|
PHENAZOPYRIDINE 100 MG TABLET
|
Facility
|
IP
|
$240.35
|
|
|
Service Code
|
NDC 65162068110
|
| Hospital Charge Code |
6193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.28 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: BCBS Trust/PPO |
$198.51
|
| Rate for Payer: BCN Commercial |
$198.51
|
| Rate for Payer: Cash Price |
$192.28
|
| Rate for Payer: Cofinity Commercial |
$206.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.28
|
| Rate for Payer: Healthscope Commercial |
$216.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.30
|
| Rate for Payer: Nomi Health Commercial |
$197.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.26
|
| Rate for Payer: PHP Commercial |
$204.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$209.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.51
|
| Rate for Payer: UHC Core |
$200.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.26
|
|
|
PHENAZOPYRIDINE 100 MG TABLET
|
Facility
|
OP
|
$240.35
|
|
|
Service Code
|
NDC 65162068110
|
| Hospital Charge Code |
6193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.37 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Medicare |
$62.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.11
|
| Rate for Payer: BCBS Complete |
$44.49
|
| Rate for Payer: BCBS MAPPO |
$60.09
|
| Rate for Payer: BCBS Trust/PPO |
$197.59
|
| Rate for Payer: BCN Commercial |
$197.59
|
| Rate for Payer: BCN Medicare Advantage |
$60.09
|
| Rate for Payer: Cash Price |
$192.28
|
| Rate for Payer: Cofinity Commercial |
$206.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.09
|
| Rate for Payer: Healthscope Commercial |
$216.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.26
|
| Rate for Payer: Mclaren Medicaid |
$42.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.09
|
| Rate for Payer: Meridian Medicaid |
$44.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.30
|
| Rate for Payer: Nomi Health Commercial |
$197.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.26
|
| Rate for Payer: PACE Senior Care Partners |
$57.08
|
| Rate for Payer: PACE SWMI |
$60.09
|
| Rate for Payer: PHP Commercial |
$204.30
|
| Rate for Payer: PHP Medicare Advantage |
$60.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$209.10
|
| Rate for Payer: Priority Health Medicare |
$60.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.28
|
| Rate for Payer: Railroad Medicare Medicare |
$60.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.51
|
| Rate for Payer: UHC Core |
$200.69
|
| Rate for Payer: UHC Exchange |
$60.09
|
| Rate for Payer: UHC Medicaid |
$42.37
|
| Rate for Payer: UHC Medicare Advantage |
$60.09
|
| Rate for Payer: UHCCP Medicaid |
$42.37
|
| Rate for Payer: VA VA |
$60.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.26
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
IP
|
$422.75
|
|
|
Service Code
|
NDC 65162068210
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$380.48 |
| Rate for Payer: Aetna Commercial |
$359.34
|
| Rate for Payer: BCBS Trust/PPO |
$349.15
|
| Rate for Payer: BCN Commercial |
$349.15
|
| Rate for Payer: Cash Price |
$338.20
|
| Rate for Payer: Cofinity Commercial |
$363.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.20
|
| Rate for Payer: Healthscope Commercial |
$380.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.34
|
| Rate for Payer: Nomi Health Commercial |
$346.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.06
|
| Rate for Payer: PHP Commercial |
$359.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$367.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.02
|
| Rate for Payer: UHC Core |
$353.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.06
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
OP
|
$326.80
|
|
|
Service Code
|
NDC 75826011510
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.61 |
| 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 |
$60.49
|
| Rate for Payer: BCBS MAPPO |
$81.70
|
| Rate for Payer: BCBS Trust/PPO |
$268.66
|
| Rate for Payer: BCN Commercial |
$268.66
|
| 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: Mclaren Medicaid |
$57.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.78
|
| Rate for Payer: Meridian Medicaid |
$60.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$89.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.78
|
| Rate for Payer: Nomi Health Commercial |
$267.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.10
|
| 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 Choice Medicaid |
$57.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$284.32
|
| Rate for Payer: Priority Health Medicare |
$82.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.45
|
| 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 Exchange |
$81.70
|
| Rate for Payer: UHC Medicaid |
$57.61
|
| Rate for Payer: UHC Medicare Advantage |
$81.70
|
| Rate for Payer: UHCCP Medicaid |
$57.61
|
| Rate for Payer: VA VA |
$81.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.10
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
IP
|
$426.55
|
|
|
Service Code
|
NDC 51293081101
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.88 |
| Max. Negotiated Rate |
$383.89 |
| Rate for Payer: Aetna Commercial |
$362.57
|
| Rate for Payer: BCBS Trust/PPO |
$352.29
|
| Rate for Payer: BCN Commercial |
$352.29
|
| 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: Opus (Opus Packaging Group) HMA |
$319.91
|
| Rate for Payer: PHP Commercial |
$362.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$371.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.88
|
| 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
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
OP
|
$318.25
|
|
|
Service Code
|
NDC 42192080201
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.11 |
| 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 |
$58.91
|
| Rate for Payer: BCBS MAPPO |
$79.56
|
| Rate for Payer: BCBS Trust/PPO |
$261.63
|
| Rate for Payer: BCN Commercial |
$261.63
|
| 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: Mclaren Medicaid |
$56.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.54
|
| Rate for Payer: Meridian Medicaid |
$58.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$87.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Nomi Health Commercial |
$260.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.69
|
| 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 Choice Medicaid |
$56.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$276.88
|
| Rate for Payer: Priority Health Medicare |
$80.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.50
|
| 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 Exchange |
$79.56
|
| Rate for Payer: UHC Medicaid |
$56.11
|
| Rate for Payer: UHC Medicare Advantage |
$79.56
|
| Rate for Payer: UHCCP Medicaid |
$56.11
|
| Rate for Payer: VA VA |
$79.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.69
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
IP
|
$318.25
|
|
|
Service Code
|
NDC 42192080201
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.50 |
| Max. Negotiated Rate |
$286.43 |
| Rate for Payer: Aetna Commercial |
$270.51
|
| Rate for Payer: BCBS Trust/PPO |
$262.84
|
| Rate for Payer: BCN Commercial |
$262.84
|
| 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: Opus (Opus Packaging Group) HMA |
$238.69
|
| Rate for Payer: PHP Commercial |
$270.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$276.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.50
|
| 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
|
IP
|
$326.80
|
|
|
Service Code
|
NDC 75826011510
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.45 |
| Max. Negotiated Rate |
$294.12 |
| Rate for Payer: Aetna Commercial |
$277.78
|
| Rate for Payer: BCBS Trust/PPO |
$269.90
|
| Rate for Payer: BCN Commercial |
$269.90
|
| 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: Opus (Opus Packaging Group) HMA |
$245.10
|
| Rate for Payer: PHP Commercial |
$277.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$284.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.45
|
| 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
|
$422.75
|
|
|
Service Code
|
NDC 65162068210
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.53 |
| Max. Negotiated Rate |
$380.48 |
| Rate for Payer: Aetna Commercial |
$359.34
|
| Rate for Payer: Aetna Medicare |
$109.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.11
|
| Rate for Payer: BCBS Complete |
$78.25
|
| Rate for Payer: BCBS MAPPO |
$105.69
|
| Rate for Payer: BCBS Trust/PPO |
$347.54
|
| Rate for Payer: BCN Commercial |
$347.54
|
| Rate for Payer: BCN Medicare Advantage |
$105.69
|
| Rate for Payer: Cash Price |
$338.20
|
| Rate for Payer: Cofinity Commercial |
$363.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.69
|
| Rate for Payer: Healthscope Commercial |
$380.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.06
|
| Rate for Payer: Mclaren Medicaid |
$74.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.97
|
| Rate for Payer: Meridian Medicaid |
$78.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.34
|
| Rate for Payer: Nomi Health Commercial |
$346.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.06
|
| Rate for Payer: PACE Senior Care Partners |
$100.40
|
| Rate for Payer: PACE SWMI |
$105.69
|
| Rate for Payer: PHP Commercial |
$359.34
|
| Rate for Payer: PHP Medicare Advantage |
$105.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$367.79
|
| Rate for Payer: Priority Health Medicare |
$106.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.23
|
| Rate for Payer: Railroad Medicare Medicare |
$105.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.02
|
| Rate for Payer: UHC Core |
$353.00
|
| Rate for Payer: UHC Exchange |
$105.69
|
| Rate for Payer: UHC Medicaid |
$74.53
|
| Rate for Payer: UHC Medicare Advantage |
$105.69
|
| Rate for Payer: UHCCP Medicaid |
$74.53
|
| Rate for Payer: VA VA |
$105.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.06
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
OP
|
$426.55
|
|
|
Service Code
|
NDC 51293081101
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.20 |
| 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 |
$78.95
|
| Rate for Payer: BCBS MAPPO |
$106.64
|
| Rate for Payer: BCBS Trust/PPO |
$350.67
|
| Rate for Payer: BCN Commercial |
$350.67
|
| 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: Mclaren Medicaid |
$75.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.97
|
| Rate for Payer: Meridian Medicaid |
$78.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$117.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.57
|
| Rate for Payer: Nomi Health Commercial |
$349.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.91
|
| 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 Choice Medicaid |
$75.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$371.10
|
| Rate for Payer: Priority Health Medicare |
$107.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.88
|
| 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 Exchange |
$106.64
|
| Rate for Payer: UHC Medicaid |
$75.20
|
| Rate for Payer: UHC Medicare Advantage |
$106.64
|
| Rate for Payer: UHCCP Medicaid |
$75.20
|
| Rate for Payer: VA VA |
$106.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.91
|
|
|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
IP
|
$350.15
|
|
|
Service Code
|
NDC 16571067301
|
| Hospital Charge Code |
6217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.70 |
| Max. Negotiated Rate |
$315.13 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: BCBS Trust/PPO |
$289.19
|
| Rate for Payer: BCN Commercial |
$289.19
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: Nomi Health Commercial |
$287.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.61
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$304.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.13
|
| Rate for Payer: UHC Core |
$292.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.61
|
|
|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
OP
|
$374.30
|
|
|
Service Code
|
NDC 00904657561
|
| Hospital Charge Code |
6217
|
|
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
|
|
|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
IP
|
$374.30
|
|
|
Service Code
|
NDC 00904657561
|
| Hospital Charge Code |
6217
|
|
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
|
|
|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
OP
|
$350.15
|
|
|
Service Code
|
NDC 16571067301
|
| Hospital Charge Code |
6217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.73 |
| Max. Negotiated Rate |
$315.13 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna Medicare |
$91.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.42
|
| Rate for Payer: BCBS Complete |
$64.81
|
| Rate for Payer: BCBS MAPPO |
$87.54
|
| Rate for Payer: BCBS Trust/PPO |
$287.86
|
| Rate for Payer: BCN Commercial |
$287.86
|
| Rate for Payer: BCN Medicare Advantage |
$87.54
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.54
|
| Rate for Payer: Healthscope Commercial |
$315.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.61
|
| Rate for Payer: Mclaren Medicaid |
$61.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.91
|
| Rate for Payer: Meridian Medicaid |
$64.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$96.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: Nomi Health Commercial |
$287.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.61
|
| Rate for Payer: PACE Senior Care Partners |
$83.16
|
| Rate for Payer: PACE SWMI |
$87.54
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: PHP Medicare Advantage |
$87.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$304.63
|
| Rate for Payer: Priority Health Medicare |
$88.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.70
|
| Rate for Payer: Railroad Medicare Medicare |
$87.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.13
|
| Rate for Payer: UHC Core |
$292.38
|
| Rate for Payer: UHC Exchange |
$87.54
|
| Rate for Payer: UHC Medicaid |
$61.73
|
| Rate for Payer: UHC Medicare Advantage |
$87.54
|
| Rate for Payer: UHCCP Medicaid |
$61.73
|
| Rate for Payer: VA VA |
$87.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.61
|
|
|
PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$180.42
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
6221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.57 |
| Max. Negotiated Rate |
$162.38 |
| Rate for Payer: Aetna Commercial |
$153.36
|
| Rate for Payer: Aetna Commercial |
$110.52
|
| Rate for Payer: Aetna Commercial |
$107.19
|
| Rate for Payer: Aetna Commercial |
$240.67
|
| Rate for Payer: BCBS Trust/PPO |
$149.01
|
| Rate for Payer: BCBS Trust/PPO |
$233.85
|
| Rate for Payer: BCBS Trust/PPO |
$107.38
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$149.01
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: BCN Commercial |
$233.85
|
| Rate for Payer: BCN Commercial |
$107.38
|
| Rate for Payer: Cash Price |
$104.02
|
| Rate for Payer: Cash Price |
$144.34
|
| Rate for Payer: Cash Price |
$226.51
|
| Rate for Payer: Cash Price |
$100.89
|
| Rate for Payer: Cofinity Commercial |
$108.45
|
| Rate for Payer: Cofinity Commercial |
$243.50
|
| Rate for Payer: Cofinity Commercial |
$155.16
|
| Rate for Payer: Cofinity Commercial |
$111.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.51
|
| Rate for Payer: Healthscope Commercial |
$254.83
|
| Rate for Payer: Healthscope Commercial |
$117.02
|
| Rate for Payer: Healthscope Commercial |
$162.38
|
| Rate for Payer: Healthscope Commercial |
$113.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.67
|
| Rate for Payer: Nomi Health Commercial |
$103.41
|
| Rate for Payer: Nomi Health Commercial |
$106.62
|
| Rate for Payer: Nomi Health Commercial |
$232.17
|
| Rate for Payer: Nomi Health Commercial |
$147.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.35
|
| Rate for Payer: PHP Commercial |
$240.67
|
| Rate for Payer: PHP Commercial |
$107.19
|
| Rate for Payer: PHP Commercial |
$110.52
|
| Rate for Payer: PHP Commercial |
$153.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$156.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$246.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$109.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$113.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.77
|
| Rate for Payer: UHC Core |
$150.65
|
| Rate for Payer: UHC Core |
$236.42
|
| Rate for Payer: UHC Core |
$108.57
|
| Rate for Payer: UHC Core |
$105.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.31
|
|
|
PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$126.11
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
6221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$113.50 |
| Rate for Payer: Aetna Commercial |
$107.19
|
| Rate for Payer: Aetna Commercial |
$153.36
|
| Rate for Payer: Aetna Commercial |
$240.67
|
| Rate for Payer: Aetna Commercial |
$110.52
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Aetna Medicare |
$32.79
|
| Rate for Payer: Aetna Medicare |
$46.91
|
| Rate for Payer: Aetna Medicare |
$73.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.41
|
| Rate for Payer: BCBS Complete |
$52.41
|
| Rate for Payer: BCBS Complete |
$24.07
|
| Rate for Payer: BCBS Complete |
$23.34
|
| Rate for Payer: BCBS Complete |
$33.40
|
| Rate for Payer: BCBS MAPPO |
$31.53
|
| Rate for Payer: BCBS MAPPO |
$32.51
|
| Rate for Payer: BCBS MAPPO |
$70.78
|
| Rate for Payer: BCBS MAPPO |
$45.10
|
| Rate for Payer: BCBS Trust/PPO |
$148.32
|
| Rate for Payer: BCBS Trust/PPO |
$103.68
|
| Rate for Payer: BCBS Trust/PPO |
$232.77
|
| Rate for Payer: BCBS Trust/PPO |
$106.89
|
| Rate for Payer: BCN Commercial |
$148.32
|
| Rate for Payer: BCN Commercial |
$232.77
|
| Rate for Payer: BCN Commercial |
$106.89
|
| Rate for Payer: BCN Commercial |
$103.68
|
| Rate for Payer: BCN Medicare Advantage |
$45.10
|
| Rate for Payer: BCN Medicare Advantage |
$32.51
|
| Rate for Payer: BCN Medicare Advantage |
$70.78
|
| Rate for Payer: BCN Medicare Advantage |
$31.53
|
| Rate for Payer: Cash Price |
$226.51
|
| Rate for Payer: Cash Price |
$144.34
|
| Rate for Payer: Cash Price |
$100.89
|
| Rate for Payer: Cash Price |
$104.02
|
| Rate for Payer: Cofinity Commercial |
$111.82
|
| Rate for Payer: Cofinity Commercial |
$108.45
|
| Rate for Payer: Cofinity Commercial |
$155.16
|
| Rate for Payer: Cofinity Commercial |
$243.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.10
|
| Rate for Payer: Healthscope Commercial |
$113.50
|
| Rate for Payer: Healthscope Commercial |
$254.83
|
| Rate for Payer: Healthscope Commercial |
$162.38
|
| Rate for Payer: Healthscope Commercial |
$117.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.58
|
| Rate for Payer: Mclaren Medicaid |
$31.81
|
| Rate for Payer: Mclaren Medicaid |
$22.92
|
| Rate for Payer: Mclaren Medicaid |
$22.23
|
| Rate for Payer: Mclaren Medicaid |
$49.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.10
|
| Rate for Payer: Meridian Medicaid |
$23.34
|
| Rate for Payer: Meridian Medicaid |
$33.40
|
| Rate for Payer: Meridian Medicaid |
$52.41
|
| Rate for Payer: Meridian Medicaid |
$24.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.67
|
| Rate for Payer: Nomi Health Commercial |
$147.94
|
| Rate for Payer: Nomi Health Commercial |
$103.41
|
| Rate for Payer: Nomi Health Commercial |
$106.62
|
| Rate for Payer: Nomi Health Commercial |
$232.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.58
|
| Rate for Payer: PACE Senior Care Partners |
$42.85
|
| Rate for Payer: PACE Senior Care Partners |
$67.25
|
| Rate for Payer: PACE Senior Care Partners |
$29.95
|
| Rate for Payer: PACE Senior Care Partners |
$30.88
|
| Rate for Payer: PACE SWMI |
$31.53
|
| Rate for Payer: PACE SWMI |
$70.78
|
| Rate for Payer: PACE SWMI |
$32.51
|
| Rate for Payer: PACE SWMI |
$45.10
|
| Rate for Payer: PHP Commercial |
$107.19
|
| Rate for Payer: PHP Commercial |
$110.52
|
| Rate for Payer: PHP Commercial |
$153.36
|
| Rate for Payer: PHP Commercial |
$240.67
|
| Rate for Payer: PHP Medicare Advantage |
$31.53
|
| Rate for Payer: PHP Medicare Advantage |
$70.78
|
| Rate for Payer: PHP Medicare Advantage |
$32.51
|
| Rate for Payer: PHP Medicare Advantage |
$45.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$156.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$246.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$113.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$109.72
|
| Rate for Payer: Priority Health Medicare |
$32.83
|
| Rate for Payer: Priority Health Medicare |
$31.84
|
| Rate for Payer: Priority Health Medicare |
$45.56
|
| Rate for Payer: Priority Health Medicare |
$71.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.77
|
| Rate for Payer: Railroad Medicare Medicare |
$45.10
|
| Rate for Payer: Railroad Medicare Medicare |
$31.53
|
| Rate for Payer: Railroad Medicare Medicare |
$70.78
|
| Rate for Payer: Railroad Medicare Medicare |
$32.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.16
|
| Rate for Payer: UHC Core |
$105.30
|
| Rate for Payer: UHC Core |
$150.65
|
| Rate for Payer: UHC Core |
$108.57
|
| Rate for Payer: UHC Core |
$236.42
|
| Rate for Payer: UHC Exchange |
$45.10
|
| Rate for Payer: UHC Exchange |
$32.51
|
| Rate for Payer: UHC Exchange |
$70.78
|
| Rate for Payer: UHC Exchange |
$31.53
|
| Rate for Payer: UHC Medicaid |
$22.23
|
| Rate for Payer: UHC Medicaid |
$22.92
|
| Rate for Payer: UHC Medicaid |
$31.81
|
| Rate for Payer: UHC Medicaid |
$49.92
|
| Rate for Payer: UHC Medicare Advantage |
$32.51
|
| Rate for Payer: UHC Medicare Advantage |
$31.53
|
| Rate for Payer: UHC Medicare Advantage |
$70.78
|
| Rate for Payer: UHC Medicare Advantage |
$45.10
|
| Rate for Payer: UHCCP Medicaid |
$31.81
|
| Rate for Payer: UHCCP Medicaid |
$49.92
|
| Rate for Payer: UHCCP Medicaid |
$22.92
|
| Rate for Payer: UHCCP Medicaid |
$22.23
|
| Rate for Payer: VA VA |
$31.53
|
| Rate for Payer: VA VA |
$70.78
|
| Rate for Payer: VA VA |
$45.10
|
| Rate for Payer: VA VA |
$32.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.35
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
OP
|
$10.98
|
|
|
Service Code
|
NDC 78112069480
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$9.88 |
| Rate for Payer: Aetna Commercial |
$9.33
|
| Rate for Payer: Aetna Medicare |
$2.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.43
|
| Rate for Payer: BCBS Complete |
$2.03
|
| Rate for Payer: BCBS MAPPO |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Commercial |
$9.03
|
| Rate for Payer: BCN Medicare Advantage |
$2.75
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cofinity Commercial |
$9.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.75
|
| Rate for Payer: Healthscope Commercial |
$9.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.23
|
| Rate for Payer: Mclaren Medicaid |
$1.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.88
|
| Rate for Payer: Meridian Medicaid |
$2.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.33
|
| Rate for Payer: Nomi Health Commercial |
$9.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.23
|
| Rate for Payer: PACE Senior Care Partners |
$2.61
|
| Rate for Payer: PACE SWMI |
$2.75
|
| Rate for Payer: PHP Commercial |
$9.33
|
| Rate for Payer: PHP Medicare Advantage |
$2.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.55
|
| Rate for Payer: Priority Health Medicare |
$2.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.64
|
| Rate for Payer: Railroad Medicare Medicare |
$2.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.66
|
| Rate for Payer: UHC Core |
$9.17
|
| Rate for Payer: UHC Exchange |
$2.75
|
| Rate for Payer: UHC Medicaid |
$1.94
|
| Rate for Payer: UHC Medicare Advantage |
$2.75
|
| Rate for Payer: UHCCP Medicaid |
$1.94
|
| Rate for Payer: VA VA |
$2.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.23
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
OP
|
$10.36
|
|
|
Service Code
|
NDC 00904630521
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$9.32 |
| Rate for Payer: Aetna Commercial |
$8.81
|
| Rate for Payer: Aetna Medicare |
$2.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.24
|
| Rate for Payer: BCBS Complete |
$1.92
|
| Rate for Payer: BCBS MAPPO |
$2.59
|
| Rate for Payer: BCBS Trust/PPO |
$8.52
|
| Rate for Payer: BCN Commercial |
$8.52
|
| Rate for Payer: BCN Medicare Advantage |
$2.59
|
| Rate for Payer: Cash Price |
$8.29
|
| Rate for Payer: Cofinity Commercial |
$8.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.59
|
| Rate for Payer: Healthscope Commercial |
$9.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.77
|
| Rate for Payer: Mclaren Medicaid |
$1.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.72
|
| Rate for Payer: Meridian Medicaid |
$1.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.81
|
| Rate for Payer: Nomi Health Commercial |
$8.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.77
|
| Rate for Payer: PACE Senior Care Partners |
$2.46
|
| Rate for Payer: PACE SWMI |
$2.59
|
| Rate for Payer: PHP Commercial |
$8.81
|
| Rate for Payer: PHP Medicare Advantage |
$2.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.01
|
| Rate for Payer: Priority Health Medicare |
$2.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.21
|
| Rate for Payer: Railroad Medicare Medicare |
$2.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.12
|
| Rate for Payer: UHC Core |
$8.65
|
| Rate for Payer: UHC Exchange |
$2.59
|
| Rate for Payer: UHC Medicaid |
$1.83
|
| Rate for Payer: UHC Medicare Advantage |
$2.59
|
| Rate for Payer: UHCCP Medicaid |
$1.83
|
| Rate for Payer: VA VA |
$2.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.77
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$10.98
|
|
|
Service Code
|
NDC 78112069480
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$9.88 |
| Rate for Payer: Aetna Commercial |
$9.33
|
| Rate for Payer: BCBS Trust/PPO |
$9.07
|
| Rate for Payer: BCN Commercial |
$9.07
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cofinity Commercial |
$9.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Healthscope Commercial |
$9.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.33
|
| Rate for Payer: Nomi Health Commercial |
$9.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.23
|
| Rate for Payer: PHP Commercial |
$9.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.66
|
| Rate for Payer: UHC Core |
$9.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.23
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$10.36
|
|
|
Service Code
|
NDC 00904630521
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$9.32 |
| Rate for Payer: Aetna Commercial |
$8.81
|
| Rate for Payer: BCBS Trust/PPO |
$8.56
|
| Rate for Payer: BCN Commercial |
$8.56
|
| Rate for Payer: Cash Price |
$8.29
|
| Rate for Payer: Cofinity Commercial |
$8.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.29
|
| Rate for Payer: Healthscope Commercial |
$9.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.81
|
| Rate for Payer: Nomi Health Commercial |
$8.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.77
|
| Rate for Payer: PHP Commercial |
$8.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.12
|
| Rate for Payer: UHC Core |
$8.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.77
|
|
|
PHENTOLAMINE 5 MG INJECTION SOLUTION
|
Facility
|
IP
|
$1,385.23
|
|
|
Service Code
|
HCPCS J2760
|
| Hospital Charge Code |
10947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$964.12 |
| Max. Negotiated Rate |
$1,246.71 |
| Rate for Payer: Aetna Commercial |
$1,177.45
|
| Rate for Payer: Aetna Commercial |
$825.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,144.06
|
| Rate for Payer: BCBS Trust/PPO |
$801.66
|
| Rate for Payer: BCN Commercial |
$1,144.06
|
| Rate for Payer: BCN Commercial |
$801.66
|
| Rate for Payer: Cash Price |
$1,108.18
|
| Rate for Payer: Cash Price |
$776.52
|
| Rate for Payer: Cofinity Commercial |
$834.76
|
| Rate for Payer: Cofinity Commercial |
$1,191.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.18
|
| Rate for Payer: Healthscope Commercial |
$1,246.71
|
| Rate for Payer: Healthscope Commercial |
$873.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,038.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$727.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,177.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.05
|
| Rate for Payer: Nomi Health Commercial |
$1,135.89
|
| Rate for Payer: Nomi Health Commercial |
$795.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,038.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$727.99
|
| Rate for Payer: PHP Commercial |
$825.05
|
| Rate for Payer: PHP Commercial |
$1,177.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$844.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,205.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$964.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$675.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,219.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.17
|
| Rate for Payer: UHC Core |
$1,156.67
|
| Rate for Payer: UHC Core |
$810.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,038.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$727.99
|
|
|
PHENTOLAMINE 5 MG INJECTION SOLUTION
|
Facility
|
OP
|
$1,385.23
|
|
|
Service Code
|
HCPCS J2760
|
| Hospital Charge Code |
10947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$244.22 |
| Max. Negotiated Rate |
$1,246.71 |
| Rate for Payer: Aetna Commercial |
$1,177.45
|
| Rate for Payer: Aetna Commercial |
$825.05
|
| Rate for Payer: Aetna Medicare |
$252.37
|
| Rate for Payer: Aetna Medicare |
$360.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$303.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$432.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$432.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$303.33
|
| Rate for Payer: BCBS Complete |
$256.41
|
| Rate for Payer: BCBS Complete |
$179.67
|
| Rate for Payer: BCBS MAPPO |
$346.31
|
| Rate for Payer: BCBS MAPPO |
$242.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,138.80
|
| Rate for Payer: BCBS Trust/PPO |
$797.97
|
| Rate for Payer: BCN Commercial |
$797.97
|
| Rate for Payer: BCN Commercial |
$1,138.80
|
| Rate for Payer: BCN Medicare Advantage |
$242.66
|
| Rate for Payer: BCN Medicare Advantage |
$346.31
|
| Rate for Payer: Cash Price |
$1,108.18
|
| Rate for Payer: Cash Price |
$776.52
|
| Rate for Payer: Cofinity Commercial |
$1,191.30
|
| Rate for Payer: Cofinity Commercial |
$834.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.31
|
| Rate for Payer: Healthscope Commercial |
$1,246.71
|
| Rate for Payer: Healthscope Commercial |
$873.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,038.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$727.99
|
| Rate for Payer: Mclaren Medicaid |
$171.13
|
| Rate for Payer: Mclaren Medicaid |
$244.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$254.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$363.62
|
| Rate for Payer: Meridian Medicaid |
$256.41
|
| Rate for Payer: Meridian Medicaid |
$179.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$279.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$398.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$266.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$380.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,177.45
|
| Rate for Payer: Nomi Health Commercial |
$795.93
|
| Rate for Payer: Nomi Health Commercial |
$1,135.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,038.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$727.99
|
| Rate for Payer: PACE Senior Care Partners |
$230.53
|
| Rate for Payer: PACE Senior Care Partners |
$328.99
|
| Rate for Payer: PACE SWMI |
$242.66
|
| Rate for Payer: PACE SWMI |
$346.31
|
| Rate for Payer: PHP Commercial |
$1,177.45
|
| Rate for Payer: PHP Commercial |
$825.05
|
| Rate for Payer: PHP Medicare Advantage |
$346.31
|
| Rate for Payer: PHP Medicare Advantage |
$242.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$244.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$844.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,205.15
|
| Rate for Payer: Priority Health Medicare |
$245.09
|
| Rate for Payer: Priority Health Medicare |
$349.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$964.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$675.57
|
| Rate for Payer: Railroad Medicare Medicare |
$346.31
|
| Rate for Payer: Railroad Medicare Medicare |
$242.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,219.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.17
|
| Rate for Payer: UHC Core |
$810.49
|
| Rate for Payer: UHC Core |
$1,156.67
|
| Rate for Payer: UHC Exchange |
$242.66
|
| Rate for Payer: UHC Exchange |
$346.31
|
| Rate for Payer: UHC Medicaid |
$171.13
|
| Rate for Payer: UHC Medicaid |
$244.22
|
| Rate for Payer: UHC Medicare Advantage |
$346.31
|
| Rate for Payer: UHC Medicare Advantage |
$242.66
|
| Rate for Payer: UHCCP Medicaid |
$244.22
|
| Rate for Payer: UHCCP Medicaid |
$171.13
|
| Rate for Payer: VA VA |
$346.31
|
| Rate for Payer: VA VA |
$242.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$727.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,038.92
|
|
|
PHENYLEPHRINE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.72
|
|
|
Service Code
|
HCPCS J2372
|
| Hospital Charge Code |
192051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Commercial |
$22.96
|
| Rate for Payer: BCBS Trust/PPO |
$22.07
|
| Rate for Payer: BCBS Trust/PPO |
$22.31
|
| Rate for Payer: BCN Commercial |
$22.07
|
| Rate for Payer: BCN Commercial |
$22.31
|
| Rate for Payer: Cash Price |
$21.38
|
| Rate for Payer: Cash Price |
$21.61
|
| Rate for Payer: Cofinity Commercial |
$23.23
|
| Rate for Payer: Cofinity Commercial |
$22.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.38
|
| Rate for Payer: Healthscope Commercial |
$24.05
|
| Rate for Payer: Healthscope Commercial |
$24.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.96
|
| Rate for Payer: Nomi Health Commercial |
$21.91
|
| Rate for Payer: Nomi Health Commercial |
$22.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.26
|
| Rate for Payer: PHP Commercial |
$22.96
|
| Rate for Payer: PHP Commercial |
$22.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.77
|
| Rate for Payer: UHC Core |
$22.31
|
| Rate for Payer: UHC Core |
$22.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.26
|
|
|
PHENYLEPHRINE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.72
|
|
|
Service Code
|
HCPCS J2372
|
| Hospital Charge Code |
192051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Commercial |
$22.96
|
| Rate for Payer: Aetna Medicare |
$7.02
|
| Rate for Payer: Aetna Medicare |
$6.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.44
|
| Rate for Payer: BCBS Complete |
$4.95
|
| Rate for Payer: BCBS Complete |
$5.00
|
| Rate for Payer: BCBS MAPPO |
$6.68
|
| Rate for Payer: BCBS MAPPO |
$6.75
|
| Rate for Payer: BCBS Trust/PPO |
$21.97
|
| Rate for Payer: BCBS Trust/PPO |
$22.20
|
| Rate for Payer: BCN Commercial |
$22.20
|
| Rate for Payer: BCN Commercial |
$21.97
|
| Rate for Payer: BCN Medicare Advantage |
$6.75
|
| Rate for Payer: BCN Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$21.38
|
| Rate for Payer: Cash Price |
$21.61
|
| Rate for Payer: Cofinity Commercial |
$22.98
|
| Rate for Payer: Cofinity Commercial |
$23.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$24.05
|
| Rate for Payer: Healthscope Commercial |
$24.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.26
|
| Rate for Payer: Mclaren Medicaid |
$4.76
|
| Rate for Payer: Mclaren Medicaid |
$4.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.01
|
| Rate for Payer: Meridian Medicaid |
$4.95
|
| Rate for Payer: Meridian Medicaid |
$5.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.71
|
| Rate for Payer: Nomi Health Commercial |
$22.15
|
| Rate for Payer: Nomi Health Commercial |
$21.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.26
|
| Rate for Payer: PACE Senior Care Partners |
$6.41
|
| Rate for Payer: PACE Senior Care Partners |
$6.35
|
| Rate for Payer: PACE SWMI |
$6.75
|
| Rate for Payer: PACE SWMI |
$6.68
|
| Rate for Payer: PHP Commercial |
$22.71
|
| Rate for Payer: PHP Commercial |
$22.96
|
| Rate for Payer: PHP Medicare Advantage |
$6.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.25
|
| Rate for Payer: Priority Health Medicare |
$6.82
|
| Rate for Payer: Priority Health Medicare |
$6.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.80
|
| Rate for Payer: Railroad Medicare Medicare |
$6.68
|
| Rate for Payer: Railroad Medicare Medicare |
$6.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.77
|
| Rate for Payer: UHC Core |
$22.55
|
| Rate for Payer: UHC Core |
$22.31
|
| Rate for Payer: UHC Exchange |
$6.75
|
| Rate for Payer: UHC Exchange |
$6.68
|
| Rate for Payer: UHC Medicaid |
$4.76
|
| Rate for Payer: UHC Medicaid |
$4.71
|
| Rate for Payer: UHC Medicare Advantage |
$6.68
|
| Rate for Payer: UHC Medicare Advantage |
$6.75
|
| Rate for Payer: UHCCP Medicaid |
$4.71
|
| Rate for Payer: UHCCP Medicaid |
$4.76
|
| Rate for Payer: VA VA |
$6.68
|
| Rate for Payer: VA VA |
$6.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.04
|
|
|
PHENYLEPHRINE 0.25 %-PRAMOXINE 1 %-GLYCERIN-WH.PETROLATUM RECTAL CREAM
|
Facility
|
OP
|
$9.25
|
|
|
Service Code
|
NDC 49781009001
|
| Hospital Charge Code |
77868
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Aetna Commercial |
$7.86
|
| Rate for Payer: Aetna Medicare |
$2.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.89
|
| Rate for Payer: BCBS Complete |
$1.71
|
| Rate for Payer: BCBS MAPPO |
$2.31
|
| Rate for Payer: BCBS Trust/PPO |
$7.60
|
| Rate for Payer: BCN Commercial |
$7.60
|
| Rate for Payer: BCN Medicare Advantage |
$2.31
|
| Rate for Payer: Cash Price |
$7.40
|
| Rate for Payer: Cofinity Commercial |
$7.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$8.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.94
|
| Rate for Payer: Mclaren Medicaid |
$1.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.43
|
| Rate for Payer: Meridian Medicaid |
$1.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.86
|
| Rate for Payer: Nomi Health Commercial |
$7.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.94
|
| Rate for Payer: PACE Senior Care Partners |
$2.20
|
| Rate for Payer: PACE SWMI |
$2.31
|
| Rate for Payer: PHP Commercial |
$7.86
|
| Rate for Payer: PHP Medicare Advantage |
$2.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.05
|
| Rate for Payer: Priority Health Medicare |
$2.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.44
|
| Rate for Payer: Railroad Medicare Medicare |
$2.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.14
|
| Rate for Payer: UHC Core |
$7.72
|
| Rate for Payer: UHC Exchange |
$2.31
|
| Rate for Payer: UHC Medicaid |
$1.63
|
| Rate for Payer: UHC Medicare Advantage |
$2.31
|
| Rate for Payer: UHCCP Medicaid |
$1.63
|
| Rate for Payer: VA VA |
$2.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.94
|
|
