|
PILOCARPINE 2 % EYE DROPS
|
Facility
|
IP
|
$136.19
|
|
|
Service Code
|
NDC 61314020415
|
| Hospital Charge Code |
6280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.92 |
| Max. Negotiated Rate |
$122.57 |
| Rate for Payer: Aetna American Axle |
$88.52
|
| Rate for Payer: Aetna Commercial |
$115.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.52
|
| Rate for Payer: Cash Price |
$108.95
|
| Rate for Payer: Cofinity Commercial |
$117.12
|
| Rate for Payer: Cofinity Commercial |
$95.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.95
|
| Rate for Payer: Healthscope Commercial |
$122.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.76
|
| Rate for Payer: PHP Commercial |
$115.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.52
|
| Rate for Payer: Priority Health SBD |
$85.80
|
| Rate for Payer: UMR Bronson Commercial |
$59.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.14
|
|
|
PILOCARPINE 2 % EYE DROPS
|
Facility
|
OP
|
$136.19
|
|
|
Service Code
|
NDC 61314020415
|
| Hospital Charge Code |
6280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$122.57 |
| Rate for Payer: Aetna American Axle |
$88.52
|
| Rate for Payer: Aetna Commercial |
$115.76
|
| Rate for Payer: Aetna Medicare |
$68.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.52
|
| Rate for Payer: BCBS Complete |
$54.48
|
| Rate for Payer: Cash Price |
$108.95
|
| Rate for Payer: Cofinity Commercial |
$117.12
|
| Rate for Payer: Cofinity Commercial |
$95.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.95
|
| Rate for Payer: Healthscope Commercial |
$122.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.76
|
| Rate for Payer: PHP Commercial |
$115.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.52
|
| Rate for Payer: Priority Health SBD |
$85.80
|
| Rate for Payer: UMR Bronson Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.14
|
|
|
PILOCARPINE 2 % EYE DROPS
|
Facility
|
OP
|
$132.62
|
|
|
Service Code
|
NDC 70069019101
|
| Hospital Charge Code |
6280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.07 |
| Max. Negotiated Rate |
$119.36 |
| Rate for Payer: Aetna American Axle |
$86.20
|
| Rate for Payer: Aetna Commercial |
$112.73
|
| Rate for Payer: Aetna Medicare |
$66.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.20
|
| Rate for Payer: BCBS Complete |
$53.05
|
| Rate for Payer: Cash Price |
$106.10
|
| Rate for Payer: Cofinity Commercial |
$114.05
|
| Rate for Payer: Cofinity Commercial |
$92.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.10
|
| Rate for Payer: Healthscope Commercial |
$119.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.73
|
| Rate for Payer: PHP Commercial |
$112.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.20
|
| Rate for Payer: Priority Health SBD |
$83.55
|
| Rate for Payer: UMR Bronson Commercial |
$49.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.46
|
|
|
PILOCARPINE 4 % EYE DROPS
|
Facility
|
IP
|
$138.92
|
|
|
Service Code
|
NDC 70069020101
|
| Hospital Charge Code |
6282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.12 |
| Max. Negotiated Rate |
$125.03 |
| Rate for Payer: Aetna American Axle |
$90.30
|
| Rate for Payer: Aetna Commercial |
$118.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.30
|
| Rate for Payer: Cash Price |
$111.14
|
| Rate for Payer: Cofinity Commercial |
$119.47
|
| Rate for Payer: Cofinity Commercial |
$97.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.14
|
| Rate for Payer: Healthscope Commercial |
$125.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.08
|
| Rate for Payer: PHP Commercial |
$118.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health SBD |
$87.52
|
| Rate for Payer: UMR Bronson Commercial |
$61.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.19
|
|
|
PILOCARPINE 4 % EYE DROPS
|
Facility
|
OP
|
$152.99
|
|
|
Service Code
|
NDC 61314020615
|
| Hospital Charge Code |
6282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.61 |
| Max. Negotiated Rate |
$137.69 |
| Rate for Payer: Aetna American Axle |
$99.44
|
| Rate for Payer: Aetna Commercial |
$130.04
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.44
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.39
|
| Rate for Payer: Cofinity Commercial |
$107.09
|
| Rate for Payer: Cofinity Commercial |
$131.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.39
|
| Rate for Payer: Healthscope Commercial |
$137.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.04
|
| Rate for Payer: PHP Commercial |
$130.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.44
|
| Rate for Payer: Priority Health SBD |
$96.38
|
| Rate for Payer: UMR Bronson Commercial |
$56.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.74
|
|
|
PILOCARPINE 4 % EYE DROPS
|
Facility
|
IP
|
$152.99
|
|
|
Service Code
|
NDC 61314020615
|
| Hospital Charge Code |
6282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.32 |
| Max. Negotiated Rate |
$137.69 |
| Rate for Payer: Aetna American Axle |
$99.44
|
| Rate for Payer: Aetna Commercial |
$130.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.44
|
| Rate for Payer: Cash Price |
$122.39
|
| Rate for Payer: Cofinity Commercial |
$107.09
|
| Rate for Payer: Cofinity Commercial |
$131.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.39
|
| Rate for Payer: Healthscope Commercial |
$137.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.04
|
| Rate for Payer: PHP Commercial |
$130.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.44
|
| Rate for Payer: Priority Health SBD |
$96.38
|
| Rate for Payer: UMR Bronson Commercial |
$67.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.74
|
|
|
PILOCARPINE 4 % EYE DROPS
|
Facility
|
OP
|
$138.92
|
|
|
Service Code
|
NDC 70069020101
|
| Hospital Charge Code |
6282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.40 |
| Max. Negotiated Rate |
$125.03 |
| Rate for Payer: Aetna American Axle |
$90.30
|
| Rate for Payer: Aetna Commercial |
$118.08
|
| Rate for Payer: Aetna Medicare |
$69.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.30
|
| Rate for Payer: BCBS Complete |
$55.57
|
| Rate for Payer: Cash Price |
$111.14
|
| Rate for Payer: Cofinity Commercial |
$119.47
|
| Rate for Payer: Cofinity Commercial |
$97.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.14
|
| Rate for Payer: Healthscope Commercial |
$125.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.08
|
| Rate for Payer: PHP Commercial |
$118.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health SBD |
$87.52
|
| Rate for Payer: UMR Bronson Commercial |
$51.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.19
|
|
|
PILOCARPINE 5 MG TABLET
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
NDC 00574079201
|
| Hospital Charge Code |
12803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.84 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna American Axle |
$234.65
|
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.65
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$252.70
|
| Rate for Payer: Cofinity Commercial |
$310.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.80
|
| Rate for Payer: Healthscope Commercial |
$324.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.85
|
| Rate for Payer: PHP Commercial |
$306.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
| Rate for Payer: Priority Health SBD |
$227.43
|
| Rate for Payer: UMR Bronson Commercial |
$158.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.75
|
|
|
PILOCARPINE 5 MG TABLET
|
Facility
|
IP
|
$275.50
|
|
|
Service Code
|
NDC 60219592201
|
| Hospital Charge Code |
12803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna American Axle |
$179.08
|
| Rate for Payer: Aetna Commercial |
$234.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.08
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Commercial |
$192.85
|
| Rate for Payer: Cofinity Commercial |
$236.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Healthscope Commercial |
$247.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: PHP Commercial |
$234.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.08
|
| Rate for Payer: Priority Health SBD |
$173.56
|
| Rate for Payer: UMR Bronson Commercial |
$121.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.62
|
|
|
PILOCARPINE 5 MG TABLET
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
NDC 00574079201
|
| Hospital Charge Code |
12803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.57 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna American Axle |
$234.65
|
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: Aetna Medicare |
$180.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.65
|
| Rate for Payer: BCBS Complete |
$144.40
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$252.70
|
| Rate for Payer: Cofinity Commercial |
$310.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.80
|
| Rate for Payer: Healthscope Commercial |
$324.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.85
|
| Rate for Payer: PHP Commercial |
$306.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
| Rate for Payer: Priority Health SBD |
$227.43
|
| Rate for Payer: UMR Bronson Commercial |
$133.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.75
|
|
|
PILOCARPINE 5 MG TABLET
|
Facility
|
IP
|
$267.36
|
|
|
Service Code
|
NDC 00115592201
|
| Hospital Charge Code |
12803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.64 |
| Max. Negotiated Rate |
$240.62 |
| Rate for Payer: Aetna American Axle |
$173.78
|
| Rate for Payer: Aetna Commercial |
$227.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.78
|
| Rate for Payer: Cash Price |
$213.89
|
| Rate for Payer: Cofinity Commercial |
$187.15
|
| Rate for Payer: Cofinity Commercial |
$229.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.89
|
| Rate for Payer: Healthscope Commercial |
$240.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.26
|
| Rate for Payer: PHP Commercial |
$227.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.78
|
| Rate for Payer: Priority Health SBD |
$168.44
|
| Rate for Payer: UMR Bronson Commercial |
$117.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.52
|
|
|
PILOCARPINE 5 MG TABLET
|
Facility
|
OP
|
$275.50
|
|
|
Service Code
|
NDC 60219592201
|
| Hospital Charge Code |
12803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna American Axle |
$179.08
|
| Rate for Payer: Aetna Commercial |
$234.18
|
| Rate for Payer: Aetna Medicare |
$137.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.08
|
| Rate for Payer: BCBS Complete |
$110.20
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Commercial |
$192.85
|
| Rate for Payer: Cofinity Commercial |
$236.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Healthscope Commercial |
$247.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: PHP Commercial |
$234.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.08
|
| Rate for Payer: Priority Health SBD |
$173.56
|
| Rate for Payer: UMR Bronson Commercial |
$101.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.62
|
|
|
PILOCARPINE 5 MG TABLET
|
Facility
|
OP
|
$267.36
|
|
|
Service Code
|
NDC 00115592201
|
| Hospital Charge Code |
12803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.92 |
| Max. Negotiated Rate |
$240.62 |
| Rate for Payer: Aetna American Axle |
$173.78
|
| Rate for Payer: Aetna Commercial |
$227.26
|
| Rate for Payer: Aetna Medicare |
$133.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.78
|
| Rate for Payer: BCBS Complete |
$106.94
|
| Rate for Payer: Cash Price |
$213.89
|
| Rate for Payer: Cofinity Commercial |
$187.15
|
| Rate for Payer: Cofinity Commercial |
$229.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.89
|
| Rate for Payer: Healthscope Commercial |
$240.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.26
|
| Rate for Payer: PHP Commercial |
$227.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.78
|
| Rate for Payer: Priority Health SBD |
$168.44
|
| Rate for Payer: UMR Bronson Commercial |
$98.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.52
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$74.39
|
|
|
Service Code
|
NDC 00093727156
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$66.95 |
| Rate for Payer: Aetna American Axle |
$48.35
|
| Rate for Payer: Aetna Commercial |
$63.23
|
| Rate for Payer: Aetna Medicare |
$37.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.35
|
| Rate for Payer: BCBS Complete |
$29.76
|
| Rate for Payer: Cash Price |
$59.51
|
| Rate for Payer: Cofinity Commercial |
$52.07
|
| Rate for Payer: Cofinity Commercial |
$63.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.51
|
| Rate for Payer: Healthscope Commercial |
$66.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.23
|
| Rate for Payer: PHP Commercial |
$63.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.35
|
| Rate for Payer: Priority Health SBD |
$46.87
|
| Rate for Payer: UMR Bronson Commercial |
$27.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.79
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$490.56
|
|
|
Service Code
|
NDC 60687039101
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.85 |
| Max. Negotiated Rate |
$441.50 |
| Rate for Payer: Cofinity Commercial |
$343.39
|
| Rate for Payer: Cofinity Commercial |
$421.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.39
|
| Rate for Payer: Aetna American Axle |
$318.86
|
| Rate for Payer: Aetna Commercial |
$416.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.86
|
| Rate for Payer: Cash Price |
$392.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.45
|
| Rate for Payer: Healthscope Commercial |
$441.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.98
|
| Rate for Payer: PHP Commercial |
$416.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.86
|
| Rate for Payer: Priority Health SBD |
$309.05
|
| Rate for Payer: UMR Bronson Commercial |
$215.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.92
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$234.77
|
|
|
Service Code
|
NDC 57237021990
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.30 |
| Max. Negotiated Rate |
$211.29 |
| Rate for Payer: Aetna American Axle |
$152.60
|
| Rate for Payer: Aetna Commercial |
$199.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.60
|
| Rate for Payer: Cash Price |
$187.82
|
| Rate for Payer: Cofinity Commercial |
$164.34
|
| Rate for Payer: Cofinity Commercial |
$201.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.82
|
| Rate for Payer: Healthscope Commercial |
$211.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.55
|
| Rate for Payer: PHP Commercial |
$199.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.60
|
| Rate for Payer: Priority Health SBD |
$147.91
|
| Rate for Payer: UMR Bronson Commercial |
$103.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.08
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$234.77
|
|
|
Service Code
|
NDC 57237021990
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.86 |
| Max. Negotiated Rate |
$211.29 |
| Rate for Payer: Aetna American Axle |
$152.60
|
| Rate for Payer: Aetna Commercial |
$199.55
|
| Rate for Payer: Aetna Medicare |
$117.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.60
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: Cash Price |
$187.82
|
| Rate for Payer: Cofinity Commercial |
$164.34
|
| Rate for Payer: Cofinity Commercial |
$201.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.82
|
| Rate for Payer: Healthscope Commercial |
$211.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.55
|
| Rate for Payer: PHP Commercial |
$199.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.60
|
| Rate for Payer: Priority Health SBD |
$147.91
|
| Rate for Payer: UMR Bronson Commercial |
$86.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.08
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$490.56
|
|
|
Service Code
|
NDC 60687039101
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.51 |
| Max. Negotiated Rate |
$441.50 |
| Rate for Payer: Aetna American Axle |
$318.86
|
| Rate for Payer: Aetna Commercial |
$416.98
|
| Rate for Payer: Aetna Medicare |
$245.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.86
|
| Rate for Payer: BCBS Complete |
$196.22
|
| Rate for Payer: Cash Price |
$392.45
|
| Rate for Payer: Cofinity Commercial |
$343.39
|
| Rate for Payer: Cofinity Commercial |
$421.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.45
|
| Rate for Payer: Healthscope Commercial |
$441.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.98
|
| Rate for Payer: PHP Commercial |
$416.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.86
|
| Rate for Payer: Priority Health SBD |
$309.05
|
| Rate for Payer: UMR Bronson Commercial |
$181.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.92
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$264.38
|
|
|
Service Code
|
NDC 16729002015
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.82 |
| Max. Negotiated Rate |
$237.94 |
| Rate for Payer: Aetna American Axle |
$171.85
|
| Rate for Payer: Aetna Commercial |
$224.72
|
| Rate for Payer: Aetna Medicare |
$132.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.85
|
| Rate for Payer: BCBS Complete |
$105.75
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cofinity Commercial |
$185.07
|
| Rate for Payer: Cofinity Commercial |
$227.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.50
|
| Rate for Payer: Healthscope Commercial |
$237.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.72
|
| Rate for Payer: PHP Commercial |
$224.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.85
|
| Rate for Payer: Priority Health SBD |
$166.56
|
| Rate for Payer: UMR Bronson Commercial |
$97.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.28
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$4.91
|
|
|
Service Code
|
NDC 60687039111
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna American Axle |
$3.19
|
| Rate for Payer: Aetna Commercial |
$4.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.19
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$4.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.93
|
| Rate for Payer: Healthscope Commercial |
$4.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.17
|
| Rate for Payer: PHP Commercial |
$4.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.19
|
| Rate for Payer: Priority Health SBD |
$3.09
|
| Rate for Payer: UMR Bronson Commercial |
$2.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.68
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$58.52
|
|
|
Service Code
|
NDC 16729002010
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.75 |
| Max. Negotiated Rate |
$52.67 |
| Rate for Payer: Aetna American Axle |
$38.04
|
| Rate for Payer: Aetna Commercial |
$49.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.04
|
| Rate for Payer: Cash Price |
$46.82
|
| Rate for Payer: Cofinity Commercial |
$40.96
|
| Rate for Payer: Cofinity Commercial |
$50.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.82
|
| Rate for Payer: Healthscope Commercial |
$52.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.74
|
| Rate for Payer: PHP Commercial |
$49.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.04
|
| Rate for Payer: Priority Health SBD |
$36.87
|
| Rate for Payer: UMR Bronson Commercial |
$25.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.89
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$58.52
|
|
|
Service Code
|
NDC 16729002010
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.65 |
| Max. Negotiated Rate |
$52.67 |
| Rate for Payer: Aetna American Axle |
$38.04
|
| Rate for Payer: Aetna Commercial |
$49.74
|
| Rate for Payer: Aetna Medicare |
$29.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.04
|
| Rate for Payer: BCBS Complete |
$23.41
|
| Rate for Payer: Cash Price |
$46.82
|
| Rate for Payer: Cofinity Commercial |
$40.96
|
| Rate for Payer: Cofinity Commercial |
$50.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.82
|
| Rate for Payer: Healthscope Commercial |
$52.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.74
|
| Rate for Payer: PHP Commercial |
$49.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.04
|
| Rate for Payer: Priority Health SBD |
$36.87
|
| Rate for Payer: UMR Bronson Commercial |
$21.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.89
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$4.91
|
|
|
Service Code
|
NDC 60687039111
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna American Axle |
$3.19
|
| Rate for Payer: Aetna Commercial |
$4.17
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.19
|
| Rate for Payer: BCBS Complete |
$1.96
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$4.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.93
|
| Rate for Payer: Healthscope Commercial |
$4.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.17
|
| Rate for Payer: PHP Commercial |
$4.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.19
|
| Rate for Payer: Priority Health SBD |
$3.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.68
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$74.39
|
|
|
Service Code
|
NDC 00093727156
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$66.95 |
| Rate for Payer: Aetna American Axle |
$48.35
|
| Rate for Payer: Aetna Commercial |
$63.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.35
|
| Rate for Payer: Cash Price |
$59.51
|
| Rate for Payer: Cofinity Commercial |
$52.07
|
| Rate for Payer: Cofinity Commercial |
$63.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.51
|
| Rate for Payer: Healthscope Commercial |
$66.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.23
|
| Rate for Payer: PHP Commercial |
$63.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.35
|
| Rate for Payer: Priority Health SBD |
$46.87
|
| Rate for Payer: UMR Bronson Commercial |
$32.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.79
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$264.38
|
|
|
Service Code
|
NDC 16729002015
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.33 |
| Max. Negotiated Rate |
$237.94 |
| Rate for Payer: Aetna American Axle |
$171.85
|
| Rate for Payer: Aetna Commercial |
$224.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.85
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cofinity Commercial |
$185.07
|
| Rate for Payer: Cofinity Commercial |
$227.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.50
|
| Rate for Payer: Healthscope Commercial |
$237.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.72
|
| Rate for Payer: PHP Commercial |
$224.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.85
|
| Rate for Payer: Priority Health SBD |
$166.56
|
| Rate for Payer: UMR Bronson Commercial |
$116.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.28
|
|
