|
AMIODARONE 50 MG/ML IV (CODE)
|
Facility
|
IP
|
$18.21
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
163703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: BCBS Trust/PPO |
$15.04
|
| Rate for Payer: BCN Commercial |
$15.04
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Nomi Health Commercial |
$14.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.02
|
| Rate for Payer: UHC Core |
$15.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
|
|
AMIODARONE 50 MG/ML IV (CODE)
|
Facility
|
OP
|
$18.21
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
163703
|
|
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 Medicare |
$4.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.69
|
| Rate for Payer: BCBS Complete |
$3.37
|
| Rate for Payer: BCBS MAPPO |
$4.55
|
| Rate for Payer: BCBS Trust/PPO |
$14.97
|
| Rate for Payer: BCN Commercial |
$14.97
|
| Rate for Payer: BCN Medicare Advantage |
$4.55
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Mclaren Medicaid |
$3.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.78
|
| Rate for Payer: Meridian Medicaid |
$3.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Nomi Health Commercial |
$14.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: PACE Senior Care Partners |
$4.32
|
| Rate for Payer: PACE SWMI |
$4.55
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: PHP Medicare Advantage |
$4.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.84
|
| Rate for Payer: Priority Health Medicare |
$4.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.67
|
| Rate for Payer: Railroad Medicare Medicare |
$4.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.02
|
| Rate for Payer: UHC Core |
$15.21
|
| Rate for Payer: UHC Exchange |
$4.55
|
| Rate for Payer: UHC Medicaid |
$3.21
|
| Rate for Payer: UHC Medicare Advantage |
$4.55
|
| Rate for Payer: UHCCP Medicaid |
$3.21
|
| Rate for Payer: VA VA |
$4.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$3.50
|
|
|
Service Code
|
NDC 50268003711
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Aetna Commercial |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.89
|
| Rate for Payer: BCN Commercial |
$2.89
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$3.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.80
|
| Rate for Payer: Healthscope Commercial |
$3.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.98
|
| Rate for Payer: Nomi Health Commercial |
$2.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.62
|
| Rate for Payer: PHP Commercial |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.08
|
| Rate for Payer: UHC Core |
$2.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.62
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$174.80
|
|
|
Service Code
|
NDC 50268003715
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.82 |
| Max. Negotiated Rate |
$157.32 |
| Rate for Payer: Aetna Commercial |
$148.58
|
| Rate for Payer: Aetna Medicare |
$45.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.62
|
| Rate for Payer: BCBS Complete |
$32.36
|
| Rate for Payer: BCBS MAPPO |
$43.70
|
| Rate for Payer: BCBS Trust/PPO |
$143.70
|
| Rate for Payer: BCN Commercial |
$143.70
|
| Rate for Payer: BCN Medicare Advantage |
$43.70
|
| Rate for Payer: Cash Price |
$139.84
|
| Rate for Payer: Cofinity Commercial |
$150.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.70
|
| Rate for Payer: Healthscope Commercial |
$157.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.10
|
| Rate for Payer: Mclaren Medicaid |
$30.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.88
|
| Rate for Payer: Meridian Medicaid |
$32.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.58
|
| Rate for Payer: Nomi Health Commercial |
$143.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.10
|
| Rate for Payer: PACE Senior Care Partners |
$41.52
|
| Rate for Payer: PACE SWMI |
$43.70
|
| Rate for Payer: PHP Commercial |
$148.58
|
| Rate for Payer: PHP Medicare Advantage |
$43.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$152.08
|
| Rate for Payer: Priority Health Medicare |
$44.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.66
|
| Rate for Payer: Railroad Medicare Medicare |
$43.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.82
|
| Rate for Payer: UHC Core |
$145.96
|
| Rate for Payer: UHC Exchange |
$43.70
|
| Rate for Payer: UHC Medicaid |
$30.82
|
| Rate for Payer: UHC Medicare Advantage |
$43.70
|
| Rate for Payer: UHCCP Medicaid |
$30.82
|
| Rate for Payer: VA VA |
$43.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.10
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 00781148601
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.37 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: BCBS Trust/PPO |
$227.08
|
| Rate for Payer: BCN Commercial |
$227.08
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.21
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$239.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.96
|
| Rate for Payer: UHC Core |
$229.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$274.95
|
|
|
Service Code
|
NDC 00781148601
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna Medicare |
$71.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.92
|
| Rate for Payer: BCBS Complete |
$50.89
|
| Rate for Payer: BCBS MAPPO |
$68.74
|
| Rate for Payer: BCBS Trust/PPO |
$226.04
|
| Rate for Payer: BCN Commercial |
$226.04
|
| Rate for Payer: BCN Medicare Advantage |
$68.74
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.74
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Mclaren Medicaid |
$48.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.17
|
| Rate for Payer: Meridian Medicaid |
$50.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.21
|
| Rate for Payer: PACE Senior Care Partners |
$65.30
|
| Rate for Payer: PACE SWMI |
$68.74
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: PHP Medicare Advantage |
$68.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$239.21
|
| Rate for Payer: Priority Health Medicare |
$69.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.37
|
| Rate for Payer: Railroad Medicare Medicare |
$68.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.96
|
| Rate for Payer: UHC Core |
$229.58
|
| Rate for Payer: UHC Exchange |
$68.74
|
| Rate for Payer: UHC Medicaid |
$48.47
|
| Rate for Payer: UHC Medicare Advantage |
$68.74
|
| Rate for Payer: UHCCP Medicaid |
$48.47
|
| Rate for Payer: VA VA |
$68.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$174.80
|
|
|
Service Code
|
NDC 50268003715
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.66 |
| Max. Negotiated Rate |
$157.32 |
| Rate for Payer: Aetna Commercial |
$148.58
|
| Rate for Payer: BCBS Trust/PPO |
$144.37
|
| Rate for Payer: BCN Commercial |
$144.37
|
| Rate for Payer: Cash Price |
$139.84
|
| Rate for Payer: Cofinity Commercial |
$150.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.84
|
| Rate for Payer: Healthscope Commercial |
$157.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.58
|
| Rate for Payer: Nomi Health Commercial |
$143.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.10
|
| Rate for Payer: PHP Commercial |
$148.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$152.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.82
|
| Rate for Payer: UHC Core |
$145.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.10
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 16729017101
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.86 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: BCBS Trust/PPO |
$112.57
|
| Rate for Payer: BCN Commercial |
$112.57
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Nomi Health Commercial |
$111.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$118.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.94
|
| Rate for Payer: UHC Core |
$113.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 70756020111
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.14 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: BCBS Trust/PPO |
$116.45
|
| Rate for Payer: BCN Commercial |
$116.45
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.75
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$122.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.08
|
| Rate for Payer: UHC Core |
$117.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$136.30
|
|
|
Service Code
|
NDC 16729017101
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.03 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna Medicare |
$35.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.59
|
| Rate for Payer: BCBS Complete |
$25.23
|
| Rate for Payer: BCBS MAPPO |
$34.08
|
| Rate for Payer: BCBS Trust/PPO |
$112.05
|
| Rate for Payer: BCN Commercial |
$112.05
|
| Rate for Payer: BCN Medicare Advantage |
$34.08
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.08
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Mclaren Medicaid |
$24.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.78
|
| Rate for Payer: Meridian Medicaid |
$25.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Nomi Health Commercial |
$111.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: PACE Senior Care Partners |
$32.37
|
| Rate for Payer: PACE SWMI |
$34.08
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: PHP Medicare Advantage |
$34.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$118.58
|
| Rate for Payer: Priority Health Medicare |
$34.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.86
|
| Rate for Payer: Railroad Medicare Medicare |
$34.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.94
|
| Rate for Payer: UHC Core |
$113.81
|
| Rate for Payer: UHC Exchange |
$34.08
|
| Rate for Payer: UHC Medicaid |
$24.03
|
| Rate for Payer: UHC Medicare Advantage |
$34.08
|
| Rate for Payer: UHCCP Medicaid |
$24.03
|
| Rate for Payer: VA VA |
$34.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 70756020111
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.86 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$36.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.06
|
| Rate for Payer: BCBS Complete |
$26.10
|
| Rate for Payer: BCBS MAPPO |
$35.25
|
| Rate for Payer: BCBS Trust/PPO |
$115.92
|
| Rate for Payer: BCN Commercial |
$115.92
|
| Rate for Payer: BCN Medicare Advantage |
$35.25
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.25
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Mclaren Medicaid |
$24.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.01
|
| Rate for Payer: Meridian Medicaid |
$26.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.75
|
| Rate for Payer: PACE Senior Care Partners |
$33.49
|
| Rate for Payer: PACE SWMI |
$35.25
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: PHP Medicare Advantage |
$35.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$122.67
|
| Rate for Payer: Priority Health Medicare |
$35.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.14
|
| Rate for Payer: Railroad Medicare Medicare |
$35.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.08
|
| Rate for Payer: UHC Core |
$117.73
|
| Rate for Payer: UHC Exchange |
$35.25
|
| Rate for Payer: UHC Medicaid |
$24.86
|
| Rate for Payer: UHC Medicare Advantage |
$35.25
|
| Rate for Payer: UHCCP Medicaid |
$24.86
|
| Rate for Payer: VA VA |
$35.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$3.50
|
|
|
Service Code
|
NDC 50268003711
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Aetna Commercial |
$2.98
|
| Rate for Payer: Aetna Medicare |
$0.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.09
|
| Rate for Payer: BCBS Complete |
$0.65
|
| Rate for Payer: BCBS MAPPO |
$0.88
|
| Rate for Payer: BCBS Trust/PPO |
$2.88
|
| Rate for Payer: BCN Commercial |
$2.88
|
| Rate for Payer: BCN Medicare Advantage |
$0.88
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$3.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.88
|
| Rate for Payer: Healthscope Commercial |
$3.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.62
|
| Rate for Payer: Mclaren Medicaid |
$0.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.92
|
| Rate for Payer: Meridian Medicaid |
$0.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.98
|
| Rate for Payer: Nomi Health Commercial |
$2.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.62
|
| Rate for Payer: PACE Senior Care Partners |
$0.83
|
| Rate for Payer: PACE SWMI |
$0.88
|
| Rate for Payer: PHP Commercial |
$2.98
|
| Rate for Payer: PHP Medicare Advantage |
$0.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.04
|
| Rate for Payer: Priority Health Medicare |
$0.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.44
|
| Rate for Payer: Railroad Medicare Medicare |
$0.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.08
|
| Rate for Payer: UHC Core |
$2.92
|
| Rate for Payer: UHC Exchange |
$0.88
|
| Rate for Payer: UHC Medicaid |
$0.62
|
| Rate for Payer: UHC Medicare Advantage |
$0.88
|
| Rate for Payer: UHCCP Medicaid |
$0.62
|
| Rate for Payer: VA VA |
$0.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.62
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 00904718461
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.70 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: BCBS Trust/PPO |
$185.95
|
| Rate for Payer: BCN Commercial |
$185.95
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Nomi Health Commercial |
$184.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.86
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$195.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.13
|
| Rate for Payer: UHC Core |
$188.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
OP
|
$225.15
|
|
|
Service Code
|
NDC 00904718461
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna Medicare |
$58.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.36
|
| Rate for Payer: BCBS Complete |
$41.68
|
| Rate for Payer: BCBS MAPPO |
$56.29
|
| Rate for Payer: BCBS Trust/PPO |
$185.10
|
| Rate for Payer: BCN Commercial |
$185.10
|
| Rate for Payer: BCN Medicare Advantage |
$56.29
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.29
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Mclaren Medicaid |
$39.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.10
|
| Rate for Payer: Meridian Medicaid |
$41.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Nomi Health Commercial |
$184.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.86
|
| Rate for Payer: PACE Senior Care Partners |
$53.47
|
| Rate for Payer: PACE SWMI |
$56.29
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: PHP Medicare Advantage |
$56.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$195.88
|
| Rate for Payer: Priority Health Medicare |
$56.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.70
|
| Rate for Payer: Railroad Medicare Medicare |
$56.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.13
|
| Rate for Payer: UHC Core |
$188.00
|
| Rate for Payer: UHC Exchange |
$56.29
|
| Rate for Payer: UHC Medicaid |
$39.69
|
| Rate for Payer: UHC Medicare Advantage |
$56.29
|
| Rate for Payer: UHCCP Medicaid |
$39.69
|
| Rate for Payer: VA VA |
$56.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
IP
|
$2.83
|
|
|
Service Code
|
NDC 50268003911
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: BCBS Trust/PPO |
$2.34
|
| Rate for Payer: BCN Commercial |
$2.34
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Healthscope Commercial |
$2.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: Nomi Health Commercial |
$2.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.49
|
| Rate for Payer: UHC Core |
$2.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.12
|
|
|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
OP
|
$336.30
|
|
|
Service Code
|
NDC 00904718561
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$302.67 |
| Rate for Payer: Aetna Commercial |
$285.86
|
| Rate for Payer: Aetna Medicare |
$87.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.09
|
| Rate for Payer: BCBS Complete |
$62.25
|
| Rate for Payer: BCBS MAPPO |
$84.08
|
| Rate for Payer: BCBS Trust/PPO |
$276.47
|
| Rate for Payer: BCN Commercial |
$276.47
|
| Rate for Payer: BCN Medicare Advantage |
$84.08
|
| Rate for Payer: Cash Price |
$269.04
|
| Rate for Payer: Cofinity Commercial |
$289.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.08
|
| Rate for Payer: Healthscope Commercial |
$302.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.22
|
| Rate for Payer: Mclaren Medicaid |
$59.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.28
|
| Rate for Payer: Meridian Medicaid |
$62.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.86
|
| Rate for Payer: Nomi Health Commercial |
$275.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.22
|
| Rate for Payer: PACE Senior Care Partners |
$79.87
|
| Rate for Payer: PACE SWMI |
$84.08
|
| Rate for Payer: PHP Commercial |
$285.86
|
| Rate for Payer: PHP Medicare Advantage |
$84.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$292.58
|
| Rate for Payer: Priority Health Medicare |
$84.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$234.06
|
| Rate for Payer: Railroad Medicare Medicare |
$84.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.94
|
| Rate for Payer: UHC Core |
$280.81
|
| Rate for Payer: UHC Exchange |
$84.08
|
| Rate for Payer: UHC Medicaid |
$59.29
|
| Rate for Payer: UHC Medicare Advantage |
$84.08
|
| Rate for Payer: UHCCP Medicaid |
$59.29
|
| Rate for Payer: VA VA |
$84.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.22
|
|
|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
IP
|
$254.88
|
|
|
Service Code
|
NDC 00603221421
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.40 |
| Max. Negotiated Rate |
$229.39 |
| Rate for Payer: Aetna Commercial |
$216.65
|
| Rate for Payer: BCBS Trust/PPO |
$210.51
|
| Rate for Payer: BCN Commercial |
$210.51
|
| Rate for Payer: Cash Price |
$203.90
|
| Rate for Payer: Cofinity Commercial |
$219.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.90
|
| Rate for Payer: Healthscope Commercial |
$229.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.65
|
| Rate for Payer: Nomi Health Commercial |
$209.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.16
|
| Rate for Payer: PHP Commercial |
$216.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$221.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.29
|
| Rate for Payer: UHC Core |
$212.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.16
|
|
|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
OP
|
$141.12
|
|
|
Service Code
|
NDC 50268003915
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$127.01 |
| Rate for Payer: Aetna Commercial |
$119.95
|
| Rate for Payer: Aetna Medicare |
$36.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.10
|
| Rate for Payer: BCBS Complete |
$26.12
|
| Rate for Payer: BCBS MAPPO |
$35.28
|
| Rate for Payer: BCBS Trust/PPO |
$116.01
|
| Rate for Payer: BCN Commercial |
$116.01
|
| Rate for Payer: BCN Medicare Advantage |
$35.28
|
| Rate for Payer: Cash Price |
$112.90
|
| Rate for Payer: Cofinity Commercial |
$121.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.28
|
| Rate for Payer: Healthscope Commercial |
$127.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.84
|
| Rate for Payer: Mclaren Medicaid |
$24.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.04
|
| Rate for Payer: Meridian Medicaid |
$26.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.95
|
| Rate for Payer: Nomi Health Commercial |
$115.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.84
|
| Rate for Payer: PACE Senior Care Partners |
$33.52
|
| Rate for Payer: PACE SWMI |
$35.28
|
| Rate for Payer: PHP Commercial |
$119.95
|
| Rate for Payer: PHP Medicare Advantage |
$35.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$122.77
|
| Rate for Payer: Priority Health Medicare |
$35.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.22
|
| Rate for Payer: Railroad Medicare Medicare |
$35.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.19
|
| Rate for Payer: UHC Core |
$117.84
|
| Rate for Payer: UHC Exchange |
$35.28
|
| Rate for Payer: UHC Medicaid |
$24.88
|
| Rate for Payer: UHC Medicare Advantage |
$35.28
|
| Rate for Payer: UHCCP Medicaid |
$24.88
|
| Rate for Payer: VA VA |
$35.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.84
|
|
|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
OP
|
$2.83
|
|
|
Service Code
|
NDC 50268003911
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: Aetna Medicare |
$0.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.88
|
| Rate for Payer: BCBS Complete |
$0.52
|
| Rate for Payer: BCBS MAPPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.33
|
| Rate for Payer: BCN Medicare Advantage |
$0.71
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.71
|
| Rate for Payer: Healthscope Commercial |
$2.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.12
|
| Rate for Payer: Mclaren Medicaid |
$0.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.74
|
| Rate for Payer: Meridian Medicaid |
$0.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: Nomi Health Commercial |
$2.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.12
|
| Rate for Payer: PACE Senior Care Partners |
$0.67
|
| Rate for Payer: PACE SWMI |
$0.71
|
| Rate for Payer: PHP Commercial |
$2.41
|
| Rate for Payer: PHP Medicare Advantage |
$0.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.46
|
| Rate for Payer: Priority Health Medicare |
$0.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.97
|
| Rate for Payer: Railroad Medicare Medicare |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.49
|
| Rate for Payer: UHC Core |
$2.36
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Medicaid |
$0.50
|
| Rate for Payer: UHC Medicare Advantage |
$0.71
|
| Rate for Payer: UHCCP Medicaid |
$0.50
|
| Rate for Payer: VA VA |
$0.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.12
|
|
|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
IP
|
$141.12
|
|
|
Service Code
|
NDC 50268003915
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.22 |
| Max. Negotiated Rate |
$127.01 |
| Rate for Payer: Aetna Commercial |
$119.95
|
| Rate for Payer: BCBS Trust/PPO |
$116.55
|
| Rate for Payer: BCN Commercial |
$116.55
|
| Rate for Payer: Cash Price |
$112.90
|
| Rate for Payer: Cofinity Commercial |
$121.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.90
|
| Rate for Payer: Healthscope Commercial |
$127.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.95
|
| Rate for Payer: Nomi Health Commercial |
$115.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.84
|
| Rate for Payer: PHP Commercial |
$119.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$122.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.19
|
| Rate for Payer: UHC Core |
$117.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.84
|
|
|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
IP
|
$336.30
|
|
|
Service Code
|
NDC 00904718561
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.06 |
| Max. Negotiated Rate |
$302.67 |
| Rate for Payer: Aetna Commercial |
$285.86
|
| Rate for Payer: BCBS Trust/PPO |
$277.75
|
| Rate for Payer: BCN Commercial |
$277.75
|
| Rate for Payer: Cash Price |
$269.04
|
| Rate for Payer: Cofinity Commercial |
$289.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.04
|
| Rate for Payer: Healthscope Commercial |
$302.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.86
|
| Rate for Payer: Nomi Health Commercial |
$275.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.22
|
| Rate for Payer: PHP Commercial |
$285.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$292.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$234.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.94
|
| Rate for Payer: UHC Core |
$280.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.22
|
|
|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
OP
|
$254.88
|
|
|
Service Code
|
NDC 00603221421
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$229.39 |
| Rate for Payer: Aetna Commercial |
$216.65
|
| Rate for Payer: Aetna Medicare |
$66.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.65
|
| Rate for Payer: BCBS Complete |
$47.18
|
| Rate for Payer: BCBS MAPPO |
$63.72
|
| Rate for Payer: BCBS Trust/PPO |
$209.54
|
| Rate for Payer: BCN Commercial |
$209.54
|
| Rate for Payer: BCN Medicare Advantage |
$63.72
|
| Rate for Payer: Cash Price |
$203.90
|
| Rate for Payer: Cofinity Commercial |
$219.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.72
|
| Rate for Payer: Healthscope Commercial |
$229.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.16
|
| Rate for Payer: Mclaren Medicaid |
$44.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.91
|
| Rate for Payer: Meridian Medicaid |
$47.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.65
|
| Rate for Payer: Nomi Health Commercial |
$209.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.16
|
| Rate for Payer: PACE Senior Care Partners |
$60.53
|
| Rate for Payer: PACE SWMI |
$63.72
|
| Rate for Payer: PHP Commercial |
$216.65
|
| Rate for Payer: PHP Medicare Advantage |
$63.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$221.75
|
| Rate for Payer: Priority Health Medicare |
$64.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.40
|
| Rate for Payer: Railroad Medicare Medicare |
$63.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.29
|
| Rate for Payer: UHC Core |
$212.82
|
| Rate for Payer: UHC Exchange |
$63.72
|
| Rate for Payer: UHC Medicaid |
$44.94
|
| Rate for Payer: UHC Medicare Advantage |
$63.72
|
| Rate for Payer: UHCCP Medicaid |
$44.94
|
| Rate for Payer: VA VA |
$63.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.16
|
|
|
AMLODIPINE 10 MG TABLET
|
Facility
|
OP
|
$40.19
|
|
|
Service Code
|
NDC 69097012805
|
| Hospital Charge Code |
9069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$36.17 |
| Rate for Payer: Aetna Commercial |
$34.16
|
| Rate for Payer: Aetna Medicare |
$10.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.56
|
| Rate for Payer: BCBS Complete |
$7.44
|
| Rate for Payer: BCBS MAPPO |
$10.05
|
| Rate for Payer: BCBS Trust/PPO |
$33.04
|
| Rate for Payer: BCN Commercial |
$33.04
|
| Rate for Payer: BCN Medicare Advantage |
$10.05
|
| Rate for Payer: Cash Price |
$32.15
|
| Rate for Payer: Cofinity Commercial |
$34.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.05
|
| Rate for Payer: Healthscope Commercial |
$36.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.14
|
| Rate for Payer: Mclaren Medicaid |
$7.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.55
|
| Rate for Payer: Meridian Medicaid |
$7.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.16
|
| Rate for Payer: Nomi Health Commercial |
$32.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.14
|
| Rate for Payer: PACE Senior Care Partners |
$9.55
|
| Rate for Payer: PACE SWMI |
$10.05
|
| Rate for Payer: PHP Commercial |
$34.16
|
| Rate for Payer: PHP Medicare Advantage |
$10.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.97
|
| Rate for Payer: Priority Health Medicare |
$10.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.97
|
| Rate for Payer: Railroad Medicare Medicare |
$10.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.37
|
| Rate for Payer: UHC Core |
$33.56
|
| Rate for Payer: UHC Exchange |
$10.05
|
| Rate for Payer: UHC Medicaid |
$7.09
|
| Rate for Payer: UHC Medicare Advantage |
$10.05
|
| Rate for Payer: UHCCP Medicaid |
$7.09
|
| Rate for Payer: VA VA |
$10.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.14
|
|
|
AMLODIPINE 10 MG TABLET
|
Facility
|
IP
|
$157.45
|
|
|
Service Code
|
NDC 00904637161
|
| Hospital Charge Code |
9069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.59 |
| Max. Negotiated Rate |
$141.71 |
| Rate for Payer: Aetna Commercial |
$133.83
|
| Rate for Payer: BCBS Trust/PPO |
$130.04
|
| Rate for Payer: BCN Commercial |
$130.04
|
| Rate for Payer: Cash Price |
$125.96
|
| Rate for Payer: Cofinity Commercial |
$135.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.96
|
| Rate for Payer: Healthscope Commercial |
$141.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.83
|
| Rate for Payer: Nomi Health Commercial |
$129.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.09
|
| Rate for Payer: PHP Commercial |
$133.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$136.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.56
|
| Rate for Payer: UHC Core |
$131.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.09
|
|
|
AMLODIPINE 10 MG TABLET
|
Facility
|
IP
|
$40.19
|
|
|
Service Code
|
NDC 69097012805
|
| Hospital Charge Code |
9069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$36.17 |
| Rate for Payer: Aetna Commercial |
$34.16
|
| Rate for Payer: BCBS Trust/PPO |
$33.19
|
| Rate for Payer: BCN Commercial |
$33.19
|
| Rate for Payer: Cash Price |
$32.15
|
| Rate for Payer: Cofinity Commercial |
$34.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.15
|
| Rate for Payer: Healthscope Commercial |
$36.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.16
|
| Rate for Payer: Nomi Health Commercial |
$32.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.14
|
| Rate for Payer: PHP Commercial |
$34.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.37
|
| Rate for Payer: UHC Core |
$33.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.14
|
|
