|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$452.20
|
|
|
Service Code
|
NDC 68084037601
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.93 |
| Max. Negotiated Rate |
$406.98 |
| Rate for Payer: Aetna Commercial |
$384.37
|
| Rate for Payer: BCBS Trust/PPO |
$369.13
|
| Rate for Payer: BCN Commercial |
$349.46
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Cofinity Commercial |
$388.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.76
|
| Rate for Payer: Healthscope Commercial |
$406.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.37
|
| Rate for Payer: Nomi Health Commercial |
$370.80
|
| Rate for Payer: PHP Commercial |
$384.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.93
|
| Rate for Payer: Priority Health HMO/PPO |
$393.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.94
|
| Rate for Payer: UHC Core |
$377.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.15
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
OP
|
$382.85
|
|
|
Service Code
|
NDC 00904618761
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.93 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: Aetna Medicare |
$99.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.64
|
| Rate for Payer: BCBS Complete |
$153.14
|
| Rate for Payer: BCBS MAPPO |
$95.71
|
| Rate for Payer: BCBS Trust/PPO |
$314.74
|
| Rate for Payer: BCN Commercial |
$297.67
|
| Rate for Payer: BCN Medicare Advantage |
$95.71
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.71
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: Nomi Health Commercial |
$313.94
|
| Rate for Payer: PACE Senior Care Partners |
$90.93
|
| Rate for Payer: PACE SWMI |
$95.71
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: PHP Medicare Advantage |
$95.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.85
|
| Rate for Payer: Priority Health HMO/PPO |
$333.08
|
| Rate for Payer: Priority Health Medicare |
$96.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.51
|
| Rate for Payer: Railroad Medicare Medicare |
$95.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.91
|
| Rate for Payer: UHC Core |
$319.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.71
|
| Rate for Payer: UHC Exchange |
$95.71
|
| Rate for Payer: UHC Medicare Advantage |
$95.71
|
| Rate for Payer: VA VA |
$95.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.14
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
OP
|
$452.20
|
|
|
Service Code
|
NDC 68084037611
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.40 |
| Max. Negotiated Rate |
$406.98 |
| Rate for Payer: Aetna Commercial |
$384.37
|
| Rate for Payer: Aetna Medicare |
$117.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.31
|
| Rate for Payer: BCBS Complete |
$180.88
|
| Rate for Payer: BCBS MAPPO |
$113.05
|
| Rate for Payer: BCBS Trust/PPO |
$371.75
|
| Rate for Payer: BCN Commercial |
$351.59
|
| Rate for Payer: BCN Medicare Advantage |
$113.05
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Cofinity Commercial |
$388.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.05
|
| Rate for Payer: Healthscope Commercial |
$406.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.37
|
| Rate for Payer: Nomi Health Commercial |
$370.80
|
| Rate for Payer: PACE Senior Care Partners |
$107.40
|
| Rate for Payer: PACE SWMI |
$113.05
|
| Rate for Payer: PHP Commercial |
$384.37
|
| Rate for Payer: PHP Medicare Advantage |
$113.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.93
|
| Rate for Payer: Priority Health HMO/PPO |
$393.41
|
| Rate for Payer: Priority Health Medicare |
$114.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.97
|
| Rate for Payer: Railroad Medicare Medicare |
$113.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.94
|
| Rate for Payer: UHC Core |
$377.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.05
|
| Rate for Payer: UHC Exchange |
$113.05
|
| Rate for Payer: UHC Medicare Advantage |
$113.05
|
| Rate for Payer: VA VA |
$113.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.15
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$382.85
|
|
|
Service Code
|
NDC 00904618761
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.85 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: BCBS Trust/PPO |
$312.52
|
| Rate for Payer: BCN Commercial |
$295.87
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: Nomi Health Commercial |
$313.94
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.85
|
| Rate for Payer: Priority Health HMO/PPO |
$333.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.91
|
| Rate for Payer: UHC Core |
$319.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.14
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
OP
|
$452.20
|
|
|
Service Code
|
NDC 68084037601
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.40 |
| Max. Negotiated Rate |
$406.98 |
| Rate for Payer: Aetna Commercial |
$384.37
|
| Rate for Payer: Aetna Medicare |
$117.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.31
|
| Rate for Payer: BCBS Complete |
$180.88
|
| Rate for Payer: BCBS MAPPO |
$113.05
|
| Rate for Payer: BCBS Trust/PPO |
$371.75
|
| Rate for Payer: BCN Commercial |
$351.59
|
| Rate for Payer: BCN Medicare Advantage |
$113.05
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Cofinity Commercial |
$388.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.05
|
| Rate for Payer: Healthscope Commercial |
$406.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.37
|
| Rate for Payer: Nomi Health Commercial |
$370.80
|
| Rate for Payer: PACE Senior Care Partners |
$107.40
|
| Rate for Payer: PACE SWMI |
$113.05
|
| Rate for Payer: PHP Commercial |
$384.37
|
| Rate for Payer: PHP Medicare Advantage |
$113.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.93
|
| Rate for Payer: Priority Health HMO/PPO |
$393.41
|
| Rate for Payer: Priority Health Medicare |
$114.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.97
|
| Rate for Payer: Railroad Medicare Medicare |
$113.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.94
|
| Rate for Payer: UHC Core |
$377.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.05
|
| Rate for Payer: UHC Exchange |
$113.05
|
| Rate for Payer: UHC Medicare Advantage |
$113.05
|
| Rate for Payer: VA VA |
$113.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.15
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$452.20
|
|
|
Service Code
|
NDC 68084037611
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.93 |
| Max. Negotiated Rate |
$406.98 |
| Rate for Payer: Aetna Commercial |
$384.37
|
| Rate for Payer: BCBS Trust/PPO |
$369.13
|
| Rate for Payer: BCN Commercial |
$349.46
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Cofinity Commercial |
$388.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.76
|
| Rate for Payer: Healthscope Commercial |
$406.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.37
|
| Rate for Payer: Nomi Health Commercial |
$370.80
|
| Rate for Payer: PHP Commercial |
$384.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.93
|
| Rate for Payer: Priority Health HMO/PPO |
$393.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.94
|
| Rate for Payer: UHC Core |
$377.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.15
|
|
|
PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$258.47
|
|
|
Service Code
|
NDC 17478051002
|
| Hospital Charge Code |
6270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.39 |
| Max. Negotiated Rate |
$232.62 |
| Rate for Payer: Aetna Commercial |
$219.70
|
| Rate for Payer: Aetna Medicare |
$67.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.77
|
| Rate for Payer: BCBS Complete |
$103.39
|
| Rate for Payer: BCBS MAPPO |
$64.62
|
| Rate for Payer: BCBS Trust/PPO |
$212.49
|
| Rate for Payer: BCN Commercial |
$200.96
|
| Rate for Payer: BCN Medicare Advantage |
$64.62
|
| Rate for Payer: Cash Price |
$206.78
|
| Rate for Payer: Cofinity Commercial |
$222.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.62
|
| Rate for Payer: Healthscope Commercial |
$232.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.70
|
| Rate for Payer: Nomi Health Commercial |
$211.95
|
| Rate for Payer: PACE Senior Care Partners |
$61.39
|
| Rate for Payer: PACE SWMI |
$64.62
|
| Rate for Payer: PHP Commercial |
$219.70
|
| Rate for Payer: PHP Medicare Advantage |
$64.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.01
|
| Rate for Payer: Priority Health HMO/PPO |
$224.87
|
| Rate for Payer: Priority Health Medicare |
$65.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.17
|
| Rate for Payer: Railroad Medicare Medicare |
$64.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.45
|
| Rate for Payer: UHC Core |
$215.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.62
|
| Rate for Payer: UHC Exchange |
$64.62
|
| Rate for Payer: UHC Medicare Advantage |
$64.62
|
| Rate for Payer: VA VA |
$64.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.85
|
|
|
PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$258.47
|
|
|
Service Code
|
NDC 17478051002
|
| Hospital Charge Code |
6270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$168.01 |
| Max. Negotiated Rate |
$232.62 |
| Rate for Payer: Aetna Commercial |
$219.70
|
| Rate for Payer: BCBS Trust/PPO |
$210.99
|
| Rate for Payer: BCN Commercial |
$199.75
|
| Rate for Payer: Cash Price |
$206.78
|
| Rate for Payer: Cofinity Commercial |
$222.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.78
|
| Rate for Payer: Healthscope Commercial |
$232.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.70
|
| Rate for Payer: Nomi Health Commercial |
$211.95
|
| Rate for Payer: PHP Commercial |
$219.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.01
|
| Rate for Payer: Priority Health HMO/PPO |
$224.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.45
|
| Rate for Payer: UHC Core |
$215.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.85
|
|
|
PHYTONADIONE (VITAMIN K1) 1,000 MCG CAPSULE
|
Facility
|
IP
|
$340.75
|
|
|
Service Code
|
NDC 05105010500
|
| Hospital Charge Code |
196288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.49 |
| Max. Negotiated Rate |
$306.68 |
| Rate for Payer: Aetna Commercial |
$289.64
|
| Rate for Payer: BCBS Trust/PPO |
$278.15
|
| Rate for Payer: BCN Commercial |
$263.33
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$293.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$306.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.64
|
| Rate for Payer: Nomi Health Commercial |
$279.42
|
| Rate for Payer: PHP Commercial |
$289.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.49
|
| Rate for Payer: Priority Health HMO/PPO |
$296.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.86
|
| Rate for Payer: UHC Core |
$284.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.56
|
|
|
PHYTONADIONE (VITAMIN K1) 1,000 MCG CAPSULE
|
Facility
|
OP
|
$340.75
|
|
|
Service Code
|
NDC 05105010500
|
| Hospital Charge Code |
196288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.93 |
| Max. Negotiated Rate |
$306.68 |
| Rate for Payer: Aetna Commercial |
$289.64
|
| Rate for Payer: Aetna Medicare |
$88.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.48
|
| Rate for Payer: BCBS Complete |
$136.30
|
| Rate for Payer: BCBS MAPPO |
$85.19
|
| Rate for Payer: BCBS Trust/PPO |
$280.13
|
| Rate for Payer: BCN Commercial |
$264.93
|
| Rate for Payer: BCN Medicare Advantage |
$85.19
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$293.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.19
|
| Rate for Payer: Healthscope Commercial |
$306.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.64
|
| Rate for Payer: Nomi Health Commercial |
$279.42
|
| Rate for Payer: PACE Senior Care Partners |
$80.93
|
| Rate for Payer: PACE SWMI |
$85.19
|
| Rate for Payer: PHP Commercial |
$289.64
|
| Rate for Payer: PHP Medicare Advantage |
$85.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.49
|
| Rate for Payer: Priority Health HMO/PPO |
$296.45
|
| Rate for Payer: Priority Health Medicare |
$86.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.30
|
| Rate for Payer: Railroad Medicare Medicare |
$85.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.86
|
| Rate for Payer: UHC Core |
$284.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.19
|
| Rate for Payer: UHC Exchange |
$85.19
|
| Rate for Payer: UHC Medicare Advantage |
$85.19
|
| Rate for Payer: VA VA |
$85.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.56
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$105.99
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
11023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.89 |
| Max. Negotiated Rate |
$95.39 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: BCBS Trust/PPO |
$86.52
|
| Rate for Payer: BCBS Trust/PPO |
$67.59
|
| Rate for Payer: BCN Commercial |
$81.91
|
| Rate for Payer: BCN Commercial |
$63.99
|
| Rate for Payer: Cash Price |
$84.79
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Cofinity Commercial |
$91.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.79
|
| Rate for Payer: Healthscope Commercial |
$95.39
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.38
|
| Rate for Payer: Nomi Health Commercial |
$86.91
|
| Rate for Payer: Nomi Health Commercial |
$67.90
|
| Rate for Payer: PHP Commercial |
$90.09
|
| Rate for Payer: PHP Commercial |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.89
|
| Rate for Payer: Priority Health HMO/PPO |
$72.04
|
| Rate for Payer: Priority Health HMO/PPO |
$92.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.86
|
| Rate for Payer: UHC Core |
$88.50
|
| Rate for Payer: UHC Core |
$69.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.10
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$82.80
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
11023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Aetna Medicare |
$21.53
|
| Rate for Payer: Aetna Medicare |
$27.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.12
|
| Rate for Payer: BCBS Complete |
$42.40
|
| Rate for Payer: BCBS Complete |
$33.12
|
| Rate for Payer: BCBS MAPPO |
$26.50
|
| Rate for Payer: BCBS MAPPO |
$20.70
|
| Rate for Payer: BCBS Trust/PPO |
$68.07
|
| Rate for Payer: BCBS Trust/PPO |
$87.13
|
| Rate for Payer: BCN Commercial |
$64.38
|
| Rate for Payer: BCN Commercial |
$82.41
|
| Rate for Payer: BCN Medicare Advantage |
$20.70
|
| Rate for Payer: BCN Medicare Advantage |
$26.50
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cash Price |
$84.79
|
| Rate for Payer: Cofinity Commercial |
$91.15
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.70
|
| Rate for Payer: Healthscope Commercial |
$95.39
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.09
|
| Rate for Payer: Nomi Health Commercial |
$67.90
|
| Rate for Payer: Nomi Health Commercial |
$86.91
|
| Rate for Payer: PACE Senior Care Partners |
$19.66
|
| Rate for Payer: PACE Senior Care Partners |
$25.17
|
| Rate for Payer: PACE SWMI |
$20.70
|
| Rate for Payer: PACE SWMI |
$26.50
|
| Rate for Payer: PHP Commercial |
$70.38
|
| Rate for Payer: PHP Commercial |
$90.09
|
| Rate for Payer: PHP Medicare Advantage |
$26.50
|
| Rate for Payer: PHP Medicare Advantage |
$20.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.89
|
| Rate for Payer: Priority Health HMO/PPO |
$92.21
|
| Rate for Payer: Priority Health HMO/PPO |
$72.04
|
| Rate for Payer: Priority Health Medicare |
$20.91
|
| Rate for Payer: Priority Health Medicare |
$26.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.01
|
| Rate for Payer: Railroad Medicare Medicare |
$26.50
|
| Rate for Payer: Railroad Medicare Medicare |
$20.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.86
|
| Rate for Payer: UHC Core |
$69.14
|
| Rate for Payer: UHC Core |
$88.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.50
|
| Rate for Payer: UHC Exchange |
$26.50
|
| Rate for Payer: UHC Exchange |
$20.70
|
| Rate for Payer: UHC Medicare Advantage |
$26.50
|
| Rate for Payer: UHC Medicare Advantage |
$20.70
|
| Rate for Payer: VA VA |
$26.50
|
| Rate for Payer: VA VA |
$20.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.49
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.09
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
108266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: BCBS Trust/PPO |
$19.66
|
| Rate for Payer: BCN Commercial |
$18.62
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health HMO/PPO |
$20.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.20
|
| Rate for Payer: UHC Core |
$20.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
108266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Medicare |
$6.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.53
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS MAPPO |
$6.02
|
| Rate for Payer: BCBS Trust/PPO |
$19.80
|
| Rate for Payer: BCN Commercial |
$18.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.02
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.02
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: PACE Senior Care Partners |
$5.72
|
| Rate for Payer: PACE SWMI |
$6.02
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: PHP Medicare Advantage |
$6.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health HMO/PPO |
$20.96
|
| Rate for Payer: Priority Health Medicare |
$6.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.20
|
| Rate for Payer: UHC Core |
$20.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.02
|
| Rate for Payer: UHC Exchange |
$6.02
|
| Rate for Payer: UHC Medicare Advantage |
$6.02
|
| Rate for Payer: VA VA |
$6.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$98.79
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
6271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.21 |
| Max. Negotiated Rate |
$88.91 |
| Rate for Payer: Aetna Commercial |
$83.97
|
| Rate for Payer: BCBS Trust/PPO |
$80.64
|
| Rate for Payer: BCN Commercial |
$76.34
|
| Rate for Payer: Cash Price |
$79.03
|
| Rate for Payer: Cofinity Commercial |
$84.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.03
|
| Rate for Payer: Healthscope Commercial |
$88.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.97
|
| Rate for Payer: Nomi Health Commercial |
$81.01
|
| Rate for Payer: PHP Commercial |
$83.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.21
|
| Rate for Payer: Priority Health HMO/PPO |
$85.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.94
|
| Rate for Payer: UHC Core |
$82.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.09
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$98.79
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
6271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$88.91 |
| Rate for Payer: Aetna Commercial |
$83.97
|
| Rate for Payer: Aetna Medicare |
$25.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.87
|
| Rate for Payer: BCBS Complete |
$39.52
|
| Rate for Payer: BCBS MAPPO |
$24.70
|
| Rate for Payer: BCBS Trust/PPO |
$81.22
|
| Rate for Payer: BCN Commercial |
$76.81
|
| Rate for Payer: BCN Medicare Advantage |
$24.70
|
| Rate for Payer: Cash Price |
$79.03
|
| Rate for Payer: Cofinity Commercial |
$84.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.70
|
| Rate for Payer: Healthscope Commercial |
$88.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.97
|
| Rate for Payer: Nomi Health Commercial |
$81.01
|
| Rate for Payer: PACE Senior Care Partners |
$23.46
|
| Rate for Payer: PACE SWMI |
$24.70
|
| Rate for Payer: PHP Commercial |
$83.97
|
| Rate for Payer: PHP Medicare Advantage |
$24.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.21
|
| Rate for Payer: Priority Health HMO/PPO |
$85.95
|
| Rate for Payer: Priority Health Medicare |
$24.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.19
|
| Rate for Payer: Railroad Medicare Medicare |
$24.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.94
|
| Rate for Payer: UHC Core |
$82.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.70
|
| Rate for Payer: UHC Exchange |
$24.70
|
| Rate for Payer: UHC Medicare Advantage |
$24.70
|
| Rate for Payer: VA VA |
$24.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.09
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET
|
Facility
|
IP
|
$4,173.09
|
|
|
Service Code
|
NDC 00904688210
|
| Hospital Charge Code |
11024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,712.51 |
| Max. Negotiated Rate |
$3,755.78 |
| Rate for Payer: Aetna Commercial |
$3,547.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,406.49
|
| Rate for Payer: BCN Commercial |
$3,224.96
|
| Rate for Payer: Cash Price |
$3,338.47
|
| Rate for Payer: Cofinity Commercial |
$3,588.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,338.47
|
| Rate for Payer: Healthscope Commercial |
$3,755.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,129.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,547.13
|
| Rate for Payer: Nomi Health Commercial |
$3,421.93
|
| Rate for Payer: PHP Commercial |
$3,547.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,712.51
|
| Rate for Payer: Priority Health HMO/PPO |
$3,630.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,795.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,672.32
|
| Rate for Payer: UHC Core |
$3,484.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,129.82
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET
|
Facility
|
OP
|
$4,173.09
|
|
|
Service Code
|
NDC 00904688210
|
| Hospital Charge Code |
11024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$991.11 |
| Max. Negotiated Rate |
$3,755.78 |
| Rate for Payer: Aetna Commercial |
$3,547.13
|
| Rate for Payer: Aetna Medicare |
$1,085.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,304.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,304.09
|
| Rate for Payer: BCBS Complete |
$1,669.24
|
| Rate for Payer: BCBS MAPPO |
$1,043.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,430.70
|
| Rate for Payer: BCN Commercial |
$3,244.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,043.27
|
| Rate for Payer: Cash Price |
$3,338.47
|
| Rate for Payer: Cofinity Commercial |
$3,588.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,338.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,043.27
|
| Rate for Payer: Healthscope Commercial |
$3,755.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,129.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,095.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,199.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,547.13
|
| Rate for Payer: Nomi Health Commercial |
$3,421.93
|
| Rate for Payer: PACE Senior Care Partners |
$991.11
|
| Rate for Payer: PACE SWMI |
$1,043.27
|
| Rate for Payer: PHP Commercial |
$3,547.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,043.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,712.51
|
| Rate for Payer: Priority Health HMO/PPO |
$3,630.59
|
| Rate for Payer: Priority Health Medicare |
$1,053.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,795.97
|
| Rate for Payer: Railroad Medicare Medicare |
$1,043.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,672.32
|
| Rate for Payer: UHC Core |
$3,484.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,043.27
|
| Rate for Payer: UHC Exchange |
$1,043.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,043.27
|
| Rate for Payer: VA VA |
$1,043.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,129.82
|
|
|
PILOCARPINE 1 % EYE DROPS
|
Facility
|
IP
|
$136.98
|
|
|
Service Code
|
NDC 61314020315
|
| Hospital Charge Code |
6279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.04 |
| Max. Negotiated Rate |
$123.28 |
| Rate for Payer: Aetna Commercial |
$116.43
|
| Rate for Payer: BCBS Trust/PPO |
$111.82
|
| Rate for Payer: BCN Commercial |
$105.86
|
| Rate for Payer: Cash Price |
$109.58
|
| Rate for Payer: Cofinity Commercial |
$117.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.58
|
| Rate for Payer: Healthscope Commercial |
$123.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.43
|
| Rate for Payer: Nomi Health Commercial |
$112.32
|
| Rate for Payer: PHP Commercial |
$116.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.04
|
| Rate for Payer: Priority Health HMO/PPO |
$119.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.54
|
| Rate for Payer: UHC Core |
$114.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.74
|
|
|
PILOCARPINE 1 % EYE DROPS
|
Facility
|
OP
|
$136.98
|
|
|
Service Code
|
NDC 61314020315
|
| Hospital Charge Code |
6279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.53 |
| Max. Negotiated Rate |
$123.28 |
| Rate for Payer: Aetna Commercial |
$116.43
|
| Rate for Payer: Aetna Medicare |
$35.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.81
|
| Rate for Payer: BCBS Complete |
$54.79
|
| Rate for Payer: BCBS MAPPO |
$34.24
|
| Rate for Payer: BCBS Trust/PPO |
$112.61
|
| Rate for Payer: BCN Commercial |
$106.50
|
| Rate for Payer: BCN Medicare Advantage |
$34.24
|
| Rate for Payer: Cash Price |
$109.58
|
| Rate for Payer: Cofinity Commercial |
$117.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.24
|
| Rate for Payer: Healthscope Commercial |
$123.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.43
|
| Rate for Payer: Nomi Health Commercial |
$112.32
|
| Rate for Payer: PACE Senior Care Partners |
$32.53
|
| Rate for Payer: PACE SWMI |
$34.24
|
| Rate for Payer: PHP Commercial |
$116.43
|
| Rate for Payer: PHP Medicare Advantage |
$34.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.04
|
| Rate for Payer: Priority Health HMO/PPO |
$119.17
|
| Rate for Payer: Priority Health Medicare |
$34.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.78
|
| Rate for Payer: Railroad Medicare Medicare |
$34.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.54
|
| Rate for Payer: UHC Core |
$114.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.24
|
| Rate for Payer: UHC Exchange |
$34.24
|
| Rate for Payer: UHC Medicare Advantage |
$34.24
|
| Rate for Payer: VA VA |
$34.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.74
|
|
|
PILOCARPINE 2 % EYE DROPS
|
Facility
|
IP
|
$311.54
|
|
|
Service Code
|
NDC 00998020415
|
| Hospital Charge Code |
6280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$280.39 |
| Rate for Payer: Aetna Commercial |
$264.81
|
| Rate for Payer: BCBS Trust/PPO |
$254.31
|
| Rate for Payer: BCN Commercial |
$240.76
|
| Rate for Payer: Cash Price |
$249.23
|
| Rate for Payer: Cofinity Commercial |
$267.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.23
|
| Rate for Payer: Healthscope Commercial |
$280.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.81
|
| Rate for Payer: Nomi Health Commercial |
$255.46
|
| Rate for Payer: PHP Commercial |
$264.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.50
|
| Rate for Payer: Priority Health HMO/PPO |
$271.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.16
|
| Rate for Payer: UHC Core |
$260.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.66
|
|
|
PILOCARPINE 2 % EYE DROPS
|
Facility
|
OP
|
$311.54
|
|
|
Service Code
|
NDC 00998020415
|
| Hospital Charge Code |
6280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$280.39 |
| Rate for Payer: Aetna Commercial |
$264.81
|
| Rate for Payer: Aetna Medicare |
$81.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.36
|
| Rate for Payer: BCBS Complete |
$124.62
|
| Rate for Payer: BCBS MAPPO |
$77.88
|
| Rate for Payer: BCBS Trust/PPO |
$256.12
|
| Rate for Payer: BCN Commercial |
$242.22
|
| Rate for Payer: BCN Medicare Advantage |
$77.88
|
| Rate for Payer: Cash Price |
$249.23
|
| Rate for Payer: Cofinity Commercial |
$267.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.88
|
| Rate for Payer: Healthscope Commercial |
$280.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.81
|
| Rate for Payer: Nomi Health Commercial |
$255.46
|
| Rate for Payer: PACE Senior Care Partners |
$73.99
|
| Rate for Payer: PACE SWMI |
$77.88
|
| Rate for Payer: PHP Commercial |
$264.81
|
| Rate for Payer: PHP Medicare Advantage |
$77.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.50
|
| Rate for Payer: Priority Health HMO/PPO |
$271.04
|
| Rate for Payer: Priority Health Medicare |
$78.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.73
|
| Rate for Payer: Railroad Medicare Medicare |
$77.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.16
|
| Rate for Payer: UHC Core |
$260.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.88
|
| Rate for Payer: UHC Exchange |
$77.88
|
| Rate for Payer: UHC Medicare Advantage |
$77.88
|
| Rate for Payer: VA VA |
$77.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.66
|
|
|
PILOCARPINE 4 % EYE DROPS
|
Facility
|
IP
|
$138.92
|
|
|
Service Code
|
NDC 70069020101
|
| Hospital Charge Code |
6282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$125.03 |
| Rate for Payer: Aetna Commercial |
$118.08
|
| Rate for Payer: BCBS Trust/PPO |
$113.40
|
| Rate for Payer: BCN Commercial |
$107.36
|
| Rate for Payer: Cash Price |
$111.14
|
| Rate for Payer: Cofinity Commercial |
$119.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.14
|
| Rate for Payer: Healthscope Commercial |
$125.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.08
|
| Rate for Payer: Nomi Health Commercial |
$113.91
|
| Rate for Payer: PHP Commercial |
$118.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health HMO/PPO |
$120.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.25
|
| Rate for Payer: UHC Core |
$116.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.19
|
|
|
PILOCARPINE 4 % EYE DROPS
|
Facility
|
IP
|
$152.99
|
|
|
Service Code
|
NDC 61314020615
|
| Hospital Charge Code |
6282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.44 |
| Max. Negotiated Rate |
$137.69 |
| Rate for Payer: Aetna Commercial |
$130.04
|
| Rate for Payer: BCBS Trust/PPO |
$124.89
|
| Rate for Payer: BCN Commercial |
$118.23
|
| Rate for Payer: Cash Price |
$122.39
|
| Rate for Payer: Cofinity Commercial |
$131.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.39
|
| Rate for Payer: Healthscope Commercial |
$137.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.04
|
| Rate for Payer: Nomi Health Commercial |
$125.45
|
| Rate for Payer: PHP Commercial |
$130.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.44
|
| Rate for Payer: Priority Health HMO/PPO |
$133.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.63
|
| Rate for Payer: UHC Core |
$127.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.74
|
|
|
PILOCARPINE 4 % EYE DROPS
|
Facility
|
OP
|
$138.92
|
|
|
Service Code
|
NDC 70069020101
|
| Hospital Charge Code |
6282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.99 |
| Max. Negotiated Rate |
$125.03 |
| Rate for Payer: Aetna Commercial |
$118.08
|
| Rate for Payer: Aetna Medicare |
$36.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.41
|
| Rate for Payer: BCBS Complete |
$55.57
|
| Rate for Payer: BCBS MAPPO |
$34.73
|
| Rate for Payer: BCBS Trust/PPO |
$114.21
|
| Rate for Payer: BCN Commercial |
$108.01
|
| Rate for Payer: BCN Medicare Advantage |
$34.73
|
| Rate for Payer: Cash Price |
$111.14
|
| Rate for Payer: Cofinity Commercial |
$119.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.73
|
| Rate for Payer: Healthscope Commercial |
$125.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.08
|
| Rate for Payer: Nomi Health Commercial |
$113.91
|
| Rate for Payer: PACE Senior Care Partners |
$32.99
|
| Rate for Payer: PACE SWMI |
$34.73
|
| Rate for Payer: PHP Commercial |
$118.08
|
| Rate for Payer: PHP Medicare Advantage |
$34.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health HMO/PPO |
$120.86
|
| Rate for Payer: Priority Health Medicare |
$35.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.08
|
| Rate for Payer: Railroad Medicare Medicare |
$34.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.25
|
| Rate for Payer: UHC Core |
$116.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.73
|
| Rate for Payer: UHC Exchange |
$34.73
|
| Rate for Payer: UHC Medicare Advantage |
$34.73
|
| Rate for Payer: VA VA |
$34.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.19
|
|
