|
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 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 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
|
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 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 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 |
$3,928.02
|
| Rate for Payer: Aetna Commercial |
$5,136.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,928.02
|
| 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 |
$3,928.02
|
| 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
|
|
|
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
|
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
|
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 |
$3,928.02
|
| Rate for Payer: Aetna Commercial |
$5,136.64
|
| Rate for Payer: Aetna Medicare |
$3,021.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,928.02
|
| 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 |
$3,928.02
|
| 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
|
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 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 |
$285.28
|
| Rate for Payer: Aetna Commercial |
$373.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.28
|
| 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 |
$285.28
|
| 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
|
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 |
$285.28
|
| Rate for Payer: Aetna Commercial |
$373.06
|
| Rate for Payer: Aetna Medicare |
$219.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.28
|
| 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 |
$285.28
|
| 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
|
$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
|
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
|
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 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
|
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 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
|
|
|
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
|
|
|
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 |
$47.56 |
| Rate for Payer: Aetna American Axle |
$32.58
|
| Rate for Payer: Aetna Commercial |
$42.60
|
| Rate for Payer: Aetna Medicare |
$25.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.58
|
| Rate for Payer: BCBS Complete |
$20.05
|
| Rate for Payer: BCBS Trust/PPO |
$47.56
|
| Rate for Payer: BCN Commercial |
$47.56
|
| Rate for Payer: Cash Price |
$40.10
|
| 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
|
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 |
$49.60
|
| Rate for Payer: Aetna Commercial |
$64.86
|
| Rate for Payer: Aetna Medicare |
$38.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.60
|
| 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 |
$57.22
|
| 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 |
$49.60
|
| 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 |
$57.22
|
|
|
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
|
|
