|
PILOCARPINE 1 % EYE DROPS
|
Facility
|
OP
|
$156.93
|
|
|
Service Code
|
NDC 17478022312
|
| Hospital Charge Code |
6279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.06 |
| Max. Negotiated Rate |
$141.24 |
| Rate for Payer: Aetna American Axle |
$102.00
|
| Rate for Payer: Aetna Commercial |
$133.39
|
| Rate for Payer: Aetna Medicare |
$78.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.00
|
| Rate for Payer: BCBS Complete |
$62.77
|
| Rate for Payer: Cash Price |
$125.54
|
| Rate for Payer: Cofinity Advantage |
$109.85
|
| Rate for Payer: Cofinity Commercial |
$134.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.54
|
| Rate for Payer: Healthscope Commercial |
$141.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.70
|
| Rate for Payer: PHP Commercial |
$133.39
|
| Rate for Payer: Priority Health SBD |
$98.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.00
|
| Rate for Payer: UHC Core |
$81.76
|
| Rate for Payer: UHC Exchange |
$61.67
|
| Rate for Payer: UMR Bronson Commercial |
$58.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.70
|
|
|
PILOCARPINE 2 % EYE DROPS
|
Facility
|
IP
|
$130.68
|
|
|
Service Code
|
NDC 61314020415
|
| Hospital Charge Code |
6280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.50 |
| Max. Negotiated Rate |
$117.61 |
| Rate for Payer: Aetna American Axle |
$84.94
|
| Rate for Payer: Aetna Commercial |
$111.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.94
|
| Rate for Payer: Cash Price |
$104.54
|
| Rate for Payer: Cofinity Advantage |
$91.48
|
| Rate for Payer: Cofinity Commercial |
$112.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.54
|
| Rate for Payer: Healthscope Commercial |
$117.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.01
|
| Rate for Payer: PHP Commercial |
$111.08
|
| Rate for Payer: Priority Health SBD |
$82.33
|
| Rate for Payer: UMR Bronson Commercial |
$57.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.01
|
|
|
PILOCARPINE 2 % EYE DROPS
|
Facility
|
IP
|
$107.42
|
|
|
Service Code
|
NDC 70069019101
|
| Hospital Charge Code |
6280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.26 |
| Max. Negotiated Rate |
$96.68 |
| Rate for Payer: Aetna American Axle |
$69.82
|
| Rate for Payer: Aetna Commercial |
$91.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.82
|
| Rate for Payer: Cash Price |
$85.94
|
| Rate for Payer: Cofinity Advantage |
$75.19
|
| Rate for Payer: Cofinity Commercial |
$92.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.94
|
| Rate for Payer: Healthscope Commercial |
$96.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.56
|
| Rate for Payer: PHP Commercial |
$91.31
|
| Rate for Payer: Priority Health SBD |
$67.67
|
| Rate for Payer: UMR Bronson Commercial |
$47.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.56
|
|
|
PILOCARPINE 2 % EYE DROPS
|
Facility
|
OP
|
$130.68
|
|
|
Service Code
|
NDC 61314020415
|
| Hospital Charge Code |
6280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$117.61 |
| Rate for Payer: Aetna American Axle |
$84.94
|
| Rate for Payer: Aetna Commercial |
$111.08
|
| Rate for Payer: Aetna Medicare |
$65.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.94
|
| Rate for Payer: BCBS Complete |
$52.27
|
| Rate for Payer: Cash Price |
$104.54
|
| Rate for Payer: Cofinity Advantage |
$91.48
|
| Rate for Payer: Cofinity Commercial |
$112.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.54
|
| Rate for Payer: Healthscope Commercial |
$117.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.01
|
| Rate for Payer: PHP Commercial |
$111.08
|
| Rate for Payer: Priority Health SBD |
$82.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.94
|
| Rate for Payer: UHC Core |
$68.08
|
| Rate for Payer: UHC Exchange |
$51.36
|
| Rate for Payer: UMR Bronson Commercial |
$48.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.01
|
|
|
PILOCARPINE 2 % EYE DROPS
|
Facility
|
OP
|
$107.42
|
|
|
Service Code
|
NDC 70069019101
|
| Hospital Charge Code |
6280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$96.68 |
| Rate for Payer: Aetna American Axle |
$69.82
|
| Rate for Payer: Aetna Commercial |
$91.31
|
| Rate for Payer: Aetna Medicare |
$53.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.82
|
| Rate for Payer: BCBS Complete |
$42.97
|
| Rate for Payer: Cash Price |
$85.94
|
| Rate for Payer: Cofinity Advantage |
$75.19
|
| Rate for Payer: Cofinity Commercial |
$92.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.94
|
| Rate for Payer: Healthscope Commercial |
$96.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.56
|
| Rate for Payer: PHP Commercial |
$91.31
|
| Rate for Payer: Priority Health SBD |
$67.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.82
|
| Rate for Payer: UHC Core |
$55.97
|
| Rate for Payer: UHC Exchange |
$42.22
|
| Rate for Payer: UMR Bronson Commercial |
$39.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.56
|
|
|
PILOCARPINE 4 % EYE DROPS
|
Facility
|
IP
|
$110.67
|
|
|
Service Code
|
NDC 70069020101
|
| Hospital Charge Code |
6282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$99.60 |
| Rate for Payer: Aetna American Axle |
$71.94
|
| Rate for Payer: Aetna Commercial |
$94.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.94
|
| Rate for Payer: Cash Price |
$88.54
|
| Rate for Payer: Cofinity Advantage |
$77.47
|
| Rate for Payer: Cofinity Commercial |
$95.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.54
|
| Rate for Payer: Healthscope Commercial |
$99.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.00
|
| Rate for Payer: PHP Commercial |
$94.07
|
| Rate for Payer: Priority Health SBD |
$69.72
|
| Rate for Payer: UMR Bronson Commercial |
$48.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.00
|
|
|
PILOCARPINE 4 % EYE DROPS
|
Facility
|
IP
|
$209.32
|
|
|
Service Code
|
NDC 61314020615
|
| Hospital Charge Code |
6282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.10 |
| Max. Negotiated Rate |
$188.39 |
| Rate for Payer: Aetna American Axle |
$136.06
|
| Rate for Payer: Aetna Commercial |
$177.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.06
|
| Rate for Payer: Cash Price |
$167.46
|
| Rate for Payer: Cofinity Advantage |
$146.52
|
| Rate for Payer: Cofinity Commercial |
$180.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.46
|
| Rate for Payer: Healthscope Commercial |
$188.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.99
|
| Rate for Payer: PHP Commercial |
$177.92
|
| Rate for Payer: Priority Health SBD |
$131.87
|
| Rate for Payer: UMR Bronson Commercial |
$92.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.99
|
|
|
PILOCARPINE 4 % EYE DROPS
|
Facility
|
OP
|
$209.32
|
|
|
Service Code
|
NDC 61314020615
|
| Hospital Charge Code |
6282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.45 |
| Max. Negotiated Rate |
$188.39 |
| Rate for Payer: Aetna American Axle |
$136.06
|
| Rate for Payer: Aetna Commercial |
$177.92
|
| Rate for Payer: Aetna Medicare |
$104.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.06
|
| Rate for Payer: BCBS Complete |
$83.73
|
| Rate for Payer: Cash Price |
$167.46
|
| Rate for Payer: Cofinity Advantage |
$146.52
|
| Rate for Payer: Cofinity Commercial |
$180.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.46
|
| Rate for Payer: Healthscope Commercial |
$188.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.99
|
| Rate for Payer: PHP Commercial |
$177.92
|
| Rate for Payer: Priority Health SBD |
$131.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.06
|
| Rate for Payer: UHC Core |
$109.06
|
| Rate for Payer: UHC Exchange |
$82.26
|
| Rate for Payer: UMR Bronson Commercial |
$77.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.99
|
|
|
PILOCARPINE 4 % EYE DROPS
|
Facility
|
OP
|
$110.67
|
|
|
Service Code
|
NDC 70069020101
|
| Hospital Charge Code |
6282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$99.60 |
| Rate for Payer: Aetna American Axle |
$71.94
|
| Rate for Payer: Aetna Commercial |
$94.07
|
| Rate for Payer: Aetna Medicare |
$55.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.94
|
| Rate for Payer: BCBS Complete |
$44.27
|
| Rate for Payer: Cash Price |
$88.54
|
| Rate for Payer: Cofinity Advantage |
$77.47
|
| Rate for Payer: Cofinity Commercial |
$95.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.54
|
| Rate for Payer: Healthscope Commercial |
$99.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.00
|
| Rate for Payer: PHP Commercial |
$94.07
|
| Rate for Payer: Priority Health SBD |
$69.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.94
|
| Rate for Payer: UHC Core |
$57.66
|
| Rate for Payer: UHC Exchange |
$43.49
|
| Rate for Payer: UMR Bronson Commercial |
$40.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.00
|
|
|
PILOCARPINE 5 MG TABLET
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
NDC 00574079201
|
| Hospital Charge Code |
12803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.57 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna American Axle |
$234.65
|
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: Aetna Medicare |
$180.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.65
|
| Rate for Payer: BCBS Complete |
$144.40
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Advantage |
$252.70
|
| Rate for Payer: Cofinity Commercial |
$310.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.80
|
| Rate for Payer: Healthscope Commercial |
$324.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$288.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.75
|
| Rate for Payer: PHP Commercial |
$306.85
|
| Rate for Payer: Priority Health SBD |
$227.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.65
|
| Rate for Payer: UHC Core |
$188.08
|
| Rate for Payer: UHC Exchange |
$141.87
|
| Rate for Payer: UMR Bronson Commercial |
$133.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.75
|
|
|
PILOCARPINE 5 MG TABLET
|
Facility
|
IP
|
$275.50
|
|
|
Service Code
|
NDC 60219592201
|
| Hospital Charge Code |
12803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna American Axle |
$179.07
|
| Rate for Payer: Aetna Commercial |
$234.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.07
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Advantage |
$192.85
|
| Rate for Payer: Cofinity Commercial |
$236.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Healthscope Commercial |
$247.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.62
|
| Rate for Payer: PHP Commercial |
$234.18
|
| Rate for Payer: Priority Health SBD |
$173.56
|
| Rate for Payer: UMR Bronson Commercial |
$121.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.62
|
|
|
PILOCARPINE 5 MG TABLET
|
Facility
|
OP
|
$267.36
|
|
|
Service Code
|
NDC 00115592201
|
| Hospital Charge Code |
12803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.92 |
| Max. Negotiated Rate |
$240.62 |
| Rate for Payer: Aetna American Axle |
$173.78
|
| Rate for Payer: Aetna Commercial |
$227.26
|
| Rate for Payer: Aetna Medicare |
$133.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.78
|
| Rate for Payer: BCBS Complete |
$106.94
|
| Rate for Payer: Cash Price |
$213.89
|
| Rate for Payer: Cofinity Advantage |
$187.15
|
| Rate for Payer: Cofinity Commercial |
$229.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.89
|
| Rate for Payer: Healthscope Commercial |
$240.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.52
|
| Rate for Payer: PHP Commercial |
$227.26
|
| Rate for Payer: Priority Health SBD |
$168.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.78
|
| Rate for Payer: UHC Core |
$139.29
|
| Rate for Payer: UHC Exchange |
$105.07
|
| Rate for Payer: UMR Bronson Commercial |
$98.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.52
|
|
|
PILOCARPINE 5 MG TABLET
|
Facility
|
OP
|
$275.50
|
|
|
Service Code
|
NDC 60219592201
|
| Hospital Charge Code |
12803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna American Axle |
$179.07
|
| Rate for Payer: Aetna Commercial |
$234.18
|
| Rate for Payer: Aetna Medicare |
$137.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.07
|
| Rate for Payer: BCBS Complete |
$110.20
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Advantage |
$192.85
|
| Rate for Payer: Cofinity Commercial |
$236.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Healthscope Commercial |
$247.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$220.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.62
|
| Rate for Payer: PHP Commercial |
$234.18
|
| Rate for Payer: Priority Health SBD |
$173.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.07
|
| Rate for Payer: UHC Core |
$143.54
|
| Rate for Payer: UHC Exchange |
$108.27
|
| Rate for Payer: UMR Bronson Commercial |
$101.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.62
|
|
|
PILOCARPINE 5 MG TABLET
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
NDC 00574079201
|
| Hospital Charge Code |
12803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.84 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna American Axle |
$234.65
|
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.65
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Advantage |
$252.70
|
| Rate for Payer: Cofinity Commercial |
$310.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.80
|
| Rate for Payer: Healthscope Commercial |
$324.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.75
|
| Rate for Payer: PHP Commercial |
$306.85
|
| Rate for Payer: Priority Health SBD |
$227.43
|
| Rate for Payer: UMR Bronson Commercial |
$158.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.75
|
|
|
PILOCARPINE 5 MG TABLET
|
Facility
|
IP
|
$267.36
|
|
|
Service Code
|
NDC 00115592201
|
| Hospital Charge Code |
12803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.64 |
| Max. Negotiated Rate |
$240.62 |
| Rate for Payer: Aetna American Axle |
$173.78
|
| Rate for Payer: Aetna Commercial |
$227.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.78
|
| Rate for Payer: Cash Price |
$213.89
|
| Rate for Payer: Cofinity Advantage |
$187.15
|
| Rate for Payer: Cofinity Commercial |
$229.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.89
|
| Rate for Payer: Healthscope Commercial |
$240.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.52
|
| Rate for Payer: PHP Commercial |
$227.26
|
| Rate for Payer: Priority Health SBD |
$168.44
|
| Rate for Payer: UMR Bronson Commercial |
$117.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.52
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$4.96
|
|
|
Service Code
|
NDC 60687039111
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna American Axle |
$3.22
|
| Rate for Payer: Aetna Commercial |
$4.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.22
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: Cofinity Advantage |
$3.47
|
| Rate for Payer: Cofinity Commercial |
$4.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.97
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.72
|
| Rate for Payer: PHP Commercial |
$4.22
|
| Rate for Payer: Priority Health SBD |
$3.12
|
| Rate for Payer: UMR Bronson Commercial |
$2.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.72
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$495.36
|
|
|
Service Code
|
NDC 60687039101
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.28 |
| Max. Negotiated Rate |
$445.82 |
| Rate for Payer: Aetna American Axle |
$321.98
|
| Rate for Payer: Aetna Commercial |
$421.06
|
| Rate for Payer: Aetna Medicare |
$247.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.98
|
| Rate for Payer: BCBS Complete |
$198.14
|
| Rate for Payer: Cash Price |
$396.29
|
| Rate for Payer: Cofinity Advantage |
$346.75
|
| Rate for Payer: Cofinity Commercial |
$426.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.29
|
| Rate for Payer: Healthscope Commercial |
$445.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$396.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.52
|
| Rate for Payer: PHP Commercial |
$421.06
|
| Rate for Payer: Priority Health SBD |
$312.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.98
|
| Rate for Payer: UHC Core |
$258.08
|
| Rate for Payer: UHC Exchange |
$194.68
|
| Rate for Payer: UMR Bronson Commercial |
$183.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.52
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$495.36
|
|
|
Service Code
|
NDC 60687039101
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.96 |
| Max. Negotiated Rate |
$445.82 |
| Rate for Payer: Aetna American Axle |
$321.98
|
| Rate for Payer: Aetna Commercial |
$421.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.98
|
| Rate for Payer: Cash Price |
$396.29
|
| Rate for Payer: Cofinity Advantage |
$346.75
|
| Rate for Payer: Cofinity Commercial |
$426.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.29
|
| Rate for Payer: Healthscope Commercial |
$445.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.52
|
| Rate for Payer: PHP Commercial |
$421.06
|
| Rate for Payer: Priority Health SBD |
$312.08
|
| Rate for Payer: UMR Bronson Commercial |
$217.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.52
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$4.96
|
|
|
Service Code
|
NDC 60687039111
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna American Axle |
$3.22
|
| Rate for Payer: Aetna Commercial |
$4.22
|
| Rate for Payer: Aetna Medicare |
$2.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.22
|
| Rate for Payer: BCBS Complete |
$1.98
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: Cofinity Advantage |
$3.47
|
| Rate for Payer: Cofinity Commercial |
$4.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.97
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.72
|
| Rate for Payer: PHP Commercial |
$4.22
|
| Rate for Payer: Priority Health SBD |
$3.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.22
|
| Rate for Payer: UHC Core |
$2.58
|
| Rate for Payer: UHC Exchange |
$1.95
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.72
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$264.38
|
|
|
Service Code
|
NDC 16729002015
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.33 |
| Max. Negotiated Rate |
$237.94 |
| Rate for Payer: Aetna American Axle |
$171.85
|
| Rate for Payer: Aetna Commercial |
$224.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.85
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cofinity Advantage |
$185.07
|
| Rate for Payer: Cofinity Commercial |
$227.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.50
|
| Rate for Payer: Healthscope Commercial |
$237.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.28
|
| Rate for Payer: PHP Commercial |
$224.72
|
| Rate for Payer: Priority Health SBD |
$166.56
|
| Rate for Payer: UMR Bronson Commercial |
$116.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.28
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$173.43
|
|
|
Service Code
|
NDC 57237021990
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.31 |
| Max. Negotiated Rate |
$156.09 |
| Rate for Payer: Aetna American Axle |
$112.73
|
| Rate for Payer: Aetna Commercial |
$147.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.73
|
| Rate for Payer: Cash Price |
$138.74
|
| Rate for Payer: Cofinity Advantage |
$121.40
|
| Rate for Payer: Cofinity Commercial |
$149.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.74
|
| Rate for Payer: Healthscope Commercial |
$156.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.07
|
| Rate for Payer: PHP Commercial |
$147.42
|
| Rate for Payer: Priority Health SBD |
$109.26
|
| Rate for Payer: UMR Bronson Commercial |
$76.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.07
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$264.38
|
|
|
Service Code
|
NDC 16729002015
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.82 |
| Max. Negotiated Rate |
$237.94 |
| Rate for Payer: Aetna American Axle |
$171.85
|
| Rate for Payer: Aetna Commercial |
$224.72
|
| Rate for Payer: Aetna Medicare |
$132.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.85
|
| Rate for Payer: BCBS Complete |
$105.75
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cofinity Advantage |
$185.07
|
| Rate for Payer: Cofinity Commercial |
$227.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.50
|
| Rate for Payer: Healthscope Commercial |
$237.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.28
|
| Rate for Payer: PHP Commercial |
$224.72
|
| Rate for Payer: Priority Health SBD |
$166.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.85
|
| Rate for Payer: UHC Core |
$137.74
|
| Rate for Payer: UHC Exchange |
$103.90
|
| Rate for Payer: UMR Bronson Commercial |
$97.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.28
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$74.39
|
|
|
Service Code
|
NDC 00093727156
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$66.95 |
| Rate for Payer: Aetna American Axle |
$48.35
|
| Rate for Payer: Aetna Commercial |
$63.23
|
| Rate for Payer: Aetna Medicare |
$37.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.35
|
| Rate for Payer: BCBS Complete |
$29.76
|
| Rate for Payer: Cash Price |
$59.51
|
| Rate for Payer: Cofinity Advantage |
$52.07
|
| Rate for Payer: Cofinity Commercial |
$63.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.51
|
| Rate for Payer: Healthscope Commercial |
$66.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.79
|
| Rate for Payer: PHP Commercial |
$63.23
|
| Rate for Payer: Priority Health SBD |
$46.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.35
|
| Rate for Payer: UHC Core |
$38.76
|
| Rate for Payer: UHC Exchange |
$29.24
|
| Rate for Payer: UMR Bronson Commercial |
$27.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.79
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$74.39
|
|
|
Service Code
|
NDC 00093727156
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$66.95 |
| Rate for Payer: Aetna American Axle |
$48.35
|
| Rate for Payer: Aetna Commercial |
$63.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.35
|
| Rate for Payer: Cash Price |
$59.51
|
| Rate for Payer: Cofinity Advantage |
$52.07
|
| Rate for Payer: Cofinity Commercial |
$63.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.51
|
| Rate for Payer: Healthscope Commercial |
$66.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.79
|
| Rate for Payer: PHP Commercial |
$63.23
|
| Rate for Payer: Priority Health SBD |
$46.87
|
| Rate for Payer: UMR Bronson Commercial |
$32.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.79
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$173.43
|
|
|
Service Code
|
NDC 57237021990
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.17 |
| Max. Negotiated Rate |
$156.09 |
| Rate for Payer: Aetna American Axle |
$112.73
|
| Rate for Payer: Aetna Commercial |
$147.42
|
| Rate for Payer: Aetna Medicare |
$86.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.73
|
| Rate for Payer: BCBS Complete |
$69.37
|
| Rate for Payer: Cash Price |
$138.74
|
| Rate for Payer: Cofinity Advantage |
$121.40
|
| Rate for Payer: Cofinity Commercial |
$149.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.74
|
| Rate for Payer: Healthscope Commercial |
$156.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.07
|
| Rate for Payer: PHP Commercial |
$147.42
|
| Rate for Payer: Priority Health SBD |
$109.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.73
|
| Rate for Payer: UHC Core |
$90.36
|
| Rate for Payer: UHC Exchange |
$68.16
|
| Rate for Payer: UMR Bronson Commercial |
$64.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.07
|
|
