|
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 |
$266.46 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: BCBS Trust/PPO |
$316.20
|
| Rate for Payer: BCN Commercial |
$316.20
|
| 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: Opus (Opus Packaging Group) HMA |
$287.14
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$333.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$266.46
|
| 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
|
IP
|
$452.20
|
|
|
Service Code
|
NDC 68084037601
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.73 |
| Max. Negotiated Rate |
$406.98 |
| Rate for Payer: Aetna Commercial |
$384.37
|
| Rate for Payer: BCBS Trust/PPO |
$373.47
|
| Rate for Payer: BCN Commercial |
$373.47
|
| 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: Opus (Opus Packaging Group) HMA |
$339.15
|
| Rate for Payer: PHP Commercial |
$384.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$393.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$314.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.94
|
| Rate for Payer: UHC Core |
$377.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.15
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
OP
|
$382.85
|
|
|
Service Code
|
NDC 00904618761
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.50 |
| 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 |
$70.87
|
| Rate for Payer: BCBS MAPPO |
$95.71
|
| Rate for Payer: BCBS Trust/PPO |
$314.74
|
| Rate for Payer: BCN Commercial |
$314.74
|
| 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: Mclaren Medicaid |
$67.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.50
|
| Rate for Payer: Meridian Medicaid |
$70.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$105.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: Nomi Health Commercial |
$313.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.14
|
| 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 Choice Medicaid |
$67.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$333.08
|
| Rate for Payer: Priority Health Medicare |
$96.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$266.46
|
| 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 Exchange |
$95.71
|
| Rate for Payer: UHC Medicaid |
$67.50
|
| Rate for Payer: UHC Medicare Advantage |
$95.71
|
| Rate for Payer: UHCCP Medicaid |
$67.50
|
| 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 68084037611
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.73 |
| Max. Negotiated Rate |
$406.98 |
| Rate for Payer: Aetna Commercial |
$384.37
|
| Rate for Payer: BCBS Trust/PPO |
$373.47
|
| Rate for Payer: BCN Commercial |
$373.47
|
| 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: Opus (Opus Packaging Group) HMA |
$339.15
|
| Rate for Payer: PHP Commercial |
$384.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$393.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$314.73
|
| 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
|
$6.86
|
|
|
Service Code
|
NDC 60687084111
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$6.17 |
| Rate for Payer: Aetna Commercial |
$5.83
|
| Rate for Payer: BCBS Trust/PPO |
$5.67
|
| Rate for Payer: BCN Commercial |
$5.67
|
| 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: Healthscope Commercial |
$6.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.14
|
| 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: PHP Commercial |
$5.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.04
|
| Rate for Payer: UHC Core |
$5.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.14
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$685.92
|
|
|
Service Code
|
NDC 60687084101
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$477.40 |
| Max. Negotiated Rate |
$617.33 |
| Rate for Payer: Aetna Commercial |
$583.03
|
| Rate for Payer: BCBS Trust/PPO |
$566.50
|
| Rate for Payer: BCN Commercial |
$566.50
|
| 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: Healthscope Commercial |
$617.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.44
|
| 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: PHP Commercial |
$583.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$596.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$477.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$603.61
|
| Rate for Payer: UHC Core |
$572.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.44
|
|
|
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 |
$79.72 |
| 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 |
$83.70
|
| Rate for Payer: BCBS MAPPO |
$113.05
|
| Rate for Payer: BCBS Trust/PPO |
$371.75
|
| Rate for Payer: BCN Commercial |
$371.75
|
| 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: Mclaren Medicaid |
$79.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.70
|
| Rate for Payer: Meridian Medicaid |
$83.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$124.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.37
|
| Rate for Payer: Nomi Health Commercial |
$370.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.15
|
| 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 Choice Medicaid |
$79.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$393.41
|
| Rate for Payer: Priority Health Medicare |
$114.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$314.73
|
| 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 Exchange |
$113.05
|
| Rate for Payer: UHC Medicaid |
$79.72
|
| Rate for Payer: UHC Medicare Advantage |
$113.05
|
| Rate for Payer: UHCCP Medicaid |
$79.72
|
| 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
|
OP
|
$452.20
|
|
|
Service Code
|
NDC 68084037601
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.72 |
| 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 |
$83.70
|
| Rate for Payer: BCBS MAPPO |
$113.05
|
| Rate for Payer: BCBS Trust/PPO |
$371.75
|
| Rate for Payer: BCN Commercial |
$371.75
|
| 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: Mclaren Medicaid |
$79.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.70
|
| Rate for Payer: Meridian Medicaid |
$83.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$124.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.37
|
| Rate for Payer: Nomi Health Commercial |
$370.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.15
|
| 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 Choice Medicaid |
$79.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$393.41
|
| Rate for Payer: Priority Health Medicare |
$114.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$314.73
|
| 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 Exchange |
$113.05
|
| Rate for Payer: UHC Medicaid |
$79.72
|
| Rate for Payer: UHC Medicare Advantage |
$113.05
|
| Rate for Payer: UHCCP Medicaid |
$79.72
|
| 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
|
OP
|
$258.47
|
|
|
Service Code
|
NDC 17478051002
|
| Hospital Charge Code |
6270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.57 |
| 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 |
$47.84
|
| Rate for Payer: BCBS MAPPO |
$64.62
|
| Rate for Payer: BCBS Trust/PPO |
$212.49
|
| Rate for Payer: BCN Commercial |
$212.49
|
| 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: Mclaren Medicaid |
$45.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.85
|
| Rate for Payer: Meridian Medicaid |
$47.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.70
|
| Rate for Payer: Nomi Health Commercial |
$211.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.85
|
| 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 Choice Medicaid |
$45.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$224.87
|
| Rate for Payer: Priority Health Medicare |
$65.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.90
|
| 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 Exchange |
$64.62
|
| Rate for Payer: UHC Medicaid |
$45.57
|
| Rate for Payer: UHC Medicare Advantage |
$64.62
|
| Rate for Payer: UHCCP Medicaid |
$45.57
|
| Rate for Payer: VA VA |
$64.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.85
|
|
|
PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$258.47
|
|
|
Service Code
|
NDC 17478051002
|
| Hospital Charge Code |
6270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$179.90 |
| Max. Negotiated Rate |
$232.62 |
| Rate for Payer: Aetna Commercial |
$219.70
|
| Rate for Payer: BCBS Trust/PPO |
$213.47
|
| Rate for Payer: BCN Commercial |
$213.47
|
| 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: Opus (Opus Packaging Group) HMA |
$193.85
|
| Rate for Payer: PHP Commercial |
$219.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$224.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.45
|
| Rate for Payer: UHC Core |
$215.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.85
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$51.36
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
11023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$46.22 |
| Rate for Payer: Aetna Commercial |
$43.66
|
| Rate for Payer: Aetna Commercial |
$73.18
|
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: Aetna Medicare |
$22.38
|
| Rate for Payer: Aetna Medicare |
$13.35
|
| Rate for Payer: Aetna Medicare |
$21.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.90
|
| Rate for Payer: BCBS Complete |
$15.33
|
| Rate for Payer: BCBS Complete |
$9.51
|
| Rate for Payer: BCBS Complete |
$15.94
|
| Rate for Payer: BCBS MAPPO |
$21.52
|
| Rate for Payer: BCBS MAPPO |
$12.84
|
| Rate for Payer: BCBS MAPPO |
$20.70
|
| Rate for Payer: BCBS Trust/PPO |
$42.22
|
| Rate for Payer: BCBS Trust/PPO |
$68.07
|
| Rate for Payer: BCBS Trust/PPO |
$70.77
|
| Rate for Payer: BCN Commercial |
$68.07
|
| Rate for Payer: BCN Commercial |
$70.77
|
| Rate for Payer: BCN Commercial |
$42.22
|
| Rate for Payer: BCN Medicare Advantage |
$21.52
|
| Rate for Payer: BCN Medicare Advantage |
$20.70
|
| Rate for Payer: BCN Medicare Advantage |
$12.84
|
| Rate for Payer: Cash Price |
$68.87
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cash Price |
$41.09
|
| Rate for Payer: Cofinity Commercial |
$44.17
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Cofinity Commercial |
$74.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.84
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Healthscope Commercial |
$46.22
|
| Rate for Payer: Healthscope Commercial |
$77.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.10
|
| Rate for Payer: Mclaren Medicaid |
$9.05
|
| Rate for Payer: Mclaren Medicaid |
$15.18
|
| Rate for Payer: Mclaren Medicaid |
$14.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.60
|
| Rate for Payer: Meridian Medicaid |
$15.94
|
| Rate for Payer: Meridian Medicaid |
$9.51
|
| Rate for Payer: Meridian Medicaid |
$15.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.38
|
| Rate for Payer: Nomi Health Commercial |
$70.59
|
| Rate for Payer: Nomi Health Commercial |
$67.90
|
| Rate for Payer: Nomi Health Commercial |
$42.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.52
|
| Rate for Payer: PACE Senior Care Partners |
$19.66
|
| Rate for Payer: PACE Senior Care Partners |
$12.20
|
| Rate for Payer: PACE Senior Care Partners |
$20.45
|
| Rate for Payer: PACE SWMI |
$21.52
|
| Rate for Payer: PACE SWMI |
$20.70
|
| Rate for Payer: PACE SWMI |
$12.84
|
| Rate for Payer: PHP Commercial |
$43.66
|
| Rate for Payer: PHP Commercial |
$73.18
|
| Rate for Payer: PHP Commercial |
$70.38
|
| Rate for Payer: PHP Medicare Advantage |
$20.70
|
| Rate for Payer: PHP Medicare Advantage |
$12.84
|
| Rate for Payer: PHP Medicare Advantage |
$21.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$72.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.90
|
| Rate for Payer: Priority Health Medicare |
$21.74
|
| Rate for Payer: Priority Health Medicare |
$20.91
|
| Rate for Payer: Priority Health Medicare |
$12.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.75
|
| Rate for Payer: Railroad Medicare Medicare |
$20.70
|
| Rate for Payer: Railroad Medicare Medicare |
$21.52
|
| Rate for Payer: Railroad Medicare Medicare |
$12.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.20
|
| Rate for Payer: UHC Core |
$42.89
|
| Rate for Payer: UHC Core |
$71.89
|
| Rate for Payer: UHC Core |
$69.14
|
| Rate for Payer: UHC Exchange |
$21.52
|
| Rate for Payer: UHC Exchange |
$20.70
|
| Rate for Payer: UHC Exchange |
$12.84
|
| Rate for Payer: UHC Medicaid |
$9.05
|
| Rate for Payer: UHC Medicaid |
$15.18
|
| Rate for Payer: UHC Medicaid |
$14.60
|
| Rate for Payer: UHC Medicare Advantage |
$20.70
|
| Rate for Payer: UHC Medicare Advantage |
$12.84
|
| Rate for Payer: UHC Medicare Advantage |
$21.52
|
| Rate for Payer: UHCCP Medicaid |
$14.60
|
| Rate for Payer: UHCCP Medicaid |
$9.05
|
| Rate for Payer: UHCCP Medicaid |
$15.18
|
| Rate for Payer: VA VA |
$12.84
|
| Rate for Payer: VA VA |
$21.52
|
| Rate for Payer: VA VA |
$20.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.57
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$51.36
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
11023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$46.22 |
| Rate for Payer: Aetna Commercial |
$43.66
|
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: Aetna Commercial |
$73.18
|
| Rate for Payer: BCBS Trust/PPO |
$68.38
|
| Rate for Payer: BCBS Trust/PPO |
$42.42
|
| Rate for Payer: BCBS Trust/PPO |
$71.10
|
| Rate for Payer: BCN Commercial |
$68.38
|
| Rate for Payer: BCN Commercial |
$42.42
|
| Rate for Payer: BCN Commercial |
$71.10
|
| Rate for Payer: Cash Price |
$41.09
|
| Rate for Payer: Cash Price |
$68.87
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cofinity Commercial |
$74.04
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Cofinity Commercial |
$44.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.87
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Healthscope Commercial |
$46.22
|
| Rate for Payer: Healthscope Commercial |
$77.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.18
|
| Rate for Payer: Nomi Health Commercial |
$42.12
|
| Rate for Payer: Nomi Health Commercial |
$67.90
|
| Rate for Payer: Nomi Health Commercial |
$70.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.57
|
| Rate for Payer: PHP Commercial |
$43.66
|
| Rate for Payer: PHP Commercial |
$73.18
|
| Rate for Payer: PHP Commercial |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$72.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.20
|
| Rate for Payer: UHC Core |
$42.89
|
| Rate for Payer: UHC Core |
$71.89
|
| Rate for Payer: UHC Core |
$69.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.10
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
108266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Medicare |
$6.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.53
|
| Rate for Payer: BCBS Complete |
$4.46
|
| Rate for Payer: BCBS MAPPO |
$6.02
|
| Rate for Payer: BCBS Trust/PPO |
$19.80
|
| Rate for Payer: BCN Commercial |
$19.80
|
| Rate for Payer: BCN Medicare Advantage |
$6.02
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.02
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Mclaren Medicaid |
$4.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.32
|
| Rate for Payer: Meridian Medicaid |
$4.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.07
|
| Rate for Payer: PACE Senior Care Partners |
$5.72
|
| Rate for Payer: PACE SWMI |
$6.02
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: PHP Medicare Advantage |
$6.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.96
|
| Rate for Payer: Priority Health Medicare |
$6.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.77
|
| Rate for Payer: Railroad Medicare Medicare |
$6.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.20
|
| Rate for Payer: UHC Core |
$20.12
|
| Rate for Payer: UHC Exchange |
$6.02
|
| Rate for Payer: UHC Medicaid |
$4.25
|
| Rate for Payer: UHC Medicare Advantage |
$6.02
|
| Rate for Payer: UHCCP Medicaid |
$4.25
|
| Rate for Payer: VA VA |
$6.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.09
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
108266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: BCBS Trust/PPO |
$19.90
|
| Rate for Payer: BCN Commercial |
$19.90
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.07
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.20
|
| Rate for Payer: UHC Core |
$20.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$98.79
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
6271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$88.91 |
| Rate for Payer: Aetna Commercial |
$83.97
|
| Rate for Payer: Aetna Medicare |
$25.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.87
|
| Rate for Payer: BCBS Complete |
$18.29
|
| Rate for Payer: BCBS MAPPO |
$24.70
|
| Rate for Payer: BCBS Trust/PPO |
$81.22
|
| Rate for Payer: BCN Commercial |
$81.22
|
| Rate for Payer: BCN Medicare Advantage |
$24.70
|
| Rate for Payer: Cash Price |
$79.03
|
| Rate for Payer: Cofinity Commercial |
$84.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.70
|
| Rate for Payer: Healthscope Commercial |
$88.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.09
|
| Rate for Payer: Mclaren Medicaid |
$17.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.93
|
| Rate for Payer: Meridian Medicaid |
$18.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.97
|
| Rate for Payer: Nomi Health Commercial |
$81.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.09
|
| Rate for Payer: PACE Senior Care Partners |
$23.46
|
| Rate for Payer: PACE SWMI |
$24.70
|
| Rate for Payer: PHP Commercial |
$83.97
|
| Rate for Payer: PHP Medicare Advantage |
$24.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$85.95
|
| Rate for Payer: Priority Health Medicare |
$24.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.76
|
| Rate for Payer: Railroad Medicare Medicare |
$24.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.94
|
| Rate for Payer: UHC Core |
$82.49
|
| Rate for Payer: UHC Exchange |
$24.70
|
| Rate for Payer: UHC Medicaid |
$17.42
|
| Rate for Payer: UHC Medicare Advantage |
$24.70
|
| Rate for Payer: UHCCP Medicaid |
$17.42
|
| Rate for Payer: VA VA |
$24.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.09
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$98.79
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
6271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.76 |
| Max. Negotiated Rate |
$88.91 |
| Rate for Payer: Aetna Commercial |
$83.97
|
| Rate for Payer: BCBS Trust/PPO |
$81.59
|
| Rate for Payer: BCN Commercial |
$81.59
|
| Rate for Payer: Cash Price |
$79.03
|
| Rate for Payer: Cofinity Commercial |
$84.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.03
|
| Rate for Payer: Healthscope Commercial |
$88.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.97
|
| Rate for Payer: Nomi Health Commercial |
$81.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.09
|
| Rate for Payer: PHP Commercial |
$83.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$85.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.94
|
| Rate for Payer: UHC Core |
$82.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.09
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET
|
Facility
|
IP
|
$4,766.57
|
|
|
Service Code
|
NDC 00904688210
|
| Hospital Charge Code |
11024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,317.53 |
| Max. Negotiated Rate |
$4,289.91 |
| Rate for Payer: Aetna Commercial |
$4,051.58
|
| Rate for Payer: BCBS Trust/PPO |
$3,936.71
|
| Rate for Payer: BCN Commercial |
$3,936.71
|
| Rate for Payer: Cash Price |
$3,813.26
|
| Rate for Payer: Cofinity Commercial |
$4,099.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,813.26
|
| Rate for Payer: Healthscope Commercial |
$4,289.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,574.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,051.58
|
| Rate for Payer: Nomi Health Commercial |
$3,908.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,574.93
|
| Rate for Payer: PHP Commercial |
$4,051.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,146.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,317.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,194.58
|
| Rate for Payer: UHC Core |
$3,980.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,574.93
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET
|
Facility
|
OP
|
$4,766.57
|
|
|
Service Code
|
NDC 00904688210
|
| Hospital Charge Code |
11024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$840.35 |
| Max. Negotiated Rate |
$4,289.91 |
| Rate for Payer: Aetna Commercial |
$4,051.58
|
| Rate for Payer: Aetna Medicare |
$1,239.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,489.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,489.55
|
| Rate for Payer: BCBS Complete |
$882.29
|
| Rate for Payer: BCBS MAPPO |
$1,191.64
|
| Rate for Payer: BCBS Trust/PPO |
$3,918.60
|
| Rate for Payer: BCN Commercial |
$3,918.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,191.64
|
| Rate for Payer: Cash Price |
$3,813.26
|
| Rate for Payer: Cofinity Commercial |
$4,099.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,813.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,191.64
|
| Rate for Payer: Healthscope Commercial |
$4,289.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,574.93
|
| Rate for Payer: Mclaren Medicaid |
$840.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.22
|
| Rate for Payer: Meridian Medicaid |
$882.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,370.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,310.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,051.58
|
| Rate for Payer: Nomi Health Commercial |
$3,908.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,574.93
|
| Rate for Payer: PACE Senior Care Partners |
$1,132.06
|
| Rate for Payer: PACE SWMI |
$1,191.64
|
| Rate for Payer: PHP Commercial |
$4,051.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,191.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,146.92
|
| Rate for Payer: Priority Health Medicare |
$1,203.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,317.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,191.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,194.58
|
| Rate for Payer: UHC Core |
$3,980.09
|
| Rate for Payer: UHC Exchange |
$1,191.64
|
| Rate for Payer: UHC Medicaid |
$840.35
|
| Rate for Payer: UHC Medicare Advantage |
$1,191.64
|
| Rate for Payer: UHCCP Medicaid |
$840.35
|
| Rate for Payer: VA VA |
$1,191.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,574.93
|
|
|
PILOCARPINE 1 % EYE DROPS
|
Facility
|
OP
|
$138.87
|
|
|
Service Code
|
NDC 61314020315
|
| Hospital Charge Code |
6279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$124.98 |
| Rate for Payer: Aetna Commercial |
$118.04
|
| Rate for Payer: Aetna Medicare |
$36.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.40
|
| Rate for Payer: BCBS Complete |
$25.70
|
| Rate for Payer: BCBS MAPPO |
$34.72
|
| Rate for Payer: BCBS Trust/PPO |
$114.17
|
| Rate for Payer: BCN Commercial |
$114.17
|
| Rate for Payer: BCN Medicare Advantage |
$34.72
|
| Rate for Payer: Cash Price |
$111.10
|
| Rate for Payer: Cofinity Commercial |
$119.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.72
|
| Rate for Payer: Healthscope Commercial |
$124.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.15
|
| Rate for Payer: Mclaren Medicaid |
$24.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.45
|
| Rate for Payer: Meridian Medicaid |
$25.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.04
|
| Rate for Payer: Nomi Health Commercial |
$113.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.15
|
| Rate for Payer: PACE Senior Care Partners |
$32.98
|
| Rate for Payer: PACE SWMI |
$34.72
|
| Rate for Payer: PHP Commercial |
$118.04
|
| Rate for Payer: PHP Medicare Advantage |
$34.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.82
|
| Rate for Payer: Priority Health Medicare |
$35.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.65
|
| Rate for Payer: Railroad Medicare Medicare |
$34.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.21
|
| Rate for Payer: UHC Core |
$115.96
|
| Rate for Payer: UHC Exchange |
$34.72
|
| Rate for Payer: UHC Medicaid |
$24.48
|
| Rate for Payer: UHC Medicare Advantage |
$34.72
|
| Rate for Payer: UHCCP Medicaid |
$24.48
|
| Rate for Payer: VA VA |
$34.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.15
|
|
|
PILOCARPINE 1 % EYE DROPS
|
Facility
|
IP
|
$138.87
|
|
|
Service Code
|
NDC 61314020315
|
| Hospital Charge Code |
6279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.65 |
| Max. Negotiated Rate |
$124.98 |
| Rate for Payer: Aetna Commercial |
$118.04
|
| Rate for Payer: BCBS Trust/PPO |
$114.69
|
| Rate for Payer: BCN Commercial |
$114.69
|
| Rate for Payer: Cash Price |
$111.10
|
| Rate for Payer: Cofinity Commercial |
$119.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.10
|
| Rate for Payer: Healthscope Commercial |
$124.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.04
|
| Rate for Payer: Nomi Health Commercial |
$113.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.15
|
| Rate for Payer: PHP Commercial |
$118.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.21
|
| Rate for Payer: UHC Core |
$115.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.15
|
|
|
PILOCARPINE 4 % EYE DROPS
|
Facility
|
OP
|
$110.67
|
|
|
Service Code
|
NDC 70069020101
|
| Hospital Charge Code |
6282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$99.60 |
| Rate for Payer: Aetna Commercial |
$94.07
|
| Rate for Payer: Aetna Medicare |
$28.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.58
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS MAPPO |
$27.67
|
| Rate for Payer: BCBS Trust/PPO |
$90.98
|
| Rate for Payer: BCN Commercial |
$90.98
|
| Rate for Payer: BCN Medicare Advantage |
$27.67
|
| Rate for Payer: Cash Price |
$88.54
|
| Rate for Payer: Cofinity Commercial |
$95.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.67
|
| Rate for Payer: Healthscope Commercial |
$99.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.00
|
| Rate for Payer: Mclaren Medicaid |
$19.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.05
|
| Rate for Payer: Meridian Medicaid |
$20.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.07
|
| Rate for Payer: Nomi Health Commercial |
$90.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.00
|
| Rate for Payer: PACE Senior Care Partners |
$26.28
|
| Rate for Payer: PACE SWMI |
$27.67
|
| Rate for Payer: PHP Commercial |
$94.07
|
| Rate for Payer: PHP Medicare Advantage |
$27.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.28
|
| Rate for Payer: Priority Health Medicare |
$27.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.03
|
| Rate for Payer: Railroad Medicare Medicare |
$27.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.39
|
| Rate for Payer: UHC Core |
$92.41
|
| Rate for Payer: UHC Exchange |
$27.67
|
| Rate for Payer: UHC Medicaid |
$19.51
|
| Rate for Payer: UHC Medicare Advantage |
$27.67
|
| Rate for Payer: UHCCP Medicaid |
$19.51
|
| Rate for Payer: VA VA |
$27.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.00
|
|
|
PILOCARPINE 4 % EYE DROPS
|
Facility
|
OP
|
$209.32
|
|
|
Service Code
|
NDC 61314020615
|
| Hospital Charge Code |
6282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$188.39 |
| Rate for Payer: Aetna Commercial |
$177.92
|
| Rate for Payer: Aetna Medicare |
$54.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.41
|
| Rate for Payer: BCBS Complete |
$38.75
|
| Rate for Payer: BCBS MAPPO |
$52.33
|
| Rate for Payer: BCBS Trust/PPO |
$172.08
|
| Rate for Payer: BCN Commercial |
$172.08
|
| Rate for Payer: BCN Medicare Advantage |
$52.33
|
| Rate for Payer: Cash Price |
$167.46
|
| Rate for Payer: Cofinity Commercial |
$180.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.33
|
| Rate for Payer: Healthscope Commercial |
$188.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.99
|
| Rate for Payer: Mclaren Medicaid |
$36.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.95
|
| Rate for Payer: Meridian Medicaid |
$38.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.92
|
| Rate for Payer: Nomi Health Commercial |
$171.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.99
|
| Rate for Payer: PACE Senior Care Partners |
$49.71
|
| Rate for Payer: PACE SWMI |
$52.33
|
| Rate for Payer: PHP Commercial |
$177.92
|
| Rate for Payer: PHP Medicare Advantage |
$52.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$182.11
|
| Rate for Payer: Priority Health Medicare |
$52.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.69
|
| Rate for Payer: Railroad Medicare Medicare |
$52.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.20
|
| Rate for Payer: UHC Core |
$174.78
|
| Rate for Payer: UHC Exchange |
$52.33
|
| Rate for Payer: UHC Medicaid |
$36.90
|
| Rate for Payer: UHC Medicare Advantage |
$52.33
|
| Rate for Payer: UHCCP Medicaid |
$36.90
|
| Rate for Payer: VA VA |
$52.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.99
|
|
|
PILOCARPINE 4 % EYE DROPS
|
Facility
|
IP
|
$209.32
|
|
|
Service Code
|
NDC 61314020615
|
| Hospital Charge Code |
6282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.69 |
| Max. Negotiated Rate |
$188.39 |
| Rate for Payer: Aetna Commercial |
$177.92
|
| Rate for Payer: BCBS Trust/PPO |
$172.88
|
| Rate for Payer: BCN Commercial |
$172.88
|
| Rate for Payer: Cash Price |
$167.46
|
| Rate for Payer: Cofinity Commercial |
$180.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.46
|
| Rate for Payer: Healthscope Commercial |
$188.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.92
|
| Rate for Payer: Nomi Health Commercial |
$171.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.99
|
| Rate for Payer: PHP Commercial |
$177.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$182.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.20
|
| Rate for Payer: UHC Core |
$174.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.99
|
|
|
PILOCARPINE 4 % EYE DROPS
|
Facility
|
IP
|
$110.67
|
|
|
Service Code
|
NDC 70069020101
|
| Hospital Charge Code |
6282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.03 |
| Max. Negotiated Rate |
$99.60 |
| Rate for Payer: Aetna Commercial |
$94.07
|
| Rate for Payer: BCBS Trust/PPO |
$91.40
|
| Rate for Payer: BCN Commercial |
$91.40
|
| Rate for Payer: Cash Price |
$88.54
|
| Rate for Payer: Cofinity Commercial |
$95.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.54
|
| Rate for Payer: Healthscope Commercial |
$99.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.07
|
| Rate for Payer: Nomi Health Commercial |
$90.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.00
|
| Rate for Payer: PHP Commercial |
$94.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.39
|
| Rate for Payer: UHC Core |
$92.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.00
|
|
|
PILOCARPINE 5 MG TABLET
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
NDC 00527131301
|
| Hospital Charge Code |
12803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.26 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: BCBS Trust/PPO |
$298.15
|
| Rate for Payer: BCN Commercial |
$298.15
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$310.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.80
|
| Rate for Payer: Healthscope Commercial |
$324.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.85
|
| Rate for Payer: Nomi Health Commercial |
$296.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.75
|
| Rate for Payer: PHP Commercial |
$306.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$314.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.68
|
| Rate for Payer: UHC Core |
$301.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.75
|
|
