|
AMINO ACID 5 % NO.6-DEXTROSE 15 %-ELECTROLYTES NO.23 IV SOLUTION
|
Facility
|
IP
|
$148.48
|
|
|
Service Code
|
NDC 00338114703
|
| Hospital Charge Code |
27963
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.54 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: Aetna Commercial |
$126.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.51
|
| Rate for Payer: Cash Price |
$118.78
|
| Rate for Payer: Cofinity Advantage |
$103.94
|
| Rate for Payer: Cofinity Commercial |
$127.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.78
|
| Rate for Payer: Healthscope Commercial |
$133.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.36
|
| Rate for Payer: PHP Commercial |
$126.21
|
| Rate for Payer: Priority Health SBD |
$93.54
|
|
|
AMINO ACID 5 % NO.6-DEXTROSE 15 %-ELECTROLYTES NO.23 IV SOLUTION
|
Facility
|
OP
|
$153.12
|
|
|
Service Code
|
NDC 00338703001
|
| Hospital Charge Code |
27963
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.18 |
| Max. Negotiated Rate |
$137.81 |
| Rate for Payer: Aetna Commercial |
$130.15
|
| Rate for Payer: Aetna Medicare |
$76.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.53
|
| Rate for Payer: BCBS Complete |
$61.25
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cofinity Advantage |
$107.18
|
| Rate for Payer: Cofinity Commercial |
$131.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.50
|
| Rate for Payer: Healthscope Commercial |
$137.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.84
|
| Rate for Payer: PHP Commercial |
$130.15
|
| Rate for Payer: Priority Health SBD |
$96.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.53
|
| Rate for Payer: UHC Core |
$79.78
|
| Rate for Payer: UHC Exchange |
$60.18
|
|
|
AMINO ACID 5 % NO.6-DEXTROSE 15 %-ELECTROLYTES NO.23 IV SOLUTION
|
Facility
|
IP
|
$153.12
|
|
|
Service Code
|
NDC 00338703006
|
| Hospital Charge Code |
27963
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.47 |
| Max. Negotiated Rate |
$137.81 |
| Rate for Payer: Aetna Commercial |
$130.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.53
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cofinity Advantage |
$107.18
|
| Rate for Payer: Cofinity Commercial |
$131.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.50
|
| Rate for Payer: Healthscope Commercial |
$137.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.84
|
| Rate for Payer: PHP Commercial |
$130.15
|
| Rate for Payer: Priority Health SBD |
$96.47
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$167.77
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$150.99 |
| Rate for Payer: Aetna Commercial |
$142.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.05
|
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Cofinity Advantage |
$117.44
|
| Rate for Payer: Cofinity Commercial |
$144.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.22
|
| Rate for Payer: Healthscope Commercial |
$150.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.83
|
| Rate for Payer: PHP Commercial |
$142.60
|
| Rate for Payer: Priority Health SBD |
$105.70
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$167.77
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$150.99 |
| Rate for Payer: Aetna Commercial |
$142.60
|
| Rate for Payer: Aetna Medicare |
$83.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.05
|
| Rate for Payer: BCBS Complete |
$67.11
|
| Rate for Payer: BCBS Trust/PPO |
$26.10
|
| Rate for Payer: BCN Commercial |
$26.10
|
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Cofinity Advantage |
$117.44
|
| Rate for Payer: Cofinity Commercial |
$144.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.22
|
| Rate for Payer: Healthscope Commercial |
$150.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.83
|
| Rate for Payer: PHP Commercial |
$142.60
|
| Rate for Payer: Priority Health SBD |
$105.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.18
|
| Rate for Payer: UHC Core |
$17.18
|
| Rate for Payer: UHC Exchange |
$17.18
|
|
|
AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.20
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
113386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.92 |
| Max. Negotiated Rate |
$29.88 |
| Rate for Payer: Aetna Commercial |
$28.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.58
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cofinity Advantage |
$23.24
|
| Rate for Payer: Cofinity Commercial |
$28.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.56
|
| Rate for Payer: Healthscope Commercial |
$29.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.90
|
| Rate for Payer: PHP Commercial |
$28.22
|
| Rate for Payer: Priority Health SBD |
$20.92
|
|
|
AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33.20
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
113386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$29.88 |
| Rate for Payer: Aetna Commercial |
$28.22
|
| Rate for Payer: Aetna Medicare |
$16.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.58
|
| Rate for Payer: BCBS Complete |
$13.28
|
| Rate for Payer: BCBS Trust/PPO |
$26.10
|
| Rate for Payer: BCN Commercial |
$26.10
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cofinity Advantage |
$23.24
|
| Rate for Payer: Cofinity Commercial |
$28.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.56
|
| Rate for Payer: Healthscope Commercial |
$29.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.90
|
| Rate for Payer: PHP Commercial |
$28.22
|
| Rate for Payer: Priority Health SBD |
$20.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.18
|
| Rate for Payer: UHC Core |
$17.18
|
| Rate for Payer: UHC Exchange |
$17.18
|
|
|
AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV
|
Facility
|
OP
|
$103.69
|
|
|
Service Code
|
HCPCS J0283
|
| Hospital Charge Code |
152869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$93.32 |
| Rate for Payer: Aetna Commercial |
$88.14
|
| Rate for Payer: Aetna Medicare |
$51.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.40
|
| Rate for Payer: BCBS Complete |
$41.48
|
| Rate for Payer: BCBS Trust/PPO |
$6.33
|
| Rate for Payer: BCN Commercial |
$6.33
|
| Rate for Payer: Cash Price |
$82.95
|
| Rate for Payer: Cash Price |
$82.95
|
| Rate for Payer: Cofinity Advantage |
$72.58
|
| Rate for Payer: Cofinity Commercial |
$89.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.95
|
| Rate for Payer: Healthscope Commercial |
$93.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.77
|
| Rate for Payer: PHP Commercial |
$88.14
|
| Rate for Payer: Priority Health SBD |
$65.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.17
|
| Rate for Payer: UHC Core |
$4.17
|
| Rate for Payer: UHC Exchange |
$4.17
|
|
|
AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV
|
Facility
|
IP
|
$103.69
|
|
|
Service Code
|
HCPCS J0283
|
| Hospital Charge Code |
152869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.32 |
| Max. Negotiated Rate |
$93.32 |
| Rate for Payer: Aetna Commercial |
$88.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.40
|
| Rate for Payer: Cash Price |
$82.95
|
| Rate for Payer: Cofinity Advantage |
$72.58
|
| Rate for Payer: Cofinity Commercial |
$89.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.95
|
| Rate for Payer: Healthscope Commercial |
$93.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.77
|
| Rate for Payer: PHP Commercial |
$88.14
|
| Rate for Payer: Priority Health SBD |
$65.32
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$199.50
|
|
|
Service Code
|
NDC 00904699361
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna Commercial |
$169.57
|
| Rate for Payer: Aetna Medicare |
$99.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.68
|
| Rate for Payer: BCBS Complete |
$79.80
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cofinity Advantage |
$139.65
|
| Rate for Payer: Cofinity Commercial |
$171.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.60
|
| Rate for Payer: Healthscope Commercial |
$179.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.62
|
| Rate for Payer: PHP Commercial |
$169.57
|
| Rate for Payer: Priority Health SBD |
$125.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.68
|
| Rate for Payer: UHC Core |
$103.94
|
| Rate for Payer: UHC Exchange |
$78.40
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$124.08
|
|
|
Service Code
|
NDC 72888003960
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.76 |
| Max. Negotiated Rate |
$111.67 |
| Rate for Payer: Aetna Commercial |
$105.47
|
| Rate for Payer: Aetna Medicare |
$62.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.65
|
| Rate for Payer: BCBS Complete |
$49.63
|
| Rate for Payer: Cash Price |
$99.26
|
| Rate for Payer: Cofinity Advantage |
$86.86
|
| Rate for Payer: Cofinity Commercial |
$106.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.26
|
| Rate for Payer: Healthscope Commercial |
$111.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.06
|
| Rate for Payer: PHP Commercial |
$105.47
|
| Rate for Payer: Priority Health SBD |
$78.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.65
|
| Rate for Payer: UHC Core |
$64.65
|
| Rate for Payer: UHC Exchange |
$48.76
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$288.80
|
|
|
Service Code
|
NDC 60687043701
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.94 |
| Max. Negotiated Rate |
$259.92 |
| Rate for Payer: Aetna Commercial |
$245.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.72
|
| Rate for Payer: Cash Price |
$231.04
|
| Rate for Payer: Cofinity Advantage |
$202.16
|
| Rate for Payer: Cofinity Commercial |
$248.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.04
|
| Rate for Payer: Healthscope Commercial |
$259.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.60
|
| Rate for Payer: PHP Commercial |
$245.48
|
| Rate for Payer: Priority Health SBD |
$181.94
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$2.89
|
|
|
Service Code
|
NDC 60687043711
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Medicare |
$1.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.88
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health SBD |
$1.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.88
|
| Rate for Payer: UHC Core |
$1.51
|
| Rate for Payer: UHC Exchange |
$1.14
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$199.50
|
|
|
Service Code
|
NDC 00904699361
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.69 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna Commercial |
$169.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.68
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cofinity Advantage |
$139.65
|
| Rate for Payer: Cofinity Commercial |
$171.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.60
|
| Rate for Payer: Healthscope Commercial |
$179.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.62
|
| Rate for Payer: PHP Commercial |
$169.57
|
| Rate for Payer: Priority Health SBD |
$125.69
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$288.80
|
|
|
Service Code
|
NDC 60687043701
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.50 |
| Max. Negotiated Rate |
$259.92 |
| Rate for Payer: Aetna Commercial |
$245.48
|
| Rate for Payer: Aetna Medicare |
$144.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.72
|
| Rate for Payer: BCBS Complete |
$115.52
|
| Rate for Payer: Cash Price |
$231.04
|
| Rate for Payer: Cofinity Advantage |
$202.16
|
| Rate for Payer: Cofinity Commercial |
$248.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.04
|
| Rate for Payer: Healthscope Commercial |
$259.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.60
|
| Rate for Payer: PHP Commercial |
$245.48
|
| Rate for Payer: Priority Health SBD |
$181.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.72
|
| Rate for Payer: UHC Core |
$150.46
|
| Rate for Payer: UHC Exchange |
$113.50
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
NDC 60687043711
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.88
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health SBD |
$1.82
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$219.45
|
|
|
Service Code
|
NDC 00245014701
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.24 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna Commercial |
$186.53
|
| Rate for Payer: Aetna Medicare |
$109.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.64
|
| Rate for Payer: BCBS Complete |
$87.78
|
| Rate for Payer: Cash Price |
$175.56
|
| Rate for Payer: Cofinity Advantage |
$153.62
|
| Rate for Payer: Cofinity Commercial |
$188.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.56
|
| Rate for Payer: Healthscope Commercial |
$197.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.59
|
| Rate for Payer: PHP Commercial |
$186.53
|
| Rate for Payer: Priority Health SBD |
$138.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.64
|
| Rate for Payer: UHC Core |
$114.33
|
| Rate for Payer: UHC Exchange |
$86.24
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$124.08
|
|
|
Service Code
|
NDC 72888003960
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.17 |
| Max. Negotiated Rate |
$111.67 |
| Rate for Payer: Aetna Commercial |
$105.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.65
|
| Rate for Payer: Cash Price |
$99.26
|
| Rate for Payer: Cofinity Advantage |
$86.86
|
| Rate for Payer: Cofinity Commercial |
$106.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.26
|
| Rate for Payer: Healthscope Commercial |
$111.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.06
|
| Rate for Payer: PHP Commercial |
$105.47
|
| Rate for Payer: Priority Health SBD |
$78.17
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$219.45
|
|
|
Service Code
|
NDC 00245014701
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.25 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna Commercial |
$186.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.64
|
| Rate for Payer: Cash Price |
$175.56
|
| Rate for Payer: Cofinity Advantage |
$153.62
|
| Rate for Payer: Cofinity Commercial |
$188.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.56
|
| Rate for Payer: Healthscope Commercial |
$197.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.59
|
| Rate for Payer: PHP Commercial |
$186.53
|
| Rate for Payer: Priority Health SBD |
$138.25
|
|
|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.71
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
9065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$19.54 |
| Rate for Payer: Aetna Commercial |
$18.45
|
| Rate for Payer: Aetna Commercial |
$47.39
|
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$23.52
|
| Rate for Payer: Aetna Commercial |
$24.41
|
| Rate for Payer: Aetna Commercial |
$22.01
|
| Rate for Payer: Aetna Commercial |
$19.20
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.24
|
| Rate for Payer: Cash Price |
$17.37
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cofinity Advantage |
$15.20
|
| Rate for Payer: Cofinity Advantage |
$11.13
|
| Rate for Payer: Cofinity Advantage |
$18.12
|
| Rate for Payer: Cofinity Advantage |
$12.05
|
| Rate for Payer: Cofinity Advantage |
$15.81
|
| Rate for Payer: Cofinity Advantage |
$12.75
|
| Rate for Payer: Cofinity Advantage |
$20.10
|
| Rate for Payer: Cofinity Advantage |
$39.02
|
| Rate for Payer: Cofinity Advantage |
$19.37
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$19.43
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$47.95
|
| Rate for Payer: Cofinity Commercial |
$13.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.98
|
| Rate for Payer: Healthscope Commercial |
$25.85
|
| Rate for Payer: Healthscope Commercial |
$24.90
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$19.54
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$20.33
|
| Rate for Payer: Healthscope Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$50.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.81
|
| Rate for Payer: PHP Commercial |
$23.52
|
| Rate for Payer: PHP Commercial |
$47.39
|
| Rate for Payer: PHP Commercial |
$24.41
|
| Rate for Payer: PHP Commercial |
$22.01
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: PHP Commercial |
$19.20
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$18.45
|
| Rate for Payer: Priority Health SBD |
$35.12
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: Priority Health SBD |
$10.02
|
| Rate for Payer: Priority Health SBD |
$14.23
|
| Rate for Payer: Priority Health SBD |
$17.43
|
| Rate for Payer: Priority Health SBD |
$16.31
|
| Rate for Payer: Priority Health SBD |
$18.09
|
| Rate for Payer: Priority Health SBD |
$13.68
|
| Rate for Payer: Priority Health SBD |
$11.47
|
|
|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.21
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
9065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$22.01
|
| Rate for Payer: Aetna Commercial |
$23.52
|
| Rate for Payer: Aetna Commercial |
$24.41
|
| Rate for Payer: Aetna Commercial |
$19.20
|
| Rate for Payer: Aetna Commercial |
$18.45
|
| Rate for Payer: Aetna Commercial |
$47.39
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Medicare |
$11.29
|
| Rate for Payer: Aetna Medicare |
$10.86
|
| Rate for Payer: Aetna Medicare |
$7.95
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Aetna Medicare |
$9.11
|
| Rate for Payer: Aetna Medicare |
$27.88
|
| Rate for Payer: Aetna Medicare |
$14.36
|
| Rate for Payer: Aetna Medicare |
$13.84
|
| Rate for Payer: Aetna Medicare |
$12.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Complete |
$22.30
|
| Rate for Payer: BCBS Complete |
$11.49
|
| Rate for Payer: BCBS Complete |
$9.04
|
| Rate for Payer: BCBS Complete |
$6.36
|
| Rate for Payer: BCBS Complete |
$11.07
|
| Rate for Payer: BCBS Complete |
$8.68
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cash Price |
$17.37
|
| Rate for Payer: Cash Price |
$17.37
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cofinity Advantage |
$39.02
|
| Rate for Payer: Cofinity Advantage |
$15.81
|
| Rate for Payer: Cofinity Advantage |
$12.75
|
| Rate for Payer: Cofinity Advantage |
$12.05
|
| Rate for Payer: Cofinity Advantage |
$18.12
|
| Rate for Payer: Cofinity Advantage |
$15.20
|
| Rate for Payer: Cofinity Advantage |
$11.13
|
| Rate for Payer: Cofinity Advantage |
$20.10
|
| Rate for Payer: Cofinity Advantage |
$19.37
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$13.67
|
| Rate for Payer: Cofinity Commercial |
$19.43
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Cofinity Commercial |
$47.95
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.60
|
| Rate for Payer: Healthscope Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$50.17
|
| Rate for Payer: Healthscope Commercial |
$25.85
|
| Rate for Payer: Healthscope Commercial |
$20.33
|
| Rate for Payer: Healthscope Commercial |
$19.54
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$24.90
|
| Rate for Payer: Healthscope Commercial |
$23.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.94
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: PHP Commercial |
$19.20
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$18.45
|
| Rate for Payer: PHP Commercial |
$23.52
|
| Rate for Payer: PHP Commercial |
$22.01
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: PHP Commercial |
$47.39
|
| Rate for Payer: PHP Commercial |
$24.41
|
| Rate for Payer: Priority Health SBD |
$18.09
|
| Rate for Payer: Priority Health SBD |
$17.43
|
| Rate for Payer: Priority Health SBD |
$14.23
|
| Rate for Payer: Priority Health SBD |
$10.02
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: Priority Health SBD |
$11.47
|
| Rate for Payer: Priority Health SBD |
$16.31
|
| Rate for Payer: Priority Health SBD |
$35.12
|
| Rate for Payer: Priority Health SBD |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
|
|
AMIODARONE 50 MG/ML IV (CODE)
|
Facility
|
IP
|
$25.89
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
163703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$23.30 |
| Rate for Payer: Aetna Commercial |
$22.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.83
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cofinity Advantage |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.71
|
| Rate for Payer: Healthscope Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.42
|
| Rate for Payer: PHP Commercial |
$22.01
|
| Rate for Payer: Priority Health SBD |
$16.31
|
|
|
AMIODARONE 50 MG/ML IV (CODE)
|
Facility
|
OP
|
$25.89
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
163703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$23.30 |
| Rate for Payer: Aetna Commercial |
$22.01
|
| Rate for Payer: Aetna Medicare |
$12.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.83
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cofinity Advantage |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.71
|
| Rate for Payer: Healthscope Commercial |
$23.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.42
|
| Rate for Payer: PHP Commercial |
$22.01
|
| Rate for Payer: Priority Health SBD |
$16.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
|
|
AMITRIPTYLINE 100 MG TABLET
|
Facility
|
OP
|
$158.40
|
|
|
Service Code
|
NDC 50268004115
|
| Hospital Charge Code |
433
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.25 |
| Max. Negotiated Rate |
$142.56 |
| Rate for Payer: Aetna Commercial |
$134.64
|
| Rate for Payer: Aetna Medicare |
$79.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.96
|
| Rate for Payer: BCBS Complete |
$63.36
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cofinity Advantage |
$110.88
|
| Rate for Payer: Cofinity Commercial |
$136.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.72
|
| Rate for Payer: Healthscope Commercial |
$142.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.80
|
| Rate for Payer: PHP Commercial |
$134.64
|
| Rate for Payer: Priority Health SBD |
$99.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.96
|
| Rate for Payer: UHC Core |
$82.53
|
| Rate for Payer: UHC Exchange |
$62.25
|
|
|
AMITRIPTYLINE 100 MG TABLET
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 16729017501
|
| Hospital Charge Code |
433
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.69 |
| Max. Negotiated Rate |
$196.69 |
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.06
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Advantage |
$152.99
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health SBD |
$137.69
|
|
