|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
IP
|
$438.90
|
|
|
Service Code
|
NDC 62559047001
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.12 |
| Max. Negotiated Rate |
$395.01 |
| Rate for Payer: Aetna American Axle |
$285.29
|
| Rate for Payer: Aetna Commercial |
$373.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.29
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cofinity Commercial |
$307.23
|
| Rate for Payer: Cofinity Commercial |
$377.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.12
|
| Rate for Payer: Healthscope Commercial |
$395.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.06
|
| Rate for Payer: PHP Commercial |
$373.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.29
|
| Rate for Payer: Priority Health SBD |
$276.51
|
| Rate for Payer: UMR Bronson Commercial |
$193.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.18
|
|
|
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 Commercial |
$255.02
|
| Rate for Payer: Cofinity Commercial |
$313.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.02
|
| 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: PHP Commercial |
$309.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.81
|
| 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
|
$429.60
|
|
|
Service Code
|
NDC 00904662261
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.95 |
| Max. Negotiated Rate |
$386.64 |
| Rate for Payer: Aetna American Axle |
$279.24
|
| Rate for Payer: Aetna Commercial |
$365.16
|
| Rate for Payer: Aetna Medicare |
$214.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.24
|
| Rate for Payer: BCBS Complete |
$171.84
|
| Rate for Payer: Cash Price |
$343.68
|
| Rate for Payer: Cofinity Commercial |
$300.72
|
| Rate for Payer: Cofinity Commercial |
$369.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.68
|
| Rate for Payer: Healthscope Commercial |
$386.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.16
|
| Rate for Payer: PHP Commercial |
$365.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.24
|
| Rate for Payer: Priority Health SBD |
$270.65
|
| Rate for Payer: UMR Bronson Commercial |
$158.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.20
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
IP
|
$429.60
|
|
|
Service Code
|
NDC 00904662261
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.02 |
| Max. Negotiated Rate |
$386.64 |
| Rate for Payer: Aetna American Axle |
$279.24
|
| Rate for Payer: Aetna Commercial |
$365.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.24
|
| Rate for Payer: Cash Price |
$343.68
|
| Rate for Payer: Cofinity Commercial |
$300.72
|
| Rate for Payer: Cofinity Commercial |
$369.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.68
|
| Rate for Payer: Healthscope Commercial |
$386.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.16
|
| Rate for Payer: PHP Commercial |
$365.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.24
|
| Rate for Payer: Priority Health SBD |
$270.65
|
| Rate for Payer: UMR Bronson Commercial |
$189.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.20
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
OP
|
$438.90
|
|
|
Service Code
|
NDC 62559047001
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.39 |
| Max. Negotiated Rate |
$395.01 |
| Rate for Payer: Aetna American Axle |
$285.29
|
| Rate for Payer: Aetna Commercial |
$373.06
|
| Rate for Payer: Aetna Medicare |
$219.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.29
|
| Rate for Payer: BCBS Complete |
$175.56
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cofinity Commercial |
$307.23
|
| Rate for Payer: Cofinity Commercial |
$377.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.12
|
| Rate for Payer: Healthscope Commercial |
$395.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.06
|
| Rate for Payer: PHP Commercial |
$373.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.29
|
| Rate for Payer: Priority Health SBD |
$276.51
|
| Rate for Payer: UMR Bronson Commercial |
$162.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.18
|
|
|
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 Commercial |
$303.24
|
| Rate for Payer: Cofinity Commercial |
$372.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$303.24
|
| 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: PHP Commercial |
$368.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.58
|
| Rate for Payer: Priority Health SBD |
$272.92
|
| 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
|
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 Commercial |
$255.02
|
| Rate for Payer: Cofinity Commercial |
$313.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.02
|
| 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: PHP Commercial |
$309.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.81
|
| Rate for Payer: Priority Health SBD |
$229.52
|
| 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 Commercial |
$303.24
|
| Rate for Payer: Cofinity Commercial |
$372.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$303.24
|
| 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: PHP Commercial |
$368.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.58
|
| 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 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 Commercial |
$473.82
|
| Rate for Payer: Cofinity Commercial |
$582.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$473.82
|
| 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: PHP Commercial |
$575.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.97
|
| 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
|
$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 Commercial |
$473.82
|
| Rate for Payer: Cofinity Commercial |
$582.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$473.82
|
| 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: PHP Commercial |
$575.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.97
|
| Rate for Payer: Priority Health SBD |
$426.43
|
| Rate for Payer: UMR Bronson Commercial |
$250.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.66
|
|
|
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 |
$45.11 |
| 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: Cash Price |
$40.10
|
| Rate for Payer: Cofinity Commercial |
$35.08
|
| Rate for Payer: Cofinity Commercial |
$43.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.08
|
| 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: PHP Commercial |
$42.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.58
|
| Rate for Payer: Priority Health SBD |
$31.58
|
| Rate for Payer: UMR Bronson Commercial |
$18.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.59
|
|
|
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 Commercial |
$35.08
|
| Rate for Payer: Cofinity Commercial |
$43.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.08
|
| 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: PHP Commercial |
$42.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.58
|
| 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
|
$76.30
|
|
|
Service Code
|
NDC 50268085915
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$68.67 |
| Rate for Payer: Aetna American Axle |
$49.59
|
| Rate for Payer: Aetna Commercial |
$64.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.59
|
| Rate for Payer: Cash Price |
$61.04
|
| Rate for Payer: Cofinity Commercial |
$53.41
|
| Rate for Payer: Cofinity Commercial |
$65.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.04
|
| Rate for Payer: Healthscope Commercial |
$68.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.86
|
| Rate for Payer: PHP Commercial |
$64.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.59
|
| Rate for Payer: Priority Health SBD |
$48.07
|
| Rate for Payer: UMR Bronson Commercial |
$33.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.23
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
IP
|
$1.53
|
|
|
Service Code
|
NDC 50268085911
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna American Axle |
$0.99
|
| Rate for Payer: Aetna Commercial |
$1.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.99
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cofinity Commercial |
$1.07
|
| Rate for Payer: Cofinity Commercial |
$1.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.22
|
| Rate for Payer: Healthscope Commercial |
$1.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.30
|
| Rate for Payer: PHP Commercial |
$1.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.99
|
| Rate for Payer: Priority Health SBD |
$0.96
|
| Rate for Payer: UMR Bronson Commercial |
$0.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.15
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
OP
|
$1.53
|
|
|
Service Code
|
NDC 50268085911
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna American Axle |
$0.99
|
| Rate for Payer: Aetna Commercial |
$1.30
|
| Rate for Payer: Aetna Medicare |
$0.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.99
|
| Rate for Payer: BCBS Complete |
$0.61
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cofinity Commercial |
$1.07
|
| Rate for Payer: Cofinity Commercial |
$1.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.22
|
| Rate for Payer: Healthscope Commercial |
$1.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.30
|
| Rate for Payer: PHP Commercial |
$1.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.99
|
| Rate for Payer: Priority Health SBD |
$0.96
|
| Rate for Payer: UMR Bronson Commercial |
$0.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.15
|
|
|
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 Commercial |
$101.43
|
| Rate for Payer: Cofinity Commercial |
$124.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.43
|
| 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: PHP Commercial |
$123.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.19
|
| 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
|
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 Commercial |
$101.43
|
| Rate for Payer: Cofinity Commercial |
$124.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.43
|
| 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: PHP Commercial |
$123.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.19
|
| Rate for Payer: Priority Health SBD |
$91.29
|
| 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
|
OP
|
$76.30
|
|
|
Service Code
|
NDC 50268085915
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.23 |
| Max. Negotiated Rate |
$68.67 |
| Rate for Payer: Aetna American Axle |
$49.59
|
| Rate for Payer: Aetna Commercial |
$64.86
|
| Rate for Payer: Aetna Medicare |
$38.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.59
|
| Rate for Payer: BCBS Complete |
$30.52
|
| Rate for Payer: Cash Price |
$61.04
|
| Rate for Payer: Cofinity Commercial |
$53.41
|
| Rate for Payer: Cofinity Commercial |
$65.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.04
|
| Rate for Payer: Healthscope Commercial |
$68.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.86
|
| Rate for Payer: PHP Commercial |
$64.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.59
|
| Rate for Payer: Priority Health SBD |
$48.07
|
| Rate for Payer: UMR Bronson Commercial |
$28.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.23
|
|
|
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 Commercial |
$66.15
|
| Rate for Payer: Cofinity Commercial |
$81.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.15
|
| 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: PHP Commercial |
$80.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.42
|
| Rate for Payer: Priority Health SBD |
$59.53
|
| 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
|
$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 Commercial |
$123.48
|
| Rate for Payer: Cofinity Commercial |
$151.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.48
|
| 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: PHP Commercial |
$149.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.66
|
| Rate for Payer: Priority Health SBD |
$111.13
|
| 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
|
$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 Commercial |
$66.15
|
| Rate for Payer: Cofinity Commercial |
$81.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.15
|
| 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: PHP Commercial |
$80.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.42
|
| 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 Commercial |
$123.48
|
| Rate for Payer: Cofinity Commercial |
$151.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.48
|
| 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: PHP Commercial |
$149.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.66
|
| 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
|
$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 Commercial |
$106.64
|
| Rate for Payer: Cofinity Commercial |
$86.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.20
|
| Rate for Payer: Healthscope Commercial |
$111.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.40
|
| Rate for Payer: PHP Commercial |
$105.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health SBD |
$78.12
|
| Rate for Payer: UMR Bronson Commercial |
$45.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.00
|
|
|
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 Commercial |
$106.64
|
| Rate for Payer: Cofinity Commercial |
$86.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.20
|
| Rate for Payer: Healthscope Commercial |
$111.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.40
|
| Rate for Payer: PHP Commercial |
$105.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health SBD |
$78.12
|
| Rate for Payer: UMR Bronson Commercial |
$54.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.00
|
|
|
QUETIAPINE 100MG/ML TOPICAL GEL CUSTOM
|
Facility
|
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 Commercial |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.09
|
| 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: PHP Commercial |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.01
|
| Rate for Payer: Priority Health SBD |
$13.58
|
| Rate for Payer: UMR Bronson Commercial |
$7.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.16
|
|
