|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$2.06
|
|
|
Service Code
|
NDC 00245014789
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$1.68
|
| Rate for Payer: BCN Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$1.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.65
|
| Rate for Payer: Healthscope Commercial |
$1.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.75
|
| Rate for Payer: Nomi Health Commercial |
$1.69
|
| Rate for Payer: PHP Commercial |
$1.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.34
|
| Rate for Payer: Priority Health HMO/PPO |
$1.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.81
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.54
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$248.16
|
|
|
Service Code
|
NDC 51672402504
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.30 |
| Max. Negotiated Rate |
$223.34 |
| Rate for Payer: Aetna Commercial |
$210.94
|
| Rate for Payer: BCBS Trust/PPO |
$202.57
|
| Rate for Payer: BCN Commercial |
$191.78
|
| Rate for Payer: Cash Price |
$198.53
|
| Rate for Payer: Cofinity Commercial |
$213.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.53
|
| Rate for Payer: Healthscope Commercial |
$223.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.94
|
| Rate for Payer: Nomi Health Commercial |
$203.49
|
| Rate for Payer: PHP Commercial |
$210.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.30
|
| Rate for Payer: Priority Health HMO/PPO |
$215.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.38
|
| Rate for Payer: UHC Core |
$207.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.12
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
NDC 00245014789
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.64
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: BCBS MAPPO |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: BCN Medicare Advantage |
$0.52
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$1.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.52
|
| Rate for Payer: Healthscope Commercial |
$1.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.75
|
| Rate for Payer: Nomi Health Commercial |
$1.69
|
| Rate for Payer: PACE Senior Care Partners |
$0.49
|
| Rate for Payer: PACE SWMI |
$0.52
|
| Rate for Payer: PHP Commercial |
$1.75
|
| Rate for Payer: PHP Medicare Advantage |
$0.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.34
|
| Rate for Payer: Priority Health HMO/PPO |
$1.79
|
| Rate for Payer: Priority Health Medicare |
$0.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.38
|
| Rate for Payer: Railroad Medicare Medicare |
$0.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.81
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.52
|
| Rate for Payer: UHC Exchange |
$0.52
|
| Rate for Payer: UHC Medicare Advantage |
$0.52
|
| Rate for Payer: VA VA |
$0.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.54
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$460.60
|
|
|
Service Code
|
NDC 00904699361
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.39 |
| Max. Negotiated Rate |
$414.54 |
| Rate for Payer: Aetna Commercial |
$391.51
|
| Rate for Payer: BCBS Trust/PPO |
$375.99
|
| Rate for Payer: BCN Commercial |
$355.95
|
| Rate for Payer: Cash Price |
$368.48
|
| Rate for Payer: Cofinity Commercial |
$396.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.48
|
| Rate for Payer: Healthscope Commercial |
$414.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$345.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.51
|
| Rate for Payer: Nomi Health Commercial |
$377.69
|
| Rate for Payer: PHP Commercial |
$391.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.39
|
| Rate for Payer: Priority Health HMO/PPO |
$400.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$308.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$405.33
|
| Rate for Payer: UHC Core |
$384.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$345.45
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$205.20
|
|
|
Service Code
|
NDC 00245014701
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.38 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$167.50
|
| Rate for Payer: BCN Commercial |
$158.58
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health HMO/PPO |
$178.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.58
|
| Rate for Payer: UHC Core |
$171.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$327.75
|
|
|
Service Code
|
NDC 68084037111
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.84 |
| Max. Negotiated Rate |
$294.98 |
| Rate for Payer: Aetna Commercial |
$278.59
|
| Rate for Payer: Aetna Medicare |
$85.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.42
|
| Rate for Payer: BCBS Complete |
$131.10
|
| Rate for Payer: BCBS MAPPO |
$81.94
|
| Rate for Payer: BCBS Trust/PPO |
$269.44
|
| Rate for Payer: BCN Commercial |
$254.83
|
| Rate for Payer: BCN Medicare Advantage |
$81.94
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cofinity Commercial |
$281.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.94
|
| Rate for Payer: Healthscope Commercial |
$294.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.59
|
| Rate for Payer: Nomi Health Commercial |
$268.76
|
| Rate for Payer: PACE Senior Care Partners |
$77.84
|
| Rate for Payer: PACE SWMI |
$81.94
|
| Rate for Payer: PHP Commercial |
$278.59
|
| Rate for Payer: PHP Medicare Advantage |
$81.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.04
|
| Rate for Payer: Priority Health HMO/PPO |
$285.14
|
| Rate for Payer: Priority Health Medicare |
$82.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.59
|
| Rate for Payer: Railroad Medicare Medicare |
$81.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.42
|
| Rate for Payer: UHC Core |
$273.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.94
|
| Rate for Payer: UHC Exchange |
$81.94
|
| Rate for Payer: UHC Medicare Advantage |
$81.94
|
| Rate for Payer: VA VA |
$81.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.81
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$327.75
|
|
|
Service Code
|
NDC 68084037111
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.04 |
| Max. Negotiated Rate |
$294.98 |
| Rate for Payer: Aetna Commercial |
$278.59
|
| Rate for Payer: BCBS Trust/PPO |
$267.54
|
| Rate for Payer: BCN Commercial |
$253.29
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cofinity Commercial |
$281.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.20
|
| Rate for Payer: Healthscope Commercial |
$294.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.59
|
| Rate for Payer: Nomi Health Commercial |
$268.76
|
| Rate for Payer: PHP Commercial |
$278.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.04
|
| Rate for Payer: Priority Health HMO/PPO |
$285.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.42
|
| Rate for Payer: UHC Core |
$273.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.81
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$248.16
|
|
|
Service Code
|
NDC 51672402504
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.94 |
| Max. Negotiated Rate |
$223.34 |
| Rate for Payer: Aetna Commercial |
$210.94
|
| Rate for Payer: Aetna Medicare |
$64.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.55
|
| Rate for Payer: BCBS Complete |
$99.26
|
| Rate for Payer: BCBS MAPPO |
$62.04
|
| Rate for Payer: BCBS Trust/PPO |
$204.01
|
| Rate for Payer: BCN Commercial |
$192.94
|
| Rate for Payer: BCN Medicare Advantage |
$62.04
|
| Rate for Payer: Cash Price |
$198.53
|
| Rate for Payer: Cofinity Commercial |
$213.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$223.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.94
|
| Rate for Payer: Nomi Health Commercial |
$203.49
|
| Rate for Payer: PACE Senior Care Partners |
$58.94
|
| Rate for Payer: PACE SWMI |
$62.04
|
| Rate for Payer: PHP Commercial |
$210.94
|
| Rate for Payer: PHP Medicare Advantage |
$62.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.30
|
| Rate for Payer: Priority Health HMO/PPO |
$215.90
|
| Rate for Payer: Priority Health Medicare |
$62.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.27
|
| Rate for Payer: Railroad Medicare Medicare |
$62.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.38
|
| Rate for Payer: UHC Core |
$207.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.04
|
| Rate for Payer: UHC Exchange |
$62.04
|
| Rate for Payer: UHC Medicare Advantage |
$62.04
|
| Rate for Payer: VA VA |
$62.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.12
|
|
|
AMIODARONE 360 MG/200 ML (1.8 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV
|
Facility
|
OP
|
$191.35
|
|
|
Service Code
|
HCPCS J0283
|
| Hospital Charge Code |
152870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$172.22 |
| Rate for Payer: Aetna Commercial |
$162.65
|
| Rate for Payer: Aetna Medicare |
$49.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.80
|
| Rate for Payer: BCBS Complete |
$76.54
|
| Rate for Payer: BCBS MAPPO |
$47.84
|
| Rate for Payer: BCBS Trust/PPO |
$157.31
|
| Rate for Payer: BCN Commercial |
$148.77
|
| Rate for Payer: BCN Medicare Advantage |
$47.84
|
| Rate for Payer: Cash Price |
$153.08
|
| Rate for Payer: Cofinity Commercial |
$164.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.84
|
| Rate for Payer: Healthscope Commercial |
$172.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.65
|
| Rate for Payer: Nomi Health Commercial |
$156.91
|
| Rate for Payer: PACE Senior Care Partners |
$45.45
|
| Rate for Payer: PACE SWMI |
$47.84
|
| Rate for Payer: PHP Commercial |
$162.65
|
| Rate for Payer: PHP Medicare Advantage |
$47.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.38
|
| Rate for Payer: Priority Health HMO/PPO |
$166.47
|
| Rate for Payer: Priority Health Medicare |
$48.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.20
|
| Rate for Payer: Railroad Medicare Medicare |
$47.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.39
|
| Rate for Payer: UHC Core |
$159.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.84
|
| Rate for Payer: UHC Exchange |
$47.84
|
| Rate for Payer: UHC Medicare Advantage |
$47.84
|
| Rate for Payer: VA VA |
$47.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.51
|
|
|
AMIODARONE 360 MG/200 ML (1.8 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV
|
Facility
|
IP
|
$191.35
|
|
|
Service Code
|
HCPCS J0283
|
| Hospital Charge Code |
152870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$124.38 |
| Max. Negotiated Rate |
$172.22 |
| Rate for Payer: Aetna Commercial |
$162.65
|
| Rate for Payer: BCBS Trust/PPO |
$156.20
|
| Rate for Payer: BCN Commercial |
$147.88
|
| Rate for Payer: Cash Price |
$153.08
|
| Rate for Payer: Cofinity Commercial |
$164.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.08
|
| Rate for Payer: Healthscope Commercial |
$172.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.65
|
| Rate for Payer: Nomi Health Commercial |
$156.91
|
| Rate for Payer: PHP Commercial |
$162.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.38
|
| Rate for Payer: Priority Health HMO/PPO |
$166.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.39
|
| Rate for Payer: UHC Core |
$159.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.51
|
|
|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.89
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
9065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$23.30 |
| Rate for Payer: Aetna Commercial |
$22.01
|
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna Medicare |
$6.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.39
|
| Rate for Payer: BCBS Complete |
$10.54
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS Complete |
$10.74
|
| Rate for Payer: BCBS MAPPO |
$6.71
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS MAPPO |
$6.59
|
| Rate for Payer: BCBS Trust/PPO |
$21.67
|
| Rate for Payer: BCBS Trust/PPO |
$21.28
|
| Rate for Payer: BCBS Trust/PPO |
$22.07
|
| Rate for Payer: BCN Commercial |
$20.49
|
| Rate for Payer: BCN Commercial |
$20.87
|
| Rate for Payer: BCN Commercial |
$20.13
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: BCN Medicare Advantage |
$6.59
|
| Rate for Payer: BCN Medicare Advantage |
$6.71
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cofinity Commercial |
$23.08
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.72
|
| Rate for Payer: Healthscope Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$24.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.01
|
| Rate for Payer: Nomi Health Commercial |
$22.01
|
| Rate for Payer: Nomi Health Commercial |
$21.23
|
| Rate for Payer: Nomi Health Commercial |
$21.62
|
| Rate for Payer: PACE Senior Care Partners |
$6.37
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE Senior Care Partners |
$6.26
|
| Rate for Payer: PACE SWMI |
$6.59
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PACE SWMI |
$6.71
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: PHP Commercial |
$22.01
|
| Rate for Payer: PHP Medicare Advantage |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$6.71
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health HMO/PPO |
$23.35
|
| Rate for Payer: Priority Health HMO/PPO |
$22.52
|
| Rate for Payer: Priority Health HMO/PPO |
$22.93
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Medicare |
$6.78
|
| Rate for Payer: Priority Health Medicare |
$6.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6.59
|
| Rate for Payer: Railroad Medicare Medicare |
$6.71
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.78
|
| Rate for Payer: UHC Core |
$22.41
|
| Rate for Payer: UHC Core |
$22.01
|
| Rate for Payer: UHC Core |
$21.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.59
|
| Rate for Payer: UHC Exchange |
$6.59
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Exchange |
$6.71
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHC Medicare Advantage |
$6.59
|
| Rate for Payer: UHC Medicare Advantage |
$6.71
|
| Rate for Payer: VA VA |
$6.59
|
| Rate for Payer: VA VA |
$6.71
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.77
|
|
|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.89
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
9065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$23.30 |
| Rate for Payer: Aetna Commercial |
$22.01
|
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: BCBS Trust/PPO |
$21.52
|
| Rate for Payer: BCBS Trust/PPO |
$21.13
|
| Rate for Payer: BCBS Trust/PPO |
$21.91
|
| Rate for Payer: BCN Commercial |
$20.37
|
| Rate for Payer: BCN Commercial |
$20.01
|
| Rate for Payer: BCN Commercial |
$20.74
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cofinity Commercial |
$23.08
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.47
|
| Rate for Payer: Healthscope Commercial |
$23.72
|
| Rate for Payer: Healthscope Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$24.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Nomi Health Commercial |
$21.23
|
| Rate for Payer: Nomi Health Commercial |
$21.62
|
| Rate for Payer: Nomi Health Commercial |
$22.01
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: PHP Commercial |
$22.01
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health HMO/PPO |
$23.35
|
| Rate for Payer: Priority Health HMO/PPO |
$22.93
|
| Rate for Payer: Priority Health HMO/PPO |
$22.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.78
|
| Rate for Payer: UHC Core |
$21.62
|
| Rate for Payer: UHC Core |
$22.41
|
| Rate for Payer: UHC Core |
$22.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.77
|
|
|
AMIODARONE 50 MG/ML IV (CODE)
|
Facility
|
IP
|
$26.36
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
163703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.13 |
| Max. Negotiated Rate |
$23.72 |
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: BCBS Trust/PPO |
$21.52
|
| Rate for Payer: BCN Commercial |
$20.37
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$23.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: Nomi Health Commercial |
$21.62
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health HMO/PPO |
$22.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.20
|
| Rate for Payer: UHC Core |
$22.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.77
|
|
|
AMIODARONE 50 MG/ML IV (CODE)
|
Facility
|
OP
|
$26.36
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
163703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$23.72 |
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna Medicare |
$6.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.24
|
| Rate for Payer: BCBS Complete |
$10.54
|
| Rate for Payer: BCBS MAPPO |
$6.59
|
| Rate for Payer: BCBS Trust/PPO |
$21.67
|
| Rate for Payer: BCN Commercial |
$20.49
|
| Rate for Payer: BCN Medicare Advantage |
$6.59
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.59
|
| Rate for Payer: Healthscope Commercial |
$23.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: Nomi Health Commercial |
$21.62
|
| Rate for Payer: PACE Senior Care Partners |
$6.26
|
| Rate for Payer: PACE SWMI |
$6.59
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: PHP Medicare Advantage |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health HMO/PPO |
$22.93
|
| Rate for Payer: Priority Health Medicare |
$6.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.66
|
| Rate for Payer: Railroad Medicare Medicare |
$6.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.20
|
| Rate for Payer: UHC Core |
$22.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.59
|
| Rate for Payer: UHC Exchange |
$6.59
|
| Rate for Payer: UHC Medicare Advantage |
$6.59
|
| Rate for Payer: VA VA |
$6.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.77
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$136.30
|
|
|
Service Code
|
NDC 16729017101
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.37 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna Medicare |
$35.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.59
|
| Rate for Payer: BCBS Complete |
$54.52
|
| Rate for Payer: BCBS MAPPO |
$34.08
|
| Rate for Payer: BCBS Trust/PPO |
$112.05
|
| Rate for Payer: BCN Commercial |
$105.97
|
| Rate for Payer: BCN Medicare Advantage |
$34.08
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.08
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Nomi Health Commercial |
$111.77
|
| Rate for Payer: PACE Senior Care Partners |
$32.37
|
| Rate for Payer: PACE SWMI |
$34.08
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: PHP Medicare Advantage |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.60
|
| Rate for Payer: Priority Health HMO/PPO |
$118.58
|
| Rate for Payer: Priority Health Medicare |
$34.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.32
|
| Rate for Payer: Railroad Medicare Medicare |
$34.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.94
|
| Rate for Payer: UHC Core |
$113.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.08
|
| Rate for Payer: UHC Exchange |
$34.08
|
| Rate for Payer: UHC Medicare Advantage |
$34.08
|
| Rate for Payer: VA VA |
$34.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 16729017101
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.60 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: BCBS Trust/PPO |
$111.26
|
| Rate for Payer: BCN Commercial |
$105.33
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Nomi Health Commercial |
$111.77
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.60
|
| Rate for Payer: Priority Health HMO/PPO |
$118.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.94
|
| Rate for Payer: UHC Core |
$113.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 70756020111
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$36.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.06
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS MAPPO |
$35.25
|
| Rate for Payer: BCBS Trust/PPO |
$115.92
|
| Rate for Payer: BCN Commercial |
$109.63
|
| Rate for Payer: BCN Medicare Advantage |
$35.25
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.25
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: PACE Senior Care Partners |
$33.49
|
| Rate for Payer: PACE SWMI |
$35.25
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: PHP Medicare Advantage |
$35.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO |
$122.67
|
| Rate for Payer: Priority Health Medicare |
$35.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.47
|
| Rate for Payer: Railroad Medicare Medicare |
$35.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.08
|
| Rate for Payer: UHC Core |
$117.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.25
|
| Rate for Payer: UHC Exchange |
$35.25
|
| Rate for Payer: UHC Medicare Advantage |
$35.25
|
| Rate for Payer: VA VA |
$35.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 70756020111
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: BCBS Trust/PPO |
$115.10
|
| Rate for Payer: BCN Commercial |
$108.96
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO |
$122.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.08
|
| Rate for Payer: UHC Core |
$117.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$274.95
|
|
|
Service Code
|
NDC 00781148601
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.30 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna Medicare |
$71.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.92
|
| Rate for Payer: BCBS Complete |
$109.98
|
| Rate for Payer: BCBS MAPPO |
$68.74
|
| Rate for Payer: BCBS Trust/PPO |
$226.04
|
| Rate for Payer: BCN Commercial |
$213.77
|
| Rate for Payer: BCN Medicare Advantage |
$68.74
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.74
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: PACE Senior Care Partners |
$65.30
|
| Rate for Payer: PACE SWMI |
$68.74
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: PHP Medicare Advantage |
$68.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health HMO/PPO |
$239.21
|
| Rate for Payer: Priority Health Medicare |
$69.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.22
|
| Rate for Payer: Railroad Medicare Medicare |
$68.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.96
|
| Rate for Payer: UHC Core |
$229.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.74
|
| Rate for Payer: UHC Exchange |
$68.74
|
| Rate for Payer: UHC Medicare Advantage |
$68.74
|
| Rate for Payer: VA VA |
$68.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 00781148601
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.72 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: BCBS Trust/PPO |
$224.44
|
| Rate for Payer: BCN Commercial |
$212.48
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health HMO/PPO |
$239.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.96
|
| Rate for Payer: UHC Core |
$229.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
OP
|
$225.15
|
|
|
Service Code
|
NDC 00904718461
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.47 |
| Max. Negotiated Rate |
$202.64 |
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna Medicare |
$58.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.36
|
| Rate for Payer: BCBS Complete |
$90.06
|
| Rate for Payer: BCBS MAPPO |
$56.29
|
| Rate for Payer: BCBS Trust/PPO |
$185.10
|
| Rate for Payer: BCN Commercial |
$175.05
|
| Rate for Payer: BCN Medicare Advantage |
$56.29
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.29
|
| Rate for Payer: Healthscope Commercial |
$202.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Nomi Health Commercial |
$184.62
|
| Rate for Payer: PACE Senior Care Partners |
$53.47
|
| Rate for Payer: PACE SWMI |
$56.29
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: PHP Medicare Advantage |
$56.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.35
|
| Rate for Payer: Priority Health HMO/PPO |
$195.88
|
| Rate for Payer: Priority Health Medicare |
$56.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.85
|
| Rate for Payer: Railroad Medicare Medicare |
$56.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.13
|
| Rate for Payer: UHC Core |
$188.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.29
|
| Rate for Payer: UHC Exchange |
$56.29
|
| Rate for Payer: UHC Medicare Advantage |
$56.29
|
| Rate for Payer: VA VA |
$56.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
IP
|
$240.35
|
|
|
Service Code
|
NDC 00904020161
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.23 |
| Max. Negotiated Rate |
$216.32 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: BCBS Trust/PPO |
$196.20
|
| Rate for Payer: BCN Commercial |
$185.74
|
| Rate for Payer: Cash Price |
$192.28
|
| Rate for Payer: Cofinity Commercial |
$206.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.28
|
| Rate for Payer: Healthscope Commercial |
$216.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.30
|
| Rate for Payer: Nomi Health Commercial |
$197.09
|
| Rate for Payer: PHP Commercial |
$204.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.23
|
| Rate for Payer: Priority Health HMO/PPO |
$209.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.51
|
| Rate for Payer: UHC Core |
$200.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.26
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
OP
|
$240.35
|
|
|
Service Code
|
NDC 00904020161
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$216.32 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Medicare |
$62.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.11
|
| Rate for Payer: BCBS Complete |
$96.14
|
| Rate for Payer: BCBS MAPPO |
$60.09
|
| Rate for Payer: BCBS Trust/PPO |
$197.59
|
| Rate for Payer: BCN Commercial |
$186.87
|
| Rate for Payer: BCN Medicare Advantage |
$60.09
|
| Rate for Payer: Cash Price |
$192.28
|
| Rate for Payer: Cofinity Commercial |
$206.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.09
|
| Rate for Payer: Healthscope Commercial |
$216.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.30
|
| Rate for Payer: Nomi Health Commercial |
$197.09
|
| Rate for Payer: PACE Senior Care Partners |
$57.08
|
| Rate for Payer: PACE SWMI |
$60.09
|
| Rate for Payer: PHP Commercial |
$204.30
|
| Rate for Payer: PHP Medicare Advantage |
$60.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.23
|
| Rate for Payer: Priority Health HMO/PPO |
$209.10
|
| Rate for Payer: Priority Health Medicare |
$60.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.03
|
| Rate for Payer: Railroad Medicare Medicare |
$60.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.51
|
| Rate for Payer: UHC Core |
$200.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.09
|
| Rate for Payer: UHC Exchange |
$60.09
|
| Rate for Payer: UHC Medicare Advantage |
$60.09
|
| Rate for Payer: VA VA |
$60.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.26
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 00904718461
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.35 |
| Max. Negotiated Rate |
$202.64 |
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: BCBS Trust/PPO |
$183.79
|
| Rate for Payer: BCN Commercial |
$174.00
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Nomi Health Commercial |
$184.62
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.35
|
| Rate for Payer: Priority Health HMO/PPO |
$195.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.13
|
| Rate for Payer: UHC Core |
$188.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
IP
|
$409.45
|
|
|
Service Code
|
NDC 00904020261
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.14 |
| Max. Negotiated Rate |
$368.50 |
| Rate for Payer: Aetna Commercial |
$348.03
|
| Rate for Payer: BCBS Trust/PPO |
$334.23
|
| Rate for Payer: BCN Commercial |
$316.42
|
| Rate for Payer: Cash Price |
$327.56
|
| Rate for Payer: Cofinity Commercial |
$352.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.56
|
| Rate for Payer: Healthscope Commercial |
$368.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.03
|
| Rate for Payer: Nomi Health Commercial |
$335.75
|
| Rate for Payer: PHP Commercial |
$348.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.14
|
| Rate for Payer: Priority Health HMO/PPO |
$356.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.32
|
| Rate for Payer: UHC Core |
$341.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.09
|
|
