|
PHENYLEPHRINE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.32
|
|
|
Service Code
|
HCPCS J2373
|
| Hospital Charge Code |
192051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna American Axle |
$15.16
|
| Rate for Payer: Aetna Commercial |
$19.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.16
|
| 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: 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: UMR Bronson Commercial |
$10.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.49
|
|
|
PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT
|
Facility
|
IP
|
$11.03
|
|
|
Service Code
|
NDC 45802018816
|
| Hospital Charge Code |
167632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$9.93 |
| Rate for Payer: Aetna American Axle |
$7.17
|
| Rate for Payer: Aetna Commercial |
$9.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.17
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cofinity Advantage |
$7.72
|
| Rate for Payer: Cofinity Commercial |
$9.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.82
|
| Rate for Payer: Healthscope Commercial |
$9.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.27
|
| Rate for Payer: PHP Commercial |
$9.38
|
| Rate for Payer: Priority Health SBD |
$6.95
|
| Rate for Payer: UMR Bronson Commercial |
$4.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.27
|
|
|
PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT
|
Facility
|
IP
|
$10.01
|
|
|
Service Code
|
NDC 00536128806
|
| Hospital Charge Code |
167632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$9.01 |
| Rate for Payer: Aetna American Axle |
$6.51
|
| Rate for Payer: Aetna Commercial |
$8.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.51
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cofinity Advantage |
$7.01
|
| Rate for Payer: Cofinity Commercial |
$8.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.01
|
| Rate for Payer: Healthscope Commercial |
$9.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.51
|
| Rate for Payer: PHP Commercial |
$8.51
|
| Rate for Payer: Priority Health SBD |
$6.31
|
| Rate for Payer: UMR Bronson Commercial |
$4.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.51
|
|
|
PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT
|
Facility
|
OP
|
$11.03
|
|
|
Service Code
|
NDC 45802018816
|
| Hospital Charge Code |
167632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$9.93 |
| Rate for Payer: Aetna American Axle |
$7.17
|
| Rate for Payer: Aetna Commercial |
$9.38
|
| Rate for Payer: Aetna Medicare |
$5.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.17
|
| Rate for Payer: BCBS Complete |
$4.41
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cofinity Advantage |
$7.72
|
| Rate for Payer: Cofinity Commercial |
$9.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.82
|
| Rate for Payer: Healthscope Commercial |
$9.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.27
|
| Rate for Payer: PHP Commercial |
$9.38
|
| Rate for Payer: Priority Health SBD |
$6.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.17
|
| Rate for Payer: UHC Core |
$5.75
|
| Rate for Payer: UHC Exchange |
$4.33
|
| Rate for Payer: UMR Bronson Commercial |
$4.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.27
|
|
|
PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT
|
Facility
|
OP
|
$10.01
|
|
|
Service Code
|
NDC 00536128806
|
| Hospital Charge Code |
167632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$9.01 |
| Rate for Payer: Aetna American Axle |
$6.51
|
| Rate for Payer: Aetna Commercial |
$8.51
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.51
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cofinity Advantage |
$7.01
|
| Rate for Payer: Cofinity Commercial |
$8.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.01
|
| Rate for Payer: Healthscope Commercial |
$9.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.51
|
| Rate for Payer: PHP Commercial |
$8.51
|
| Rate for Payer: Priority Health SBD |
$6.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.51
|
| Rate for Payer: UHC Core |
$5.22
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UMR Bronson Commercial |
$3.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.51
|
|
|
PHENYLEPHRINE 0.25 % NASAL SPRAY
|
Facility
|
OP
|
$19.78
|
|
|
Service Code
|
NDC 00225080047
|
| Hospital Charge Code |
6243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$17.80 |
| Rate for Payer: Aetna American Axle |
$12.86
|
| Rate for Payer: Aetna Commercial |
$16.81
|
| Rate for Payer: Aetna Medicare |
$9.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.86
|
| Rate for Payer: BCBS Complete |
$7.91
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Advantage |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$17.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$17.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.84
|
| Rate for Payer: PHP Commercial |
$16.81
|
| Rate for Payer: Priority Health SBD |
$12.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.86
|
| Rate for Payer: UHC Core |
$10.31
|
| Rate for Payer: UHC Exchange |
$7.77
|
| Rate for Payer: UMR Bronson Commercial |
$7.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.84
|
|
|
PHENYLEPHRINE 0.25 % NASAL SPRAY
|
Facility
|
IP
|
$19.78
|
|
|
Service Code
|
NDC 00225080047
|
| Hospital Charge Code |
6243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$17.80 |
| Rate for Payer: Aetna American Axle |
$12.86
|
| Rate for Payer: Aetna Commercial |
$16.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.86
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Advantage |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$17.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$17.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.84
|
| Rate for Payer: PHP Commercial |
$16.81
|
| Rate for Payer: Priority Health SBD |
$12.46
|
| Rate for Payer: UMR Bronson Commercial |
$8.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.84
|
|
|
PHENYLEPHRINE 0.5 % NASAL SPRAY
|
Facility
|
IP
|
$19.78
|
|
|
Service Code
|
NDC 00225080547
|
| Hospital Charge Code |
6244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$17.80 |
| Rate for Payer: Aetna American Axle |
$12.86
|
| Rate for Payer: Aetna Commercial |
$16.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.86
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Advantage |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$17.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$17.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.84
|
| Rate for Payer: PHP Commercial |
$16.81
|
| Rate for Payer: Priority Health SBD |
$12.46
|
| Rate for Payer: UMR Bronson Commercial |
$8.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.84
|
|
|
PHENYLEPHRINE 0.5 % NASAL SPRAY
|
Facility
|
OP
|
$19.78
|
|
|
Service Code
|
NDC 00225080547
|
| Hospital Charge Code |
6244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$17.80 |
| Rate for Payer: Aetna American Axle |
$12.86
|
| Rate for Payer: Aetna Commercial |
$16.81
|
| Rate for Payer: Aetna Medicare |
$9.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.86
|
| Rate for Payer: BCBS Complete |
$7.91
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Advantage |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$17.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$17.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.84
|
| Rate for Payer: PHP Commercial |
$16.81
|
| Rate for Payer: Priority Health SBD |
$12.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.86
|
| Rate for Payer: UHC Core |
$10.31
|
| Rate for Payer: UHC Exchange |
$7.77
|
| Rate for Payer: UMR Bronson Commercial |
$7.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.84
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
IP
|
$60.27
|
|
|
Service Code
|
NDC 69315032405
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$54.24 |
| Rate for Payer: Aetna American Axle |
$39.18
|
| Rate for Payer: Aetna Commercial |
$51.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.18
|
| Rate for Payer: Cash Price |
$48.22
|
| Rate for Payer: Cofinity Advantage |
$42.19
|
| Rate for Payer: Cofinity Commercial |
$51.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.22
|
| Rate for Payer: Healthscope Commercial |
$54.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.20
|
| Rate for Payer: PHP Commercial |
$51.23
|
| Rate for Payer: Priority Health SBD |
$37.97
|
| Rate for Payer: UMR Bronson Commercial |
$26.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.20
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
OP
|
$130.20
|
|
|
Service Code
|
NDC 42702010305
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.17 |
| Max. Negotiated Rate |
$117.18 |
| Rate for Payer: Aetna American Axle |
$84.63
|
| Rate for Payer: Aetna Commercial |
$110.67
|
| Rate for Payer: Aetna Medicare |
$65.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.63
|
| Rate for Payer: BCBS Complete |
$52.08
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$104.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.65
|
| Rate for Payer: PHP Commercial |
$110.67
|
| Rate for Payer: Priority Health SBD |
$82.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.63
|
| Rate for Payer: UHC Core |
$67.83
|
| Rate for Payer: UHC Exchange |
$51.17
|
| Rate for Payer: UMR Bronson Commercial |
$48.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.65
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
OP
|
$60.17
|
|
|
Service Code
|
NDC 70756061430
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.26 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Aetna American Axle |
$39.11
|
| Rate for Payer: Aetna Commercial |
$51.14
|
| Rate for Payer: Aetna Medicare |
$30.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.11
|
| Rate for Payer: BCBS Complete |
$24.07
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Advantage |
$42.12
|
| Rate for Payer: Cofinity Commercial |
$51.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Healthscope Commercial |
$54.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.13
|
| Rate for Payer: PHP Commercial |
$51.14
|
| Rate for Payer: Priority Health SBD |
$37.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.11
|
| Rate for Payer: UHC Core |
$31.35
|
| Rate for Payer: UHC Exchange |
$23.65
|
| Rate for Payer: UMR Bronson Commercial |
$22.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.13
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
IP
|
$54.67
|
|
|
Service Code
|
NDC 75907013023
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$49.20 |
| Rate for Payer: Aetna American Axle |
$35.54
|
| Rate for Payer: Aetna Commercial |
$46.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.54
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: Cofinity Advantage |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$47.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.74
|
| Rate for Payer: Healthscope Commercial |
$49.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.00
|
| Rate for Payer: PHP Commercial |
$46.47
|
| Rate for Payer: Priority Health SBD |
$34.44
|
| Rate for Payer: UMR Bronson Commercial |
$24.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.00
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
IP
|
$60.17
|
|
|
Service Code
|
NDC 70756061430
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Aetna American Axle |
$39.11
|
| Rate for Payer: Aetna Commercial |
$51.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.11
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Advantage |
$42.12
|
| Rate for Payer: Cofinity Commercial |
$51.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Healthscope Commercial |
$54.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.13
|
| Rate for Payer: PHP Commercial |
$51.14
|
| Rate for Payer: Priority Health SBD |
$37.91
|
| Rate for Payer: UMR Bronson Commercial |
$26.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.13
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
IP
|
$119.25
|
|
|
Service Code
|
NDC 17478020605
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.47 |
| Max. Negotiated Rate |
$107.33 |
| 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 Advantage |
$83.47
|
| Rate for Payer: Cofinity Commercial |
$102.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.40
|
| Rate for Payer: Healthscope Commercial |
$107.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.44
|
| Rate for Payer: PHP Commercial |
$101.36
|
| 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
|
OP
|
$60.27
|
|
|
Service Code
|
NDC 69315032405
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.30 |
| Max. Negotiated Rate |
$54.24 |
| Rate for Payer: Aetna American Axle |
$39.18
|
| Rate for Payer: Aetna Commercial |
$51.23
|
| Rate for Payer: Aetna Medicare |
$30.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.18
|
| Rate for Payer: BCBS Complete |
$24.11
|
| Rate for Payer: Cash Price |
$48.22
|
| Rate for Payer: Cofinity Advantage |
$42.19
|
| Rate for Payer: Cofinity Commercial |
$51.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.22
|
| Rate for Payer: Healthscope Commercial |
$54.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.20
|
| Rate for Payer: PHP Commercial |
$51.23
|
| Rate for Payer: Priority Health SBD |
$37.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.18
|
| Rate for Payer: UHC Core |
$31.40
|
| Rate for Payer: UHC Exchange |
$23.69
|
| Rate for Payer: UMR Bronson Commercial |
$22.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.20
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
OP
|
$54.67
|
|
|
Service Code
|
NDC 75907013023
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.23 |
| Max. Negotiated Rate |
$49.20 |
| Rate for Payer: Aetna American Axle |
$35.54
|
| Rate for Payer: Aetna Commercial |
$46.47
|
| Rate for Payer: Aetna Medicare |
$27.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.54
|
| Rate for Payer: BCBS Complete |
$21.87
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: Cofinity Advantage |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$47.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.74
|
| Rate for Payer: Healthscope Commercial |
$49.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.00
|
| Rate for Payer: PHP Commercial |
$46.47
|
| Rate for Payer: Priority Health SBD |
$34.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.54
|
| Rate for Payer: UHC Core |
$28.48
|
| Rate for Payer: UHC Exchange |
$21.49
|
| Rate for Payer: UMR Bronson Commercial |
$20.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.00
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
OP
|
$119.25
|
|
|
Service Code
|
NDC 17478020605
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.12 |
| Max. Negotiated Rate |
$107.33 |
| Rate for Payer: Aetna American Axle |
$77.51
|
| Rate for Payer: Aetna Commercial |
$101.36
|
| Rate for Payer: Aetna Medicare |
$59.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.51
|
| Rate for Payer: BCBS Complete |
$47.70
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cofinity Advantage |
$83.47
|
| Rate for Payer: Cofinity Commercial |
$102.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.40
|
| Rate for Payer: Healthscope Commercial |
$107.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.44
|
| Rate for Payer: PHP Commercial |
$101.36
|
| Rate for Payer: Priority Health SBD |
$75.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.51
|
| Rate for Payer: UHC Core |
$62.13
|
| Rate for Payer: UHC Exchange |
$46.87
|
| Rate for Payer: UMR Bronson Commercial |
$44.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.44
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
IP
|
$130.20
|
|
|
Service Code
|
NDC 42702010305
|
| 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 Advantage |
$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 Commercial |
$110.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.65
|
| Rate for Payer: PHP Commercial |
$110.67
|
| 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 MG IN NS 200 ML
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 99000000209
|
| 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 Advantage |
$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 Commercial |
$29.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PHP Commercial |
$29.75
|
| 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 IN NS 200 ML
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 99000000209
|
| Hospital Charge Code |
155016
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna American Axle |
$22.75
|
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.75
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health SBD |
$22.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.75
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: UHC Exchange |
$13.76
|
| Rate for Payer: UMR Bronson Commercial |
$12.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$203.50
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.54 |
| Max. Negotiated Rate |
$183.15 |
| Rate for Payer: Aetna American Axle |
$132.28
|
| Rate for Payer: Aetna American Axle |
$114.61
|
| Rate for Payer: Aetna American Axle |
$97.55
|
| Rate for Payer: Aetna American Axle |
$120.93
|
| Rate for Payer: Aetna American Axle |
$108.06
|
| Rate for Payer: Aetna American Axle |
$13.50
|
| Rate for Payer: Aetna American Axle |
$94.72
|
| Rate for Payer: Aetna American Axle |
$155.42
|
| Rate for Payer: Aetna American Axle |
$141.28
|
| Rate for Payer: Aetna American Axle |
$9.16
|
| Rate for Payer: Aetna American Axle |
$34.64
|
| Rate for Payer: Aetna American Axle |
$66.64
|
| Rate for Payer: Aetna American Axle |
$41.00
|
| Rate for Payer: Aetna American Axle |
$91.05
|
| Rate for Payer: Aetna American Axle |
$81.06
|
| Rate for Payer: Aetna American Axle |
$68.33
|
| Rate for Payer: Aetna American Axle |
$68.05
|
| Rate for Payer: Aetna Commercial |
$45.30
|
| Rate for Payer: Aetna Commercial |
$11.98
|
| Rate for Payer: Aetna Commercial |
$87.14
|
| Rate for Payer: Aetna Commercial |
$184.76
|
| Rate for Payer: Aetna Commercial |
$141.31
|
| Rate for Payer: Aetna Commercial |
$158.13
|
| Rate for Payer: Aetna Commercial |
$88.99
|
| Rate for Payer: Aetna Commercial |
$127.57
|
| Rate for Payer: Aetna Commercial |
$172.97
|
| Rate for Payer: Aetna Commercial |
$106.00
|
| Rate for Payer: Aetna Commercial |
$53.62
|
| Rate for Payer: Aetna Commercial |
$123.87
|
| Rate for Payer: Aetna Commercial |
$149.87
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$203.24
|
| Rate for Payer: Aetna Commercial |
$89.36
|
| Rate for Payer: Aetna Commercial |
$119.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.64
|
| Rate for Payer: Cash Price |
$83.75
|
| Rate for Payer: Cash Price |
$82.02
|
| Rate for Payer: Cash Price |
$99.76
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$42.63
|
| Rate for Payer: Cash Price |
$173.89
|
| Rate for Payer: Cash Price |
$141.06
|
| Rate for Payer: Cash Price |
$148.83
|
| Rate for Payer: Cash Price |
$191.29
|
| Rate for Payer: Cash Price |
$120.06
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cash Price |
$112.06
|
| Rate for Payer: Cash Price |
$84.10
|
| Rate for Payer: Cofinity Advantage |
$98.05
|
| Rate for Payer: Cofinity Advantage |
$123.42
|
| Rate for Payer: Cofinity Advantage |
$73.28
|
| Rate for Payer: Cofinity Advantage |
$87.29
|
| Rate for Payer: Cofinity Advantage |
$73.59
|
| Rate for Payer: Cofinity Advantage |
$71.76
|
| Rate for Payer: Cofinity Advantage |
$44.16
|
| Rate for Payer: Cofinity Advantage |
$37.30
|
| Rate for Payer: Cofinity Advantage |
$167.38
|
| Rate for Payer: Cofinity Advantage |
$152.15
|
| Rate for Payer: Cofinity Advantage |
$9.87
|
| Rate for Payer: Cofinity Advantage |
$14.54
|
| Rate for Payer: Cofinity Advantage |
$102.01
|
| Rate for Payer: Cofinity Advantage |
$142.45
|
| Rate for Payer: Cofinity Advantage |
$105.06
|
| Rate for Payer: Cofinity Advantage |
$130.23
|
| Rate for Payer: Cofinity Advantage |
$116.38
|
| Rate for Payer: Cofinity Commercial |
$12.13
|
| Rate for Payer: Cofinity Commercial |
$186.93
|
| Rate for Payer: Cofinity Commercial |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$45.83
|
| Rate for Payer: Cofinity Commercial |
$125.33
|
| Rate for Payer: Cofinity Commercial |
$54.25
|
| Rate for Payer: Cofinity Commercial |
$175.01
|
| Rate for Payer: Cofinity Commercial |
$142.97
|
| Rate for Payer: Cofinity Commercial |
$129.07
|
| Rate for Payer: Cofinity Commercial |
$159.99
|
| Rate for Payer: Cofinity Commercial |
$107.24
|
| Rate for Payer: Cofinity Commercial |
$90.41
|
| Rate for Payer: Cofinity Commercial |
$90.03
|
| Rate for Payer: Cofinity Commercial |
$88.17
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$120.46
|
| Rate for Payer: Cofinity Commercial |
$151.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.10
|
| 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 |
$83.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.00
|
| Rate for Payer: Healthscope Commercial |
$135.07
|
| Rate for Payer: Healthscope Commercial |
$131.16
|
| Rate for Payer: Healthscope Commercial |
$158.69
|
| Rate for Payer: Healthscope Commercial |
$12.69
|
| Rate for Payer: Healthscope Commercial |
$149.62
|
| Rate for Payer: Healthscope Commercial |
$183.15
|
| Rate for Payer: Healthscope Commercial |
$56.77
|
| Rate for Payer: Healthscope Commercial |
$94.62
|
| Rate for Payer: Healthscope Commercial |
$94.22
|
| Rate for Payer: Healthscope Commercial |
$167.44
|
| Rate for Payer: Healthscope Commercial |
$112.23
|
| Rate for Payer: Healthscope Commercial |
$92.27
|
| Rate for Payer: Healthscope Commercial |
$47.96
|
| Rate for Payer: Healthscope Commercial |
$215.20
|
| Rate for Payer: Healthscope Commercial |
$195.62
|
| Rate for Payer: Healthscope Commercial |
$18.69
|
| Rate for Payer: Healthscope Commercial |
$126.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.58
|
| Rate for Payer: PHP Commercial |
$89.36
|
| Rate for Payer: PHP Commercial |
$149.87
|
| Rate for Payer: PHP Commercial |
$127.57
|
| Rate for Payer: PHP Commercial |
$158.13
|
| Rate for Payer: PHP Commercial |
$123.87
|
| Rate for Payer: PHP Commercial |
$172.97
|
| Rate for Payer: PHP Commercial |
$11.98
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$119.06
|
| Rate for Payer: PHP Commercial |
$53.62
|
| Rate for Payer: PHP Commercial |
$184.76
|
| Rate for Payer: PHP Commercial |
$203.24
|
| Rate for Payer: PHP Commercial |
$106.00
|
| Rate for Payer: PHP Commercial |
$87.14
|
| Rate for Payer: PHP Commercial |
$88.99
|
| Rate for Payer: PHP Commercial |
$45.30
|
| Rate for Payer: PHP Commercial |
$141.31
|
| Rate for Payer: Priority Health SBD |
$65.95
|
| Rate for Payer: Priority Health SBD |
$94.55
|
| Rate for Payer: Priority Health SBD |
$117.21
|
| Rate for Payer: Priority Health SBD |
$33.57
|
| Rate for Payer: Priority Health SBD |
$64.59
|
| Rate for Payer: Priority Health SBD |
$111.08
|
| Rate for Payer: Priority Health SBD |
$8.88
|
| Rate for Payer: Priority Health SBD |
$91.81
|
| Rate for Payer: Priority Health SBD |
$66.23
|
| Rate for Payer: Priority Health SBD |
$128.21
|
| Rate for Payer: Priority Health SBD |
$78.56
|
| Rate for Payer: Priority Health SBD |
$39.74
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: Priority Health SBD |
$88.24
|
| Rate for Payer: Priority Health SBD |
$136.94
|
| Rate for Payer: Priority Health SBD |
$104.74
|
| Rate for Payer: Priority Health SBD |
$150.64
|
| Rate for Payer: UMR Bronson Commercial |
$73.15
|
| Rate for Payer: UMR Bronson Commercial |
$95.64
|
| Rate for Payer: UMR Bronson Commercial |
$46.26
|
| Rate for Payer: UMR Bronson Commercial |
$45.11
|
| Rate for Payer: UMR Bronson Commercial |
$54.87
|
| Rate for Payer: UMR Bronson Commercial |
$46.06
|
| Rate for Payer: UMR Bronson Commercial |
$61.63
|
| Rate for Payer: UMR Bronson Commercial |
$105.21
|
| Rate for Payer: UMR Bronson Commercial |
$77.58
|
| Rate for Payer: UMR Bronson Commercial |
$89.54
|
| Rate for Payer: UMR Bronson Commercial |
$27.76
|
| Rate for Payer: UMR Bronson Commercial |
$6.20
|
| Rate for Payer: UMR Bronson Commercial |
$23.45
|
| Rate for Payer: UMR Bronson Commercial |
$64.12
|
| Rate for Payer: UMR Bronson Commercial |
$81.86
|
| Rate for Payer: UMR Bronson Commercial |
$66.04
|
| Rate for Payer: UMR Bronson Commercial |
$9.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.30
|
| 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 |
$112.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.69
|
|
|
PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$145.73
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$131.16 |
| Rate for Payer: Aetna American Axle |
$94.72
|
| Rate for Payer: Aetna American Axle |
$120.93
|
| Rate for Payer: Aetna American Axle |
$13.50
|
| Rate for Payer: Aetna American Axle |
$34.64
|
| Rate for Payer: Aetna American Axle |
$68.33
|
| Rate for Payer: Aetna American Axle |
$108.06
|
| Rate for Payer: Aetna American Axle |
$68.05
|
| Rate for Payer: Aetna American Axle |
$132.28
|
| Rate for Payer: Aetna American Axle |
$9.16
|
| Rate for Payer: Aetna American Axle |
$41.00
|
| Rate for Payer: Aetna American Axle |
$114.61
|
| Rate for Payer: Aetna American Axle |
$141.28
|
| Rate for Payer: Aetna American Axle |
$155.42
|
| Rate for Payer: Aetna American Axle |
$81.06
|
| Rate for Payer: Aetna American Axle |
$91.05
|
| Rate for Payer: Aetna American Axle |
$97.55
|
| Rate for Payer: Aetna American Axle |
$66.64
|
| Rate for Payer: Aetna Commercial |
$89.36
|
| Rate for Payer: Aetna Commercial |
$203.24
|
| Rate for Payer: Aetna Commercial |
$149.87
|
| Rate for Payer: Aetna Commercial |
$184.76
|
| Rate for Payer: Aetna Commercial |
$106.00
|
| Rate for Payer: Aetna Commercial |
$119.06
|
| Rate for Payer: Aetna Commercial |
$127.57
|
| Rate for Payer: Aetna Commercial |
$172.97
|
| Rate for Payer: Aetna Commercial |
$88.99
|
| Rate for Payer: Aetna Commercial |
$11.98
|
| Rate for Payer: Aetna Commercial |
$158.13
|
| Rate for Payer: Aetna Commercial |
$53.62
|
| Rate for Payer: Aetna Commercial |
$141.31
|
| Rate for Payer: Aetna Commercial |
$123.87
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$45.30
|
| Rate for Payer: Aetna Commercial |
$87.14
|
| Rate for Payer: Aetna Medicare |
$88.16
|
| Rate for Payer: Aetna Medicare |
$108.68
|
| Rate for Payer: Aetna Medicare |
$101.75
|
| Rate for Payer: Aetna Medicare |
$10.38
|
| Rate for Payer: Aetna Medicare |
$72.86
|
| Rate for Payer: Aetna Medicare |
$83.12
|
| Rate for Payer: Aetna Medicare |
$62.35
|
| Rate for Payer: Aetna Medicare |
$93.02
|
| Rate for Payer: Aetna Medicare |
$52.56
|
| Rate for Payer: Aetna Medicare |
$7.05
|
| Rate for Payer: Aetna Medicare |
$52.34
|
| Rate for Payer: Aetna Medicare |
$70.03
|
| Rate for Payer: Aetna Medicare |
$26.64
|
| Rate for Payer: Aetna Medicare |
$119.56
|
| Rate for Payer: Aetna Medicare |
$75.04
|
| Rate for Payer: Aetna Medicare |
$51.26
|
| Rate for Payer: Aetna Medicare |
$31.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.28
|
| Rate for Payer: BCBS Complete |
$41.88
|
| Rate for Payer: BCBS Complete |
$66.50
|
| Rate for Payer: BCBS Complete |
$21.32
|
| Rate for Payer: BCBS Complete |
$25.23
|
| Rate for Payer: BCBS Complete |
$56.03
|
| Rate for Payer: BCBS Complete |
$41.01
|
| Rate for Payer: BCBS Complete |
$5.64
|
| Rate for Payer: BCBS Complete |
$74.42
|
| Rate for Payer: BCBS Complete |
$60.03
|
| Rate for Payer: BCBS Complete |
$58.29
|
| Rate for Payer: BCBS Complete |
$42.05
|
| Rate for Payer: BCBS Complete |
$81.40
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS Complete |
$70.53
|
| Rate for Payer: BCBS Complete |
$86.94
|
| Rate for Payer: BCBS Complete |
$95.64
|
| Rate for Payer: BCBS Complete |
$8.31
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$141.06
|
| Rate for Payer: Cash Price |
$148.83
|
| Rate for Payer: Cash Price |
$120.06
|
| Rate for Payer: Cash Price |
$191.29
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cash Price |
$82.02
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Cash Price |
$42.63
|
| Rate for Payer: Cash Price |
$42.63
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cash Price |
$83.75
|
| Rate for Payer: Cash Price |
$83.75
|
| Rate for Payer: Cash Price |
$84.10
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Cash Price |
$148.83
|
| Rate for Payer: Cash Price |
$84.10
|
| Rate for Payer: Cash Price |
$120.06
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cash Price |
$99.76
|
| Rate for Payer: Cash Price |
$82.02
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$112.06
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$141.06
|
| Rate for Payer: Cash Price |
$112.06
|
| Rate for Payer: Cash Price |
$173.89
|
| Rate for Payer: Cash Price |
$173.89
|
| Rate for Payer: Cash Price |
$99.76
|
| Rate for Payer: Cash Price |
$191.29
|
| Rate for Payer: Cofinity Advantage |
$116.38
|
| Rate for Payer: Cofinity Advantage |
$73.59
|
| Rate for Payer: Cofinity Advantage |
$73.28
|
| Rate for Payer: Cofinity Advantage |
$71.76
|
| Rate for Payer: Cofinity Advantage |
$87.29
|
| Rate for Payer: Cofinity Advantage |
$98.05
|
| Rate for Payer: Cofinity Advantage |
$9.87
|
| Rate for Payer: Cofinity Advantage |
$102.01
|
| Rate for Payer: Cofinity Advantage |
$105.06
|
| Rate for Payer: Cofinity Advantage |
$123.42
|
| Rate for Payer: Cofinity Advantage |
$130.23
|
| Rate for Payer: Cofinity Advantage |
$142.45
|
| Rate for Payer: Cofinity Advantage |
$14.54
|
| Rate for Payer: Cofinity Advantage |
$152.15
|
| Rate for Payer: Cofinity Advantage |
$167.38
|
| Rate for Payer: Cofinity Advantage |
$37.30
|
| Rate for Payer: Cofinity Advantage |
$44.16
|
| Rate for Payer: Cofinity Commercial |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$12.13
|
| Rate for Payer: Cofinity Commercial |
$45.83
|
| Rate for Payer: Cofinity Commercial |
$142.97
|
| Rate for Payer: Cofinity Commercial |
$175.01
|
| Rate for Payer: Cofinity Commercial |
$54.25
|
| Rate for Payer: Cofinity Commercial |
$88.17
|
| Rate for Payer: Cofinity Commercial |
$90.03
|
| Rate for Payer: Cofinity Commercial |
$90.41
|
| Rate for Payer: Cofinity Commercial |
$125.33
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$186.93
|
| Rate for Payer: Cofinity Commercial |
$129.07
|
| Rate for Payer: Cofinity Commercial |
$107.24
|
| Rate for Payer: Cofinity Commercial |
$151.64
|
| Rate for Payer: Cofinity Commercial |
$120.46
|
| Rate for Payer: Cofinity Commercial |
$159.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.62
|
| Rate for Payer: Healthscope Commercial |
$183.15
|
| Rate for Payer: Healthscope Commercial |
$112.23
|
| Rate for Payer: Healthscope Commercial |
$135.07
|
| Rate for Payer: Healthscope Commercial |
$94.22
|
| Rate for Payer: Healthscope Commercial |
$92.27
|
| Rate for Payer: Healthscope Commercial |
$12.69
|
| Rate for Payer: Healthscope Commercial |
$47.96
|
| Rate for Payer: Healthscope Commercial |
$149.62
|
| Rate for Payer: Healthscope Commercial |
$215.20
|
| Rate for Payer: Healthscope Commercial |
$131.16
|
| Rate for Payer: Healthscope Commercial |
$126.06
|
| Rate for Payer: Healthscope Commercial |
$158.69
|
| Rate for Payer: Healthscope Commercial |
$195.62
|
| Rate for Payer: Healthscope Commercial |
$94.62
|
| Rate for Payer: Healthscope Commercial |
$18.69
|
| Rate for Payer: Healthscope Commercial |
$167.44
|
| Rate for Payer: Healthscope Commercial |
$56.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.53
|
| Rate for Payer: PHP Commercial |
$127.57
|
| Rate for Payer: PHP Commercial |
$184.76
|
| Rate for Payer: PHP Commercial |
$172.97
|
| Rate for Payer: PHP Commercial |
$11.98
|
| Rate for Payer: PHP Commercial |
$149.87
|
| Rate for Payer: PHP Commercial |
$158.13
|
| Rate for Payer: PHP Commercial |
$89.36
|
| Rate for Payer: PHP Commercial |
$45.30
|
| Rate for Payer: PHP Commercial |
$141.31
|
| Rate for Payer: PHP Commercial |
$123.87
|
| Rate for Payer: PHP Commercial |
$106.00
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$203.24
|
| Rate for Payer: PHP Commercial |
$119.06
|
| Rate for Payer: PHP Commercial |
$88.99
|
| Rate for Payer: PHP Commercial |
$87.14
|
| Rate for Payer: PHP Commercial |
$53.62
|
| Rate for Payer: Priority Health SBD |
$91.81
|
| Rate for Payer: Priority Health SBD |
$66.23
|
| Rate for Payer: Priority Health SBD |
$128.21
|
| Rate for Payer: Priority Health SBD |
$150.64
|
| Rate for Payer: Priority Health SBD |
$64.59
|
| Rate for Payer: Priority Health SBD |
$8.88
|
| Rate for Payer: Priority Health SBD |
$136.94
|
| Rate for Payer: Priority Health SBD |
$104.74
|
| Rate for Payer: Priority Health SBD |
$88.24
|
| Rate for Payer: Priority Health SBD |
$78.56
|
| Rate for Payer: Priority Health SBD |
$33.57
|
| Rate for Payer: Priority Health SBD |
$65.95
|
| Rate for Payer: Priority Health SBD |
$117.21
|
| Rate for Payer: Priority Health SBD |
$39.74
|
| Rate for Payer: Priority Health SBD |
$94.55
|
| Rate for Payer: Priority Health SBD |
$111.08
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UMR Bronson Commercial |
$80.42
|
| Rate for Payer: UMR Bronson Commercial |
$65.24
|
| Rate for Payer: UMR Bronson Commercial |
$38.74
|
| Rate for Payer: UMR Bronson Commercial |
$37.93
|
| Rate for Payer: UMR Bronson Commercial |
$61.51
|
| Rate for Payer: UMR Bronson Commercial |
$53.92
|
| Rate for Payer: UMR Bronson Commercial |
$88.47
|
| Rate for Payer: UMR Bronson Commercial |
$7.68
|
| Rate for Payer: UMR Bronson Commercial |
$51.83
|
| Rate for Payer: UMR Bronson Commercial |
$23.34
|
| Rate for Payer: UMR Bronson Commercial |
$46.14
|
| Rate for Payer: UMR Bronson Commercial |
$19.72
|
| Rate for Payer: UMR Bronson Commercial |
$55.53
|
| Rate for Payer: UMR Bronson Commercial |
$38.90
|
| Rate for Payer: UMR Bronson Commercial |
$75.30
|
| Rate for Payer: UMR Bronson Commercial |
$5.22
|
| Rate for Payer: UMR Bronson Commercial |
$68.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.05
|
| 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 |
$132.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.85
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 69374095710
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna American Axle |
$2.76
|
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Advantage |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health SBD |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.76
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Exchange |
$1.67
|
| Rate for Payer: UMR Bronson Commercial |
$1.57
|
| 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
|
$23.86
|
|
|
Service Code
|
NDC 70092004646
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$21.47 |
| Rate for Payer: Aetna American Axle |
$15.51
|
| Rate for Payer: Aetna Commercial |
$20.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.51
|
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: Cofinity Advantage |
$16.70
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.09
|
| Rate for Payer: Healthscope Commercial |
$21.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.89
|
| Rate for Payer: PHP Commercial |
$20.28
|
| Rate for Payer: Priority Health SBD |
$15.03
|
| Rate for Payer: UMR Bronson Commercial |
$10.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.89
|
|
