|
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
|
IP
|
$197.40
|
|
|
Service Code
|
NDC 00245014760
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.86 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna American Axle |
$128.31
|
| Rate for Payer: Aetna Commercial |
$167.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.31
|
| 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 |
$86.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.05
|
|
|
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
|
|
|
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 |
$229.42
|
| Rate for Payer: Cofinity Commercial |
$281.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.42
|
| 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 |
$229.42
|
| 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 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 |
$229.42
|
| Rate for Payer: Cofinity Commercial |
$281.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.42
|
| 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 |
$229.42
|
| 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
|
IP
|
$327.75
|
|
|
Service Code
|
NDC 68084037111
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.21 |
| Max. Negotiated Rate |
$294.98 |
| Rate for Payer: Aetna American Axle |
$213.04
|
| Rate for Payer: Aetna Commercial |
$278.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.04
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cofinity Commercial |
$229.42
|
| Rate for Payer: Cofinity Commercial |
$281.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.42
|
| 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 |
$229.42
|
| 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 |
$144.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.81
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 63739005110
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.77 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna American Axle |
$169.55
|
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.55
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$182.60
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.60
|
| 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 |
$182.60
|
| 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 |
$114.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
NDC 00245014789
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna American Axle |
$1.34
|
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.34
|
| Rate for Payer: BCBS Complete |
$0.82
|
| 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 |
$0.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.54
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$205.20
|
|
|
Service Code
|
NDC 00245014701
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.92 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna American Axle |
$133.38
|
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna Medicare |
$102.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.38
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health SBD |
$129.28
|
| Rate for Payer: UMR Bronson Commercial |
$75.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
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 |
$130.42
|
| 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 |
$182.60
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.60
|
| 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 |
$182.60
|
| 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
|
IP
|
$327.75
|
|
|
Service Code
|
NDC 68084037101
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.21 |
| Max. Negotiated Rate |
$294.98 |
| Rate for Payer: Aetna American Axle |
$213.04
|
| Rate for Payer: Aetna Commercial |
$278.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.04
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cofinity Commercial |
$229.42
|
| Rate for Payer: Cofinity Commercial |
$281.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.42
|
| 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 |
$229.42
|
| 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 |
$144.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.81
|
|
|
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 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.72
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
9065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$25.85 |
| Rate for Payer: Aetna American Axle |
$18.67
|
| Rate for Payer: Aetna American Axle |
$17.99
|
| Rate for Payer: Aetna American Axle |
$17.45
|
| Rate for Payer: Aetna American Axle |
$16.83
|
| Rate for Payer: Aetna American Axle |
$10.34
|
| Rate for Payer: Aetna American Axle |
$14.68
|
| Rate for Payer: Aetna American Axle |
$17.13
|
| Rate for Payer: Aetna American Axle |
$36.24
|
| Rate for Payer: Aetna Commercial |
$47.39
|
| Rate for Payer: Aetna Commercial |
$24.41
|
| Rate for Payer: Aetna Commercial |
$22.01
|
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna Commercial |
$19.20
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Commercial |
$23.52
|
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.45
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Cofinity Commercial |
$11.13
|
| Rate for Payer: Cofinity Commercial |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$19.43
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Commercial |
$13.67
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$23.08
|
| Rate for Payer: Cofinity Commercial |
$19.37
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$39.02
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.71
|
| Rate for Payer: Healthscope Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$50.18
|
| Rate for Payer: Healthscope Commercial |
$25.85
|
| Rate for Payer: Healthscope Commercial |
$24.16
|
| Rate for Payer: Healthscope Commercial |
$24.90
|
| Rate for Payer: Healthscope Commercial |
$23.72
|
| Rate for Payer: Healthscope Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$20.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.01
|
| Rate for Payer: PHP Commercial |
$24.41
|
| Rate for Payer: PHP Commercial |
$22.01
|
| Rate for Payer: PHP Commercial |
$23.52
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: PHP Commercial |
$47.39
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: PHP Commercial |
$19.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.83
|
| Rate for Payer: Priority Health SBD |
$16.31
|
| Rate for Payer: Priority Health SBD |
$14.23
|
| Rate for Payer: Priority Health SBD |
$10.02
|
| Rate for Payer: Priority Health SBD |
$16.61
|
| Rate for Payer: Priority Health SBD |
$17.43
|
| Rate for Payer: Priority Health SBD |
$16.91
|
| Rate for Payer: Priority Health SBD |
$35.12
|
| Rate for Payer: Priority Health SBD |
$18.09
|
| Rate for Payer: UMR Bronson Commercial |
$11.39
|
| Rate for Payer: UMR Bronson Commercial |
$11.60
|
| Rate for Payer: UMR Bronson Commercial |
$12.17
|
| Rate for Payer: UMR Bronson Commercial |
$12.64
|
| Rate for Payer: UMR Bronson Commercial |
$9.94
|
| Rate for Payer: UMR Bronson Commercial |
$24.53
|
| Rate for Payer: UMR Bronson Commercial |
$11.81
|
| Rate for Payer: UMR Bronson Commercial |
$7.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.13
|
|
|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$55.75
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
9065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$50.18 |
| Rate for Payer: Aetna American Axle |
$36.24
|
| Rate for Payer: Aetna American Axle |
$18.67
|
| Rate for Payer: Aetna American Axle |
$17.45
|
| Rate for Payer: Aetna American Axle |
$17.13
|
| Rate for Payer: Aetna American Axle |
$17.99
|
| Rate for Payer: Aetna American Axle |
$10.34
|
| Rate for Payer: Aetna American Axle |
$16.83
|
| Rate for Payer: Aetna American Axle |
$14.68
|
| Rate for Payer: Aetna Commercial |
$22.01
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Commercial |
$19.20
|
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna Commercial |
$23.52
|
| Rate for Payer: Aetna Commercial |
$24.41
|
| Rate for Payer: Aetna Commercial |
$47.39
|
| Rate for Payer: Aetna Medicare |
$13.18
|
| Rate for Payer: Aetna Medicare |
$11.30
|
| Rate for Payer: Aetna Medicare |
$14.36
|
| Rate for Payer: Aetna Medicare |
$12.94
|
| Rate for Payer: Aetna Medicare |
$27.88
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: Aetna Medicare |
$7.95
|
| Rate for Payer: Aetna Medicare |
$13.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.45
|
| Rate for Payer: BCBS Complete |
$22.30
|
| Rate for Payer: BCBS Complete |
$11.07
|
| Rate for Payer: BCBS Complete |
$10.54
|
| Rate for Payer: BCBS Complete |
$9.04
|
| Rate for Payer: BCBS Complete |
$6.36
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS Complete |
$11.49
|
| Rate for Payer: BCBS Complete |
$10.74
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cofinity Commercial |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$19.37
|
| Rate for Payer: Cofinity Commercial |
$11.13
|
| Rate for Payer: Cofinity Commercial |
$19.43
|
| Rate for Payer: Cofinity Commercial |
$39.02
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Cofinity Commercial |
$23.08
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$13.67
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.72
|
| Rate for Payer: Healthscope Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$23.72
|
| Rate for Payer: Healthscope Commercial |
$25.85
|
| Rate for Payer: Healthscope Commercial |
$50.18
|
| Rate for Payer: Healthscope Commercial |
$24.90
|
| Rate for Payer: Healthscope Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$20.33
|
| Rate for Payer: Healthscope Commercial |
$24.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: PHP Commercial |
$23.52
|
| Rate for Payer: PHP Commercial |
$19.20
|
| Rate for Payer: PHP Commercial |
$47.39
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: PHP Commercial |
$22.01
|
| Rate for Payer: PHP Commercial |
$24.41
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.67
|
| Rate for Payer: Priority Health SBD |
$10.02
|
| Rate for Payer: Priority Health SBD |
$35.12
|
| Rate for Payer: Priority Health SBD |
$16.61
|
| Rate for Payer: Priority Health SBD |
$16.91
|
| Rate for Payer: Priority Health SBD |
$14.23
|
| Rate for Payer: Priority Health SBD |
$16.31
|
| Rate for Payer: Priority Health SBD |
$18.09
|
| Rate for Payer: Priority Health SBD |
$17.43
|
| Rate for Payer: UMR Bronson Commercial |
$10.63
|
| Rate for Payer: UMR Bronson Commercial |
$20.63
|
| Rate for Payer: UMR Bronson Commercial |
$10.24
|
| Rate for Payer: UMR Bronson Commercial |
$9.93
|
| Rate for Payer: UMR Bronson Commercial |
$9.75
|
| Rate for Payer: UMR Bronson Commercial |
$8.36
|
| Rate for Payer: UMR Bronson Commercial |
$5.88
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.92
|
|
|
AMIODARONE 50 MG/ML IV (CODE)
|
Facility
|
OP
|
$55.75
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
163703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$50.18 |
| Rate for Payer: Aetna American Axle |
$36.24
|
| Rate for Payer: Aetna American Axle |
$17.13
|
| Rate for Payer: Aetna American Axle |
$14.68
|
| Rate for Payer: Aetna Commercial |
$47.39
|
| Rate for Payer: Aetna Commercial |
$19.20
|
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna Medicare |
$13.18
|
| Rate for Payer: Aetna Medicare |
$11.30
|
| Rate for Payer: Aetna Medicare |
$27.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.13
|
| Rate for Payer: BCBS Complete |
$10.54
|
| Rate for Payer: BCBS Complete |
$22.30
|
| Rate for Payer: BCBS Complete |
$9.04
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Cofinity Commercial |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$19.43
|
| Rate for Payer: Cofinity Commercial |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$39.02
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.60
|
| Rate for Payer: Healthscope Commercial |
$50.18
|
| Rate for Payer: Healthscope Commercial |
$23.72
|
| Rate for Payer: Healthscope Commercial |
$20.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.39
|
| Rate for Payer: PHP Commercial |
$47.39
|
| Rate for Payer: PHP Commercial |
$19.20
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.24
|
| Rate for Payer: Priority Health SBD |
$16.61
|
| Rate for Payer: Priority Health SBD |
$35.12
|
| Rate for Payer: Priority Health SBD |
$14.23
|
| Rate for Payer: UMR Bronson Commercial |
$20.63
|
| Rate for Payer: UMR Bronson Commercial |
$8.36
|
| Rate for Payer: UMR Bronson Commercial |
$9.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.81
|
|
|
AMIODARONE 50 MG/ML IV (CODE)
|
Facility
|
IP
|
$22.59
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
163703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Aetna American Axle |
$14.68
|
| Rate for Payer: Aetna American Axle |
$17.13
|
| Rate for Payer: Aetna American Axle |
$36.24
|
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna Commercial |
$19.20
|
| Rate for Payer: Aetna Commercial |
$47.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.13
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cofinity Commercial |
$19.43
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Cofinity Commercial |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Cofinity Commercial |
$39.02
|
| Rate for Payer: Cofinity Commercial |
$15.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$23.72
|
| Rate for Payer: Healthscope Commercial |
$20.33
|
| Rate for Payer: Healthscope Commercial |
$50.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: PHP Commercial |
$47.39
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: PHP Commercial |
$19.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.68
|
| Rate for Payer: Priority Health SBD |
$35.12
|
| Rate for Payer: Priority Health SBD |
$16.61
|
| Rate for Payer: Priority Health SBD |
$14.23
|
| Rate for Payer: UMR Bronson Commercial |
$9.94
|
| Rate for Payer: UMR Bronson Commercial |
$24.53
|
| Rate for Payer: UMR Bronson Commercial |
$11.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.77
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$176.23
|
|
|
Service Code
|
NDC 50268003715
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.21 |
| Max. Negotiated Rate |
$158.61 |
| Rate for Payer: Cofinity Commercial |
$151.56
|
| Rate for Payer: Aetna American Axle |
$114.55
|
| Rate for Payer: Aetna Commercial |
$149.80
|
| Rate for Payer: Aetna Medicare |
$88.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.55
|
| Rate for Payer: BCBS Complete |
$70.49
|
| Rate for Payer: Cash Price |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$123.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.98
|
| Rate for Payer: Healthscope Commercial |
$158.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.80
|
| Rate for Payer: PHP Commercial |
$149.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.55
|
| Rate for Payer: Priority Health SBD |
$111.02
|
| Rate for Payer: UMR Bronson Commercial |
$65.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.17
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$136.30
|
|
|
Service Code
|
NDC 16729017101
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna American Axle |
$88.60
|
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna Medicare |
$68.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.60
|
| Rate for Payer: BCBS Complete |
$54.52
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Cofinity Commercial |
$95.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.60
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UMR Bronson Commercial |
$50.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$3.53
|
|
|
Service Code
|
NDC 50268003711
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna American Axle |
$2.29
|
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.29
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.65
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 16729017101
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.97 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna American Axle |
$88.60
|
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.60
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Cofinity Commercial |
$95.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.60
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UMR Bronson Commercial |
$59.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$164.50
|
|
|
Service Code
|
NDC 29300041901
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$148.05 |
| Rate for Payer: Aetna American Axle |
$106.92
|
| Rate for Payer: Aetna Commercial |
$139.82
|
| Rate for Payer: Aetna Medicare |
$82.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.92
|
| Rate for Payer: BCBS Complete |
$65.80
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$115.15
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.60
|
| Rate for Payer: Healthscope Commercial |
$148.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.82
|
| Rate for Payer: PHP Commercial |
$139.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.92
|
| Rate for Payer: Priority Health SBD |
$103.64
|
| Rate for Payer: UMR Bronson Commercial |
$60.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.38
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 70756020111
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$52.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$176.23
|
|
|
Service Code
|
NDC 50268003715
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.54 |
| Max. Negotiated Rate |
$158.61 |
| Rate for Payer: Aetna American Axle |
$114.55
|
| Rate for Payer: Aetna Commercial |
$149.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.55
|
| Rate for Payer: Cash Price |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$123.36
|
| Rate for Payer: Cofinity Commercial |
$151.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.98
|
| Rate for Payer: Healthscope Commercial |
$158.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.80
|
| Rate for Payer: PHP Commercial |
$149.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.55
|
| Rate for Payer: Priority Health SBD |
$111.02
|
| Rate for Payer: UMR Bronson Commercial |
$77.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.17
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 70756020111
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$62.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$3.53
|
|
|
Service Code
|
NDC 50268003711
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna American Axle |
$2.29
|
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: BCBS Complete |
$1.41
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.29
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: UMR Bronson Commercial |
$1.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.65
|
|
