|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC
|
Facility
|
IP
|
$55,451.21
|
|
|
Service Code
|
MSDRG 061
|
| Min. Negotiated Rate |
$20,792.15 |
| Max. Negotiated Rate |
$55,451.21 |
| Rate for Payer: Aetna Medicare |
$22,761.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,358.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,358.09
|
| Rate for Payer: BCBS MAPPO |
$21,886.47
|
| Rate for Payer: BCBS Trust/PPO |
$55,451.21
|
| Rate for Payer: BCN Commercial |
$55,451.21
|
| Rate for Payer: BCN Medicare Advantage |
$21,886.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,886.47
|
| Rate for Payer: Mclaren Medicare |
$21,886.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,980.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,169.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,075.12
|
| Rate for Payer: Nomi Health Commercial |
$35,566.59
|
| Rate for Payer: PACE Medicare |
$20,792.15
|
| Rate for Payer: PACE SWMI |
$21,886.47
|
| Rate for Payer: PHP Medicare Advantage |
$21,886.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$44,450.35
|
| Rate for Payer: Priority Health Medicare |
$21,886.47
|
| Rate for Payer: Priority Health Tiered Network |
$35,560.28
|
| Rate for Payer: Railroad Medicare Medicare |
$21,886.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,940.73
|
| Rate for Payer: UHC Core |
$37,598.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,886.47
|
| Rate for Payer: UHC Exchange |
$30,705.82
|
| Rate for Payer: VA VA |
$21,886.47
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC
|
Facility
|
IP
|
$34,494.03
|
|
|
Service Code
|
MSDRG 063
|
| Min. Negotiated Rate |
$10,856.50 |
| Max. Negotiated Rate |
$34,494.03 |
| Rate for Payer: PHP Medicare Advantage |
$11,427.89
|
| Rate for Payer: Aetna Medicare |
$11,885.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,284.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,284.86
|
| Rate for Payer: BCBS MAPPO |
$11,427.89
|
| Rate for Payer: BCBS Trust/PPO |
$34,494.03
|
| Rate for Payer: BCN Commercial |
$34,494.03
|
| Rate for Payer: BCN Medicare Advantage |
$11,427.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,427.89
|
| Rate for Payer: Mclaren Medicare |
$11,427.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,999.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,142.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,570.68
|
| Rate for Payer: Nomi Health Commercial |
$18,109.02
|
| Rate for Payer: PACE Medicare |
$10,856.50
|
| Rate for Payer: PACE SWMI |
$11,427.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,632.26
|
| Rate for Payer: Priority Health Medicare |
$11,427.89
|
| Rate for Payer: Priority Health Tiered Network |
$18,105.81
|
| Rate for Payer: Railroad Medicare Medicare |
$11,427.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,881.94
|
| Rate for Payer: UHC Core |
$19,143.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,427.89
|
| Rate for Payer: UHC Exchange |
$15,634.12
|
| Rate for Payer: VA VA |
$11,427.89
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
OP
|
$4.70
|
|
|
Service Code
|
NDC 51079008301
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Aetna Medicare |
$2.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.06
|
| Rate for Payer: BCBS Complete |
$1.88
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cofinity Advantage |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$4.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$4.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.52
|
| Rate for Payer: PHP Commercial |
$4.00
|
| Rate for Payer: Priority Health SBD |
$2.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.06
|
| Rate for Payer: UHC Core |
$2.45
|
| Rate for Payer: UHC Exchange |
$1.85
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
OP
|
$394.80
|
|
|
Service Code
|
NDC 00555007102
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.16 |
| Max. Negotiated Rate |
$355.32 |
| Rate for Payer: Aetna Commercial |
$335.58
|
| Rate for Payer: Aetna Medicare |
$197.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.62
|
| Rate for Payer: BCBS Complete |
$157.92
|
| Rate for Payer: Cash Price |
$315.84
|
| Rate for Payer: Cofinity Advantage |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.84
|
| Rate for Payer: Healthscope Commercial |
$355.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$315.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.10
|
| Rate for Payer: PHP Commercial |
$335.58
|
| Rate for Payer: Priority Health SBD |
$248.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.62
|
| Rate for Payer: UHC Core |
$205.69
|
| Rate for Payer: UHC Exchange |
$155.16
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
IP
|
$469.44
|
|
|
Service Code
|
NDC 51079008320
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$295.75 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna Commercial |
$399.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.14
|
| Rate for Payer: Cash Price |
$375.55
|
| Rate for Payer: Cofinity Advantage |
$328.61
|
| Rate for Payer: Cofinity Commercial |
$403.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.55
|
| Rate for Payer: Healthscope Commercial |
$422.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.08
|
| Rate for Payer: PHP Commercial |
$399.02
|
| Rate for Payer: Priority Health SBD |
$295.75
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
IP
|
$394.80
|
|
|
Service Code
|
NDC 00555007102
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.72 |
| Max. Negotiated Rate |
$355.32 |
| Rate for Payer: Aetna Commercial |
$335.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.62
|
| Rate for Payer: Cash Price |
$315.84
|
| Rate for Payer: Cofinity Advantage |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.84
|
| Rate for Payer: Healthscope Commercial |
$355.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.10
|
| Rate for Payer: PHP Commercial |
$335.58
|
| Rate for Payer: Priority Health SBD |
$248.72
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
OP
|
$1,004.92
|
|
|
Service Code
|
NDC 64950021710
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$394.93 |
| Max. Negotiated Rate |
$904.43 |
| Rate for Payer: Aetna Commercial |
$854.18
|
| Rate for Payer: Aetna Medicare |
$502.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.20
|
| Rate for Payer: BCBS Complete |
$401.97
|
| Rate for Payer: Cash Price |
$803.94
|
| Rate for Payer: Cofinity Advantage |
$703.44
|
| Rate for Payer: Cofinity Commercial |
$864.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$803.94
|
| Rate for Payer: Healthscope Commercial |
$904.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$803.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$854.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$753.69
|
| Rate for Payer: PHP Commercial |
$854.18
|
| Rate for Payer: Priority Health SBD |
$633.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$653.20
|
| Rate for Payer: UHC Core |
$523.56
|
| Rate for Payer: UHC Exchange |
$394.93
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
IP
|
$1,004.92
|
|
|
Service Code
|
NDC 64950021710
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$633.10 |
| Max. Negotiated Rate |
$904.43 |
| Rate for Payer: Aetna Commercial |
$854.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.20
|
| Rate for Payer: Cash Price |
$803.94
|
| Rate for Payer: Cofinity Advantage |
$703.44
|
| Rate for Payer: Cofinity Commercial |
$864.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$803.94
|
| Rate for Payer: Healthscope Commercial |
$904.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$854.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$753.69
|
| Rate for Payer: PHP Commercial |
$854.18
|
| Rate for Payer: Priority Health SBD |
$633.10
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
OP
|
$469.44
|
|
|
Service Code
|
NDC 51079008320
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.49 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna Commercial |
$399.02
|
| Rate for Payer: Aetna Medicare |
$234.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.14
|
| Rate for Payer: BCBS Complete |
$187.78
|
| Rate for Payer: Cash Price |
$375.55
|
| Rate for Payer: Cofinity Advantage |
$328.61
|
| Rate for Payer: Cofinity Commercial |
$403.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.55
|
| Rate for Payer: Healthscope Commercial |
$422.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$375.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.08
|
| Rate for Payer: PHP Commercial |
$399.02
|
| Rate for Payer: Priority Health SBD |
$295.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.14
|
| Rate for Payer: UHC Core |
$244.58
|
| Rate for Payer: UHC Exchange |
$184.49
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
IP
|
$4.70
|
|
|
Service Code
|
NDC 51079008301
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.06
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cofinity Advantage |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$4.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$4.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.52
|
| Rate for Payer: PHP Commercial |
$4.00
|
| Rate for Payer: Priority Health SBD |
$2.96
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$164.88
|
|
|
Service Code
|
NDC 50268044815
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$148.39 |
| Rate for Payer: Aetna Commercial |
$140.15
|
| Rate for Payer: Aetna Medicare |
$82.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.17
|
| Rate for Payer: BCBS Complete |
$65.95
|
| Rate for Payer: Cash Price |
$131.90
|
| Rate for Payer: Cofinity Advantage |
$115.42
|
| Rate for Payer: Cofinity Commercial |
$141.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.90
|
| Rate for Payer: Healthscope Commercial |
$148.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.66
|
| Rate for Payer: PHP Commercial |
$140.15
|
| Rate for Payer: Priority Health SBD |
$103.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.17
|
| Rate for Payer: UHC Core |
$85.90
|
| Rate for Payer: UHC Exchange |
$64.80
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 72888008201
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$288.70 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.86
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Advantage |
$320.77
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health SBD |
$288.70
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
NDC 68084008211
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.83
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Advantage |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.40
|
| Rate for Payer: Priority Health SBD |
$1.78
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
NDC 68084008211
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna Medicare |
$1.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.83
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Advantage |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.40
|
| Rate for Payer: Priority Health SBD |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.83
|
| Rate for Payer: UHC Core |
$1.47
|
| Rate for Payer: UHC Exchange |
$1.11
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$262.08
|
|
|
Service Code
|
NDC 63739056910
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Aetna Commercial |
$222.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.35
|
| Rate for Payer: Cash Price |
$209.66
|
| Rate for Payer: Cofinity Advantage |
$183.46
|
| Rate for Payer: Cofinity Commercial |
$225.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.66
|
| Rate for Payer: Healthscope Commercial |
$235.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.56
|
| Rate for Payer: PHP Commercial |
$222.77
|
| Rate for Payer: Priority Health SBD |
$165.11
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$281.28
|
|
|
Service Code
|
NDC 68084008201
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.54 |
| Max. Negotiated Rate |
$253.15 |
| Rate for Payer: Aetna Commercial |
$239.09
|
| Rate for Payer: Aetna Medicare |
$140.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.83
|
| Rate for Payer: BCBS Complete |
$112.51
|
| Rate for Payer: Cash Price |
$225.02
|
| Rate for Payer: Cofinity Advantage |
$196.90
|
| Rate for Payer: Cofinity Commercial |
$241.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.02
|
| Rate for Payer: Healthscope Commercial |
$253.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.96
|
| Rate for Payer: PHP Commercial |
$239.09
|
| Rate for Payer: Priority Health SBD |
$177.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.83
|
| Rate for Payer: UHC Core |
$146.55
|
| Rate for Payer: UHC Exchange |
$110.54
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$164.88
|
|
|
Service Code
|
NDC 50268044815
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$148.39 |
| Rate for Payer: Aetna Commercial |
$140.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.17
|
| Rate for Payer: Cash Price |
$131.90
|
| Rate for Payer: Cofinity Advantage |
$115.42
|
| Rate for Payer: Cofinity Commercial |
$141.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.90
|
| Rate for Payer: Healthscope Commercial |
$148.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.66
|
| Rate for Payer: PHP Commercial |
$140.15
|
| Rate for Payer: Priority Health SBD |
$103.87
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$262.08
|
|
|
Service Code
|
NDC 63739056910
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.00 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Aetna Commercial |
$222.77
|
| Rate for Payer: Aetna Medicare |
$131.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.35
|
| Rate for Payer: BCBS Complete |
$104.83
|
| Rate for Payer: Cash Price |
$209.66
|
| Rate for Payer: Cofinity Advantage |
$183.46
|
| Rate for Payer: Cofinity Commercial |
$225.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.66
|
| Rate for Payer: Healthscope Commercial |
$235.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.56
|
| Rate for Payer: PHP Commercial |
$222.77
|
| Rate for Payer: Priority Health SBD |
$165.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.35
|
| Rate for Payer: UHC Core |
$136.54
|
| Rate for Payer: UHC Exchange |
$103.00
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$3.30
|
|
|
Service Code
|
NDC 50268044811
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Medicare |
$1.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.15
|
| Rate for Payer: BCBS Complete |
$1.32
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cofinity Advantage |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.64
|
| Rate for Payer: Healthscope Commercial |
$2.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.48
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: Priority Health SBD |
$2.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.15
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.30
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$281.28
|
|
|
Service Code
|
NDC 68084008201
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.21 |
| Max. Negotiated Rate |
$253.15 |
| Rate for Payer: Aetna Commercial |
$239.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.83
|
| Rate for Payer: Cash Price |
$225.02
|
| Rate for Payer: Cofinity Advantage |
$196.90
|
| Rate for Payer: Cofinity Commercial |
$241.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.02
|
| Rate for Payer: Healthscope Commercial |
$253.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.96
|
| Rate for Payer: PHP Commercial |
$239.09
|
| Rate for Payer: Priority Health SBD |
$177.21
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$255.84
|
|
|
Service Code
|
NDC 00904661961
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.18 |
| Max. Negotiated Rate |
$230.26 |
| Rate for Payer: Aetna Commercial |
$217.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.30
|
| Rate for Payer: Cash Price |
$204.67
|
| Rate for Payer: Cofinity Advantage |
$179.09
|
| Rate for Payer: Cofinity Commercial |
$220.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.67
|
| Rate for Payer: Healthscope Commercial |
$230.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.88
|
| Rate for Payer: PHP Commercial |
$217.46
|
| Rate for Payer: Priority Health SBD |
$161.18
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$255.84
|
|
|
Service Code
|
NDC 00904661961
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.55 |
| Max. Negotiated Rate |
$230.26 |
| Rate for Payer: Aetna Commercial |
$217.46
|
| Rate for Payer: Aetna Medicare |
$127.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.30
|
| Rate for Payer: BCBS Complete |
$102.34
|
| Rate for Payer: Cash Price |
$204.67
|
| Rate for Payer: Cofinity Advantage |
$179.09
|
| Rate for Payer: Cofinity Commercial |
$220.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.67
|
| Rate for Payer: Healthscope Commercial |
$230.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.88
|
| Rate for Payer: PHP Commercial |
$217.46
|
| Rate for Payer: Priority Health SBD |
$161.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.30
|
| Rate for Payer: UHC Core |
$133.29
|
| Rate for Payer: UHC Exchange |
$100.55
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$3.30
|
|
|
Service Code
|
NDC 50268044811
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.15
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cofinity Advantage |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.64
|
| Rate for Payer: Healthscope Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.48
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: Priority Health SBD |
$2.08
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 72888008201
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.09 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna Medicare |
$229.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.86
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Advantage |
$320.77
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$366.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health SBD |
$288.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.86
|
| Rate for Payer: UHC Core |
$238.75
|
| Rate for Payer: UHC Exchange |
$180.09
|
|
|
ISOSORBIDE MONONITRATE 20 MG TABLET
|
Facility
|
IP
|
$1,242.09
|
|
|
Service Code
|
NDC 81665010310
|
| Hospital Charge Code |
10357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$782.52 |
| Max. Negotiated Rate |
$1,117.88 |
| Rate for Payer: Aetna Commercial |
$1,055.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.36
|
| Rate for Payer: Cash Price |
$993.67
|
| Rate for Payer: Cofinity Advantage |
$869.46
|
| Rate for Payer: Cofinity Commercial |
$1,068.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$993.67
|
| Rate for Payer: Healthscope Commercial |
$1,117.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,055.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$931.57
|
| Rate for Payer: PHP Commercial |
$1,055.78
|
| Rate for Payer: Priority Health SBD |
$782.52
|
|
