|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$446.50
|
|
|
Service Code
|
NDC 00527058601
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna American Axle |
$290.22
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna Medicare |
$223.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.22
|
| Rate for Payer: BCBS Complete |
$178.60
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.52
|
| Rate for Payer: PHP Commercial |
$379.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.22
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: UMR Bronson Commercial |
$165.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 00591079401
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.32 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$192.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$4.38
|
|
|
Service Code
|
NDC 60687036911
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna American Axle |
$2.85
|
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.85
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.85
|
| Rate for Payer: Priority Health SBD |
$2.76
|
| Rate for Payer: UMR Bronson Commercial |
$1.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$178.60
|
|
|
Service Code
|
NDC 00378161001
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna American Axle |
$116.09
|
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.09
|
| Rate for Payer: BCBS Complete |
$71.44
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Commercial |
$125.02
|
| Rate for Payer: Cofinity Commercial |
$153.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.81
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.09
|
| Rate for Payer: Priority Health SBD |
$112.52
|
| Rate for Payer: UMR Bronson Commercial |
$66.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$381.90
|
|
|
Service Code
|
NDC 51079011820
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.30 |
| Max. Negotiated Rate |
$343.71 |
| Rate for Payer: Aetna American Axle |
$248.24
|
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: Aetna Medicare |
$190.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.24
|
| Rate for Payer: BCBS Complete |
$152.76
|
| Rate for Payer: Cash Price |
$305.52
|
| Rate for Payer: Cofinity Commercial |
$267.33
|
| Rate for Payer: Cofinity Commercial |
$328.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$267.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.52
|
| Rate for Payer: Healthscope Commercial |
$343.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$267.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.62
|
| Rate for Payer: PHP Commercial |
$324.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.24
|
| Rate for Payer: Priority Health SBD |
$240.60
|
| Rate for Payer: UMR Bronson Commercial |
$141.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.42
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 00143312601
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.73 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$161.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$398.05
|
|
|
Service Code
|
NDC 00904698761
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.28 |
| Max. Negotiated Rate |
$358.24 |
| Rate for Payer: Aetna American Axle |
$258.73
|
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna Medicare |
$199.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: BCBS Complete |
$159.22
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Commercial |
$278.64
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: UMR Bronson Commercial |
$147.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$381.90
|
|
|
Service Code
|
NDC 51079011820
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.04 |
| Max. Negotiated Rate |
$343.71 |
| Rate for Payer: Aetna American Axle |
$248.24
|
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.24
|
| Rate for Payer: Cash Price |
$305.52
|
| Rate for Payer: Cofinity Commercial |
$267.33
|
| Rate for Payer: Cofinity Commercial |
$328.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$267.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.52
|
| Rate for Payer: Healthscope Commercial |
$343.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$267.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.62
|
| Rate for Payer: PHP Commercial |
$324.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.24
|
| Rate for Payer: Priority Health SBD |
$240.60
|
| Rate for Payer: UMR Bronson Commercial |
$168.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.42
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$446.50
|
|
|
Service Code
|
NDC 00527058601
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.46 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna American Axle |
$290.22
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.22
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.52
|
| Rate for Payer: PHP Commercial |
$379.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.22
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: UMR Bronson Commercial |
$196.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$398.05
|
|
|
Service Code
|
NDC 00904698761
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.14 |
| Max. Negotiated Rate |
$358.24 |
| Rate for Payer: Aetna American Axle |
$258.73
|
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Commercial |
$278.64
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: UMR Bronson Commercial |
$175.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 51079011801
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Aetna American Axle |
$2.48
|
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Aetna Medicare |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.48
|
| Rate for Payer: BCBS Complete |
$1.53
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: PHP Commercial |
$3.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.48
|
| Rate for Payer: Priority Health SBD |
$2.41
|
| Rate for Payer: UMR Bronson Commercial |
$1.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.86
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$4.38
|
|
|
Service Code
|
NDC 60687036911
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna American Axle |
$2.85
|
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Aetna Medicare |
$2.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.85
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.85
|
| Rate for Payer: Priority Health SBD |
$2.76
|
| Rate for Payer: UMR Bronson Commercial |
$1.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 00591079401
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.73 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$161.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$437.95
|
|
|
Service Code
|
NDC 60687036901
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.70 |
| Max. Negotiated Rate |
$394.16 |
| Rate for Payer: Cofinity Commercial |
$306.56
|
| Rate for Payer: Cofinity Commercial |
$376.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$306.56
|
| Rate for Payer: Aetna American Axle |
$284.67
|
| Rate for Payer: Aetna Commercial |
$372.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.67
|
| Rate for Payer: Cash Price |
$350.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.36
|
| Rate for Payer: Healthscope Commercial |
$394.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$306.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.26
|
| Rate for Payer: PHP Commercial |
$372.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.67
|
| Rate for Payer: Priority Health SBD |
$275.91
|
| Rate for Payer: UMR Bronson Commercial |
$192.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.46
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$90.29
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.73 |
| Max. Negotiated Rate |
$81.26 |
| Rate for Payer: Healthscope Commercial |
$81.26
|
| Rate for Payer: Healthscope Commercial |
$24.77
|
| Rate for Payer: Aetna American Axle |
$58.69
|
| Rate for Payer: Aetna American Axle |
$180.39
|
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna Commercial |
$23.39
|
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Commercial |
$235.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.39
|
| Rate for Payer: Cash Price |
$222.02
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$72.23
|
| Rate for Payer: Cofinity Commercial |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$238.67
|
| Rate for Payer: Cofinity Commercial |
$194.26
|
| Rate for Payer: Cofinity Commercial |
$23.67
|
| Rate for Payer: Cofinity Commercial |
$77.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Healthscope Commercial |
$249.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.89
|
| Rate for Payer: PHP Commercial |
$76.75
|
| Rate for Payer: PHP Commercial |
$23.39
|
| Rate for Payer: PHP Commercial |
$235.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.39
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: Priority Health SBD |
$174.84
|
| Rate for Payer: Priority Health SBD |
$56.88
|
| Rate for Payer: UMR Bronson Commercial |
$12.11
|
| Rate for Payer: UMR Bronson Commercial |
$122.11
|
| Rate for Payer: UMR Bronson Commercial |
$39.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.14
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$90.29
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.41 |
| Max. Negotiated Rate |
$81.26 |
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: UMR Bronson Commercial |
$33.41
|
| Rate for Payer: UMR Bronson Commercial |
$10.18
|
| Rate for Payer: UMR Bronson Commercial |
$102.68
|
| Rate for Payer: Aetna American Axle |
$58.69
|
| Rate for Payer: Aetna American Axle |
$180.39
|
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Commercial |
$23.39
|
| Rate for Payer: Aetna Commercial |
$235.89
|
| Rate for Payer: Aetna Medicare |
$138.76
|
| Rate for Payer: Aetna Medicare |
$13.76
|
| Rate for Payer: Aetna Medicare |
$45.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.39
|
| Rate for Payer: BCBS Complete |
$111.01
|
| Rate for Payer: BCBS Complete |
$36.12
|
| Rate for Payer: BCBS Complete |
$11.01
|
| Rate for Payer: BCBS Trust/PPO |
$42.79
|
| Rate for Payer: BCBS Trust/PPO |
$42.79
|
| Rate for Payer: BCBS Trust/PPO |
$42.79
|
| Rate for Payer: BCN Commercial |
$42.79
|
| Rate for Payer: BCN Commercial |
$42.79
|
| Rate for Payer: BCN Commercial |
$42.79
|
| Rate for Payer: Cash Price |
$222.02
|
| Rate for Payer: Cash Price |
$72.23
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$222.02
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$72.23
|
| Rate for Payer: Cofinity Commercial |
$238.67
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$23.67
|
| Rate for Payer: Cofinity Commercial |
$194.26
|
| Rate for Payer: Cofinity Commercial |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$77.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.23
|
| Rate for Payer: Healthscope Commercial |
$81.26
|
| Rate for Payer: Healthscope Commercial |
$249.77
|
| Rate for Payer: Healthscope Commercial |
$24.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.75
|
| Rate for Payer: PHP Commercial |
$76.75
|
| Rate for Payer: PHP Commercial |
$23.39
|
| Rate for Payer: PHP Commercial |
$235.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.69
|
| Rate for Payer: Priority Health SBD |
$174.84
|
| Rate for Payer: Priority Health SBD |
$56.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.72
|
|
|
DICYCLOMINE 20 MG TABLET
|
Facility
|
IP
|
$425.60
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.26 |
| Max. Negotiated Rate |
$383.04 |
| Rate for Payer: Aetna American Axle |
$276.64
|
| Rate for Payer: Aetna American Axle |
$163.02
|
| Rate for Payer: Aetna American Axle |
$251.94
|
| Rate for Payer: Aetna American Axle |
$2.77
|
| Rate for Payer: Aetna American Axle |
$2,566.20
|
| Rate for Payer: Aetna Commercial |
$361.76
|
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: Aetna Commercial |
$213.18
|
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Aetna Commercial |
$3,355.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,566.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.94
|
| Rate for Payer: Cash Price |
$340.48
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cash Price |
$3,158.40
|
| Rate for Payer: Cash Price |
$200.64
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$366.02
|
| Rate for Payer: Cofinity Commercial |
$297.92
|
| Rate for Payer: Cofinity Commercial |
$2,763.60
|
| Rate for Payer: Cofinity Commercial |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Cofinity Commercial |
$3,395.28
|
| Rate for Payer: Cofinity Commercial |
$215.69
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,763.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,158.40
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Healthscope Commercial |
$383.04
|
| Rate for Payer: Healthscope Commercial |
$3,553.20
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Healthscope Commercial |
$225.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,763.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,961.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,355.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.18
|
| Rate for Payer: PHP Commercial |
$213.18
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: PHP Commercial |
$3,355.80
|
| Rate for Payer: PHP Commercial |
$361.76
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,566.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.02
|
| Rate for Payer: Priority Health SBD |
$2.68
|
| Rate for Payer: Priority Health SBD |
$2,487.24
|
| Rate for Payer: Priority Health SBD |
$244.19
|
| Rate for Payer: Priority Health SBD |
$158.00
|
| Rate for Payer: Priority Health SBD |
$268.13
|
| Rate for Payer: UMR Bronson Commercial |
$110.35
|
| Rate for Payer: UMR Bronson Commercial |
$170.54
|
| Rate for Payer: UMR Bronson Commercial |
$187.26
|
| Rate for Payer: UMR Bronson Commercial |
$1.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,737.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,961.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.20
|
|
|
DICYCLOMINE 20 MG TABLET
|
Facility
|
OP
|
$387.60
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.79 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Healthscope Commercial |
$3,553.20
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Aetna American Axle |
$251.94
|
| Rate for Payer: Aetna American Axle |
$276.64
|
| Rate for Payer: Aetna American Axle |
$2,566.20
|
| Rate for Payer: Aetna American Axle |
$163.02
|
| Rate for Payer: Aetna American Axle |
$2.77
|
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: Aetna Commercial |
$213.18
|
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Aetna Commercial |
$3,355.80
|
| Rate for Payer: Aetna Commercial |
$361.76
|
| Rate for Payer: Aetna Medicare |
$1,974.00
|
| Rate for Payer: Aetna Medicare |
$212.80
|
| Rate for Payer: Aetna Medicare |
$193.80
|
| Rate for Payer: Aetna Medicare |
$125.40
|
| Rate for Payer: Aetna Medicare |
$2.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,566.20
|
| Rate for Payer: BCBS Complete |
$155.04
|
| Rate for Payer: BCBS Complete |
$100.32
|
| Rate for Payer: BCBS Complete |
$170.24
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: BCBS Complete |
$1,579.20
|
| Rate for Payer: BCBS Trust/PPO |
$42.79
|
| Rate for Payer: BCBS Trust/PPO |
$42.79
|
| Rate for Payer: BCBS Trust/PPO |
$42.79
|
| Rate for Payer: BCBS Trust/PPO |
$42.79
|
| Rate for Payer: BCBS Trust/PPO |
$42.79
|
| Rate for Payer: BCN Commercial |
$42.79
|
| Rate for Payer: BCN Commercial |
$42.79
|
| Rate for Payer: BCN Commercial |
$42.79
|
| Rate for Payer: BCN Commercial |
$42.79
|
| Rate for Payer: BCN Commercial |
$42.79
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cash Price |
$3,158.40
|
| Rate for Payer: Cash Price |
$200.64
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cash Price |
$200.64
|
| Rate for Payer: Cash Price |
$3,158.40
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$340.48
|
| Rate for Payer: Cash Price |
$340.48
|
| Rate for Payer: Cofinity Commercial |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Cofinity Commercial |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$3,395.28
|
| Rate for Payer: Cofinity Commercial |
$2,763.60
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$366.02
|
| Rate for Payer: Cofinity Commercial |
$297.92
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Cofinity Commercial |
$215.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,763.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,158.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.48
|
| Rate for Payer: Healthscope Commercial |
$383.04
|
| Rate for Payer: Healthscope Commercial |
$225.72
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,763.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,961.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,355.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.18
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: PHP Commercial |
$361.76
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: PHP Commercial |
$213.18
|
| Rate for Payer: PHP Commercial |
$3,355.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,566.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.94
|
| Rate for Payer: Priority Health SBD |
$244.19
|
| Rate for Payer: Priority Health SBD |
$2.68
|
| Rate for Payer: Priority Health SBD |
$268.13
|
| Rate for Payer: Priority Health SBD |
$158.00
|
| Rate for Payer: Priority Health SBD |
$2,487.24
|
| Rate for Payer: UMR Bronson Commercial |
$92.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,460.76
|
| Rate for Payer: UMR Bronson Commercial |
$143.41
|
| Rate for Payer: UMR Bronson Commercial |
$157.47
|
| Rate for Payer: UMR Bronson Commercial |
$1.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,961.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.10
|
|
|
DIGOXIN 100 MCG/ML (0.1 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$454.72
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
9853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$200.08 |
| Max. Negotiated Rate |
$409.25 |
| Rate for Payer: Aetna American Axle |
$295.57
|
| Rate for Payer: Aetna Commercial |
$386.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.57
|
| Rate for Payer: Cash Price |
$363.78
|
| Rate for Payer: Cofinity Commercial |
$318.30
|
| Rate for Payer: Cofinity Commercial |
$391.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$318.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.78
|
| Rate for Payer: Healthscope Commercial |
$409.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$318.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$386.51
|
| Rate for Payer: PHP Commercial |
$386.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.57
|
| Rate for Payer: Priority Health SBD |
$286.47
|
| Rate for Payer: UMR Bronson Commercial |
$200.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.04
|
|
|
DIGOXIN 100 MCG/ML (0.1 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$454.72
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
9853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.37 |
| Max. Negotiated Rate |
$409.25 |
| Rate for Payer: Aetna American Axle |
$295.57
|
| Rate for Payer: Aetna Commercial |
$386.51
|
| Rate for Payer: Aetna Medicare |
$227.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.57
|
| Rate for Payer: BCBS Complete |
$181.89
|
| Rate for Payer: BCBS Trust/PPO |
$42.37
|
| Rate for Payer: BCN Commercial |
$42.37
|
| Rate for Payer: Cash Price |
$363.78
|
| Rate for Payer: Cash Price |
$363.78
|
| Rate for Payer: Cofinity Commercial |
$318.30
|
| Rate for Payer: Cofinity Commercial |
$391.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$318.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.78
|
| Rate for Payer: Healthscope Commercial |
$409.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$318.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$386.51
|
| Rate for Payer: PHP Commercial |
$386.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.57
|
| Rate for Payer: Priority Health SBD |
$286.47
|
| Rate for Payer: UMR Bronson Commercial |
$168.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.04
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
OP
|
$426.72
|
|
|
Service Code
|
NDC 00904592161
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.89 |
| Max. Negotiated Rate |
$384.05 |
| Rate for Payer: Aetna American Axle |
$277.37
|
| Rate for Payer: Aetna Commercial |
$362.71
|
| Rate for Payer: Aetna Medicare |
$213.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.37
|
| Rate for Payer: BCBS Complete |
$170.69
|
| Rate for Payer: Cash Price |
$341.38
|
| Rate for Payer: Cofinity Commercial |
$298.70
|
| Rate for Payer: Cofinity Commercial |
$366.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.38
|
| Rate for Payer: Healthscope Commercial |
$384.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.71
|
| Rate for Payer: PHP Commercial |
$362.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.37
|
| Rate for Payer: Priority Health SBD |
$268.83
|
| Rate for Payer: UMR Bronson Commercial |
$157.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.04
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
OP
|
$265.05
|
|
|
Service Code
|
NDC 00143124001
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.07 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna Medicare |
$132.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: BCBS Complete |
$106.02
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Commercial |
$185.54
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.28
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$98.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 00143124001
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Commercial |
$185.54
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.28
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$116.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$426.72
|
|
|
Service Code
|
NDC 00904592161
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.76 |
| Max. Negotiated Rate |
$384.05 |
| Rate for Payer: Aetna American Axle |
$277.37
|
| Rate for Payer: Aetna Commercial |
$362.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.37
|
| Rate for Payer: Cash Price |
$341.38
|
| Rate for Payer: Cofinity Commercial |
$298.70
|
| Rate for Payer: Cofinity Commercial |
$366.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.38
|
| Rate for Payer: Healthscope Commercial |
$384.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.71
|
| Rate for Payer: PHP Commercial |
$362.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.37
|
| Rate for Payer: Priority Health SBD |
$268.83
|
| Rate for Payer: UMR Bronson Commercial |
$187.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.04
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET
|
Facility
|
OP
|
$43.97
|
|
|
Service Code
|
NDC 00904592261
|
| Hospital Charge Code |
2445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.27 |
| Max. Negotiated Rate |
$39.57 |
| Rate for Payer: Aetna American Axle |
$28.58
|
| Rate for Payer: Aetna Commercial |
$37.37
|
| Rate for Payer: Aetna Medicare |
$21.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.58
|
| Rate for Payer: BCBS Complete |
$17.59
|
| Rate for Payer: Cash Price |
$35.18
|
| Rate for Payer: Cofinity Commercial |
$30.78
|
| Rate for Payer: Cofinity Commercial |
$37.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.18
|
| Rate for Payer: Healthscope Commercial |
$39.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.37
|
| Rate for Payer: PHP Commercial |
$37.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.58
|
| Rate for Payer: Priority Health SBD |
$27.70
|
| Rate for Payer: UMR Bronson Commercial |
$16.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.98
|
|
