|
PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); EACH SEPARATE/ADDITIONAL LESION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$196.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.38
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$24.89
|
|
|
PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION
|
Facility
|
OP
|
$1,115.78
|
|
|
Service Code
|
CPT 11104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$45.51 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$175.45
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.06
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$45.51
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST
|
Facility
|
OP
|
$1,115.78
|
|
|
Service Code
|
CPT 10160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$95.29 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$277.63
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.82
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$95.29
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST
|
Facility
|
OP
|
$1,115.78
|
|
|
Service Code
|
CPT 10160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$95.29 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$277.63
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.82
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$95.29
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
PUNCTURE ASPIRATION OF HYDROCELE, TUNICA VAGINALIS, WITH OR WITHOUT INJECTION OF MEDICATION
|
Facility
|
OP
|
$1,968.76
|
|
|
Service Code
|
CPT 55000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$1,968.76 |
| Rate for Payer: Aetna Medicare |
$650.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$79.25
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,968.76
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,575.01
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.12
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$625.39
|
| Rate for Payer: UHC Exchange |
$82.84
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$948.17
|
|
|
Service Code
|
NDC 61748-012-06
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$417.19 |
| Max. Negotiated Rate |
$853.35 |
| Rate for Payer: Aetna American Axle |
$616.31
|
| Rate for Payer: Aetna Commercial |
$805.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.31
|
| Rate for Payer: Cash Price |
$758.54
|
| Rate for Payer: Cofinity Commercial |
$663.72
|
| Rate for Payer: Cofinity Commercial |
$815.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.54
|
| Rate for Payer: Healthscope Commercial |
$853.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$663.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$711.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$805.94
|
| Rate for Payer: PHP Commercial |
$805.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.72
|
| Rate for Payer: Priority Health SBD |
$597.35
|
| Rate for Payer: UMR Bronson Commercial |
$417.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.13
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$1,420.25
|
|
|
Service Code
|
NDC 61748-012-09
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$624.91 |
| Max. Negotiated Rate |
$1,278.22 |
| Rate for Payer: Aetna American Axle |
$923.16
|
| Rate for Payer: Aetna Commercial |
$1,207.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.16
|
| Rate for Payer: Cash Price |
$1,136.20
|
| Rate for Payer: Cofinity Commercial |
$1,221.42
|
| Rate for Payer: Cofinity Commercial |
$994.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.20
|
| Rate for Payer: Healthscope Commercial |
$1,278.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$994.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.21
|
| Rate for Payer: PHP Commercial |
$1,207.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.18
|
| Rate for Payer: Priority Health SBD |
$894.76
|
| Rate for Payer: UMR Bronson Commercial |
$624.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.19
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$839.83
|
|
|
Service Code
|
NDC 70954-484-10
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$369.53 |
| Max. Negotiated Rate |
$755.85 |
| Rate for Payer: Aetna American Axle |
$545.89
|
| Rate for Payer: Aetna Commercial |
$713.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.89
|
| Rate for Payer: Cash Price |
$671.86
|
| Rate for Payer: Cofinity Commercial |
$722.25
|
| Rate for Payer: Cofinity Commercial |
$587.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.86
|
| Rate for Payer: Healthscope Commercial |
$755.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$587.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$713.86
|
| Rate for Payer: PHP Commercial |
$713.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.88
|
| Rate for Payer: Priority Health SBD |
$529.09
|
| Rate for Payer: UMR Bronson Commercial |
$369.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.87
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$124.60
|
|
|
Service Code
|
NDC 0781-3040-72
|
| Hospital Charge Code |
11237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.82 |
| Max. Negotiated Rate |
$112.14 |
| Rate for Payer: Aetna American Axle |
$80.99
|
| Rate for Payer: Aetna Commercial |
$105.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.99
|
| Rate for Payer: Cash Price |
$99.68
|
| Rate for Payer: Cofinity Commercial |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.68
|
| Rate for Payer: Healthscope Commercial |
$112.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.91
|
| Rate for Payer: PHP Commercial |
$105.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.22
|
| Rate for Payer: Priority Health SBD |
$78.50
|
| Rate for Payer: UMR Bronson Commercial |
$54.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.45
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$124.60
|
|
|
Service Code
|
NDC 0781-3040-95
|
| Hospital Charge Code |
11237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.82 |
| Max. Negotiated Rate |
$112.14 |
| Rate for Payer: Aetna American Axle |
$80.99
|
| Rate for Payer: Aetna Commercial |
$105.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.99
|
| Rate for Payer: Cash Price |
$99.68
|
| Rate for Payer: Cofinity Commercial |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.68
|
| Rate for Payer: Healthscope Commercial |
$112.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.91
|
| Rate for Payer: PHP Commercial |
$105.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.22
|
| Rate for Payer: Priority Health SBD |
$78.50
|
| Rate for Payer: UMR Bronson Commercial |
$54.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.45
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$5,647.58
|
|
|
Service Code
|
NDC 0187-3012-20
|
| Hospital Charge Code |
11238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,484.94 |
| Max. Negotiated Rate |
$5,082.82 |
| Rate for Payer: Aetna American Axle |
$3,670.93
|
| Rate for Payer: Aetna Commercial |
$4,800.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,670.93
|
| Rate for Payer: Cash Price |
$4,518.06
|
| Rate for Payer: Cofinity Commercial |
$3,953.31
|
| Rate for Payer: Cofinity Commercial |
$4,856.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,518.06
|
| Rate for Payer: Healthscope Commercial |
$5,082.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,953.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,235.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,800.44
|
| Rate for Payer: PHP Commercial |
$4,800.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,953.31
|
| Rate for Payer: Priority Health SBD |
$3,557.98
|
| Rate for Payer: UMR Bronson Commercial |
$2,484.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,235.68
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$3,721.19
|
|
|
Service Code
|
NDC 68682-307-05
|
| Hospital Charge Code |
11238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,637.32 |
| Max. Negotiated Rate |
$3,349.07 |
| Rate for Payer: Aetna American Axle |
$2,418.77
|
| Rate for Payer: Aetna Commercial |
$3,163.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,418.77
|
| Rate for Payer: Cash Price |
$2,976.95
|
| Rate for Payer: Cofinity Commercial |
$2,604.83
|
| Rate for Payer: Cofinity Commercial |
$3,200.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,976.95
|
| Rate for Payer: Healthscope Commercial |
$3,349.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,604.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,790.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,163.01
|
| Rate for Payer: PHP Commercial |
$3,163.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,604.83
|
| Rate for Payer: Priority Health SBD |
$2,344.35
|
| Rate for Payer: UMR Bronson Commercial |
$1,637.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,790.89
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$2,679.08
|
|
|
Service Code
|
NDC 70954-148-10
|
| Hospital Charge Code |
11238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,178.80 |
| Max. Negotiated Rate |
$2,411.17 |
| Rate for Payer: Aetna American Axle |
$1,741.40
|
| Rate for Payer: Aetna Commercial |
$2,277.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,741.40
|
| Rate for Payer: Cash Price |
$2,143.26
|
| Rate for Payer: Cofinity Commercial |
$1,875.36
|
| Rate for Payer: Cofinity Commercial |
$2,304.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,143.26
|
| Rate for Payer: Healthscope Commercial |
$2,411.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,875.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,009.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,277.22
|
| Rate for Payer: PHP Commercial |
$2,277.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,875.36
|
| Rate for Payer: Priority Health SBD |
$1,687.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,178.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,009.31
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
IP
|
$433.20
|
|
|
Service Code
|
NDC 68682-302-10
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.61 |
| Max. Negotiated Rate |
$389.88 |
| Rate for Payer: Aetna American Axle |
$281.58
|
| Rate for Payer: Aetna Commercial |
$368.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.58
|
| Rate for Payer: Cash Price |
$346.56
|
| Rate for Payer: Cofinity Commercial |
$303.24
|
| Rate for Payer: Cofinity Commercial |
$372.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.56
|
| Rate for Payer: Healthscope Commercial |
$389.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$368.22
|
| Rate for Payer: PHP Commercial |
$368.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.24
|
| Rate for Payer: Priority Health SBD |
$272.92
|
| Rate for Payer: UMR Bronson Commercial |
$190.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.90
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
IP
|
$364.32
|
|
|
Service Code
|
NDC 0115-3511-01
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$327.89 |
| Rate for Payer: Aetna American Axle |
$236.81
|
| Rate for Payer: Aetna Commercial |
$309.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.81
|
| Rate for Payer: Cash Price |
$291.46
|
| Rate for Payer: Cofinity Commercial |
$255.02
|
| Rate for Payer: Cofinity Commercial |
$313.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.46
|
| Rate for Payer: Healthscope Commercial |
$327.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$255.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$309.67
|
| Rate for Payer: PHP Commercial |
$309.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.02
|
| Rate for Payer: Priority Health SBD |
$229.52
|
| Rate for Payer: UMR Bronson Commercial |
$160.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.24
|
|
|
PYRIDOSTIGMINE BROMIDE ER 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$676.88
|
|
|
Service Code
|
NDC 68682-301-30
|
| Hospital Charge Code |
11240
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.83 |
| Max. Negotiated Rate |
$609.19 |
| Rate for Payer: Aetna American Axle |
$439.97
|
| Rate for Payer: Aetna Commercial |
$575.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.97
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cofinity Commercial |
$473.82
|
| Rate for Payer: Cofinity Commercial |
$582.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.50
|
| Rate for Payer: Healthscope Commercial |
$609.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$473.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$575.35
|
| Rate for Payer: PHP Commercial |
$575.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.82
|
| Rate for Payer: Priority Health SBD |
$426.43
|
| Rate for Payer: UMR Bronson Commercial |
$297.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.66
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$78.84
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
6744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.17 |
| Max. Negotiated Rate |
$70.96 |
| Rate for Payer: Aetna American Axle |
$51.25
|
| Rate for Payer: Aetna Commercial |
$67.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.25
|
| Rate for Payer: BCBS Complete |
$31.54
|
| Rate for Payer: BCBS Trust/PPO |
$47.89
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cofinity Commercial |
$55.19
|
| Rate for Payer: Cofinity Commercial |
$67.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.07
|
| Rate for Payer: Healthscope Commercial |
$70.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.01
|
| Rate for Payer: PHP Commercial |
$67.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.19
|
| Rate for Payer: Priority Health SBD |
$49.67
|
| Rate for Payer: UMR Bronson Commercial |
$29.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.13
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$78.84
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
6744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.69 |
| Max. Negotiated Rate |
$70.96 |
| Rate for Payer: Aetna American Axle |
$51.25
|
| Rate for Payer: Aetna Commercial |
$67.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.25
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cofinity Commercial |
$67.80
|
| Rate for Payer: Cofinity Commercial |
$55.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.07
|
| Rate for Payer: Healthscope Commercial |
$70.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.01
|
| Rate for Payer: PHP Commercial |
$67.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.19
|
| Rate for Payer: Priority Health SBD |
$49.67
|
| Rate for Payer: UMR Bronson Commercial |
$34.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.13
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
IP
|
$144.90
|
|
|
Service Code
|
NDC 5789685401
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.76 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna American Axle |
$94.18
|
| Rate for Payer: Aetna Commercial |
$123.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.18
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: Cofinity Commercial |
$101.43
|
| Rate for Payer: Cofinity Commercial |
$124.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.92
|
| Rate for Payer: Healthscope Commercial |
$130.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.16
|
| Rate for Payer: PHP Commercial |
$123.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.43
|
| Rate for Payer: Priority Health SBD |
$91.29
|
| Rate for Payer: UMR Bronson Commercial |
$63.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.68
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 5026885911
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna American Axle |
$0.98
|
| Rate for Payer: Aetna Commercial |
$1.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.98
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cofinity Commercial |
$1.05
|
| Rate for Payer: Cofinity Commercial |
$1.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.20
|
| Rate for Payer: Healthscope Commercial |
$1.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.28
|
| Rate for Payer: PHP Commercial |
$1.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.05
|
| Rate for Payer: Priority Health SBD |
$0.95
|
| Rate for Payer: UMR Bronson Commercial |
$0.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
IP
|
$74.55
|
|
|
Service Code
|
NDC 5026885915
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$67.10 |
| Rate for Payer: Aetna American Axle |
$48.46
|
| Rate for Payer: Aetna Commercial |
$63.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.46
|
| Rate for Payer: Cash Price |
$59.64
|
| Rate for Payer: Cofinity Commercial |
$52.18
|
| Rate for Payer: Cofinity Commercial |
$64.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.64
|
| Rate for Payer: Healthscope Commercial |
$67.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.37
|
| Rate for Payer: PHP Commercial |
$63.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.18
|
| Rate for Payer: Priority Health SBD |
$46.97
|
| Rate for Payer: UMR Bronson Commercial |
$32.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.91
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$132.30
|
|
|
Service Code
|
NDC 1000670012
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.21 |
| Max. Negotiated Rate |
$119.07 |
| Rate for Payer: Aetna American Axle |
$86.00
|
| Rate for Payer: Aetna Commercial |
$112.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.00
|
| Rate for Payer: Cash Price |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$113.78
|
| Rate for Payer: Cofinity Commercial |
$92.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.84
|
| Rate for Payer: Healthscope Commercial |
$119.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.46
|
| Rate for Payer: PHP Commercial |
$112.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.61
|
| Rate for Payer: Priority Health SBD |
$83.35
|
| Rate for Payer: UMR Bronson Commercial |
$58.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.22
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$176.40
|
|
|
Service Code
|
NDC 3786490901
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.62 |
| Max. Negotiated Rate |
$158.76 |
| Rate for Payer: Aetna American Axle |
$114.66
|
| Rate for Payer: Aetna Commercial |
$149.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.66
|
| Rate for Payer: Cash Price |
$141.12
|
| Rate for Payer: Cofinity Commercial |
$123.48
|
| Rate for Payer: Cofinity Commercial |
$151.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.12
|
| Rate for Payer: Healthscope Commercial |
$158.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.94
|
| Rate for Payer: PHP Commercial |
$149.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.48
|
| Rate for Payer: Priority Health SBD |
$111.13
|
| Rate for Payer: UMR Bronson Commercial |
$77.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.30
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
NDC 1000673017
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.56 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna American Axle |
$80.60
|
| Rate for Payer: Aetna Commercial |
$105.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.60
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$106.64
|
| Rate for Payer: Cofinity Commercial |
$86.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.20
|
| Rate for Payer: Healthscope Commercial |
$111.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.40
|
| Rate for Payer: PHP Commercial |
$105.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.80
|
| Rate for Payer: Priority Health SBD |
$78.12
|
| Rate for Payer: UMR Bronson Commercial |
$54.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.00
|
|
|
QUETIAPINE 100MG/ML TOPICAL GEL CUSTOM
|
Facility
|
IP
|
$21.55
|
|
|
Service Code
|
NDC 9900-0003-67
|
| Hospital Charge Code |
161484
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Aetna American Axle |
$14.01
|
| Rate for Payer: Aetna Commercial |
$18.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.01
|
| Rate for Payer: Cash Price |
$17.24
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.24
|
| Rate for Payer: Healthscope Commercial |
$19.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.32
|
| Rate for Payer: PHP Commercial |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.08
|
| Rate for Payer: Priority Health SBD |
$13.58
|
| Rate for Payer: UMR Bronson Commercial |
$9.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.16
|
|
