|
PYRIDOSTIGMINE BROMIDE 30 MG TABLET
|
Facility
|
IP
|
$503.11
|
|
|
Service Code
|
NDC 58657081021
|
| Hospital Charge Code |
190688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.37 |
| Max. Negotiated Rate |
$452.80 |
| Rate for Payer: Aetna American Axle |
$327.02
|
| Rate for Payer: Aetna Commercial |
$427.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.02
|
| Rate for Payer: Cash Price |
$402.49
|
| Rate for Payer: Cofinity Advantage |
$352.18
|
| Rate for Payer: Cofinity Commercial |
$432.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.49
|
| Rate for Payer: Healthscope Commercial |
$452.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$377.33
|
| Rate for Payer: PHP Commercial |
$427.64
|
| Rate for Payer: Priority Health SBD |
$316.96
|
| Rate for Payer: UMR Bronson Commercial |
$221.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.33
|
|
|
PYRIDOSTIGMINE BROMIDE 30 MG TABLET
|
Facility
|
OP
|
$503.11
|
|
|
Service Code
|
NDC 58657081021
|
| Hospital Charge Code |
190688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.15 |
| Max. Negotiated Rate |
$452.80 |
| Rate for Payer: Aetna American Axle |
$327.02
|
| Rate for Payer: Aetna Commercial |
$427.64
|
| Rate for Payer: Aetna Medicare |
$251.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.02
|
| Rate for Payer: BCBS Complete |
$201.24
|
| Rate for Payer: Cash Price |
$402.49
|
| Rate for Payer: Cofinity Advantage |
$352.18
|
| Rate for Payer: Cofinity Commercial |
$432.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.49
|
| Rate for Payer: Healthscope Commercial |
$452.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$377.33
|
| Rate for Payer: PHP Commercial |
$427.64
|
| Rate for Payer: Priority Health SBD |
$316.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.02
|
| Rate for Payer: UHC Core |
$262.12
|
| Rate for Payer: UHC Exchange |
$197.72
|
| Rate for Payer: UMR Bronson Commercial |
$186.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.33
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$124.60
|
|
|
Service Code
|
NDC 00781304095
|
| 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 Advantage |
$87.22
|
| Rate for Payer: Cofinity Commercial |
$107.16
|
| 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 Commercial |
$105.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.45
|
| Rate for Payer: PHP Commercial |
$105.91
|
| 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
|
OP
|
$124.60
|
|
|
Service Code
|
NDC 00781304095
|
| Hospital Charge Code |
11237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.10 |
| Max. Negotiated Rate |
$112.14 |
| Rate for Payer: Aetna American Axle |
$80.99
|
| Rate for Payer: Aetna Commercial |
$105.91
|
| Rate for Payer: Aetna Medicare |
$62.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.99
|
| Rate for Payer: BCBS Complete |
$49.84
|
| Rate for Payer: Cash Price |
$99.68
|
| Rate for Payer: Cofinity Advantage |
$87.22
|
| Rate for Payer: Cofinity Commercial |
$107.16
|
| 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: MI Amish Medical Board Commercial |
$99.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.45
|
| Rate for Payer: PHP Commercial |
$105.91
|
| Rate for Payer: Priority Health SBD |
$78.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.99
|
| Rate for Payer: UHC Core |
$64.92
|
| Rate for Payer: UHC Exchange |
$48.97
|
| Rate for Payer: UMR Bronson Commercial |
$46.10
|
| 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 00781304072
|
| 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 Advantage |
$87.22
|
| Rate for Payer: Cofinity Commercial |
$107.16
|
| 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 Commercial |
$105.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.45
|
| Rate for Payer: PHP Commercial |
$105.91
|
| 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
|
OP
|
$124.60
|
|
|
Service Code
|
NDC 00781304072
|
| Hospital Charge Code |
11237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.10 |
| Max. Negotiated Rate |
$112.14 |
| Rate for Payer: Aetna American Axle |
$80.99
|
| Rate for Payer: Aetna Commercial |
$105.91
|
| Rate for Payer: Aetna Medicare |
$62.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.99
|
| Rate for Payer: BCBS Complete |
$49.84
|
| Rate for Payer: Cash Price |
$99.68
|
| Rate for Payer: Cofinity Advantage |
$87.22
|
| Rate for Payer: Cofinity Commercial |
$107.16
|
| 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: MI Amish Medical Board Commercial |
$99.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.45
|
| Rate for Payer: PHP Commercial |
$105.91
|
| Rate for Payer: Priority Health SBD |
$78.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.99
|
| Rate for Payer: UHC Core |
$64.92
|
| Rate for Payer: UHC Exchange |
$48.97
|
| Rate for Payer: UMR Bronson Commercial |
$46.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.45
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$6,641.63
|
|
|
Service Code
|
NDC 00187301220
|
| Hospital Charge Code |
11238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,922.32 |
| Max. Negotiated Rate |
$5,977.47 |
| Rate for Payer: Aetna American Axle |
$4,317.06
|
| Rate for Payer: Aetna Commercial |
$5,645.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,317.06
|
| Rate for Payer: Cash Price |
$5,313.30
|
| Rate for Payer: Cofinity Advantage |
$4,649.14
|
| Rate for Payer: Cofinity Commercial |
$5,711.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,313.30
|
| Rate for Payer: Healthscope Commercial |
$5,977.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,649.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,981.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,645.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,981.22
|
| Rate for Payer: PHP Commercial |
$5,645.39
|
| Rate for Payer: Priority Health SBD |
$4,184.23
|
| Rate for Payer: UMR Bronson Commercial |
$2,922.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,981.22
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$3,836.22
|
|
|
Service Code
|
NDC 68682030705
|
| Hospital Charge Code |
11238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,687.94 |
| Max. Negotiated Rate |
$3,452.60 |
| Rate for Payer: Aetna American Axle |
$2,493.54
|
| Rate for Payer: Aetna Commercial |
$3,260.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,493.54
|
| Rate for Payer: Cash Price |
$3,068.98
|
| Rate for Payer: Cofinity Advantage |
$2,685.35
|
| Rate for Payer: Cofinity Commercial |
$3,299.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,068.98
|
| Rate for Payer: Healthscope Commercial |
$3,452.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,685.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,877.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,260.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,877.16
|
| Rate for Payer: PHP Commercial |
$3,260.79
|
| Rate for Payer: Priority Health SBD |
$2,416.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,687.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,877.16
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$2,679.08
|
|
|
Service Code
|
NDC 70954014810
|
| 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 Advantage |
$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 Commercial |
$2,277.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,009.31
|
| Rate for Payer: PHP Commercial |
$2,277.22
|
| 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/5 ML ORAL SYRUP
|
Facility
|
OP
|
$2,679.08
|
|
|
Service Code
|
NDC 70954014810
|
| Hospital Charge Code |
11238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$991.26 |
| 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 Medicare |
$1,339.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,741.40
|
| Rate for Payer: BCBS Complete |
$1,071.63
|
| Rate for Payer: Cash Price |
$2,143.26
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$2,143.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,277.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,009.31
|
| Rate for Payer: PHP Commercial |
$2,277.22
|
| Rate for Payer: Priority Health SBD |
$1,687.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,741.40
|
| Rate for Payer: UHC Core |
$1,395.80
|
| Rate for Payer: UHC Exchange |
$1,052.88
|
| Rate for Payer: UMR Bronson Commercial |
$991.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,009.31
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$3,836.22
|
|
|
Service Code
|
NDC 68682030705
|
| Hospital Charge Code |
11238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,419.40 |
| Max. Negotiated Rate |
$3,452.60 |
| Rate for Payer: Aetna American Axle |
$2,493.54
|
| Rate for Payer: Aetna Commercial |
$3,260.79
|
| Rate for Payer: Aetna Medicare |
$1,918.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,493.54
|
| Rate for Payer: BCBS Complete |
$1,534.49
|
| Rate for Payer: Cash Price |
$3,068.98
|
| Rate for Payer: Cofinity Advantage |
$2,685.35
|
| Rate for Payer: Cofinity Commercial |
$3,299.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,068.98
|
| Rate for Payer: Healthscope Commercial |
$3,452.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,685.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,877.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,068.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,260.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,877.16
|
| Rate for Payer: PHP Commercial |
$3,260.79
|
| Rate for Payer: Priority Health SBD |
$2,416.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,493.54
|
| Rate for Payer: UHC Core |
$1,998.67
|
| Rate for Payer: UHC Exchange |
$1,507.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,419.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,877.16
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$6,641.63
|
|
|
Service Code
|
NDC 00187301220
|
| Hospital Charge Code |
11238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,457.40 |
| Max. Negotiated Rate |
$5,977.47 |
| Rate for Payer: Aetna American Axle |
$4,317.06
|
| Rate for Payer: Aetna Commercial |
$5,645.39
|
| Rate for Payer: Aetna Medicare |
$3,320.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,317.06
|
| Rate for Payer: BCBS Complete |
$2,656.65
|
| Rate for Payer: Cash Price |
$5,313.30
|
| Rate for Payer: Cofinity Advantage |
$4,649.14
|
| Rate for Payer: Cofinity Commercial |
$5,711.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,313.30
|
| Rate for Payer: Healthscope Commercial |
$5,977.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,649.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,981.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,313.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,645.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,981.22
|
| Rate for Payer: PHP Commercial |
$5,645.39
|
| Rate for Payer: Priority Health SBD |
$4,184.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,317.06
|
| Rate for Payer: UHC Core |
$3,460.29
|
| Rate for Payer: UHC Exchange |
$2,610.16
|
| Rate for Payer: UMR Bronson Commercial |
$2,457.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,981.22
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
IP
|
$351.50
|
|
|
Service Code
|
NDC 62559047001
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.66 |
| Max. Negotiated Rate |
$316.35 |
| Rate for Payer: Aetna American Axle |
$228.47
|
| Rate for Payer: Aetna Commercial |
$298.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.47
|
| Rate for Payer: Cash Price |
$281.20
|
| Rate for Payer: Cofinity Advantage |
$246.05
|
| Rate for Payer: Cofinity Commercial |
$302.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.20
|
| Rate for Payer: Healthscope Commercial |
$316.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.62
|
| Rate for Payer: PHP Commercial |
$298.77
|
| Rate for Payer: Priority Health SBD |
$221.44
|
| Rate for Payer: UMR Bronson Commercial |
$154.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.62
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
OP
|
$433.20
|
|
|
Service Code
|
NDC 68682030210
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.28 |
| Max. Negotiated Rate |
$389.88 |
| Rate for Payer: Aetna American Axle |
$281.58
|
| Rate for Payer: Aetna Commercial |
$368.22
|
| Rate for Payer: Aetna Medicare |
$216.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.58
|
| Rate for Payer: BCBS Complete |
$173.28
|
| Rate for Payer: Cash Price |
$346.56
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$346.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.90
|
| Rate for Payer: PHP Commercial |
$368.22
|
| Rate for Payer: Priority Health SBD |
$272.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.58
|
| Rate for Payer: UHC Core |
$225.70
|
| Rate for Payer: UHC Exchange |
$170.25
|
| Rate for Payer: UMR Bronson Commercial |
$160.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.90
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
IP
|
$494.88
|
|
|
Service Code
|
NDC 00904662261
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$445.39 |
| Rate for Payer: Aetna American Axle |
$321.67
|
| Rate for Payer: Aetna Commercial |
$420.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.67
|
| Rate for Payer: Cash Price |
$395.90
|
| Rate for Payer: Cofinity Advantage |
$346.42
|
| Rate for Payer: Cofinity Commercial |
$425.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.90
|
| Rate for Payer: Healthscope Commercial |
$445.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.16
|
| Rate for Payer: PHP Commercial |
$420.65
|
| Rate for Payer: Priority Health SBD |
$311.77
|
| Rate for Payer: UMR Bronson Commercial |
$217.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.16
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
IP
|
$364.32
|
|
|
Service Code
|
NDC 00115351101
|
| 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 Advantage |
$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 Commercial |
$309.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.24
|
| Rate for Payer: PHP Commercial |
$309.67
|
| 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 60 MG TABLET
|
Facility
|
OP
|
$364.32
|
|
|
Service Code
|
NDC 00115351101
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.80 |
| Max. Negotiated Rate |
$327.89 |
| Rate for Payer: Aetna American Axle |
$236.81
|
| Rate for Payer: Aetna Commercial |
$309.67
|
| Rate for Payer: Aetna Medicare |
$182.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.81
|
| Rate for Payer: BCBS Complete |
$145.73
|
| Rate for Payer: Cash Price |
$291.46
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$291.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.24
|
| Rate for Payer: PHP Commercial |
$309.67
|
| Rate for Payer: Priority Health SBD |
$229.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.81
|
| Rate for Payer: UHC Core |
$189.81
|
| Rate for Payer: UHC Exchange |
$143.18
|
| Rate for Payer: UMR Bronson Commercial |
$134.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.24
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
IP
|
$433.20
|
|
|
Service Code
|
NDC 68682030210
|
| 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 Advantage |
$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 Commercial |
$368.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.90
|
| Rate for Payer: PHP Commercial |
$368.22
|
| 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
|
OP
|
$351.50
|
|
|
Service Code
|
NDC 62559047001
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.06 |
| Max. Negotiated Rate |
$316.35 |
| Rate for Payer: Aetna American Axle |
$228.47
|
| Rate for Payer: Aetna Commercial |
$298.77
|
| Rate for Payer: Aetna Medicare |
$175.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.47
|
| Rate for Payer: BCBS Complete |
$140.60
|
| Rate for Payer: Cash Price |
$281.20
|
| Rate for Payer: Cofinity Advantage |
$246.05
|
| Rate for Payer: Cofinity Commercial |
$302.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.20
|
| Rate for Payer: Healthscope Commercial |
$316.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$281.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.62
|
| Rate for Payer: PHP Commercial |
$298.77
|
| Rate for Payer: Priority Health SBD |
$221.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.47
|
| Rate for Payer: UHC Core |
$183.13
|
| Rate for Payer: UHC Exchange |
$138.14
|
| Rate for Payer: UMR Bronson Commercial |
$130.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.62
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
OP
|
$494.88
|
|
|
Service Code
|
NDC 00904662261
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.11 |
| Max. Negotiated Rate |
$445.39 |
| Rate for Payer: Aetna American Axle |
$321.67
|
| Rate for Payer: Aetna Commercial |
$420.65
|
| Rate for Payer: Aetna Medicare |
$247.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.67
|
| Rate for Payer: BCBS Complete |
$197.95
|
| Rate for Payer: Cash Price |
$395.90
|
| Rate for Payer: Cofinity Advantage |
$346.42
|
| Rate for Payer: Cofinity Commercial |
$425.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.90
|
| Rate for Payer: Healthscope Commercial |
$445.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.16
|
| Rate for Payer: PHP Commercial |
$420.65
|
| Rate for Payer: Priority Health SBD |
$311.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.67
|
| Rate for Payer: UHC Core |
$257.83
|
| Rate for Payer: UHC Exchange |
$194.49
|
| Rate for Payer: UMR Bronson Commercial |
$183.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.16
|
|
|
PYRIDOSTIGMINE BROMIDE ER 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$676.88
|
|
|
Service Code
|
NDC 68682030130
|
| Hospital Charge Code |
11240
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.45 |
| Max. Negotiated Rate |
$609.19 |
| Rate for Payer: Aetna American Axle |
$439.97
|
| Rate for Payer: Aetna Commercial |
$575.35
|
| Rate for Payer: Aetna Medicare |
$338.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.97
|
| Rate for Payer: BCBS Complete |
$270.75
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$541.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$575.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.66
|
| Rate for Payer: PHP Commercial |
$575.35
|
| Rate for Payer: Priority Health SBD |
$426.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$439.97
|
| Rate for Payer: UHC Core |
$352.65
|
| Rate for Payer: UHC Exchange |
$266.01
|
| Rate for Payer: UMR Bronson Commercial |
$250.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.66
|
|
|
PYRIDOSTIGMINE BROMIDE ER 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$704.30
|
|
|
Service Code
|
NDC 47781033530
|
| Hospital Charge Code |
11240
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$309.89 |
| Max. Negotiated Rate |
$633.87 |
| Rate for Payer: Aetna American Axle |
$457.80
|
| Rate for Payer: Aetna Commercial |
$598.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.80
|
| Rate for Payer: Cash Price |
$563.44
|
| Rate for Payer: Cofinity Advantage |
$493.01
|
| Rate for Payer: Cofinity Commercial |
$605.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.44
|
| Rate for Payer: Healthscope Commercial |
$633.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$493.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.23
|
| Rate for Payer: PHP Commercial |
$598.65
|
| Rate for Payer: Priority Health SBD |
$443.71
|
| Rate for Payer: UMR Bronson Commercial |
$309.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.23
|
|
|
PYRIDOSTIGMINE BROMIDE ER 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$676.88
|
|
|
Service Code
|
NDC 68682030130
|
| 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 Advantage |
$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 Commercial |
$575.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.66
|
| Rate for Payer: PHP Commercial |
$575.35
|
| 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
|
|
|
PYRIDOSTIGMINE BROMIDE ER 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$704.30
|
|
|
Service Code
|
NDC 47781033530
|
| Hospital Charge Code |
11240
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.59 |
| Max. Negotiated Rate |
$633.87 |
| Rate for Payer: Aetna American Axle |
$457.80
|
| Rate for Payer: Aetna Commercial |
$598.65
|
| Rate for Payer: Aetna Medicare |
$352.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.80
|
| Rate for Payer: BCBS Complete |
$281.72
|
| Rate for Payer: Cash Price |
$563.44
|
| Rate for Payer: Cofinity Advantage |
$493.01
|
| Rate for Payer: Cofinity Commercial |
$605.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.44
|
| Rate for Payer: Healthscope Commercial |
$633.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$493.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.23
|
| Rate for Payer: PHP Commercial |
$598.65
|
| Rate for Payer: Priority Health SBD |
$443.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.80
|
| Rate for Payer: UHC Core |
$366.94
|
| Rate for Payer: UHC Exchange |
$276.79
|
| Rate for Payer: UMR Bronson Commercial |
$260.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.23
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$50.12
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
6744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$50.41 |
| Rate for Payer: Aetna American Axle |
$32.58
|
| Rate for Payer: Aetna Commercial |
$42.60
|
| Rate for Payer: Aetna Medicare |
$25.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.58
|
| Rate for Payer: BCBS Complete |
$20.05
|
| Rate for Payer: BCBS Trust/PPO |
$50.41
|
| Rate for Payer: BCN Commercial |
$50.41
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cofinity Advantage |
$35.08
|
| Rate for Payer: Cofinity Commercial |
$43.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.10
|
| Rate for Payer: Healthscope Commercial |
$45.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.59
|
| Rate for Payer: PHP Commercial |
$42.60
|
| Rate for Payer: Priority Health SBD |
$31.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.67
|
| Rate for Payer: UHC Core |
$25.67
|
| Rate for Payer: UHC Exchange |
$25.67
|
| Rate for Payer: UMR Bronson Commercial |
$18.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.59
|
|
