|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 51079011801
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Aetna Medicare |
$0.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.19
|
| Rate for Payer: BCBS Complete |
$1.53
|
| Rate for Payer: BCBS MAPPO |
$0.96
|
| Rate for Payer: BCBS Trust/PPO |
$3.14
|
| Rate for Payer: BCN Commercial |
$2.97
|
| Rate for Payer: BCN Medicare Advantage |
$0.96
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.96
|
| Rate for Payer: Healthscope Commercial |
$3.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Nomi Health Commercial |
$3.13
|
| Rate for Payer: PACE Senior Care Partners |
$0.91
|
| Rate for Payer: PACE SWMI |
$0.96
|
| Rate for Payer: PHP Commercial |
$3.25
|
| Rate for Payer: PHP Medicare Advantage |
$0.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.48
|
| Rate for Payer: Priority Health HMO/PPO |
$3.32
|
| Rate for Payer: Priority Health Medicare |
$0.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.56
|
| Rate for Payer: Railroad Medicare Medicare |
$0.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.36
|
| Rate for Payer: UHC Core |
$3.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.96
|
| Rate for Payer: UHC Exchange |
$0.96
|
| Rate for Payer: UHC Medicare Advantage |
$0.96
|
| Rate for Payer: VA VA |
$0.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.86
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$381.90
|
|
|
Service Code
|
NDC 51079011820
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.24 |
| Max. Negotiated Rate |
$343.71 |
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: BCBS Trust/PPO |
$311.74
|
| Rate for Payer: BCN Commercial |
$295.13
|
| Rate for Payer: Cash Price |
$305.52
|
| Rate for Payer: Cofinity Commercial |
$328.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.52
|
| Rate for Payer: Healthscope Commercial |
$343.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.62
|
| Rate for Payer: Nomi Health Commercial |
$313.16
|
| Rate for Payer: PHP Commercial |
$324.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.24
|
| Rate for Payer: Priority Health HMO/PPO |
$332.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$255.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.07
|
| Rate for Payer: UHC Core |
$318.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.42
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$437.95
|
|
|
Service Code
|
NDC 60687036901
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$394.16 |
| Rate for Payer: Aetna Commercial |
$372.26
|
| Rate for Payer: Aetna Medicare |
$113.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136.86
|
| Rate for Payer: BCBS Complete |
$175.18
|
| Rate for Payer: BCBS MAPPO |
$109.49
|
| Rate for Payer: BCBS Trust/PPO |
$360.04
|
| Rate for Payer: BCN Commercial |
$340.51
|
| Rate for Payer: BCN Medicare Advantage |
$109.49
|
| Rate for Payer: Cash Price |
$350.36
|
| Rate for Payer: Cofinity Commercial |
$376.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.49
|
| Rate for Payer: Healthscope Commercial |
$394.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.26
|
| Rate for Payer: Nomi Health Commercial |
$359.12
|
| Rate for Payer: PACE Senior Care Partners |
$104.01
|
| Rate for Payer: PACE SWMI |
$109.49
|
| Rate for Payer: PHP Commercial |
$372.26
|
| Rate for Payer: PHP Medicare Advantage |
$109.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.67
|
| Rate for Payer: Priority Health HMO/PPO |
$381.02
|
| Rate for Payer: Priority Health Medicare |
$110.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.43
|
| Rate for Payer: Railroad Medicare Medicare |
$109.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.40
|
| Rate for Payer: UHC Core |
$365.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.49
|
| Rate for Payer: UHC Exchange |
$109.49
|
| Rate for Payer: UHC Medicare Advantage |
$109.49
|
| Rate for Payer: VA VA |
$109.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.46
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$398.05
|
|
|
Service Code
|
NDC 00904698761
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.73 |
| Max. Negotiated Rate |
$358.24 |
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: BCBS Trust/PPO |
$324.93
|
| Rate for Payer: BCN Commercial |
$307.61
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Nomi Health Commercial |
$326.40
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health HMO/PPO |
$346.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$266.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.28
|
| Rate for Payer: UHC Core |
$332.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$381.90
|
|
|
Service Code
|
NDC 51079011820
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.70 |
| Max. Negotiated Rate |
$343.71 |
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: Aetna Medicare |
$99.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.34
|
| Rate for Payer: BCBS Complete |
$152.76
|
| Rate for Payer: BCBS MAPPO |
$95.48
|
| Rate for Payer: BCBS Trust/PPO |
$313.96
|
| Rate for Payer: BCN Commercial |
$296.93
|
| Rate for Payer: BCN Medicare Advantage |
$95.48
|
| Rate for Payer: Cash Price |
$305.52
|
| Rate for Payer: Cofinity Commercial |
$328.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.48
|
| Rate for Payer: Healthscope Commercial |
$343.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.62
|
| Rate for Payer: Nomi Health Commercial |
$313.16
|
| Rate for Payer: PACE Senior Care Partners |
$90.70
|
| Rate for Payer: PACE SWMI |
$95.48
|
| Rate for Payer: PHP Commercial |
$324.62
|
| Rate for Payer: PHP Medicare Advantage |
$95.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.24
|
| Rate for Payer: Priority Health HMO/PPO |
$332.25
|
| Rate for Payer: Priority Health Medicare |
$96.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$255.87
|
| Rate for Payer: Railroad Medicare Medicare |
$95.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.07
|
| Rate for Payer: UHC Core |
$318.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.48
|
| Rate for Payer: UHC Exchange |
$95.48
|
| Rate for Payer: UHC Medicare Advantage |
$95.48
|
| Rate for Payer: VA VA |
$95.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.42
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$437.95
|
|
|
Service Code
|
NDC 60687036901
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.67 |
| Max. Negotiated Rate |
$394.16 |
| Rate for Payer: Aetna Commercial |
$372.26
|
| Rate for Payer: BCBS Trust/PPO |
$357.50
|
| Rate for Payer: BCN Commercial |
$338.45
|
| Rate for Payer: Cash Price |
$350.36
|
| Rate for Payer: Cofinity Commercial |
$376.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.36
|
| Rate for Payer: Healthscope Commercial |
$394.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.26
|
| Rate for Payer: Nomi Health Commercial |
$359.12
|
| Rate for Payer: PHP Commercial |
$372.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.67
|
| Rate for Payer: Priority Health HMO/PPO |
$381.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.40
|
| Rate for Payer: UHC Core |
$365.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.46
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$4.38
|
|
|
Service Code
|
NDC 60687036911
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.37
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS MAPPO |
$1.10
|
| Rate for Payer: BCBS Trust/PPO |
$3.60
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: BCN Medicare Advantage |
$1.10
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.10
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: Nomi Health Commercial |
$3.59
|
| Rate for Payer: PACE Senior Care Partners |
$1.04
|
| Rate for Payer: PACE SWMI |
$1.10
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: PHP Medicare Advantage |
$1.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.85
|
| Rate for Payer: Priority Health HMO/PPO |
$3.81
|
| Rate for Payer: Priority Health Medicare |
$1.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.85
|
| Rate for Payer: UHC Core |
$3.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.10
|
| Rate for Payer: UHC Exchange |
$1.10
|
| Rate for Payer: UHC Medicare Advantage |
$1.10
|
| Rate for Payer: VA VA |
$1.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$398.05
|
|
|
Service Code
|
NDC 00904698761
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.54 |
| Max. Negotiated Rate |
$358.24 |
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna Medicare |
$103.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.39
|
| Rate for Payer: BCBS Complete |
$159.22
|
| Rate for Payer: BCBS MAPPO |
$99.51
|
| Rate for Payer: BCBS Trust/PPO |
$327.24
|
| Rate for Payer: BCN Commercial |
$309.48
|
| Rate for Payer: BCN Medicare Advantage |
$99.51
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.51
|
| Rate for Payer: Healthscope Commercial |
$358.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Nomi Health Commercial |
$326.40
|
| Rate for Payer: PACE Senior Care Partners |
$94.54
|
| Rate for Payer: PACE SWMI |
$99.51
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: PHP Medicare Advantage |
$99.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health HMO/PPO |
$346.30
|
| Rate for Payer: Priority Health Medicare |
$100.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$266.69
|
| Rate for Payer: Railroad Medicare Medicare |
$99.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.28
|
| Rate for Payer: UHC Core |
$332.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.51
|
| Rate for Payer: UHC Exchange |
$99.51
|
| Rate for Payer: UHC Medicare Advantage |
$99.51
|
| Rate for Payer: VA VA |
$99.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$154.86
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.78 |
| Max. Negotiated Rate |
$139.37 |
| Rate for Payer: Aetna Commercial |
$131.63
|
| Rate for Payer: Aetna Commercial |
$235.89
|
| Rate for Payer: Aetna Commercial |
$23.39
|
| Rate for Payer: Aetna Medicare |
$72.16
|
| Rate for Payer: Aetna Medicare |
$40.26
|
| Rate for Payer: Aetna Medicare |
$7.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.72
|
| Rate for Payer: BCBS Complete |
$11.01
|
| Rate for Payer: BCBS Complete |
$61.94
|
| Rate for Payer: BCBS Complete |
$111.01
|
| Rate for Payer: BCBS MAPPO |
$69.38
|
| Rate for Payer: BCBS MAPPO |
$38.72
|
| Rate for Payer: BCBS MAPPO |
$6.88
|
| Rate for Payer: BCBS Trust/PPO |
$22.62
|
| Rate for Payer: BCBS Trust/PPO |
$127.31
|
| Rate for Payer: BCBS Trust/PPO |
$228.15
|
| Rate for Payer: BCN Commercial |
$21.40
|
| Rate for Payer: BCN Commercial |
$215.77
|
| Rate for Payer: BCN Commercial |
$120.40
|
| Rate for Payer: BCN Medicare Advantage |
$38.72
|
| Rate for Payer: BCN Medicare Advantage |
$6.88
|
| Rate for Payer: BCN Medicare Advantage |
$69.38
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$222.02
|
| Rate for Payer: Cash Price |
$123.89
|
| Rate for Payer: Cofinity Commercial |
$238.67
|
| Rate for Payer: Cofinity Commercial |
$133.18
|
| Rate for Payer: Cofinity Commercial |
$23.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.72
|
| Rate for Payer: Healthscope Commercial |
$24.77
|
| Rate for Payer: Healthscope Commercial |
$139.37
|
| Rate for Payer: Healthscope Commercial |
$249.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.63
|
| Rate for Payer: Nomi Health Commercial |
$227.57
|
| Rate for Payer: Nomi Health Commercial |
$126.99
|
| Rate for Payer: Nomi Health Commercial |
$22.57
|
| Rate for Payer: PACE Senior Care Partners |
$65.91
|
| Rate for Payer: PACE Senior Care Partners |
$36.78
|
| Rate for Payer: PACE Senior Care Partners |
$6.54
|
| Rate for Payer: PACE SWMI |
$6.88
|
| Rate for Payer: PACE SWMI |
$38.72
|
| Rate for Payer: PACE SWMI |
$69.38
|
| Rate for Payer: PHP Commercial |
$235.89
|
| Rate for Payer: PHP Commercial |
$23.39
|
| Rate for Payer: PHP Commercial |
$131.63
|
| Rate for Payer: PHP Medicare Advantage |
$6.88
|
| Rate for Payer: PHP Medicare Advantage |
$69.38
|
| Rate for Payer: PHP Medicare Advantage |
$38.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.89
|
| Rate for Payer: Priority Health HMO/PPO |
$241.44
|
| Rate for Payer: Priority Health HMO/PPO |
$134.73
|
| Rate for Payer: Priority Health HMO/PPO |
$23.94
|
| Rate for Payer: Priority Health Medicare |
$39.10
|
| Rate for Payer: Priority Health Medicare |
$70.07
|
| Rate for Payer: Priority Health Medicare |
$6.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.76
|
| Rate for Payer: Railroad Medicare Medicare |
$6.88
|
| Rate for Payer: Railroad Medicare Medicare |
$69.38
|
| Rate for Payer: Railroad Medicare Medicare |
$38.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.28
|
| Rate for Payer: UHC Core |
$231.73
|
| Rate for Payer: UHC Core |
$22.98
|
| Rate for Payer: UHC Core |
$129.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.88
|
| Rate for Payer: UHC Exchange |
$6.88
|
| Rate for Payer: UHC Exchange |
$38.72
|
| Rate for Payer: UHC Exchange |
$69.38
|
| Rate for Payer: UHC Medicare Advantage |
$38.72
|
| Rate for Payer: UHC Medicare Advantage |
$6.88
|
| Rate for Payer: UHC Medicare Advantage |
$69.38
|
| Rate for Payer: VA VA |
$6.88
|
| Rate for Payer: VA VA |
$69.38
|
| Rate for Payer: VA VA |
$38.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.64
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$154.86
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.66 |
| Max. Negotiated Rate |
$139.37 |
| Rate for Payer: Aetna Commercial |
$131.63
|
| Rate for Payer: Aetna Commercial |
$235.89
|
| Rate for Payer: Aetna Commercial |
$23.39
|
| Rate for Payer: BCBS Trust/PPO |
$22.46
|
| Rate for Payer: BCBS Trust/PPO |
$126.41
|
| Rate for Payer: BCBS Trust/PPO |
$226.54
|
| Rate for Payer: BCN Commercial |
$214.47
|
| Rate for Payer: BCN Commercial |
$119.68
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$123.89
|
| Rate for Payer: Cash Price |
$222.02
|
| Rate for Payer: Cofinity Commercial |
$133.18
|
| Rate for Payer: Cofinity Commercial |
$238.67
|
| Rate for Payer: Cofinity Commercial |
$23.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.02
|
| Rate for Payer: Healthscope Commercial |
$249.77
|
| Rate for Payer: Healthscope Commercial |
$139.37
|
| Rate for Payer: Healthscope Commercial |
$24.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.63
|
| Rate for Payer: Nomi Health Commercial |
$126.99
|
| Rate for Payer: Nomi Health Commercial |
$227.57
|
| Rate for Payer: Nomi Health Commercial |
$22.57
|
| Rate for Payer: PHP Commercial |
$235.89
|
| Rate for Payer: PHP Commercial |
$131.63
|
| Rate for Payer: PHP Commercial |
$23.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.66
|
| Rate for Payer: Priority Health HMO/PPO |
$241.44
|
| Rate for Payer: Priority Health HMO/PPO |
$23.94
|
| Rate for Payer: Priority Health HMO/PPO |
$134.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.22
|
| Rate for Payer: UHC Core |
$129.31
|
| Rate for Payer: UHC Core |
$22.98
|
| Rate for Payer: UHC Core |
$231.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.14
|
|
|
DICYCLOMINE 20 MG TABLET
|
Facility
|
OP
|
$387.60
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.06 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: Aetna Medicare |
$100.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.12
|
| Rate for Payer: BCBS Complete |
$155.04
|
| Rate for Payer: BCBS MAPPO |
$96.90
|
| Rate for Payer: BCBS Trust/PPO |
$318.65
|
| Rate for Payer: BCN Commercial |
$301.36
|
| Rate for Payer: BCN Medicare Advantage |
$96.90
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.90
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.46
|
| Rate for Payer: Nomi Health Commercial |
$317.83
|
| Rate for Payer: PACE Senior Care Partners |
$92.06
|
| Rate for Payer: PACE SWMI |
$96.90
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: PHP Medicare Advantage |
$96.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.94
|
| Rate for Payer: Priority Health HMO/PPO |
$337.21
|
| Rate for Payer: Priority Health Medicare |
$97.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.69
|
| Rate for Payer: Railroad Medicare Medicare |
$96.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.09
|
| Rate for Payer: UHC Core |
$323.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.90
|
| Rate for Payer: UHC Exchange |
$96.90
|
| Rate for Payer: UHC Medicare Advantage |
$96.90
|
| Rate for Payer: VA VA |
$96.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.70
|
|
|
DICYCLOMINE 20 MG TABLET
|
Facility
|
IP
|
$387.60
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$251.94 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: BCBS Trust/PPO |
$316.40
|
| Rate for Payer: BCN Commercial |
$299.54
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.46
|
| Rate for Payer: Nomi Health Commercial |
$317.83
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.94
|
| Rate for Payer: Priority Health HMO/PPO |
$337.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.09
|
| Rate for Payer: UHC Core |
$323.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.70
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$426.72
|
|
|
Service Code
|
NDC 00904592161
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$384.05 |
| Rate for Payer: Aetna Commercial |
$362.71
|
| Rate for Payer: BCBS Trust/PPO |
$348.33
|
| Rate for Payer: BCN Commercial |
$329.77
|
| Rate for Payer: Cash Price |
$341.38
|
| Rate for Payer: Cofinity Commercial |
$366.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.38
|
| Rate for Payer: Healthscope Commercial |
$384.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.71
|
| Rate for Payer: Nomi Health Commercial |
$349.91
|
| Rate for Payer: PHP Commercial |
$362.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.37
|
| Rate for Payer: Priority Health HMO/PPO |
$371.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.51
|
| Rate for Payer: UHC Core |
$356.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.04
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
OP
|
$3.91
|
|
|
Service Code
|
NDC 68084036611
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.22
|
| Rate for Payer: BCBS Complete |
$1.56
|
| Rate for Payer: BCBS MAPPO |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$3.21
|
| Rate for Payer: BCN Commercial |
$3.04
|
| Rate for Payer: BCN Medicare Advantage |
$0.98
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cofinity Commercial |
$3.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.98
|
| Rate for Payer: Healthscope Commercial |
$3.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.32
|
| Rate for Payer: Nomi Health Commercial |
$3.21
|
| Rate for Payer: PACE Senior Care Partners |
$0.93
|
| Rate for Payer: PACE SWMI |
$0.98
|
| Rate for Payer: PHP Commercial |
$3.32
|
| Rate for Payer: PHP Medicare Advantage |
$0.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.54
|
| Rate for Payer: Priority Health HMO/PPO |
$3.40
|
| Rate for Payer: Priority Health Medicare |
$0.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.62
|
| Rate for Payer: Railroad Medicare Medicare |
$0.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.44
|
| Rate for Payer: UHC Core |
$3.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.98
|
| Rate for Payer: UHC Exchange |
$0.98
|
| Rate for Payer: UHC Medicare Advantage |
$0.98
|
| Rate for Payer: VA VA |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.93
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$390.72
|
|
|
Service Code
|
NDC 68084036601
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.97 |
| Max. Negotiated Rate |
$351.65 |
| Rate for Payer: Aetna Commercial |
$332.11
|
| Rate for Payer: BCBS Trust/PPO |
$318.94
|
| Rate for Payer: BCN Commercial |
$301.95
|
| Rate for Payer: Cash Price |
$312.58
|
| Rate for Payer: Cofinity Commercial |
$336.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.58
|
| Rate for Payer: Healthscope Commercial |
$351.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$293.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.11
|
| Rate for Payer: Nomi Health Commercial |
$320.39
|
| Rate for Payer: PHP Commercial |
$332.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.97
|
| Rate for Payer: Priority Health HMO/PPO |
$339.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.83
|
| Rate for Payer: UHC Core |
$326.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$293.04
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
OP
|
$390.72
|
|
|
Service Code
|
NDC 68084036601
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$351.65 |
| Rate for Payer: Aetna Commercial |
$332.11
|
| Rate for Payer: Aetna Medicare |
$101.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.10
|
| Rate for Payer: BCBS Complete |
$156.29
|
| Rate for Payer: BCBS MAPPO |
$97.68
|
| Rate for Payer: BCBS Trust/PPO |
$321.21
|
| Rate for Payer: BCN Commercial |
$303.78
|
| Rate for Payer: BCN Medicare Advantage |
$97.68
|
| Rate for Payer: Cash Price |
$312.58
|
| Rate for Payer: Cofinity Commercial |
$336.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.68
|
| Rate for Payer: Healthscope Commercial |
$351.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$293.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.11
|
| Rate for Payer: Nomi Health Commercial |
$320.39
|
| Rate for Payer: PACE Senior Care Partners |
$92.80
|
| Rate for Payer: PACE SWMI |
$97.68
|
| Rate for Payer: PHP Commercial |
$332.11
|
| Rate for Payer: PHP Medicare Advantage |
$97.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.97
|
| Rate for Payer: Priority Health HMO/PPO |
$339.93
|
| Rate for Payer: Priority Health Medicare |
$98.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.78
|
| Rate for Payer: Railroad Medicare Medicare |
$97.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.83
|
| Rate for Payer: UHC Core |
$326.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.68
|
| Rate for Payer: UHC Exchange |
$97.68
|
| Rate for Payer: UHC Medicare Advantage |
$97.68
|
| Rate for Payer: VA VA |
$97.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$293.04
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$3.91
|
|
|
Service Code
|
NDC 68084036611
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$3.19
|
| Rate for Payer: BCN Commercial |
$3.02
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cofinity Commercial |
$3.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.13
|
| Rate for Payer: Healthscope Commercial |
$3.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.32
|
| Rate for Payer: Nomi Health Commercial |
$3.21
|
| Rate for Payer: PHP Commercial |
$3.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.54
|
| Rate for Payer: Priority Health HMO/PPO |
$3.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.44
|
| Rate for Payer: UHC Core |
$3.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.93
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
OP
|
$426.72
|
|
|
Service Code
|
NDC 00904592161
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.35 |
| Max. Negotiated Rate |
$384.05 |
| Rate for Payer: Aetna Commercial |
$362.71
|
| Rate for Payer: Aetna Medicare |
$110.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.35
|
| Rate for Payer: BCBS Complete |
$170.69
|
| Rate for Payer: BCBS MAPPO |
$106.68
|
| Rate for Payer: BCBS Trust/PPO |
$350.81
|
| Rate for Payer: BCN Commercial |
$331.77
|
| Rate for Payer: BCN Medicare Advantage |
$106.68
|
| Rate for Payer: Cash Price |
$341.38
|
| Rate for Payer: Cofinity Commercial |
$366.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.68
|
| Rate for Payer: Healthscope Commercial |
$384.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.71
|
| Rate for Payer: Nomi Health Commercial |
$349.91
|
| Rate for Payer: PACE Senior Care Partners |
$101.35
|
| Rate for Payer: PACE SWMI |
$106.68
|
| Rate for Payer: PHP Commercial |
$362.71
|
| Rate for Payer: PHP Medicare Advantage |
$106.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.37
|
| Rate for Payer: Priority Health HMO/PPO |
$371.25
|
| Rate for Payer: Priority Health Medicare |
$107.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.90
|
| Rate for Payer: Railroad Medicare Medicare |
$106.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.51
|
| Rate for Payer: UHC Core |
$356.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.68
|
| Rate for Payer: UHC Exchange |
$106.68
|
| Rate for Payer: UHC Medicare Advantage |
$106.68
|
| Rate for Payer: VA VA |
$106.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.04
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$21.14
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
108720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$19.03 |
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.61
|
| Rate for Payer: BCBS Complete |
$8.46
|
| Rate for Payer: BCBS MAPPO |
$5.28
|
| Rate for Payer: BCBS Trust/PPO |
$17.38
|
| Rate for Payer: BCN Commercial |
$16.44
|
| Rate for Payer: BCN Medicare Advantage |
$5.28
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.28
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.97
|
| Rate for Payer: Nomi Health Commercial |
$17.33
|
| Rate for Payer: PACE Senior Care Partners |
$5.02
|
| Rate for Payer: PACE SWMI |
$5.28
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: PHP Medicare Advantage |
$5.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.74
|
| Rate for Payer: Priority Health HMO/PPO |
$18.39
|
| Rate for Payer: Priority Health Medicare |
$5.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.60
|
| Rate for Payer: UHC Core |
$17.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.28
|
| Rate for Payer: UHC Exchange |
$5.28
|
| Rate for Payer: UHC Medicare Advantage |
$5.28
|
| Rate for Payer: VA VA |
$5.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$21.14
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
108720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$19.03 |
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: BCBS Trust/PPO |
$17.26
|
| Rate for Payer: BCN Commercial |
$16.34
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.97
|
| Rate for Payer: Nomi Health Commercial |
$17.33
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.74
|
| Rate for Payer: Priority Health HMO/PPO |
$18.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.60
|
| Rate for Payer: UHC Core |
$17.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11,565.30
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
31432
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,746.76 |
| Max. Negotiated Rate |
$10,408.77 |
| Rate for Payer: Aetna Commercial |
$9,830.50
|
| Rate for Payer: Aetna Medicare |
$3,006.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,614.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,614.16
|
| Rate for Payer: BCBS Complete |
$3,849.13
|
| Rate for Payer: BCBS MAPPO |
$2,891.32
|
| Rate for Payer: BCBS Trust/PPO |
$9,507.83
|
| Rate for Payer: BCN Commercial |
$8,992.02
|
| Rate for Payer: BCN Medicare Advantage |
$2,891.32
|
| Rate for Payer: Cash Price |
$9,252.24
|
| Rate for Payer: Cash Price |
$9,252.24
|
| Rate for Payer: Cofinity Commercial |
$9,946.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,252.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,891.32
|
| Rate for Payer: Healthscope Commercial |
$10,408.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,673.98
|
| Rate for Payer: Mclaren Medicaid |
$3,665.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,035.89
|
| Rate for Payer: Meridian Medicaid |
$3,849.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,325.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,830.50
|
| Rate for Payer: Nomi Health Commercial |
$9,483.55
|
| Rate for Payer: PACE Senior Care Partners |
$2,746.76
|
| Rate for Payer: PACE SWMI |
$2,891.32
|
| Rate for Payer: PHP Commercial |
$9,830.50
|
| Rate for Payer: PHP Medicare Advantage |
$2,891.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,665.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,517.44
|
| Rate for Payer: Priority Health HMO/PPO |
$10,061.81
|
| Rate for Payer: Priority Health Medicare |
$2,920.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,748.75
|
| Rate for Payer: Railroad Medicare Medicare |
$2,891.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,177.46
|
| Rate for Payer: UHC Core |
$9,657.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,891.32
|
| Rate for Payer: UHC Exchange |
$2,891.32
|
| Rate for Payer: UHC Medicare Advantage |
$2,891.32
|
| Rate for Payer: UHCCP Medicaid |
$3,665.60
|
| Rate for Payer: VA VA |
$2,891.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,673.98
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$11,565.30
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
31432
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,517.44 |
| Max. Negotiated Rate |
$10,408.77 |
| Rate for Payer: Aetna Commercial |
$9,830.50
|
| Rate for Payer: BCBS Trust/PPO |
$9,440.75
|
| Rate for Payer: BCN Commercial |
$8,937.66
|
| Rate for Payer: Cash Price |
$9,252.24
|
| Rate for Payer: Cofinity Commercial |
$9,946.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,252.24
|
| Rate for Payer: Healthscope Commercial |
$10,408.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,673.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,830.50
|
| Rate for Payer: Nomi Health Commercial |
$9,483.55
|
| Rate for Payer: PHP Commercial |
$9,830.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,517.44
|
| Rate for Payer: Priority Health HMO/PPO |
$10,061.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,748.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,177.46
|
| Rate for Payer: UHC Core |
$9,657.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,673.98
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$180.65
|
|
|
Service Code
|
HCPCS J1110
|
| Hospital Charge Code |
9859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.42 |
| Max. Negotiated Rate |
$162.58 |
| Rate for Payer: Aetna Commercial |
$153.55
|
| Rate for Payer: Aetna Commercial |
$170.62
|
| Rate for Payer: Aetna Commercial |
$370.74
|
| Rate for Payer: BCBS Trust/PPO |
$163.86
|
| Rate for Payer: BCBS Trust/PPO |
$147.46
|
| Rate for Payer: BCBS Trust/PPO |
$356.05
|
| Rate for Payer: BCN Commercial |
$155.12
|
| Rate for Payer: BCN Commercial |
$139.61
|
| Rate for Payer: BCN Commercial |
$337.07
|
| Rate for Payer: Cash Price |
$144.52
|
| Rate for Payer: Cash Price |
$348.94
|
| Rate for Payer: Cash Price |
$160.58
|
| Rate for Payer: Cofinity Commercial |
$375.11
|
| Rate for Payer: Cofinity Commercial |
$172.63
|
| Rate for Payer: Cofinity Commercial |
$155.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.94
|
| Rate for Payer: Healthscope Commercial |
$180.66
|
| Rate for Payer: Healthscope Commercial |
$162.58
|
| Rate for Payer: Healthscope Commercial |
$392.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$370.74
|
| Rate for Payer: Nomi Health Commercial |
$148.13
|
| Rate for Payer: Nomi Health Commercial |
$164.60
|
| Rate for Payer: Nomi Health Commercial |
$357.66
|
| Rate for Payer: PHP Commercial |
$170.62
|
| Rate for Payer: PHP Commercial |
$153.55
|
| Rate for Payer: PHP Commercial |
$370.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.47
|
| Rate for Payer: Priority Health HMO/PPO |
$379.47
|
| Rate for Payer: Priority Health HMO/PPO |
$174.64
|
| Rate for Payer: Priority Health HMO/PPO |
$157.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.97
|
| Rate for Payer: UHC Core |
$150.84
|
| Rate for Payer: UHC Core |
$364.20
|
| Rate for Payer: UHC Core |
$167.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.55
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$180.65
|
|
|
Service Code
|
HCPCS J1110
|
| Hospital Charge Code |
9859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$162.58 |
| Rate for Payer: Aetna Commercial |
$153.55
|
| Rate for Payer: Aetna Commercial |
$370.74
|
| Rate for Payer: Aetna Commercial |
$170.62
|
| Rate for Payer: Aetna Medicare |
$113.40
|
| Rate for Payer: Aetna Medicare |
$46.97
|
| Rate for Payer: Aetna Medicare |
$52.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136.30
|
| Rate for Payer: BCBS Complete |
$80.29
|
| Rate for Payer: BCBS Complete |
$72.26
|
| Rate for Payer: BCBS Complete |
$174.47
|
| Rate for Payer: BCBS MAPPO |
$109.04
|
| Rate for Payer: BCBS MAPPO |
$45.16
|
| Rate for Payer: BCBS MAPPO |
$50.18
|
| Rate for Payer: BCBS Trust/PPO |
$165.02
|
| Rate for Payer: BCBS Trust/PPO |
$148.51
|
| Rate for Payer: BCBS Trust/PPO |
$358.58
|
| Rate for Payer: BCN Commercial |
$156.07
|
| Rate for Payer: BCN Commercial |
$339.12
|
| Rate for Payer: BCN Commercial |
$140.46
|
| Rate for Payer: BCN Medicare Advantage |
$45.16
|
| Rate for Payer: BCN Medicare Advantage |
$50.18
|
| Rate for Payer: BCN Medicare Advantage |
$109.04
|
| Rate for Payer: Cash Price |
$160.58
|
| Rate for Payer: Cash Price |
$348.94
|
| Rate for Payer: Cash Price |
$144.52
|
| Rate for Payer: Cofinity Commercial |
$375.11
|
| Rate for Payer: Cofinity Commercial |
$155.36
|
| Rate for Payer: Cofinity Commercial |
$172.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.16
|
| Rate for Payer: Healthscope Commercial |
$180.66
|
| Rate for Payer: Healthscope Commercial |
$162.58
|
| Rate for Payer: Healthscope Commercial |
$392.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$370.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.55
|
| Rate for Payer: Nomi Health Commercial |
$357.66
|
| Rate for Payer: Nomi Health Commercial |
$148.13
|
| Rate for Payer: Nomi Health Commercial |
$164.60
|
| Rate for Payer: PACE Senior Care Partners |
$103.59
|
| Rate for Payer: PACE Senior Care Partners |
$42.90
|
| Rate for Payer: PACE Senior Care Partners |
$47.67
|
| Rate for Payer: PACE SWMI |
$50.18
|
| Rate for Payer: PACE SWMI |
$45.16
|
| Rate for Payer: PACE SWMI |
$109.04
|
| Rate for Payer: PHP Commercial |
$370.74
|
| Rate for Payer: PHP Commercial |
$170.62
|
| Rate for Payer: PHP Commercial |
$153.55
|
| Rate for Payer: PHP Medicare Advantage |
$50.18
|
| Rate for Payer: PHP Medicare Advantage |
$109.04
|
| Rate for Payer: PHP Medicare Advantage |
$45.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.47
|
| Rate for Payer: Priority Health HMO/PPO |
$379.47
|
| Rate for Payer: Priority Health HMO/PPO |
$157.17
|
| Rate for Payer: Priority Health HMO/PPO |
$174.64
|
| Rate for Payer: Priority Health Medicare |
$45.61
|
| Rate for Payer: Priority Health Medicare |
$110.13
|
| Rate for Payer: Priority Health Medicare |
$50.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.04
|
| Rate for Payer: Railroad Medicare Medicare |
$50.18
|
| Rate for Payer: Railroad Medicare Medicare |
$109.04
|
| Rate for Payer: Railroad Medicare Medicare |
$45.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.97
|
| Rate for Payer: UHC Core |
$364.20
|
| Rate for Payer: UHC Core |
$167.61
|
| Rate for Payer: UHC Core |
$150.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.18
|
| Rate for Payer: UHC Exchange |
$50.18
|
| Rate for Payer: UHC Exchange |
$45.16
|
| Rate for Payer: UHC Exchange |
$109.04
|
| Rate for Payer: UHC Medicare Advantage |
$45.16
|
| Rate for Payer: UHC Medicare Advantage |
$50.18
|
| Rate for Payer: UHC Medicare Advantage |
$109.04
|
| Rate for Payer: VA VA |
$50.18
|
| Rate for Payer: VA VA |
$109.04
|
| Rate for Payer: VA VA |
$45.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.55
|
|
|
DILTIAZEM 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$82.05
|
|
|
Service Code
|
NDC 00409435003
|
| Hospital Charge Code |
22156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$73.84 |
| Rate for Payer: Aetna Commercial |
$69.74
|
| Rate for Payer: Aetna Medicare |
$21.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.64
|
| Rate for Payer: BCBS Complete |
$32.82
|
| Rate for Payer: BCBS MAPPO |
$20.51
|
| Rate for Payer: BCBS Trust/PPO |
$67.45
|
| Rate for Payer: BCN Commercial |
$63.79
|
| Rate for Payer: BCN Medicare Advantage |
$20.51
|
| Rate for Payer: Cash Price |
$65.64
|
| Rate for Payer: Cofinity Commercial |
$70.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.51
|
| Rate for Payer: Healthscope Commercial |
$73.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.74
|
| Rate for Payer: Nomi Health Commercial |
$67.28
|
| Rate for Payer: PACE Senior Care Partners |
$19.49
|
| Rate for Payer: PACE SWMI |
$20.51
|
| Rate for Payer: PHP Commercial |
$69.74
|
| Rate for Payer: PHP Medicare Advantage |
$20.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.33
|
| Rate for Payer: Priority Health HMO/PPO |
$71.38
|
| Rate for Payer: Priority Health Medicare |
$20.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.97
|
| Rate for Payer: Railroad Medicare Medicare |
$20.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.20
|
| Rate for Payer: UHC Core |
$68.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.51
|
| Rate for Payer: UHC Exchange |
$20.51
|
| Rate for Payer: UHC Medicare Advantage |
$20.51
|
| Rate for Payer: VA VA |
$20.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.54
|
|
