|
PHENYLEPHRINE 0.25 %-PRAMOXINE 1 %-GLYCERIN-WH.PETROLATUM RECTAL CREAM
|
Facility
|
OP
|
$11.34
|
|
|
Service Code
|
NDC 70000042501
|
| Hospital Charge Code |
77868
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$10.21 |
| Rate for Payer: Aetna Commercial |
$9.64
|
| Rate for Payer: Aetna Medicare |
$2.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.54
|
| Rate for Payer: BCBS Complete |
$2.10
|
| Rate for Payer: BCBS MAPPO |
$2.83
|
| Rate for Payer: BCBS Trust/PPO |
$9.32
|
| Rate for Payer: BCN Commercial |
$9.32
|
| Rate for Payer: BCN Medicare Advantage |
$2.83
|
| Rate for Payer: Cash Price |
$9.07
|
| Rate for Payer: Cofinity Commercial |
$9.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.83
|
| Rate for Payer: Healthscope Commercial |
$10.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.51
|
| Rate for Payer: Mclaren Medicaid |
$2.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.98
|
| Rate for Payer: Meridian Medicaid |
$2.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.64
|
| Rate for Payer: Nomi Health Commercial |
$9.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.51
|
| Rate for Payer: PACE Senior Care Partners |
$2.69
|
| Rate for Payer: PACE SWMI |
$2.83
|
| Rate for Payer: PHP Commercial |
$9.64
|
| Rate for Payer: PHP Medicare Advantage |
$2.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.87
|
| Rate for Payer: Priority Health Medicare |
$2.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.89
|
| Rate for Payer: Railroad Medicare Medicare |
$2.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.98
|
| Rate for Payer: UHC Core |
$9.47
|
| Rate for Payer: UHC Exchange |
$2.83
|
| Rate for Payer: UHC Medicaid |
$2.00
|
| Rate for Payer: UHC Medicare Advantage |
$2.83
|
| Rate for Payer: UHCCP Medicaid |
$2.00
|
| Rate for Payer: VA VA |
$2.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.51
|
|
|
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 |
$6.44 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Aetna Commercial |
$7.86
|
| Rate for Payer: BCBS Trust/PPO |
$7.64
|
| Rate for Payer: BCN Commercial |
$7.64
|
| 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: Opus (Opus Packaging Group) HMA |
$6.94
|
| Rate for Payer: PHP Commercial |
$7.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.44
|
| 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
|
IP
|
$11.34
|
|
|
Service Code
|
NDC 70000042501
|
| Hospital Charge Code |
77868
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$10.21 |
| Rate for Payer: Aetna Commercial |
$9.64
|
| Rate for Payer: BCBS Trust/PPO |
$9.37
|
| Rate for Payer: BCN Commercial |
$9.37
|
| Rate for Payer: Cash Price |
$9.07
|
| Rate for Payer: Cofinity Commercial |
$9.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.07
|
| Rate for Payer: Healthscope Commercial |
$10.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.64
|
| Rate for Payer: Nomi Health Commercial |
$9.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.51
|
| Rate for Payer: PHP Commercial |
$9.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.98
|
| Rate for Payer: UHC Core |
$9.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.51
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
IP
|
$119.25
|
|
|
Service Code
|
NDC 17478020605
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$107.33 |
| Rate for Payer: Aetna Commercial |
$101.36
|
| Rate for Payer: BCBS Trust/PPO |
$98.49
|
| Rate for Payer: BCN Commercial |
$98.49
|
| 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: Opus (Opus Packaging Group) HMA |
$89.44
|
| Rate for Payer: PHP Commercial |
$101.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$103.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.00
|
| 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 % EYE DROPS
|
Facility
|
OP
|
$119.25
|
|
|
Service Code
|
NDC 17478020605
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.02 |
| 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 |
$22.07
|
| Rate for Payer: BCBS MAPPO |
$29.81
|
| Rate for Payer: BCBS Trust/PPO |
$98.04
|
| Rate for Payer: BCN Commercial |
$98.04
|
| 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: Mclaren Medicaid |
$21.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.30
|
| Rate for Payer: Meridian Medicaid |
$22.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.36
|
| Rate for Payer: Nomi Health Commercial |
$97.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.44
|
| 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 Choice Medicaid |
$21.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$103.75
|
| Rate for Payer: Priority Health Medicare |
$30.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.00
|
| 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 Exchange |
$29.81
|
| Rate for Payer: UHC Medicaid |
$21.02
|
| Rate for Payer: UHC Medicare Advantage |
$29.81
|
| Rate for Payer: UHCCP Medicaid |
$21.02
|
| Rate for Payer: VA VA |
$29.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.44
|
|
|
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 |
$24.36 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: BCBS Trust/PPO |
$28.91
|
| Rate for Payer: BCN Commercial |
$28.91
|
| 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: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.36
|
| 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 IN NS 200 ML
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 99000000209
|
| Hospital Charge Code |
155016
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.17 |
| 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 |
$6.48
|
| Rate for Payer: BCBS MAPPO |
$8.75
|
| Rate for Payer: BCBS Trust/PPO |
$28.77
|
| Rate for Payer: BCN Commercial |
$28.77
|
| 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: Mclaren Medicaid |
$6.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.19
|
| Rate for Payer: Meridian Medicaid |
$6.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Nomi Health Commercial |
$28.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| 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 Choice Medicaid |
$6.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.45
|
| Rate for Payer: Priority Health Medicare |
$8.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.36
|
| 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 Exchange |
$8.75
|
| Rate for Payer: UHC Medicaid |
$6.17
|
| Rate for Payer: UHC Medicare Advantage |
$8.75
|
| Rate for Payer: UHCCP Medicaid |
$6.17
|
| Rate for Payer: VA VA |
$8.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
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 |
$11.25 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna Commercial |
$10.92
|
| Rate for Payer: Aetna Commercial |
$11.98
|
| Rate for Payer: Aetna Commercial |
$13.07
|
| Rate for Payer: Aetna Commercial |
$9.79
|
| Rate for Payer: BCBS Trust/PPO |
$12.70
|
| Rate for Payer: BCBS Trust/PPO |
$13.35
|
| Rate for Payer: BCBS Trust/PPO |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$9.51
|
| Rate for Payer: BCN Commercial |
$12.70
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: BCN Commercial |
$9.51
|
| Rate for Payer: BCN Commercial |
$10.61
|
| Rate for Payer: BCN Commercial |
$13.35
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Cash Price |
$10.28
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$9.91
|
| Rate for Payer: Cofinity Commercial |
$13.23
|
| Rate for Payer: Cofinity Commercial |
$12.13
|
| Rate for Payer: Cofinity Commercial |
$11.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Healthscope Commercial |
$11.56
|
| Rate for Payer: Healthscope Commercial |
$12.69
|
| Rate for Payer: Healthscope Commercial |
$10.37
|
| Rate for Payer: Healthscope Commercial |
$13.84
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.98
|
| 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 |
$10.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.07
|
| Rate for Payer: Nomi Health Commercial |
$9.45
|
| Rate for Payer: Nomi Health Commercial |
$10.54
|
| Rate for Payer: Nomi Health Commercial |
$11.56
|
| Rate for Payer: Nomi Health Commercial |
$12.61
|
| Rate for Payer: Nomi Health Commercial |
$13.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.13
|
| Rate for Payer: PHP Commercial |
$10.92
|
| Rate for Payer: PHP Commercial |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: PHP Commercial |
$13.07
|
| Rate for Payer: PHP Commercial |
$9.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.53
|
| Rate for Payer: UHC Core |
$9.62
|
| Rate for Payer: UHC Core |
$10.73
|
| Rate for Payer: UHC Core |
$12.84
|
| Rate for Payer: UHC Core |
$13.50
|
| Rate for Payer: UHC Core |
$11.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.54
|
|
|
PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$16.17
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna Commercial |
$10.92
|
| Rate for Payer: Aetna Commercial |
$13.07
|
| Rate for Payer: Aetna Commercial |
$9.79
|
| Rate for Payer: Aetna Commercial |
$11.98
|
| Rate for Payer: Aetna Medicare |
$3.34
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna Medicare |
$3.67
|
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.81
|
| Rate for Payer: BCBS Complete |
$2.38
|
| Rate for Payer: BCBS Complete |
$2.13
|
| Rate for Payer: BCBS Complete |
$2.61
|
| Rate for Payer: BCBS Complete |
$2.99
|
| Rate for Payer: BCBS Complete |
$2.85
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$3.21
|
| Rate for Payer: BCBS MAPPO |
$2.88
|
| Rate for Payer: BCBS MAPPO |
$3.52
|
| Rate for Payer: BCBS MAPPO |
$3.85
|
| Rate for Payer: BCBS Trust/PPO |
$11.59
|
| Rate for Payer: BCBS Trust/PPO |
$9.47
|
| Rate for Payer: BCBS Trust/PPO |
$10.56
|
| Rate for Payer: BCBS Trust/PPO |
$13.29
|
| Rate for Payer: BCBS Trust/PPO |
$12.64
|
| Rate for Payer: BCN Commercial |
$11.59
|
| Rate for Payer: BCN Commercial |
$10.56
|
| Rate for Payer: BCN Commercial |
$9.47
|
| Rate for Payer: BCN Commercial |
$13.29
|
| Rate for Payer: BCN Commercial |
$12.64
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: BCN Medicare Advantage |
$3.85
|
| Rate for Payer: BCN Medicare Advantage |
$3.52
|
| Rate for Payer: BCN Medicare Advantage |
$3.21
|
| Rate for Payer: BCN Medicare Advantage |
$2.88
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cash Price |
$10.28
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Cofinity Commercial |
$13.23
|
| Rate for Payer: Cofinity Commercial |
$12.13
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$9.91
|
| Rate for Payer: Cofinity Commercial |
$11.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$10.37
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Healthscope Commercial |
$13.84
|
| Rate for Payer: Healthscope Commercial |
$11.56
|
| Rate for Payer: Healthscope Commercial |
$12.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.57
|
| Rate for Payer: Mclaren Medicaid |
$2.27
|
| Rate for Payer: Mclaren Medicaid |
$2.71
|
| Rate for Payer: Mclaren Medicaid |
$2.49
|
| Rate for Payer: Mclaren Medicaid |
$2.85
|
| Rate for Payer: Mclaren Medicaid |
$2.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.37
|
| 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 |
$3.70
|
| Rate for Payer: Meridian Medicaid |
$2.38
|
| Rate for Payer: Meridian Medicaid |
$2.13
|
| Rate for Payer: Meridian Medicaid |
$2.61
|
| Rate for Payer: Meridian Medicaid |
$2.85
|
| Rate for Payer: Meridian Medicaid |
$2.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: Nomi Health Commercial |
$13.26
|
| Rate for Payer: Nomi Health Commercial |
$11.56
|
| Rate for Payer: Nomi Health Commercial |
$12.61
|
| Rate for Payer: Nomi Health Commercial |
$9.45
|
| Rate for Payer: Nomi Health Commercial |
$10.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.13
|
| Rate for Payer: PACE Senior Care Partners |
$2.74
|
| Rate for Payer: PACE Senior Care Partners |
$3.05
|
| Rate for Payer: PACE Senior Care Partners |
$3.84
|
| Rate for Payer: PACE Senior Care Partners |
$3.65
|
| Rate for Payer: PACE Senior Care Partners |
$3.35
|
| Rate for Payer: PACE SWMI |
$2.88
|
| Rate for Payer: PACE SWMI |
$3.21
|
| Rate for Payer: PACE SWMI |
$3.52
|
| Rate for Payer: PACE SWMI |
$3.85
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PHP Commercial |
$13.07
|
| Rate for Payer: PHP Commercial |
$9.79
|
| Rate for Payer: PHP Commercial |
$11.98
|
| Rate for Payer: PHP Commercial |
$10.92
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: PHP Medicare Advantage |
$3.21
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$2.88
|
| Rate for Payer: PHP Medicare Advantage |
$3.85
|
| Rate for Payer: PHP Medicare Advantage |
$3.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.18
|
| Rate for Payer: Priority Health Medicare |
$3.24
|
| Rate for Payer: Priority Health Medicare |
$4.08
|
| Rate for Payer: Priority Health Medicare |
$2.91
|
| Rate for Payer: Priority Health Medicare |
$3.88
|
| Rate for Payer: Priority Health Medicare |
$3.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.02
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$3.85
|
| Rate for Payer: Railroad Medicare Medicare |
$3.52
|
| Rate for Payer: Railroad Medicare Medicare |
$2.88
|
| Rate for Payer: Railroad Medicare Medicare |
$3.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.23
|
| Rate for Payer: UHC Core |
$12.84
|
| Rate for Payer: UHC Core |
$9.62
|
| Rate for Payer: UHC Core |
$13.50
|
| Rate for Payer: UHC Core |
$11.77
|
| Rate for Payer: UHC Core |
$10.73
|
| Rate for Payer: UHC Exchange |
$2.88
|
| Rate for Payer: UHC Exchange |
$3.85
|
| Rate for Payer: UHC Exchange |
$3.21
|
| Rate for Payer: UHC Exchange |
$4.04
|
| Rate for Payer: UHC Exchange |
$3.52
|
| Rate for Payer: UHC Medicaid |
$2.85
|
| Rate for Payer: UHC Medicaid |
$2.71
|
| Rate for Payer: UHC Medicaid |
$2.27
|
| Rate for Payer: UHC Medicaid |
$2.49
|
| Rate for Payer: UHC Medicaid |
$2.03
|
| Rate for Payer: UHC Medicare Advantage |
$3.52
|
| Rate for Payer: UHC Medicare Advantage |
$2.88
|
| Rate for Payer: UHC Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Medicare Advantage |
$3.21
|
| Rate for Payer: UHC Medicare Advantage |
$3.85
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: UHCCP Medicaid |
$2.85
|
| Rate for Payer: UHCCP Medicaid |
$2.49
|
| Rate for Payer: UHCCP Medicaid |
$2.03
|
| Rate for Payer: UHCCP Medicaid |
$2.27
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: VA VA |
$2.88
|
| Rate for Payer: VA VA |
$3.85
|
| Rate for Payer: VA VA |
$3.21
|
| Rate for Payer: VA VA |
$3.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.64
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
IP
|
$23.86
|
|
|
Service Code
|
NDC 70092104646
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$21.47 |
| Rate for Payer: Aetna Commercial |
$20.28
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.09
|
| Rate for Payer: Healthscope Commercial |
$21.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.28
|
| Rate for Payer: Nomi Health Commercial |
$19.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.89
|
| Rate for Payer: PHP Commercial |
$20.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.00
|
| Rate for Payer: UHC Core |
$19.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.89
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
OP
|
$23.86
|
|
|
Service Code
|
NDC 70092004646
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$21.47 |
| Rate for Payer: Aetna Commercial |
$20.28
|
| Rate for Payer: Aetna Medicare |
$6.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.46
|
| Rate for Payer: BCBS Complete |
$4.42
|
| Rate for Payer: BCBS MAPPO |
$5.96
|
| Rate for Payer: BCBS Trust/PPO |
$19.62
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: BCN Medicare Advantage |
$5.96
|
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.96
|
| Rate for Payer: Healthscope Commercial |
$21.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.89
|
| Rate for Payer: Mclaren Medicaid |
$4.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.26
|
| Rate for Payer: Meridian Medicaid |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.28
|
| Rate for Payer: Nomi Health Commercial |
$19.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.89
|
| Rate for Payer: PACE Senior Care Partners |
$5.67
|
| Rate for Payer: PACE SWMI |
$5.96
|
| Rate for Payer: PHP Commercial |
$20.28
|
| Rate for Payer: PHP Medicare Advantage |
$5.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.76
|
| Rate for Payer: Priority Health Medicare |
$6.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.61
|
| Rate for Payer: Railroad Medicare Medicare |
$5.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.00
|
| Rate for Payer: UHC Core |
$19.92
|
| Rate for Payer: UHC Exchange |
$5.96
|
| Rate for Payer: UHC Medicaid |
$4.21
|
| Rate for Payer: UHC Medicare Advantage |
$5.96
|
| Rate for Payer: UHCCP Medicaid |
$4.21
|
| Rate for Payer: VA VA |
$5.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.89
|
|
|
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 |
$0.75 |
| 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 |
$0.79
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.49
|
| Rate for Payer: BCN Commercial |
$3.49
|
| 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: Mclaren Medicaid |
$0.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.12
|
| Rate for Payer: Meridian Medicaid |
$0.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.19
|
| 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 Choice Medicaid |
$0.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.70
|
| Rate for Payer: Priority Health Medicare |
$1.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.96
|
| 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 Exchange |
$1.06
|
| Rate for Payer: UHC Medicaid |
$0.75
|
| Rate for Payer: UHC Medicare Advantage |
$1.06
|
| Rate for Payer: UHCCP Medicaid |
$0.75
|
| 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 |
$4.92 |
| 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 |
$5.17
|
| Rate for Payer: BCBS MAPPO |
$6.98
|
| Rate for Payer: BCBS Trust/PPO |
$22.94
|
| Rate for Payer: BCN Commercial |
$22.94
|
| 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: Mclaren Medicaid |
$4.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.33
|
| Rate for Payer: Meridian Medicaid |
$5.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.72
|
| Rate for Payer: Nomi Health Commercial |
$22.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.93
|
| 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 Choice Medicaid |
$4.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.28
|
| Rate for Payer: Priority Health Medicare |
$7.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.43
|
| 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 Exchange |
$6.98
|
| Rate for Payer: UHC Medicaid |
$4.92
|
| Rate for Payer: UHC Medicare Advantage |
$6.98
|
| Rate for Payer: UHCCP Medicaid |
$4.92
|
| 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 |
$19.43 |
| Max. Negotiated Rate |
$25.12 |
| Rate for Payer: Aetna Commercial |
$23.72
|
| Rate for Payer: BCBS Trust/PPO |
$23.05
|
| Rate for Payer: BCN Commercial |
$23.05
|
| 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: Opus (Opus Packaging Group) HMA |
$20.93
|
| Rate for Payer: PHP Commercial |
$23.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.43
|
| 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
|
OP
|
$23.86
|
|
|
Service Code
|
NDC 70092104646
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$21.47 |
| Rate for Payer: Aetna Commercial |
$20.28
|
| Rate for Payer: Aetna Medicare |
$6.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.46
|
| Rate for Payer: BCBS Complete |
$4.42
|
| Rate for Payer: BCBS MAPPO |
$5.96
|
| Rate for Payer: BCBS Trust/PPO |
$19.62
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: BCN Medicare Advantage |
$5.96
|
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.96
|
| Rate for Payer: Healthscope Commercial |
$21.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.89
|
| Rate for Payer: Mclaren Medicaid |
$4.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.26
|
| Rate for Payer: Meridian Medicaid |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.28
|
| Rate for Payer: Nomi Health Commercial |
$19.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.89
|
| Rate for Payer: PACE Senior Care Partners |
$5.67
|
| Rate for Payer: PACE SWMI |
$5.96
|
| Rate for Payer: PHP Commercial |
$20.28
|
| Rate for Payer: PHP Medicare Advantage |
$5.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.76
|
| Rate for Payer: Priority Health Medicare |
$6.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.61
|
| Rate for Payer: Railroad Medicare Medicare |
$5.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.00
|
| Rate for Payer: UHC Core |
$19.92
|
| Rate for Payer: UHC Exchange |
$5.96
|
| Rate for Payer: UHC Medicaid |
$4.21
|
| Rate for Payer: UHC Medicare Advantage |
$5.96
|
| Rate for Payer: UHCCP Medicaid |
$4.21
|
| Rate for Payer: VA VA |
$5.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.89
|
|
|
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 |
$2.96 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.51
|
| Rate for Payer: BCN Commercial |
$3.51
|
| 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: Opus (Opus Packaging Group) HMA |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.96
|
| 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
|
IP
|
$23.86
|
|
|
Service Code
|
NDC 70092004646
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$21.47 |
| Rate for Payer: Aetna Commercial |
$20.28
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.09
|
| Rate for Payer: Healthscope Commercial |
$21.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.28
|
| Rate for Payer: Nomi Health Commercial |
$19.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.89
|
| Rate for Payer: PHP Commercial |
$20.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.00
|
| Rate for Payer: UHC Core |
$19.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.89
|
|
|
PHENYLEPHRINE IV INFUSION (INTRA-OP)
|
Facility
|
OP
|
$16.25
|
|
|
Service Code
|
NDC 09900000362
|
| Hospital Charge Code |
155179
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.86 |
| 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 |
$3.01
|
| Rate for Payer: BCBS MAPPO |
$4.06
|
| Rate for Payer: BCBS Trust/PPO |
$13.36
|
| Rate for Payer: BCN Commercial |
$13.36
|
| 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: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.27
|
| Rate for Payer: Meridian Medicaid |
$3.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.81
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.19
|
| 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 Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.14
|
| Rate for Payer: Priority Health Medicare |
$4.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.31
|
| 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 Exchange |
$4.06
|
| Rate for Payer: UHC Medicaid |
$2.86
|
| Rate for Payer: UHC Medicare Advantage |
$4.06
|
| Rate for Payer: UHCCP Medicaid |
$2.86
|
| Rate for Payer: VA VA |
$4.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.19
|
|
|
PHENYLEPHRINE IV INFUSION (INTRA-OP)
|
Facility
|
IP
|
$16.25
|
|
|
Service Code
|
NDC 09900000362
|
| Hospital Charge Code |
155179
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.81
|
| Rate for Payer: BCBS Trust/PPO |
$13.42
|
| Rate for Payer: BCN Commercial |
$13.42
|
| 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: Opus (Opus Packaging Group) HMA |
$12.19
|
| Rate for Payer: PHP Commercial |
$13.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.31
|
| 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
|
|
|
PHENYTOIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$590.37
|
|
|
Service Code
|
NDC 60432013108
|
| Hospital Charge Code |
6255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$410.90 |
| Max. Negotiated Rate |
$531.33 |
| Rate for Payer: Aetna Commercial |
$501.81
|
| Rate for Payer: BCBS Trust/PPO |
$487.59
|
| Rate for Payer: BCN Commercial |
$487.59
|
| Rate for Payer: Cash Price |
$472.30
|
| Rate for Payer: Cofinity Commercial |
$507.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.30
|
| Rate for Payer: Healthscope Commercial |
$531.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.81
|
| Rate for Payer: Nomi Health Commercial |
$484.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$442.78
|
| Rate for Payer: PHP Commercial |
$501.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$513.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$410.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.53
|
| Rate for Payer: UHC Core |
$492.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.78
|
|
|
PHENYTOIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$295.19
|
|
|
Service Code
|
NDC 51672406901
|
| Hospital Charge Code |
6255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.04 |
| Max. Negotiated Rate |
$265.67 |
| Rate for Payer: Aetna Commercial |
$250.91
|
| Rate for Payer: Aetna Medicare |
$76.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.25
|
| Rate for Payer: BCBS Complete |
$54.64
|
| Rate for Payer: BCBS MAPPO |
$73.80
|
| Rate for Payer: BCBS Trust/PPO |
$242.68
|
| Rate for Payer: BCN Commercial |
$242.68
|
| Rate for Payer: BCN Medicare Advantage |
$73.80
|
| Rate for Payer: Cash Price |
$236.15
|
| Rate for Payer: Cofinity Commercial |
$253.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.80
|
| Rate for Payer: Healthscope Commercial |
$265.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.39
|
| Rate for Payer: Mclaren Medicaid |
$52.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.49
|
| Rate for Payer: Meridian Medicaid |
$54.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.91
|
| Rate for Payer: Nomi Health Commercial |
$242.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$221.39
|
| Rate for Payer: PACE Senior Care Partners |
$70.11
|
| Rate for Payer: PACE SWMI |
$73.80
|
| Rate for Payer: PHP Commercial |
$250.91
|
| Rate for Payer: PHP Medicare Advantage |
$73.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$256.82
|
| Rate for Payer: Priority Health Medicare |
$74.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.45
|
| Rate for Payer: Railroad Medicare Medicare |
$73.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.77
|
| Rate for Payer: UHC Core |
$246.48
|
| Rate for Payer: UHC Exchange |
$73.80
|
| Rate for Payer: UHC Medicaid |
$52.04
|
| Rate for Payer: UHC Medicare Advantage |
$73.80
|
| Rate for Payer: UHCCP Medicaid |
$52.04
|
| Rate for Payer: VA VA |
$73.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.39
|
|
|
PHENYTOIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$590.37
|
|
|
Service Code
|
NDC 60432013108
|
| Hospital Charge Code |
6255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.08 |
| Max. Negotiated Rate |
$531.33 |
| Rate for Payer: Aetna Commercial |
$501.81
|
| Rate for Payer: Aetna Medicare |
$153.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$184.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$184.49
|
| Rate for Payer: BCBS Complete |
$109.28
|
| Rate for Payer: BCBS MAPPO |
$147.59
|
| Rate for Payer: BCBS Trust/PPO |
$485.34
|
| Rate for Payer: BCN Commercial |
$485.34
|
| Rate for Payer: BCN Medicare Advantage |
$147.59
|
| Rate for Payer: Cash Price |
$472.30
|
| Rate for Payer: Cofinity Commercial |
$507.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.59
|
| Rate for Payer: Healthscope Commercial |
$531.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.78
|
| Rate for Payer: Mclaren Medicaid |
$104.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.97
|
| Rate for Payer: Meridian Medicaid |
$109.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$162.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.81
|
| Rate for Payer: Nomi Health Commercial |
$484.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$442.78
|
| Rate for Payer: PACE Senior Care Partners |
$140.21
|
| Rate for Payer: PACE SWMI |
$147.59
|
| Rate for Payer: PHP Commercial |
$501.81
|
| Rate for Payer: PHP Medicare Advantage |
$147.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$513.62
|
| Rate for Payer: Priority Health Medicare |
$149.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$410.90
|
| Rate for Payer: Railroad Medicare Medicare |
$147.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.53
|
| Rate for Payer: UHC Core |
$492.96
|
| Rate for Payer: UHC Exchange |
$147.59
|
| Rate for Payer: UHC Medicaid |
$104.08
|
| Rate for Payer: UHC Medicare Advantage |
$147.59
|
| Rate for Payer: UHCCP Medicaid |
$104.08
|
| Rate for Payer: VA VA |
$147.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.78
|
|
|
PHENYTOIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$295.19
|
|
|
Service Code
|
NDC 51672406901
|
| Hospital Charge Code |
6255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.45 |
| Max. Negotiated Rate |
$265.67 |
| Rate for Payer: Aetna Commercial |
$250.91
|
| Rate for Payer: BCBS Trust/PPO |
$243.80
|
| Rate for Payer: BCN Commercial |
$243.80
|
| Rate for Payer: Cash Price |
$236.15
|
| Rate for Payer: Cofinity Commercial |
$253.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.15
|
| Rate for Payer: Healthscope Commercial |
$265.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.91
|
| Rate for Payer: Nomi Health Commercial |
$242.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$221.39
|
| Rate for Payer: PHP Commercial |
$250.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$256.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.77
|
| Rate for Payer: UHC Core |
$246.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.39
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
OP
|
$685.92
|
|
|
Service Code
|
NDC 60687084101
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.93 |
| Max. Negotiated Rate |
$617.33 |
| Rate for Payer: Aetna Commercial |
$583.03
|
| Rate for Payer: Aetna Medicare |
$178.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$214.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$214.35
|
| Rate for Payer: BCBS Complete |
$126.96
|
| Rate for Payer: BCBS MAPPO |
$171.48
|
| Rate for Payer: BCBS Trust/PPO |
$563.89
|
| Rate for Payer: BCN Commercial |
$563.89
|
| Rate for Payer: BCN Medicare Advantage |
$171.48
|
| Rate for Payer: Cash Price |
$548.74
|
| Rate for Payer: Cofinity Commercial |
$589.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.48
|
| Rate for Payer: Healthscope Commercial |
$617.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.44
|
| Rate for Payer: Mclaren Medicaid |
$120.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.05
|
| Rate for Payer: Meridian Medicaid |
$126.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$188.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.03
|
| Rate for Payer: Nomi Health Commercial |
$562.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$514.44
|
| Rate for Payer: PACE Senior Care Partners |
$162.91
|
| Rate for Payer: PACE SWMI |
$171.48
|
| Rate for Payer: PHP Commercial |
$583.03
|
| Rate for Payer: PHP Medicare Advantage |
$171.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$596.75
|
| Rate for Payer: Priority Health Medicare |
$173.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$477.40
|
| Rate for Payer: Railroad Medicare Medicare |
$171.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$603.61
|
| Rate for Payer: UHC Core |
$572.74
|
| Rate for Payer: UHC Exchange |
$171.48
|
| Rate for Payer: UHC Medicaid |
$120.93
|
| Rate for Payer: UHC Medicare Advantage |
$171.48
|
| Rate for Payer: UHCCP Medicaid |
$120.93
|
| Rate for Payer: VA VA |
$171.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.44
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
OP
|
$6.86
|
|
|
Service Code
|
NDC 60687084111
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$6.17 |
| Rate for Payer: Aetna Commercial |
$5.83
|
| Rate for Payer: Aetna Medicare |
$1.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.14
|
| Rate for Payer: BCBS Complete |
$1.27
|
| Rate for Payer: BCBS MAPPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$5.64
|
| Rate for Payer: BCN Commercial |
$5.64
|
| Rate for Payer: BCN Medicare Advantage |
$1.72
|
| Rate for Payer: Cash Price |
$5.49
|
| Rate for Payer: Cofinity Commercial |
$5.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.72
|
| Rate for Payer: Healthscope Commercial |
$6.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.14
|
| Rate for Payer: Mclaren Medicaid |
$1.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.80
|
| Rate for Payer: Meridian Medicaid |
$1.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.83
|
| Rate for Payer: Nomi Health Commercial |
$5.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.14
|
| Rate for Payer: PACE Senior Care Partners |
$1.63
|
| Rate for Payer: PACE SWMI |
$1.72
|
| Rate for Payer: PHP Commercial |
$5.83
|
| Rate for Payer: PHP Medicare Advantage |
$1.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.97
|
| Rate for Payer: Priority Health Medicare |
$1.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.77
|
| Rate for Payer: Railroad Medicare Medicare |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.04
|
| Rate for Payer: UHC Core |
$5.73
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UHC Medicaid |
$1.21
|
| Rate for Payer: UHC Medicare Advantage |
$1.72
|
| Rate for Payer: UHCCP Medicaid |
$1.21
|
| Rate for Payer: VA VA |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.14
|
|
