|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY
|
Facility
|
IP
|
$117.18
|
|
|
Service Code
|
NDC 00054004544
|
| Hospital Charge Code |
16070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.56 |
| Max. Negotiated Rate |
$105.46 |
| Rate for Payer: Aetna Commercial |
$99.60
|
| Rate for Payer: BCBS Trust/PPO |
$96.78
|
| Rate for Payer: BCN Commercial |
$96.78
|
| Rate for Payer: Cash Price |
$93.74
|
| Rate for Payer: Cofinity Commercial |
$100.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.74
|
| Rate for Payer: Healthscope Commercial |
$105.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.60
|
| Rate for Payer: Nomi Health Commercial |
$96.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.89
|
| Rate for Payer: PHP Commercial |
$99.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$101.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.12
|
| Rate for Payer: UHC Core |
$97.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.89
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY
|
Facility
|
OP
|
$111.30
|
|
|
Service Code
|
NDC 69238201603
|
| Hospital Charge Code |
16070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$100.17 |
| Rate for Payer: Aetna Commercial |
$94.61
|
| Rate for Payer: Aetna Medicare |
$28.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.78
|
| Rate for Payer: BCBS Complete |
$20.60
|
| Rate for Payer: BCBS MAPPO |
$27.82
|
| Rate for Payer: BCBS Trust/PPO |
$91.50
|
| Rate for Payer: BCN Commercial |
$91.50
|
| Rate for Payer: BCN Medicare Advantage |
$27.82
|
| Rate for Payer: Cash Price |
$89.04
|
| Rate for Payer: Cofinity Commercial |
$95.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.82
|
| Rate for Payer: Healthscope Commercial |
$100.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.47
|
| Rate for Payer: Mclaren Medicaid |
$19.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.22
|
| Rate for Payer: Meridian Medicaid |
$20.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.61
|
| Rate for Payer: Nomi Health Commercial |
$91.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.47
|
| Rate for Payer: PACE Senior Care Partners |
$26.43
|
| Rate for Payer: PACE SWMI |
$27.82
|
| Rate for Payer: PHP Commercial |
$94.61
|
| Rate for Payer: PHP Medicare Advantage |
$27.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.83
|
| Rate for Payer: Priority Health Medicare |
$28.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.46
|
| Rate for Payer: Railroad Medicare Medicare |
$27.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.94
|
| Rate for Payer: UHC Core |
$92.94
|
| Rate for Payer: UHC Exchange |
$27.82
|
| Rate for Payer: UHC Medicaid |
$19.62
|
| Rate for Payer: UHC Medicare Advantage |
$27.82
|
| Rate for Payer: UHCCP Medicaid |
$19.62
|
| Rate for Payer: VA VA |
$27.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.47
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$169.77
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.16 |
| Max. Negotiated Rate |
$152.79 |
| Rate for Payer: Aetna Commercial |
$144.30
|
| Rate for Payer: BCBS Trust/PPO |
$140.21
|
| Rate for Payer: BCN Commercial |
$140.21
|
| Rate for Payer: Cash Price |
$135.82
|
| Rate for Payer: Cofinity Commercial |
$146.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.82
|
| Rate for Payer: Healthscope Commercial |
$152.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.30
|
| Rate for Payer: Nomi Health Commercial |
$139.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.33
|
| Rate for Payer: PHP Commercial |
$144.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$147.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.40
|
| Rate for Payer: UHC Core |
$141.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.33
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$169.77
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.93 |
| Max. Negotiated Rate |
$152.79 |
| Rate for Payer: Aetna Commercial |
$144.30
|
| Rate for Payer: Aetna Medicare |
$44.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.05
|
| Rate for Payer: BCBS Complete |
$31.42
|
| Rate for Payer: BCBS MAPPO |
$42.44
|
| Rate for Payer: BCBS Trust/PPO |
$139.57
|
| Rate for Payer: BCN Commercial |
$139.57
|
| Rate for Payer: BCN Medicare Advantage |
$42.44
|
| Rate for Payer: Cash Price |
$135.82
|
| Rate for Payer: Cofinity Commercial |
$146.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.44
|
| Rate for Payer: Healthscope Commercial |
$152.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.33
|
| Rate for Payer: Mclaren Medicaid |
$29.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.56
|
| Rate for Payer: Meridian Medicaid |
$31.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.30
|
| Rate for Payer: Nomi Health Commercial |
$139.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.33
|
| Rate for Payer: PACE Senior Care Partners |
$40.32
|
| Rate for Payer: PACE SWMI |
$42.44
|
| Rate for Payer: PHP Commercial |
$144.30
|
| Rate for Payer: PHP Medicare Advantage |
$42.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$147.70
|
| Rate for Payer: Priority Health Medicare |
$42.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.16
|
| Rate for Payer: Railroad Medicare Medicare |
$42.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.40
|
| Rate for Payer: UHC Core |
$141.76
|
| Rate for Payer: UHC Exchange |
$42.44
|
| Rate for Payer: UHC Medicaid |
$29.93
|
| Rate for Payer: UHC Medicare Advantage |
$42.44
|
| Rate for Payer: UHCCP Medicaid |
$29.93
|
| Rate for Payer: VA VA |
$42.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.33
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$68.98
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.01 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$58.63
|
| Rate for Payer: Aetna Commercial |
$84.83
|
| Rate for Payer: BCBS Trust/PPO |
$56.97
|
| Rate for Payer: BCBS Trust/PPO |
$82.42
|
| Rate for Payer: BCN Commercial |
$56.97
|
| Rate for Payer: BCN Commercial |
$82.42
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cash Price |
$79.84
|
| Rate for Payer: Cofinity Commercial |
$85.83
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.18
|
| Rate for Payer: Healthscope Commercial |
$62.08
|
| Rate for Payer: Healthscope Commercial |
$89.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.83
|
| Rate for Payer: Nomi Health Commercial |
$56.56
|
| Rate for Payer: Nomi Health Commercial |
$81.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.85
|
| Rate for Payer: PHP Commercial |
$84.83
|
| Rate for Payer: PHP Commercial |
$58.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$86.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.82
|
| Rate for Payer: UHC Core |
$57.60
|
| Rate for Payer: UHC Core |
$83.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.85
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$68.98
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$58.63
|
| Rate for Payer: Aetna Commercial |
$84.83
|
| Rate for Payer: Aetna Medicare |
$25.95
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.19
|
| Rate for Payer: BCBS Complete |
$12.77
|
| Rate for Payer: BCBS Complete |
$18.47
|
| Rate for Payer: BCBS MAPPO |
$17.25
|
| Rate for Payer: BCBS MAPPO |
$24.95
|
| Rate for Payer: BCBS Trust/PPO |
$56.71
|
| Rate for Payer: BCBS Trust/PPO |
$82.05
|
| Rate for Payer: BCN Commercial |
$82.05
|
| Rate for Payer: BCN Commercial |
$56.71
|
| Rate for Payer: BCN Medicare Advantage |
$24.95
|
| Rate for Payer: BCN Medicare Advantage |
$17.25
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cash Price |
$79.84
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Cofinity Commercial |
$85.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$62.08
|
| Rate for Payer: Healthscope Commercial |
$89.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.85
|
| Rate for Payer: Mclaren Medicaid |
$17.59
|
| Rate for Payer: Mclaren Medicaid |
$12.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.11
|
| Rate for Payer: Meridian Medicaid |
$12.77
|
| Rate for Payer: Meridian Medicaid |
$18.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.63
|
| Rate for Payer: Nomi Health Commercial |
$81.84
|
| Rate for Payer: Nomi Health Commercial |
$56.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.85
|
| Rate for Payer: PACE Senior Care Partners |
$23.70
|
| Rate for Payer: PACE Senior Care Partners |
$16.38
|
| Rate for Payer: PACE SWMI |
$24.95
|
| Rate for Payer: PACE SWMI |
$17.25
|
| Rate for Payer: PHP Commercial |
$58.63
|
| Rate for Payer: PHP Commercial |
$84.83
|
| Rate for Payer: PHP Medicare Advantage |
$17.25
|
| Rate for Payer: PHP Medicare Advantage |
$24.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$86.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.01
|
| Rate for Payer: Priority Health Medicare |
$25.20
|
| Rate for Payer: Priority Health Medicare |
$17.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.46
|
| Rate for Payer: Railroad Medicare Medicare |
$17.25
|
| Rate for Payer: Railroad Medicare Medicare |
$24.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.82
|
| Rate for Payer: UHC Core |
$83.33
|
| Rate for Payer: UHC Core |
$57.60
|
| Rate for Payer: UHC Exchange |
$24.95
|
| Rate for Payer: UHC Exchange |
$17.25
|
| Rate for Payer: UHC Medicaid |
$17.59
|
| Rate for Payer: UHC Medicaid |
$12.16
|
| Rate for Payer: UHC Medicare Advantage |
$17.25
|
| Rate for Payer: UHC Medicare Advantage |
$24.95
|
| Rate for Payer: UHCCP Medicaid |
$12.16
|
| Rate for Payer: UHCCP Medicaid |
$17.59
|
| Rate for Payer: VA VA |
$17.25
|
| Rate for Payer: VA VA |
$24.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.73
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$82.51
|
|
|
Service Code
|
NDC 10019036040
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.43 |
| Max. Negotiated Rate |
$74.26 |
| Rate for Payer: Aetna Commercial |
$70.13
|
| Rate for Payer: BCBS Trust/PPO |
$68.15
|
| Rate for Payer: BCN Commercial |
$68.15
|
| Rate for Payer: Cash Price |
$66.01
|
| Rate for Payer: Cofinity Commercial |
$70.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.01
|
| Rate for Payer: Healthscope Commercial |
$74.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.13
|
| Rate for Payer: Nomi Health Commercial |
$67.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.88
|
| Rate for Payer: PHP Commercial |
$70.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.61
|
| Rate for Payer: UHC Core |
$68.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.88
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$52.91
|
|
|
Service Code
|
NDC 66794001910
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.83 |
| Max. Negotiated Rate |
$47.62 |
| Rate for Payer: Aetna Commercial |
$44.97
|
| Rate for Payer: BCBS Trust/PPO |
$43.70
|
| Rate for Payer: BCN Commercial |
$43.70
|
| Rate for Payer: Cash Price |
$42.33
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.33
|
| Rate for Payer: Healthscope Commercial |
$47.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.97
|
| Rate for Payer: Nomi Health Commercial |
$43.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.68
|
| Rate for Payer: PHP Commercial |
$44.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.56
|
| Rate for Payer: UHC Core |
$44.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.68
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
OP
|
$106.38
|
|
|
Service Code
|
NDC 66794001925
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$95.74 |
| Rate for Payer: Aetna Commercial |
$90.42
|
| Rate for Payer: Aetna Medicare |
$27.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.24
|
| Rate for Payer: BCBS Complete |
$19.69
|
| Rate for Payer: BCBS MAPPO |
$26.59
|
| Rate for Payer: BCBS Trust/PPO |
$87.45
|
| Rate for Payer: BCN Commercial |
$87.45
|
| Rate for Payer: BCN Medicare Advantage |
$26.59
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Cofinity Commercial |
$91.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.59
|
| Rate for Payer: Healthscope Commercial |
$95.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.78
|
| Rate for Payer: Mclaren Medicaid |
$18.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.92
|
| Rate for Payer: Meridian Medicaid |
$19.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.42
|
| Rate for Payer: Nomi Health Commercial |
$87.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.78
|
| Rate for Payer: PACE Senior Care Partners |
$25.27
|
| Rate for Payer: PACE SWMI |
$26.59
|
| Rate for Payer: PHP Commercial |
$90.42
|
| Rate for Payer: PHP Medicare Advantage |
$26.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$92.55
|
| Rate for Payer: Priority Health Medicare |
$26.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.04
|
| Rate for Payer: Railroad Medicare Medicare |
$26.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.61
|
| Rate for Payer: UHC Core |
$88.83
|
| Rate for Payer: UHC Exchange |
$26.59
|
| Rate for Payer: UHC Medicaid |
$18.75
|
| Rate for Payer: UHC Medicare Advantage |
$26.59
|
| Rate for Payer: UHCCP Medicaid |
$18.75
|
| Rate for Payer: VA VA |
$26.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.78
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
OP
|
$82.51
|
|
|
Service Code
|
NDC 10019036040
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$74.26 |
| Rate for Payer: Aetna Commercial |
$70.13
|
| Rate for Payer: Aetna Medicare |
$21.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.78
|
| Rate for Payer: BCBS Complete |
$15.27
|
| Rate for Payer: BCBS MAPPO |
$20.63
|
| Rate for Payer: BCBS Trust/PPO |
$67.83
|
| Rate for Payer: BCN Commercial |
$67.83
|
| Rate for Payer: BCN Medicare Advantage |
$20.63
|
| Rate for Payer: Cash Price |
$66.01
|
| Rate for Payer: Cofinity Commercial |
$70.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.63
|
| Rate for Payer: Healthscope Commercial |
$74.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.88
|
| Rate for Payer: Mclaren Medicaid |
$14.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.66
|
| Rate for Payer: Meridian Medicaid |
$15.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.13
|
| Rate for Payer: Nomi Health Commercial |
$67.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.88
|
| Rate for Payer: PACE Senior Care Partners |
$19.60
|
| Rate for Payer: PACE SWMI |
$20.63
|
| Rate for Payer: PHP Commercial |
$70.13
|
| Rate for Payer: PHP Medicare Advantage |
$20.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.78
|
| Rate for Payer: Priority Health Medicare |
$20.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.43
|
| Rate for Payer: Railroad Medicare Medicare |
$20.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.61
|
| Rate for Payer: UHC Core |
$68.90
|
| Rate for Payer: UHC Exchange |
$20.63
|
| Rate for Payer: UHC Medicaid |
$14.55
|
| Rate for Payer: UHC Medicare Advantage |
$20.63
|
| Rate for Payer: UHCCP Medicaid |
$14.55
|
| Rate for Payer: VA VA |
$20.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.88
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
OP
|
$52.91
|
|
|
Service Code
|
NDC 66794001910
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$47.62 |
| Rate for Payer: Aetna Commercial |
$44.97
|
| Rate for Payer: Aetna Medicare |
$13.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.53
|
| Rate for Payer: BCBS Complete |
$9.79
|
| Rate for Payer: BCBS MAPPO |
$13.23
|
| Rate for Payer: BCBS Trust/PPO |
$43.50
|
| Rate for Payer: BCN Commercial |
$43.50
|
| Rate for Payer: BCN Medicare Advantage |
$13.23
|
| Rate for Payer: Cash Price |
$42.33
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.23
|
| Rate for Payer: Healthscope Commercial |
$47.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.68
|
| Rate for Payer: Mclaren Medicaid |
$9.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.89
|
| Rate for Payer: Meridian Medicaid |
$9.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.97
|
| Rate for Payer: Nomi Health Commercial |
$43.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.68
|
| Rate for Payer: PACE Senior Care Partners |
$12.57
|
| Rate for Payer: PACE SWMI |
$13.23
|
| Rate for Payer: PHP Commercial |
$44.97
|
| Rate for Payer: PHP Medicare Advantage |
$13.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.03
|
| Rate for Payer: Priority Health Medicare |
$13.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.83
|
| Rate for Payer: Railroad Medicare Medicare |
$13.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.56
|
| Rate for Payer: UHC Core |
$44.18
|
| Rate for Payer: UHC Exchange |
$13.23
|
| Rate for Payer: UHC Medicaid |
$9.33
|
| Rate for Payer: UHC Medicare Advantage |
$13.23
|
| Rate for Payer: UHCCP Medicaid |
$9.33
|
| Rate for Payer: VA VA |
$13.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.68
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$106.38
|
|
|
Service Code
|
NDC 66794001925
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.04 |
| Max. Negotiated Rate |
$95.74 |
| Rate for Payer: Aetna Commercial |
$90.42
|
| Rate for Payer: BCBS Trust/PPO |
$87.86
|
| Rate for Payer: BCN Commercial |
$87.86
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Cofinity Commercial |
$91.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.10
|
| Rate for Payer: Healthscope Commercial |
$95.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.42
|
| Rate for Payer: Nomi Health Commercial |
$87.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.78
|
| Rate for Payer: PHP Commercial |
$90.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$92.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.61
|
| Rate for Payer: UHC Core |
$88.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.78
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$255.84
|
|
|
Service Code
|
NDC 00904661961
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.10 |
| Max. Negotiated Rate |
$230.26 |
| Rate for Payer: Aetna Commercial |
$217.46
|
| Rate for Payer: Aetna Medicare |
$66.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.95
|
| Rate for Payer: BCBS Complete |
$47.36
|
| Rate for Payer: BCBS MAPPO |
$63.96
|
| Rate for Payer: BCBS Trust/PPO |
$210.33
|
| Rate for Payer: BCN Commercial |
$210.33
|
| Rate for Payer: BCN Medicare Advantage |
$63.96
|
| Rate for Payer: Cash Price |
$204.67
|
| Rate for Payer: Cofinity Commercial |
$220.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.96
|
| Rate for Payer: Healthscope Commercial |
$230.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.88
|
| Rate for Payer: Mclaren Medicaid |
$45.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.16
|
| Rate for Payer: Meridian Medicaid |
$47.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.46
|
| Rate for Payer: Nomi Health Commercial |
$209.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.88
|
| Rate for Payer: PACE Senior Care Partners |
$60.76
|
| Rate for Payer: PACE SWMI |
$63.96
|
| Rate for Payer: PHP Commercial |
$217.46
|
| Rate for Payer: PHP Medicare Advantage |
$63.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$222.58
|
| Rate for Payer: Priority Health Medicare |
$64.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.06
|
| Rate for Payer: Railroad Medicare Medicare |
$63.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.14
|
| Rate for Payer: UHC Core |
$213.63
|
| Rate for Payer: UHC Exchange |
$63.96
|
| Rate for Payer: UHC Medicaid |
$45.10
|
| Rate for Payer: UHC Medicare Advantage |
$63.96
|
| Rate for Payer: UHCCP Medicaid |
$45.10
|
| Rate for Payer: VA VA |
$63.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.88
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$164.88
|
|
|
Service Code
|
NDC 50268044815
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.07 |
| Max. Negotiated Rate |
$148.39 |
| Rate for Payer: Aetna Commercial |
$140.15
|
| Rate for Payer: Aetna Medicare |
$42.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.52
|
| Rate for Payer: BCBS Complete |
$30.52
|
| Rate for Payer: BCBS MAPPO |
$41.22
|
| Rate for Payer: BCBS Trust/PPO |
$135.55
|
| Rate for Payer: BCN Commercial |
$135.55
|
| Rate for Payer: BCN Medicare Advantage |
$41.22
|
| Rate for Payer: Cash Price |
$131.90
|
| Rate for Payer: Cofinity Commercial |
$141.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.22
|
| Rate for Payer: Healthscope Commercial |
$148.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.66
|
| Rate for Payer: Mclaren Medicaid |
$29.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.28
|
| Rate for Payer: Meridian Medicaid |
$30.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.15
|
| Rate for Payer: Nomi Health Commercial |
$135.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.66
|
| Rate for Payer: PACE Senior Care Partners |
$39.16
|
| Rate for Payer: PACE SWMI |
$41.22
|
| Rate for Payer: PHP Commercial |
$140.15
|
| Rate for Payer: PHP Medicare Advantage |
$41.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.45
|
| Rate for Payer: Priority Health Medicare |
$41.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.76
|
| Rate for Payer: Railroad Medicare Medicare |
$41.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.09
|
| Rate for Payer: UHC Core |
$137.67
|
| Rate for Payer: UHC Exchange |
$41.22
|
| Rate for Payer: UHC Medicaid |
$29.07
|
| Rate for Payer: UHC Medicare Advantage |
$41.22
|
| Rate for Payer: UHCCP Medicaid |
$29.07
|
| Rate for Payer: VA VA |
$41.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.66
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$3.30
|
|
|
Service Code
|
NDC 50268044811
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.64
|
| Rate for Payer: Healthscope Commercial |
$2.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.81
|
| Rate for Payer: Nomi Health Commercial |
$2.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.48
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.90
|
| Rate for Payer: UHC Core |
$2.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.48
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
NDC 68084008211
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.33
|
| 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 |
$2.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.40
|
| Rate for Payer: Nomi Health Commercial |
$2.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.48
|
| Rate for Payer: UHC Core |
$2.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.12
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$262.08
|
|
|
Service Code
|
NDC 63739056910
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Aetna Commercial |
$222.77
|
| Rate for Payer: Aetna Medicare |
$68.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.90
|
| Rate for Payer: BCBS Complete |
$48.51
|
| Rate for Payer: BCBS MAPPO |
$65.52
|
| Rate for Payer: BCBS Trust/PPO |
$215.46
|
| Rate for Payer: BCN Commercial |
$215.46
|
| Rate for Payer: BCN Medicare Advantage |
$65.52
|
| Rate for Payer: Cash Price |
$209.66
|
| Rate for Payer: Cofinity Commercial |
$225.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.52
|
| Rate for Payer: Healthscope Commercial |
$235.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.56
|
| Rate for Payer: Mclaren Medicaid |
$46.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.80
|
| Rate for Payer: Meridian Medicaid |
$48.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.77
|
| Rate for Payer: Nomi Health Commercial |
$214.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.56
|
| Rate for Payer: PACE Senior Care Partners |
$62.24
|
| Rate for Payer: PACE SWMI |
$65.52
|
| Rate for Payer: PHP Commercial |
$222.77
|
| Rate for Payer: PHP Medicare Advantage |
$65.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$228.01
|
| Rate for Payer: Priority Health Medicare |
$66.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.41
|
| Rate for Payer: Railroad Medicare Medicare |
$65.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.63
|
| Rate for Payer: UHC Core |
$218.84
|
| Rate for Payer: UHC Exchange |
$65.52
|
| Rate for Payer: UHC Medicaid |
$46.20
|
| Rate for Payer: UHC Medicare Advantage |
$65.52
|
| Rate for Payer: UHCCP Medicaid |
$46.20
|
| Rate for Payer: VA VA |
$65.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.56
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$262.08
|
|
|
Service Code
|
NDC 63739056910
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.41 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Aetna Commercial |
$222.77
|
| Rate for Payer: BCBS Trust/PPO |
$216.45
|
| Rate for Payer: BCN Commercial |
$216.45
|
| Rate for Payer: Cash Price |
$209.66
|
| Rate for Payer: Cofinity Commercial |
$225.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.66
|
| Rate for Payer: Healthscope Commercial |
$235.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.77
|
| Rate for Payer: Nomi Health Commercial |
$214.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.56
|
| Rate for Payer: PHP Commercial |
$222.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$228.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.63
|
| Rate for Payer: UHC Core |
$218.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.56
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$255.84
|
|
|
Service Code
|
NDC 00904661961
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.06 |
| Max. Negotiated Rate |
$230.26 |
| Rate for Payer: Aetna Commercial |
$217.46
|
| Rate for Payer: BCBS Trust/PPO |
$211.30
|
| Rate for Payer: BCN Commercial |
$211.30
|
| Rate for Payer: Cash Price |
$204.67
|
| Rate for Payer: Cofinity Commercial |
$220.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.67
|
| Rate for Payer: Healthscope Commercial |
$230.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.46
|
| Rate for Payer: Nomi Health Commercial |
$209.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.88
|
| Rate for Payer: PHP Commercial |
$217.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$222.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.14
|
| Rate for Payer: UHC Core |
$213.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.88
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$3.30
|
|
|
Service Code
|
NDC 50268044811
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Medicare |
$0.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.03
|
| Rate for Payer: BCBS Complete |
$0.61
|
| Rate for Payer: BCBS MAPPO |
$0.83
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.71
|
| Rate for Payer: BCN Medicare Advantage |
$0.83
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$2.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.48
|
| Rate for Payer: Mclaren Medicaid |
$0.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.87
|
| Rate for Payer: Meridian Medicaid |
$0.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.81
|
| Rate for Payer: Nomi Health Commercial |
$2.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.48
|
| Rate for Payer: PACE Senior Care Partners |
$0.78
|
| Rate for Payer: PACE SWMI |
$0.83
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: PHP Medicare Advantage |
$0.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.87
|
| Rate for Payer: Priority Health Medicare |
$0.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.90
|
| Rate for Payer: UHC Core |
$2.76
|
| Rate for Payer: UHC Exchange |
$0.83
|
| Rate for Payer: UHC Medicaid |
$0.58
|
| Rate for Payer: UHC Medicare Advantage |
$0.83
|
| Rate for Payer: UHCCP Medicaid |
$0.58
|
| Rate for Payer: VA VA |
$0.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.48
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$164.88
|
|
|
Service Code
|
NDC 50268044815
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.76 |
| Max. Negotiated Rate |
$148.39 |
| Rate for Payer: Aetna Commercial |
$140.15
|
| Rate for Payer: BCBS Trust/PPO |
$136.17
|
| Rate for Payer: BCN Commercial |
$136.17
|
| Rate for Payer: Cash Price |
$131.90
|
| Rate for Payer: Cofinity Commercial |
$141.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.90
|
| Rate for Payer: Healthscope Commercial |
$148.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.15
|
| Rate for Payer: Nomi Health Commercial |
$135.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.66
|
| Rate for Payer: PHP Commercial |
$140.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.09
|
| Rate for Payer: UHC Core |
$137.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.66
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
NDC 68084008211
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| 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 |
$2.32
|
| Rate for Payer: BCN Commercial |
$2.32
|
| 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 |
$2.54
|
| 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 |
$2.40
|
| Rate for Payer: Nomi Health Commercial |
$2.31
|
| 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 |
$2.40
|
| 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 |
$2.45
|
| Rate for Payer: Priority Health Medicare |
$0.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.96
|
| Rate for Payer: Railroad Medicare Medicare |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.48
|
| Rate for Payer: UHC Core |
$2.35
|
| 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
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$245.10
|
|
|
Service Code
|
NDC 00904644961
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.21 |
| Max. Negotiated Rate |
$220.59 |
| Rate for Payer: Aetna Commercial |
$208.34
|
| Rate for Payer: Aetna Medicare |
$63.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.59
|
| Rate for Payer: BCBS Complete |
$45.37
|
| Rate for Payer: BCBS MAPPO |
$61.27
|
| Rate for Payer: BCBS Trust/PPO |
$201.50
|
| Rate for Payer: BCN Commercial |
$201.50
|
| Rate for Payer: BCN Medicare Advantage |
$61.27
|
| Rate for Payer: Cash Price |
$196.08
|
| Rate for Payer: Cofinity Commercial |
$210.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.27
|
| Rate for Payer: Healthscope Commercial |
$220.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.82
|
| Rate for Payer: Mclaren Medicaid |
$43.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.34
|
| Rate for Payer: Meridian Medicaid |
$45.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.34
|
| Rate for Payer: Nomi Health Commercial |
$200.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.82
|
| Rate for Payer: PACE Senior Care Partners |
$58.21
|
| Rate for Payer: PACE SWMI |
$61.27
|
| Rate for Payer: PHP Commercial |
$208.34
|
| Rate for Payer: PHP Medicare Advantage |
$61.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$213.24
|
| Rate for Payer: Priority Health Medicare |
$61.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.59
|
| Rate for Payer: Railroad Medicare Medicare |
$61.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.69
|
| Rate for Payer: UHC Core |
$204.66
|
| Rate for Payer: UHC Exchange |
$61.27
|
| Rate for Payer: UHC Medicaid |
$43.21
|
| Rate for Payer: UHC Medicare Advantage |
$61.27
|
| Rate for Payer: UHCCP Medicaid |
$43.21
|
| Rate for Payer: VA VA |
$61.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.82
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$245.10
|
|
|
Service Code
|
NDC 00904644961
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.59 |
| Max. Negotiated Rate |
$220.59 |
| Rate for Payer: Aetna Commercial |
$208.34
|
| Rate for Payer: BCBS Trust/PPO |
$202.43
|
| Rate for Payer: BCN Commercial |
$202.43
|
| Rate for Payer: Cash Price |
$196.08
|
| Rate for Payer: Cofinity Commercial |
$210.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.08
|
| Rate for Payer: Healthscope Commercial |
$220.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.34
|
| Rate for Payer: Nomi Health Commercial |
$200.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.82
|
| Rate for Payer: PHP Commercial |
$208.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$213.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.69
|
| Rate for Payer: UHC Core |
$204.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.82
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$292.60
|
|
|
Service Code
|
NDC 00904645061
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.59 |
| Max. Negotiated Rate |
$263.34 |
| Rate for Payer: Aetna Commercial |
$248.71
|
| Rate for Payer: Aetna Medicare |
$76.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.44
|
| Rate for Payer: BCBS Complete |
$54.16
|
| Rate for Payer: BCBS MAPPO |
$73.15
|
| Rate for Payer: BCBS Trust/PPO |
$240.55
|
| Rate for Payer: BCN Commercial |
$240.55
|
| Rate for Payer: BCN Medicare Advantage |
$73.15
|
| Rate for Payer: Cash Price |
$234.08
|
| Rate for Payer: Cofinity Commercial |
$251.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.15
|
| Rate for Payer: Healthscope Commercial |
$263.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.45
|
| Rate for Payer: Mclaren Medicaid |
$51.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.81
|
| Rate for Payer: Meridian Medicaid |
$54.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.71
|
| Rate for Payer: Nomi Health Commercial |
$239.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.45
|
| Rate for Payer: PACE Senior Care Partners |
$69.49
|
| Rate for Payer: PACE SWMI |
$73.15
|
| Rate for Payer: PHP Commercial |
$248.71
|
| Rate for Payer: PHP Medicare Advantage |
$73.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$254.56
|
| Rate for Payer: Priority Health Medicare |
$73.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.65
|
| Rate for Payer: Railroad Medicare Medicare |
$73.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.49
|
| Rate for Payer: UHC Core |
$244.32
|
| Rate for Payer: UHC Exchange |
$73.15
|
| Rate for Payer: UHC Medicaid |
$51.59
|
| Rate for Payer: UHC Medicare Advantage |
$73.15
|
| Rate for Payer: UHCCP Medicaid |
$51.59
|
| Rate for Payer: VA VA |
$73.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.45
|
|
