|
AMIODARONE 100 MG TABLET
|
Facility
|
OP
|
$387.60
|
|
|
Service Code
|
NDC 00245014401
|
| Hospital Charge Code |
36959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.41 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna American Axle |
$251.94
|
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: Aetna Medicare |
$193.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.94
|
| Rate for Payer: BCBS Complete |
$155.04
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Advantage |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$310.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.70
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: Priority Health SBD |
$244.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.94
|
| Rate for Payer: UHC Core |
$201.94
|
| Rate for Payer: UHC Exchange |
$152.33
|
| Rate for Payer: UMR Bronson Commercial |
$143.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.70
|
|
|
AMIODARONE 100 MG TABLET
|
Facility
|
OP
|
$287.72
|
|
|
Service Code
|
NDC 75907000530
|
| Hospital Charge Code |
36959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.46 |
| Max. Negotiated Rate |
$258.95 |
| Rate for Payer: Aetna American Axle |
$187.02
|
| Rate for Payer: Aetna Commercial |
$244.56
|
| Rate for Payer: Aetna Medicare |
$143.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.02
|
| Rate for Payer: BCBS Complete |
$115.09
|
| Rate for Payer: Cash Price |
$230.18
|
| Rate for Payer: Cofinity Advantage |
$201.40
|
| Rate for Payer: Cofinity Commercial |
$247.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.18
|
| Rate for Payer: Healthscope Commercial |
$258.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.79
|
| Rate for Payer: PHP Commercial |
$244.56
|
| Rate for Payer: Priority Health SBD |
$181.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.02
|
| Rate for Payer: UHC Core |
$149.90
|
| Rate for Payer: UHC Exchange |
$113.07
|
| Rate for Payer: UMR Bronson Commercial |
$106.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.79
|
|
|
AMIODARONE 100 MG TABLET
|
Facility
|
OP
|
$82.37
|
|
|
Service Code
|
NDC 72888006030
|
| Hospital Charge Code |
36959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$74.13 |
| Rate for Payer: Aetna American Axle |
$53.54
|
| Rate for Payer: Aetna Commercial |
$70.01
|
| Rate for Payer: Aetna Medicare |
$41.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.54
|
| Rate for Payer: BCBS Complete |
$32.95
|
| Rate for Payer: Cash Price |
$65.90
|
| Rate for Payer: Cofinity Advantage |
$57.66
|
| Rate for Payer: Cofinity Commercial |
$70.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.90
|
| Rate for Payer: Healthscope Commercial |
$74.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.78
|
| Rate for Payer: PHP Commercial |
$70.01
|
| Rate for Payer: Priority Health SBD |
$51.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.54
|
| Rate for Payer: UHC Core |
$42.91
|
| Rate for Payer: UHC Exchange |
$32.37
|
| Rate for Payer: UMR Bronson Commercial |
$30.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.78
|
|
|
AMIODARONE 100 MG TABLET
|
Facility
|
IP
|
$287.72
|
|
|
Service Code
|
NDC 75907000530
|
| Hospital Charge Code |
36959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.60 |
| Max. Negotiated Rate |
$258.95 |
| Rate for Payer: Aetna American Axle |
$187.02
|
| Rate for Payer: Aetna Commercial |
$244.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.02
|
| Rate for Payer: Cash Price |
$230.18
|
| Rate for Payer: Cofinity Advantage |
$201.40
|
| Rate for Payer: Cofinity Commercial |
$247.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.18
|
| Rate for Payer: Healthscope Commercial |
$258.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.79
|
| Rate for Payer: PHP Commercial |
$244.56
|
| Rate for Payer: Priority Health SBD |
$181.26
|
| Rate for Payer: UMR Bronson Commercial |
$126.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.79
|
|
|
AMIODARONE 100 MG TABLET
|
Facility
|
IP
|
$387.60
|
|
|
Service Code
|
NDC 00245014401
|
| Hospital Charge Code |
36959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.54 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna American Axle |
$251.94
|
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.94
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Advantage |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.70
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: Priority Health SBD |
$244.19
|
| Rate for Payer: UMR Bronson Commercial |
$170.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.70
|
|
|
AMIODARONE 100 MG TABLET
|
Facility
|
IP
|
$82.37
|
|
|
Service Code
|
NDC 72888006030
|
| Hospital Charge Code |
36959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.24 |
| Max. Negotiated Rate |
$74.13 |
| Rate for Payer: Aetna American Axle |
$53.54
|
| Rate for Payer: Aetna Commercial |
$70.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.54
|
| Rate for Payer: Cash Price |
$65.90
|
| Rate for Payer: Cofinity Advantage |
$57.66
|
| Rate for Payer: Cofinity Commercial |
$70.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.90
|
| Rate for Payer: Healthscope Commercial |
$74.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.78
|
| Rate for Payer: PHP Commercial |
$70.01
|
| Rate for Payer: Priority Health SBD |
$51.89
|
| Rate for Payer: UMR Bronson Commercial |
$36.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.78
|
|
|
AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV
|
Facility
|
IP
|
$103.69
|
|
|
Service Code
|
HCPCS J0283
|
| Hospital Charge Code |
152869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$93.32 |
| Rate for Payer: Aetna American Axle |
$67.40
|
| Rate for Payer: Aetna Commercial |
$88.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.40
|
| Rate for Payer: Cash Price |
$82.95
|
| Rate for Payer: Cofinity Advantage |
$72.58
|
| Rate for Payer: Cofinity Commercial |
$89.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.95
|
| Rate for Payer: Healthscope Commercial |
$93.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.77
|
| Rate for Payer: PHP Commercial |
$88.14
|
| Rate for Payer: Priority Health SBD |
$65.32
|
| Rate for Payer: UMR Bronson Commercial |
$45.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.77
|
|
|
AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV
|
Facility
|
OP
|
$103.69
|
|
|
Service Code
|
HCPCS J0283
|
| Hospital Charge Code |
152869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$93.32 |
| Rate for Payer: Aetna American Axle |
$67.40
|
| Rate for Payer: Aetna Commercial |
$88.14
|
| Rate for Payer: Aetna Medicare |
$51.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.40
|
| Rate for Payer: BCBS Complete |
$41.48
|
| Rate for Payer: BCBS Trust/PPO |
$8.18
|
| Rate for Payer: BCN Commercial |
$8.18
|
| Rate for Payer: Cash Price |
$82.95
|
| Rate for Payer: Cash Price |
$82.95
|
| Rate for Payer: Cofinity Advantage |
$72.58
|
| Rate for Payer: Cofinity Commercial |
$89.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.95
|
| Rate for Payer: Healthscope Commercial |
$93.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.77
|
| Rate for Payer: PHP Commercial |
$88.14
|
| Rate for Payer: Priority Health SBD |
$65.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.17
|
| Rate for Payer: UHC Core |
$4.17
|
| Rate for Payer: UHC Exchange |
$4.17
|
| Rate for Payer: UMR Bronson Commercial |
$38.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.77
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$143.07
|
|
|
Service Code
|
NDC 68382022714
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.95 |
| Max. Negotiated Rate |
$128.76 |
| Rate for Payer: Aetna American Axle |
$93.00
|
| Rate for Payer: Aetna Commercial |
$121.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.00
|
| Rate for Payer: Cash Price |
$114.46
|
| Rate for Payer: Cofinity Advantage |
$100.15
|
| Rate for Payer: Cofinity Commercial |
$123.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.46
|
| Rate for Payer: Healthscope Commercial |
$128.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.30
|
| Rate for Payer: PHP Commercial |
$121.61
|
| Rate for Payer: Priority Health SBD |
$90.13
|
| Rate for Payer: UMR Bronson Commercial |
$62.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.30
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
NDC 00245014789
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna American Axle |
$1.43
|
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.43
|
| Rate for Payer: BCBS Complete |
$0.88
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Advantage |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$1.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.65
|
| Rate for Payer: PHP Commercial |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.43
|
| Rate for Payer: UHC Core |
$1.15
|
| Rate for Payer: UHC Exchange |
$0.86
|
| Rate for Payer: UMR Bronson Commercial |
$0.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.65
|
|
|
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 Advantage |
$229.43
|
| Rate for Payer: Cofinity Commercial |
$281.87
|
| 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: Opus (Opus Packaging Group) HMA |
$245.81
|
| Rate for Payer: PHP Commercial |
$278.59
|
| 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
|
$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 Advantage |
$229.43
|
| Rate for Payer: Cofinity Commercial |
$281.87
|
| 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: Opus (Opus Packaging Group) HMA |
$245.81
|
| Rate for Payer: PHP Commercial |
$278.59
|
| 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
|
$248.16
|
|
|
Service Code
|
NDC 29300035916
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.19 |
| Max. Negotiated Rate |
$223.34 |
| Rate for Payer: Aetna American Axle |
$161.30
|
| Rate for Payer: Aetna Commercial |
$210.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.30
|
| Rate for Payer: Cash Price |
$198.53
|
| Rate for Payer: Cofinity Advantage |
$173.71
|
| Rate for Payer: Cofinity Commercial |
$213.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.53
|
| Rate for Payer: Healthscope Commercial |
$223.34
|
| Rate for Payer: 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: Opus (Opus Packaging Group) HMA |
$186.12
|
| Rate for Payer: PHP Commercial |
$210.94
|
| Rate for Payer: Priority Health SBD |
$156.34
|
| Rate for Payer: UMR Bronson Commercial |
$109.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.12
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 00245014760
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.16 |
| Max. Negotiated Rate |
$196.69 |
| Rate for Payer: Aetna American Axle |
$142.06
|
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.06
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Advantage |
$152.99
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health SBD |
$137.69
|
| Rate for Payer: UMR Bronson Commercial |
$96.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.91
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$143.07
|
|
|
Service Code
|
NDC 65862073260
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$128.76 |
| Rate for Payer: Aetna American Axle |
$93.00
|
| Rate for Payer: Aetna Commercial |
$121.61
|
| Rate for Payer: Aetna Medicare |
$71.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.00
|
| Rate for Payer: BCBS Complete |
$57.23
|
| Rate for Payer: Cash Price |
$114.46
|
| Rate for Payer: Cofinity Advantage |
$100.15
|
| Rate for Payer: Cofinity Commercial |
$123.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.46
|
| Rate for Payer: Healthscope Commercial |
$128.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.30
|
| Rate for Payer: PHP Commercial |
$121.61
|
| Rate for Payer: Priority Health SBD |
$90.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.00
|
| Rate for Payer: UHC Core |
$74.54
|
| Rate for Payer: UHC Exchange |
$56.23
|
| Rate for Payer: UMR Bronson Commercial |
$52.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.30
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$143.07
|
|
|
Service Code
|
NDC 65862073260
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.95 |
| Max. Negotiated Rate |
$128.76 |
| Rate for Payer: Aetna American Axle |
$93.00
|
| Rate for Payer: Aetna Commercial |
$121.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.00
|
| Rate for Payer: Cash Price |
$114.46
|
| Rate for Payer: Cofinity Advantage |
$100.15
|
| Rate for Payer: Cofinity Commercial |
$123.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.46
|
| Rate for Payer: Healthscope Commercial |
$128.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.30
|
| Rate for Payer: PHP Commercial |
$121.61
|
| Rate for Payer: Priority Health SBD |
$90.13
|
| Rate for Payer: UMR Bronson Commercial |
$62.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.30
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
NDC 00245014789
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna American Axle |
$1.43
|
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.43
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Advantage |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$1.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.65
|
| Rate for Payer: PHP Commercial |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.39
|
| Rate for Payer: UMR Bronson Commercial |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.65
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$218.55
|
|
|
Service Code
|
NDC 00245014760
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.86 |
| Max. Negotiated Rate |
$196.69 |
| Rate for Payer: Aetna American Axle |
$142.06
|
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna Medicare |
$109.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.06
|
| Rate for Payer: BCBS Complete |
$87.42
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Advantage |
$152.99
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health SBD |
$137.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.06
|
| Rate for Payer: UHC Core |
$113.86
|
| Rate for Payer: UHC Exchange |
$85.89
|
| Rate for Payer: UMR Bronson Commercial |
$80.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.91
|
|
|
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 Advantage |
$173.71
|
| Rate for Payer: Cofinity Commercial |
$213.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.53
|
| Rate for Payer: Healthscope Commercial |
$223.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.12
|
| Rate for Payer: PHP Commercial |
$210.94
|
| Rate for Payer: Priority Health SBD |
$156.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$129.29
|
| Rate for Payer: UHC Exchange |
$97.53
|
| Rate for Payer: UMR Bronson Commercial |
$91.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.12
|
|
|
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 Advantage |
$182.59
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| 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: Opus (Opus Packaging Group) HMA |
$195.64
|
| Rate for Payer: PHP Commercial |
$221.72
|
| 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
|
$219.45
|
|
|
Service Code
|
NDC 00245014701
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna American Axle |
$142.64
|
| Rate for Payer: Aetna Commercial |
$186.53
|
| Rate for Payer: Aetna Medicare |
$109.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.64
|
| Rate for Payer: BCBS Complete |
$87.78
|
| Rate for Payer: Cash Price |
$175.56
|
| Rate for Payer: Cofinity Advantage |
$153.62
|
| Rate for Payer: Cofinity Commercial |
$188.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.56
|
| Rate for Payer: Healthscope Commercial |
$197.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.59
|
| Rate for Payer: PHP Commercial |
$186.53
|
| Rate for Payer: Priority Health SBD |
$138.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.64
|
| Rate for Payer: UHC Core |
$114.33
|
| Rate for Payer: UHC Exchange |
$86.24
|
| Rate for Payer: UMR Bronson Commercial |
$81.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.59
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$248.16
|
|
|
Service Code
|
NDC 29300035916
|
| 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 Advantage |
$173.71
|
| Rate for Payer: Cofinity Commercial |
$213.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.53
|
| Rate for Payer: Healthscope Commercial |
$223.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.12
|
| Rate for Payer: PHP Commercial |
$210.94
|
| Rate for Payer: Priority Health SBD |
$156.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$129.29
|
| Rate for Payer: UHC Exchange |
$97.53
|
| 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
|
$143.07
|
|
|
Service Code
|
NDC 68382022714
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$128.76 |
| Rate for Payer: Aetna American Axle |
$93.00
|
| Rate for Payer: Aetna Commercial |
$121.61
|
| Rate for Payer: Aetna Medicare |
$71.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.00
|
| Rate for Payer: BCBS Complete |
$57.23
|
| Rate for Payer: Cash Price |
$114.46
|
| Rate for Payer: Cofinity Advantage |
$100.15
|
| Rate for Payer: Cofinity Commercial |
$123.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.46
|
| Rate for Payer: Healthscope Commercial |
$128.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.30
|
| Rate for Payer: PHP Commercial |
$121.61
|
| Rate for Payer: Priority Health SBD |
$90.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.00
|
| Rate for Payer: UHC Core |
$74.54
|
| Rate for Payer: UHC Exchange |
$56.23
|
| Rate for Payer: UMR Bronson Commercial |
$52.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.30
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$248.16
|
|
|
Service Code
|
NDC 51672402504
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.19 |
| Max. Negotiated Rate |
$223.34 |
| Rate for Payer: Aetna American Axle |
$161.30
|
| Rate for Payer: Aetna Commercial |
$210.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.30
|
| Rate for Payer: Cash Price |
$198.53
|
| Rate for Payer: Cofinity Advantage |
$173.71
|
| Rate for Payer: Cofinity Commercial |
$213.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.53
|
| Rate for Payer: Healthscope Commercial |
$223.34
|
| Rate for Payer: 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: Opus (Opus Packaging Group) HMA |
$186.12
|
| Rate for Payer: PHP Commercial |
$210.94
|
| Rate for Payer: Priority Health SBD |
$156.34
|
| Rate for Payer: UMR Bronson Commercial |
$109.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.12
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$219.45
|
|
|
Service Code
|
NDC 00245014701
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.56 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna American Axle |
$142.64
|
| Rate for Payer: Aetna Commercial |
$186.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.64
|
| Rate for Payer: Cash Price |
$175.56
|
| Rate for Payer: Cofinity Advantage |
$153.62
|
| Rate for Payer: Cofinity Commercial |
$188.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.56
|
| Rate for Payer: Healthscope Commercial |
$197.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.59
|
| Rate for Payer: PHP Commercial |
$186.53
|
| Rate for Payer: Priority Health SBD |
$138.25
|
| Rate for Payer: UMR Bronson Commercial |
$96.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.59
|
|
