|
PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$50.12
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
6744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$45.11 |
| Rate for Payer: Aetna American Axle |
$32.58
|
| Rate for Payer: Aetna Commercial |
$42.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.58
|
| 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: 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: UMR Bronson Commercial |
$22.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.59
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
IP
|
$163.90
|
|
|
Service Code
|
NDC 77333094510
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$147.51 |
| Rate for Payer: Aetna American Axle |
$106.53
|
| Rate for Payer: Aetna Commercial |
$139.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.53
|
| Rate for Payer: Cash Price |
$131.12
|
| Rate for Payer: Cofinity Advantage |
$114.73
|
| Rate for Payer: Cofinity Commercial |
$140.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.12
|
| Rate for Payer: Healthscope Commercial |
$147.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.92
|
| Rate for Payer: PHP Commercial |
$139.31
|
| Rate for Payer: Priority Health SBD |
$103.26
|
| Rate for Payer: UMR Bronson Commercial |
$72.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.92
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
IP
|
$1.54
|
|
|
Service Code
|
NDC 50268085911
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Aetna American Axle |
$1.00
|
| Rate for Payer: Aetna Commercial |
$1.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.00
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Cofinity Advantage |
$1.08
|
| Rate for Payer: Cofinity Commercial |
$1.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.23
|
| Rate for Payer: Healthscope Commercial |
$1.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.16
|
| Rate for Payer: PHP Commercial |
$1.31
|
| Rate for Payer: Priority Health SBD |
$0.97
|
| Rate for Payer: UMR Bronson Commercial |
$0.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.16
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
OP
|
$163.90
|
|
|
Service Code
|
NDC 77333094510
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$147.51 |
| Rate for Payer: Aetna American Axle |
$106.53
|
| Rate for Payer: Aetna Commercial |
$139.31
|
| Rate for Payer: Aetna Medicare |
$81.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.53
|
| Rate for Payer: BCBS Complete |
$65.56
|
| Rate for Payer: Cash Price |
$131.12
|
| Rate for Payer: Cofinity Advantage |
$114.73
|
| Rate for Payer: Cofinity Commercial |
$140.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.12
|
| Rate for Payer: Healthscope Commercial |
$147.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.92
|
| Rate for Payer: PHP Commercial |
$139.31
|
| Rate for Payer: Priority Health SBD |
$103.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.53
|
| Rate for Payer: UHC Core |
$85.39
|
| Rate for Payer: UHC Exchange |
$64.41
|
| Rate for Payer: UMR Bronson Commercial |
$60.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.92
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
OP
|
$1.54
|
|
|
Service Code
|
NDC 50268085911
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Aetna American Axle |
$1.00
|
| Rate for Payer: Aetna Commercial |
$1.31
|
| Rate for Payer: Aetna Medicare |
$0.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.00
|
| Rate for Payer: BCBS Complete |
$0.62
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Cofinity Advantage |
$1.08
|
| Rate for Payer: Cofinity Commercial |
$1.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.23
|
| Rate for Payer: Healthscope Commercial |
$1.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.16
|
| Rate for Payer: PHP Commercial |
$1.31
|
| Rate for Payer: Priority Health SBD |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.00
|
| Rate for Payer: UHC Core |
$0.80
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UMR Bronson Commercial |
$0.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.16
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
IP
|
$144.90
|
|
|
Service Code
|
NDC 57896085401
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.76 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna American Axle |
$94.19
|
| Rate for Payer: Aetna Commercial |
$123.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.19
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: Cofinity Advantage |
$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 |
$108.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.67
|
| Rate for Payer: PHP Commercial |
$123.17
|
| 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 |
$108.67
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
IP
|
$1.64
|
|
|
Service Code
|
NDC 77333094525
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna American Axle |
$1.07
|
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.07
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cofinity Advantage |
$1.15
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.31
|
| Rate for Payer: Healthscope Commercial |
$1.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.23
|
| Rate for Payer: PHP Commercial |
$1.39
|
| Rate for Payer: Priority Health SBD |
$1.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.23
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
OP
|
$1.64
|
|
|
Service Code
|
NDC 77333094525
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna American Axle |
$1.07
|
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Aetna Medicare |
$0.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.07
|
| Rate for Payer: BCBS Complete |
$0.66
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cofinity Advantage |
$1.15
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.31
|
| Rate for Payer: Healthscope Commercial |
$1.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.23
|
| Rate for Payer: PHP Commercial |
$1.39
|
| Rate for Payer: Priority Health SBD |
$1.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC Core |
$0.85
|
| Rate for Payer: UHC Exchange |
$0.64
|
| Rate for Payer: UMR Bronson Commercial |
$0.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.23
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
OP
|
$144.90
|
|
|
Service Code
|
NDC 57896085401
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.61 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna American Axle |
$94.19
|
| Rate for Payer: Aetna Commercial |
$123.17
|
| Rate for Payer: Aetna Medicare |
$72.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.19
|
| Rate for Payer: BCBS Complete |
$57.96
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: Cofinity Advantage |
$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 |
$108.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.67
|
| Rate for Payer: PHP Commercial |
$123.17
|
| Rate for Payer: Priority Health SBD |
$91.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.19
|
| Rate for Payer: UHC Core |
$75.49
|
| Rate for Payer: UHC Exchange |
$56.95
|
| Rate for Payer: UMR Bronson Commercial |
$53.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.67
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
NDC 50268085915
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna American Axle |
$50.05
|
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.05
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Advantage |
$53.90
|
| Rate for Payer: Cofinity Commercial |
$66.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.60
|
| Rate for Payer: Healthscope Commercial |
$69.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.75
|
| Rate for Payer: PHP Commercial |
$65.45
|
| Rate for Payer: Priority Health SBD |
$48.51
|
| Rate for Payer: UMR Bronson Commercial |
$33.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.75
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
NDC 50268085915
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna American Axle |
$50.05
|
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.05
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Advantage |
$53.90
|
| Rate for Payer: Cofinity Commercial |
$66.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.60
|
| Rate for Payer: Healthscope Commercial |
$69.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.75
|
| Rate for Payer: PHP Commercial |
$65.45
|
| Rate for Payer: Priority Health SBD |
$48.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.05
|
| Rate for Payer: UHC Core |
$40.12
|
| Rate for Payer: UHC Exchange |
$30.26
|
| Rate for Payer: UMR Bronson Commercial |
$28.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.75
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$94.50
|
|
|
Service Code
|
NDC 10006070012
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$85.05 |
| Rate for Payer: Aetna American Axle |
$61.42
|
| Rate for Payer: Aetna Commercial |
$80.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.42
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cofinity Advantage |
$66.15
|
| Rate for Payer: Cofinity Commercial |
$81.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.60
|
| Rate for Payer: Healthscope Commercial |
$85.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.88
|
| Rate for Payer: PHP Commercial |
$80.33
|
| Rate for Payer: Priority Health SBD |
$59.53
|
| Rate for Payer: UMR Bronson Commercial |
$41.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.88
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$176.40
|
|
|
Service Code
|
NDC 37864090901
|
| 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 Advantage |
$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 Commercial |
$149.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.30
|
| Rate for Payer: PHP Commercial |
$149.94
|
| 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
|
OP
|
$176.40
|
|
|
Service Code
|
NDC 37864090901
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.27 |
| Max. Negotiated Rate |
$158.76 |
| Rate for Payer: Aetna American Axle |
$114.66
|
| Rate for Payer: Aetna Commercial |
$149.94
|
| Rate for Payer: Aetna Medicare |
$88.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.66
|
| Rate for Payer: BCBS Complete |
$70.56
|
| Rate for Payer: Cash Price |
$141.12
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$141.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.30
|
| Rate for Payer: PHP Commercial |
$149.94
|
| Rate for Payer: Priority Health SBD |
$111.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.66
|
| Rate for Payer: UHC Core |
$91.90
|
| Rate for Payer: UHC Exchange |
$69.33
|
| Rate for Payer: UMR Bronson Commercial |
$65.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.30
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
NDC 10006073017
|
| 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 Advantage |
$86.80
|
| Rate for Payer: Cofinity Commercial |
$106.64
|
| 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 Commercial |
$105.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.00
|
| Rate for Payer: PHP Commercial |
$105.40
|
| 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
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$94.50
|
|
|
Service Code
|
NDC 10006070012
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.97 |
| Max. Negotiated Rate |
$85.05 |
| Rate for Payer: Aetna American Axle |
$61.42
|
| Rate for Payer: Aetna Commercial |
$80.33
|
| Rate for Payer: Aetna Medicare |
$47.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.42
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cofinity Advantage |
$66.15
|
| Rate for Payer: Cofinity Commercial |
$81.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.60
|
| Rate for Payer: Healthscope Commercial |
$85.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.88
|
| Rate for Payer: PHP Commercial |
$80.33
|
| Rate for Payer: Priority Health SBD |
$59.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.42
|
| Rate for Payer: UHC Core |
$49.23
|
| Rate for Payer: UHC Exchange |
$37.14
|
| Rate for Payer: UMR Bronson Commercial |
$34.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.88
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
NDC 10006073017
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna American Axle |
$80.60
|
| Rate for Payer: Aetna Commercial |
$105.40
|
| Rate for Payer: Aetna Medicare |
$62.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.60
|
| Rate for Payer: BCBS Complete |
$49.60
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Advantage |
$86.80
|
| Rate for Payer: Cofinity Commercial |
$106.64
|
| 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: MI Amish Medical Board Commercial |
$99.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.00
|
| Rate for Payer: PHP Commercial |
$105.40
|
| Rate for Payer: Priority Health SBD |
$78.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.60
|
| Rate for Payer: UHC Core |
$64.60
|
| Rate for Payer: UHC Exchange |
$48.73
|
| Rate for Payer: UMR Bronson Commercial |
$45.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.00
|
|
|
QUADRICEPSPLASTY (EG, BENNETT OR THOMPSON TYPE)
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 27430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,985.59
|
| Rate for Payer: BCN Commercial |
$4,985.59
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
QUETIAPINE 100MG/ML TOPICAL GEL CUSTOM
|
Facility
|
IP
|
$21.55
|
|
|
Service Code
|
NDC 09900000367
|
| Hospital Charge Code |
161484
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$19.39 |
| 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 Advantage |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.24
|
| Rate for Payer: Healthscope Commercial |
$19.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.16
|
| Rate for Payer: PHP Commercial |
$18.32
|
| 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
|
|
|
QUETIAPINE 100MG/ML TOPICAL GEL CUSTOM
|
Facility
|
OP
|
$21.55
|
|
|
Service Code
|
NDC 09900000367
|
| Hospital Charge Code |
161484
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Aetna American Axle |
$14.01
|
| Rate for Payer: Aetna Commercial |
$18.32
|
| Rate for Payer: Aetna Medicare |
$10.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.01
|
| Rate for Payer: BCBS Complete |
$8.62
|
| Rate for Payer: Cash Price |
$17.24
|
| Rate for Payer: Cofinity Advantage |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.24
|
| Rate for Payer: Healthscope Commercial |
$19.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.16
|
| Rate for Payer: PHP Commercial |
$18.32
|
| Rate for Payer: Priority Health SBD |
$13.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.01
|
| Rate for Payer: UHC Core |
$11.23
|
| Rate for Payer: UHC Exchange |
$8.47
|
| Rate for Payer: UMR Bronson Commercial |
$7.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.16
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$2.25
|
|
|
Service Code
|
NDC 60687034911
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna American Axle |
$1.46
|
| Rate for Payer: Aetna Commercial |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.46
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cofinity Advantage |
$1.57
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.80
|
| Rate for Payer: Healthscope Commercial |
$2.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.69
|
| Rate for Payer: PHP Commercial |
$1.91
|
| Rate for Payer: Priority Health SBD |
$1.42
|
| Rate for Payer: UMR Bronson Commercial |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.69
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$224.20
|
|
|
Service Code
|
NDC 60687034901
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.65 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna American Axle |
$145.73
|
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.73
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Advantage |
$156.94
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.15
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: UMR Bronson Commercial |
$98.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.15
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$2.25
|
|
|
Service Code
|
NDC 60687034911
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna American Axle |
$1.46
|
| Rate for Payer: Aetna Commercial |
$1.91
|
| Rate for Payer: Aetna Medicare |
$1.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.46
|
| Rate for Payer: BCBS Complete |
$0.90
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cofinity Advantage |
$1.57
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.80
|
| Rate for Payer: Healthscope Commercial |
$2.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.69
|
| Rate for Payer: PHP Commercial |
$1.91
|
| Rate for Payer: Priority Health SBD |
$1.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.46
|
| Rate for Payer: UHC Core |
$1.17
|
| Rate for Payer: UHC Exchange |
$0.88
|
| Rate for Payer: UMR Bronson Commercial |
$0.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.69
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 67877025001
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.39 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna American Axle |
$100.81
|
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare |
$77.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.81
|
| Rate for Payer: BCBS Complete |
$62.04
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Advantage |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.33
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health SBD |
$97.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.81
|
| Rate for Payer: UHC Core |
$80.81
|
| Rate for Payer: UHC Exchange |
$60.95
|
| Rate for Payer: UMR Bronson Commercial |
$57.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.33
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$204.25
|
|
|
Service Code
|
NDC 00904664061
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.87 |
| Max. Negotiated Rate |
$183.82 |
| Rate for Payer: Aetna American Axle |
$132.76
|
| Rate for Payer: Aetna Commercial |
$173.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.76
|
| Rate for Payer: Cash Price |
$163.40
|
| Rate for Payer: Cofinity Advantage |
$142.97
|
| Rate for Payer: Cofinity Commercial |
$175.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.40
|
| Rate for Payer: Healthscope Commercial |
$183.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.19
|
| Rate for Payer: PHP Commercial |
$173.61
|
| Rate for Payer: Priority Health SBD |
$128.68
|
| Rate for Payer: UMR Bronson Commercial |
$89.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.19
|
|
