|
PR XTRNL ECG REC<48 HRS RECORDING
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 93225
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$2,547.99 |
| Rate for Payer: Aetna Commercial |
$21.44
|
| Rate for Payer: Aetna Medicare |
$16.64
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS MAPPO |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,547.99
|
| Rate for Payer: BCN Commercial |
$26.88
|
| Rate for Payer: BCN Medicare Advantage |
$16.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$23.04
|
| Rate for Payer: Cofinity Commercial |
$21.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.80
|
| Rate for Payer: Nomi Health Commercial |
$19.20
|
| Rate for Payer: PACE SWMI |
$16.00
|
| Rate for Payer: PHP Medicare Advantage |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health HMO/PPO |
$25.90
|
| Rate for Payer: Priority Health Medicare |
$16.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.00
|
| Rate for Payer: UHC Exchange |
$16.00
|
| Rate for Payer: UHC Medicare Advantage |
$16.00
|
|
|
PR XTRNL ECG REC<48 HRS RECORDING SCAN A/R R&I
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 93224
|
| Min. Negotiated Rate |
$63.55 |
| Max. Negotiated Rate |
$1,872.30 |
| Rate for Payer: Aetna Commercial |
$85.16
|
| Rate for Payer: Aetna Medicare |
$66.09
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS MAPPO |
$63.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,872.30
|
| Rate for Payer: BCN Commercial |
$106.04
|
| Rate for Payer: BCN Medicare Advantage |
$63.55
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$91.51
|
| Rate for Payer: Cofinity Commercial |
$85.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.73
|
| Rate for Payer: Nomi Health Commercial |
$76.26
|
| Rate for Payer: PACE SWMI |
$63.55
|
| Rate for Payer: PHP Medicare Advantage |
$63.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health HMO/PPO |
$101.70
|
| Rate for Payer: Priority Health Medicare |
$64.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.55
|
| Rate for Payer: UHC Exchange |
$63.55
|
| Rate for Payer: UHC Medicare Advantage |
$63.55
|
|
|
PR XTRNL ECG REC<48 HRS RVW&INTERPJ PHYS/QHP
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 93227
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$2,081.50 |
| Rate for Payer: Aetna Commercial |
$22.94
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS MAPPO |
$17.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,081.50
|
| Rate for Payer: BCN Commercial |
$26.39
|
| Rate for Payer: BCN Medicare Advantage |
$17.12
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$24.65
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.12
|
| Rate for Payer: Mclaren Medicaid |
$11.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.98
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Nomi Health Commercial |
$20.54
|
| Rate for Payer: PACE SWMI |
$17.12
|
| Rate for Payer: PHP Medicare Advantage |
$17.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health HMO/PPO |
$25.43
|
| Rate for Payer: Priority Health Medicare |
$17.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.12
|
| Rate for Payer: UHC Exchange |
$17.12
|
| Rate for Payer: UHC Medicare Advantage |
$17.12
|
| Rate for Payer: UHCCP Medicaid |
$11.50
|
|
|
PR XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 93228
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$454.34 |
| Rate for Payer: Aetna Commercial |
$31.81
|
| Rate for Payer: Aetna Medicare |
$24.69
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS MAPPO |
$23.74
|
| Rate for Payer: BCBS Trust/PPO |
$454.34
|
| Rate for Payer: BCN Commercial |
$36.65
|
| Rate for Payer: BCN Medicare Advantage |
$23.74
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$34.19
|
| Rate for Payer: Cofinity Commercial |
$31.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.74
|
| Rate for Payer: Mclaren Medicaid |
$15.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.93
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Nomi Health Commercial |
$28.49
|
| Rate for Payer: PACE SWMI |
$23.74
|
| Rate for Payer: PHP Medicare Advantage |
$23.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health HMO/PPO |
$34.84
|
| Rate for Payer: Priority Health Medicare |
$23.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.74
|
| Rate for Payer: UHC Exchange |
$23.74
|
| Rate for Payer: UHC Medicare Advantage |
$23.74
|
| Rate for Payer: UHCCP Medicaid |
$15.98
|
|
|
PR XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS
|
Professional
|
Both
|
$654.00
|
|
|
Service Code
|
HCPCS 93271
|
| Min. Negotiated Rate |
$120.90 |
| Max. Negotiated Rate |
$867.47 |
| Rate for Payer: Aetna Commercial |
$162.01
|
| Rate for Payer: Aetna Medicare |
$125.74
|
| Rate for Payer: BCBS Complete |
$261.60
|
| Rate for Payer: BCBS MAPPO |
$120.90
|
| Rate for Payer: BCBS Trust/PPO |
$867.47
|
| Rate for Payer: BCN Commercial |
$213.55
|
| Rate for Payer: BCN Medicare Advantage |
$120.90
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cofinity Commercial |
$174.10
|
| Rate for Payer: Cofinity Commercial |
$162.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.94
|
| Rate for Payer: Nomi Health Commercial |
$145.08
|
| Rate for Payer: PACE SWMI |
$120.90
|
| Rate for Payer: PHP Medicare Advantage |
$120.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.10
|
| Rate for Payer: Priority Health HMO/PPO |
$201.98
|
| Rate for Payer: Priority Health Medicare |
$122.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.90
|
| Rate for Payer: UHC Exchange |
$120.90
|
| Rate for Payer: UHC Medicare Advantage |
$120.90
|
|
|
PR XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 93270
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$1,098.86 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: Aetna Medicare |
$7.45
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS MAPPO |
$7.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.86
|
| Rate for Payer: BCN Commercial |
$12.22
|
| Rate for Payer: BCN Medicare Advantage |
$7.16
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$9.59
|
| Rate for Payer: Cofinity Commercial |
$10.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.52
|
| Rate for Payer: Nomi Health Commercial |
$8.59
|
| Rate for Payer: PACE SWMI |
$7.16
|
| Rate for Payer: PHP Medicare Advantage |
$7.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.95
|
| Rate for Payer: Priority Health HMO/PPO |
$11.77
|
| Rate for Payer: Priority Health Medicare |
$7.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.16
|
| Rate for Payer: UHC Exchange |
$7.16
|
| Rate for Payer: UHC Medicare Advantage |
$7.16
|
|
|
PR XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS
|
Professional
|
Both
|
$871.00
|
|
|
Service Code
|
HCPCS 93268
|
| Min. Negotiated Rate |
$150.65 |
| Max. Negotiated Rate |
$869.58 |
| Rate for Payer: Aetna Commercial |
$201.87
|
| Rate for Payer: Aetna Medicare |
$156.68
|
| Rate for Payer: BCBS Complete |
$348.40
|
| Rate for Payer: BCBS MAPPO |
$150.65
|
| Rate for Payer: BCBS Trust/PPO |
$869.58
|
| Rate for Payer: BCN Commercial |
$260.46
|
| Rate for Payer: BCN Medicare Advantage |
$150.65
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Cofinity Commercial |
$216.94
|
| Rate for Payer: Cofinity Commercial |
$201.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.18
|
| Rate for Payer: Nomi Health Commercial |
$180.78
|
| Rate for Payer: PACE SWMI |
$150.65
|
| Rate for Payer: PHP Medicare Advantage |
$150.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.15
|
| Rate for Payer: Priority Health HMO/PPO |
$247.19
|
| Rate for Payer: Priority Health Medicare |
$152.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.65
|
| Rate for Payer: UHC Exchange |
$150.65
|
| Rate for Payer: UHC Medicare Advantage |
$150.65
|
|
|
PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS 93272
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$934.03 |
| Rate for Payer: Aetna Commercial |
$30.27
|
| Rate for Payer: Aetna Medicare |
$23.49
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS MAPPO |
$22.59
|
| Rate for Payer: BCBS Trust/PPO |
$934.03
|
| Rate for Payer: BCN Commercial |
$34.70
|
| Rate for Payer: BCN Medicare Advantage |
$22.59
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cofinity Commercial |
$30.27
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.59
|
| Rate for Payer: Mclaren Medicaid |
$15.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.72
|
| Rate for Payer: Meridian Medicaid |
$15.88
|
| Rate for Payer: Nomi Health Commercial |
$27.11
|
| Rate for Payer: PACE SWMI |
$22.59
|
| Rate for Payer: PHP Medicare Advantage |
$22.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.10
|
| Rate for Payer: Priority Health HMO/PPO |
$33.42
|
| Rate for Payer: Priority Health Medicare |
$22.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.59
|
| Rate for Payer: UHC Exchange |
$22.59
|
| Rate for Payer: UHC Medicare Advantage |
$22.59
|
| Rate for Payer: UHCCP Medicaid |
$15.12
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 41015
|
| Min. Negotiated Rate |
$194.90 |
| Max. Negotiated Rate |
$1,058.71 |
| Rate for Payer: Aetna Commercial |
$381.47
|
| Rate for Payer: Aetna Medicare |
$296.07
|
| Rate for Payer: BCBS Complete |
$204.64
|
| Rate for Payer: BCBS MAPPO |
$284.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.71
|
| Rate for Payer: BCN Commercial |
$583.48
|
| Rate for Payer: BCN Medicare Advantage |
$284.68
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$409.94
|
| Rate for Payer: Cofinity Commercial |
$381.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$284.68
|
| Rate for Payer: Mclaren Medicaid |
$194.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.91
|
| Rate for Payer: Meridian Medicaid |
$204.64
|
| Rate for Payer: Nomi Health Commercial |
$341.62
|
| Rate for Payer: PACE SWMI |
$284.68
|
| Rate for Payer: PHP Medicare Advantage |
$284.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health HMO/PPO |
$535.74
|
| Rate for Payer: Priority Health Medicare |
$287.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$535.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$284.68
|
| Rate for Payer: UHC Exchange |
$284.68
|
| Rate for Payer: UHC Medicare Advantage |
$284.68
|
| Rate for Payer: UHCCP Medicaid |
$194.90
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB
|
Professional
|
Both
|
$902.00
|
|
|
Service Code
|
HCPCS 41017
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$686.10 |
| Rate for Payer: Aetna Commercial |
$431.88
|
| Rate for Payer: Aetna Medicare |
$335.19
|
| Rate for Payer: BCBS Complete |
$232.38
|
| Rate for Payer: BCBS MAPPO |
$322.30
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: BCN Commercial |
$686.10
|
| Rate for Payer: BCN Medicare Advantage |
$322.30
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cofinity Commercial |
$464.11
|
| Rate for Payer: Cofinity Commercial |
$431.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.30
|
| Rate for Payer: Mclaren Medicaid |
$221.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.42
|
| Rate for Payer: Meridian Medicaid |
$232.38
|
| Rate for Payer: Nomi Health Commercial |
$386.76
|
| Rate for Payer: PACE SWMI |
$322.30
|
| Rate for Payer: PHP Medicare Advantage |
$322.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$221.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.30
|
| Rate for Payer: Priority Health HMO/PPO |
$614.49
|
| Rate for Payer: Priority Health Medicare |
$325.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$614.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.30
|
| Rate for Payer: UHC Exchange |
$322.30
|
| Rate for Payer: UHC Medicare Advantage |
$322.30
|
| Rate for Payer: UHCCP Medicaid |
$221.31
|
|
|
PR ZINC PASTE BAND W >=3""<5""/YD
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS A6456
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: BCN Commercial |
$1.39
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.70
|
|
|
PR ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 90736
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$221.01 |
| Rate for Payer: Aetna Commercial |
$216.92
|
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: BCBS Trust/PPO |
$221.01
|
| Rate for Payer: BCN Commercial |
$216.92
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
OP
|
$22.56
|
|
|
Service Code
|
NDC 00904633724
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$20.30 |
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: Aetna Medicare |
$5.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.05
|
| Rate for Payer: BCBS Complete |
$9.02
|
| Rate for Payer: BCBS MAPPO |
$5.64
|
| Rate for Payer: BCBS Trust/PPO |
$18.55
|
| Rate for Payer: BCN Commercial |
$17.54
|
| Rate for Payer: BCN Medicare Advantage |
$5.64
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$19.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.64
|
| Rate for Payer: Healthscope Commercial |
$20.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.18
|
| Rate for Payer: Nomi Health Commercial |
$18.50
|
| Rate for Payer: PACE Senior Care Partners |
$5.36
|
| Rate for Payer: PACE SWMI |
$5.64
|
| Rate for Payer: PHP Commercial |
$19.18
|
| Rate for Payer: PHP Medicare Advantage |
$5.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.66
|
| Rate for Payer: Priority Health HMO/PPO |
$19.63
|
| Rate for Payer: Priority Health Medicare |
$5.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.12
|
| Rate for Payer: Railroad Medicare Medicare |
$5.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.85
|
| Rate for Payer: UHC Core |
$18.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.64
|
| Rate for Payer: UHC Exchange |
$5.64
|
| Rate for Payer: UHC Medicare Advantage |
$5.64
|
| Rate for Payer: VA VA |
$5.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.92
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
IP
|
$22.56
|
|
|
Service Code
|
NDC 00904633724
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$20.30 |
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: BCBS Trust/PPO |
$18.42
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$19.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$20.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.18
|
| Rate for Payer: Nomi Health Commercial |
$18.50
|
| Rate for Payer: PHP Commercial |
$19.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.66
|
| Rate for Payer: Priority Health HMO/PPO |
$19.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.85
|
| Rate for Payer: UHC Core |
$18.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.92
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
IP
|
$44.65
|
|
|
Service Code
|
NDC 00904505359
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.02 |
| Max. Negotiated Rate |
$40.18 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: BCBS Trust/PPO |
$36.45
|
| Rate for Payer: BCN Commercial |
$34.51
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$38.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$40.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.95
|
| Rate for Payer: Nomi Health Commercial |
$36.61
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.02
|
| Rate for Payer: Priority Health HMO/PPO |
$38.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.29
|
| Rate for Payer: UHC Core |
$37.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.49
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
OP
|
$44.65
|
|
|
Service Code
|
NDC 00904505359
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$40.18 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: Aetna Medicare |
$11.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.95
|
| Rate for Payer: BCBS Complete |
$17.86
|
| Rate for Payer: BCBS MAPPO |
$11.16
|
| Rate for Payer: BCBS Trust/PPO |
$36.71
|
| Rate for Payer: BCN Commercial |
$34.72
|
| Rate for Payer: BCN Medicare Advantage |
$11.16
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$38.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$40.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.95
|
| Rate for Payer: Nomi Health Commercial |
$36.61
|
| Rate for Payer: PACE Senior Care Partners |
$10.60
|
| Rate for Payer: PACE SWMI |
$11.16
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: PHP Medicare Advantage |
$11.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.02
|
| Rate for Payer: Priority Health HMO/PPO |
$38.85
|
| Rate for Payer: Priority Health Medicare |
$11.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.92
|
| Rate for Payer: Railroad Medicare Medicare |
$11.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.29
|
| Rate for Payer: UHC Core |
$37.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.16
|
| Rate for Payer: UHC Exchange |
$11.16
|
| Rate for Payer: UHC Medicare Advantage |
$11.16
|
| Rate for Payer: VA VA |
$11.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.49
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$27.74
|
|
|
Service Code
|
NDC 45802010752
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$24.97 |
| Rate for Payer: Aetna Commercial |
$23.58
|
| Rate for Payer: Aetna Medicare |
$7.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.67
|
| Rate for Payer: BCBS Complete |
$11.10
|
| Rate for Payer: BCBS MAPPO |
$6.94
|
| Rate for Payer: BCBS Trust/PPO |
$22.81
|
| Rate for Payer: BCN Commercial |
$21.57
|
| Rate for Payer: BCN Medicare Advantage |
$6.94
|
| Rate for Payer: Cash Price |
$22.19
|
| Rate for Payer: Cofinity Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.94
|
| Rate for Payer: Healthscope Commercial |
$24.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.58
|
| Rate for Payer: Nomi Health Commercial |
$22.75
|
| Rate for Payer: PACE Senior Care Partners |
$6.59
|
| Rate for Payer: PACE SWMI |
$6.94
|
| Rate for Payer: PHP Commercial |
$23.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.03
|
| Rate for Payer: Priority Health HMO/PPO |
$24.13
|
| Rate for Payer: Priority Health Medicare |
$7.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.59
|
| Rate for Payer: Railroad Medicare Medicare |
$6.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.41
|
| Rate for Payer: UHC Core |
$23.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.94
|
| Rate for Payer: UHC Exchange |
$6.94
|
| Rate for Payer: UHC Medicare Advantage |
$6.94
|
| Rate for Payer: VA VA |
$6.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.80
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
NDC 00904675415
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Medicare |
$8.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.95
|
| Rate for Payer: BCBS Complete |
$12.73
|
| Rate for Payer: BCBS MAPPO |
$7.96
|
| Rate for Payer: BCBS Trust/PPO |
$26.17
|
| Rate for Payer: BCN Commercial |
$24.75
|
| Rate for Payer: BCN Medicare Advantage |
$7.96
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.96
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: PACE Senior Care Partners |
$7.56
|
| Rate for Payer: PACE SWMI |
$7.96
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Medicare Advantage |
$7.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.69
|
| Rate for Payer: Priority Health HMO/PPO |
$27.69
|
| Rate for Payer: Priority Health Medicare |
$8.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.33
|
| Rate for Payer: Railroad Medicare Medicare |
$7.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.01
|
| Rate for Payer: UHC Core |
$26.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.96
|
| Rate for Payer: UHC Exchange |
$7.96
|
| Rate for Payer: UHC Medicare Advantage |
$7.96
|
| Rate for Payer: VA VA |
$7.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.87
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
NDC 00904675415
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.69 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: BCBS Trust/PPO |
$25.98
|
| Rate for Payer: BCN Commercial |
$24.60
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.69
|
| Rate for Payer: Priority Health HMO/PPO |
$27.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.01
|
| Rate for Payer: UHC Core |
$26.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.87
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$27.74
|
|
|
Service Code
|
NDC 45802010752
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$24.97 |
| Rate for Payer: Aetna Commercial |
$23.58
|
| Rate for Payer: BCBS Trust/PPO |
$22.64
|
| Rate for Payer: BCN Commercial |
$21.44
|
| Rate for Payer: Cash Price |
$22.19
|
| Rate for Payer: Cofinity Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.19
|
| Rate for Payer: Healthscope Commercial |
$24.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.58
|
| Rate for Payer: Nomi Health Commercial |
$22.75
|
| Rate for Payer: PHP Commercial |
$23.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.03
|
| Rate for Payer: Priority Health HMO/PPO |
$24.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.41
|
| Rate for Payer: UHC Core |
$23.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.80
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
OP
|
$8.85
|
|
|
Service Code
|
NDC 37000002410
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: Aetna Medicare |
$2.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.77
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: BCBS MAPPO |
$2.21
|
| Rate for Payer: BCBS Trust/PPO |
$7.28
|
| Rate for Payer: BCN Commercial |
$6.88
|
| Rate for Payer: BCN Medicare Advantage |
$2.21
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.21
|
| Rate for Payer: Healthscope Commercial |
$7.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.52
|
| Rate for Payer: Nomi Health Commercial |
$7.26
|
| Rate for Payer: PACE Senior Care Partners |
$2.10
|
| Rate for Payer: PACE SWMI |
$2.21
|
| Rate for Payer: PHP Commercial |
$7.52
|
| Rate for Payer: PHP Medicare Advantage |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.75
|
| Rate for Payer: Priority Health HMO/PPO |
$7.70
|
| Rate for Payer: Priority Health Medicare |
$2.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.93
|
| Rate for Payer: Railroad Medicare Medicare |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.79
|
| Rate for Payer: UHC Core |
$7.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Medicare Advantage |
$2.21
|
| Rate for Payer: VA VA |
$2.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
IP
|
$8.85
|
|
|
Service Code
|
NDC 37000002410
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: BCBS Trust/PPO |
$7.22
|
| Rate for Payer: BCN Commercial |
$6.84
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Healthscope Commercial |
$7.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.52
|
| Rate for Payer: Nomi Health Commercial |
$7.26
|
| Rate for Payer: PHP Commercial |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.75
|
| Rate for Payer: Priority Health HMO/PPO |
$7.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.79
|
| Rate for Payer: UHC Core |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
OP
|
$429.60
|
|
|
Service Code
|
NDC 00904662261
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.03 |
| Max. Negotiated Rate |
$386.64 |
| Rate for Payer: Aetna Commercial |
$365.16
|
| Rate for Payer: Aetna Medicare |
$111.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.25
|
| Rate for Payer: BCBS Complete |
$171.84
|
| Rate for Payer: BCBS MAPPO |
$107.40
|
| Rate for Payer: BCBS Trust/PPO |
$353.17
|
| Rate for Payer: BCN Commercial |
$334.01
|
| Rate for Payer: BCN Medicare Advantage |
$107.40
|
| Rate for Payer: Cash Price |
$343.68
|
| Rate for Payer: Cofinity Commercial |
$369.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.40
|
| Rate for Payer: Healthscope Commercial |
$386.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.16
|
| Rate for Payer: Nomi Health Commercial |
$352.27
|
| Rate for Payer: PACE Senior Care Partners |
$102.03
|
| Rate for Payer: PACE SWMI |
$107.40
|
| Rate for Payer: PHP Commercial |
$365.16
|
| Rate for Payer: PHP Medicare Advantage |
$107.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.24
|
| Rate for Payer: Priority Health HMO/PPO |
$373.75
|
| Rate for Payer: Priority Health Medicare |
$108.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.83
|
| Rate for Payer: Railroad Medicare Medicare |
$107.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.05
|
| Rate for Payer: UHC Core |
$358.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.40
|
| Rate for Payer: UHC Exchange |
$107.40
|
| Rate for Payer: UHC Medicare Advantage |
$107.40
|
| Rate for Payer: VA VA |
$107.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.20
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
IP
|
$429.60
|
|
|
Service Code
|
NDC 00904662261
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.24 |
| Max. Negotiated Rate |
$386.64 |
| Rate for Payer: Aetna Commercial |
$365.16
|
| Rate for Payer: BCBS Trust/PPO |
$350.68
|
| Rate for Payer: BCN Commercial |
$331.99
|
| Rate for Payer: Cash Price |
$343.68
|
| Rate for Payer: Cofinity Commercial |
$369.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.68
|
| Rate for Payer: Healthscope Commercial |
$386.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.16
|
| Rate for Payer: Nomi Health Commercial |
$352.27
|
| Rate for Payer: PHP Commercial |
$365.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.24
|
| Rate for Payer: Priority Health HMO/PPO |
$373.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.05
|
| Rate for Payer: UHC Core |
$358.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.20
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$157.50
|
|
|
Service Code
|
NDC 57896085301
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.41 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: Aetna Medicare |
$40.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.22
|
| Rate for Payer: BCBS Complete |
$63.00
|
| Rate for Payer: BCBS MAPPO |
$39.38
|
| Rate for Payer: BCBS Trust/PPO |
$129.48
|
| Rate for Payer: BCN Commercial |
$122.46
|
| Rate for Payer: BCN Medicare Advantage |
$39.38
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.38
|
| Rate for Payer: Healthscope Commercial |
$141.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.88
|
| Rate for Payer: Nomi Health Commercial |
$129.15
|
| Rate for Payer: PACE Senior Care Partners |
$37.41
|
| Rate for Payer: PACE SWMI |
$39.38
|
| Rate for Payer: PHP Commercial |
$133.88
|
| Rate for Payer: PHP Medicare Advantage |
$39.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.38
|
| Rate for Payer: Priority Health HMO/PPO |
$137.02
|
| Rate for Payer: Priority Health Medicare |
$39.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.52
|
| Rate for Payer: Railroad Medicare Medicare |
$39.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.60
|
| Rate for Payer: UHC Core |
$131.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.38
|
| Rate for Payer: UHC Exchange |
$39.38
|
| Rate for Payer: UHC Medicare Advantage |
$39.38
|
| Rate for Payer: VA VA |
$39.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.12
|
|
