|
PHENAZOPYRIDINE 100 MG TABLET
|
Facility
|
OP
|
$211.85
|
|
|
Service Code
|
NDC 42192080101
|
| Hospital Charge Code |
6193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna American Axle |
$137.70
|
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: Aetna Medicare |
$105.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.70
|
| Rate for Payer: BCBS Complete |
$84.74
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Commercial |
$148.30
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$190.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.70
|
| Rate for Payer: Priority Health SBD |
$133.47
|
| Rate for Payer: UMR Bronson Commercial |
$78.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
|
PHENOBARB-HYOSCYAMN-ATROPINE-SCOP 16.2 MG-0.1037 MG-0.0194 MG TABLET
|
Facility
|
OP
|
$4,576.53
|
|
|
Service Code
|
NDC 59212042510
|
| Hospital Charge Code |
28134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,693.32 |
| Max. Negotiated Rate |
$4,118.88 |
| Rate for Payer: Aetna American Axle |
$2,974.74
|
| Rate for Payer: Aetna Commercial |
$3,890.05
|
| Rate for Payer: Aetna Medicare |
$2,288.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,974.74
|
| Rate for Payer: BCBS Complete |
$1,830.61
|
| Rate for Payer: Cash Price |
$3,661.22
|
| Rate for Payer: Cofinity Commercial |
$3,203.57
|
| Rate for Payer: Cofinity Commercial |
$3,935.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,203.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,661.22
|
| Rate for Payer: Healthscope Commercial |
$4,118.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,203.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,432.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,890.05
|
| Rate for Payer: PHP Commercial |
$3,890.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,974.74
|
| Rate for Payer: Priority Health SBD |
$2,883.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,693.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,432.40
|
|
|
PHENOBARB-HYOSCYAMN-ATROPINE-SCOP 16.2 MG-0.1037 MG-0.0194 MG TABLET
|
Facility
|
IP
|
$4,576.53
|
|
|
Service Code
|
NDC 59212042510
|
| Hospital Charge Code |
28134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,013.67 |
| Max. Negotiated Rate |
$4,118.88 |
| Rate for Payer: Aetna American Axle |
$2,974.74
|
| Rate for Payer: Aetna Commercial |
$3,890.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,974.74
|
| Rate for Payer: Cash Price |
$3,661.22
|
| Rate for Payer: Cofinity Commercial |
$3,203.57
|
| Rate for Payer: Cofinity Commercial |
$3,935.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,203.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,661.22
|
| Rate for Payer: Healthscope Commercial |
$4,118.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,203.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,432.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,890.05
|
| Rate for Payer: PHP Commercial |
$3,890.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,974.74
|
| Rate for Payer: Priority Health SBD |
$2,883.21
|
| Rate for Payer: UMR Bronson Commercial |
$2,013.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,432.40
|
|
|
PHENOBARBITAL 16.2 MG TABLET
|
Facility
|
IP
|
$913.50
|
|
|
Service Code
|
NDC 63739019210
|
| Hospital Charge Code |
6215
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$401.94 |
| Max. Negotiated Rate |
$822.15 |
| Rate for Payer: Aetna American Axle |
$593.78
|
| Rate for Payer: Aetna Commercial |
$776.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.78
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cofinity Commercial |
$639.45
|
| Rate for Payer: Cofinity Commercial |
$785.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$639.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.80
|
| Rate for Payer: Healthscope Commercial |
$822.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$639.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$685.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.48
|
| Rate for Payer: PHP Commercial |
$776.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.78
|
| Rate for Payer: Priority Health SBD |
$575.50
|
| Rate for Payer: UMR Bronson Commercial |
$401.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$685.12
|
|
|
PHENOBARBITAL 16.2 MG TABLET
|
Facility
|
OP
|
$913.50
|
|
|
Service Code
|
NDC 63739019210
|
| Hospital Charge Code |
6215
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$822.15 |
| Rate for Payer: Aetna American Axle |
$593.78
|
| Rate for Payer: Aetna Commercial |
$776.48
|
| Rate for Payer: Aetna Medicare |
$456.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.78
|
| Rate for Payer: BCBS Complete |
$365.40
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cofinity Commercial |
$639.45
|
| Rate for Payer: Cofinity Commercial |
$785.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$639.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.80
|
| Rate for Payer: Healthscope Commercial |
$822.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$639.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$685.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.48
|
| Rate for Payer: PHP Commercial |
$776.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.78
|
| Rate for Payer: Priority Health SBD |
$575.50
|
| Rate for Payer: UMR Bronson Commercial |
$338.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$685.12
|
|
|
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR
|
Facility
|
OP
|
$216.97
|
|
|
Service Code
|
NDC 00603150858
|
| Hospital Charge Code |
6212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.28 |
| Max. Negotiated Rate |
$195.27 |
| Rate for Payer: Aetna American Axle |
$141.03
|
| Rate for Payer: Aetna Commercial |
$184.42
|
| Rate for Payer: Aetna Medicare |
$108.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.03
|
| Rate for Payer: BCBS Complete |
$86.79
|
| Rate for Payer: Cash Price |
$173.58
|
| Rate for Payer: Cofinity Commercial |
$151.88
|
| Rate for Payer: Cofinity Commercial |
$186.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.58
|
| Rate for Payer: Healthscope Commercial |
$195.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.42
|
| Rate for Payer: PHP Commercial |
$184.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.03
|
| Rate for Payer: Priority Health SBD |
$136.69
|
| Rate for Payer: UMR Bronson Commercial |
$80.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.73
|
|
|
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR
|
Facility
|
IP
|
$21.06
|
|
|
Service Code
|
NDC 00121282650
|
| Hospital Charge Code |
6212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Aetna American Axle |
$13.69
|
| Rate for Payer: Aetna Commercial |
$17.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.69
|
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Cofinity Commercial |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$18.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$18.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.90
|
| Rate for Payer: PHP Commercial |
$17.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.69
|
| Rate for Payer: Priority Health SBD |
$13.27
|
| Rate for Payer: UMR Bronson Commercial |
$9.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.80
|
|
|
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR
|
Facility
|
OP
|
$21.06
|
|
|
Service Code
|
NDC 00121282615
|
| Hospital Charge Code |
6212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Aetna American Axle |
$13.69
|
| Rate for Payer: Aetna Commercial |
$17.90
|
| Rate for Payer: Aetna Medicare |
$10.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.69
|
| Rate for Payer: BCBS Complete |
$8.42
|
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Cofinity Commercial |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$18.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$18.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.90
|
| Rate for Payer: PHP Commercial |
$17.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.69
|
| Rate for Payer: Priority Health SBD |
$13.27
|
| Rate for Payer: UMR Bronson Commercial |
$7.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.80
|
|
|
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR
|
Facility
|
OP
|
$21.06
|
|
|
Service Code
|
NDC 00121282650
|
| Hospital Charge Code |
6212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Aetna American Axle |
$13.69
|
| Rate for Payer: Aetna Commercial |
$17.90
|
| Rate for Payer: Aetna Medicare |
$10.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.69
|
| Rate for Payer: BCBS Complete |
$8.42
|
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Cofinity Commercial |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$18.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$18.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.90
|
| Rate for Payer: PHP Commercial |
$17.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.69
|
| Rate for Payer: Priority Health SBD |
$13.27
|
| Rate for Payer: UMR Bronson Commercial |
$7.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.80
|
|
|
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR
|
Facility
|
IP
|
$21.06
|
|
|
Service Code
|
NDC 00121282615
|
| Hospital Charge Code |
6212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Aetna American Axle |
$13.69
|
| Rate for Payer: Aetna Commercial |
$17.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.69
|
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Cofinity Commercial |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$18.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$18.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.90
|
| Rate for Payer: PHP Commercial |
$17.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.69
|
| Rate for Payer: Priority Health SBD |
$13.27
|
| Rate for Payer: UMR Bronson Commercial |
$9.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.80
|
|
|
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR
|
Facility
|
IP
|
$216.97
|
|
|
Service Code
|
NDC 00603150858
|
| Hospital Charge Code |
6212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.47 |
| Max. Negotiated Rate |
$195.27 |
| Rate for Payer: Aetna American Axle |
$141.03
|
| Rate for Payer: Aetna Commercial |
$184.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.03
|
| Rate for Payer: Cash Price |
$173.58
|
| Rate for Payer: Cofinity Commercial |
$151.88
|
| Rate for Payer: Cofinity Commercial |
$186.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.58
|
| Rate for Payer: Healthscope Commercial |
$195.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.42
|
| Rate for Payer: PHP Commercial |
$184.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.03
|
| Rate for Payer: Priority Health SBD |
$136.69
|
| Rate for Payer: UMR Bronson Commercial |
$95.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.73
|
|
|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
NDC 00904657561
|
| Hospital Charge Code |
6217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.89 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna American Axle |
$181.54
|
| Rate for Payer: Aetna Commercial |
$237.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.40
|
| Rate for Payer: PHP Commercial |
$237.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.54
|
| Rate for Payer: Priority Health SBD |
$175.96
|
| Rate for Payer: UMR Bronson Commercial |
$122.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.48
|
|
|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
OP
|
$279.30
|
|
|
Service Code
|
NDC 00904657561
|
| Hospital Charge Code |
6217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.34 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna American Axle |
$181.54
|
| Rate for Payer: Aetna Commercial |
$237.40
|
| Rate for Payer: Aetna Medicare |
$139.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: BCBS Complete |
$111.72
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.40
|
| Rate for Payer: PHP Commercial |
$237.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.54
|
| Rate for Payer: Priority Health SBD |
$175.96
|
| Rate for Payer: UMR Bronson Commercial |
$103.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.48
|
|
|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
IP
|
$240.96
|
|
|
Service Code
|
NDC 00603516621
|
| Hospital Charge Code |
6217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.02 |
| Max. Negotiated Rate |
$216.86 |
| Rate for Payer: Aetna American Axle |
$156.62
|
| Rate for Payer: Aetna Commercial |
$204.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.62
|
| Rate for Payer: Cash Price |
$192.77
|
| Rate for Payer: Cofinity Commercial |
$168.67
|
| Rate for Payer: Cofinity Commercial |
$207.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.77
|
| Rate for Payer: Healthscope Commercial |
$216.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.82
|
| Rate for Payer: PHP Commercial |
$204.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.62
|
| Rate for Payer: Priority Health SBD |
$151.80
|
| Rate for Payer: UMR Bronson Commercial |
$106.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.72
|
|
|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
OP
|
$240.96
|
|
|
Service Code
|
NDC 00603516621
|
| Hospital Charge Code |
6217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.16 |
| Max. Negotiated Rate |
$216.86 |
| Rate for Payer: Aetna American Axle |
$156.62
|
| Rate for Payer: Aetna Commercial |
$204.82
|
| Rate for Payer: Aetna Medicare |
$120.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.62
|
| Rate for Payer: BCBS Complete |
$96.38
|
| Rate for Payer: Cash Price |
$192.77
|
| Rate for Payer: Cofinity Commercial |
$168.67
|
| Rate for Payer: Cofinity Commercial |
$207.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.77
|
| Rate for Payer: Healthscope Commercial |
$216.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.82
|
| Rate for Payer: PHP Commercial |
$204.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.62
|
| Rate for Payer: Priority Health SBD |
$151.80
|
| Rate for Payer: UMR Bronson Commercial |
$89.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.72
|
|
|
PHENOBARBITAL 97.2 MG TABLET
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
NDC 16571066801
|
| Hospital Charge Code |
6220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.33 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UMR Bronson Commercial |
$77.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
PHENOBARBITAL 97.2 MG TABLET
|
Facility
|
IP
|
$425.76
|
|
|
Service Code
|
NDC 51293062801
|
| Hospital Charge Code |
6220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.33 |
| Max. Negotiated Rate |
$383.18 |
| Rate for Payer: Aetna American Axle |
$276.74
|
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.74
|
| Rate for Payer: Cash Price |
$340.61
|
| Rate for Payer: Cofinity Commercial |
$298.03
|
| Rate for Payer: Cofinity Commercial |
$366.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.61
|
| Rate for Payer: Healthscope Commercial |
$383.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.90
|
| Rate for Payer: PHP Commercial |
$361.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.74
|
| Rate for Payer: Priority Health SBD |
$268.23
|
| Rate for Payer: UMR Bronson Commercial |
$187.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.32
|
|
|
PHENOBARBITAL 97.2 MG TABLET
|
Facility
|
OP
|
$425.76
|
|
|
Service Code
|
NDC 51293062801
|
| Hospital Charge Code |
6220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.53 |
| Max. Negotiated Rate |
$383.18 |
| Rate for Payer: Aetna American Axle |
$276.74
|
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Aetna Medicare |
$212.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.74
|
| Rate for Payer: BCBS Complete |
$170.30
|
| Rate for Payer: Cash Price |
$340.61
|
| Rate for Payer: Cofinity Commercial |
$298.03
|
| Rate for Payer: Cofinity Commercial |
$366.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.61
|
| Rate for Payer: Healthscope Commercial |
$383.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.90
|
| Rate for Payer: PHP Commercial |
$361.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.74
|
| Rate for Payer: Priority Health SBD |
$268.23
|
| Rate for Payer: UMR Bronson Commercial |
$157.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.32
|
|
|
PHENOBARBITAL 97.2 MG TABLET
|
Facility
|
IP
|
$425.28
|
|
|
Service Code
|
NDC 00603516821
|
| Hospital Charge Code |
6220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.12 |
| Max. Negotiated Rate |
$382.75 |
| Rate for Payer: Aetna American Axle |
$276.43
|
| Rate for Payer: Aetna Commercial |
$361.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.43
|
| Rate for Payer: Cash Price |
$340.22
|
| Rate for Payer: Cofinity Commercial |
$297.70
|
| Rate for Payer: Cofinity Commercial |
$365.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.22
|
| Rate for Payer: Healthscope Commercial |
$382.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.49
|
| Rate for Payer: PHP Commercial |
$361.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.43
|
| Rate for Payer: Priority Health SBD |
$267.93
|
| Rate for Payer: UMR Bronson Commercial |
$187.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.96
|
|
|
PHENOBARBITAL 97.2 MG TABLET
|
Facility
|
OP
|
$425.28
|
|
|
Service Code
|
NDC 00603516821
|
| Hospital Charge Code |
6220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.35 |
| Max. Negotiated Rate |
$382.75 |
| Rate for Payer: Aetna American Axle |
$276.43
|
| Rate for Payer: Aetna Commercial |
$361.49
|
| Rate for Payer: Aetna Medicare |
$212.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.43
|
| Rate for Payer: BCBS Complete |
$170.11
|
| Rate for Payer: Cash Price |
$340.22
|
| Rate for Payer: Cofinity Commercial |
$297.70
|
| Rate for Payer: Cofinity Commercial |
$365.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.22
|
| Rate for Payer: Healthscope Commercial |
$382.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.49
|
| Rate for Payer: PHP Commercial |
$361.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.43
|
| Rate for Payer: Priority Health SBD |
$267.93
|
| Rate for Payer: UMR Bronson Commercial |
$157.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.96
|
|
|
PHENOBARBITAL 97.2 MG TABLET
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
NDC 16571066801
|
| Hospital Charge Code |
6220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UMR Bronson Commercial |
$91.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$130.02
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
6221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.21 |
| Max. Negotiated Rate |
$117.02 |
| Rate for Payer: Aetna American Axle |
$84.51
|
| Rate for Payer: Aetna American Axle |
$118.48
|
| Rate for Payer: Aetna American Axle |
$184.04
|
| Rate for Payer: Aetna Commercial |
$154.94
|
| Rate for Payer: Aetna Commercial |
$110.52
|
| Rate for Payer: Aetna Commercial |
$240.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.48
|
| Rate for Payer: Cash Price |
$226.51
|
| Rate for Payer: Cash Price |
$145.82
|
| Rate for Payer: Cash Price |
$104.02
|
| Rate for Payer: Cofinity Commercial |
$91.01
|
| Rate for Payer: Cofinity Commercial |
$156.76
|
| Rate for Payer: Cofinity Commercial |
$127.60
|
| Rate for Payer: Cofinity Commercial |
$243.50
|
| Rate for Payer: Cofinity Commercial |
$198.20
|
| Rate for Payer: Cofinity Commercial |
$111.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$198.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.82
|
| Rate for Payer: Healthscope Commercial |
$164.05
|
| Rate for Payer: Healthscope Commercial |
$117.02
|
| Rate for Payer: Healthscope Commercial |
$254.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.94
|
| Rate for Payer: PHP Commercial |
$240.67
|
| Rate for Payer: PHP Commercial |
$154.94
|
| Rate for Payer: PHP Commercial |
$110.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.51
|
| Rate for Payer: Priority Health SBD |
$178.38
|
| Rate for Payer: Priority Health SBD |
$114.84
|
| Rate for Payer: Priority Health SBD |
$81.91
|
| Rate for Payer: UMR Bronson Commercial |
$57.21
|
| Rate for Payer: UMR Bronson Commercial |
$124.58
|
| Rate for Payer: UMR Bronson Commercial |
$80.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.71
|
|
|
PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$283.14
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
6221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.61 |
| Max. Negotiated Rate |
$254.83 |
| Rate for Payer: Aetna American Axle |
$184.04
|
| Rate for Payer: Aetna American Axle |
$118.48
|
| Rate for Payer: Aetna American Axle |
$84.51
|
| Rate for Payer: Aetna Commercial |
$240.67
|
| Rate for Payer: Aetna Commercial |
$110.52
|
| Rate for Payer: Aetna Commercial |
$154.94
|
| Rate for Payer: Aetna Medicare |
$91.14
|
| Rate for Payer: Aetna Medicare |
$65.01
|
| Rate for Payer: Aetna Medicare |
$141.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.48
|
| Rate for Payer: BCBS Complete |
$72.91
|
| Rate for Payer: BCBS Complete |
$113.26
|
| Rate for Payer: BCBS Complete |
$52.01
|
| Rate for Payer: BCBS Trust/PPO |
$84.61
|
| Rate for Payer: BCBS Trust/PPO |
$84.61
|
| Rate for Payer: BCBS Trust/PPO |
$84.61
|
| Rate for Payer: BCN Commercial |
$84.61
|
| Rate for Payer: BCN Commercial |
$84.61
|
| Rate for Payer: BCN Commercial |
$84.61
|
| Rate for Payer: Cash Price |
$145.82
|
| Rate for Payer: Cash Price |
$226.51
|
| Rate for Payer: Cash Price |
$104.02
|
| Rate for Payer: Cash Price |
$145.82
|
| Rate for Payer: Cash Price |
$104.02
|
| Rate for Payer: Cash Price |
$226.51
|
| Rate for Payer: Cofinity Commercial |
$156.76
|
| Rate for Payer: Cofinity Commercial |
$111.82
|
| Rate for Payer: Cofinity Commercial |
$91.01
|
| Rate for Payer: Cofinity Commercial |
$127.60
|
| Rate for Payer: Cofinity Commercial |
$198.20
|
| Rate for Payer: Cofinity Commercial |
$243.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$198.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.51
|
| Rate for Payer: Healthscope Commercial |
$254.83
|
| Rate for Payer: Healthscope Commercial |
$164.05
|
| Rate for Payer: Healthscope Commercial |
$117.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.67
|
| Rate for Payer: PHP Commercial |
$240.67
|
| Rate for Payer: PHP Commercial |
$110.52
|
| Rate for Payer: PHP Commercial |
$154.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.04
|
| Rate for Payer: Priority Health SBD |
$114.84
|
| Rate for Payer: Priority Health SBD |
$178.38
|
| Rate for Payer: Priority Health SBD |
$81.91
|
| Rate for Payer: UMR Bronson Commercial |
$104.76
|
| Rate for Payer: UMR Bronson Commercial |
$48.11
|
| Rate for Payer: UMR Bronson Commercial |
$67.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.36
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
OP
|
$10.98
|
|
|
Service Code
|
NDC 78112069480
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$9.88 |
| Rate for Payer: Aetna American Axle |
$7.14
|
| Rate for Payer: Aetna Commercial |
$9.33
|
| Rate for Payer: Aetna Medicare |
$5.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.14
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cofinity Commercial |
$7.69
|
| Rate for Payer: Cofinity Commercial |
$9.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Healthscope Commercial |
$9.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.33
|
| Rate for Payer: PHP Commercial |
$9.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: Priority Health SBD |
$6.92
|
| Rate for Payer: UMR Bronson Commercial |
$4.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.24
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$10.98
|
|
|
Service Code
|
NDC 78112069480
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$9.88 |
| Rate for Payer: Aetna American Axle |
$7.14
|
| Rate for Payer: Aetna Commercial |
$9.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.14
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cofinity Commercial |
$7.69
|
| Rate for Payer: Cofinity Commercial |
$9.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Healthscope Commercial |
$9.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.33
|
| Rate for Payer: PHP Commercial |
$9.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: Priority Health SBD |
$6.92
|
| Rate for Payer: UMR Bronson Commercial |
$4.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.24
|
|
