|
PSYLLIUM ORAL PACKET
|
Facility
|
IP
|
$8.85
|
|
|
Service Code
|
NDC 37000002410
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna American Axle |
$5.75
|
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.75
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$6.20
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Healthscope Commercial |
$7.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.52
|
| Rate for Payer: PHP Commercial |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.75
|
| Rate for Payer: Priority Health SBD |
$5.58
|
| Rate for Payer: UMR Bronson Commercial |
$3.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION
|
Facility
|
OP
|
$1,096.83
|
|
|
Service Code
|
CPT 11104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$744.66
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST
|
Facility
|
OP
|
$1,096.83
|
|
|
Service Code
|
CPT 10160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$744.66
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST
|
Facility
|
OP
|
$1,096.83
|
|
|
Service Code
|
CPT 10160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$744.66
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PUNCTURE ASPIRATION OF HYDROCELE, TUNICA VAGINALIS, WITH OR WITHOUT INJECTION OF MEDICATION
|
Facility
|
OP
|
$1,931.58
|
|
|
Service Code
|
CPT 55000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,311.40
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$1,368.63
|
|
|
Service Code
|
NDC 70954048430
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$602.20 |
| Max. Negotiated Rate |
$1,231.77 |
| Rate for Payer: Aetna American Axle |
$889.61
|
| Rate for Payer: Aetna Commercial |
$1,163.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.61
|
| Rate for Payer: Cash Price |
$1,094.90
|
| Rate for Payer: Cofinity Commercial |
$1,177.02
|
| Rate for Payer: Cofinity Commercial |
$958.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$958.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,094.90
|
| Rate for Payer: Healthscope Commercial |
$1,231.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$958.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,026.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.34
|
| Rate for Payer: PHP Commercial |
$1,163.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.61
|
| Rate for Payer: Priority Health SBD |
$862.24
|
| Rate for Payer: UMR Bronson Commercial |
$602.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,026.47
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
OP
|
$1,368.63
|
|
|
Service Code
|
NDC 70954048430
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$506.39 |
| Max. Negotiated Rate |
$1,231.77 |
| Rate for Payer: Aetna American Axle |
$889.61
|
| Rate for Payer: Aetna Commercial |
$1,163.34
|
| Rate for Payer: Aetna Medicare |
$684.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.61
|
| Rate for Payer: BCBS Complete |
$547.45
|
| Rate for Payer: Cash Price |
$1,094.90
|
| Rate for Payer: Cofinity Commercial |
$1,177.02
|
| Rate for Payer: Cofinity Commercial |
$958.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$958.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,094.90
|
| Rate for Payer: Healthscope Commercial |
$1,231.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$958.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,026.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.34
|
| Rate for Payer: PHP Commercial |
$1,163.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.61
|
| Rate for Payer: Priority Health SBD |
$862.24
|
| Rate for Payer: UMR Bronson Commercial |
$506.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,026.47
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$862.47
|
|
|
Service Code
|
NDC 70954048410
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$379.49 |
| Max. Negotiated Rate |
$776.22 |
| Rate for Payer: Aetna American Axle |
$560.61
|
| Rate for Payer: Aetna Commercial |
$733.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.61
|
| Rate for Payer: Cash Price |
$689.98
|
| Rate for Payer: Cofinity Commercial |
$603.73
|
| Rate for Payer: Cofinity Commercial |
$741.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$603.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.98
|
| Rate for Payer: Healthscope Commercial |
$776.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$603.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$646.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.10
|
| Rate for Payer: PHP Commercial |
$733.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.61
|
| Rate for Payer: Priority Health SBD |
$543.36
|
| Rate for Payer: UMR Bronson Commercial |
$379.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$646.85
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$948.17
|
|
|
Service Code
|
NDC 61748001206
|
| 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: Cofinity Medicare Advantage |
$663.72
|
| 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 Commercial |
$805.94
|
| Rate for Payer: PHP Commercial |
$805.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.31
|
| 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 61748001209
|
| 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 |
$1,221.41
|
| Rate for Payer: Cofinity Commercial |
$994.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$994.17
|
| 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 |
$994.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.21
|
| Rate for Payer: PHP Commercial |
$1,207.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.16
|
| 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
|
OP
|
$948.17
|
|
|
Service Code
|
NDC 61748001206
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$350.82 |
| Max. Negotiated Rate |
$853.35 |
| Rate for Payer: Aetna American Axle |
$616.31
|
| Rate for Payer: Aetna Commercial |
$805.94
|
| Rate for Payer: Aetna Medicare |
$474.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.31
|
| Rate for Payer: BCBS Complete |
$379.27
|
| Rate for Payer: Cash Price |
$758.54
|
| Rate for Payer: Cofinity Commercial |
$663.72
|
| Rate for Payer: Cofinity Commercial |
$815.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$663.72
|
| 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 Commercial |
$805.94
|
| Rate for Payer: PHP Commercial |
$805.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.31
|
| Rate for Payer: Priority Health SBD |
$597.35
|
| Rate for Payer: UMR Bronson Commercial |
$350.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.13
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
OP
|
$1,420.25
|
|
|
Service Code
|
NDC 61748001209
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$525.49 |
| 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 Medicare |
$710.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.16
|
| Rate for Payer: BCBS Complete |
$568.10
|
| Rate for Payer: Cash Price |
$1,136.20
|
| Rate for Payer: Cofinity Commercial |
$1,221.41
|
| Rate for Payer: Cofinity Commercial |
$994.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$994.17
|
| 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 |
$994.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.21
|
| Rate for Payer: PHP Commercial |
$1,207.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.16
|
| Rate for Payer: Priority Health SBD |
$894.76
|
| Rate for Payer: UMR Bronson Commercial |
$525.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.19
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
OP
|
$862.47
|
|
|
Service Code
|
NDC 70954048410
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$319.11 |
| Max. Negotiated Rate |
$776.22 |
| Rate for Payer: Aetna American Axle |
$560.61
|
| Rate for Payer: Aetna Commercial |
$733.10
|
| Rate for Payer: Aetna Medicare |
$431.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.61
|
| Rate for Payer: BCBS Complete |
$344.99
|
| Rate for Payer: Cash Price |
$689.98
|
| Rate for Payer: Cofinity Commercial |
$603.73
|
| Rate for Payer: Cofinity Commercial |
$741.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$603.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.98
|
| Rate for Payer: Healthscope Commercial |
$776.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$603.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$646.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.10
|
| Rate for Payer: PHP Commercial |
$733.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.61
|
| Rate for Payer: Priority Health SBD |
$543.36
|
| Rate for Payer: UMR Bronson Commercial |
$319.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$646.85
|
|
|
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 Commercial |
$352.18
|
| Rate for Payer: Cofinity Commercial |
$432.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$352.18
|
| 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: PHP Commercial |
$427.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.02
|
| Rate for Payer: Priority Health SBD |
$316.96
|
| Rate for Payer: UMR Bronson Commercial |
$186.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.33
|
|
|
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 Commercial |
$352.18
|
| Rate for Payer: Cofinity Commercial |
$432.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$352.18
|
| 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: PHP Commercial |
$427.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.02
|
| 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 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 Commercial |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$105.91
|
| Rate for Payer: PHP Commercial |
$105.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.99
|
| Rate for Payer: Priority Health SBD |
$78.50
|
| 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 Commercial |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$105.91
|
| Rate for Payer: PHP Commercial |
$105.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.99
|
| 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 Commercial |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$105.91
|
| Rate for Payer: PHP Commercial |
$105.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.99
|
| Rate for Payer: Priority Health SBD |
$78.50
|
| 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 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 Commercial |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$105.91
|
| Rate for Payer: PHP Commercial |
$105.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.99
|
| 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
|
OP
|
$6,043.10
|
|
|
Service Code
|
NDC 00187301220
|
| Hospital Charge Code |
11238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,235.95 |
| Max. Negotiated Rate |
$5,438.79 |
| Rate for Payer: Aetna American Axle |
$3,928.01
|
| Rate for Payer: Aetna Commercial |
$5,136.64
|
| Rate for Payer: Aetna Medicare |
$3,021.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,928.01
|
| Rate for Payer: BCBS Complete |
$2,417.24
|
| Rate for Payer: Cash Price |
$4,834.48
|
| Rate for Payer: Cofinity Commercial |
$4,230.17
|
| Rate for Payer: Cofinity Commercial |
$5,197.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,230.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,834.48
|
| Rate for Payer: Healthscope Commercial |
$5,438.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,230.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,532.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,136.64
|
| Rate for Payer: PHP Commercial |
$5,136.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,928.01
|
| Rate for Payer: Priority Health SBD |
$3,807.15
|
| Rate for Payer: UMR Bronson Commercial |
$2,235.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,532.32
|
|
|
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 Commercial |
$1,875.36
|
| Rate for Payer: Cofinity Commercial |
$2,304.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,875.36
|
| 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: PHP Commercial |
$2,277.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,741.40
|
| Rate for Payer: Priority Health SBD |
$1,687.82
|
| 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 Commercial |
$2,685.35
|
| Rate for Payer: Cofinity Commercial |
$3,299.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,685.35
|
| 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: PHP Commercial |
$3,260.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,493.54
|
| Rate for Payer: Priority Health SBD |
$2,416.82
|
| 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
|
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 Commercial |
$1,875.36
|
| Rate for Payer: Cofinity Commercial |
$2,304.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,875.36
|
| 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: PHP Commercial |
$2,277.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,741.40
|
| 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
|
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 Commercial |
$2,685.35
|
| Rate for Payer: Cofinity Commercial |
$3,299.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,685.35
|
| 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: PHP Commercial |
$3,260.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,493.54
|
| 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
|
$6,043.10
|
|
|
Service Code
|
NDC 00187301220
|
| Hospital Charge Code |
11238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,658.96 |
| Max. Negotiated Rate |
$5,438.79 |
| Rate for Payer: Aetna American Axle |
$3,928.01
|
| Rate for Payer: Aetna Commercial |
$5,136.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,928.01
|
| Rate for Payer: Cash Price |
$4,834.48
|
| Rate for Payer: Cofinity Commercial |
$4,230.17
|
| Rate for Payer: Cofinity Commercial |
$5,197.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,230.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,834.48
|
| Rate for Payer: Healthscope Commercial |
$5,438.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,230.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,532.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,136.64
|
| Rate for Payer: PHP Commercial |
$5,136.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,928.01
|
| Rate for Payer: Priority Health SBD |
$3,807.15
|
| Rate for Payer: UMR Bronson Commercial |
$2,658.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,532.32
|
|
