75
|
| Rate for Payer: BCN Medicare Advantage |
$91.56
|
| Rate for Payer: Cash Price |
$292.99
|
| Rate for Payer: Cofinity Commercial |
$314.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.56
|
| Rate for Payer: Healthscope Commercial |
$329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.30
|
| Rate for Payer: Nomi Health Commercial |
$300.32
|
| Rate for Payer: PACE Senior Care Partners |
$86.98
|
| Rate for Payer: PACE SWMI |
$91.56
|
| Rate for Payer: PHP Commercial |
$311.30
|
| Rate for Payer: PHP Medicare Advantage |
$91.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.06
|
| Rate for Payer: Priority Health HMO/PPO |
$318.63
|
| Rate for Payer: Priority Health Medicare |
$92.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.38
|
| Rate for Payer: Railroad Medicare Medicare |
$91.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.29
|
| Rate for Payer: UHC Core |
$305.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.56
|
| Rate for Payer: UHC Exchange |
$91.56
|
| Rate for Payer: UHC Medicare Advantage |
$91.56
|
| Rate for Payer: VA VA |
$91.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.68
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
IP
|
$353.40
|
|
|
Service Code
|
NDC 65162068210
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.71 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: BCBS Trust/PPO |
$288.48
|
| Rate for Payer: BCN Commercial |
$273.11
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$318.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: Nomi Health Commercial |
$289.79
|
| Rate for Payer: PHP Commercial |
$300.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.71
|
| Rate for Payer: Priority Health HMO/PPO |
$307.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.99
|
| Rate for Payer: UHC Core |
$295.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.05
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
IP
|
$318.25
|
|
|
Service Code
|
NDC 42192080201
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.86 |
| Max. Negotiated Rate |
$286.43 |
| Rate for Payer: Aetna Commercial |
$270.51
|
| Rate for Payer: BCBS Trust/PPO |
$259.79
|
| Rate for Payer: BCN Commercial |
$245.94
|
| Rate for Payer: Cash Price |
$254.60
|
| Rate for Payer: Cofinity Commercial |
$273.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Healthscope Commercial |
$286.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Nomi Health Commercial |
$260.96
|
| Rate for Payer: PHP Commercial |
$270.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.86
|
| Rate for Payer: Priority Health HMO/PPO |
$276.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.06
|
| Rate for Payer: UHC Core |
$265.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.69
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
OP
|
$353.40
|
|
|
Service Code
|
NDC 65162068210
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.93 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: Aetna Medicare |
$91.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.44
|
| Rate for Payer: BCBS Complete |
$141.36
|
| Rate for Payer: BCBS MAPPO |
$88.35
|
| Rate for Payer: BCBS Trust/PPO |
$290.53
|
| Rate for Payer: BCN Commercial |
$274.77
|
| Rate for Payer: BCN Medicare Advantage |
$88.35
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.35
|
| Rate for Payer: Healthscope Commercial |
$318.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: Nomi Health Commercial |
$289.79
|
| Rate for Payer: PACE Senior Care Partners |
$83.93
|
| Rate for Payer: PACE SWMI |
$88.35
|
| Rate for Payer: PHP Commercial |
$300.39
|
| Rate for Payer: PHP Medicare Advantage |
$88.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.71
|
| Rate for Payer: Priority Health HMO/PPO |
$307.46
|
| Rate for Payer: Priority Health Medicare |
$89.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.78
|
| Rate for Payer: Railroad Medicare Medicare |
$88.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.99
|
| Rate for Payer: UHC Core |
$295.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.35
|
| Rate for Payer: UHC Exchange |
$88.35
|
| Rate for Payer: UHC Medicare Advantage |
$88.35
|
| Rate for Payer: VA VA |
$88.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.05
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
IP
|
$326.80
|
|
|
Service Code
|
NDC 75826011510
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.42 |
| Max. Negotiated Rate |
$294.12 |
| Rate for Payer: Aetna Commercial |
$277.78
|
| Rate for Payer: BCBS Trust/PPO |
$266.77
|
| Rate for Payer: BCN Commercial |
$252.55
|
| Rate for Payer: Cash Price |
$261.44
|
| Rate for Payer: Cofinity Commercial |
$281.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.44
|
| Rate for Payer: Healthscope Commercial |
$294.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.78
|
| Rate for Payer: Nomi Health Commercial |
$267.98
|
| Rate for Payer: PHP Commercial |
$277.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.42
|
| Rate for Payer: Priority Health HMO/PPO |
$284.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.58
|
| Rate for Payer: UHC Core |
$272.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.10
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
OP
|
$326.80
|
|
|
Service Code
|
NDC 75826011510
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.61 |
| Max. Negotiated Rate |
$294.12 |
| Rate for Payer: Aetna Commercial |
$277.78
|
| Rate for Payer: Aetna Medicare |
$84.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.12
|
| Rate for Payer: BCBS Complete |
$130.72
|
| Rate for Payer: BCBS MAPPO |
$81.70
|
| Rate for Payer: BCBS Trust/PPO |
$268.66
|
| Rate for Payer: BCN Commercial |
$254.09
|
| Rate for Payer: BCN Medicare Advantage |
$81.70
|
| Rate for Payer: Cash Price |
$261.44
|
| Rate for Payer: Cofinity Commercial |
$281.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.70
|
| Rate for Payer: Healthscope Commercial |
$294.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.78
|
| Rate for Payer: Nomi Health Commercial |
$267.98
|
| Rate for Payer: PACE Senior Care Partners |
$77.61
|
| Rate for Payer: PACE SWMI |
$81.70
|
| Rate for Payer: PHP Commercial |
$277.78
|
| Rate for Payer: PHP Medicare Advantage |
$81.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.42
|
| Rate for Payer: Priority Health HMO/PPO |
$284.32
|
| Rate for Payer: Priority Health Medicare |
$82.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.96
|
| Rate for Payer: Railroad Medicare Medicare |
$81.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.58
|
| Rate for Payer: UHC Core |
$272.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.70
|
| Rate for Payer: UHC Exchange |
$81.70
|
| Rate for Payer: UHC Medicare Advantage |
$81.70
|
| Rate for Payer: VA VA |
$81.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.10
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
OP
|
$426.55
|
|
|
Service Code
|
NDC 51293081101
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.31 |
| Max. Negotiated Rate |
$383.89 |
| Rate for Payer: Aetna Commercial |
$362.57
|
| Rate for Payer: Aetna Medicare |
$110.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.30
|
| Rate for Payer: BCBS Complete |
$170.62
|
| Rate for Payer: BCBS MAPPO |
$106.64
|
| Rate for Payer: BCBS Trust/PPO |
$350.67
|
| Rate for Payer: BCN Commercial |
$331.64
|
| Rate for Payer: BCN Medicare Advantage |
$106.64
|
| Rate for Payer: Cash Price |
$341.24
|
| Rate for Payer: Cofinity Commercial |
$366.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.64
|
| Rate for Payer: Healthscope Commercial |
$383.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.57
|
| Rate for Payer: Nomi Health Commercial |
$349.77
|
| Rate for Payer: PACE Senior Care Partners |
$101.31
|
| Rate for Payer: PACE SWMI |
$106.64
|
| Rate for Payer: PHP Commercial |
$362.57
|
| Rate for Payer: PHP Medicare Advantage |
$106.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.26
|
| Rate for Payer: Priority Health HMO/PPO |
$371.10
|
| Rate for Payer: Priority Health Medicare |
$107.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.79
|
| Rate for Payer: Railroad Medicare Medicare |
$106.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.36
|
| Rate for Payer: UHC Core |
$356.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.64
|
| Rate for Payer: UHC Exchange |
$106.64
|
| Rate for Payer: UHC Medicare Advantage |
$106.64
|
| Rate for Payer: VA VA |
$106.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.91
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
OP
|
$318.25
|
|
|
Service Code
|
NDC 42192080201
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.58 |
| Max. Negotiated Rate |
$286.43 |
| Rate for Payer: Aetna Commercial |
$270.51
|
| Rate for Payer: Aetna Medicare |
$82.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.45
|
| Rate for Payer: BCBS Complete |
$127.30
|
| Rate for Payer: BCBS MAPPO |
$79.56
|
| Rate for Payer: BCBS Trust/PPO |
$261.63
|
| Rate for Payer: BCN Commercial |
$247.44
|
| Rate for Payer: BCN Medicare Advantage |
$79.56
|
| Rate for Payer: Cash Price |
$254.60
|
| Rate for Payer: Cofinity Commercial |
$273.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.56
|
| Rate for Payer: Healthscope Commercial |
$286.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Nomi Health Commercial |
$260.96
|
| Rate for Payer: PACE Senior Care Partners |
$75.58
|
| Rate for Payer: PACE SWMI |
$79.56
|
| Rate for Payer: PHP Commercial |
$270.51
|
| Rate for Payer: PHP Medicare Advantage |
$79.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.86
|
| Rate for Payer: Priority Health HMO/PPO |
$276.88
|
| Rate for Payer: Priority Health Medicare |
$80.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.23
|
| Rate for Payer: Railroad Medicare Medicare |
$79.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.06
|
| Rate for Payer: UHC Core |
$265.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.56
|
| Rate for Payer: UHC Exchange |
$79.56
|
| Rate for Payer: UHC Medicare Advantage |
$79.56
|
| Rate for Payer: VA VA |
$79.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.69
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
IP
|
$426.55
|
|
|
Service Code
|
NDC 51293081101
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.26 |
| Max. Negotiated Rate |
$383.89 |
| Rate for Payer: Aetna Commercial |
$362.57
|
| Rate for Payer: BCBS Trust/PPO |
$348.19
|
| Rate for Payer: BCN Commercial |
$329.64
|
| Rate for Payer: Cash Price |
$341.24
|
| Rate for Payer: Cofinity Commercial |
$366.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.24
|
| Rate for Payer: Healthscope Commercial |
$383.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.57
|
| Rate for Payer: Nomi Health Commercial |
$349.77
|
| Rate for Payer: PHP Commercial |
$362.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.26
|
| Rate for Payer: Priority Health HMO/PPO |
$371.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.36
|
| Rate for Payer: UHC Core |
$356.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.91
|
|
|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
OP
|
$279.30
|
|
|
Service Code
|
NDC 00904657561
|
| Hospital Charge Code |
6217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.33 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna Commercial |
$237.41
|
| Rate for Payer: Aetna Medicare |
$72.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.28
|
| Rate for Payer: BCBS Complete |
$111.72
|
| Rate for Payer: BCBS MAPPO |
$69.83
|
| Rate for Payer: BCBS Trust/PPO |
$229.61
|
| Rate for Payer: BCN Commercial |
$217.16
|
| Rate for Payer: BCN Medicare Advantage |
$69.83
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.83
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Nomi Health Commercial |
$229.03
|
| Rate for Payer: PACE Senior Care Partners |
$66.33
|
| Rate for Payer: PACE SWMI |
$69.83
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: PHP Medicare Advantage |
$69.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.54
|
| Rate for Payer: Priority Health HMO/PPO |
$242.99
|
| Rate for Payer: Priority Health Medicare |
$70.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.13
|
| Rate for Payer: Railroad Medicare Medicare |
$69.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.78
|
| Rate for Payer: UHC Core |
$233.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.83
|
| Rate for Payer: UHC Exchange |
$69.83
|
| Rate for Payer: UHC Medicare Advantage |
$69.83
|
| Rate for Payer: VA VA |
$69.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.47
|
|
