|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$58.83
|
|
|
Service Code
|
NDC 70000045102
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$52.95 |
| Rate for Payer: Aetna American Axle |
$38.24
|
| Rate for Payer: Aetna Commercial |
$50.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.24
|
| Rate for Payer: Cash Price |
$47.06
|
| Rate for Payer: Cofinity Commercial |
$41.18
|
| Rate for Payer: Cofinity Commercial |
$50.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.06
|
| Rate for Payer: Healthscope Commercial |
$52.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.01
|
| Rate for Payer: PHP Commercial |
$50.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.24
|
| Rate for Payer: Priority Health SBD |
$37.06
|
| Rate for Payer: UMR Bronson Commercial |
$25.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.12
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$26.94
|
|
|
Service Code
|
NDC 81421002101
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$24.25 |
| Rate for Payer: Aetna American Axle |
$17.51
|
| Rate for Payer: Aetna Commercial |
$22.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.51
|
| Rate for Payer: Cash Price |
$21.55
|
| Rate for Payer: Cofinity Commercial |
$18.86
|
| Rate for Payer: Cofinity Commercial |
$23.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.55
|
| Rate for Payer: Healthscope Commercial |
$24.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.90
|
| Rate for Payer: PHP Commercial |
$22.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.51
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: UMR Bronson Commercial |
$11.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.20
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$58.83
|
|
|
Service Code
|
NDC 70000045102
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$52.95 |
| Rate for Payer: Aetna American Axle |
$38.24
|
| Rate for Payer: Aetna Commercial |
$50.01
|
| Rate for Payer: Aetna Medicare |
$29.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.24
|
| Rate for Payer: BCBS Complete |
$23.53
|
| Rate for Payer: Cash Price |
$47.06
|
| Rate for Payer: Cofinity Commercial |
$41.18
|
| Rate for Payer: Cofinity Commercial |
$50.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.06
|
| Rate for Payer: Healthscope Commercial |
$52.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.01
|
| Rate for Payer: PHP Commercial |
$50.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.24
|
| Rate for Payer: Priority Health SBD |
$37.06
|
| Rate for Payer: UMR Bronson Commercial |
$21.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.12
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$36.38
|
|
|
Service Code
|
NDC 68784010212
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.01 |
| Max. Negotiated Rate |
$32.74 |
| Rate for Payer: Aetna American Axle |
$23.65
|
| Rate for Payer: Aetna Commercial |
$30.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.65
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cofinity Commercial |
$25.47
|
| Rate for Payer: Cofinity Commercial |
$31.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.10
|
| Rate for Payer: Healthscope Commercial |
$32.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.92
|
| Rate for Payer: PHP Commercial |
$30.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.65
|
| Rate for Payer: Priority Health SBD |
$22.92
|
| Rate for Payer: UMR Bronson Commercial |
$16.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.28
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$191.53
|
|
|
Service Code
|
NDC 00574705050
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.27 |
| Max. Negotiated Rate |
$172.38 |
| Rate for Payer: Aetna American Axle |
$124.49
|
| Rate for Payer: Aetna Commercial |
$162.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.49
|
| Rate for Payer: Cash Price |
$153.22
|
| Rate for Payer: Cofinity Commercial |
$134.07
|
| Rate for Payer: Cofinity Commercial |
$164.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.22
|
| Rate for Payer: Healthscope Commercial |
$172.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.80
|
| Rate for Payer: PHP Commercial |
$162.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.49
|
| Rate for Payer: Priority Health SBD |
$120.66
|
| Rate for Payer: UMR Bronson Commercial |
$84.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.65
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$45.55
|
|
|
Service Code
|
NDC 81421002102
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Aetna American Axle |
$29.61
|
| Rate for Payer: Aetna Commercial |
$38.72
|
| Rate for Payer: Aetna Medicare |
$22.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.61
|
| Rate for Payer: BCBS Complete |
$18.22
|
| Rate for Payer: Cash Price |
$36.44
|
| Rate for Payer: Cofinity Commercial |
$31.88
|
| Rate for Payer: Cofinity Commercial |
$39.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.44
|
| Rate for Payer: Healthscope Commercial |
$41.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.72
|
| Rate for Payer: PHP Commercial |
$38.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.61
|
| Rate for Payer: Priority Health SBD |
$28.70
|
| Rate for Payer: UMR Bronson Commercial |
$16.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.16
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$45.55
|
|
|
Service Code
|
NDC 81421002102
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.04 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Aetna American Axle |
$29.61
|
| Rate for Payer: Aetna Commercial |
$38.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.61
|
| Rate for Payer: Cash Price |
$36.44
|
| Rate for Payer: Cofinity Commercial |
$31.88
|
| Rate for Payer: Cofinity Commercial |
$39.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.44
|
| Rate for Payer: Healthscope Commercial |
$41.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.72
|
| Rate for Payer: PHP Commercial |
$38.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.61
|
| Rate for Payer: Priority Health SBD |
$28.70
|
| Rate for Payer: UMR Bronson Commercial |
$20.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.16
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$12.93
|
|
|
Service Code
|
NDC 50844060756
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Aetna American Axle |
$8.40
|
| Rate for Payer: Aetna Commercial |
$10.99
|
| Rate for Payer: Aetna Medicare |
$6.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.40
|
| Rate for Payer: BCBS Complete |
$5.17
|
| Rate for Payer: Cash Price |
$10.34
|
| Rate for Payer: Cofinity Commercial |
$11.12
|
| Rate for Payer: Cofinity Commercial |
$9.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.34
|
| Rate for Payer: Healthscope Commercial |
$11.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.99
|
| Rate for Payer: PHP Commercial |
$10.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health SBD |
$8.15
|
| Rate for Payer: UMR Bronson Commercial |
$4.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.70
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
NDC 09900001926
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna American Axle |
$0.38
|
| Rate for Payer: Aetna Commercial |
$0.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.38
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cofinity Commercial |
$0.41
|
| Rate for Payer: Cofinity Commercial |
$0.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.47
|
| Rate for Payer: Healthscope Commercial |
$0.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.50
|
| Rate for Payer: PHP Commercial |
$0.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.38
|
| Rate for Payer: Priority Health SBD |
$0.37
|
| Rate for Payer: UMR Bronson Commercial |
$0.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.44
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$19.98
|
|
|
Service Code
|
NDC 00904674817
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$17.98 |
| Rate for Payer: Aetna American Axle |
$12.99
|
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: Aetna Medicare |
$9.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.99
|
| Rate for Payer: BCBS Complete |
$7.99
|
| Rate for Payer: Cash Price |
$15.98
|
| Rate for Payer: Cofinity Commercial |
$13.99
|
| Rate for Payer: Cofinity Commercial |
$17.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.98
|
| Rate for Payer: Healthscope Commercial |
$17.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.98
|
| Rate for Payer: PHP Commercial |
$16.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.99
|
| Rate for Payer: Priority Health SBD |
$12.59
|
| Rate for Payer: UMR Bronson Commercial |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.98
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$5.88
|
|
|
Service Code
|
NDC 00904640761
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna American Axle |
$3.82
|
| Rate for Payer: Aetna Commercial |
$5.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.82
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cofinity Commercial |
$4.12
|
| Rate for Payer: Cofinity Commercial |
$5.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.70
|
| Rate for Payer: Healthscope Commercial |
$5.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.00
|
| Rate for Payer: PHP Commercial |
$5.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.82
|
| Rate for Payer: Priority Health SBD |
$3.70
|
| Rate for Payer: UMR Bronson Commercial |
$2.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.41
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$12.93
|
|
|
Service Code
|
NDC 50844060756
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Aetna American Axle |
$8.40
|
| Rate for Payer: Aetna Commercial |
$10.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.40
|
| Rate for Payer: Cash Price |
$10.34
|
| Rate for Payer: Cofinity Commercial |
$11.12
|
| Rate for Payer: Cofinity Commercial |
$9.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.34
|
| Rate for Payer: Healthscope Commercial |
$11.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.99
|
| Rate for Payer: PHP Commercial |
$10.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health SBD |
$8.15
|
| Rate for Payer: UMR Bronson Commercial |
$5.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.70
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$5.88
|
|
|
Service Code
|
NDC 00904640761
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna American Axle |
$3.82
|
| Rate for Payer: Aetna Commercial |
$5.00
|
| Rate for Payer: Aetna Medicare |
$2.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.82
|
| Rate for Payer: BCBS Complete |
$2.35
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cofinity Commercial |
$4.12
|
| Rate for Payer: Cofinity Commercial |
$5.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.70
|
| Rate for Payer: Healthscope Commercial |
$5.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.00
|
| Rate for Payer: PHP Commercial |
$5.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.82
|
| Rate for Payer: Priority Health SBD |
$3.70
|
| Rate for Payer: UMR Bronson Commercial |
$2.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.41
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$19.98
|
|
|
Service Code
|
NDC 00904674817
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$17.98 |
| Rate for Payer: Aetna American Axle |
$12.99
|
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.99
|
| Rate for Payer: Cash Price |
$15.98
|
| Rate for Payer: Cofinity Commercial |
$13.99
|
| Rate for Payer: Cofinity Commercial |
$17.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.98
|
| Rate for Payer: Healthscope Commercial |
$17.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.98
|
| Rate for Payer: PHP Commercial |
$16.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.99
|
| Rate for Payer: Priority Health SBD |
$12.59
|
| Rate for Payer: UMR Bronson Commercial |
$8.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.98
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
NDC 09900001926
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna American Axle |
$0.38
|
| Rate for Payer: Aetna Commercial |
$0.50
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.38
|
| Rate for Payer: BCBS Complete |
$0.24
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cofinity Commercial |
$0.41
|
| Rate for Payer: Cofinity Commercial |
$0.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.47
|
| Rate for Payer: Healthscope Commercial |
$0.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.50
|
| Rate for Payer: PHP Commercial |
$0.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.38
|
| Rate for Payer: Priority Health SBD |
$0.37
|
| Rate for Payer: UMR Bronson Commercial |
$0.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.44
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$10.67
|
|
|
Service Code
|
NDC 00536128636
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna American Axle |
$6.94
|
| Rate for Payer: Aetna Commercial |
$9.07
|
| Rate for Payer: Aetna Medicare |
$5.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.94
|
| Rate for Payer: BCBS Complete |
$4.27
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cofinity Commercial |
$7.47
|
| Rate for Payer: Cofinity Commercial |
$9.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$9.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.07
|
| Rate for Payer: PHP Commercial |
$9.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.94
|
| Rate for Payer: Priority Health SBD |
$6.72
|
| Rate for Payer: UMR Bronson Commercial |
$3.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.00
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$21.24
|
|
|
Service Code
|
NDC 01490003956
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Aetna American Axle |
$13.81
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.81
|
| Rate for Payer: Priority Health SBD |
$13.38
|
| Rate for Payer: UMR Bronson Commercial |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.93
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$21.24
|
|
|
Service Code
|
NDC 01490003956
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Aetna American Axle |
$13.81
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$10.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: BCBS Complete |
$8.50
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.81
|
| Rate for Payer: Priority Health SBD |
$13.38
|
| Rate for Payer: UMR Bronson Commercial |
$7.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.93
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$21.33
|
|
|
Service Code
|
NDC 01490003908
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna American Axle |
$13.86
|
| Rate for Payer: Aetna Commercial |
$18.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.86
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cofinity Commercial |
$14.93
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$19.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.13
|
| Rate for Payer: PHP Commercial |
$18.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.86
|
| Rate for Payer: Priority Health SBD |
$13.44
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.00
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$21.33
|
|
|
Service Code
|
NDC 01490003908
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna American Axle |
$13.86
|
| Rate for Payer: Aetna Commercial |
$18.13
|
| Rate for Payer: Aetna Medicare |
$10.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.86
|
| Rate for Payer: BCBS Complete |
$8.53
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cofinity Commercial |
$14.93
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$19.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.13
|
| Rate for Payer: PHP Commercial |
$18.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.86
|
| Rate for Payer: Priority Health SBD |
$13.44
|
| Rate for Payer: UMR Bronson Commercial |
$7.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.00
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$10.67
|
|
|
Service Code
|
NDC 00536128636
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna American Axle |
$6.94
|
| Rate for Payer: Aetna Commercial |
$9.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.94
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cofinity Commercial |
$7.47
|
| Rate for Payer: Cofinity Commercial |
$9.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$9.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.07
|
| Rate for Payer: PHP Commercial |
$9.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.94
|
| Rate for Payer: Priority Health SBD |
$6.72
|
| Rate for Payer: UMR Bronson Commercial |
$4.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.00
|
|
|
BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
OP
|
$90.29
|
|
|
Service Code
|
NDC 00093324356
|
| Hospital Charge Code |
18289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.41 |
| Max. Negotiated Rate |
$81.26 |
| Rate for Payer: Aetna American Axle |
$58.69
|
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Medicare |
$45.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.69
|
| Rate for Payer: BCBS Complete |
$36.12
|
| Rate for Payer: Cash Price |
$72.23
|
| Rate for Payer: Cofinity Commercial |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$77.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.23
|
| Rate for Payer: Healthscope Commercial |
$81.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.75
|
| Rate for Payer: PHP Commercial |
$76.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.69
|
| Rate for Payer: Priority Health SBD |
$56.88
|
| Rate for Payer: UMR Bronson Commercial |
$33.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.72
|
|
|
BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
IP
|
$320.15
|
|
|
Service Code
|
NDC 00378050501
|
| Hospital Charge Code |
18289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.87 |
| Max. Negotiated Rate |
$288.14 |
| Rate for Payer: Aetna American Axle |
$208.10
|
| Rate for Payer: Aetna Commercial |
$272.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.10
|
| Rate for Payer: Cash Price |
$256.12
|
| Rate for Payer: Cofinity Commercial |
$224.10
|
| Rate for Payer: Cofinity Commercial |
$275.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.12
|
| Rate for Payer: Healthscope Commercial |
$288.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.13
|
| Rate for Payer: PHP Commercial |
$272.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.10
|
| Rate for Payer: Priority Health SBD |
$201.69
|
| Rate for Payer: UMR Bronson Commercial |
$140.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.11
|
|
|
BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
IP
|
$90.29
|
|
|
Service Code
|
NDC 00093324356
|
| Hospital Charge Code |
18289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.73 |
| Max. Negotiated Rate |
$81.26 |
| Rate for Payer: Aetna American Axle |
$58.69
|
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.69
|
| Rate for Payer: Cash Price |
$72.23
|
| Rate for Payer: Cofinity Commercial |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$77.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.23
|
| Rate for Payer: Healthscope Commercial |
$81.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.75
|
| Rate for Payer: PHP Commercial |
$76.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.69
|
| Rate for Payer: Priority Health SBD |
$56.88
|
| Rate for Payer: UMR Bronson Commercial |
$39.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.72
|
|
|
BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
IP
|
$128.25
|
|
|
Service Code
|
NDC 29300018913
|
| Hospital Charge Code |
18289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.43 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna American Axle |
$83.36
|
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Cofinity Commercial |
$89.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.60
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.01
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.36
|
| Rate for Payer: Priority Health SBD |
$80.80
|
| Rate for Payer: UMR Bronson Commercial |
$56.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.19
|
|
