|
PHENTOLAMINE 0.5 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
OP
|
$309.10
|
|
|
Service Code
|
NDC 09900001943
|
| Hospital Charge Code |
150967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$114.37 |
| Max. Negotiated Rate |
$278.19 |
| Rate for Payer: Aetna American Axle |
$200.91
|
| Rate for Payer: Aetna Commercial |
$262.74
|
| Rate for Payer: Aetna Medicare |
$154.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.91
|
| Rate for Payer: BCBS Complete |
$123.64
|
| Rate for Payer: Cash Price |
$247.28
|
| Rate for Payer: Cofinity Commercial |
$216.37
|
| Rate for Payer: Cofinity Commercial |
$265.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.28
|
| Rate for Payer: Healthscope Commercial |
$278.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.74
|
| Rate for Payer: PHP Commercial |
$262.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.91
|
| Rate for Payer: Priority Health SBD |
$194.73
|
| Rate for Payer: UMR Bronson Commercial |
$114.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.82
|
|
|
PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
OP
|
$618.20
|
|
|
Service Code
|
NDC 09900001944
|
| Hospital Charge Code |
301530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$228.73 |
| Max. Negotiated Rate |
$556.38 |
| Rate for Payer: Aetna American Axle |
$401.83
|
| Rate for Payer: Aetna Commercial |
$525.47
|
| Rate for Payer: Aetna Medicare |
$309.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.83
|
| Rate for Payer: BCBS Complete |
$247.28
|
| Rate for Payer: Cash Price |
$494.56
|
| Rate for Payer: Cofinity Commercial |
$432.74
|
| Rate for Payer: Cofinity Commercial |
$531.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.56
|
| Rate for Payer: Healthscope Commercial |
$556.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.47
|
| Rate for Payer: PHP Commercial |
$525.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.83
|
| Rate for Payer: Priority Health SBD |
$389.47
|
| Rate for Payer: UMR Bronson Commercial |
$228.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.65
|
|
|
PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
IP
|
$618.20
|
|
|
Service Code
|
NDC 09900001944
|
| Hospital Charge Code |
301530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$272.01 |
| Max. Negotiated Rate |
$556.38 |
| Rate for Payer: Aetna American Axle |
$401.83
|
| Rate for Payer: Aetna Commercial |
$525.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.83
|
| Rate for Payer: Cash Price |
$494.56
|
| Rate for Payer: Cofinity Commercial |
$432.74
|
| Rate for Payer: Cofinity Commercial |
$531.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.56
|
| Rate for Payer: Healthscope Commercial |
$556.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.47
|
| Rate for Payer: PHP Commercial |
$525.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.83
|
| Rate for Payer: Priority Health SBD |
$389.47
|
| Rate for Payer: UMR Bronson Commercial |
$272.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.65
|
|
|
PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
OP
|
$1,671.75
|
|
|
Service Code
|
NDC 09900001945
|
| Hospital Charge Code |
301530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$618.55 |
| Max. Negotiated Rate |
$1,504.58 |
| Rate for Payer: Aetna American Axle |
$1,086.64
|
| Rate for Payer: Aetna Commercial |
$1,420.99
|
| Rate for Payer: Aetna Medicare |
$835.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,086.64
|
| Rate for Payer: BCBS Complete |
$668.70
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cofinity Commercial |
$1,170.22
|
| Rate for Payer: Cofinity Commercial |
$1,437.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,170.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.40
|
| Rate for Payer: Healthscope Commercial |
$1,504.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,170.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,253.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,420.99
|
| Rate for Payer: PHP Commercial |
$1,420.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,086.64
|
| Rate for Payer: Priority Health SBD |
$1,053.20
|
| Rate for Payer: UMR Bronson Commercial |
$618.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,253.81
|
|
|
PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
IP
|
$1,671.75
|
|
|
Service Code
|
NDC 09900001945
|
| Hospital Charge Code |
301530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$735.57 |
| Max. Negotiated Rate |
$1,504.58 |
| Rate for Payer: Aetna American Axle |
$1,086.64
|
| Rate for Payer: Aetna Commercial |
$1,420.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,086.64
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cofinity Commercial |
$1,170.22
|
| Rate for Payer: Cofinity Commercial |
$1,437.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,170.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.40
|
| Rate for Payer: Healthscope Commercial |
$1,504.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,170.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,253.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,420.99
|
| Rate for Payer: PHP Commercial |
$1,420.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,086.64
|
| Rate for Payer: Priority Health SBD |
$1,053.20
|
| Rate for Payer: UMR Bronson Commercial |
$735.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,253.81
|
|
|
PHENTOLAMINE 5 MG INJECTION SOLUTION
|
Facility
|
OP
|
$1,385.25
|
|
|
Service Code
|
HCPCS J2760
|
| Hospital Charge Code |
10947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$231.56 |
| Max. Negotiated Rate |
$1,246.72 |
| Rate for Payer: Aetna American Axle |
$900.41
|
| Rate for Payer: Aetna American Axle |
$685.89
|
| Rate for Payer: Aetna Commercial |
$896.93
|
| Rate for Payer: Aetna Commercial |
$1,177.46
|
| Rate for Payer: Aetna Medicare |
$449.30
|
| Rate for Payer: Aetna Medicare |
$449.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$900.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$685.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$540.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$540.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$540.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$540.02
|
| Rate for Payer: BCBS Complete |
$243.14
|
| Rate for Payer: BCBS Complete |
$243.14
|
| Rate for Payer: BCBS MAPPO |
$432.02
|
| Rate for Payer: BCBS MAPPO |
$432.02
|
| Rate for Payer: BCN Medicare Advantage |
$432.02
|
| Rate for Payer: BCN Medicare Advantage |
$432.02
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: Cash Price |
$1,108.20
|
| Rate for Payer: Cash Price |
$1,108.20
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: Cofinity Commercial |
$738.65
|
| Rate for Payer: Cofinity Commercial |
$907.48
|
| Rate for Payer: Cofinity Commercial |
$1,191.32
|
| Rate for Payer: Cofinity Commercial |
$969.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$738.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$969.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$432.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$432.02
|
| Rate for Payer: Healthscope Commercial |
$1,246.72
|
| Rate for Payer: Healthscope Commercial |
$949.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$969.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$738.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$791.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,038.94
|
| Rate for Payer: Mclaren Medicaid |
$231.56
|
| Rate for Payer: Mclaren Medicaid |
$231.56
|
| Rate for Payer: Mclaren Medicare |
$432.02
|
| Rate for Payer: Mclaren Medicare |
$432.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$453.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$453.62
|
| Rate for Payer: Meridian Medicaid |
$243.14
|
| Rate for Payer: Meridian Medicaid |
$243.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$496.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$496.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,177.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$896.93
|
| Rate for Payer: PACE Medicare |
$410.42
|
| Rate for Payer: PACE Medicare |
$410.42
|
| Rate for Payer: PACE SWMI |
$432.02
|
| Rate for Payer: PACE SWMI |
$432.02
|
| Rate for Payer: PHP Commercial |
$896.93
|
| Rate for Payer: PHP Commercial |
$1,177.46
|
| Rate for Payer: PHP Medicare Advantage |
$432.02
|
| Rate for Payer: PHP Medicare Advantage |
$432.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$231.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$231.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$685.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.41
|
| Rate for Payer: Priority Health Medicare |
$432.02
|
| Rate for Payer: Priority Health Medicare |
$432.02
|
| Rate for Payer: Priority Health SBD |
$664.78
|
| Rate for Payer: Priority Health SBD |
$872.71
|
| Rate for Payer: Railroad Medicare Medicare |
$432.02
|
| Rate for Payer: Railroad Medicare Medicare |
$432.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,216.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,216.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$432.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$432.02
|
| Rate for Payer: UHC Exchange |
$825.63
|
| Rate for Payer: UHC Exchange |
$825.63
|
| Rate for Payer: UHC Medicare Advantage |
$432.02
|
| Rate for Payer: UHC Medicare Advantage |
$432.02
|
| Rate for Payer: UHCCP Medicaid |
$231.56
|
| Rate for Payer: UHCCP Medicaid |
$231.56
|
| Rate for Payer: UMR Bronson Commercial |
$390.43
|
| Rate for Payer: UMR Bronson Commercial |
$512.54
|
| Rate for Payer: VA VA |
$432.02
|
| Rate for Payer: VA VA |
$432.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,038.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$791.41
|
|
|
PHENTOLAMINE 5 MG INJECTION SOLUTION
|
Facility
|
IP
|
$1,055.21
|
|
|
Service Code
|
HCPCS J2760
|
| Hospital Charge Code |
10947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$464.29 |
| Max. Negotiated Rate |
$949.69 |
| Rate for Payer: Aetna American Axle |
$685.89
|
| Rate for Payer: Aetna American Axle |
$900.41
|
| Rate for Payer: Aetna Commercial |
$896.93
|
| Rate for Payer: Aetna Commercial |
$1,177.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$685.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$900.41
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: Cash Price |
$1,108.20
|
| Rate for Payer: Cofinity Commercial |
$969.67
|
| Rate for Payer: Cofinity Commercial |
$1,191.32
|
| Rate for Payer: Cofinity Commercial |
$738.65
|
| Rate for Payer: Cofinity Commercial |
$907.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$738.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$969.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.20
|
| Rate for Payer: Healthscope Commercial |
$949.69
|
| Rate for Payer: Healthscope Commercial |
$1,246.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$738.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$969.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$791.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,038.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,177.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$896.93
|
| Rate for Payer: PHP Commercial |
$1,177.46
|
| Rate for Payer: PHP Commercial |
$896.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$685.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.41
|
| Rate for Payer: Priority Health SBD |
$664.78
|
| Rate for Payer: Priority Health SBD |
$872.71
|
| Rate for Payer: UMR Bronson Commercial |
$464.29
|
| Rate for Payer: UMR Bronson Commercial |
$609.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$791.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,038.94
|
|
|
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 Commercial |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$20.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.32
|
| 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: PHP Commercial |
$19.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.16
|
| 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 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.32
|
|
|
Service Code
|
HCPCS J2373
|
| Hospital Charge Code |
192051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna American Axle |
$15.16
|
| Rate for Payer: Aetna Commercial |
$19.82
|
| Rate for Payer: Aetna Medicare |
$0.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.18
|
| Rate for Payer: BCBS Complete |
$0.08
|
| Rate for Payer: BCBS MAPPO |
$0.14
|
| Rate for Payer: BCN Medicare Advantage |
$0.14
|
| Rate for Payer: Cash Price |
$18.66
|
| Rate for Payer: Cash Price |
$18.66
|
| Rate for Payer: Cofinity Commercial |
$20.06
|
| Rate for Payer: Cofinity Commercial |
$16.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.14
|
| 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: Mclaren Medicaid |
$0.08
|
| Rate for Payer: Mclaren Medicare |
$0.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.15
|
| Rate for Payer: Meridian Medicaid |
$0.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.82
|
| Rate for Payer: PACE Medicare |
$0.13
|
| Rate for Payer: PACE SWMI |
$0.14
|
| Rate for Payer: PHP Commercial |
$19.82
|
| Rate for Payer: PHP Medicare Advantage |
$0.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.16
|
| Rate for Payer: Priority Health Medicare |
$0.14
|
| Rate for Payer: Priority Health SBD |
$14.69
|
| Rate for Payer: Railroad Medicare Medicare |
$0.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.14
|
| Rate for Payer: UHC Exchange |
$0.27
|
| Rate for Payer: UHC Medicare Advantage |
$0.14
|
| Rate for Payer: UHCCP Medicaid |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$8.63
|
| Rate for Payer: VA VA |
$0.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.49
|
|
|
PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
NDC 45802018816
|
| Hospital Charge Code |
167632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Aetna American Axle |
$6.17
|
| Rate for Payer: Aetna Commercial |
$8.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.17
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Cofinity Commercial |
$6.65
|
| Rate for Payer: Cofinity Commercial |
$8.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.60
|
| Rate for Payer: Healthscope Commercial |
$8.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.07
|
| Rate for Payer: PHP Commercial |
$8.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.17
|
| Rate for Payer: Priority Health SBD |
$5.99
|
| Rate for Payer: UMR Bronson Commercial |
$4.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.12
|
|
|
PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
NDC 45802018816
|
| Hospital Charge Code |
167632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Aetna American Axle |
$6.17
|
| Rate for Payer: Aetna Commercial |
$8.07
|
| Rate for Payer: Aetna Medicare |
$4.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.17
|
| Rate for Payer: BCBS Complete |
$3.80
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Cofinity Commercial |
$6.65
|
| Rate for Payer: Cofinity Commercial |
$8.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.60
|
| Rate for Payer: Healthscope Commercial |
$8.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.07
|
| Rate for Payer: PHP Commercial |
$8.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.17
|
| Rate for Payer: Priority Health SBD |
$5.99
|
| Rate for Payer: UMR Bronson Commercial |
$3.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.12
|
|
|
PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT
|
Facility
|
IP
|
$11.63
|
|
|
Service Code
|
NDC 00536128806
|
| Hospital Charge Code |
167632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$10.47 |
| Rate for Payer: Aetna American Axle |
$7.56
|
| Rate for Payer: Aetna Commercial |
$9.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.56
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Commercial |
$10.00
|
| Rate for Payer: Cofinity Commercial |
$8.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$10.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.89
|
| Rate for Payer: PHP Commercial |
$9.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.56
|
| Rate for Payer: Priority Health SBD |
$7.33
|
| Rate for Payer: UMR Bronson Commercial |
$5.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.72
|
|
|
PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT
|
Facility
|
OP
|
$11.63
|
|
|
Service Code
|
NDC 00536128806
|
| Hospital Charge Code |
167632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$10.47 |
| Rate for Payer: Aetna American Axle |
$7.56
|
| Rate for Payer: Aetna Commercial |
$9.89
|
| Rate for Payer: Aetna Medicare |
$5.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.56
|
| Rate for Payer: BCBS Complete |
$4.65
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Commercial |
$10.00
|
| Rate for Payer: Cofinity Commercial |
$8.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$10.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.89
|
| Rate for Payer: PHP Commercial |
$9.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.56
|
| Rate for Payer: Priority Health SBD |
$7.33
|
| Rate for Payer: UMR Bronson Commercial |
$4.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.72
|
|
|
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 Commercial |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$17.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.85
|
| 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: PHP Commercial |
$16.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.86
|
| Rate for Payer: Priority Health SBD |
$12.46
|
| 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 Commercial |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$17.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.85
|
| 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: PHP Commercial |
$16.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.86
|
| 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 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 Commercial |
$111.97
|
| Rate for Payer: Cofinity Commercial |
$91.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.14
|
| 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: PHP Commercial |
$110.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.63
|
| Rate for Payer: Priority Health SBD |
$82.03
|
| 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
|
$94.75
|
|
|
Service Code
|
NDC 70756061430
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.06 |
| Max. Negotiated Rate |
$85.28 |
| Rate for Payer: Aetna American Axle |
$61.59
|
| Rate for Payer: Aetna Commercial |
$80.54
|
| Rate for Payer: Aetna Medicare |
$47.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.59
|
| Rate for Payer: BCBS Complete |
$37.90
|
| Rate for Payer: Cash Price |
$75.80
|
| Rate for Payer: Cofinity Commercial |
$66.33
|
| Rate for Payer: Cofinity Commercial |
$81.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.80
|
| Rate for Payer: Healthscope Commercial |
$85.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.54
|
| Rate for Payer: PHP Commercial |
$80.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.59
|
| Rate for Payer: Priority Health SBD |
$59.69
|
| Rate for Payer: UMR Bronson Commercial |
$35.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.06
|
|
|
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 Commercial |
$102.56
|
| Rate for Payer: Cofinity Commercial |
$83.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.47
|
| 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: PHP Commercial |
$101.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.51
|
| Rate for Payer: Priority Health SBD |
$75.13
|
| 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 Commercial |
$111.97
|
| Rate for Payer: Cofinity Commercial |
$91.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.14
|
| 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: PHP Commercial |
$110.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.63
|
| Rate for Payer: Priority Health SBD |
$82.03
|
| Rate for Payer: UMR Bronson Commercial |
$57.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.65
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
IP
|
$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 Commercial |
$102.56
|
| Rate for Payer: Cofinity Commercial |
$83.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.47
|
| 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: PHP Commercial |
$101.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.51
|
| Rate for Payer: Priority Health SBD |
$75.13
|
| Rate for Payer: UMR Bronson Commercial |
$52.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.44
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
IP
|
$94.75
|
|
|
Service Code
|
NDC 70756061430
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.69 |
| Max. Negotiated Rate |
$85.28 |
| Rate for Payer: Aetna American Axle |
$61.59
|
| Rate for Payer: Aetna Commercial |
$80.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.59
|
| Rate for Payer: Cash Price |
$75.80
|
| Rate for Payer: Cofinity Commercial |
$66.33
|
| Rate for Payer: Cofinity Commercial |
$81.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.80
|
| Rate for Payer: Healthscope Commercial |
$85.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.54
|
| Rate for Payer: PHP Commercial |
$80.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.59
|
| Rate for Payer: Priority Health SBD |
$59.69
|
| Rate for Payer: UMR Bronson Commercial |
$41.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.06
|
|
|
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 Commercial |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.50
|
| 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: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| 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 Commercial |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.50
|
| 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: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health SBD |
$22.05
|
| 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 |
$96.99
|
| Rate for Payer: Aetna American Axle |
$155.42
|
| Rate for Payer: Aetna American Axle |
$114.61
|
| Rate for Payer: Aetna American Axle |
$127.80
|
| Rate for Payer: Aetna American Axle |
$10.52
|
| Rate for Payer: Aetna American Axle |
$66.64
|
| Rate for Payer: Aetna American Axle |
$81.06
|
| Rate for Payer: Aetna American Axle |
$179.74
|
| Rate for Payer: Aetna American Axle |
$97.55
|
| Rate for Payer: Aetna American Axle |
$141.28
|
| Rate for Payer: Aetna American Axle |
$120.93
|
| Rate for Payer: Aetna American Axle |
$34.64
|
| Rate for Payer: Aetna American Axle |
$91.05
|
| Rate for Payer: Aetna American Axle |
$13.50
|
| Rate for Payer: Aetna American Axle |
$67.77
|
| Rate for Payer: Aetna American Axle |
$41.00
|
| Rate for Payer: Aetna American Axle |
$114.80
|
| Rate for Payer: Aetna Commercial |
$126.83
|
| Rate for Payer: Aetna Commercial |
$235.04
|
| Rate for Payer: Aetna Commercial |
$158.13
|
| Rate for Payer: Aetna Commercial |
$87.14
|
| Rate for Payer: Aetna Commercial |
$45.30
|
| Rate for Payer: Aetna Commercial |
$13.76
|
| Rate for Payer: Aetna Commercial |
$172.97
|
| Rate for Payer: Aetna Commercial |
$149.87
|
| Rate for Payer: Aetna Commercial |
$127.57
|
| Rate for Payer: Aetna Commercial |
$184.76
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$203.24
|
| Rate for Payer: Aetna Commercial |
$88.62
|
| Rate for Payer: Aetna Commercial |
$106.00
|
| Rate for Payer: Aetna Commercial |
$150.12
|
| Rate for Payer: Aetna Commercial |
$167.13
|
| Rate for Payer: Aetna Commercial |
$119.06
|
| Rate for Payer: Aetna Commercial |
$53.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.52
|
| Rate for Payer: Cash Price |
$119.37
|
| Rate for Payer: Cash Price |
$148.83
|
| Rate for Payer: Cash Price |
$173.89
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$191.29
|
| Rate for Payer: Cash Price |
$82.02
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Cash Price |
$42.63
|
| Rate for Payer: Cash Price |
$141.06
|
| Rate for Payer: Cash Price |
$83.41
|
| Rate for Payer: Cash Price |
$221.22
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$141.29
|
| Rate for Payer: Cash Price |
$120.06
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cash Price |
$99.76
|
| Rate for Payer: Cash Price |
$112.06
|
| Rate for Payer: Cofinity Commercial |
$152.15
|
| Rate for Payer: Cofinity Commercial |
$151.64
|
| Rate for Payer: Cofinity Commercial |
$72.98
|
| Rate for Payer: Cofinity Commercial |
$123.42
|
| Rate for Payer: Cofinity Commercial |
$71.76
|
| Rate for Payer: Cofinity Commercial |
$13.92
|
| Rate for Payer: Cofinity Commercial |
$105.06
|
| Rate for Payer: Cofinity Commercial |
$129.07
|
| Rate for Payer: Cofinity Commercial |
$107.24
|
| Rate for Payer: Cofinity Commercial |
$169.09
|
| Rate for Payer: Cofinity Commercial |
$88.17
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Cofinity Commercial |
$237.81
|
| Rate for Payer: Cofinity Commercial |
$193.56
|
| Rate for Payer: Cofinity Commercial |
$37.30
|
| Rate for Payer: Cofinity Commercial |
$45.83
|
| Rate for Payer: Cofinity Commercial |
$44.16
|
| Rate for Payer: Cofinity Commercial |
$11.33
|
| Rate for Payer: Cofinity Commercial |
$120.46
|
| Rate for Payer: Cofinity Commercial |
$98.05
|
| Rate for Payer: Cofinity Commercial |
$54.25
|
| Rate for Payer: Cofinity Commercial |
$142.45
|
| Rate for Payer: Cofinity Commercial |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$167.38
|
| Rate for Payer: Cofinity Commercial |
$175.01
|
| Rate for Payer: Cofinity Commercial |
$123.63
|
| Rate for Payer: Cofinity Commercial |
$130.23
|
| Rate for Payer: Cofinity Commercial |
$159.99
|
| Rate for Payer: Cofinity Commercial |
$151.88
|
| Rate for Payer: Cofinity Commercial |
$87.29
|
| Rate for Payer: Cofinity Commercial |
$104.45
|
| Rate for Payer: Cofinity Commercial |
$128.32
|
| Rate for Payer: Cofinity Commercial |
$89.66
|
| Rate for Payer: Cofinity Commercial |
$137.63
|
| Rate for Payer: Cofinity Commercial |
$186.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$134.29
|
| Rate for Payer: Healthscope Commercial |
$93.83
|
| Rate for Payer: Healthscope Commercial |
$92.27
|
| Rate for Payer: Healthscope Commercial |
$112.23
|
| Rate for Payer: Healthscope Commercial |
$126.06
|
| Rate for Payer: Healthscope Commercial |
$135.07
|
| Rate for Payer: Healthscope Commercial |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$158.69
|
| Rate for Payer: Healthscope Commercial |
$158.95
|
| Rate for Payer: Healthscope Commercial |
$167.44
|
| Rate for Payer: Healthscope Commercial |
$176.96
|
| Rate for Payer: Healthscope Commercial |
$183.15
|
| Rate for Payer: Healthscope Commercial |
$18.69
|
| Rate for Payer: Healthscope Commercial |
$195.62
|
| Rate for Payer: Healthscope Commercial |
$215.20
|
| Rate for Payer: Healthscope Commercial |
$248.87
|
| Rate for Payer: Healthscope Commercial |
$47.96
|
| Rate for Payer: Healthscope Commercial |
$56.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.56
|
| 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 |
$152.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.24
|
| 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 |
$167.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.76
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$119.06
|
| Rate for Payer: PHP Commercial |
$13.76
|
| Rate for Payer: PHP Commercial |
$87.14
|
| Rate for Payer: PHP Commercial |
$88.62
|
| Rate for Payer: PHP Commercial |
$158.13
|
| Rate for Payer: PHP Commercial |
$203.24
|
| Rate for Payer: PHP Commercial |
$106.00
|
| Rate for Payer: PHP Commercial |
$150.12
|
| Rate for Payer: PHP Commercial |
$126.83
|
| Rate for Payer: PHP Commercial |
$184.76
|
| Rate for Payer: PHP Commercial |
$167.13
|
| Rate for Payer: PHP Commercial |
$127.57
|
| Rate for Payer: PHP Commercial |
$235.04
|
| Rate for Payer: PHP Commercial |
$149.87
|
| Rate for Payer: PHP Commercial |
$45.30
|
| Rate for Payer: PHP Commercial |
$172.97
|
| Rate for Payer: PHP Commercial |
$53.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.80
|
| Rate for Payer: Priority Health SBD |
$150.64
|
| Rate for Payer: Priority Health SBD |
$10.20
|
| Rate for Payer: Priority Health SBD |
$33.57
|
| Rate for Payer: Priority Health SBD |
$117.21
|
| Rate for Payer: Priority Health SBD |
$94.00
|
| Rate for Payer: Priority Health SBD |
$136.94
|
| Rate for Payer: Priority Health SBD |
$64.59
|
| Rate for Payer: Priority Health SBD |
$65.68
|
| Rate for Payer: Priority Health SBD |
$128.21
|
| Rate for Payer: Priority Health SBD |
$88.24
|
| Rate for Payer: Priority Health SBD |
$111.08
|
| Rate for Payer: Priority Health SBD |
$39.74
|
| Rate for Payer: Priority Health SBD |
$111.26
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: Priority Health SBD |
$94.55
|
| Rate for Payer: Priority Health SBD |
$78.56
|
| Rate for Payer: Priority Health SBD |
$123.87
|
| Rate for Payer: Priority Health SBD |
$174.21
|
| Rate for Payer: UMR Bronson Commercial |
$61.63
|
| Rate for Payer: UMR Bronson Commercial |
$105.21
|
| Rate for Payer: UMR Bronson Commercial |
$54.87
|
| Rate for Payer: UMR Bronson Commercial |
$65.65
|
| Rate for Payer: UMR Bronson Commercial |
$9.14
|
| Rate for Payer: UMR Bronson Commercial |
$66.04
|
| Rate for Payer: UMR Bronson Commercial |
$121.67
|
| Rate for Payer: UMR Bronson Commercial |
$45.11
|
| Rate for Payer: UMR Bronson Commercial |
$45.87
|
| Rate for Payer: UMR Bronson Commercial |
$81.86
|
| Rate for Payer: UMR Bronson Commercial |
$27.76
|
| Rate for Payer: UMR Bronson Commercial |
$89.54
|
| Rate for Payer: UMR Bronson Commercial |
$23.45
|
| Rate for Payer: UMR Bronson Commercial |
$7.12
|
| Rate for Payer: UMR Bronson Commercial |
$86.51
|
| Rate for Payer: UMR Bronson Commercial |
$77.58
|
| Rate for Payer: UMR Bronson Commercial |
$77.71
|
| Rate for Payer: UMR Bronson Commercial |
$95.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.53
|
|
|
PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$176.32
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.24 |
| Max. Negotiated Rate |
$158.69 |
| Rate for Payer: Aetna American Axle |
$114.61
|
| Rate for Payer: Aetna American Axle |
$91.05
|
| Rate for Payer: Aetna American Axle |
$127.80
|
| Rate for Payer: Aetna American Axle |
$141.28
|
| Rate for Payer: Aetna American Axle |
$67.77
|
| Rate for Payer: Aetna American Axle |
$34.64
|
| Rate for Payer: Aetna American Axle |
$81.06
|
| Rate for Payer: Aetna American Axle |
$114.80
|
| Rate for Payer: Aetna American Axle |
$10.52
|
| Rate for Payer: Aetna American Axle |
$132.28
|
| Rate for Payer: Aetna American Axle |
$66.64
|
| Rate for Payer: Aetna American Axle |
$41.00
|
| Rate for Payer: Aetna American Axle |
$179.74
|
| Rate for Payer: Aetna American Axle |
$155.42
|
| Rate for Payer: Aetna American Axle |
$120.93
|
| Rate for Payer: Aetna American Axle |
$13.50
|
| Rate for Payer: Aetna American Axle |
$97.55
|
| Rate for Payer: Aetna American Axle |
$96.99
|
| Rate for Payer: Aetna Commercial |
$184.76
|
| Rate for Payer: Aetna Commercial |
$235.04
|
| Rate for Payer: Aetna Commercial |
$203.24
|
| Rate for Payer: Aetna Commercial |
$106.00
|
| Rate for Payer: Aetna Commercial |
$158.13
|
| Rate for Payer: Aetna Commercial |
$87.14
|
| Rate for Payer: Aetna Commercial |
$149.87
|
| Rate for Payer: Aetna Commercial |
$167.13
|
| Rate for Payer: Aetna Commercial |
$88.62
|
| Rate for Payer: Aetna Commercial |
$13.76
|
| Rate for Payer: Aetna Commercial |
$172.97
|
| Rate for Payer: Aetna Commercial |
$119.06
|
| Rate for Payer: Aetna Commercial |
$127.57
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$150.12
|
| Rate for Payer: Aetna Commercial |
$53.62
|
| Rate for Payer: Aetna Commercial |
$126.83
|
| Rate for Payer: Aetna Commercial |
$45.30
|
| Rate for Payer: Aetna Medicare |
$88.16
|
| Rate for Payer: Aetna Medicare |
$88.31
|
| Rate for Payer: Aetna Medicare |
$108.68
|
| Rate for Payer: Aetna Medicare |
$119.56
|
| Rate for Payer: Aetna Medicare |
$31.54
|
| Rate for Payer: Aetna Medicare |
$138.26
|
| Rate for Payer: Aetna Medicare |
$52.13
|
| Rate for Payer: Aetna Medicare |
$10.38
|
| Rate for Payer: Aetna Medicare |
$70.03
|
| Rate for Payer: Aetna Medicare |
$74.61
|
| Rate for Payer: Aetna Medicare |
$62.35
|
| Rate for Payer: Aetna Medicare |
$101.75
|
| Rate for Payer: Aetna Medicare |
$51.26
|
| Rate for Payer: Aetna Medicare |
$75.04
|
| Rate for Payer: Aetna Medicare |
$8.10
|
| Rate for Payer: Aetna Medicare |
$98.31
|
| Rate for Payer: Aetna Medicare |
$93.02
|
| Rate for Payer: Aetna Medicare |
$26.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.06
|
| 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) |
$41.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.61
|
| Rate for Payer: BCBS Complete |
$78.65
|
| Rate for Payer: BCBS Complete |
$8.31
|
| Rate for Payer: BCBS Complete |
$70.53
|
| Rate for Payer: BCBS Complete |
$110.61
|
| Rate for Payer: BCBS Complete |
$74.42
|
| Rate for Payer: BCBS Complete |
$59.68
|
| Rate for Payer: BCBS Complete |
$41.70
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS Complete |
$56.03
|
| Rate for Payer: BCBS Complete |
$41.01
|
| Rate for Payer: BCBS Complete |
$95.64
|
| Rate for Payer: BCBS Complete |
$21.32
|
| Rate for Payer: BCBS Complete |
$70.64
|
| Rate for Payer: BCBS Complete |
$81.40
|
| Rate for Payer: BCBS Complete |
$60.03
|
| Rate for Payer: BCBS Complete |
$25.23
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: BCBS Complete |
$86.94
|
| Rate for Payer: Cash Price |
$99.76
|
| Rate for Payer: Cash Price |
$221.22
|
| Rate for Payer: Cash Price |
$42.63
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Cash Price |
$141.06
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$120.06
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$112.06
|
| Rate for Payer: Cash Price |
$83.41
|
| Rate for Payer: Cash Price |
$82.02
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cash Price |
$148.83
|
| Rate for Payer: Cash Price |
$141.29
|
| Rate for Payer: Cash Price |
$191.29
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cash Price |
$119.37
|
| Rate for Payer: Cash Price |
$173.89
|
| Rate for Payer: Cofinity Commercial |
$151.64
|
| Rate for Payer: Cofinity Commercial |
$193.56
|
| Rate for Payer: Cofinity Commercial |
$237.81
|
| Rate for Payer: Cofinity Commercial |
$123.63
|
| Rate for Payer: Cofinity Commercial |
$104.45
|
| Rate for Payer: Cofinity Commercial |
$128.32
|
| Rate for Payer: Cofinity Commercial |
$37.30
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Cofinity Commercial |
$45.83
|
| Rate for Payer: Cofinity Commercial |
$175.01
|
| Rate for Payer: Cofinity Commercial |
$142.45
|
| Rate for Payer: Cofinity Commercial |
$44.16
|
| Rate for Payer: Cofinity Commercial |
$54.25
|
| Rate for Payer: Cofinity Commercial |
$72.98
|
| Rate for Payer: Cofinity Commercial |
$105.06
|
| Rate for Payer: Cofinity Commercial |
$129.07
|
| Rate for Payer: Cofinity Commercial |
$88.17
|
| Rate for Payer: Cofinity Commercial |
$123.42
|
| Rate for Payer: Cofinity Commercial |
$120.46
|
| Rate for Payer: Cofinity Commercial |
$107.24
|
| Rate for Payer: Cofinity Commercial |
$87.29
|
| Rate for Payer: Cofinity Commercial |
$169.09
|
| Rate for Payer: Cofinity Commercial |
$137.63
|
| Rate for Payer: Cofinity Commercial |
$71.76
|
| Rate for Payer: Cofinity Commercial |
$98.05
|
| Rate for Payer: Cofinity Commercial |
$89.66
|
| Rate for Payer: Cofinity Commercial |
$151.88
|
| Rate for Payer: Cofinity Commercial |
$11.33
|
| Rate for Payer: Cofinity Commercial |
$13.92
|
| Rate for Payer: Cofinity Commercial |
$159.99
|
| Rate for Payer: Cofinity Commercial |
$130.23
|
| Rate for Payer: Cofinity Commercial |
$167.38
|
| Rate for Payer: Cofinity Commercial |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$186.93
|
| Rate for Payer: Cofinity Commercial |
$152.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.29
|
| Rate for Payer: Healthscope Commercial |
$158.69
|
| Rate for Payer: Healthscope Commercial |
$18.69
|
| Rate for Payer: Healthscope Commercial |
$134.29
|
| Rate for Payer: Healthscope Commercial |
$112.23
|
| Rate for Payer: Healthscope Commercial |
$92.27
|
| Rate for Payer: Healthscope Commercial |
$93.83
|
| Rate for Payer: Healthscope Commercial |
$56.77
|
| Rate for Payer: Healthscope Commercial |
$167.44
|
| Rate for Payer: Healthscope Commercial |
$158.95
|
| Rate for Payer: Healthscope Commercial |
$47.96
|
| Rate for Payer: Healthscope Commercial |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$176.96
|
| Rate for Payer: Healthscope Commercial |
$248.87
|
| Rate for Payer: Healthscope Commercial |
$135.07
|
| Rate for Payer: Healthscope Commercial |
$215.20
|
| Rate for Payer: Healthscope Commercial |
$183.15
|
| Rate for Payer: Healthscope Commercial |
$126.06
|
| Rate for Payer: Healthscope Commercial |
$195.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.42
|
| 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 |
$11.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.06
|
| 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 |
$235.04
|
| 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 |
$88.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.87
|
| Rate for Payer: PHP Commercial |
$106.00
|
| Rate for Payer: PHP Commercial |
$203.24
|
| Rate for Payer: PHP Commercial |
$127.57
|
| Rate for Payer: PHP Commercial |
$172.97
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$119.06
|
| Rate for Payer: PHP Commercial |
$13.76
|
| Rate for Payer: PHP Commercial |
$158.13
|
| Rate for Payer: PHP Commercial |
$45.30
|
| Rate for Payer: PHP Commercial |
$184.76
|
| Rate for Payer: PHP Commercial |
$126.83
|
| Rate for Payer: PHP Commercial |
$167.13
|
| Rate for Payer: PHP Commercial |
$150.12
|
| Rate for Payer: PHP Commercial |
$88.62
|
| Rate for Payer: PHP Commercial |
$235.04
|
| Rate for Payer: PHP Commercial |
$53.62
|
| Rate for Payer: PHP Commercial |
$149.87
|
| Rate for Payer: PHP Commercial |
$87.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.05
|
| Rate for Payer: Priority Health SBD |
$39.74
|
| Rate for Payer: Priority Health SBD |
$111.26
|
| Rate for Payer: Priority Health SBD |
$136.94
|
| Rate for Payer: Priority Health SBD |
$111.08
|
| Rate for Payer: Priority Health SBD |
$94.55
|
| Rate for Payer: Priority Health SBD |
$150.64
|
| Rate for Payer: Priority Health SBD |
$78.56
|
| Rate for Payer: Priority Health SBD |
$117.21
|
| Rate for Payer: Priority Health SBD |
$123.87
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: Priority Health SBD |
$10.20
|
| Rate for Payer: Priority Health SBD |
$128.21
|
| Rate for Payer: Priority Health SBD |
$94.00
|
| Rate for Payer: Priority Health SBD |
$174.21
|
| Rate for Payer: Priority Health SBD |
$64.59
|
| Rate for Payer: Priority Health SBD |
$88.24
|
| Rate for Payer: Priority Health SBD |
$33.57
|
| Rate for Payer: Priority Health SBD |
$65.68
|
| Rate for Payer: UMR Bronson Commercial |
$46.14
|
| Rate for Payer: UMR Bronson Commercial |
$72.75
|
| Rate for Payer: UMR Bronson Commercial |
$7.68
|
| Rate for Payer: UMR Bronson Commercial |
$102.31
|
| Rate for Payer: UMR Bronson Commercial |
$80.42
|
| Rate for Payer: UMR Bronson Commercial |
$65.35
|
| Rate for Payer: UMR Bronson Commercial |
$55.53
|
| Rate for Payer: UMR Bronson Commercial |
$23.34
|
| Rate for Payer: UMR Bronson Commercial |
$68.83
|
| Rate for Payer: UMR Bronson Commercial |
$65.24
|
| Rate for Payer: UMR Bronson Commercial |
$19.72
|
| Rate for Payer: UMR Bronson Commercial |
$51.83
|
| Rate for Payer: UMR Bronson Commercial |
$75.30
|
| Rate for Payer: UMR Bronson Commercial |
$5.99
|
| Rate for Payer: UMR Bronson Commercial |
$55.21
|
| Rate for Payer: UMR Bronson Commercial |
$37.93
|
| Rate for Payer: UMR Bronson Commercial |
$38.58
|
| Rate for Payer: UMR Bronson Commercial |
$88.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.46
|
|
