|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00121176130
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$4.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.78
|
| Rate for Payer: BCBS Complete |
$3.42
|
| Rate for Payer: BCBS MAPPO |
$4.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.21
|
| Rate for Payer: BCN Commercial |
$15.21
|
| Rate for Payer: BCN Medicare Advantage |
$4.62
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.62
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.86
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: PACE Senior Care Partners |
$4.39
|
| Rate for Payer: PACE SWMI |
$4.62
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: PHP Medicare Advantage |
$4.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Medicare |
$4.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.88
|
| Rate for Payer: Railroad Medicare Medicare |
$4.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: UHC Exchange |
$4.62
|
| Rate for Payer: UHC Medicaid |
$3.26
|
| Rate for Payer: UHC Medicare Advantage |
$4.62
|
| Rate for Payer: UHCCP Medicaid |
$3.26
|
| Rate for Payer: VA VA |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$15.21
|
|
|
Service Code
|
NDC 09900000191
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$13.69 |
| Rate for Payer: Aetna Commercial |
$12.93
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.75
|
| Rate for Payer: BCBS Complete |
$2.82
|
| Rate for Payer: BCBS MAPPO |
$3.80
|
| Rate for Payer: BCBS Trust/PPO |
$12.50
|
| Rate for Payer: BCN Commercial |
$12.50
|
| Rate for Payer: BCN Medicare Advantage |
$3.80
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$13.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.41
|
| Rate for Payer: Mclaren Medicaid |
$2.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.99
|
| Rate for Payer: Meridian Medicaid |
$2.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.93
|
| Rate for Payer: Nomi Health Commercial |
$12.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.41
|
| Rate for Payer: PACE Senior Care Partners |
$3.61
|
| Rate for Payer: PACE SWMI |
$3.80
|
| Rate for Payer: PHP Commercial |
$12.93
|
| Rate for Payer: PHP Medicare Advantage |
$3.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.23
|
| Rate for Payer: Priority Health Medicare |
$3.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.59
|
| Rate for Payer: Railroad Medicare Medicare |
$3.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.38
|
| Rate for Payer: UHC Core |
$12.70
|
| Rate for Payer: UHC Exchange |
$3.80
|
| Rate for Payer: UHC Medicaid |
$2.68
|
| Rate for Payer: UHC Medicare Advantage |
$3.80
|
| Rate for Payer: UHCCP Medicaid |
$2.68
|
| Rate for Payer: VA VA |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.41
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$12.83
|
|
|
Service Code
|
NDC 00904732573
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Aetna Commercial |
$10.91
|
| Rate for Payer: Aetna Medicare |
$3.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.01
|
| Rate for Payer: BCBS Complete |
$2.37
|
| Rate for Payer: BCBS MAPPO |
$3.21
|
| Rate for Payer: BCBS Trust/PPO |
$10.55
|
| Rate for Payer: BCN Commercial |
$10.55
|
| Rate for Payer: BCN Medicare Advantage |
$3.21
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Cofinity Commercial |
$11.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.21
|
| Rate for Payer: Healthscope Commercial |
$11.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.62
|
| Rate for Payer: Mclaren Medicaid |
$2.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.37
|
| Rate for Payer: Meridian Medicaid |
$2.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.91
|
| Rate for Payer: Nomi Health Commercial |
$10.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.62
|
| Rate for Payer: PACE Senior Care Partners |
$3.05
|
| Rate for Payer: PACE SWMI |
$3.21
|
| Rate for Payer: PHP Commercial |
$10.91
|
| Rate for Payer: PHP Medicare Advantage |
$3.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.16
|
| Rate for Payer: Priority Health Medicare |
$3.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.29
|
| Rate for Payer: UHC Core |
$10.71
|
| Rate for Payer: UHC Exchange |
$3.21
|
| Rate for Payer: UHC Medicaid |
$2.26
|
| Rate for Payer: UHC Medicare Advantage |
$3.21
|
| Rate for Payer: UHCCP Medicaid |
$2.26
|
| Rate for Payer: VA VA |
$3.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.62
|
|
|
ALVIMOPAN 12 MG CAPSULE
|
Facility
|
OP
|
$20,184.24
|
|
|
Service Code
|
NDC 67919002010
|
| Hospital Charge Code |
91870
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,558.48 |
| Max. Negotiated Rate |
$18,165.82 |
| Rate for Payer: Aetna Commercial |
$17,156.60
|
| Rate for Payer: Aetna Medicare |
$5,247.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,307.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,307.57
|
| Rate for Payer: BCBS Complete |
$3,736.10
|
| Rate for Payer: BCBS MAPPO |
$5,046.06
|
| Rate for Payer: BCBS Trust/PPO |
$16,593.46
|
| Rate for Payer: BCN Commercial |
$16,593.46
|
| Rate for Payer: BCN Medicare Advantage |
$5,046.06
|
| Rate for Payer: Cash Price |
$16,147.39
|
| Rate for Payer: Cofinity Commercial |
$17,358.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,147.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,046.06
|
| Rate for Payer: Healthscope Commercial |
$18,165.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,138.18
|
| Rate for Payer: Mclaren Medicaid |
$3,558.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,298.36
|
| Rate for Payer: Meridian Medicaid |
$3,736.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,802.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,550.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,156.60
|
| Rate for Payer: Nomi Health Commercial |
$16,551.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,138.18
|
| Rate for Payer: PACE Senior Care Partners |
$4,793.76
|
| Rate for Payer: PACE SWMI |
$5,046.06
|
| Rate for Payer: PHP Commercial |
$17,156.60
|
| Rate for Payer: PHP Medicare Advantage |
$5,046.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,558.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17,560.29
|
| Rate for Payer: Priority Health Medicare |
$5,096.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14,048.23
|
| Rate for Payer: Railroad Medicare Medicare |
$5,046.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,762.13
|
| Rate for Payer: UHC Core |
$16,853.84
|
| Rate for Payer: UHC Exchange |
$5,046.06
|
| Rate for Payer: UHC Medicaid |
$3,558.48
|
| Rate for Payer: UHC Medicare Advantage |
$5,046.06
|
| Rate for Payer: UHCCP Medicaid |
$3,558.48
|
| Rate for Payer: VA VA |
$5,046.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,138.18
|
|
|
ALVIMOPAN 12 MG CAPSULE
|
Facility
|
IP
|
$20,184.24
|
|
|
Service Code
|
NDC 67919002010
|
| Hospital Charge Code |
91870
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14,048.23 |
| Max. Negotiated Rate |
$18,165.82 |
| Rate for Payer: Aetna Commercial |
$17,156.60
|
| Rate for Payer: BCBS Trust/PPO |
$16,670.16
|
| Rate for Payer: BCN Commercial |
$16,670.16
|
| Rate for Payer: Cash Price |
$16,147.39
|
| Rate for Payer: Cofinity Commercial |
$17,358.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,147.39
|
| Rate for Payer: Healthscope Commercial |
$18,165.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,138.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,156.60
|
| Rate for Payer: Nomi Health Commercial |
$16,551.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,138.18
|
| Rate for Payer: PHP Commercial |
$17,156.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17,560.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14,048.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,762.13
|
| Rate for Payer: UHC Core |
$16,853.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,138.18
|
|
|
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 |
$29.58 |
| Max. Negotiated Rate |
$150.99 |
| Rate for Payer: Aetna Commercial |
$142.60
|
| Rate for Payer: Aetna Medicare |
$43.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.43
|
| Rate for Payer: BCBS Complete |
$31.05
|
| Rate for Payer: BCBS MAPPO |
$41.94
|
| Rate for Payer: BCBS Trust/PPO |
$137.92
|
| Rate for Payer: BCN Commercial |
$137.92
|
| Rate for Payer: BCN Medicare Advantage |
$41.94
|
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Cofinity Commercial |
$144.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.94
|
| Rate for Payer: Healthscope Commercial |
$150.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.83
|
| Rate for Payer: Mclaren Medicaid |
$29.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.04
|
| Rate for Payer: Meridian Medicaid |
$31.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.60
|
| Rate for Payer: Nomi Health Commercial |
$137.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.83
|
| Rate for Payer: PACE Senior Care Partners |
$39.85
|
| Rate for Payer: PACE SWMI |
$41.94
|
| Rate for Payer: PHP Commercial |
$142.60
|
| Rate for Payer: PHP Medicare Advantage |
$41.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$145.96
|
| Rate for Payer: Priority Health Medicare |
$42.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.77
|
| Rate for Payer: Railroad Medicare Medicare |
$41.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.64
|
| Rate for Payer: UHC Core |
$140.09
|
| Rate for Payer: UHC Exchange |
$41.94
|
| Rate for Payer: UHC Medicaid |
$29.58
|
| Rate for Payer: UHC Medicare Advantage |
$41.94
|
| Rate for Payer: UHCCP Medicaid |
$29.58
|
| Rate for Payer: VA VA |
$41.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.83
|
|
|
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 |
$116.77 |
| Max. Negotiated Rate |
$150.99 |
| Rate for Payer: Aetna Commercial |
$142.60
|
| Rate for Payer: BCBS Trust/PPO |
$138.56
|
| Rate for Payer: BCN Commercial |
$138.56
|
| Rate for Payer: Cash Price |
$134.22
|
| 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: Lakeland Regional Health Systems Commercial |
$125.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.60
|
| Rate for Payer: Nomi Health Commercial |
$137.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.83
|
| Rate for Payer: PHP Commercial |
$142.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$145.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.64
|
| Rate for Payer: UHC Core |
$140.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.83
|
|
|
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 |
$23.11 |
| Max. Negotiated Rate |
$29.88 |
| Rate for Payer: Aetna Commercial |
$28.22
|
| Rate for Payer: BCBS Trust/PPO |
$27.42
|
| Rate for Payer: BCN Commercial |
$27.42
|
| Rate for Payer: Cash Price |
$26.56
|
| 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: Lakeland Regional Health Systems Commercial |
$24.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.22
|
| Rate for Payer: Nomi Health Commercial |
$27.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.90
|
| Rate for Payer: PHP Commercial |
$28.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.22
|
| Rate for Payer: UHC Core |
$27.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.90
|
|
|
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 |
$5.85 |
| Max. Negotiated Rate |
$29.88 |
| Rate for Payer: Aetna Commercial |
$28.22
|
| Rate for Payer: Aetna Medicare |
$8.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.38
|
| Rate for Payer: BCBS Complete |
$6.15
|
| Rate for Payer: BCBS MAPPO |
$8.30
|
| Rate for Payer: BCBS Trust/PPO |
$27.29
|
| Rate for Payer: BCN Commercial |
$27.29
|
| Rate for Payer: BCN Medicare Advantage |
$8.30
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cofinity Commercial |
$28.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.30
|
| Rate for Payer: Healthscope Commercial |
$29.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.90
|
| Rate for Payer: Mclaren Medicaid |
$5.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.71
|
| Rate for Payer: Meridian Medicaid |
$6.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.22
|
| Rate for Payer: Nomi Health Commercial |
$27.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.90
|
| Rate for Payer: PACE Senior Care Partners |
$7.88
|
| Rate for Payer: PACE SWMI |
$8.30
|
| Rate for Payer: PHP Commercial |
$28.22
|
| Rate for Payer: PHP Medicare Advantage |
$8.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.88
|
| Rate for Payer: Priority Health Medicare |
$8.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.11
|
| Rate for Payer: Railroad Medicare Medicare |
$8.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.22
|
| Rate for Payer: UHC Core |
$27.72
|
| Rate for Payer: UHC Exchange |
$8.30
|
| Rate for Payer: UHC Medicaid |
$5.85
|
| Rate for Payer: UHC Medicare Advantage |
$8.30
|
| Rate for Payer: UHCCP Medicaid |
$5.85
|
| Rate for Payer: VA VA |
$8.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.90
|
|
|
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 |
$18.28 |
| Max. Negotiated Rate |
$93.32 |
| Rate for Payer: Aetna Commercial |
$88.14
|
| Rate for Payer: Aetna Medicare |
$26.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.40
|
| Rate for Payer: BCBS Complete |
$19.19
|
| Rate for Payer: BCBS MAPPO |
$25.92
|
| Rate for Payer: BCBS Trust/PPO |
$85.24
|
| Rate for Payer: BCN Commercial |
$85.24
|
| Rate for Payer: BCN Medicare Advantage |
$25.92
|
| Rate for Payer: Cash Price |
$82.95
|
| Rate for Payer: Cofinity Commercial |
$89.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.92
|
| Rate for Payer: Healthscope Commercial |
$93.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.77
|
| Rate for Payer: Mclaren Medicaid |
$18.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.22
|
| Rate for Payer: Meridian Medicaid |
$19.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.14
|
| Rate for Payer: Nomi Health Commercial |
$85.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.77
|
| Rate for Payer: PACE Senior Care Partners |
$24.63
|
| Rate for Payer: PACE SWMI |
$25.92
|
| Rate for Payer: PHP Commercial |
$88.14
|
| Rate for Payer: PHP Medicare Advantage |
$25.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$90.21
|
| Rate for Payer: Priority Health Medicare |
$26.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.17
|
| Rate for Payer: Railroad Medicare Medicare |
$25.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.25
|
| Rate for Payer: UHC Core |
$86.58
|
| Rate for Payer: UHC Exchange |
$25.92
|
| Rate for Payer: UHC Medicaid |
$18.28
|
| Rate for Payer: UHC Medicare Advantage |
$25.92
|
| Rate for Payer: UHCCP Medicaid |
$18.28
|
| Rate for Payer: VA VA |
$25.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.77
|
|
|
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 |
$72.17 |
| Max. Negotiated Rate |
$93.32 |
| Rate for Payer: Aetna Commercial |
$88.14
|
| Rate for Payer: BCBS Trust/PPO |
$85.64
|
| Rate for Payer: BCN Commercial |
$85.64
|
| Rate for Payer: Cash Price |
$82.95
|
| 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: Lakeland Regional Health Systems Commercial |
$77.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.14
|
| Rate for Payer: Nomi Health Commercial |
$85.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.77
|
| Rate for Payer: PHP Commercial |
$88.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$90.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.25
|
| Rate for Payer: UHC Core |
$86.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.77
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$219.45
|
|
|
Service Code
|
NDC 00245014701
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.74 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna Commercial |
$186.53
|
| Rate for Payer: BCBS Trust/PPO |
$181.24
|
| Rate for Payer: BCN Commercial |
$181.24
|
| Rate for Payer: Cash Price |
$175.56
|
| 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: Lakeland Regional Health Systems Commercial |
$164.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.53
|
| Rate for Payer: Nomi Health Commercial |
$179.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.59
|
| Rate for Payer: PHP Commercial |
$186.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$190.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.12
|
| Rate for Payer: UHC Core |
$183.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.59
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$327.75
|
|
|
Service Code
|
NDC 68084037111
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.78 |
| Max. Negotiated Rate |
$294.98 |
| Rate for Payer: Aetna Commercial |
$278.59
|
| Rate for Payer: Aetna Medicare |
$85.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.42
|
| Rate for Payer: BCBS Complete |
$60.67
|
| Rate for Payer: BCBS MAPPO |
$81.94
|
| Rate for Payer: BCBS Trust/PPO |
$269.44
|
| Rate for Payer: BCN Commercial |
$269.44
|
| Rate for Payer: BCN Medicare Advantage |
$81.94
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cofinity Commercial |
$281.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.94
|
| Rate for Payer: Healthscope Commercial |
$294.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.81
|
| Rate for Payer: Mclaren Medicaid |
$57.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.03
|
| Rate for Payer: Meridian Medicaid |
$60.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$90.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.59
|
| Rate for Payer: Nomi Health Commercial |
$268.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.81
|
| Rate for Payer: PACE Senior Care Partners |
$77.84
|
| Rate for Payer: PACE SWMI |
$81.94
|
| Rate for Payer: PHP Commercial |
$278.59
|
| Rate for Payer: PHP Medicare Advantage |
$81.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$285.14
|
| Rate for Payer: Priority Health Medicare |
$82.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.11
|
| Rate for Payer: Railroad Medicare Medicare |
$81.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.42
|
| Rate for Payer: UHC Core |
$273.67
|
| Rate for Payer: UHC Exchange |
$81.94
|
| Rate for Payer: UHC Medicaid |
$57.78
|
| Rate for Payer: UHC Medicare Advantage |
$81.94
|
| Rate for Payer: UHCCP Medicaid |
$57.78
|
| Rate for Payer: VA VA |
$81.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.81
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$248.16
|
|
|
Service Code
|
NDC 51672402504
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.72 |
| Max. Negotiated Rate |
$223.34 |
| Rate for Payer: Aetna Commercial |
$210.94
|
| Rate for Payer: BCBS Trust/PPO |
$204.96
|
| Rate for Payer: BCN Commercial |
$204.96
|
| Rate for Payer: Cash Price |
$198.53
|
| Rate for Payer: Cofinity Commercial |
$213.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.53
|
| Rate for Payer: Healthscope Commercial |
$223.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.94
|
| Rate for Payer: Nomi Health Commercial |
$203.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.12
|
| Rate for Payer: PHP Commercial |
$210.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$215.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.38
|
| Rate for Payer: UHC Core |
$207.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.12
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$219.45
|
|
|
Service Code
|
NDC 00245014701
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.69 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna Commercial |
$186.53
|
| Rate for Payer: Aetna Medicare |
$57.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.58
|
| Rate for Payer: BCBS Complete |
$40.62
|
| Rate for Payer: BCBS MAPPO |
$54.86
|
| Rate for Payer: BCBS Trust/PPO |
$180.41
|
| Rate for Payer: BCN Commercial |
$180.41
|
| Rate for Payer: BCN Medicare Advantage |
$54.86
|
| Rate for Payer: Cash Price |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$188.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.86
|
| Rate for Payer: Healthscope Commercial |
$197.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.59
|
| Rate for Payer: Mclaren Medicaid |
$38.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.61
|
| Rate for Payer: Meridian Medicaid |
$40.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.53
|
| Rate for Payer: Nomi Health Commercial |
$179.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.59
|
| Rate for Payer: PACE Senior Care Partners |
$52.12
|
| Rate for Payer: PACE SWMI |
$54.86
|
| Rate for Payer: PHP Commercial |
$186.53
|
| Rate for Payer: PHP Medicare Advantage |
$54.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$190.92
|
| Rate for Payer: Priority Health Medicare |
$55.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.74
|
| Rate for Payer: Railroad Medicare Medicare |
$54.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.12
|
| Rate for Payer: UHC Core |
$183.24
|
| Rate for Payer: UHC Exchange |
$54.86
|
| Rate for Payer: UHC Medicaid |
$38.69
|
| Rate for Payer: UHC Medicare Advantage |
$54.86
|
| Rate for Payer: UHCCP Medicaid |
$38.69
|
| Rate for Payer: VA VA |
$54.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.59
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$199.50
|
|
|
Service Code
|
NDC 00904699361
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.85 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna Commercial |
$169.57
|
| Rate for Payer: BCBS Trust/PPO |
$164.77
|
| Rate for Payer: BCN Commercial |
$164.77
|
| Rate for Payer: Cash Price |
$159.60
|
| 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: Lakeland Regional Health Systems Commercial |
$149.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.57
|
| Rate for Payer: Nomi Health Commercial |
$163.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.62
|
| Rate for Payer: PHP Commercial |
$169.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$173.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.56
|
| Rate for Payer: UHC Core |
$166.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.62
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
NDC 00245014789
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: BCBS Trust/PPO |
$1.82
|
| Rate for Payer: BCN Commercial |
$1.82
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$1.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.87
|
| Rate for Payer: Nomi Health Commercial |
$1.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.65
|
| Rate for Payer: PHP Commercial |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.94
|
| Rate for Payer: UHC Core |
$1.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.65
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
NDC 00245014789
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Medicare |
$0.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.69
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS MAPPO |
$0.55
|
| Rate for Payer: BCBS Trust/PPO |
$1.81
|
| Rate for Payer: BCN Commercial |
$1.81
|
| Rate for Payer: BCN Medicare Advantage |
$0.55
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.55
|
| Rate for Payer: Healthscope Commercial |
$1.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.65
|
| Rate for Payer: Mclaren Medicaid |
$0.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.58
|
| Rate for Payer: Meridian Medicaid |
$0.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.87
|
| Rate for Payer: Nomi Health Commercial |
$1.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.65
|
| Rate for Payer: PACE Senior Care Partners |
$0.52
|
| Rate for Payer: PACE SWMI |
$0.55
|
| Rate for Payer: PHP Commercial |
$1.87
|
| Rate for Payer: PHP Medicare Advantage |
$0.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.91
|
| Rate for Payer: Priority Health Medicare |
$0.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.53
|
| Rate for Payer: Railroad Medicare Medicare |
$0.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.94
|
| Rate for Payer: UHC Core |
$1.84
|
| Rate for Payer: UHC Exchange |
$0.55
|
| Rate for Payer: UHC Medicaid |
$0.39
|
| Rate for Payer: UHC Medicare Advantage |
$0.55
|
| Rate for Payer: UHCCP Medicaid |
$0.39
|
| Rate for Payer: VA VA |
$0.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.65
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$248.16
|
|
|
Service Code
|
NDC 51672402504
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$223.34 |
| Rate for Payer: Aetna Commercial |
$210.94
|
| Rate for Payer: Aetna Medicare |
$64.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.55
|
| Rate for Payer: BCBS Complete |
$45.93
|
| Rate for Payer: BCBS MAPPO |
$62.04
|
| Rate for Payer: BCBS Trust/PPO |
$204.01
|
| Rate for Payer: BCN Commercial |
$204.01
|
| Rate for Payer: BCN Medicare Advantage |
$62.04
|
| Rate for Payer: Cash Price |
$198.53
|
| Rate for Payer: Cofinity Commercial |
$213.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$223.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.12
|
| Rate for Payer: Mclaren Medicaid |
$43.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.14
|
| Rate for Payer: Meridian Medicaid |
$45.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.94
|
| Rate for Payer: Nomi Health Commercial |
$203.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.12
|
| Rate for Payer: PACE Senior Care Partners |
$58.94
|
| Rate for Payer: PACE SWMI |
$62.04
|
| Rate for Payer: PHP Commercial |
$210.94
|
| Rate for Payer: PHP Medicare Advantage |
$62.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$215.90
|
| Rate for Payer: Priority Health Medicare |
$62.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.72
|
| Rate for Payer: Railroad Medicare Medicare |
$62.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.38
|
| Rate for Payer: UHC Core |
$207.21
|
| Rate for Payer: UHC Exchange |
$62.04
|
| Rate for Payer: UHC Medicaid |
$43.75
|
| Rate for Payer: UHC Medicare Advantage |
$62.04
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: VA VA |
$62.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.12
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$199.50
|
|
|
Service Code
|
NDC 00904699361
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.17 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna Commercial |
$169.57
|
| Rate for Payer: Aetna Medicare |
$51.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.34
|
| Rate for Payer: BCBS Complete |
$36.93
|
| Rate for Payer: BCBS MAPPO |
$49.88
|
| Rate for Payer: BCBS Trust/PPO |
$164.01
|
| Rate for Payer: BCN Commercial |
$164.01
|
| Rate for Payer: BCN Medicare Advantage |
$49.88
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$171.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.88
|
| Rate for Payer: Healthscope Commercial |
$179.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.62
|
| Rate for Payer: Mclaren Medicaid |
$35.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.37
|
| Rate for Payer: Meridian Medicaid |
$36.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.57
|
| Rate for Payer: Nomi Health Commercial |
$163.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.62
|
| Rate for Payer: PACE Senior Care Partners |
$47.38
|
| Rate for Payer: PACE SWMI |
$49.88
|
| Rate for Payer: PHP Commercial |
$169.57
|
| Rate for Payer: PHP Medicare Advantage |
$49.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$173.56
|
| Rate for Payer: Priority Health Medicare |
$50.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.85
|
| Rate for Payer: Railroad Medicare Medicare |
$49.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.56
|
| Rate for Payer: UHC Core |
$166.58
|
| Rate for Payer: UHC Exchange |
$49.88
|
| Rate for Payer: UHC Medicaid |
$35.17
|
| Rate for Payer: UHC Medicare Advantage |
$49.88
|
| Rate for Payer: UHCCP Medicaid |
$35.17
|
| Rate for Payer: VA VA |
$49.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.62
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$327.75
|
|
|
Service Code
|
NDC 68084037111
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.11 |
| Max. Negotiated Rate |
$294.98 |
| Rate for Payer: Aetna Commercial |
$278.59
|
| Rate for Payer: BCBS Trust/PPO |
$270.69
|
| Rate for Payer: BCN Commercial |
$270.69
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cofinity Commercial |
$281.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.20
|
| Rate for Payer: Healthscope Commercial |
$294.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.59
|
| Rate for Payer: Nomi Health Commercial |
$268.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.81
|
| Rate for Payer: PHP Commercial |
$278.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$285.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.42
|
| Rate for Payer: UHC Core |
$273.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.81
|
|
|
AMIODARONE 360 MG/200 ML (1.8 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV
|
Facility
|
OP
|
$191.35
|
|
|
Service Code
|
HCPCS J0283
|
| Hospital Charge Code |
152870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$172.22 |
| Rate for Payer: Aetna Commercial |
$162.65
|
| Rate for Payer: Aetna Medicare |
$49.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.80
|
| Rate for Payer: BCBS Complete |
$35.42
|
| Rate for Payer: BCBS MAPPO |
$47.84
|
| Rate for Payer: BCBS Trust/PPO |
$157.31
|
| Rate for Payer: BCN Commercial |
$157.31
|
| Rate for Payer: BCN Medicare Advantage |
$47.84
|
| Rate for Payer: Cash Price |
$153.08
|
| Rate for Payer: Cofinity Commercial |
$164.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.84
|
| Rate for Payer: Healthscope Commercial |
$172.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.51
|
| Rate for Payer: Mclaren Medicaid |
$33.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.23
|
| Rate for Payer: Meridian Medicaid |
$35.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$52.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.65
|
| Rate for Payer: Nomi Health Commercial |
$156.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.51
|
| Rate for Payer: PACE Senior Care Partners |
$45.45
|
| Rate for Payer: PACE SWMI |
$47.84
|
| Rate for Payer: PHP Commercial |
$162.65
|
| Rate for Payer: PHP Medicare Advantage |
$47.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$166.47
|
| Rate for Payer: Priority Health Medicare |
$48.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.18
|
| Rate for Payer: Railroad Medicare Medicare |
$47.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.39
|
| Rate for Payer: UHC Core |
$159.78
|
| Rate for Payer: UHC Exchange |
$47.84
|
| Rate for Payer: UHC Medicaid |
$33.74
|
| Rate for Payer: UHC Medicare Advantage |
$47.84
|
| Rate for Payer: UHCCP Medicaid |
$33.74
|
| Rate for Payer: VA VA |
$47.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.51
|
|
|
AMIODARONE 360 MG/200 ML (1.8 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV
|
Facility
|
IP
|
$191.35
|
|
|
Service Code
|
HCPCS J0283
|
| Hospital Charge Code |
152870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.18 |
| Max. Negotiated Rate |
$172.22 |
| Rate for Payer: Aetna Commercial |
$162.65
|
| Rate for Payer: BCBS Trust/PPO |
$158.04
|
| Rate for Payer: BCN Commercial |
$158.04
|
| Rate for Payer: Cash Price |
$153.08
|
| Rate for Payer: Cofinity Commercial |
$164.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.08
|
| Rate for Payer: Healthscope Commercial |
$172.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.65
|
| Rate for Payer: Nomi Health Commercial |
$156.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.51
|
| Rate for Payer: PHP Commercial |
$162.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$166.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.39
|
| Rate for Payer: UHC Core |
$159.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.51
|
|
|
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 |
$3.21 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$22.01
|
| Rate for Payer: Aetna Commercial |
$18.45
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna Medicare |
$4.73
|
| Rate for Payer: Aetna Medicare |
$5.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.02
|
| Rate for Payer: BCBS Complete |
$3.37
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS MAPPO |
$4.55
|
| Rate for Payer: BCBS MAPPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$14.97
|
| Rate for Payer: BCBS Trust/PPO |
$17.85
|
| Rate for Payer: BCBS Trust/PPO |
$21.28
|
| Rate for Payer: BCN Commercial |
$17.85
|
| Rate for Payer: BCN Commercial |
$21.28
|
| Rate for Payer: BCN Commercial |
$14.97
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: BCN Medicare Advantage |
$5.43
|
| Rate for Payer: BCN Medicare Advantage |
$4.55
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$17.37
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| 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 |
$20.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$19.54
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$23.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.28
|
| Rate for Payer: Mclaren Medicaid |
$3.21
|
| Rate for Payer: Mclaren Medicaid |
$4.56
|
| Rate for Payer: Mclaren Medicaid |
$3.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: Meridian Medicaid |
$3.37
|
| Rate for Payer: Meridian Medicaid |
$4.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.01
|
| 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 |
$18.45
|
| Rate for Payer: Nomi Health Commercial |
$21.23
|
| Rate for Payer: Nomi Health Commercial |
$17.80
|
| Rate for Payer: Nomi Health Commercial |
$14.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: PACE Senior Care Partners |
$5.16
|
| Rate for Payer: PACE Senior Care Partners |
$4.32
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PACE SWMI |
$5.43
|
| Rate for Payer: PACE SWMI |
$4.55
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: PHP Commercial |
$22.01
|
| Rate for Payer: PHP Commercial |
$18.45
|
| Rate for Payer: PHP Medicare Advantage |
$5.43
|
| Rate for Payer: PHP Medicare Advantage |
$4.55
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.52
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Medicare |
$5.48
|
| Rate for Payer: Priority Health Medicare |
$4.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: Railroad Medicare Medicare |
$4.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.02
|
| Rate for Payer: UHC Core |
$15.21
|
| Rate for Payer: UHC Core |
$21.62
|
| Rate for Payer: UHC Core |
$18.13
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Exchange |
$5.43
|
| Rate for Payer: UHC Exchange |
$4.55
|
| Rate for Payer: UHC Medicaid |
$3.21
|
| Rate for Payer: UHC Medicaid |
$4.56
|
| Rate for Payer: UHC Medicaid |
$3.83
|
| Rate for Payer: UHC Medicare Advantage |
$5.43
|
| Rate for Payer: UHC Medicare Advantage |
$4.55
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$3.83
|
| Rate for Payer: UHCCP Medicaid |
$3.21
|
| Rate for Payer: UHCCP Medicaid |
$4.56
|
| Rate for Payer: VA VA |
$4.55
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: VA VA |
$5.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
|
|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.21
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
9065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$18.45
|
| Rate for Payer: Aetna Commercial |
$22.01
|
| Rate for Payer: BCBS Trust/PPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$15.04
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Commercial |
$17.93
|
| Rate for Payer: BCN Commercial |
$15.04
|
| Rate for Payer: BCN Commercial |
$21.38
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$17.37
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| 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 |
$20.71
|
| Rate for Payer: Healthscope Commercial |
$19.54
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$23.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.01
|
| Rate for Payer: Nomi Health Commercial |
$14.93
|
| Rate for Payer: Nomi Health Commercial |
$17.80
|
| Rate for Payer: Nomi Health Commercial |
$21.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.42
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: PHP Commercial |
$22.01
|
| Rate for Payer: PHP Commercial |
$18.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.02
|
| Rate for Payer: UHC Core |
$15.21
|
| Rate for Payer: UHC Core |
$21.62
|
| Rate for Payer: UHC Core |
$18.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.28
|
|
