|
PHENYLEPHRINE 0.5 % NASAL SPRAY
|
Facility
|
IP
|
$17.96
|
|
|
Service Code
|
NDC 69536-050-15
|
| Hospital Charge Code |
6244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna American Axle |
$11.67
|
| Rate for Payer: Aetna Commercial |
$15.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.67
|
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: Cofinity Commercial |
$12.57
|
| Rate for Payer: Cofinity Commercial |
$15.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.37
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.27
|
| Rate for Payer: PHP Commercial |
$15.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.57
|
| Rate for Payer: Priority Health SBD |
$11.31
|
| Rate for Payer: UMR Bronson Commercial |
$7.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.47
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
IP
|
$119.25
|
|
|
Service Code
|
NDC 17478-206-05
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.47 |
| Max. Negotiated Rate |
$107.32 |
| Rate for Payer: Aetna American Axle |
$77.51
|
| Rate for Payer: Aetna Commercial |
$101.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.51
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cofinity Commercial |
$102.56
|
| Rate for Payer: Cofinity Commercial |
$83.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.40
|
| Rate for Payer: Healthscope Commercial |
$107.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.36
|
| Rate for Payer: PHP Commercial |
$101.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.48
|
| Rate for Payer: Priority Health SBD |
$75.13
|
| Rate for Payer: UMR Bronson Commercial |
$52.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.44
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
IP
|
$130.20
|
|
|
Service Code
|
NDC 42702-103-05
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$117.18 |
| Rate for Payer: Aetna American Axle |
$84.63
|
| Rate for Payer: Aetna Commercial |
$110.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.63
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cofinity Commercial |
$91.14
|
| Rate for Payer: Cofinity Commercial |
$111.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.16
|
| Rate for Payer: Healthscope Commercial |
$117.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.67
|
| Rate for Payer: PHP Commercial |
$110.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.14
|
| Rate for Payer: Priority Health SBD |
$82.03
|
| Rate for Payer: UMR Bronson Commercial |
$57.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.65
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
IP
|
$130.17
|
|
|
Service Code
|
NDC 70756-614-30
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.27 |
| Max. Negotiated Rate |
$117.15 |
| Rate for Payer: Aetna American Axle |
$84.61
|
| Rate for Payer: Aetna Commercial |
$110.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.61
|
| Rate for Payer: Cash Price |
$104.14
|
| Rate for Payer: Cofinity Commercial |
$91.12
|
| Rate for Payer: Cofinity Commercial |
$111.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.14
|
| Rate for Payer: Healthscope Commercial |
$117.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.64
|
| Rate for Payer: PHP Commercial |
$110.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.12
|
| Rate for Payer: Priority Health SBD |
$82.01
|
| Rate for Payer: UMR Bronson Commercial |
$57.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.63
|
|
|
PHENYLEPHRINE 10 MG IN NS 200 ML
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 9900-0002-09
|
| Hospital Charge Code |
155016
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna American Axle |
$22.75
|
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.75
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.75
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health SBD |
$22.05
|
| Rate for Payer: UMR Bronson Commercial |
$15.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$196.62
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.51 |
| Max. Negotiated Rate |
$176.96 |
| Rate for Payer: Aetna American Axle |
$127.80
|
| Rate for Payer: Aetna American Axle |
$97.55
|
| Rate for Payer: Aetna American Axle |
$119.04
|
| Rate for Payer: Aetna American Axle |
$192.35
|
| Rate for Payer: Aetna American Axle |
$41.00
|
| Rate for Payer: Aetna American Axle |
$120.93
|
| Rate for Payer: Aetna American Axle |
$66.45
|
| Rate for Payer: Aetna American Axle |
$13.50
|
| Rate for Payer: Aetna American Axle |
$114.80
|
| Rate for Payer: Aetna American Axle |
$141.28
|
| Rate for Payer: Aetna American Axle |
$10.52
|
| Rate for Payer: Aetna American Axle |
$155.42
|
| Rate for Payer: Aetna American Axle |
$179.74
|
| Rate for Payer: Aetna Commercial |
$203.24
|
| Rate for Payer: Aetna Commercial |
$158.13
|
| Rate for Payer: Aetna Commercial |
$53.62
|
| Rate for Payer: Aetna Commercial |
$86.90
|
| Rate for Payer: Aetna Commercial |
$235.04
|
| Rate for Payer: Aetna Commercial |
$127.57
|
| Rate for Payer: Aetna Commercial |
$13.76
|
| Rate for Payer: Aetna Commercial |
$184.76
|
| Rate for Payer: Aetna Commercial |
$150.12
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$155.67
|
| Rate for Payer: Aetna Commercial |
$251.54
|
| Rate for Payer: Aetna Commercial |
$167.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.74
|
| Rate for Payer: Cash Price |
$191.29
|
| Rate for Payer: Cash Price |
$221.22
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$236.74
|
| Rate for Payer: Cash Price |
$173.89
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Cash Price |
$81.78
|
| Rate for Payer: Cash Price |
$141.29
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cash Price |
$148.83
|
| Rate for Payer: Cash Price |
$146.51
|
| Rate for Payer: Cash Price |
$120.06
|
| Rate for Payer: Cofinity Commercial |
$123.63
|
| Rate for Payer: Cofinity Commercial |
$151.88
|
| Rate for Payer: Cofinity Commercial |
$237.81
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Cofinity Commercial |
$129.07
|
| Rate for Payer: Cofinity Commercial |
$13.92
|
| Rate for Payer: Cofinity Commercial |
$159.99
|
| Rate for Payer: Cofinity Commercial |
$11.33
|
| Rate for Payer: Cofinity Commercial |
$137.63
|
| Rate for Payer: Cofinity Commercial |
$207.15
|
| Rate for Payer: Cofinity Commercial |
$169.09
|
| Rate for Payer: Cofinity Commercial |
$44.16
|
| Rate for Payer: Cofinity Commercial |
$193.56
|
| Rate for Payer: Cofinity Commercial |
$54.25
|
| Rate for Payer: Cofinity Commercial |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$128.20
|
| Rate for Payer: Cofinity Commercial |
$157.50
|
| Rate for Payer: Cofinity Commercial |
$130.23
|
| Rate for Payer: Cofinity Commercial |
$254.50
|
| Rate for Payer: Cofinity Commercial |
$87.92
|
| Rate for Payer: Cofinity Commercial |
$71.56
|
| Rate for Payer: Cofinity Commercial |
$167.38
|
| Rate for Payer: Cofinity Commercial |
$152.15
|
| Rate for Payer: Cofinity Commercial |
$186.93
|
| Rate for Payer: Cofinity Commercial |
$105.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.22
|
| Rate for Payer: Healthscope Commercial |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$195.62
|
| Rate for Payer: Healthscope Commercial |
$164.83
|
| Rate for Payer: Healthscope Commercial |
$92.01
|
| Rate for Payer: Healthscope Commercial |
$176.96
|
| Rate for Payer: Healthscope Commercial |
$167.44
|
| Rate for Payer: Healthscope Commercial |
$248.87
|
| Rate for Payer: Healthscope Commercial |
$266.34
|
| Rate for Payer: Healthscope Commercial |
$56.77
|
| Rate for Payer: Healthscope Commercial |
$158.95
|
| Rate for Payer: Healthscope Commercial |
$135.07
|
| Rate for Payer: Healthscope Commercial |
$18.69
|
| Rate for Payer: Healthscope Commercial |
$215.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$167.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.04
|
| Rate for Payer: PHP Commercial |
$13.76
|
| Rate for Payer: PHP Commercial |
$127.57
|
| Rate for Payer: PHP Commercial |
$53.62
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$203.24
|
| Rate for Payer: PHP Commercial |
$251.54
|
| Rate for Payer: PHP Commercial |
$86.90
|
| Rate for Payer: PHP Commercial |
$150.12
|
| Rate for Payer: PHP Commercial |
$167.13
|
| Rate for Payer: PHP Commercial |
$158.13
|
| Rate for Payer: PHP Commercial |
$235.04
|
| Rate for Payer: PHP Commercial |
$155.67
|
| Rate for Payer: PHP Commercial |
$184.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.38
|
| Rate for Payer: Priority Health SBD |
$174.21
|
| Rate for Payer: Priority Health SBD |
$150.64
|
| Rate for Payer: Priority Health SBD |
$39.74
|
| Rate for Payer: Priority Health SBD |
$64.40
|
| Rate for Payer: Priority Health SBD |
$136.94
|
| Rate for Payer: Priority Health SBD |
$115.38
|
| Rate for Payer: Priority Health SBD |
$111.26
|
| Rate for Payer: Priority Health SBD |
$123.87
|
| Rate for Payer: Priority Health SBD |
$186.44
|
| Rate for Payer: Priority Health SBD |
$94.55
|
| Rate for Payer: Priority Health SBD |
$10.20
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: Priority Health SBD |
$117.21
|
| Rate for Payer: UMR Bronson Commercial |
$80.58
|
| Rate for Payer: UMR Bronson Commercial |
$44.98
|
| Rate for Payer: UMR Bronson Commercial |
$66.04
|
| Rate for Payer: UMR Bronson Commercial |
$7.12
|
| Rate for Payer: UMR Bronson Commercial |
$77.71
|
| Rate for Payer: UMR Bronson Commercial |
$81.86
|
| Rate for Payer: UMR Bronson Commercial |
$86.51
|
| Rate for Payer: UMR Bronson Commercial |
$9.14
|
| Rate for Payer: UMR Bronson Commercial |
$95.64
|
| Rate for Payer: UMR Bronson Commercial |
$105.21
|
| Rate for Payer: UMR Bronson Commercial |
$121.67
|
| Rate for Payer: UMR Bronson Commercial |
$130.21
|
| Rate for Payer: UMR Bronson Commercial |
$27.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.31
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
IP
|
$23.19
|
|
|
Service Code
|
NDC 70092-1046-46
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$20.87 |
| Rate for Payer: Aetna American Axle |
$15.07
|
| Rate for Payer: Aetna Commercial |
$19.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.07
|
| Rate for Payer: Cash Price |
$18.55
|
| Rate for Payer: Cofinity Commercial |
$16.23
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.55
|
| Rate for Payer: Healthscope Commercial |
$20.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.71
|
| Rate for Payer: PHP Commercial |
$19.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health SBD |
$14.61
|
| Rate for Payer: UMR Bronson Commercial |
$10.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.39
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 69374-957-10
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna American Axle |
$2.76
|
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.61
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health SBD |
$2.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.19
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 9900-0010-05
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna American Axle |
$0.98
|
| Rate for Payer: Aetna Commercial |
$1.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.98
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cofinity Commercial |
$1.05
|
| Rate for Payer: Cofinity Commercial |
$1.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.20
|
| Rate for Payer: Healthscope Commercial |
$1.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.28
|
| Rate for Payer: PHP Commercial |
$1.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.05
|
| Rate for Payer: Priority Health SBD |
$0.95
|
| Rate for Payer: UMR Bronson Commercial |
$0.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
PHENYLEPHRINE 20MG/250ML NS (IV PREMIX)
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
NDC 9900-0001-62
|
| Hospital Charge Code |
500533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Aetna American Axle |
$6.18
|
| Rate for Payer: Aetna Commercial |
$8.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.18
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Cofinity Commercial |
$6.65
|
| Rate for Payer: Cofinity Commercial |
$8.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.60
|
| Rate for Payer: Healthscope Commercial |
$8.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.08
|
| Rate for Payer: PHP Commercial |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.65
|
| Rate for Payer: Priority Health SBD |
$5.98
|
| Rate for Payer: UMR Bronson Commercial |
$4.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.12
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
IP
|
$294.63
|
|
|
Service Code
|
NDC 42702-102-15
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.64 |
| Max. Negotiated Rate |
$265.17 |
| Rate for Payer: Aetna American Axle |
$191.51
|
| Rate for Payer: Aetna Commercial |
$250.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.51
|
| Rate for Payer: Cash Price |
$235.70
|
| Rate for Payer: Cofinity Commercial |
$206.24
|
| Rate for Payer: Cofinity Commercial |
$253.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.70
|
| Rate for Payer: Healthscope Commercial |
$265.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.44
|
| Rate for Payer: PHP Commercial |
$250.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.24
|
| Rate for Payer: Priority Health SBD |
$185.62
|
| Rate for Payer: UMR Bronson Commercial |
$129.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.97
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
IP
|
$292.90
|
|
|
Service Code
|
NDC 70756-649-35
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.88 |
| Max. Negotiated Rate |
$263.61 |
| Rate for Payer: Aetna American Axle |
$190.38
|
| Rate for Payer: Aetna Commercial |
$248.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.38
|
| Rate for Payer: Cash Price |
$234.32
|
| Rate for Payer: Cofinity Commercial |
$205.03
|
| Rate for Payer: Cofinity Commercial |
$251.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.32
|
| Rate for Payer: Healthscope Commercial |
$263.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.96
|
| Rate for Payer: PHP Commercial |
$248.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.03
|
| Rate for Payer: Priority Health SBD |
$184.53
|
| Rate for Payer: UMR Bronson Commercial |
$128.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.68
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
IP
|
$83.83
|
|
|
Service Code
|
NDC 70756-629-25
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.89 |
| Max. Negotiated Rate |
$75.45 |
| Rate for Payer: Aetna American Axle |
$54.49
|
| Rate for Payer: Aetna Commercial |
$71.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.49
|
| Rate for Payer: Cash Price |
$67.06
|
| Rate for Payer: Cofinity Commercial |
$58.68
|
| Rate for Payer: Cofinity Commercial |
$72.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.06
|
| Rate for Payer: Healthscope Commercial |
$75.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.26
|
| Rate for Payer: PHP Commercial |
$71.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.68
|
| Rate for Payer: Priority Health SBD |
$52.81
|
| Rate for Payer: UMR Bronson Commercial |
$36.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.87
|
|
|
PHENYLEPHRINE IV INFUSION (INTRA-OP)
|
Facility
|
IP
|
$16.25
|
|
|
Service Code
|
NDC 9900-0003-62
|
| Hospital Charge Code |
155179
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna American Axle |
$10.56
|
| Rate for Payer: Aetna Commercial |
$13.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.56
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.00
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.81
|
| Rate for Payer: PHP Commercial |
$13.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.38
|
| Rate for Payer: Priority Health SBD |
$10.24
|
| Rate for Payer: UMR Bronson Commercial |
$7.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.19
|
|
|
PHENYTOIN 100 MG/4 ML ORAL SUSPENSION
|
Facility
|
IP
|
$21.17
|
|
|
Service Code
|
NDC 66689-036-01
|
| Hospital Charge Code |
118124
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna American Axle |
$13.76
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.76
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.99
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.82
|
| Rate for Payer: Priority Health SBD |
$13.34
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.88
|
|
|
PHENYTOIN 100 MG/4 ML ORAL SUSPENSION
|
Facility
|
IP
|
$21.17
|
|
|
Service Code
|
NDC 66689-036-50
|
| Hospital Charge Code |
118124
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna American Axle |
$13.76
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.76
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.99
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.82
|
| Rate for Payer: Priority Health SBD |
$13.34
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.88
|
|
|
PHENYTOIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$590.37
|
|
|
Service Code
|
NDC 60432-131-08
|
| Hospital Charge Code |
6255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.76 |
| Max. Negotiated Rate |
$531.33 |
| Rate for Payer: Aetna American Axle |
$383.74
|
| Rate for Payer: Aetna Commercial |
$501.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.74
|
| Rate for Payer: Cash Price |
$472.30
|
| Rate for Payer: Cofinity Commercial |
$413.26
|
| Rate for Payer: Cofinity Commercial |
$507.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.30
|
| Rate for Payer: Healthscope Commercial |
$531.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$413.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$501.81
|
| Rate for Payer: PHP Commercial |
$501.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$413.26
|
| Rate for Payer: Priority Health SBD |
$371.93
|
| Rate for Payer: UMR Bronson Commercial |
$259.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.78
|
|
|
PHENYTOIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$256.20
|
|
|
Service Code
|
NDC 51672-4069-1
|
| Hospital Charge Code |
6255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.73 |
| Max. Negotiated Rate |
$230.58 |
| Rate for Payer: Aetna American Axle |
$166.53
|
| Rate for Payer: Aetna Commercial |
$217.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.53
|
| Rate for Payer: Cash Price |
$204.96
|
| Rate for Payer: Cofinity Commercial |
$179.34
|
| Rate for Payer: Cofinity Commercial |
$220.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.96
|
| Rate for Payer: Healthscope Commercial |
$230.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.77
|
| Rate for Payer: PHP Commercial |
$217.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.34
|
| Rate for Payer: Priority Health SBD |
$161.41
|
| Rate for Payer: UMR Bronson Commercial |
$112.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.15
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
IP
|
$950.40
|
|
|
Service Code
|
NDC 0071-0007-40
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$418.18 |
| Max. Negotiated Rate |
$855.36 |
| Rate for Payer: Aetna American Axle |
$617.76
|
| Rate for Payer: Aetna Commercial |
$807.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.76
|
| Rate for Payer: Cash Price |
$760.32
|
| Rate for Payer: Cofinity Commercial |
$665.28
|
| Rate for Payer: Cofinity Commercial |
$817.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.32
|
| Rate for Payer: Healthscope Commercial |
$855.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$665.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$712.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$807.84
|
| Rate for Payer: PHP Commercial |
$807.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.28
|
| Rate for Payer: Priority Health SBD |
$598.75
|
| Rate for Payer: UMR Bronson Commercial |
$418.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$712.80
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
IP
|
$216.60
|
|
|
Service Code
|
NDC 51672-4146-1
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$194.94 |
| Rate for Payer: Aetna American Axle |
$140.79
|
| Rate for Payer: Aetna Commercial |
$184.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.79
|
| Rate for Payer: Cash Price |
$173.28
|
| Rate for Payer: Cofinity Commercial |
$151.62
|
| Rate for Payer: Cofinity Commercial |
$186.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.28
|
| Rate for Payer: Healthscope Commercial |
$194.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.11
|
| Rate for Payer: PHP Commercial |
$184.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.62
|
| Rate for Payer: Priority Health SBD |
$136.46
|
| Rate for Payer: UMR Bronson Commercial |
$95.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.45
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
IP
|
$146.16
|
|
|
Service Code
|
NDC 0904-7199-07
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.31 |
| Max. Negotiated Rate |
$131.54 |
| Rate for Payer: Aetna American Axle |
$95.00
|
| Rate for Payer: Aetna Commercial |
$124.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.00
|
| Rate for Payer: Cash Price |
$116.93
|
| Rate for Payer: Cofinity Commercial |
$102.31
|
| Rate for Payer: Cofinity Commercial |
$125.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.93
|
| Rate for Payer: Healthscope Commercial |
$131.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.24
|
| Rate for Payer: PHP Commercial |
$124.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.31
|
| Rate for Payer: Priority Health SBD |
$92.08
|
| Rate for Payer: UMR Bronson Commercial |
$64.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.62
|
|
|
PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14.97
|
|
|
Service Code
|
HCPCS J1165
|
| Hospital Charge Code |
6256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$13.47 |
| Rate for Payer: Aetna American Axle |
$9.73
|
| Rate for Payer: Aetna American Axle |
$14.00
|
| Rate for Payer: Aetna American Axle |
$15.69
|
| Rate for Payer: Aetna American Axle |
$13.53
|
| Rate for Payer: Aetna Commercial |
$18.31
|
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Commercial |
$20.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.73
|
| Rate for Payer: Cash Price |
$17.23
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$19.31
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$20.76
|
| Rate for Payer: Cofinity Commercial |
$16.90
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$10.48
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$18.52
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.23
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Healthscope Commercial |
$13.47
|
| Rate for Payer: Healthscope Commercial |
$19.39
|
| Rate for Payer: Healthscope Commercial |
$21.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.72
|
| Rate for Payer: PHP Commercial |
$20.52
|
| Rate for Payer: PHP Commercial |
$18.31
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$12.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.08
|
| Rate for Payer: Priority Health SBD |
$9.43
|
| Rate for Payer: Priority Health SBD |
$13.57
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: Priority Health SBD |
$15.21
|
| Rate for Payer: UMR Bronson Commercial |
$6.59
|
| Rate for Payer: UMR Bronson Commercial |
$9.48
|
| Rate for Payer: UMR Bronson Commercial |
$10.62
|
| Rate for Payer: UMR Bronson Commercial |
$9.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$452.20
|
|
|
Service Code
|
NDC 68084-376-11
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.97 |
| Max. Negotiated Rate |
$406.98 |
| Rate for Payer: Aetna American Axle |
$293.93
|
| Rate for Payer: Aetna Commercial |
$384.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.93
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Cofinity Commercial |
$316.54
|
| Rate for Payer: Cofinity Commercial |
$388.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.76
|
| Rate for Payer: Healthscope Commercial |
$406.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$384.37
|
| Rate for Payer: PHP Commercial |
$384.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.54
|
| Rate for Payer: Priority Health SBD |
$284.89
|
| Rate for Payer: UMR Bronson Commercial |
$198.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.15
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$382.85
|
|
|
Service Code
|
NDC 0904-6187-61
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.45 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna American Axle |
$248.85
|
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.85
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Commercial |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.42
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.00
|
| Rate for Payer: Priority Health SBD |
$241.20
|
| Rate for Payer: UMR Bronson Commercial |
$168.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.14
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$715.20
|
|
|
Service Code
|
NDC 0071-0369-24
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.69 |
| Max. Negotiated Rate |
$643.68 |
| Rate for Payer: Aetna American Axle |
$464.88
|
| Rate for Payer: Aetna Commercial |
$607.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.88
|
| Rate for Payer: Cash Price |
$572.16
|
| Rate for Payer: Cofinity Commercial |
$500.64
|
| Rate for Payer: Cofinity Commercial |
$615.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.16
|
| Rate for Payer: Healthscope Commercial |
$643.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$500.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$536.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$607.92
|
| Rate for Payer: PHP Commercial |
$607.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$500.64
|
| Rate for Payer: Priority Health SBD |
$450.58
|
| Rate for Payer: UMR Bronson Commercial |
$314.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$536.40
|
|
