|
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 |
$140.21 |
| 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 |
$236.15
|
| Rate for Payer: BCBS MAPPO |
$147.59
|
| Rate for Payer: BCBS Trust/PPO |
$485.34
|
| Rate for Payer: BCN Commercial |
$459.01
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.81
|
| Rate for Payer: Nomi Health Commercial |
$484.10
|
| 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 Cigna Priority Health |
$383.74
|
| Rate for Payer: Priority Health HMO/PPO |
$513.62
|
| Rate for Payer: Priority Health Medicare |
$149.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$395.55
|
| 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 Dual Complete DSNP |
$147.59
|
| Rate for Payer: UHC Exchange |
$147.59
|
| Rate for Payer: UHC Medicare Advantage |
$147.59
|
| 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
|
OP
|
$295.19
|
|
|
Service Code
|
NDC 51672406901
|
| Hospital Charge Code |
6255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.11 |
| 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 |
$118.08
|
| Rate for Payer: BCBS MAPPO |
$73.80
|
| Rate for Payer: BCBS Trust/PPO |
$242.68
|
| Rate for Payer: BCN Commercial |
$229.51
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.91
|
| Rate for Payer: Nomi Health Commercial |
$242.06
|
| 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 Cigna Priority Health |
$191.87
|
| Rate for Payer: Priority Health HMO/PPO |
$256.82
|
| Rate for Payer: Priority Health Medicare |
$74.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.78
|
| 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 Dual Complete DSNP |
$73.80
|
| Rate for Payer: UHC Exchange |
$73.80
|
| Rate for Payer: UHC Medicare Advantage |
$73.80
|
| 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
|
IP
|
$295.19
|
|
|
Service Code
|
NDC 51672406901
|
| Hospital Charge Code |
6255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.87 |
| Max. Negotiated Rate |
$265.67 |
| Rate for Payer: Aetna Commercial |
$250.91
|
| Rate for Payer: BCBS Trust/PPO |
$240.96
|
| Rate for Payer: BCN Commercial |
$228.12
|
| 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: PHP Commercial |
$250.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.87
|
| Rate for Payer: Priority Health HMO/PPO |
$256.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.78
|
| 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 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 |
$383.74 |
| Max. Negotiated Rate |
$531.33 |
| Rate for Payer: Aetna Commercial |
$501.81
|
| Rate for Payer: BCBS Trust/PPO |
$481.92
|
| Rate for Payer: BCN Commercial |
$456.24
|
| 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: PHP Commercial |
$501.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.74
|
| Rate for Payer: Priority Health HMO/PPO |
$513.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$395.55
|
| 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 50 MG CHEWABLE TABLET
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
NDC 51079012901
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.88
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: BCBS MAPPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.32
|
| Rate for Payer: BCN Commercial |
$2.19
|
| Rate for Payer: BCN Medicare Advantage |
$0.71
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.71
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.40
|
| Rate for Payer: Nomi Health Commercial |
$2.31
|
| Rate for Payer: PACE Senior Care Partners |
$0.67
|
| Rate for Payer: PACE SWMI |
$0.71
|
| Rate for Payer: PHP Commercial |
$2.40
|
| Rate for Payer: PHP Medicare Advantage |
$0.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: Priority Health HMO/PPO |
$2.45
|
| Rate for Payer: Priority Health Medicare |
$0.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.89
|
| Rate for Payer: Railroad Medicare Medicare |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.48
|
| Rate for Payer: UHC Core |
$2.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.71
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Medicare Advantage |
$0.71
|
| Rate for Payer: VA VA |
$0.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.12
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
NDC 51079012901
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.40
|
| Rate for Payer: Nomi Health Commercial |
$2.31
|
| Rate for Payer: PHP Commercial |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: Priority Health HMO/PPO |
$2.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.48
|
| Rate for Payer: UHC Core |
$2.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.12
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
IP
|
$162.58
|
|
|
Service Code
|
NDC 60687015625
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.68 |
| Max. Negotiated Rate |
$146.32 |
| Rate for Payer: Aetna Commercial |
$138.19
|
| Rate for Payer: BCBS Trust/PPO |
$132.71
|
| Rate for Payer: BCN Commercial |
$125.64
|
| Rate for Payer: Cash Price |
$130.06
|
| Rate for Payer: Cofinity Commercial |
$139.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.06
|
| Rate for Payer: Healthscope Commercial |
$146.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.19
|
| Rate for Payer: Nomi Health Commercial |
$133.32
|
| Rate for Payer: PHP Commercial |
$138.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.68
|
| Rate for Payer: Priority Health HMO/PPO |
$141.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.07
|
| Rate for Payer: UHC Core |
$135.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.94
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
OP
|
$5.42
|
|
|
Service Code
|
NDC 60687015695
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Aetna Commercial |
$4.61
|
| Rate for Payer: Aetna Medicare |
$1.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.69
|
| Rate for Payer: BCBS Complete |
$2.17
|
| Rate for Payer: BCBS MAPPO |
$1.35
|
| Rate for Payer: BCBS Trust/PPO |
$4.46
|
| Rate for Payer: BCN Commercial |
$4.21
|
| Rate for Payer: BCN Medicare Advantage |
$1.35
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cofinity Commercial |
$4.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.35
|
| Rate for Payer: Healthscope Commercial |
$4.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.61
|
| Rate for Payer: Nomi Health Commercial |
$4.44
|
| Rate for Payer: PACE Senior Care Partners |
$1.29
|
| Rate for Payer: PACE SWMI |
$1.35
|
| Rate for Payer: PHP Commercial |
$4.61
|
| Rate for Payer: PHP Medicare Advantage |
$1.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.52
|
| Rate for Payer: Priority Health HMO/PPO |
$4.72
|
| Rate for Payer: Priority Health Medicare |
$1.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.63
|
| Rate for Payer: Railroad Medicare Medicare |
$1.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.77
|
| Rate for Payer: UHC Core |
$4.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.35
|
| Rate for Payer: UHC Exchange |
$1.35
|
| Rate for Payer: UHC Medicare Advantage |
$1.35
|
| Rate for Payer: VA VA |
$1.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.07
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
OP
|
$147.75
|
|
|
Service Code
|
NDC 00904719907
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna Commercial |
$125.59
|
| Rate for Payer: Aetna Medicare |
$38.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.17
|
| Rate for Payer: BCBS Complete |
$59.10
|
| Rate for Payer: BCBS MAPPO |
$36.94
|
| Rate for Payer: BCBS Trust/PPO |
$121.47
|
| Rate for Payer: BCN Commercial |
$114.88
|
| Rate for Payer: BCN Medicare Advantage |
$36.94
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.94
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.59
|
| Rate for Payer: Nomi Health Commercial |
$121.16
|
| Rate for Payer: PACE Senior Care Partners |
$35.09
|
| Rate for Payer: PACE SWMI |
$36.94
|
| Rate for Payer: PHP Commercial |
$125.59
|
| Rate for Payer: PHP Medicare Advantage |
$36.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.04
|
| Rate for Payer: Priority Health HMO/PPO |
$128.54
|
| Rate for Payer: Priority Health Medicare |
$37.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.99
|
| Rate for Payer: Railroad Medicare Medicare |
$36.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.02
|
| Rate for Payer: UHC Core |
$123.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.94
|
| Rate for Payer: UHC Exchange |
$36.94
|
| Rate for Payer: UHC Medicare Advantage |
$36.94
|
| Rate for Payer: VA VA |
$36.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.81
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
OP
|
$140.64
|
|
|
Service Code
|
NDC 51079012906
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.40 |
| Max. Negotiated Rate |
$126.58 |
| Rate for Payer: Aetna Commercial |
$119.54
|
| Rate for Payer: Aetna Medicare |
$36.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.95
|
| Rate for Payer: BCBS Complete |
$56.26
|
| Rate for Payer: BCBS MAPPO |
$35.16
|
| Rate for Payer: BCBS Trust/PPO |
$115.62
|
| Rate for Payer: BCN Commercial |
$109.35
|
| Rate for Payer: BCN Medicare Advantage |
$35.16
|
| Rate for Payer: Cash Price |
$112.51
|
| Rate for Payer: Cofinity Commercial |
$120.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.16
|
| Rate for Payer: Healthscope Commercial |
$126.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.54
|
| Rate for Payer: Nomi Health Commercial |
$115.32
|
| Rate for Payer: PACE Senior Care Partners |
$33.40
|
| Rate for Payer: PACE SWMI |
$35.16
|
| Rate for Payer: PHP Commercial |
$119.54
|
| Rate for Payer: PHP Medicare Advantage |
$35.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.42
|
| Rate for Payer: Priority Health HMO/PPO |
$122.36
|
| Rate for Payer: Priority Health Medicare |
$35.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.23
|
| Rate for Payer: Railroad Medicare Medicare |
$35.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.76
|
| Rate for Payer: UHC Core |
$117.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.16
|
| Rate for Payer: UHC Exchange |
$35.16
|
| Rate for Payer: UHC Medicare Advantage |
$35.16
|
| Rate for Payer: VA VA |
$35.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.48
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
IP
|
$147.75
|
|
|
Service Code
|
NDC 00904719907
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.04 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna Commercial |
$125.59
|
| Rate for Payer: BCBS Trust/PPO |
$120.61
|
| Rate for Payer: BCN Commercial |
$114.18
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.20
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.59
|
| Rate for Payer: Nomi Health Commercial |
$121.16
|
| Rate for Payer: PHP Commercial |
$125.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.04
|
| Rate for Payer: Priority Health HMO/PPO |
$128.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.02
|
| Rate for Payer: UHC Core |
$123.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.81
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
OP
|
$162.58
|
|
|
Service Code
|
NDC 60687015625
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.61 |
| Max. Negotiated Rate |
$146.32 |
| Rate for Payer: Aetna Commercial |
$138.19
|
| Rate for Payer: Aetna Medicare |
$42.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.81
|
| Rate for Payer: BCBS Complete |
$65.03
|
| Rate for Payer: BCBS MAPPO |
$40.65
|
| Rate for Payer: BCBS Trust/PPO |
$133.66
|
| Rate for Payer: BCN Commercial |
$126.41
|
| Rate for Payer: BCN Medicare Advantage |
$40.65
|
| Rate for Payer: Cash Price |
$130.06
|
| Rate for Payer: Cofinity Commercial |
$139.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.65
|
| Rate for Payer: Healthscope Commercial |
$146.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.19
|
| Rate for Payer: Nomi Health Commercial |
$133.32
|
| Rate for Payer: PACE Senior Care Partners |
$38.61
|
| Rate for Payer: PACE SWMI |
$40.65
|
| Rate for Payer: PHP Commercial |
$138.19
|
| Rate for Payer: PHP Medicare Advantage |
$40.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.68
|
| Rate for Payer: Priority Health HMO/PPO |
$141.44
|
| Rate for Payer: Priority Health Medicare |
$41.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.93
|
| Rate for Payer: Railroad Medicare Medicare |
$40.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.07
|
| Rate for Payer: UHC Core |
$135.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.65
|
| Rate for Payer: UHC Exchange |
$40.65
|
| Rate for Payer: UHC Medicare Advantage |
$40.65
|
| Rate for Payer: VA VA |
$40.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.94
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
IP
|
$5.42
|
|
|
Service Code
|
NDC 60687015695
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Aetna Commercial |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$4.42
|
| Rate for Payer: BCN Commercial |
$4.19
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cofinity Commercial |
$4.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.34
|
| Rate for Payer: Healthscope Commercial |
$4.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.61
|
| Rate for Payer: Nomi Health Commercial |
$4.44
|
| Rate for Payer: PHP Commercial |
$4.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.52
|
| Rate for Payer: Priority Health HMO/PPO |
$4.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.77
|
| Rate for Payer: UHC Core |
$4.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.07
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
IP
|
$140.64
|
|
|
Service Code
|
NDC 51079012906
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.42 |
| Max. Negotiated Rate |
$126.58 |
| Rate for Payer: Aetna Commercial |
$119.54
|
| Rate for Payer: BCBS Trust/PPO |
$114.80
|
| Rate for Payer: BCN Commercial |
$108.69
|
| Rate for Payer: Cash Price |
$112.51
|
| Rate for Payer: Cofinity Commercial |
$120.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.51
|
| Rate for Payer: Healthscope Commercial |
$126.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.54
|
| Rate for Payer: Nomi Health Commercial |
$115.32
|
| Rate for Payer: PHP Commercial |
$119.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.42
|
| Rate for Payer: Priority Health HMO/PPO |
$122.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.76
|
| Rate for Payer: UHC Core |
$117.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.48
|
|
|
PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14.97
|
|
|
Service Code
|
HCPCS J1165
|
| Hospital Charge Code |
6256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$13.47 |
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: Aetna Commercial |
$18.31
|
| Rate for Payer: BCBS Trust/PPO |
$12.22
|
| Rate for Payer: BCBS Trust/PPO |
$17.58
|
| Rate for Payer: BCN Commercial |
$11.57
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$18.52
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$13.47
|
| Rate for Payer: Healthscope Commercial |
$19.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.31
|
| Rate for Payer: Nomi Health Commercial |
$12.28
|
| Rate for Payer: Nomi Health Commercial |
$17.66
|
| Rate for Payer: PHP Commercial |
$12.72
|
| Rate for Payer: PHP Commercial |
$18.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.73
|
| Rate for Payer: Priority Health HMO/PPO |
$18.74
|
| Rate for Payer: Priority Health HMO/PPO |
$13.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.96
|
| Rate for Payer: UHC Core |
$12.50
|
| Rate for Payer: UHC Core |
$17.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.16
|
|
|
PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.54
|
|
|
Service Code
|
HCPCS J1165
|
| Hospital Charge Code |
6256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Aetna Commercial |
$18.31
|
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: Aetna Medicare |
$5.60
|
| Rate for Payer: Aetna Medicare |
$3.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.68
|
| Rate for Payer: BCBS Complete |
$5.99
|
| Rate for Payer: BCBS Complete |
$8.62
|
| Rate for Payer: BCBS MAPPO |
$3.74
|
| Rate for Payer: BCBS MAPPO |
$5.38
|
| Rate for Payer: BCBS Trust/PPO |
$17.71
|
| Rate for Payer: BCBS Trust/PPO |
$12.31
|
| Rate for Payer: BCN Commercial |
$16.75
|
| Rate for Payer: BCN Commercial |
$11.64
|
| Rate for Payer: BCN Medicare Advantage |
$5.38
|
| Rate for Payer: BCN Medicare Advantage |
$3.74
|
| Rate for Payer: Cash Price |
$17.23
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$18.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.38
|
| Rate for Payer: Healthscope Commercial |
$13.47
|
| Rate for Payer: Healthscope Commercial |
$19.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.72
|
| Rate for Payer: Nomi Health Commercial |
$17.66
|
| Rate for Payer: Nomi Health Commercial |
$12.28
|
| Rate for Payer: PACE Senior Care Partners |
$5.12
|
| Rate for Payer: PACE Senior Care Partners |
$3.56
|
| Rate for Payer: PACE SWMI |
$5.38
|
| Rate for Payer: PACE SWMI |
$3.74
|
| Rate for Payer: PHP Commercial |
$18.31
|
| Rate for Payer: PHP Commercial |
$12.72
|
| Rate for Payer: PHP Medicare Advantage |
$3.74
|
| Rate for Payer: PHP Medicare Advantage |
$5.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.73
|
| Rate for Payer: Priority Health HMO/PPO |
$13.02
|
| Rate for Payer: Priority Health HMO/PPO |
$18.74
|
| Rate for Payer: Priority Health Medicare |
$5.44
|
| Rate for Payer: Priority Health Medicare |
$3.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.03
|
| Rate for Payer: Railroad Medicare Medicare |
$3.74
|
| Rate for Payer: Railroad Medicare Medicare |
$5.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.96
|
| Rate for Payer: UHC Core |
$17.99
|
| Rate for Payer: UHC Core |
$12.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.74
|
| Rate for Payer: UHC Exchange |
$3.74
|
| Rate for Payer: UHC Exchange |
$5.38
|
| Rate for Payer: UHC Medicare Advantage |
$3.74
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$3.74
|
| Rate for Payer: VA VA |
$5.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.23
|
|
|
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
|
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
|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
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 |
$88.59
|
| 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 |
$293.05
|
| 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
|
|
