|
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
|
$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
|
$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
|
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
|
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
|
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 |
$5.33
|
| 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
|
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
|
$21.24
|
|
|
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
|
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
|
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
|
OP
|
$320.15
|
|
|
Service Code
|
NDC 00378050501
|
| Hospital Charge Code |
18289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.46 |
| Max. Negotiated Rate |
$288.13 |
| Rate for Payer: Aetna American Axle |
$208.10
|
| Rate for Payer: Aetna Commercial |
$272.13
|
| Rate for Payer: Aetna Medicare |
$160.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.10
|
| Rate for Payer: BCBS Complete |
$128.06
|
| 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 |
$288.13
|
| 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 |
$118.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.11
|
|
|
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
|
|
|
BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
OP
|
$128.25
|
|
|
Service Code
|
NDC 29300018913
|
| Hospital Charge Code |
18289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna American Axle |
$83.36
|
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: Aetna Medicare |
$64.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: BCBS Complete |
$51.30
|
| 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 |
$47.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.19
|
|
|
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 |
$288.13 |
| 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 |
$288.13
|
| 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
|
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 |
$45.15
|
| 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 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
OP
|
$128.25
|
|
|
Service Code
|
NDC 29300018713
|
| Hospital Charge Code |
18291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna American Axle |
$83.36
|
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: Aetna Medicare |
$64.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: BCBS Complete |
$51.30
|
| 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 |
$47.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.19
|
|
|
BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
IP
|
$375.25
|
|
|
Service Code
|
NDC 29300018701
|
| Hospital Charge Code |
18291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$337.73 |
| Rate for Payer: Aetna American Axle |
$243.91
|
| Rate for Payer: Aetna Commercial |
$318.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.91
|
| Rate for Payer: Cash Price |
$300.20
|
| Rate for Payer: Cofinity Commercial |
$262.68
|
| Rate for Payer: Cofinity Commercial |
$322.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$262.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.20
|
| Rate for Payer: Healthscope Commercial |
$337.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.96
|
| Rate for Payer: PHP Commercial |
$318.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.91
|
| Rate for Payer: Priority Health SBD |
$236.41
|
| Rate for Payer: UMR Bronson Commercial |
$165.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.44
|
|
|
BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
IP
|
$128.25
|
|
|
Service Code
|
NDC 29300018713
|
| Hospital Charge Code |
18291
|
|
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
|
|
|
BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
OP
|
$375.25
|
|
|
Service Code
|
NDC 29300018701
|
| Hospital Charge Code |
18291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.84 |
| Max. Negotiated Rate |
$337.73 |
| Rate for Payer: Aetna American Axle |
$243.91
|
| Rate for Payer: Aetna Commercial |
$318.96
|
| Rate for Payer: Aetna Medicare |
$187.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.91
|
| Rate for Payer: BCBS Complete |
$150.10
|
| Rate for Payer: Cash Price |
$300.20
|
| Rate for Payer: Cofinity Commercial |
$262.68
|
| Rate for Payer: Cofinity Commercial |
$322.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$262.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.20
|
| Rate for Payer: Healthscope Commercial |
$337.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.96
|
| Rate for Payer: PHP Commercial |
$318.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.91
|
| Rate for Payer: Priority Health SBD |
$236.41
|
| Rate for Payer: UMR Bronson Commercial |
$138.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.44
|
|
|
BISOPROLOL 5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
IP
|
$375.25
|
|
|
Service Code
|
NDC 29300018801
|
| Hospital Charge Code |
18290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$337.73 |
| Rate for Payer: Aetna American Axle |
$243.91
|
| Rate for Payer: Aetna Commercial |
$318.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.91
|
| Rate for Payer: Cash Price |
$300.20
|
| Rate for Payer: Cofinity Commercial |
$262.68
|
| Rate for Payer: Cofinity Commercial |
$322.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$262.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.20
|
| Rate for Payer: Healthscope Commercial |
$337.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.96
|
| Rate for Payer: PHP Commercial |
$318.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.91
|
| Rate for Payer: Priority Health SBD |
$236.41
|
| Rate for Payer: UMR Bronson Commercial |
$165.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.44
|
|
|
BISOPROLOL 5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
OP
|
$375.25
|
|
|
Service Code
|
NDC 29300018801
|
| Hospital Charge Code |
18290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.84 |
| Max. Negotiated Rate |
$337.73 |
| Rate for Payer: Aetna American Axle |
$243.91
|
| Rate for Payer: Aetna Commercial |
$318.96
|
| Rate for Payer: Aetna Medicare |
$187.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.91
|
| Rate for Payer: BCBS Complete |
$150.10
|
| Rate for Payer: Cash Price |
$300.20
|
| Rate for Payer: Cofinity Commercial |
$262.68
|
| Rate for Payer: Cofinity Commercial |
$322.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$262.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.20
|
| Rate for Payer: Healthscope Commercial |
$337.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.96
|
| Rate for Payer: PHP Commercial |
$318.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.91
|
| Rate for Payer: Priority Health SBD |
$236.41
|
| Rate for Payer: UMR Bronson Commercial |
$138.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.44
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$124.79
|
|
|
Service Code
|
NDC 52817027030
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.17 |
| Max. Negotiated Rate |
$112.31 |
| Rate for Payer: Aetna American Axle |
$81.11
|
| Rate for Payer: Aetna Commercial |
$106.07
|
| Rate for Payer: Aetna Medicare |
$62.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.11
|
| Rate for Payer: BCBS Complete |
$49.92
|
| Rate for Payer: Cash Price |
$99.83
|
| Rate for Payer: Cofinity Commercial |
$107.32
|
| Rate for Payer: Cofinity Commercial |
$87.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.83
|
| Rate for Payer: Healthscope Commercial |
$112.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.07
|
| Rate for Payer: PHP Commercial |
$106.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.11
|
| Rate for Payer: Priority Health SBD |
$78.62
|
| Rate for Payer: UMR Bronson Commercial |
$46.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.59
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$60.71
|
|
|
Service Code
|
NDC 70954045510
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$54.64 |
| Rate for Payer: Aetna American Axle |
$39.46
|
| Rate for Payer: Aetna Commercial |
$51.60
|
| Rate for Payer: Aetna Medicare |
$30.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.46
|
| Rate for Payer: BCBS Complete |
$24.28
|
| Rate for Payer: Cash Price |
$48.57
|
| Rate for Payer: Cofinity Commercial |
$42.50
|
| Rate for Payer: Cofinity Commercial |
$52.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.57
|
| Rate for Payer: Healthscope Commercial |
$54.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.60
|
| Rate for Payer: PHP Commercial |
$51.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.46
|
| Rate for Payer: Priority Health SBD |
$38.25
|
| Rate for Payer: UMR Bronson Commercial |
$22.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.53
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$75.81
|
|
|
Service Code
|
NDC 29300012613
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$68.23 |
| Rate for Payer: Aetna American Axle |
$49.28
|
| Rate for Payer: Aetna Commercial |
$64.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.28
|
| Rate for Payer: Cash Price |
$60.65
|
| Rate for Payer: Cofinity Commercial |
$53.07
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.65
|
| Rate for Payer: Healthscope Commercial |
$68.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.44
|
| Rate for Payer: PHP Commercial |
$64.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.28
|
| Rate for Payer: Priority Health SBD |
$47.76
|
| Rate for Payer: UMR Bronson Commercial |
$33.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.86
|
|
