|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
IP
|
$374.30
|
|
|
Service Code
|
NDC 00904657561
|
| Hospital Charge Code |
6217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.69 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna American Axle |
$243.29
|
| Rate for Payer: Aetna Commercial |
$318.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.29
|
| Rate for Payer: Cash Price |
$299.44
|
| Rate for Payer: Cofinity Advantage |
$262.01
|
| Rate for Payer: Cofinity Commercial |
$321.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.44
|
| Rate for Payer: Healthscope Commercial |
$336.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.73
|
| Rate for Payer: PHP Commercial |
$318.15
|
| Rate for Payer: Priority Health SBD |
$235.81
|
| Rate for Payer: UMR Bronson Commercial |
$164.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.73
|
|
|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
IP
|
$240.96
|
|
|
Service Code
|
NDC 00603516621
|
| Hospital Charge Code |
6217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.02 |
| Max. Negotiated Rate |
$216.86 |
| Rate for Payer: Aetna American Axle |
$156.62
|
| Rate for Payer: Aetna Commercial |
$204.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.62
|
| Rate for Payer: Cash Price |
$192.77
|
| Rate for Payer: Cofinity Advantage |
$168.67
|
| Rate for Payer: Cofinity Commercial |
$207.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.77
|
| Rate for Payer: Healthscope Commercial |
$216.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.72
|
| Rate for Payer: PHP Commercial |
$204.82
|
| Rate for Payer: Priority Health SBD |
$151.80
|
| Rate for Payer: UMR Bronson Commercial |
$106.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.72
|
|
|
PHENOBARBITAL 97.2 MG TABLET
|
Facility
|
OP
|
$202.35
|
|
|
Service Code
|
NDC 16571066801
|
| Hospital Charge Code |
6220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.87 |
| Max. Negotiated Rate |
$182.12 |
| Rate for Payer: Aetna American Axle |
$131.53
|
| Rate for Payer: Aetna Commercial |
$172.00
|
| Rate for Payer: Aetna Medicare |
$101.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.53
|
| Rate for Payer: BCBS Complete |
$80.94
|
| Rate for Payer: Cash Price |
$161.88
|
| Rate for Payer: Cofinity Advantage |
$141.65
|
| Rate for Payer: Cofinity Commercial |
$174.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.88
|
| Rate for Payer: Healthscope Commercial |
$182.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.76
|
| Rate for Payer: PHP Commercial |
$172.00
|
| Rate for Payer: Priority Health SBD |
$127.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.53
|
| Rate for Payer: UHC Core |
$105.42
|
| Rate for Payer: UHC Exchange |
$79.52
|
| Rate for Payer: UMR Bronson Commercial |
$74.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.76
|
|
|
PHENOBARBITAL 97.2 MG TABLET
|
Facility
|
IP
|
$202.35
|
|
|
Service Code
|
NDC 16571066801
|
| Hospital Charge Code |
6220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.03 |
| Max. Negotiated Rate |
$182.12 |
| Rate for Payer: Aetna American Axle |
$131.53
|
| Rate for Payer: Aetna Commercial |
$172.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.53
|
| Rate for Payer: Cash Price |
$161.88
|
| Rate for Payer: Cofinity Advantage |
$141.65
|
| Rate for Payer: Cofinity Commercial |
$174.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.88
|
| Rate for Payer: Healthscope Commercial |
$182.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.76
|
| Rate for Payer: PHP Commercial |
$172.00
|
| Rate for Payer: Priority Health SBD |
$127.48
|
| Rate for Payer: UMR Bronson Commercial |
$89.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.76
|
|
|
PHENOBARBITAL 97.2 MG TABLET
|
Facility
|
OP
|
$425.76
|
|
|
Service Code
|
NDC 51293062801
|
| Hospital Charge Code |
6220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.53 |
| Max. Negotiated Rate |
$383.18 |
| Rate for Payer: Aetna American Axle |
$276.74
|
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Aetna Medicare |
$212.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.74
|
| Rate for Payer: BCBS Complete |
$170.30
|
| Rate for Payer: Cash Price |
$340.61
|
| Rate for Payer: Cofinity Advantage |
$298.03
|
| Rate for Payer: Cofinity Commercial |
$366.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.61
|
| Rate for Payer: Healthscope Commercial |
$383.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.32
|
| Rate for Payer: PHP Commercial |
$361.90
|
| Rate for Payer: Priority Health SBD |
$268.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.74
|
| Rate for Payer: UHC Core |
$221.82
|
| Rate for Payer: UHC Exchange |
$167.32
|
| Rate for Payer: UMR Bronson Commercial |
$157.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.32
|
|
|
PHENOBARBITAL 97.2 MG TABLET
|
Facility
|
OP
|
$425.28
|
|
|
Service Code
|
NDC 00603516821
|
| Hospital Charge Code |
6220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.35 |
| Max. Negotiated Rate |
$382.75 |
| Rate for Payer: Aetna American Axle |
$276.43
|
| Rate for Payer: Aetna Commercial |
$361.49
|
| Rate for Payer: Aetna Medicare |
$212.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.43
|
| Rate for Payer: BCBS Complete |
$170.11
|
| Rate for Payer: Cash Price |
$340.22
|
| Rate for Payer: Cofinity Advantage |
$297.70
|
| Rate for Payer: Cofinity Commercial |
$365.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.22
|
| Rate for Payer: Healthscope Commercial |
$382.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.96
|
| Rate for Payer: PHP Commercial |
$361.49
|
| Rate for Payer: Priority Health SBD |
$267.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.43
|
| Rate for Payer: UHC Core |
$221.57
|
| Rate for Payer: UHC Exchange |
$167.14
|
| Rate for Payer: UMR Bronson Commercial |
$157.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.96
|
|
|
PHENOBARBITAL 97.2 MG TABLET
|
Facility
|
IP
|
$425.76
|
|
|
Service Code
|
NDC 51293062801
|
| Hospital Charge Code |
6220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.33 |
| Max. Negotiated Rate |
$383.18 |
| Rate for Payer: Aetna American Axle |
$276.74
|
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.74
|
| Rate for Payer: Cash Price |
$340.61
|
| Rate for Payer: Cofinity Advantage |
$298.03
|
| Rate for Payer: Cofinity Commercial |
$366.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.61
|
| Rate for Payer: Healthscope Commercial |
$383.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.32
|
| Rate for Payer: PHP Commercial |
$361.90
|
| Rate for Payer: Priority Health SBD |
$268.23
|
| Rate for Payer: UMR Bronson Commercial |
$187.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.32
|
|
|
PHENOBARBITAL 97.2 MG TABLET
|
Facility
|
IP
|
$425.28
|
|
|
Service Code
|
NDC 00603516821
|
| Hospital Charge Code |
6220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.12 |
| Max. Negotiated Rate |
$382.75 |
| Rate for Payer: Aetna American Axle |
$276.43
|
| Rate for Payer: Aetna Commercial |
$361.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.43
|
| Rate for Payer: Cash Price |
$340.22
|
| Rate for Payer: Cofinity Advantage |
$297.70
|
| Rate for Payer: Cofinity Commercial |
$365.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.22
|
| Rate for Payer: Healthscope Commercial |
$382.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.96
|
| Rate for Payer: PHP Commercial |
$361.49
|
| Rate for Payer: Priority Health SBD |
$267.93
|
| Rate for Payer: UMR Bronson Commercial |
$187.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.96
|
|
|
PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$180.42
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
6221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.98 |
| Max. Negotiated Rate |
$162.38 |
| Rate for Payer: Aetna American Axle |
$117.27
|
| Rate for Payer: Aetna American Axle |
$81.97
|
| Rate for Payer: Aetna American Axle |
$184.04
|
| Rate for Payer: Aetna Commercial |
$153.36
|
| Rate for Payer: Aetna Commercial |
$240.67
|
| Rate for Payer: Aetna Commercial |
$107.19
|
| Rate for Payer: Aetna Medicare |
$90.21
|
| Rate for Payer: Aetna Medicare |
$63.05
|
| Rate for Payer: Aetna Medicare |
$141.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.04
|
| Rate for Payer: BCBS Complete |
$50.44
|
| Rate for Payer: BCBS Complete |
$72.17
|
| Rate for Payer: BCBS Complete |
$113.26
|
| Rate for Payer: BCBS Trust/PPO |
$94.27
|
| Rate for Payer: BCBS Trust/PPO |
$94.27
|
| Rate for Payer: BCBS Trust/PPO |
$94.27
|
| Rate for Payer: BCN Commercial |
$94.27
|
| Rate for Payer: BCN Commercial |
$94.27
|
| Rate for Payer: BCN Commercial |
$94.27
|
| Rate for Payer: Cash Price |
$100.89
|
| Rate for Payer: Cash Price |
$100.89
|
| Rate for Payer: Cash Price |
$226.51
|
| Rate for Payer: Cash Price |
$226.51
|
| Rate for Payer: Cash Price |
$144.34
|
| Rate for Payer: Cash Price |
$144.34
|
| Rate for Payer: Cofinity Advantage |
$198.20
|
| Rate for Payer: Cofinity Advantage |
$126.29
|
| Rate for Payer: Cofinity Advantage |
$88.28
|
| Rate for Payer: Cofinity Commercial |
$108.45
|
| Rate for Payer: Cofinity Commercial |
$155.16
|
| Rate for Payer: Cofinity Commercial |
$243.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.34
|
| Rate for Payer: Healthscope Commercial |
$113.50
|
| Rate for Payer: Healthscope Commercial |
$162.38
|
| Rate for Payer: Healthscope Commercial |
$254.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.35
|
| Rate for Payer: PHP Commercial |
$153.36
|
| Rate for Payer: PHP Commercial |
$107.19
|
| Rate for Payer: PHP Commercial |
$240.67
|
| Rate for Payer: Priority Health SBD |
$79.45
|
| Rate for Payer: Priority Health SBD |
$178.38
|
| Rate for Payer: Priority Health SBD |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.98
|
| Rate for Payer: UHC Core |
$47.98
|
| Rate for Payer: UHC Core |
$47.98
|
| Rate for Payer: UHC Core |
$47.98
|
| Rate for Payer: UHC Exchange |
$47.98
|
| Rate for Payer: UHC Exchange |
$47.98
|
| Rate for Payer: UHC Exchange |
$47.98
|
| Rate for Payer: UMR Bronson Commercial |
$104.76
|
| Rate for Payer: UMR Bronson Commercial |
$46.66
|
| Rate for Payer: UMR Bronson Commercial |
$66.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.35
|
|
|
PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$126.11
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
6221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.49 |
| Max. Negotiated Rate |
$113.50 |
| Rate for Payer: Aetna American Axle |
$81.97
|
| Rate for Payer: Aetna American Axle |
$184.04
|
| Rate for Payer: Aetna American Axle |
$117.27
|
| Rate for Payer: Aetna Commercial |
$153.36
|
| Rate for Payer: Aetna Commercial |
$107.19
|
| Rate for Payer: Aetna Commercial |
$240.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.27
|
| Rate for Payer: Cash Price |
$144.34
|
| Rate for Payer: Cash Price |
$100.89
|
| Rate for Payer: Cash Price |
$226.51
|
| Rate for Payer: Cofinity Advantage |
$198.20
|
| Rate for Payer: Cofinity Advantage |
$88.28
|
| Rate for Payer: Cofinity Advantage |
$126.29
|
| Rate for Payer: Cofinity Commercial |
$243.50
|
| Rate for Payer: Cofinity Commercial |
$108.45
|
| Rate for Payer: Cofinity Commercial |
$155.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.51
|
| Rate for Payer: Healthscope Commercial |
$162.38
|
| Rate for Payer: Healthscope Commercial |
$254.83
|
| Rate for Payer: Healthscope Commercial |
$113.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.35
|
| Rate for Payer: PHP Commercial |
$153.36
|
| Rate for Payer: PHP Commercial |
$107.19
|
| Rate for Payer: PHP Commercial |
$240.67
|
| Rate for Payer: Priority Health SBD |
$79.45
|
| Rate for Payer: Priority Health SBD |
$113.66
|
| Rate for Payer: Priority Health SBD |
$178.38
|
| Rate for Payer: UMR Bronson Commercial |
$55.49
|
| Rate for Payer: UMR Bronson Commercial |
$124.58
|
| Rate for Payer: UMR Bronson Commercial |
$79.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.35
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
OP
|
$10.98
|
|
|
Service Code
|
NDC 78112069480
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$9.88 |
| Rate for Payer: Aetna American Axle |
$7.14
|
| Rate for Payer: Aetna Commercial |
$9.33
|
| Rate for Payer: Aetna Medicare |
$5.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.14
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cofinity Advantage |
$7.69
|
| Rate for Payer: Cofinity Commercial |
$9.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Healthscope Commercial |
$9.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.23
|
| Rate for Payer: PHP Commercial |
$9.33
|
| Rate for Payer: Priority Health SBD |
$6.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.14
|
| Rate for Payer: UHC Core |
$5.72
|
| Rate for Payer: UHC Exchange |
$4.32
|
| Rate for Payer: UMR Bronson Commercial |
$4.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.23
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$10.98
|
|
|
Service Code
|
NDC 78112069480
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$9.88 |
| Rate for Payer: Aetna American Axle |
$7.14
|
| Rate for Payer: Aetna Commercial |
$9.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.14
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cofinity Advantage |
$7.69
|
| Rate for Payer: Cofinity Commercial |
$9.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Healthscope Commercial |
$9.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.23
|
| Rate for Payer: PHP Commercial |
$9.33
|
| Rate for Payer: Priority Health SBD |
$6.92
|
| Rate for Payer: UMR Bronson Commercial |
$4.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.23
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
OP
|
$11.95
|
|
|
Service Code
|
NDC 00536122858
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.76 |
| Rate for Payer: Aetna American Axle |
$7.77
|
| Rate for Payer: Aetna Commercial |
$10.16
|
| Rate for Payer: Aetna Medicare |
$5.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.77
|
| Rate for Payer: BCBS Complete |
$4.78
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Cofinity Advantage |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$10.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.56
|
| Rate for Payer: Healthscope Commercial |
$10.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.96
|
| Rate for Payer: PHP Commercial |
$10.16
|
| Rate for Payer: Priority Health SBD |
$7.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.77
|
| Rate for Payer: UHC Core |
$6.23
|
| Rate for Payer: UHC Exchange |
$4.70
|
| Rate for Payer: UMR Bronson Commercial |
$4.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.96
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$11.95
|
|
|
Service Code
|
NDC 00536122858
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$10.76 |
| Rate for Payer: Aetna American Axle |
$7.77
|
| Rate for Payer: Aetna Commercial |
$10.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.77
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Cofinity Advantage |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$10.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.56
|
| Rate for Payer: Healthscope Commercial |
$10.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.96
|
| Rate for Payer: PHP Commercial |
$10.16
|
| Rate for Payer: Priority Health SBD |
$7.53
|
| Rate for Payer: UMR Bronson Commercial |
$5.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.96
|
|
|
PHENOL 1.5 %-GLYCERIN 33 % MUCOSAL SPRAY
|
Facility
|
IP
|
$15.86
|
|
|
Service Code
|
NDC 78112000068
|
| Hospital Charge Code |
164911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$14.27 |
| Rate for Payer: Aetna American Axle |
$10.31
|
| Rate for Payer: Aetna Commercial |
$13.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.31
|
| Rate for Payer: Cash Price |
$12.69
|
| Rate for Payer: Cofinity Advantage |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.69
|
| Rate for Payer: Healthscope Commercial |
$14.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.89
|
| Rate for Payer: PHP Commercial |
$13.48
|
| Rate for Payer: Priority Health SBD |
$9.99
|
| Rate for Payer: UMR Bronson Commercial |
$6.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.89
|
|
|
PHENOL 1.5 %-GLYCERIN 33 % MUCOSAL SPRAY
|
Facility
|
OP
|
$15.86
|
|
|
Service Code
|
NDC 78112000068
|
| Hospital Charge Code |
164911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$14.27 |
| Rate for Payer: Aetna American Axle |
$10.31
|
| Rate for Payer: Aetna Commercial |
$13.48
|
| Rate for Payer: Aetna Medicare |
$7.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.31
|
| Rate for Payer: BCBS Complete |
$6.34
|
| Rate for Payer: Cash Price |
$12.69
|
| Rate for Payer: Cofinity Advantage |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.69
|
| Rate for Payer: Healthscope Commercial |
$14.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.89
|
| Rate for Payer: PHP Commercial |
$13.48
|
| Rate for Payer: Priority Health SBD |
$9.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.31
|
| Rate for Payer: UHC Core |
$8.26
|
| Rate for Payer: UHC Exchange |
$6.23
|
| Rate for Payer: UMR Bronson Commercial |
$5.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.89
|
|
|
PHENTOLAMINE 0.5 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
IP
|
$309.10
|
|
|
Service Code
|
NDC 09900001943
|
| Hospital Charge Code |
150967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$278.19 |
| Rate for Payer: Aetna American Axle |
$200.91
|
| Rate for Payer: Aetna Commercial |
$262.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.91
|
| Rate for Payer: Cash Price |
$247.28
|
| Rate for Payer: Cofinity Advantage |
$216.37
|
| Rate for Payer: Cofinity Commercial |
$265.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.28
|
| Rate for Payer: Healthscope Commercial |
$278.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.82
|
| Rate for Payer: PHP Commercial |
$262.74
|
| Rate for Payer: Priority Health SBD |
$194.73
|
| Rate for Payer: UMR Bronson Commercial |
$136.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.82
|
|
|
PHENTOLAMINE 0.5 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
OP
|
$309.10
|
|
|
Service Code
|
NDC 09900001943
|
| Hospital Charge Code |
150967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$114.37 |
| Max. Negotiated Rate |
$278.19 |
| Rate for Payer: Aetna American Axle |
$200.91
|
| Rate for Payer: Aetna Commercial |
$262.74
|
| Rate for Payer: Aetna Medicare |
$154.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.91
|
| Rate for Payer: BCBS Complete |
$123.64
|
| Rate for Payer: Cash Price |
$247.28
|
| Rate for Payer: Cofinity Advantage |
$216.37
|
| Rate for Payer: Cofinity Commercial |
$265.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.28
|
| Rate for Payer: Healthscope Commercial |
$278.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.82
|
| Rate for Payer: PHP Commercial |
$262.74
|
| Rate for Payer: Priority Health SBD |
$194.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.91
|
| Rate for Payer: UHC Core |
$161.04
|
| Rate for Payer: UHC Exchange |
$121.48
|
| Rate for Payer: UMR Bronson Commercial |
$114.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.82
|
|
|
PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
IP
|
$1,671.75
|
|
|
Service Code
|
NDC 09900001945
|
| Hospital Charge Code |
301530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$735.57 |
| Max. Negotiated Rate |
$1,504.58 |
| Rate for Payer: Aetna American Axle |
$1,086.64
|
| Rate for Payer: Aetna Commercial |
$1,420.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,086.64
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cofinity Advantage |
$1,170.22
|
| Rate for Payer: Cofinity Commercial |
$1,437.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.40
|
| Rate for Payer: Healthscope Commercial |
$1,504.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,170.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,253.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,420.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,253.81
|
| Rate for Payer: PHP Commercial |
$1,420.99
|
| Rate for Payer: Priority Health SBD |
$1,053.20
|
| Rate for Payer: UMR Bronson Commercial |
$735.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,253.81
|
|
|
PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
OP
|
$618.20
|
|
|
Service Code
|
NDC 09900001944
|
| Hospital Charge Code |
301530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$228.73 |
| Max. Negotiated Rate |
$556.38 |
| Rate for Payer: Aetna American Axle |
$401.83
|
| Rate for Payer: Aetna Commercial |
$525.47
|
| Rate for Payer: Aetna Medicare |
$309.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.83
|
| Rate for Payer: BCBS Complete |
$247.28
|
| Rate for Payer: Cash Price |
$494.56
|
| Rate for Payer: Cofinity Advantage |
$432.74
|
| Rate for Payer: Cofinity Commercial |
$531.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.56
|
| Rate for Payer: Healthscope Commercial |
$556.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$494.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$463.65
|
| Rate for Payer: PHP Commercial |
$525.47
|
| Rate for Payer: Priority Health SBD |
$389.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$401.83
|
| Rate for Payer: UHC Core |
$322.08
|
| Rate for Payer: UHC Exchange |
$242.95
|
| Rate for Payer: UMR Bronson Commercial |
$228.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.65
|
|
|
PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
OP
|
$1,671.75
|
|
|
Service Code
|
NDC 09900001945
|
| Hospital Charge Code |
301530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$618.55 |
| Max. Negotiated Rate |
$1,504.58 |
| Rate for Payer: Aetna American Axle |
$1,086.64
|
| Rate for Payer: Aetna Commercial |
$1,420.99
|
| Rate for Payer: Aetna Medicare |
$835.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,086.64
|
| Rate for Payer: BCBS Complete |
$668.70
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cofinity Advantage |
$1,170.22
|
| Rate for Payer: Cofinity Commercial |
$1,437.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.40
|
| Rate for Payer: Healthscope Commercial |
$1,504.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,170.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,253.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,337.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,420.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,253.81
|
| Rate for Payer: PHP Commercial |
$1,420.99
|
| Rate for Payer: Priority Health SBD |
$1,053.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,086.64
|
| Rate for Payer: UHC Core |
$870.98
|
| Rate for Payer: UHC Exchange |
$657.00
|
| Rate for Payer: UMR Bronson Commercial |
$618.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,253.81
|
|
|
PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
IP
|
$618.20
|
|
|
Service Code
|
NDC 09900001944
|
| Hospital Charge Code |
301530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$272.01 |
| Max. Negotiated Rate |
$556.38 |
| Rate for Payer: Aetna American Axle |
$401.83
|
| Rate for Payer: Aetna Commercial |
$525.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.83
|
| Rate for Payer: Cash Price |
$494.56
|
| Rate for Payer: Cofinity Advantage |
$432.74
|
| Rate for Payer: Cofinity Commercial |
$531.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.56
|
| Rate for Payer: Healthscope Commercial |
$556.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$463.65
|
| Rate for Payer: PHP Commercial |
$525.47
|
| Rate for Payer: Priority Health SBD |
$389.47
|
| Rate for Payer: UMR Bronson Commercial |
$272.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.65
|
|
|
PHENTOLAMINE 5 MG INJECTION SOLUTION
|
Facility
|
IP
|
$1,055.21
|
|
|
Service Code
|
HCPCS J2760
|
| Hospital Charge Code |
10947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$464.29 |
| Max. Negotiated Rate |
$949.69 |
| Rate for Payer: Aetna American Axle |
$685.89
|
| Rate for Payer: Aetna American Axle |
$630.92
|
| Rate for Payer: Aetna American Axle |
$900.40
|
| Rate for Payer: Aetna Commercial |
$1,177.45
|
| Rate for Payer: Aetna Commercial |
$896.93
|
| Rate for Payer: Aetna Commercial |
$825.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$685.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$900.40
|
| Rate for Payer: Cash Price |
$1,108.18
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: Cash Price |
$776.52
|
| Rate for Payer: Cofinity Advantage |
$679.46
|
| Rate for Payer: Cofinity Advantage |
$738.65
|
| Rate for Payer: Cofinity Advantage |
$969.66
|
| Rate for Payer: Cofinity Commercial |
$834.76
|
| Rate for Payer: Cofinity Commercial |
$907.48
|
| Rate for Payer: Cofinity Commercial |
$1,191.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.52
|
| Rate for Payer: Healthscope Commercial |
$1,246.71
|
| Rate for Payer: Healthscope Commercial |
$873.59
|
| Rate for Payer: Healthscope Commercial |
$949.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$969.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$738.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$679.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$727.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$791.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,038.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$896.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,177.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$791.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,038.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$727.99
|
| Rate for Payer: PHP Commercial |
$1,177.45
|
| Rate for Payer: PHP Commercial |
$896.93
|
| Rate for Payer: PHP Commercial |
$825.05
|
| Rate for Payer: Priority Health SBD |
$664.78
|
| Rate for Payer: Priority Health SBD |
$872.69
|
| Rate for Payer: Priority Health SBD |
$611.51
|
| Rate for Payer: UMR Bronson Commercial |
$464.29
|
| Rate for Payer: UMR Bronson Commercial |
$427.09
|
| Rate for Payer: UMR Bronson Commercial |
$609.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,038.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$791.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$727.99
|
|
|
PHENTOLAMINE 5 MG INJECTION SOLUTION
|
Facility
|
OP
|
$970.65
|
|
|
Service Code
|
HCPCS J2760
|
| Hospital Charge Code |
10947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.65 |
| Max. Negotiated Rate |
$1,363.71 |
| Rate for Payer: Aetna American Axle |
$630.92
|
| Rate for Payer: Aetna American Axle |
$685.89
|
| Rate for Payer: Aetna American Axle |
$900.40
|
| Rate for Payer: Aetna Commercial |
$825.05
|
| Rate for Payer: Aetna Commercial |
$1,177.45
|
| Rate for Payer: Aetna Commercial |
$896.93
|
| Rate for Payer: Aetna Medicare |
$267.75
|
| Rate for Payer: Aetna Medicare |
$267.75
|
| Rate for Payer: Aetna Medicare |
$267.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$685.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$900.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$321.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$321.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$321.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$321.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$321.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$321.81
|
| Rate for Payer: BCBS Complete |
$141.39
|
| Rate for Payer: BCBS Complete |
$141.39
|
| Rate for Payer: BCBS Complete |
$141.39
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,363.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,363.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,363.71
|
| Rate for Payer: BCN Commercial |
$1,363.71
|
| Rate for Payer: BCN Commercial |
$1,363.71
|
| Rate for Payer: BCN Commercial |
$1,363.71
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$1,108.18
|
| Rate for Payer: Cash Price |
$776.52
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: Cash Price |
$776.52
|
| Rate for Payer: Cash Price |
$1,108.18
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: Cofinity Advantage |
$738.65
|
| Rate for Payer: Cofinity Advantage |
$969.66
|
| Rate for Payer: Cofinity Advantage |
$679.46
|
| Rate for Payer: Cofinity Commercial |
$1,191.30
|
| Rate for Payer: Cofinity Commercial |
$834.76
|
| Rate for Payer: Cofinity Commercial |
$907.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Healthscope Commercial |
$949.69
|
| Rate for Payer: Healthscope Commercial |
$1,246.71
|
| Rate for Payer: Healthscope Commercial |
$873.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$969.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$738.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$679.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,038.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$727.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$791.41
|
| Rate for Payer: Mclaren Medicaid |
$257.45
|
| Rate for Payer: Mclaren Medicaid |
$257.45
|
| Rate for Payer: Mclaren Medicaid |
$257.45
|
| Rate for Payer: Mclaren Medicare |
$257.45
|
| Rate for Payer: Mclaren Medicare |
$257.45
|
| Rate for Payer: Mclaren Medicare |
$257.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: Meridian Medicaid |
$270.32
|
| Rate for Payer: Meridian Medicaid |
$270.32
|
| Rate for Payer: Meridian Medicaid |
$270.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$283.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$283.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$283.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$896.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,177.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.05
|
| Rate for Payer: Nomi Health Commercial |
$772.35
|
| Rate for Payer: Nomi Health Commercial |
$772.35
|
| Rate for Payer: Nomi Health Commercial |
$772.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$791.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,038.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$727.99
|
| Rate for Payer: PACE Medicare |
$244.58
|
| Rate for Payer: PACE Medicare |
$244.58
|
| Rate for Payer: PACE Medicare |
$244.58
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PHP Commercial |
$825.05
|
| Rate for Payer: PHP Commercial |
$896.93
|
| Rate for Payer: PHP Commercial |
$1,177.45
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,362.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,362.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,362.57
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: Priority Health SBD |
$611.51
|
| Rate for Payer: Priority Health SBD |
$872.69
|
| Rate for Payer: Priority Health SBD |
$664.78
|
| Rate for Payer: Priority Health Tiered Network |
$1,090.06
|
| Rate for Payer: Priority Health Tiered Network |
$1,090.06
|
| Rate for Payer: Priority Health Tiered Network |
$1,090.06
|
| Rate for Payer: Railroad Medicare Medicare |
$257.45
|
| Rate for Payer: Railroad Medicare Medicare |
$257.45
|
| Rate for Payer: Railroad Medicare Medicare |
$257.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.92
|
| Rate for Payer: UHC Core |
$693.92
|
| Rate for Payer: UHC Core |
$693.92
|
| Rate for Payer: UHC Core |
$693.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$257.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$257.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$257.45
|
| Rate for Payer: UHC Exchange |
$693.92
|
| Rate for Payer: UHC Exchange |
$693.92
|
| Rate for Payer: UHC Exchange |
$693.92
|
| Rate for Payer: UHC Medicaid |
$134.65
|
| Rate for Payer: UHC Medicaid |
$134.65
|
| Rate for Payer: UHC Medicaid |
$134.65
|
| Rate for Payer: UHCCP Medicaid |
$134.65
|
| Rate for Payer: UHCCP Medicaid |
$134.65
|
| Rate for Payer: UHCCP Medicaid |
$134.65
|
| Rate for Payer: UMR Bronson Commercial |
$512.54
|
| Rate for Payer: UMR Bronson Commercial |
$390.43
|
| Rate for Payer: UMR Bronson Commercial |
$359.14
|
| Rate for Payer: VA VA |
$257.45
|
| Rate for Payer: VA VA |
$257.45
|
| Rate for Payer: VA VA |
$257.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$791.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$727.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,038.92
|
|
|
PHENYLEPHRINE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.32
|
|
|
Service Code
|
HCPCS J2373
|
| Hospital Charge Code |
192051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna American Axle |
$15.16
|
| Rate for Payer: Aetna Commercial |
$19.82
|
| Rate for Payer: Aetna Medicare |
$11.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.16
|
| Rate for Payer: BCBS Complete |
$9.33
|
| Rate for Payer: BCBS Trust/PPO |
$0.41
|
| Rate for Payer: BCN Commercial |
$0.41
|
| Rate for Payer: Cash Price |
$18.66
|
| Rate for Payer: Cash Price |
$18.66
|
| Rate for Payer: Cofinity Advantage |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$20.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.66
|
| Rate for Payer: Healthscope Commercial |
$20.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.49
|
| Rate for Payer: PHP Commercial |
$19.82
|
| Rate for Payer: Priority Health SBD |
$14.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UMR Bronson Commercial |
$8.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.49
|
|
