|
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 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: MI Amish Medical Board Commercial |
$208.68
|
| 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: UHC All Payor (Choice/PPO) |
$169.55
|
| Rate for Payer: UHC Core |
$135.90
|
| Rate for Payer: UHC Exchange |
$102.51
|
| 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
|
$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
|
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 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.21
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
9065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna American Axle |
$11.84
|
| Rate for Payer: Aetna American Axle |
$14.11
|
| Rate for Payer: Aetna American Axle |
$16.83
|
| Rate for Payer: Aetna American Axle |
$14.68
|
| Rate for Payer: Aetna American Axle |
$11.19
|
| Rate for Payer: Aetna American Axle |
$10.34
|
| Rate for Payer: Aetna American Axle |
$36.24
|
| Rate for Payer: Aetna American Axle |
$18.67
|
| Rate for Payer: Aetna American Axle |
$17.99
|
| Rate for Payer: Aetna Commercial |
$19.20
|
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Commercial |
$18.45
|
| Rate for Payer: Aetna Commercial |
$22.01
|
| 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 |
$9.11
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Aetna Medicare |
$13.84
|
| Rate for Payer: Aetna Medicare |
$7.95
|
| Rate for Payer: Aetna Medicare |
$27.88
|
| Rate for Payer: Aetna Medicare |
$11.29
|
| Rate for Payer: Aetna Medicare |
$10.86
|
| Rate for Payer: Aetna Medicare |
$14.36
|
| Rate for Payer: Aetna Medicare |
$12.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.84
|
| 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) |
$16.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.11
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS Complete |
$8.68
|
| Rate for Payer: BCBS Complete |
$11.07
|
| Rate for Payer: BCBS Complete |
$9.04
|
| Rate for Payer: BCBS Complete |
$22.30
|
| Rate for Payer: BCBS Complete |
$11.49
|
| Rate for Payer: BCBS Complete |
$6.36
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$17.37
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$17.37
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cofinity Advantage |
$12.05
|
| Rate for Payer: Cofinity Advantage |
$12.75
|
| Rate for Payer: Cofinity Advantage |
$11.13
|
| Rate for Payer: Cofinity Advantage |
$15.20
|
| Rate for Payer: Cofinity Advantage |
$15.81
|
| Rate for Payer: Cofinity Advantage |
$18.12
|
| Rate for Payer: Cofinity Advantage |
$19.37
|
| Rate for Payer: Cofinity Advantage |
$20.10
|
| Rate for Payer: Cofinity Advantage |
$39.02
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$13.67
|
| Rate for Payer: Cofinity Commercial |
$19.43
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$47.95
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$50.17
|
| Rate for Payer: Healthscope Commercial |
$19.54
|
| Rate for Payer: Healthscope Commercial |
$25.85
|
| Rate for Payer: Healthscope Commercial |
$24.90
|
| Rate for Payer: Healthscope Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$20.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.75
|
| 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 |
$39.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| 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 |
$18.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.54
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: PHP Commercial |
$18.45
|
| Rate for Payer: PHP Commercial |
$19.20
|
| Rate for Payer: PHP Commercial |
$47.39
|
| Rate for Payer: PHP Commercial |
$22.01
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$23.52
|
| Rate for Payer: PHP Commercial |
$24.41
|
| Rate for Payer: Priority Health SBD |
$14.23
|
| Rate for Payer: Priority Health SBD |
$17.43
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: Priority Health SBD |
$11.47
|
| Rate for Payer: Priority Health SBD |
$16.31
|
| Rate for Payer: Priority Health SBD |
$35.12
|
| Rate for Payer: Priority Health SBD |
$10.02
|
| Rate for Payer: Priority Health SBD |
$13.68
|
| Rate for Payer: Priority Health SBD |
$18.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: UMR Bronson Commercial |
$6.74
|
| Rate for Payer: UMR Bronson Commercial |
$8.36
|
| Rate for Payer: UMR Bronson Commercial |
$10.24
|
| Rate for Payer: UMR Bronson Commercial |
$10.63
|
| Rate for Payer: UMR Bronson Commercial |
$20.63
|
| Rate for Payer: UMR Bronson Commercial |
$5.88
|
| Rate for Payer: UMR Bronson Commercial |
$6.37
|
| Rate for Payer: UMR Bronson Commercial |
$8.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
|
|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$55.75
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
9065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$50.17 |
| Rate for Payer: Aetna American Axle |
$36.24
|
| Rate for Payer: Aetna American Axle |
$18.67
|
| Rate for Payer: Aetna American Axle |
$10.34
|
| Rate for Payer: Aetna American Axle |
$17.99
|
| Rate for Payer: Aetna American Axle |
$16.83
|
| Rate for Payer: Aetna American Axle |
$14.68
|
| Rate for Payer: Aetna American Axle |
$14.11
|
| Rate for Payer: Aetna American Axle |
$11.84
|
| Rate for Payer: Aetna American Axle |
$11.19
|
| Rate for Payer: Aetna Commercial |
$24.41
|
| Rate for Payer: Aetna Commercial |
$22.01
|
| Rate for Payer: Aetna Commercial |
$23.52
|
| Rate for Payer: Aetna Commercial |
$18.45
|
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Commercial |
$47.39
|
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$19.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.11
|
| 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: Cash Price |
$22.14
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$17.37
|
| Rate for Payer: Cofinity Advantage |
$12.75
|
| Rate for Payer: Cofinity Advantage |
$15.20
|
| Rate for Payer: Cofinity Advantage |
$15.81
|
| Rate for Payer: Cofinity Advantage |
$12.05
|
| Rate for Payer: Cofinity Advantage |
$39.02
|
| Rate for Payer: Cofinity Advantage |
$19.37
|
| Rate for Payer: Cofinity Advantage |
$18.12
|
| Rate for Payer: Cofinity Advantage |
$20.10
|
| Rate for Payer: Cofinity Advantage |
$11.13
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$19.43
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$13.67
|
| Rate for Payer: Cofinity Commercial |
$47.95
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.71
|
| Rate for Payer: Healthscope Commercial |
$25.85
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$24.90
|
| Rate for Payer: Healthscope Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$19.54
|
| Rate for Payer: Healthscope Commercial |
$50.17
|
| Rate for Payer: Healthscope Commercial |
$20.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.02
|
| 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 |
$19.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.75
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$18.45
|
| Rate for Payer: PHP Commercial |
$24.41
|
| Rate for Payer: PHP Commercial |
$19.20
|
| Rate for Payer: PHP Commercial |
$22.01
|
| Rate for Payer: PHP Commercial |
$23.52
|
| Rate for Payer: PHP Commercial |
$47.39
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: Priority Health SBD |
$16.31
|
| Rate for Payer: Priority Health SBD |
$14.23
|
| Rate for Payer: Priority Health SBD |
$35.12
|
| Rate for Payer: Priority Health SBD |
$17.43
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: Priority Health SBD |
$10.02
|
| Rate for Payer: Priority Health SBD |
$18.09
|
| Rate for Payer: Priority Health SBD |
$11.47
|
| Rate for Payer: Priority Health SBD |
$13.68
|
| Rate for Payer: UMR Bronson Commercial |
$7.00
|
| Rate for Payer: UMR Bronson Commercial |
$8.01
|
| Rate for Payer: UMR Bronson Commercial |
$11.39
|
| Rate for Payer: UMR Bronson Commercial |
$9.55
|
| Rate for Payer: UMR Bronson Commercial |
$12.17
|
| Rate for Payer: UMR Bronson Commercial |
$9.94
|
| Rate for Payer: UMR Bronson Commercial |
$24.53
|
| Rate for Payer: UMR Bronson Commercial |
$7.57
|
| Rate for Payer: UMR Bronson Commercial |
$12.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.81
|
|
|
AMIODARONE 50 MG/ML IV (CODE)
|
Facility
|
OP
|
$22.59
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
163703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Aetna American Axle |
$14.68
|
| Rate for Payer: Aetna American Axle |
$11.84
|
| Rate for Payer: Aetna American Axle |
$36.24
|
| Rate for Payer: Aetna Commercial |
$19.20
|
| Rate for Payer: Aetna Commercial |
$47.39
|
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Medicare |
$11.29
|
| Rate for Payer: Aetna Medicare |
$9.11
|
| Rate for Payer: Aetna Medicare |
$27.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.24
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS Complete |
$9.04
|
| Rate for Payer: BCBS Complete |
$22.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cofinity Advantage |
$39.02
|
| Rate for Payer: Cofinity Advantage |
$15.81
|
| Rate for Payer: Cofinity Advantage |
$12.75
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$19.43
|
| Rate for Payer: Cofinity Commercial |
$47.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.07
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$20.33
|
| Rate for Payer: Healthscope Commercial |
$50.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.81
|
| Rate for Payer: PHP Commercial |
$19.20
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: PHP Commercial |
$47.39
|
| Rate for Payer: Priority Health SBD |
$11.47
|
| Rate for Payer: Priority Health SBD |
$35.12
|
| Rate for Payer: Priority Health SBD |
$14.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UMR Bronson Commercial |
$20.63
|
| Rate for Payer: UMR Bronson Commercial |
$6.74
|
| Rate for Payer: UMR Bronson Commercial |
$8.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.81
|
|
|
AMIODARONE 50 MG/ML IV (CODE)
|
Facility
|
IP
|
$18.21
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
163703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna American Axle |
$11.84
|
| Rate for Payer: Aetna American Axle |
$36.24
|
| Rate for Payer: Aetna American Axle |
$14.68
|
| Rate for Payer: Aetna Commercial |
$19.20
|
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$47.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.68
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cofinity Advantage |
$39.02
|
| Rate for Payer: Cofinity Advantage |
$12.75
|
| Rate for Payer: Cofinity Advantage |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$47.95
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$19.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.60
|
| Rate for Payer: Healthscope Commercial |
$20.33
|
| Rate for Payer: Healthscope Commercial |
$50.17
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.81
|
| Rate for Payer: PHP Commercial |
$19.20
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: PHP Commercial |
$47.39
|
| Rate for Payer: Priority Health SBD |
$11.47
|
| Rate for Payer: Priority Health SBD |
$14.23
|
| Rate for Payer: Priority Health SBD |
$35.12
|
| Rate for Payer: UMR Bronson Commercial |
$8.01
|
| Rate for Payer: UMR Bronson Commercial |
$24.53
|
| Rate for Payer: UMR Bronson Commercial |
$9.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.81
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$3.50
|
|
|
Service Code
|
NDC 50268003711
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Aetna American Axle |
$2.27
|
| Rate for Payer: Aetna Commercial |
$2.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.27
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cofinity Advantage |
$2.45
|
| Rate for Payer: Cofinity Commercial |
$3.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.80
|
| Rate for Payer: Healthscope Commercial |
$3.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.62
|
| Rate for Payer: PHP Commercial |
$2.98
|
| Rate for Payer: Priority Health SBD |
$2.21
|
| Rate for Payer: UMR Bronson Commercial |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.62
|
|
|
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 |
$88.59
|
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.59
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Advantage |
$95.41
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| 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: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: PHP Commercial |
$115.86
|
| 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
|
$3.50
|
|
|
Service Code
|
NDC 50268003711
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Aetna American Axle |
$2.27
|
| Rate for Payer: Aetna Commercial |
$2.98
|
| Rate for Payer: Aetna Medicare |
$1.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.27
|
| Rate for Payer: BCBS Complete |
$1.40
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cofinity Advantage |
$2.45
|
| Rate for Payer: Cofinity Commercial |
$3.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.80
|
| Rate for Payer: Healthscope Commercial |
$3.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.62
|
| Rate for Payer: PHP Commercial |
$2.98
|
| Rate for Payer: Priority Health SBD |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.27
|
| Rate for Payer: UHC Core |
$1.82
|
| Rate for Payer: UHC Exchange |
$1.38
|
| Rate for Payer: UMR Bronson Commercial |
$1.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.62
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$274.95
|
|
|
Service Code
|
NDC 00781148601
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.73 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna American Axle |
$178.72
|
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna Medicare |
$137.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.72
|
| Rate for Payer: BCBS Complete |
$109.98
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Advantage |
$192.47
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.21
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health SBD |
$173.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.72
|
| Rate for Payer: UHC Core |
$143.25
|
| Rate for Payer: UHC Exchange |
$108.06
|
| Rate for Payer: UMR Bronson Commercial |
$101.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$174.80
|
|
|
Service Code
|
NDC 50268003715
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$157.32 |
| Rate for Payer: Aetna American Axle |
$113.62
|
| Rate for Payer: Aetna Commercial |
$148.58
|
| Rate for Payer: Aetna Medicare |
$87.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.62
|
| Rate for Payer: BCBS Complete |
$69.92
|
| Rate for Payer: Cash Price |
$139.84
|
| Rate for Payer: Cofinity Advantage |
$122.36
|
| Rate for Payer: Cofinity Commercial |
$150.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.84
|
| Rate for Payer: Healthscope Commercial |
$157.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.10
|
| Rate for Payer: PHP Commercial |
$148.58
|
| Rate for Payer: Priority Health SBD |
$110.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.62
|
| Rate for Payer: UHC Core |
$91.07
|
| Rate for Payer: UHC Exchange |
$68.70
|
| Rate for Payer: UMR Bronson Commercial |
$64.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.10
|
|
|
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 |
$88.59
|
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna Medicare |
$68.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.59
|
| Rate for Payer: BCBS Complete |
$54.52
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Advantage |
$95.41
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| 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: MI Amish Medical Board Commercial |
$109.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.59
|
| Rate for Payer: UHC Core |
$71.01
|
| Rate for Payer: UHC Exchange |
$53.57
|
| 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
|
$124.55
|
|
|
Service Code
|
NDC 29300041901
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Aetna American Axle |
$80.96
|
| Rate for Payer: Aetna Commercial |
$105.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.96
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Advantage |
$87.19
|
| Rate for Payer: Cofinity Commercial |
$107.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.41
|
| Rate for Payer: PHP Commercial |
$105.87
|
| Rate for Payer: Priority Health SBD |
$78.47
|
| Rate for Payer: UMR Bronson Commercial |
$54.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.41
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 00781148601
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.98 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna American Axle |
$178.72
|
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.72
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Advantage |
$192.47
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.21
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health SBD |
$173.22
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$174.80
|
|
|
Service Code
|
NDC 50268003715
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.91 |
| Max. Negotiated Rate |
$157.32 |
| Rate for Payer: Aetna American Axle |
$113.62
|
| Rate for Payer: Aetna Commercial |
$148.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.62
|
| Rate for Payer: Cash Price |
$139.84
|
| Rate for Payer: Cofinity Advantage |
$122.36
|
| Rate for Payer: Cofinity Commercial |
$150.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.84
|
| Rate for Payer: Healthscope Commercial |
$157.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.10
|
| Rate for Payer: PHP Commercial |
$148.58
|
| Rate for Payer: Priority Health SBD |
$110.12
|
| Rate for Payer: UMR Bronson Commercial |
$76.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.10
|
|
|
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 Advantage |
$98.70
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| 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: MI Amish Medical Board Commercial |
$112.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.75
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.65
|
| Rate for Payer: UHC Core |
$73.46
|
| Rate for Payer: UHC Exchange |
$55.41
|
| Rate for Payer: UMR Bronson Commercial |
$52.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$124.55
|
|
|
Service Code
|
NDC 29300041901
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Aetna American Axle |
$80.96
|
| Rate for Payer: Aetna Commercial |
$105.87
|
| Rate for Payer: Aetna Medicare |
$62.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.96
|
| Rate for Payer: BCBS Complete |
$49.82
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Advantage |
$87.19
|
| Rate for Payer: Cofinity Commercial |
$107.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.41
|
| Rate for Payer: PHP Commercial |
$105.87
|
| Rate for Payer: Priority Health SBD |
$78.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.96
|
| Rate for Payer: UHC Core |
$64.89
|
| Rate for Payer: UHC Exchange |
$48.95
|
| Rate for Payer: UMR Bronson Commercial |
$46.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.41
|
|
|
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 Advantage |
$98.70
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| 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: Opus (Opus Packaging Group) HMA |
$105.75
|
| Rate for Payer: PHP Commercial |
$119.85
|
| 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 25 MG TABLET
|
Facility
|
IP
|
$3.37
|
|
|
Service Code
|
NDC 60687043311
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna American Axle |
$2.19
|
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.19
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Advantage |
$2.36
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.53
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health SBD |
$2.12
|
| Rate for Payer: UMR Bronson Commercial |
$1.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.53
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
OP
|
$305.90
|
|
|
Service Code
|
NDC 00904741061
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.18 |
| Max. Negotiated Rate |
$275.31 |
| Rate for Payer: Aetna American Axle |
$198.84
|
| Rate for Payer: Aetna Commercial |
$260.01
|
| Rate for Payer: Aetna Medicare |
$152.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.84
|
| Rate for Payer: BCBS Complete |
$122.36
|
| Rate for Payer: Cash Price |
$244.72
|
| Rate for Payer: Cofinity Advantage |
$214.13
|
| Rate for Payer: Cofinity Commercial |
$263.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.72
|
| Rate for Payer: Healthscope Commercial |
$275.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.43
|
| Rate for Payer: PHP Commercial |
$260.01
|
| Rate for Payer: Priority Health SBD |
$192.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.84
|
| Rate for Payer: UHC Core |
$159.37
|
| Rate for Payer: UHC Exchange |
$120.22
|
| Rate for Payer: UMR Bronson Commercial |
$113.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.43
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
IP
|
$305.90
|
|
|
Service Code
|
NDC 00904741061
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.60 |
| Max. Negotiated Rate |
$275.31 |
| Rate for Payer: Aetna American Axle |
$198.84
|
| Rate for Payer: Aetna Commercial |
$260.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.84
|
| Rate for Payer: Cash Price |
$244.72
|
| Rate for Payer: Cofinity Advantage |
$214.13
|
| Rate for Payer: Cofinity Commercial |
$263.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.72
|
| Rate for Payer: Healthscope Commercial |
$275.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.43
|
| Rate for Payer: PHP Commercial |
$260.01
|
| Rate for Payer: Priority Health SBD |
$192.72
|
| Rate for Payer: UMR Bronson Commercial |
$134.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.43
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
OP
|
$225.15
|
|
|
Service Code
|
NDC 00904718461
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.31 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna Medicare |
$112.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.35
|
| Rate for Payer: BCBS Complete |
$90.06
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Advantage |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.86
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.35
|
| Rate for Payer: UHC Core |
$117.30
|
| Rate for Payer: UHC Exchange |
$88.48
|
| Rate for Payer: UMR Bronson Commercial |
$83.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
OP
|
$3.37
|
|
|
Service Code
|
NDC 60687043311
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna American Axle |
$2.19
|
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Medicare |
$1.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.19
|
| Rate for Payer: BCBS Complete |
$1.35
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Advantage |
$2.36
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.53
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health SBD |
$2.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC Core |
$1.76
|
| Rate for Payer: UHC Exchange |
$1.32
|
| Rate for Payer: UMR Bronson Commercial |
$1.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.53
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 00904718461
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.07 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.35
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Advantage |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.86
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UMR Bronson Commercial |
$99.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
