|
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); SINGLE LESION
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$67.44
|
| Rate for Payer: BCN Commercial |
$67.44
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.50
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$15.00
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
PAROXETINE 10 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,959.60
|
|
|
Service Code
|
NDC 60505040205
|
| Hospital Charge Code |
22959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$725.05 |
| Max. Negotiated Rate |
$1,763.64 |
| Rate for Payer: Aetna American Axle |
$1,273.74
|
| Rate for Payer: Aetna Commercial |
$1,665.66
|
| Rate for Payer: Aetna Medicare |
$979.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.74
|
| Rate for Payer: BCBS Complete |
$783.84
|
| Rate for Payer: Cash Price |
$1,567.68
|
| Rate for Payer: Cofinity Commercial |
$1,371.72
|
| Rate for Payer: Cofinity Commercial |
$1,685.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,371.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.68
|
| Rate for Payer: Healthscope Commercial |
$1,763.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,371.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,469.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.66
|
| Rate for Payer: PHP Commercial |
$1,665.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.74
|
| Rate for Payer: Priority Health SBD |
$1,234.55
|
| Rate for Payer: UMR Bronson Commercial |
$725.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,469.70
|
|
|
PAROXETINE 10 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,959.60
|
|
|
Service Code
|
NDC 60505040205
|
| Hospital Charge Code |
22959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$1,763.64 |
| Rate for Payer: Aetna American Axle |
$1,273.74
|
| Rate for Payer: Aetna Commercial |
$1,665.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.74
|
| Rate for Payer: Cash Price |
$1,567.68
|
| Rate for Payer: Cofinity Commercial |
$1,371.72
|
| Rate for Payer: Cofinity Commercial |
$1,685.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,371.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.68
|
| Rate for Payer: Healthscope Commercial |
$1,763.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,371.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,469.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.66
|
| Rate for Payer: PHP Commercial |
$1,665.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.74
|
| Rate for Payer: Priority Health SBD |
$1,234.55
|
| Rate for Payer: UMR Bronson Commercial |
$862.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,469.70
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
IP
|
$357.20
|
|
|
Service Code
|
NDC 00904567661
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.17 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna American Axle |
$232.18
|
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health SBD |
$225.04
|
| Rate for Payer: UMR Bronson Commercial |
$157.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
IP
|
$470.25
|
|
|
Service Code
|
NDC 68084004411
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.91 |
| Max. Negotiated Rate |
$423.22 |
| Rate for Payer: Aetna American Axle |
$305.66
|
| Rate for Payer: Aetna Commercial |
$399.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.66
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cofinity Commercial |
$329.18
|
| Rate for Payer: Cofinity Commercial |
$404.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.20
|
| Rate for Payer: Healthscope Commercial |
$423.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.71
|
| Rate for Payer: PHP Commercial |
$399.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.66
|
| Rate for Payer: Priority Health SBD |
$296.26
|
| Rate for Payer: UMR Bronson Commercial |
$206.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.69
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
IP
|
$470.25
|
|
|
Service Code
|
NDC 68084004401
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.91 |
| Max. Negotiated Rate |
$423.22 |
| Rate for Payer: Aetna American Axle |
$305.66
|
| Rate for Payer: Aetna Commercial |
$399.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.66
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cofinity Commercial |
$329.18
|
| Rate for Payer: Cofinity Commercial |
$404.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.20
|
| Rate for Payer: Healthscope Commercial |
$423.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.71
|
| Rate for Payer: PHP Commercial |
$399.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.66
|
| Rate for Payer: Priority Health SBD |
$296.26
|
| Rate for Payer: UMR Bronson Commercial |
$206.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.69
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
OP
|
$470.25
|
|
|
Service Code
|
NDC 68084004401
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.99 |
| Max. Negotiated Rate |
$423.22 |
| Rate for Payer: Aetna American Axle |
$305.66
|
| Rate for Payer: Aetna Commercial |
$399.71
|
| Rate for Payer: Aetna Medicare |
$235.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.66
|
| Rate for Payer: BCBS Complete |
$188.10
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cofinity Commercial |
$329.18
|
| Rate for Payer: Cofinity Commercial |
$404.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.20
|
| Rate for Payer: Healthscope Commercial |
$423.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.71
|
| Rate for Payer: PHP Commercial |
$399.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.66
|
| Rate for Payer: Priority Health SBD |
$296.26
|
| Rate for Payer: UMR Bronson Commercial |
$173.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.69
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
OP
|
$357.20
|
|
|
Service Code
|
NDC 00904567661
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.16 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna American Axle |
$232.18
|
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna Medicare |
$178.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| Rate for Payer: BCBS Complete |
$142.88
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health SBD |
$225.04
|
| Rate for Payer: UMR Bronson Commercial |
$132.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
OP
|
$470.25
|
|
|
Service Code
|
NDC 68084004411
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.99 |
| Max. Negotiated Rate |
$423.22 |
| Rate for Payer: Aetna American Axle |
$305.66
|
| Rate for Payer: Aetna Commercial |
$399.71
|
| Rate for Payer: Aetna Medicare |
$235.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.66
|
| Rate for Payer: BCBS Complete |
$188.10
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cofinity Commercial |
$329.18
|
| Rate for Payer: Cofinity Commercial |
$404.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.20
|
| Rate for Payer: Healthscope Commercial |
$423.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.71
|
| Rate for Payer: PHP Commercial |
$399.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.66
|
| Rate for Payer: Priority Health SBD |
$296.26
|
| Rate for Payer: UMR Bronson Commercial |
$173.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.69
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
OP
|
$439.45
|
|
|
Service Code
|
NDC 68084004511
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.60 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna American Axle |
$285.64
|
| Rate for Payer: Aetna Commercial |
$373.53
|
| Rate for Payer: Aetna Medicare |
$219.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.64
|
| Rate for Payer: BCBS Complete |
$175.78
|
| Rate for Payer: Cash Price |
$351.56
|
| Rate for Payer: Cofinity Commercial |
$307.62
|
| Rate for Payer: Cofinity Commercial |
$377.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.56
|
| Rate for Payer: Healthscope Commercial |
$395.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.53
|
| Rate for Payer: PHP Commercial |
$373.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.64
|
| Rate for Payer: Priority Health SBD |
$276.85
|
| Rate for Payer: UMR Bronson Commercial |
$162.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.59
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
NDC 68084004511
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.36 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna American Axle |
$285.64
|
| Rate for Payer: Aetna Commercial |
$373.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.64
|
| Rate for Payer: Cash Price |
$351.56
|
| Rate for Payer: Cofinity Commercial |
$307.62
|
| Rate for Payer: Cofinity Commercial |
$377.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.56
|
| Rate for Payer: Healthscope Commercial |
$395.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.53
|
| Rate for Payer: PHP Commercial |
$373.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.64
|
| Rate for Payer: Priority Health SBD |
$276.85
|
| Rate for Payer: UMR Bronson Commercial |
$193.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.59
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
OP
|
$397.15
|
|
|
Service Code
|
NDC 00904567761
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.95 |
| Max. Negotiated Rate |
$357.44 |
| Rate for Payer: Aetna American Axle |
$258.15
|
| Rate for Payer: Aetna Commercial |
$337.58
|
| Rate for Payer: Aetna Medicare |
$198.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.15
|
| Rate for Payer: BCBS Complete |
$158.86
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Cofinity Commercial |
$278.00
|
| Rate for Payer: Cofinity Commercial |
$341.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.72
|
| Rate for Payer: Healthscope Commercial |
$357.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.58
|
| Rate for Payer: PHP Commercial |
$337.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.15
|
| Rate for Payer: Priority Health SBD |
$250.20
|
| Rate for Payer: UMR Bronson Commercial |
$146.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.86
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
IP
|
$397.15
|
|
|
Service Code
|
NDC 00904567761
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.75 |
| Max. Negotiated Rate |
$357.44 |
| Rate for Payer: Aetna American Axle |
$258.15
|
| Rate for Payer: Aetna Commercial |
$337.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.15
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Cofinity Commercial |
$278.00
|
| Rate for Payer: Cofinity Commercial |
$341.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.72
|
| Rate for Payer: Healthscope Commercial |
$357.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.58
|
| Rate for Payer: PHP Commercial |
$337.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.15
|
| Rate for Payer: Priority Health SBD |
$250.20
|
| Rate for Payer: UMR Bronson Commercial |
$174.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.86
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
OP
|
$4.18
|
|
|
Service Code
|
NDC 68084004611
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Aetna American Axle |
$2.72
|
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Aetna Medicare |
$2.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.72
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$3.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.55
|
| Rate for Payer: PHP Commercial |
$3.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.72
|
| Rate for Payer: Priority Health SBD |
$2.63
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.14
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
OP
|
$73.32
|
|
|
Service Code
|
NDC 13107015630
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.13 |
| Max. Negotiated Rate |
$65.99 |
| Rate for Payer: Aetna American Axle |
$47.66
|
| Rate for Payer: Aetna Commercial |
$62.32
|
| Rate for Payer: Aetna Medicare |
$36.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.66
|
| Rate for Payer: BCBS Complete |
$29.33
|
| Rate for Payer: Cash Price |
$58.66
|
| Rate for Payer: Cofinity Commercial |
$51.32
|
| Rate for Payer: Cofinity Commercial |
$63.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.66
|
| Rate for Payer: Healthscope Commercial |
$65.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.32
|
| Rate for Payer: PHP Commercial |
$62.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.66
|
| Rate for Payer: Priority Health SBD |
$46.19
|
| Rate for Payer: UMR Bronson Commercial |
$27.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.99
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
OP
|
$156.28
|
|
|
Service Code
|
NDC 50268064215
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna American Axle |
$101.58
|
| Rate for Payer: Aetna Commercial |
$132.84
|
| Rate for Payer: Aetna Medicare |
$78.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.58
|
| Rate for Payer: BCBS Complete |
$62.51
|
| Rate for Payer: Cash Price |
$125.02
|
| Rate for Payer: Cofinity Commercial |
$109.40
|
| Rate for Payer: Cofinity Commercial |
$134.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.02
|
| Rate for Payer: Healthscope Commercial |
$140.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.84
|
| Rate for Payer: PHP Commercial |
$132.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.58
|
| Rate for Payer: Priority Health SBD |
$98.46
|
| Rate for Payer: UMR Bronson Commercial |
$57.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.21
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
OP
|
$417.60
|
|
|
Service Code
|
NDC 68084004601
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.51 |
| Max. Negotiated Rate |
$375.84 |
| Rate for Payer: Aetna American Axle |
$271.44
|
| Rate for Payer: Aetna Commercial |
$354.96
|
| Rate for Payer: Aetna Medicare |
$208.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.44
|
| Rate for Payer: BCBS Complete |
$167.04
|
| Rate for Payer: Cash Price |
$334.08
|
| Rate for Payer: Cofinity Commercial |
$292.32
|
| Rate for Payer: Cofinity Commercial |
$359.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$292.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.08
|
| Rate for Payer: Healthscope Commercial |
$375.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.96
|
| Rate for Payer: PHP Commercial |
$354.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.44
|
| Rate for Payer: Priority Health SBD |
$263.09
|
| Rate for Payer: UMR Bronson Commercial |
$154.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.20
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
IP
|
$126.20
|
|
|
Service Code
|
NDC 60505008401
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.53 |
| Max. Negotiated Rate |
$113.58 |
| Rate for Payer: Aetna American Axle |
$82.03
|
| Rate for Payer: Aetna Commercial |
$107.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.03
|
| Rate for Payer: Cash Price |
$100.96
|
| Rate for Payer: Cofinity Commercial |
$108.53
|
| Rate for Payer: Cofinity Commercial |
$88.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.96
|
| Rate for Payer: Healthscope Commercial |
$113.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.27
|
| Rate for Payer: PHP Commercial |
$107.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.03
|
| Rate for Payer: Priority Health SBD |
$79.51
|
| Rate for Payer: UMR Bronson Commercial |
$55.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.65
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
OP
|
$126.20
|
|
|
Service Code
|
NDC 60505008401
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.69 |
| Max. Negotiated Rate |
$113.58 |
| Rate for Payer: Aetna American Axle |
$82.03
|
| Rate for Payer: Aetna Commercial |
$107.27
|
| Rate for Payer: Aetna Medicare |
$63.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.03
|
| Rate for Payer: BCBS Complete |
$50.48
|
| Rate for Payer: Cash Price |
$100.96
|
| Rate for Payer: Cofinity Commercial |
$108.53
|
| Rate for Payer: Cofinity Commercial |
$88.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.96
|
| Rate for Payer: Healthscope Commercial |
$113.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.27
|
| Rate for Payer: PHP Commercial |
$107.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.03
|
| Rate for Payer: Priority Health SBD |
$79.51
|
| Rate for Payer: UMR Bronson Commercial |
$46.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.65
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
IP
|
$3.13
|
|
|
Service Code
|
NDC 50268064211
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Aetna American Axle |
$2.03
|
| Rate for Payer: Aetna Commercial |
$2.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.66
|
| Rate for Payer: PHP Commercial |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health SBD |
$1.97
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.35
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
IP
|
$4.18
|
|
|
Service Code
|
NDC 68084004611
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Aetna American Axle |
$2.72
|
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.72
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$3.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.55
|
| Rate for Payer: PHP Commercial |
$3.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.72
|
| Rate for Payer: Priority Health SBD |
$2.63
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.14
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
IP
|
$73.32
|
|
|
Service Code
|
NDC 13107015630
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.26 |
| Max. Negotiated Rate |
$65.99 |
| Rate for Payer: Aetna American Axle |
$47.66
|
| Rate for Payer: Aetna Commercial |
$62.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.66
|
| Rate for Payer: Cash Price |
$58.66
|
| Rate for Payer: Cofinity Commercial |
$51.32
|
| Rate for Payer: Cofinity Commercial |
$63.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.66
|
| Rate for Payer: Healthscope Commercial |
$65.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.32
|
| Rate for Payer: PHP Commercial |
$62.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.66
|
| Rate for Payer: Priority Health SBD |
$46.19
|
| Rate for Payer: UMR Bronson Commercial |
$32.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.99
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
IP
|
$156.28
|
|
|
Service Code
|
NDC 50268064215
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.76 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna American Axle |
$101.58
|
| Rate for Payer: Aetna Commercial |
$132.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.58
|
| Rate for Payer: Cash Price |
$125.02
|
| Rate for Payer: Cofinity Commercial |
$109.40
|
| Rate for Payer: Cofinity Commercial |
$134.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.02
|
| Rate for Payer: Healthscope Commercial |
$140.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.84
|
| Rate for Payer: PHP Commercial |
$132.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.58
|
| Rate for Payer: Priority Health SBD |
$98.46
|
| Rate for Payer: UMR Bronson Commercial |
$68.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.21
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
IP
|
$417.60
|
|
|
Service Code
|
NDC 68084004601
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.74 |
| Max. Negotiated Rate |
$375.84 |
| Rate for Payer: Aetna American Axle |
$271.44
|
| Rate for Payer: Aetna Commercial |
$354.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.44
|
| Rate for Payer: Cash Price |
$334.08
|
| Rate for Payer: Cofinity Commercial |
$292.32
|
| Rate for Payer: Cofinity Commercial |
$359.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$292.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.08
|
| Rate for Payer: Healthscope Commercial |
$375.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.96
|
| Rate for Payer: PHP Commercial |
$354.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.44
|
| Rate for Payer: Priority Health SBD |
$263.09
|
| Rate for Payer: UMR Bronson Commercial |
$183.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.20
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
OP
|
$3.13
|
|
|
Service Code
|
NDC 50268064211
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Aetna American Axle |
$2.03
|
| Rate for Payer: Aetna Commercial |
$2.66
|
| Rate for Payer: Aetna Medicare |
$1.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.66
|
| Rate for Payer: PHP Commercial |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health SBD |
$1.97
|
| Rate for Payer: UMR Bronson Commercial |
$1.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.35
|
|
