|
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 |
$66.32
|
| Rate for Payer: Cofinity Commercial |
$81.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.32
|
| 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 |
$66.32
|
| 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
|
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 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/ML INJECTION SOLUTION
|
Facility
|
OP
|
$140.07
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$126.06 |
| Rate for Payer: Aetna American Axle |
$91.05
|
| Rate for Payer: Aetna American Axle |
$81.06
|
| Rate for Payer: Aetna American Axle |
$34.64
|
| Rate for Payer: Aetna American Axle |
$10.52
|
| Rate for Payer: Aetna American Axle |
$114.61
|
| Rate for Payer: Aetna American Axle |
$132.28
|
| Rate for Payer: Aetna American Axle |
$97.55
|
| Rate for Payer: Aetna American Axle |
$179.74
|
| Rate for Payer: Aetna American Axle |
$13.50
|
| Rate for Payer: Aetna American Axle |
$67.77
|
| Rate for Payer: Aetna American Axle |
$66.64
|
| Rate for Payer: Aetna American Axle |
$41.00
|
| Rate for Payer: Aetna American Axle |
$96.99
|
| Rate for Payer: Aetna American Axle |
$114.80
|
| Rate for Payer: Aetna American Axle |
$127.80
|
| Rate for Payer: Aetna American Axle |
$141.28
|
| Rate for Payer: Aetna American Axle |
$120.93
|
| Rate for Payer: Aetna American Axle |
$155.42
|
| Rate for Payer: Aetna Commercial |
$203.24
|
| Rate for Payer: Aetna Commercial |
$53.62
|
| Rate for Payer: Aetna Commercial |
$150.12
|
| Rate for Payer: Aetna Commercial |
$126.83
|
| Rate for Payer: Aetna Commercial |
$127.57
|
| Rate for Payer: Aetna Commercial |
$45.30
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$119.06
|
| Rate for Payer: Aetna Commercial |
$149.87
|
| Rate for Payer: Aetna Commercial |
$184.76
|
| Rate for Payer: Aetna Commercial |
$167.13
|
| Rate for Payer: Aetna Commercial |
$13.76
|
| Rate for Payer: Aetna Commercial |
$172.98
|
| Rate for Payer: Aetna Commercial |
$158.13
|
| Rate for Payer: Aetna Commercial |
$106.00
|
| Rate for Payer: Aetna Commercial |
$87.14
|
| Rate for Payer: Aetna Commercial |
$88.62
|
| Rate for Payer: Aetna Commercial |
$235.04
|
| Rate for Payer: Aetna Medicare |
$93.02
|
| Rate for Payer: Aetna Medicare |
$62.35
|
| Rate for Payer: Aetna Medicare |
$98.31
|
| Rate for Payer: Aetna Medicare |
$119.56
|
| Rate for Payer: Aetna Medicare |
$74.60
|
| Rate for Payer: Aetna Medicare |
$70.04
|
| Rate for Payer: Aetna Medicare |
$8.10
|
| Rate for Payer: Aetna Medicare |
$108.68
|
| Rate for Payer: Aetna Medicare |
$101.75
|
| Rate for Payer: Aetna Medicare |
$52.13
|
| Rate for Payer: Aetna Medicare |
$51.26
|
| Rate for Payer: Aetna Medicare |
$31.54
|
| Rate for Payer: Aetna Medicare |
$88.30
|
| Rate for Payer: Aetna Medicare |
$75.04
|
| Rate for Payer: Aetna Medicare |
$88.16
|
| Rate for Payer: Aetna Medicare |
$26.64
|
| Rate for Payer: Aetna Medicare |
$10.38
|
| Rate for Payer: Aetna Medicare |
$138.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.93
|
| 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) |
$132.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.55
|
| 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) |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.05
|
| Rate for Payer: BCBS Complete |
$70.53
|
| Rate for Payer: BCBS Complete |
$41.01
|
| Rate for Payer: BCBS Complete |
$70.64
|
| Rate for Payer: BCBS Complete |
$25.23
|
| Rate for Payer: BCBS Complete |
$21.32
|
| Rate for Payer: BCBS Complete |
$110.61
|
| Rate for Payer: BCBS Complete |
$95.64
|
| Rate for Payer: BCBS Complete |
$56.03
|
| Rate for Payer: BCBS Complete |
$86.94
|
| Rate for Payer: BCBS Complete |
$59.68
|
| Rate for Payer: BCBS Complete |
$8.31
|
| Rate for Payer: BCBS Complete |
$60.03
|
| Rate for Payer: BCBS Complete |
$81.40
|
| Rate for Payer: BCBS Complete |
$78.65
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: BCBS Complete |
$41.70
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS Complete |
$74.42
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cash Price |
$173.89
|
| Rate for Payer: Cash Price |
$120.06
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cash Price |
$99.76
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$141.29
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$83.41
|
| Rate for Payer: Cash Price |
$191.29
|
| Rate for Payer: Cash Price |
$112.06
|
| Rate for Payer: Cash Price |
$191.29
|
| Rate for Payer: Cash Price |
$112.06
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$148.83
|
| Rate for Payer: Cash Price |
$221.22
|
| Rate for Payer: Cash Price |
$221.22
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$173.89
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Cash Price |
$119.37
|
| Rate for Payer: Cash Price |
$119.37
|
| Rate for Payer: Cash Price |
$148.83
|
| Rate for Payer: Cash Price |
$42.63
|
| Rate for Payer: Cash Price |
$42.63
|
| Rate for Payer: Cash Price |
$141.06
|
| 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 |
$50.46
|
| Rate for Payer: Cash Price |
$141.06
|
| Rate for Payer: Cash Price |
$99.76
|
| Rate for Payer: Cash Price |
$82.02
|
| Rate for Payer: Cash Price |
$83.41
|
| Rate for Payer: Cash Price |
$82.02
|
| Rate for Payer: Cofinity Commercial |
$128.32
|
| Rate for Payer: Cofinity Commercial |
$89.66
|
| Rate for Payer: Cofinity Commercial |
$71.76
|
| Rate for Payer: Cofinity Commercial |
$88.17
|
| Rate for Payer: Cofinity Commercial |
$72.98
|
| Rate for Payer: Cofinity Commercial |
$107.24
|
| Rate for Payer: Cofinity Commercial |
$87.29
|
| Rate for Payer: Cofinity Commercial |
$120.46
|
| Rate for Payer: Cofinity Commercial |
$98.05
|
| Rate for Payer: Cofinity Commercial |
$104.45
|
| Rate for Payer: Cofinity Commercial |
$105.06
|
| Rate for Payer: Cofinity Commercial |
$129.07
|
| Rate for Payer: Cofinity Commercial |
$11.33
|
| Rate for Payer: Cofinity Commercial |
$13.92
|
| Rate for Payer: Cofinity Commercial |
$123.42
|
| Rate for Payer: Cofinity Commercial |
$151.64
|
| Rate for Payer: Cofinity Commercial |
$123.63
|
| Rate for Payer: Cofinity Commercial |
$151.88
|
| Rate for Payer: Cofinity Commercial |
$130.23
|
| Rate for Payer: Cofinity Commercial |
$159.99
|
| Rate for Payer: Cofinity Commercial |
$137.63
|
| Rate for Payer: Cofinity Commercial |
$169.09
|
| Rate for Payer: Cofinity Commercial |
$142.45
|
| Rate for Payer: Cofinity Commercial |
$175.01
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$152.15
|
| Rate for Payer: Cofinity Commercial |
$186.93
|
| Rate for Payer: Cofinity Commercial |
$167.38
|
| Rate for Payer: Cofinity Commercial |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$193.56
|
| Rate for Payer: Cofinity Commercial |
$237.81
|
| 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 |
$54.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.95
|
| 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 |
$221.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.83
|
| 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 |
$157.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.63
|
| Rate for Payer: Healthscope Commercial |
$47.96
|
| 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 |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$56.77
|
| Rate for Payer: Healthscope Commercial |
$18.69
|
| Rate for Payer: Healthscope Commercial |
$176.96
|
| Rate for Payer: Healthscope Commercial |
$158.95
|
| Rate for Payer: Healthscope Commercial |
$183.15
|
| Rate for Payer: Healthscope Commercial |
$134.29
|
| Rate for Payer: Healthscope Commercial |
$126.06
|
| Rate for Payer: Healthscope Commercial |
$112.23
|
| Rate for Payer: Healthscope Commercial |
$195.62
|
| Rate for Payer: Healthscope Commercial |
$167.44
|
| Rate for Payer: Healthscope Commercial |
$158.69
|
| Rate for Payer: Healthscope Commercial |
$93.83
|
| Rate for Payer: Healthscope Commercial |
$92.27
|
| 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 |
$11.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.63
|
| 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 |
$104.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.05
|
| 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 |
$167.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.52
|
| 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 |
$203.24
|
| 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 |
$172.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.83
|
| 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 |
$45.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.76
|
| 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 |
$106.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.76
|
| Rate for Payer: PHP Commercial |
$149.87
|
| Rate for Payer: PHP Commercial |
$13.76
|
| Rate for Payer: PHP Commercial |
$106.00
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$172.98
|
| Rate for Payer: PHP Commercial |
$88.62
|
| Rate for Payer: PHP Commercial |
$203.24
|
| Rate for Payer: PHP Commercial |
$53.62
|
| Rate for Payer: PHP Commercial |
$235.04
|
| Rate for Payer: PHP Commercial |
$87.14
|
| Rate for Payer: PHP Commercial |
$126.83
|
| Rate for Payer: PHP Commercial |
$167.13
|
| Rate for Payer: PHP Commercial |
$158.13
|
| Rate for Payer: PHP Commercial |
$45.30
|
| Rate for Payer: PHP Commercial |
$127.57
|
| Rate for Payer: PHP Commercial |
$184.76
|
| Rate for Payer: PHP Commercial |
$119.06
|
| Rate for Payer: PHP Commercial |
$150.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.28
|
| 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 |
$67.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.99
|
| Rate for Payer: Priority Health SBD |
$111.26
|
| Rate for Payer: Priority Health SBD |
$150.64
|
| Rate for Payer: Priority Health SBD |
$39.74
|
| Rate for Payer: Priority Health SBD |
$117.21
|
| Rate for Payer: Priority Health SBD |
$94.00
|
| Rate for Payer: Priority Health SBD |
$111.08
|
| Rate for Payer: Priority Health SBD |
$64.59
|
| Rate for Payer: Priority Health SBD |
$123.87
|
| Rate for Payer: Priority Health SBD |
$128.20
|
| Rate for Payer: Priority Health SBD |
$88.24
|
| Rate for Payer: Priority Health SBD |
$10.20
|
| Rate for Payer: Priority Health SBD |
$33.57
|
| Rate for Payer: Priority Health SBD |
$65.68
|
| Rate for Payer: Priority Health SBD |
$94.55
|
| Rate for Payer: Priority Health SBD |
$78.56
|
| Rate for Payer: Priority Health SBD |
$174.21
|
| Rate for Payer: Priority Health SBD |
$136.94
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: UMR Bronson Commercial |
$55.53
|
| Rate for Payer: UMR Bronson Commercial |
$68.83
|
| Rate for Payer: UMR Bronson Commercial |
$46.14
|
| Rate for Payer: UMR Bronson Commercial |
$37.93
|
| Rate for Payer: UMR Bronson Commercial |
$38.58
|
| Rate for Payer: UMR Bronson Commercial |
$75.30
|
| Rate for Payer: UMR Bronson Commercial |
$102.31
|
| Rate for Payer: UMR Bronson Commercial |
$80.42
|
| Rate for Payer: UMR Bronson Commercial |
$55.21
|
| Rate for Payer: UMR Bronson Commercial |
$65.35
|
| Rate for Payer: UMR Bronson Commercial |
$72.75
|
| Rate for Payer: UMR Bronson Commercial |
$23.34
|
| Rate for Payer: UMR Bronson Commercial |
$19.72
|
| Rate for Payer: UMR Bronson Commercial |
$5.99
|
| Rate for Payer: UMR Bronson Commercial |
$65.24
|
| Rate for Payer: UMR Bronson Commercial |
$51.83
|
| Rate for Payer: UMR Bronson Commercial |
$7.68
|
| Rate for Payer: UMR Bronson Commercial |
$88.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.46
|
| 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 |
$112.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.53
|
|
|
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 |
$127.80
|
| Rate for Payer: Aetna American Axle |
$34.64
|
| Rate for Payer: Aetna American Axle |
$114.80
|
| Rate for Payer: Aetna American Axle |
$10.52
|
| Rate for Payer: Aetna American Axle |
$13.50
|
| Rate for Payer: Aetna American Axle |
$179.74
|
| Rate for Payer: Aetna American Axle |
$91.05
|
| Rate for Payer: Aetna American Axle |
$96.99
|
| Rate for Payer: Aetna American Axle |
$114.61
|
| Rate for Payer: Aetna American Axle |
$155.42
|
| Rate for Payer: Aetna American Axle |
$120.93
|
| Rate for Payer: Aetna American Axle |
$67.77
|
| Rate for Payer: Aetna American Axle |
$81.06
|
| Rate for Payer: Aetna American Axle |
$141.28
|
| Rate for Payer: Aetna American Axle |
$41.00
|
| Rate for Payer: Aetna American Axle |
$66.64
|
| Rate for Payer: Aetna American Axle |
$97.55
|
| Rate for Payer: Aetna Commercial |
$106.00
|
| Rate for Payer: Aetna Commercial |
$119.06
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$88.62
|
| Rate for Payer: Aetna Commercial |
$172.98
|
| Rate for Payer: Aetna Commercial |
$87.14
|
| Rate for Payer: Aetna Commercial |
$167.13
|
| Rate for Payer: Aetna Commercial |
$53.62
|
| Rate for Payer: Aetna Commercial |
$149.87
|
| Rate for Payer: Aetna Commercial |
$13.76
|
| Rate for Payer: Aetna Commercial |
$45.30
|
| Rate for Payer: Aetna Commercial |
$235.04
|
| Rate for Payer: Aetna Commercial |
$150.12
|
| Rate for Payer: Aetna Commercial |
$203.24
|
| Rate for Payer: Aetna Commercial |
$126.83
|
| Rate for Payer: Aetna Commercial |
$184.76
|
| Rate for Payer: Aetna Commercial |
$158.13
|
| Rate for Payer: Aetna Commercial |
$127.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.55
|
| 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) |
$141.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.99
|
| Rate for Payer: Cash Price |
$112.06
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cash Price |
$83.41
|
| Rate for Payer: Cash Price |
$120.06
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$173.89
|
| Rate for Payer: Cash Price |
$141.29
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$191.29
|
| Rate for Payer: Cash Price |
$221.22
|
| Rate for Payer: Cash Price |
$141.06
|
| Rate for Payer: Cash Price |
$119.37
|
| Rate for Payer: Cash Price |
$42.63
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Cash Price |
$148.83
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cash Price |
$99.76
|
| Rate for Payer: Cash Price |
$82.02
|
| Rate for Payer: Cofinity Commercial |
$107.24
|
| Rate for Payer: Cofinity Commercial |
$71.76
|
| Rate for Payer: Cofinity Commercial |
$89.66
|
| Rate for Payer: Cofinity Commercial |
$72.98
|
| Rate for Payer: Cofinity Commercial |
$88.17
|
| Rate for Payer: Cofinity Commercial |
$87.29
|
| Rate for Payer: Cofinity Commercial |
$120.46
|
| Rate for Payer: Cofinity Commercial |
$98.05
|
| Rate for Payer: Cofinity Commercial |
$104.45
|
| Rate for Payer: Cofinity Commercial |
$128.32
|
| Rate for Payer: Cofinity Commercial |
$105.06
|
| Rate for Payer: Cofinity Commercial |
$129.07
|
| Rate for Payer: Cofinity Commercial |
$11.33
|
| Rate for Payer: Cofinity Commercial |
$13.92
|
| Rate for Payer: Cofinity Commercial |
$123.42
|
| Rate for Payer: Cofinity Commercial |
$151.64
|
| Rate for Payer: Cofinity Commercial |
$123.63
|
| Rate for Payer: Cofinity Commercial |
$151.88
|
| Rate for Payer: Cofinity Commercial |
$130.23
|
| Rate for Payer: Cofinity Commercial |
$159.99
|
| Rate for Payer: Cofinity Commercial |
$137.63
|
| Rate for Payer: Cofinity Commercial |
$169.09
|
| Rate for Payer: Cofinity Commercial |
$142.45
|
| Rate for Payer: Cofinity Commercial |
$175.01
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$152.15
|
| Rate for Payer: Cofinity Commercial |
$186.93
|
| Rate for Payer: Cofinity Commercial |
$167.38
|
| Rate for Payer: Cofinity Commercial |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$193.56
|
| Rate for Payer: Cofinity Commercial |
$237.81
|
| 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 |
$54.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.06
|
| 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 |
$50.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.37
|
| 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 |
$148.83
|
| Rate for Payer: Healthscope Commercial |
$167.44
|
| Rate for Payer: Healthscope Commercial |
$93.83
|
| Rate for Payer: Healthscope Commercial |
$112.23
|
| Rate for Payer: Healthscope Commercial |
$215.20
|
| Rate for Payer: Healthscope Commercial |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$158.69
|
| Rate for Payer: Healthscope Commercial |
$56.77
|
| Rate for Payer: Healthscope Commercial |
$18.69
|
| Rate for Payer: Healthscope Commercial |
$134.29
|
| Rate for Payer: Healthscope Commercial |
$135.07
|
| Rate for Payer: Healthscope Commercial |
$158.95
|
| Rate for Payer: Healthscope Commercial |
$195.62
|
| Rate for Payer: Healthscope Commercial |
$126.06
|
| Rate for Payer: Healthscope Commercial |
$47.96
|
| Rate for Payer: Healthscope Commercial |
$248.87
|
| Rate for Payer: Healthscope Commercial |
$92.27
|
| Rate for Payer: Healthscope Commercial |
$183.15
|
| Rate for Payer: Healthscope Commercial |
$176.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.23
|
| 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 |
$98.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.76
|
| 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 |
$104.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.24
|
| 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 |
$150.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.98
|
| Rate for Payer: PHP Commercial |
$45.30
|
| Rate for Payer: PHP Commercial |
$172.98
|
| Rate for Payer: PHP Commercial |
$88.62
|
| Rate for Payer: PHP Commercial |
$13.76
|
| Rate for Payer: PHP Commercial |
$158.13
|
| Rate for Payer: PHP Commercial |
$150.12
|
| Rate for Payer: PHP Commercial |
$119.06
|
| Rate for Payer: PHP Commercial |
$127.57
|
| Rate for Payer: PHP Commercial |
$87.14
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$53.62
|
| Rate for Payer: PHP Commercial |
$184.76
|
| Rate for Payer: PHP Commercial |
$203.24
|
| Rate for Payer: PHP Commercial |
$149.87
|
| Rate for Payer: PHP Commercial |
$235.04
|
| Rate for Payer: PHP Commercial |
$167.13
|
| Rate for Payer: PHP Commercial |
$106.00
|
| Rate for Payer: PHP Commercial |
$126.83
|
| 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 |
$91.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.61
|
| 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 |
$81.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.55
|
| Rate for Payer: Priority Health SBD |
$10.20
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: Priority Health SBD |
$65.68
|
| Rate for Payer: Priority Health SBD |
$94.55
|
| Rate for Payer: Priority Health SBD |
$123.87
|
| Rate for Payer: Priority Health SBD |
$78.56
|
| Rate for Payer: Priority Health SBD |
$111.26
|
| Rate for Payer: Priority Health SBD |
$39.74
|
| Rate for Payer: Priority Health SBD |
$150.64
|
| Rate for Payer: Priority Health SBD |
$88.24
|
| Rate for Payer: Priority Health SBD |
$94.00
|
| Rate for Payer: Priority Health SBD |
$174.21
|
| Rate for Payer: Priority Health SBD |
$33.57
|
| Rate for Payer: Priority Health SBD |
$136.94
|
| Rate for Payer: Priority Health SBD |
$64.59
|
| Rate for Payer: Priority Health SBD |
$117.21
|
| Rate for Payer: Priority Health SBD |
$111.08
|
| Rate for Payer: Priority Health SBD |
$128.20
|
| Rate for Payer: UMR Bronson Commercial |
$121.67
|
| Rate for Payer: UMR Bronson Commercial |
$77.71
|
| Rate for Payer: UMR Bronson Commercial |
$23.45
|
| Rate for Payer: UMR Bronson Commercial |
$9.14
|
| Rate for Payer: UMR Bronson Commercial |
$77.58
|
| Rate for Payer: UMR Bronson Commercial |
$66.04
|
| Rate for Payer: UMR Bronson Commercial |
$95.64
|
| Rate for Payer: UMR Bronson Commercial |
$61.63
|
| Rate for Payer: UMR Bronson Commercial |
$27.76
|
| Rate for Payer: UMR Bronson Commercial |
$86.51
|
| Rate for Payer: UMR Bronson Commercial |
$45.11
|
| Rate for Payer: UMR Bronson Commercial |
$54.87
|
| Rate for Payer: UMR Bronson Commercial |
$45.87
|
| Rate for Payer: UMR Bronson Commercial |
$65.65
|
| Rate for Payer: UMR Bronson Commercial |
$105.21
|
| Rate for Payer: UMR Bronson Commercial |
$7.12
|
| Rate for Payer: UMR Bronson Commercial |
$81.86
|
| Rate for Payer: UMR Bronson Commercial |
$89.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.02
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 69374095710
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna American Axle |
$2.76
|
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: Priority Health SBD |
$2.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.19
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 09900001005
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna American Axle |
$0.98
|
| Rate for Payer: Aetna Commercial |
$1.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.98
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cofinity Commercial |
$1.05
|
| Rate for Payer: Cofinity Commercial |
$1.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.20
|
| Rate for Payer: Healthscope Commercial |
$1.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.28
|
| Rate for Payer: PHP Commercial |
$1.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.98
|
| Rate for Payer: Priority Health SBD |
$0.95
|
| Rate for Payer: UMR Bronson Commercial |
$0.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
OP
|
$23.19
|
|
|
Service Code
|
NDC 70092004646
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$20.87 |
| Rate for Payer: Aetna American Axle |
$15.07
|
| Rate for Payer: Aetna Commercial |
$19.71
|
| Rate for Payer: Aetna Medicare |
$11.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.07
|
| Rate for Payer: BCBS Complete |
$9.28
|
| Rate for Payer: Cash Price |
$18.55
|
| Rate for Payer: Cofinity Commercial |
$16.23
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.55
|
| Rate for Payer: Healthscope Commercial |
$20.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.71
|
| Rate for Payer: PHP Commercial |
$19.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.07
|
| Rate for Payer: Priority Health SBD |
$14.61
|
| Rate for Payer: UMR Bronson Commercial |
$8.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.39
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
NDC 09900001005
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna American Axle |
$0.98
|
| Rate for Payer: Aetna Commercial |
$1.28
|
| Rate for Payer: Aetna Medicare |
$0.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.98
|
| Rate for Payer: BCBS Complete |
$0.60
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cofinity Commercial |
$1.05
|
| Rate for Payer: Cofinity Commercial |
$1.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.20
|
| Rate for Payer: Healthscope Commercial |
$1.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.28
|
| Rate for Payer: PHP Commercial |
$1.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.98
|
| Rate for Payer: Priority Health SBD |
$0.95
|
| Rate for Payer: UMR Bronson Commercial |
$0.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 69374095710
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna American Axle |
$2.76
|
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: Priority Health SBD |
$2.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.19
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
IP
|
$23.19
|
|
|
Service Code
|
NDC 70092004646
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$20.87 |
| Rate for Payer: Aetna American Axle |
$15.07
|
| Rate for Payer: Aetna Commercial |
$19.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.07
|
| Rate for Payer: Cash Price |
$18.55
|
| Rate for Payer: Cofinity Commercial |
$16.23
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.55
|
| Rate for Payer: Healthscope Commercial |
$20.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.71
|
| Rate for Payer: PHP Commercial |
$19.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.07
|
| Rate for Payer: Priority Health SBD |
$14.61
|
| Rate for Payer: UMR Bronson Commercial |
$10.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.39
|
|
|
PHENYLEPHRINE 20 MG/250 ML (80 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$23.50
|
|
|
Service Code
|
HCPCS J7999
|
| Hospital Charge Code |
155583
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna American Axle |
$15.28
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: UMR Bronson Commercial |
$10.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
PHENYLEPHRINE 20 MG/250 ML (80 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$23.50
|
|
|
Service Code
|
HCPCS J7999
|
| Hospital Charge Code |
155583
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna American Axle |
$15.28
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$11.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: UMR Bronson Commercial |
$8.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
PHENYLEPHRINE 20MG/250ML NS (IV PREMIX)
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
NDC 09900000162
|
| Hospital Charge Code |
500533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Aetna American Axle |
$6.18
|
| Rate for Payer: Aetna Commercial |
$8.08
|
| Rate for Payer: Aetna Medicare |
$4.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.18
|
| 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 |
$8.08
|
| Rate for Payer: PHP Commercial |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.18
|
| Rate for Payer: Priority Health SBD |
$5.98
|
| Rate for Payer: UMR Bronson Commercial |
$3.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.12
|
|
|
PHENYLEPHRINE 20MG/250ML NS (IV PREMIX)
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
NDC 09900000162
|
| Hospital Charge Code |
500533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Aetna American Axle |
$6.18
|
| Rate for Payer: Aetna Commercial |
$8.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.18
|
| 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 |
$8.08
|
| Rate for Payer: PHP Commercial |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.18
|
| Rate for Payer: Priority Health SBD |
$5.98
|
| Rate for Payer: UMR Bronson Commercial |
$4.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.12
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
OP
|
$183.49
|
|
|
Service Code
|
NDC 70756064935
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.89 |
| Max. Negotiated Rate |
$165.14 |
| Rate for Payer: Aetna American Axle |
$119.27
|
| Rate for Payer: Aetna Commercial |
$155.97
|
| Rate for Payer: Aetna Medicare |
$91.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.27
|
| Rate for Payer: BCBS Complete |
$73.40
|
| Rate for Payer: Cash Price |
$146.79
|
| Rate for Payer: Cofinity Commercial |
$128.44
|
| Rate for Payer: Cofinity Commercial |
$157.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.79
|
| Rate for Payer: Healthscope Commercial |
$165.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.97
|
| Rate for Payer: PHP Commercial |
$155.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.27
|
| Rate for Payer: Priority Health SBD |
$115.60
|
| Rate for Payer: UMR Bronson Commercial |
$67.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.62
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
IP
|
$294.63
|
|
|
Service Code
|
NDC 42702010215
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.64 |
| Max. Negotiated Rate |
$265.17 |
| Rate for Payer: Aetna American Axle |
$191.51
|
| Rate for Payer: Aetna Commercial |
$250.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.51
|
| Rate for Payer: Cash Price |
$235.70
|
| Rate for Payer: Cofinity Commercial |
$206.24
|
| Rate for Payer: Cofinity Commercial |
$253.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$206.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.70
|
| Rate for Payer: Healthscope Commercial |
$265.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.44
|
| Rate for Payer: PHP Commercial |
$250.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.51
|
| Rate for Payer: Priority Health SBD |
$185.62
|
| Rate for Payer: UMR Bronson Commercial |
$129.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.97
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
OP
|
$294.63
|
|
|
Service Code
|
NDC 42702010215
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.01 |
| Max. Negotiated Rate |
$265.17 |
| Rate for Payer: Aetna American Axle |
$191.51
|
| Rate for Payer: Aetna Commercial |
$250.44
|
| Rate for Payer: Aetna Medicare |
$147.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.51
|
| Rate for Payer: BCBS Complete |
$117.85
|
| Rate for Payer: Cash Price |
$235.70
|
| Rate for Payer: Cofinity Commercial |
$206.24
|
| Rate for Payer: Cofinity Commercial |
$253.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$206.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.70
|
| Rate for Payer: Healthscope Commercial |
$265.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.44
|
| Rate for Payer: PHP Commercial |
$250.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.51
|
| Rate for Payer: Priority Health SBD |
$185.62
|
| Rate for Payer: UMR Bronson Commercial |
$109.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.97
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
IP
|
$52.75
|
|
|
Service Code
|
NDC 70756062925
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.21 |
| Max. Negotiated Rate |
$47.48 |
| Rate for Payer: Aetna American Axle |
$34.29
|
| Rate for Payer: Aetna Commercial |
$44.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.29
|
| Rate for Payer: Cash Price |
$42.20
|
| Rate for Payer: Cofinity Commercial |
$36.92
|
| Rate for Payer: Cofinity Commercial |
$45.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.20
|
| Rate for Payer: Healthscope Commercial |
$47.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.84
|
| Rate for Payer: PHP Commercial |
$44.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.29
|
| Rate for Payer: Priority Health SBD |
$33.23
|
| Rate for Payer: UMR Bronson Commercial |
$23.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.56
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
IP
|
$183.49
|
|
|
Service Code
|
NDC 70756064935
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.74 |
| Max. Negotiated Rate |
$165.14 |
| Rate for Payer: Aetna American Axle |
$119.27
|
| Rate for Payer: Aetna Commercial |
$155.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.27
|
| Rate for Payer: Cash Price |
$146.79
|
| Rate for Payer: Cofinity Commercial |
$128.44
|
| Rate for Payer: Cofinity Commercial |
$157.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.79
|
| Rate for Payer: Healthscope Commercial |
$165.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.97
|
| Rate for Payer: PHP Commercial |
$155.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.27
|
| Rate for Payer: Priority Health SBD |
$115.60
|
| Rate for Payer: UMR Bronson Commercial |
$80.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.62
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
OP
|
$52.75
|
|
|
Service Code
|
NDC 70756062925
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$47.48 |
| Rate for Payer: Aetna American Axle |
$34.29
|
| Rate for Payer: Aetna Commercial |
$44.84
|
| Rate for Payer: Aetna Medicare |
$26.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.29
|
| Rate for Payer: BCBS Complete |
$21.10
|
| Rate for Payer: Cash Price |
$42.20
|
| Rate for Payer: Cofinity Commercial |
$36.92
|
| Rate for Payer: Cofinity Commercial |
$45.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.20
|
| Rate for Payer: Healthscope Commercial |
$47.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.84
|
| Rate for Payer: PHP Commercial |
$44.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.29
|
| Rate for Payer: Priority Health SBD |
$33.23
|
| Rate for Payer: UMR Bronson Commercial |
$19.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.56
|
|
|
PHENYLEPHRINE IV INFUSION (INTRA-OP)
|
Facility
|
IP
|
$16.25
|
|
|
Service Code
|
NDC 09900000362
|
| Hospital Charge Code |
155179
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna American Axle |
$10.56
|
| Rate for Payer: Aetna Commercial |
$13.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.56
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.00
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.81
|
| Rate for Payer: PHP Commercial |
$13.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health SBD |
$10.24
|
| Rate for Payer: UMR Bronson Commercial |
$7.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.19
|
|
|
PHENYLEPHRINE IV INFUSION (INTRA-OP)
|
Facility
|
OP
|
$16.25
|
|
|
Service Code
|
NDC 09900000362
|
| Hospital Charge Code |
155179
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna American Axle |
$10.56
|
| Rate for Payer: Aetna Commercial |
$13.81
|
| Rate for Payer: Aetna Medicare |
$8.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.56
|
| Rate for Payer: BCBS Complete |
$6.50
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.00
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.81
|
| Rate for Payer: PHP Commercial |
$13.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health SBD |
$10.24
|
| Rate for Payer: UMR Bronson Commercial |
$6.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.19
|
|
|
PHENYTOIN 100 MG/4 ML ORAL SUSPENSION
|
Facility
|
OP
|
$21.17
|
|
|
Service Code
|
NDC 66689003601
|
| Hospital Charge Code |
118124
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna American Axle |
$13.76
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna Medicare |
$10.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.76
|
| Rate for Payer: BCBS Complete |
$8.47
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.76
|
| Rate for Payer: Priority Health SBD |
$13.34
|
| Rate for Payer: UMR Bronson Commercial |
$7.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.88
|
|
|
PHENYTOIN 100 MG/4 ML ORAL SUSPENSION
|
Facility
|
IP
|
$21.17
|
|
|
Service Code
|
NDC 66689003601
|
| Hospital Charge Code |
118124
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna American Axle |
$13.76
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.76
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.76
|
| Rate for Payer: Priority Health SBD |
$13.34
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.88
|
|
