|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
NDC 00904657561
|
| Hospital Charge Code |
6217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.54 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna Commercial |
$237.41
|
| Rate for Payer: BCBS Trust/PPO |
$227.99
|
| Rate for Payer: BCN Commercial |
$215.84
|
| 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: Healthscope Commercial |
$251.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Nomi Health Commercial |
$229.03
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.54
|
| Rate for Payer: Priority Health HMO/PPO |
$242.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.78
|
| Rate for Payer: UHC Core |
$233.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.47
|
|
|
PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$130.02
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
6221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.51 |
| Max. Negotiated Rate |
$117.02 |
| Rate for Payer: Aetna Commercial |
$110.52
|
| Rate for Payer: Aetna Commercial |
$154.94
|
| Rate for Payer: Aetna Commercial |
$240.67
|
| Rate for Payer: BCBS Trust/PPO |
$148.80
|
| Rate for Payer: BCBS Trust/PPO |
$106.14
|
| Rate for Payer: BCBS Trust/PPO |
$231.13
|
| Rate for Payer: BCN Commercial |
$140.87
|
| Rate for Payer: BCN Commercial |
$100.48
|
| Rate for Payer: BCN Commercial |
$218.81
|
| Rate for Payer: Cash Price |
$104.02
|
| Rate for Payer: Cash Price |
$226.51
|
| Rate for Payer: Cash Price |
$145.82
|
| Rate for Payer: Cofinity Commercial |
$243.50
|
| Rate for Payer: Cofinity Commercial |
$156.76
|
| Rate for Payer: Cofinity Commercial |
$111.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.82
|
| 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 |
$164.05
|
| Rate for Payer: Healthscope Commercial |
$117.02
|
| Rate for Payer: Healthscope Commercial |
$254.83
|
| 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 |
$136.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.94
|
| 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 |
$106.62
|
| Rate for Payer: Nomi Health Commercial |
$149.47
|
| Rate for Payer: Nomi Health Commercial |
$232.17
|
| Rate for Payer: PHP Commercial |
$154.94
|
| Rate for Payer: PHP Commercial |
$110.52
|
| Rate for Payer: PHP Commercial |
$240.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.48
|
| Rate for Payer: Priority Health HMO/PPO |
$246.33
|
| Rate for Payer: Priority Health HMO/PPO |
$158.58
|
| Rate for Payer: Priority Health HMO/PPO |
$113.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.42
|
| Rate for Payer: UHC Core |
$108.57
|
| Rate for Payer: UHC Core |
$236.42
|
| Rate for Payer: UHC Core |
$152.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.71
|
|
|
PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$130.02
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
6221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.88 |
| Max. Negotiated Rate |
$117.02 |
| Rate for Payer: Aetna Commercial |
$110.52
|
| Rate for Payer: Aetna Commercial |
$240.67
|
| Rate for Payer: Aetna Commercial |
$154.94
|
| Rate for Payer: Aetna Medicare |
$73.62
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Aetna Medicare |
$47.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.48
|
| Rate for Payer: BCBS Complete |
$72.91
|
| Rate for Payer: BCBS Complete |
$52.01
|
| Rate for Payer: BCBS Complete |
$113.26
|
| Rate for Payer: BCBS MAPPO |
$70.78
|
| Rate for Payer: BCBS MAPPO |
$32.51
|
| Rate for Payer: BCBS MAPPO |
$45.57
|
| Rate for Payer: BCBS Trust/PPO |
$149.85
|
| Rate for Payer: BCBS Trust/PPO |
$106.89
|
| Rate for Payer: BCBS Trust/PPO |
$232.77
|
| Rate for Payer: BCN Commercial |
$141.72
|
| Rate for Payer: BCN Commercial |
$220.14
|
| Rate for Payer: BCN Commercial |
$101.09
|
| Rate for Payer: BCN Medicare Advantage |
$32.51
|
| Rate for Payer: BCN Medicare Advantage |
$45.57
|
| Rate for Payer: BCN Medicare Advantage |
$70.78
|
| Rate for Payer: Cash Price |
$145.82
|
| Rate for Payer: Cash Price |
$226.51
|
| Rate for Payer: Cash Price |
$104.02
|
| Rate for Payer: Cofinity Commercial |
$243.50
|
| Rate for Payer: Cofinity Commercial |
$111.82
|
| Rate for Payer: Cofinity Commercial |
$156.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.51
|
| Rate for Payer: Healthscope Commercial |
$164.05
|
| Rate for Payer: Healthscope Commercial |
$117.02
|
| Rate for Payer: Healthscope Commercial |
$254.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.52
|
| 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 |
$47.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.52
|
| Rate for Payer: Nomi Health Commercial |
$232.17
|
| Rate for Payer: Nomi Health Commercial |
$106.62
|
| Rate for Payer: Nomi Health Commercial |
$149.47
|
| Rate for Payer: PACE Senior Care Partners |
$67.25
|
| Rate for Payer: PACE Senior Care Partners |
$30.88
|
| Rate for Payer: PACE Senior Care Partners |
$43.29
|
| Rate for Payer: PACE SWMI |
$45.57
|
| Rate for Payer: PACE SWMI |
$32.51
|
| Rate for Payer: PACE SWMI |
$70.78
|
| Rate for Payer: PHP Commercial |
$240.67
|
| Rate for Payer: PHP Commercial |
$154.94
|
| Rate for Payer: PHP Commercial |
$110.52
|
| Rate for Payer: PHP Medicare Advantage |
$45.57
|
| Rate for Payer: PHP Medicare Advantage |
$70.78
|
| Rate for Payer: PHP Medicare Advantage |
$32.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.48
|
| Rate for Payer: Priority Health HMO/PPO |
$246.33
|
| Rate for Payer: Priority Health HMO/PPO |
$113.12
|
| Rate for Payer: Priority Health HMO/PPO |
$158.58
|
| Rate for Payer: Priority Health Medicare |
$32.83
|
| Rate for Payer: Priority Health Medicare |
$71.49
|
| Rate for Payer: Priority Health Medicare |
$46.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.11
|
| Rate for Payer: Railroad Medicare Medicare |
$45.57
|
| Rate for Payer: Railroad Medicare Medicare |
$70.78
|
| Rate for Payer: Railroad Medicare Medicare |
$32.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.42
|
| Rate for Payer: UHC Core |
$236.42
|
| Rate for Payer: UHC Core |
$152.20
|
| Rate for Payer: UHC Core |
$108.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.57
|
| Rate for Payer: UHC Exchange |
$45.57
|
| Rate for Payer: UHC Exchange |
$32.51
|
| Rate for Payer: UHC Exchange |
$70.78
|
| Rate for Payer: UHC Medicare Advantage |
$32.51
|
| Rate for Payer: UHC Medicare Advantage |
$45.57
|
| Rate for Payer: UHC Medicare Advantage |
$70.78
|
| Rate for Payer: VA VA |
$45.57
|
| Rate for Payer: VA VA |
$70.78
|
| Rate for Payer: VA VA |
$32.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.71
|
|
|
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 |
$2.61 |
| 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 |
$4.39
|
| Rate for Payer: BCBS MAPPO |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Commercial |
$8.54
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.33
|
| Rate for Payer: Nomi Health Commercial |
$9.00
|
| 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 Cigna Priority Health |
$7.14
|
| Rate for Payer: Priority Health HMO/PPO |
$9.55
|
| Rate for Payer: Priority Health Medicare |
$2.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.36
|
| 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 Dual Complete DSNP |
$2.75
|
| Rate for Payer: UHC Exchange |
$2.75
|
| Rate for Payer: UHC Medicare Advantage |
$2.75
|
| 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
|
IP
|
$10.98
|
|
|
Service Code
|
NDC 78112069480
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$9.88 |
| Rate for Payer: Aetna Commercial |
$9.33
|
| Rate for Payer: BCBS Trust/PPO |
$8.96
|
| Rate for Payer: BCN Commercial |
$8.49
|
| 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: PHP Commercial |
$9.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: Priority Health HMO/PPO |
$9.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.36
|
| 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
|
|
|
PHENYLEPHRINE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.01
|
|
|
Service Code
|
HCPCS J2372
|
| Hospital Charge Code |
192051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$24.31 |
| Rate for Payer: Aetna Commercial |
$22.96
|
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Medicare |
$7.02
|
| Rate for Payer: Aetna Medicare |
$6.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.35
|
| Rate for Payer: BCBS Complete |
$10.69
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS MAPPO |
$6.68
|
| Rate for Payer: BCBS MAPPO |
$6.75
|
| Rate for Payer: BCBS Trust/PPO |
$22.20
|
| Rate for Payer: BCBS Trust/PPO |
$21.97
|
| Rate for Payer: BCN Commercial |
$21.00
|
| Rate for Payer: BCN Commercial |
$20.77
|
| Rate for Payer: BCN Medicare Advantage |
$6.75
|
| Rate for Payer: BCN Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$21.61
|
| Rate for Payer: Cash Price |
$21.38
|
| 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 |
$6.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.75
|
| Rate for Payer: Healthscope Commercial |
$24.05
|
| Rate for Payer: Healthscope Commercial |
$24.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.77
|
| 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: 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 |
$22.96
|
| Rate for Payer: PHP Commercial |
$22.71
|
| Rate for Payer: PHP Medicare Advantage |
$6.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.37
|
| Rate for Payer: Priority Health HMO/PPO |
$23.25
|
| Rate for Payer: Priority Health HMO/PPO |
$23.50
|
| Rate for Payer: Priority Health Medicare |
$6.82
|
| Rate for Payer: Priority Health Medicare |
$6.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.90
|
| 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 Dual Complete DSNP |
$6.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.68
|
| Rate for Payer: UHC Exchange |
$6.68
|
| Rate for Payer: UHC Exchange |
$6.75
|
| Rate for Payer: UHC Medicare Advantage |
$6.68
|
| Rate for Payer: UHC Medicare Advantage |
$6.75
|
| 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 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.72
|
|
|
Service Code
|
HCPCS J2372
|
| Hospital Charge Code |
192051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.37 |
| 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 |
$21.81
|
| Rate for Payer: BCBS Trust/PPO |
$22.05
|
| Rate for Payer: BCN Commercial |
$20.65
|
| Rate for Payer: BCN Commercial |
$20.87
|
| 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: PHP Commercial |
$22.71
|
| Rate for Payer: PHP Commercial |
$22.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.37
|
| Rate for Payer: Priority Health HMO/PPO |
$23.50
|
| Rate for Payer: Priority Health HMO/PPO |
$23.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.10
|
| 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 0.25 % NASAL SPRAY
|
Facility
|
OP
|
$19.78
|
|
|
Service Code
|
NDC 00225080047
|
| Hospital Charge Code |
6243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$17.80 |
| Rate for Payer: Aetna Commercial |
$16.81
|
| Rate for Payer: Aetna Medicare |
$5.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.18
|
| Rate for Payer: BCBS Complete |
$7.91
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS Trust/PPO |
$16.26
|
| Rate for Payer: BCN Commercial |
$15.38
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Commercial |
$17.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Healthscope Commercial |
$17.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.81
|
| Rate for Payer: Nomi Health Commercial |
$16.22
|
| Rate for Payer: PACE Senior Care Partners |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PHP Commercial |
$16.81
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.86
|
| Rate for Payer: Priority Health HMO/PPO |
$17.21
|
| Rate for Payer: Priority Health Medicare |
$4.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.25
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.41
|
| Rate for Payer: UHC Core |
$16.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Exchange |
$4.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: VA VA |
$4.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.84
|
|
|
PHENYLEPHRINE 0.25 % NASAL SPRAY
|
Facility
|
IP
|
$19.78
|
|
|
Service Code
|
NDC 00225080047
|
| Hospital Charge Code |
6243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$17.80 |
| Rate for Payer: Aetna Commercial |
$16.81
|
| Rate for Payer: BCBS Trust/PPO |
$16.15
|
| Rate for Payer: BCN Commercial |
$15.29
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Commercial |
$17.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$17.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.81
|
| Rate for Payer: Nomi Health Commercial |
$16.22
|
| Rate for Payer: PHP Commercial |
$16.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.86
|
| Rate for Payer: Priority Health HMO/PPO |
$17.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.41
|
| Rate for Payer: UHC Core |
$16.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.84
|
|
|
PHENYLEPHRINE 0.25 %-PRAMOXINE 1 %-GLYCERIN-WH.PETROLATUM RECTAL CREAM
|
Facility
|
IP
|
$9.25
|
|
|
Service Code
|
NDC 49781009001
|
| Hospital Charge Code |
77868
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Aetna Commercial |
$7.86
|
| Rate for Payer: BCBS Trust/PPO |
$7.55
|
| Rate for Payer: BCN Commercial |
$7.15
|
| 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: Healthscope Commercial |
$8.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.86
|
| Rate for Payer: Nomi Health Commercial |
$7.58
|
| Rate for Payer: PHP Commercial |
$7.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.01
|
| Rate for Payer: Priority Health HMO/PPO |
$8.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.14
|
| Rate for Payer: UHC Core |
$7.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.94
|
|
|
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 |
$2.20 |
| 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 |
$3.70
|
| Rate for Payer: BCBS MAPPO |
$2.31
|
| Rate for Payer: BCBS Trust/PPO |
$7.60
|
| Rate for Payer: BCN Commercial |
$7.19
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.86
|
| Rate for Payer: Nomi Health Commercial |
$7.58
|
| 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 Cigna Priority Health |
$6.01
|
| Rate for Payer: Priority Health HMO/PPO |
$8.05
|
| Rate for Payer: Priority Health Medicare |
$2.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.20
|
| 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 Dual Complete DSNP |
$2.31
|
| Rate for Payer: UHC Exchange |
$2.31
|
| Rate for Payer: UHC Medicare Advantage |
$2.31
|
| Rate for Payer: VA VA |
$2.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.94
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
OP
|
$119.25
|
|
|
Service Code
|
NDC 17478020605
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$107.33 |
| Rate for Payer: Aetna Commercial |
$101.36
|
| Rate for Payer: Aetna Medicare |
$31.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.27
|
| Rate for Payer: BCBS Complete |
$47.70
|
| Rate for Payer: BCBS MAPPO |
$29.81
|
| Rate for Payer: BCBS Trust/PPO |
$98.04
|
| Rate for Payer: BCN Commercial |
$92.72
|
| Rate for Payer: BCN Medicare Advantage |
$29.81
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cofinity Commercial |
$102.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.81
|
| Rate for Payer: Healthscope Commercial |
$107.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.36
|
| Rate for Payer: Nomi Health Commercial |
$97.78
|
| Rate for Payer: PACE Senior Care Partners |
$28.32
|
| Rate for Payer: PACE SWMI |
$29.81
|
| Rate for Payer: PHP Commercial |
$101.36
|
| Rate for Payer: PHP Medicare Advantage |
$29.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.51
|
| Rate for Payer: Priority Health HMO/PPO |
$103.75
|
| Rate for Payer: Priority Health Medicare |
$30.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.90
|
| Rate for Payer: Railroad Medicare Medicare |
$29.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.94
|
| Rate for Payer: UHC Core |
$99.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.81
|
| Rate for Payer: UHC Exchange |
$29.81
|
| Rate for Payer: UHC Medicare Advantage |
$29.81
|
| Rate for Payer: VA VA |
$29.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.44
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
IP
|
$119.25
|
|
|
Service Code
|
NDC 17478020605
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.51 |
| Max. Negotiated Rate |
$107.33 |
| Rate for Payer: Aetna Commercial |
$101.36
|
| Rate for Payer: BCBS Trust/PPO |
$97.34
|
| Rate for Payer: BCN Commercial |
$92.16
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cofinity Commercial |
$102.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.40
|
| Rate for Payer: Healthscope Commercial |
$107.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.36
|
| Rate for Payer: Nomi Health Commercial |
$97.78
|
| Rate for Payer: PHP Commercial |
$101.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.51
|
| Rate for Payer: Priority Health HMO/PPO |
$103.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.94
|
| Rate for Payer: UHC Core |
$99.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.44
|
|
|
PHENYLEPHRINE 10 MG IN NS 200 ML
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 99000000209
|
| Hospital Charge Code |
155016
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna Medicare |
$9.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.94
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$8.75
|
| Rate for Payer: BCBS Trust/PPO |
$28.77
|
| Rate for Payer: BCN Commercial |
$27.21
|
| Rate for Payer: BCN Medicare Advantage |
$8.75
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.75
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Nomi Health Commercial |
$28.70
|
| Rate for Payer: PACE Senior Care Partners |
$8.31
|
| Rate for Payer: PACE SWMI |
$8.75
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: PHP Medicare Advantage |
$8.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health HMO/PPO |
$30.45
|
| Rate for Payer: Priority Health Medicare |
$8.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.45
|
| Rate for Payer: Railroad Medicare Medicare |
$8.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.80
|
| Rate for Payer: UHC Core |
$29.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.75
|
| Rate for Payer: UHC Exchange |
$8.75
|
| Rate for Payer: UHC Medicare Advantage |
$8.75
|
| Rate for Payer: VA VA |
$8.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
PHENYLEPHRINE 10 MG IN NS 200 ML
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 99000000209
|
| Hospital Charge Code |
155016
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: BCBS Trust/PPO |
$28.57
|
| Rate for Payer: BCN Commercial |
$27.05
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Nomi Health Commercial |
$28.70
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health HMO/PPO |
$30.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.80
|
| Rate for Payer: UHC Core |
$29.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$11.52
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$10.37 |
| Rate for Payer: Aetna Commercial |
$9.79
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Commercial |
$13.76
|
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: Aetna Medicare |
$4.21
|
| Rate for Payer: Aetna Medicare |
$4.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.60
|
| Rate for Payer: BCBS Complete |
$4.61
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: BCBS Complete |
$6.66
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: BCBS MAPPO |
$2.88
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$4.16
|
| Rate for Payer: BCBS MAPPO |
$4.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.47
|
| Rate for Payer: BCBS Trust/PPO |
$13.69
|
| Rate for Payer: BCBS Trust/PPO |
$13.29
|
| Rate for Payer: BCBS Trust/PPO |
$13.31
|
| Rate for Payer: BCN Commercial |
$8.96
|
| Rate for Payer: BCN Commercial |
$12.59
|
| Rate for Payer: BCN Commercial |
$12.57
|
| Rate for Payer: BCN Commercial |
$12.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: BCN Medicare Advantage |
$4.16
|
| Rate for Payer: BCN Medicare Advantage |
$2.88
|
| Rate for Payer: BCN Medicare Advantage |
$4.05
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$9.91
|
| Rate for Payer: Cofinity Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.05
|
| Rate for Payer: Healthscope Commercial |
$10.37
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.76
|
| Rate for Payer: Nomi Health Commercial |
$13.28
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: Nomi Health Commercial |
$9.45
|
| Rate for Payer: Nomi Health Commercial |
$13.26
|
| Rate for Payer: PACE Senior Care Partners |
$2.74
|
| Rate for Payer: PACE Senior Care Partners |
$3.85
|
| Rate for Payer: PACE Senior Care Partners |
$3.95
|
| Rate for Payer: PACE Senior Care Partners |
$3.84
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PACE SWMI |
$2.88
|
| Rate for Payer: PACE SWMI |
$4.05
|
| Rate for Payer: PACE SWMI |
$4.16
|
| Rate for Payer: PHP Commercial |
$13.76
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: PHP Commercial |
$9.79
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$2.88
|
| Rate for Payer: PHP Medicare Advantage |
$4.16
|
| Rate for Payer: PHP Medicare Advantage |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.49
|
| Rate for Payer: Priority Health HMO/PPO |
$14.07
|
| Rate for Payer: Priority Health HMO/PPO |
$14.49
|
| Rate for Payer: Priority Health HMO/PPO |
$14.09
|
| Rate for Payer: Priority Health HMO/PPO |
$10.02
|
| Rate for Payer: Priority Health Medicare |
$4.09
|
| Rate for Payer: Priority Health Medicare |
$2.91
|
| Rate for Payer: Priority Health Medicare |
$4.08
|
| Rate for Payer: Priority Health Medicare |
$4.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.72
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4.05
|
| Rate for Payer: Railroad Medicare Medicare |
$2.88
|
| Rate for Payer: Railroad Medicare Medicare |
$4.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.23
|
| Rate for Payer: UHC Core |
$9.62
|
| Rate for Payer: UHC Core |
$13.90
|
| Rate for Payer: UHC Core |
$13.50
|
| Rate for Payer: UHC Core |
$13.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.04
|
| Rate for Payer: UHC Exchange |
$4.16
|
| Rate for Payer: UHC Exchange |
$4.04
|
| Rate for Payer: UHC Exchange |
$2.88
|
| Rate for Payer: UHC Exchange |
$4.05
|
| Rate for Payer: UHC Medicare Advantage |
$4.16
|
| Rate for Payer: UHC Medicare Advantage |
$2.88
|
| Rate for Payer: UHC Medicare Advantage |
$4.05
|
| Rate for Payer: UHC Medicare Advantage |
$4.04
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: VA VA |
$4.16
|
| Rate for Payer: VA VA |
$4.05
|
| Rate for Payer: VA VA |
$2.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.14
|
|
|
PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$16.17
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Commercial |
$9.79
|
| Rate for Payer: Aetna Commercial |
$13.76
|
| Rate for Payer: BCBS Trust/PPO |
$13.22
|
| Rate for Payer: BCBS Trust/PPO |
$13.20
|
| Rate for Payer: BCBS Trust/PPO |
$13.59
|
| Rate for Payer: BCBS Trust/PPO |
$9.40
|
| Rate for Payer: BCN Commercial |
$12.50
|
| Rate for Payer: BCN Commercial |
$8.90
|
| Rate for Payer: BCN Commercial |
$12.51
|
| Rate for Payer: BCN Commercial |
$12.87
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$9.91
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Healthscope Commercial |
$10.37
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.76
|
| Rate for Payer: Nomi Health Commercial |
$13.26
|
| Rate for Payer: Nomi Health Commercial |
$9.45
|
| Rate for Payer: Nomi Health Commercial |
$13.28
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Commercial |
$13.76
|
| Rate for Payer: PHP Commercial |
$9.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health HMO/PPO |
$10.02
|
| Rate for Payer: Priority Health HMO/PPO |
$14.09
|
| Rate for Payer: Priority Health HMO/PPO |
$14.07
|
| Rate for Payer: Priority Health HMO/PPO |
$14.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.14
|
| Rate for Payer: UHC Core |
$13.90
|
| Rate for Payer: UHC Core |
$9.62
|
| Rate for Payer: UHC Core |
$13.50
|
| Rate for Payer: UHC Core |
$13.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.49
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 69374095710
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.28
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: Priority Health HMO/PPO |
$3.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.74
|
| Rate for Payer: UHC Core |
$3.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.19
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 69374095710
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.33
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.49
|
| Rate for Payer: BCN Commercial |
$3.30
|
| Rate for Payer: BCN Medicare Advantage |
$1.06
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.06
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: PACE Senior Care Partners |
$1.01
|
| Rate for Payer: PACE SWMI |
$1.06
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: PHP Medicare Advantage |
$1.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: Priority Health HMO/PPO |
$3.70
|
| Rate for Payer: Priority Health Medicare |
$1.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.74
|
| Rate for Payer: UHC Core |
$3.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.06
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UHC Medicare Advantage |
$1.06
|
| Rate for Payer: VA VA |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.19
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
OP
|
$27.91
|
|
|
Service Code
|
NDC 73177010803
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$25.12 |
| Rate for Payer: Aetna Commercial |
$23.72
|
| Rate for Payer: Aetna Medicare |
$7.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.72
|
| Rate for Payer: BCBS Complete |
$11.16
|
| Rate for Payer: BCBS MAPPO |
$6.98
|
| Rate for Payer: BCBS Trust/PPO |
$22.94
|
| Rate for Payer: BCN Commercial |
$21.70
|
| Rate for Payer: BCN Medicare Advantage |
$6.98
|
| Rate for Payer: Cash Price |
$22.33
|
| Rate for Payer: Cofinity Commercial |
$24.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.98
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.72
|
| Rate for Payer: Nomi Health Commercial |
$22.89
|
| Rate for Payer: PACE Senior Care Partners |
$6.63
|
| Rate for Payer: PACE SWMI |
$6.98
|
| Rate for Payer: PHP Commercial |
$23.72
|
| Rate for Payer: PHP Medicare Advantage |
$6.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.14
|
| Rate for Payer: Priority Health HMO/PPO |
$24.28
|
| Rate for Payer: Priority Health Medicare |
$7.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.70
|
| Rate for Payer: Railroad Medicare Medicare |
$6.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.56
|
| Rate for Payer: UHC Core |
$23.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.98
|
| Rate for Payer: UHC Exchange |
$6.98
|
| Rate for Payer: UHC Medicare Advantage |
$6.98
|
| Rate for Payer: VA VA |
$6.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.93
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
IP
|
$27.91
|
|
|
Service Code
|
NDC 73177010803
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$25.12 |
| Rate for Payer: Aetna Commercial |
$23.72
|
| Rate for Payer: BCBS Trust/PPO |
$22.78
|
| Rate for Payer: BCN Commercial |
$21.57
|
| Rate for Payer: Cash Price |
$22.33
|
| Rate for Payer: Cofinity Commercial |
$24.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.33
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.72
|
| Rate for Payer: Nomi Health Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$23.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.14
|
| Rate for Payer: Priority Health HMO/PPO |
$24.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.56
|
| Rate for Payer: UHC Core |
$23.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.93
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
IP
|
$23.19
|
|
|
Service Code
|
NDC 70092004646
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$20.87 |
| Rate for Payer: Aetna Commercial |
$19.71
|
| Rate for Payer: BCBS Trust/PPO |
$18.93
|
| Rate for Payer: BCN Commercial |
$17.92
|
| Rate for Payer: Cash Price |
$18.55
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.55
|
| Rate for Payer: Healthscope Commercial |
$20.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.71
|
| Rate for Payer: Nomi Health Commercial |
$19.02
|
| Rate for Payer: PHP Commercial |
$19.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.07
|
| Rate for Payer: Priority Health HMO/PPO |
$20.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.41
|
| Rate for Payer: UHC Core |
$19.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.39
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
OP
|
$23.19
|
|
|
Service Code
|
NDC 70092004646
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$20.87 |
| Rate for Payer: Aetna Commercial |
$19.71
|
| Rate for Payer: Aetna Medicare |
$6.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.25
|
| Rate for Payer: BCBS Complete |
$9.28
|
| Rate for Payer: BCBS MAPPO |
$5.80
|
| Rate for Payer: BCBS Trust/PPO |
$19.06
|
| Rate for Payer: BCN Commercial |
$18.03
|
| Rate for Payer: BCN Medicare Advantage |
$5.80
|
| Rate for Payer: Cash Price |
$18.55
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.80
|
| Rate for Payer: Healthscope Commercial |
$20.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.71
|
| Rate for Payer: Nomi Health Commercial |
$19.02
|
| Rate for Payer: PACE Senior Care Partners |
$5.51
|
| Rate for Payer: PACE SWMI |
$5.80
|
| Rate for Payer: PHP Commercial |
$19.71
|
| Rate for Payer: PHP Medicare Advantage |
$5.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.07
|
| Rate for Payer: Priority Health HMO/PPO |
$20.18
|
| Rate for Payer: Priority Health Medicare |
$5.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.54
|
| Rate for Payer: Railroad Medicare Medicare |
$5.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.41
|
| Rate for Payer: UHC Core |
$19.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.80
|
| Rate for Payer: UHC Exchange |
$5.80
|
| Rate for Payer: UHC Medicare Advantage |
$5.80
|
| Rate for Payer: VA VA |
$5.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.39
|
|
|
PHENYLEPHRINE IV INFUSION (INTRA-OP)
|
Facility
|
IP
|
$16.25
|
|
|
Service Code
|
NDC 09900000362
|
| Hospital Charge Code |
155179
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.81
|
| Rate for Payer: BCBS Trust/PPO |
$13.26
|
| Rate for Payer: BCN Commercial |
$12.56
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.00
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.81
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: PHP Commercial |
$13.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health HMO/PPO |
$14.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.30
|
| Rate for Payer: UHC Core |
$13.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.19
|
|
|
PHENYLEPHRINE IV INFUSION (INTRA-OP)
|
Facility
|
OP
|
$16.25
|
|
|
Service Code
|
NDC 09900000362
|
| Hospital Charge Code |
155179
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.81
|
| Rate for Payer: Aetna Medicare |
$4.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.08
|
| Rate for Payer: BCBS Complete |
$6.50
|
| Rate for Payer: BCBS MAPPO |
$4.06
|
| Rate for Payer: BCBS Trust/PPO |
$13.36
|
| Rate for Payer: BCN Commercial |
$12.63
|
| Rate for Payer: BCN Medicare Advantage |
$4.06
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.06
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.81
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: PACE Senior Care Partners |
$3.86
|
| Rate for Payer: PACE SWMI |
$4.06
|
| Rate for Payer: PHP Commercial |
$13.81
|
| Rate for Payer: PHP Medicare Advantage |
$4.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health HMO/PPO |
$14.14
|
| Rate for Payer: Priority Health Medicare |
$4.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.89
|
| Rate for Payer: Railroad Medicare Medicare |
$4.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.30
|
| Rate for Payer: UHC Core |
$13.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.06
|
| Rate for Payer: UHC Exchange |
$4.06
|
| Rate for Payer: UHC Medicare Advantage |
$4.06
|
| Rate for Payer: VA VA |
$4.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.19
|
|
