|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.84
|
|
|
Service Code
|
NDC 00409434616
|
| Hospital Charge Code |
403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$25.96 |
| Rate for Payer: Aetna American Axle |
$18.75
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.51
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.75
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: UMR Bronson Commercial |
$12.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.63
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28.84
|
|
|
Service Code
|
NDC 00409434673
|
| Hospital Charge Code |
403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.67 |
| Max. Negotiated Rate |
$25.96 |
| Rate for Payer: Aetna American Axle |
$18.75
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna Medicare |
$14.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.51
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.75
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: UMR Bronson Commercial |
$10.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.63
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.84
|
|
|
Service Code
|
NDC 00409434673
|
| Hospital Charge Code |
403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$25.96 |
| Rate for Payer: Aetna American Axle |
$18.75
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.51
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.75
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: UMR Bronson Commercial |
$12.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.63
|
|
|
AMINOCAPROIC ACID 250 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$61.56
|
|
|
Service Code
|
NDC 00409434673
|
| Hospital Charge Code |
180367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.09 |
| Max. Negotiated Rate |
$55.40 |
| Rate for Payer: Aetna American Axle |
$40.01
|
| Rate for Payer: Aetna Commercial |
$52.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.01
|
| Rate for Payer: Cash Price |
$49.25
|
| Rate for Payer: Cofinity Commercial |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$52.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.25
|
| Rate for Payer: Healthscope Commercial |
$55.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.33
|
| Rate for Payer: PHP Commercial |
$52.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.01
|
| Rate for Payer: Priority Health SBD |
$38.78
|
| Rate for Payer: UMR Bronson Commercial |
$27.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.17
|
|
|
AMINOCAPROIC ACID 250 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$61.56
|
|
|
Service Code
|
NDC 00409434673
|
| Hospital Charge Code |
180367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.78 |
| Max. Negotiated Rate |
$55.40 |
| Rate for Payer: Aetna American Axle |
$40.01
|
| Rate for Payer: Aetna Commercial |
$52.33
|
| Rate for Payer: Aetna Medicare |
$30.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.01
|
| Rate for Payer: BCBS Complete |
$24.62
|
| Rate for Payer: Cash Price |
$49.25
|
| Rate for Payer: Cofinity Commercial |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$52.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.25
|
| Rate for Payer: Healthscope Commercial |
$55.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.33
|
| Rate for Payer: PHP Commercial |
$52.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.01
|
| Rate for Payer: Priority Health SBD |
$38.78
|
| Rate for Payer: UMR Bronson Commercial |
$22.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.17
|
|
|
AMINOCAPROIC ACID 500 MG TABLET
|
Facility
|
IP
|
$431.68
|
|
|
Service Code
|
NDC 69238163703
|
| Hospital Charge Code |
9063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.94 |
| Max. Negotiated Rate |
$388.51 |
| Rate for Payer: Aetna American Axle |
$280.59
|
| Rate for Payer: Aetna Commercial |
$366.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.59
|
| Rate for Payer: Cash Price |
$345.34
|
| Rate for Payer: Cofinity Commercial |
$302.18
|
| Rate for Payer: Cofinity Commercial |
$371.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.34
|
| Rate for Payer: Healthscope Commercial |
$388.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.93
|
| Rate for Payer: PHP Commercial |
$366.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.59
|
| Rate for Payer: Priority Health SBD |
$271.96
|
| Rate for Payer: UMR Bronson Commercial |
$189.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.76
|
|
|
AMINOCAPROIC ACID 500 MG TABLET
|
Facility
|
OP
|
$431.68
|
|
|
Service Code
|
NDC 69238163703
|
| Hospital Charge Code |
9063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.72 |
| Max. Negotiated Rate |
$388.51 |
| Rate for Payer: Aetna American Axle |
$280.59
|
| Rate for Payer: Aetna Commercial |
$366.93
|
| Rate for Payer: Aetna Medicare |
$215.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.59
|
| Rate for Payer: BCBS Complete |
$172.67
|
| Rate for Payer: Cash Price |
$345.34
|
| Rate for Payer: Cofinity Commercial |
$302.18
|
| Rate for Payer: Cofinity Commercial |
$371.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.34
|
| Rate for Payer: Healthscope Commercial |
$388.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.93
|
| Rate for Payer: PHP Commercial |
$366.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.59
|
| Rate for Payer: Priority Health SBD |
$271.96
|
| Rate for Payer: UMR Bronson Commercial |
$159.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.76
|
|
|
AMINOCAPROIC ACID 500 MG TABLET
|
Facility
|
OP
|
$615.94
|
|
|
Service Code
|
NDC 69680011530
|
| Hospital Charge Code |
9063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.90 |
| Max. Negotiated Rate |
$554.35 |
| Rate for Payer: Aetna American Axle |
$400.36
|
| Rate for Payer: Aetna Commercial |
$523.55
|
| Rate for Payer: Aetna Medicare |
$307.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.36
|
| Rate for Payer: BCBS Complete |
$246.38
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cofinity Commercial |
$431.16
|
| Rate for Payer: Cofinity Commercial |
$529.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$431.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.75
|
| Rate for Payer: Healthscope Commercial |
$554.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$431.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.55
|
| Rate for Payer: PHP Commercial |
$523.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.36
|
| Rate for Payer: Priority Health SBD |
$388.04
|
| Rate for Payer: UMR Bronson Commercial |
$227.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.95
|
|
|
AMINOCAPROIC ACID 500 MG TABLET
|
Facility
|
IP
|
$2,217.34
|
|
|
Service Code
|
NDC 49411005030
|
| Hospital Charge Code |
9063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$975.63 |
| Max. Negotiated Rate |
$1,995.61 |
| Rate for Payer: Aetna American Axle |
$1,441.27
|
| Rate for Payer: Aetna Commercial |
$1,884.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,441.27
|
| Rate for Payer: Cash Price |
$1,773.87
|
| Rate for Payer: Cofinity Commercial |
$1,552.14
|
| Rate for Payer: Cofinity Commercial |
$1,906.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,552.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,773.87
|
| Rate for Payer: Healthscope Commercial |
$1,995.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,552.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,663.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,884.74
|
| Rate for Payer: PHP Commercial |
$1,884.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,441.27
|
| Rate for Payer: Priority Health SBD |
$1,396.92
|
| Rate for Payer: UMR Bronson Commercial |
$975.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,663.01
|
|
|
AMINOCAPROIC ACID 500 MG TABLET
|
Facility
|
OP
|
$2,217.34
|
|
|
Service Code
|
NDC 49411005030
|
| Hospital Charge Code |
9063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$820.42 |
| Max. Negotiated Rate |
$1,995.61 |
| Rate for Payer: Aetna American Axle |
$1,441.27
|
| Rate for Payer: Aetna Commercial |
$1,884.74
|
| Rate for Payer: Aetna Medicare |
$1,108.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,441.27
|
| Rate for Payer: BCBS Complete |
$886.94
|
| Rate for Payer: Cash Price |
$1,773.87
|
| Rate for Payer: Cofinity Commercial |
$1,552.14
|
| Rate for Payer: Cofinity Commercial |
$1,906.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,552.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,773.87
|
| Rate for Payer: Healthscope Commercial |
$1,995.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,552.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,663.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,884.74
|
| Rate for Payer: PHP Commercial |
$1,884.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,441.27
|
| Rate for Payer: Priority Health SBD |
$1,396.92
|
| Rate for Payer: UMR Bronson Commercial |
$820.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,663.01
|
|
|
AMINOCAPROIC ACID 500 MG TABLET
|
Facility
|
IP
|
$615.94
|
|
|
Service Code
|
NDC 69680011530
|
| Hospital Charge Code |
9063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.01 |
| Max. Negotiated Rate |
$554.35 |
| Rate for Payer: Aetna American Axle |
$400.36
|
| Rate for Payer: Aetna Commercial |
$523.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.36
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cofinity Commercial |
$431.16
|
| Rate for Payer: Cofinity Commercial |
$529.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$431.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.75
|
| Rate for Payer: Healthscope Commercial |
$554.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$431.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.55
|
| Rate for Payer: PHP Commercial |
$523.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.36
|
| Rate for Payer: Priority Health SBD |
$388.04
|
| Rate for Payer: UMR Bronson Commercial |
$271.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.95
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$165.30
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.16 |
| Max. Negotiated Rate |
$148.77 |
| Rate for Payer: Aetna American Axle |
$107.44
|
| Rate for Payer: Aetna Commercial |
$140.50
|
| Rate for Payer: Aetna Medicare |
$82.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.44
|
| Rate for Payer: BCBS Complete |
$66.12
|
| Rate for Payer: Cash Price |
$132.24
|
| Rate for Payer: Cofinity Commercial |
$115.71
|
| Rate for Payer: Cofinity Commercial |
$142.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.24
|
| Rate for Payer: Healthscope Commercial |
$148.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.50
|
| Rate for Payer: PHP Commercial |
$140.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.44
|
| Rate for Payer: Priority Health SBD |
$104.14
|
| Rate for Payer: UMR Bronson Commercial |
$61.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.97
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$165.30
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.73 |
| Max. Negotiated Rate |
$148.77 |
| Rate for Payer: Aetna American Axle |
$107.44
|
| Rate for Payer: Aetna Commercial |
$140.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.44
|
| Rate for Payer: Cash Price |
$132.24
|
| Rate for Payer: Cofinity Commercial |
$115.71
|
| Rate for Payer: Cofinity Commercial |
$142.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.24
|
| Rate for Payer: Healthscope Commercial |
$148.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.50
|
| Rate for Payer: PHP Commercial |
$140.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.44
|
| Rate for Payer: Priority Health SBD |
$104.14
|
| Rate for Payer: UMR Bronson Commercial |
$72.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.97
|
|
|
AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$32.76
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
113386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$29.48 |
| Rate for Payer: Aetna American Axle |
$21.29
|
| Rate for Payer: Aetna Commercial |
$27.85
|
| Rate for Payer: Aetna Medicare |
$16.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.29
|
| Rate for Payer: BCBS Complete |
$13.10
|
| Rate for Payer: Cash Price |
$26.21
|
| Rate for Payer: Cofinity Commercial |
$22.93
|
| Rate for Payer: Cofinity Commercial |
$28.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.21
|
| Rate for Payer: Healthscope Commercial |
$29.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.85
|
| Rate for Payer: PHP Commercial |
$27.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.29
|
| Rate for Payer: Priority Health SBD |
$20.64
|
| Rate for Payer: UMR Bronson Commercial |
$12.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.57
|
|
|
AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$32.76
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
113386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$29.48 |
| Rate for Payer: Aetna American Axle |
$21.29
|
| Rate for Payer: Aetna Commercial |
$27.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.29
|
| Rate for Payer: Cash Price |
$26.21
|
| Rate for Payer: Cofinity Commercial |
$22.93
|
| Rate for Payer: Cofinity Commercial |
$28.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.21
|
| Rate for Payer: Healthscope Commercial |
$29.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.85
|
| Rate for Payer: PHP Commercial |
$27.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.29
|
| Rate for Payer: Priority Health SBD |
$20.64
|
| Rate for Payer: UMR Bronson Commercial |
$14.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.57
|
|
|
AMIODARONE 100 MG TABLET
|
Facility
|
IP
|
$380.95
|
|
|
Service Code
|
NDC 00245014401
|
| Hospital Charge Code |
36959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.62 |
| Max. Negotiated Rate |
$342.86 |
| Rate for Payer: Aetna American Axle |
$247.62
|
| Rate for Payer: Aetna Commercial |
$323.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.62
|
| Rate for Payer: Cash Price |
$304.76
|
| Rate for Payer: Cofinity Commercial |
$266.67
|
| Rate for Payer: Cofinity Commercial |
$327.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.76
|
| Rate for Payer: Healthscope Commercial |
$342.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.81
|
| Rate for Payer: PHP Commercial |
$323.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.62
|
| Rate for Payer: Priority Health SBD |
$240.00
|
| Rate for Payer: UMR Bronson Commercial |
$167.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.71
|
|
|
AMIODARONE 100 MG TABLET
|
Facility
|
OP
|
$380.95
|
|
|
Service Code
|
NDC 00245014401
|
| Hospital Charge Code |
36959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.95 |
| Max. Negotiated Rate |
$342.86 |
| Rate for Payer: Aetna American Axle |
$247.62
|
| Rate for Payer: Aetna Commercial |
$323.81
|
| Rate for Payer: Aetna Medicare |
$190.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.62
|
| Rate for Payer: BCBS Complete |
$152.38
|
| Rate for Payer: Cash Price |
$304.76
|
| Rate for Payer: Cofinity Commercial |
$266.67
|
| Rate for Payer: Cofinity Commercial |
$327.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.76
|
| Rate for Payer: Healthscope Commercial |
$342.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.81
|
| Rate for Payer: PHP Commercial |
$323.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.62
|
| Rate for Payer: Priority Health SBD |
$240.00
|
| Rate for Payer: UMR Bronson Commercial |
$140.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.71
|
|
|
AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV
|
Facility
|
OP
|
$93.90
|
|
|
Service Code
|
HCPCS J0283
|
| Hospital Charge Code |
152869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.74 |
| Max. Negotiated Rate |
$84.51 |
| Rate for Payer: Aetna American Axle |
$61.03
|
| Rate for Payer: Aetna Commercial |
$79.81
|
| Rate for Payer: Aetna Medicare |
$46.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.03
|
| Rate for Payer: BCBS Complete |
$37.56
|
| Rate for Payer: Cash Price |
$75.12
|
| Rate for Payer: Cofinity Commercial |
$65.73
|
| Rate for Payer: Cofinity Commercial |
$80.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.12
|
| Rate for Payer: Healthscope Commercial |
$84.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.81
|
| Rate for Payer: PHP Commercial |
$79.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.03
|
| Rate for Payer: Priority Health SBD |
$59.16
|
| Rate for Payer: UMR Bronson Commercial |
$34.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.42
|
|
|
AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV
|
Facility
|
IP
|
$93.90
|
|
|
Service Code
|
HCPCS J0283
|
| Hospital Charge Code |
152869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$84.51 |
| Rate for Payer: Aetna American Axle |
$61.03
|
| Rate for Payer: Aetna Commercial |
$79.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.03
|
| Rate for Payer: Cash Price |
$75.12
|
| Rate for Payer: Cofinity Commercial |
$65.73
|
| Rate for Payer: Cofinity Commercial |
$80.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.12
|
| Rate for Payer: Healthscope Commercial |
$84.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.81
|
| Rate for Payer: PHP Commercial |
$79.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.03
|
| Rate for Payer: Priority Health SBD |
$59.16
|
| Rate for Payer: UMR Bronson Commercial |
$41.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.42
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$327.75
|
|
|
Service Code
|
NDC 68084037101
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.27 |
| Max. Negotiated Rate |
$294.98 |
| Rate for Payer: Aetna American Axle |
$213.04
|
| Rate for Payer: Aetna Commercial |
$278.59
|
| Rate for Payer: Aetna Medicare |
$163.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.04
|
| Rate for Payer: BCBS Complete |
$131.10
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cofinity Commercial |
$229.43
|
| Rate for Payer: Cofinity Commercial |
$281.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.20
|
| Rate for Payer: Healthscope Commercial |
$294.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.59
|
| Rate for Payer: PHP Commercial |
$278.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.04
|
| Rate for Payer: Priority Health SBD |
$206.48
|
| Rate for Payer: UMR Bronson Commercial |
$121.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.81
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$327.75
|
|
|
Service Code
|
NDC 68084037111
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.27 |
| Max. Negotiated Rate |
$294.98 |
| Rate for Payer: Aetna American Axle |
$213.04
|
| Rate for Payer: Aetna Commercial |
$278.59
|
| Rate for Payer: Aetna Medicare |
$163.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.04
|
| Rate for Payer: BCBS Complete |
$131.10
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cofinity Commercial |
$229.43
|
| Rate for Payer: Cofinity Commercial |
$281.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.20
|
| Rate for Payer: Healthscope Commercial |
$294.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.59
|
| Rate for Payer: PHP Commercial |
$278.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.04
|
| Rate for Payer: Priority Health SBD |
$206.48
|
| Rate for Payer: UMR Bronson Commercial |
$121.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.81
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$260.85
|
|
|
Service Code
|
NDC 63739005110
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.51 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna American Axle |
$169.55
|
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna Medicare |
$130.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.55
|
| Rate for Payer: BCBS Complete |
$104.34
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$182.59
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.55
|
| Rate for Payer: Priority Health SBD |
$164.34
|
| Rate for Payer: UMR Bronson Commercial |
$96.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$197.40
|
|
|
Service Code
|
NDC 00245014760
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.04 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna American Axle |
$128.31
|
| Rate for Payer: Aetna Commercial |
$167.79
|
| Rate for Payer: Aetna Medicare |
$98.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.31
|
| Rate for Payer: BCBS Complete |
$78.96
|
| Rate for Payer: Cash Price |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$138.18
|
| Rate for Payer: Cofinity Commercial |
$169.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.92
|
| Rate for Payer: Healthscope Commercial |
$177.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.79
|
| Rate for Payer: PHP Commercial |
$167.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.31
|
| Rate for Payer: Priority Health SBD |
$124.36
|
| Rate for Payer: UMR Bronson Commercial |
$73.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.05
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$2.06
|
|
|
Service Code
|
NDC 00245014789
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna American Axle |
$1.34
|
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.34
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Cofinity Commercial |
$1.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.65
|
| Rate for Payer: Healthscope Commercial |
$1.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.75
|
| Rate for Payer: PHP Commercial |
$1.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.34
|
| Rate for Payer: Priority Health SBD |
$1.30
|
| Rate for Payer: UMR Bronson Commercial |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.54
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$248.16
|
|
|
Service Code
|
NDC 51672402504
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.82 |
| Max. Negotiated Rate |
$223.34 |
| Rate for Payer: Aetna American Axle |
$161.30
|
| Rate for Payer: Aetna Commercial |
$210.94
|
| Rate for Payer: Aetna Medicare |
$124.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.30
|
| Rate for Payer: BCBS Complete |
$99.26
|
| Rate for Payer: Cash Price |
$198.53
|
| Rate for Payer: Cofinity Commercial |
$173.71
|
| Rate for Payer: Cofinity Commercial |
$213.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.53
|
| Rate for Payer: Healthscope Commercial |
$223.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.94
|
| Rate for Payer: PHP Commercial |
$210.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.30
|
| Rate for Payer: Priority Health SBD |
$156.34
|
| Rate for Payer: UMR Bronson Commercial |
$91.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.12
|
|
