|
AMLODIPINE 10 MG TABLET
|
Facility
|
IP
|
$71.91
|
|
|
Service Code
|
NDC 67877019990
|
| Hospital Charge Code |
9069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Aetna American Axle |
$46.74
|
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.74
|
| Rate for Payer: Cash Price |
$57.53
|
| Rate for Payer: Cofinity Advantage |
$50.34
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.53
|
| Rate for Payer: Healthscope Commercial |
$64.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.93
|
| Rate for Payer: PHP Commercial |
$61.12
|
| Rate for Payer: Priority Health SBD |
$45.30
|
| Rate for Payer: UMR Bronson Commercial |
$31.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.93
|
|
|
AMLODIPINE 10 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 60687049601
|
| Hospital Charge Code |
9069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.90 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna American Axle |
$219.96
|
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Advantage |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.80
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: UMR Bronson Commercial |
$148.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
AMLODIPINE 10 MG TABLET
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
NDC 60687049611
|
| Hospital Charge Code |
9069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna American Axle |
$2.20
|
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Advantage |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
AMLODIPINE 10 MG TABLET
|
Facility
|
OP
|
$338.40
|
|
|
Service Code
|
NDC 60687049601
|
| Hospital Charge Code |
9069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.21 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna American Axle |
$219.96
|
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna Medicare |
$169.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: BCBS Complete |
$135.36
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Advantage |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.80
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.96
|
| Rate for Payer: UHC Core |
$176.31
|
| Rate for Payer: UHC Exchange |
$132.99
|
| Rate for Payer: UMR Bronson Commercial |
$125.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
AMLODIPINE 2.5 MG TABLET
|
Facility
|
IP
|
$227.95
|
|
|
Service Code
|
NDC 00904636961
|
| Hospital Charge Code |
9070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.30 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna American Axle |
$148.17
|
| Rate for Payer: Aetna Commercial |
$193.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.17
|
| Rate for Payer: Cash Price |
$182.36
|
| Rate for Payer: Cofinity Advantage |
$159.56
|
| Rate for Payer: Cofinity Commercial |
$196.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.36
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.96
|
| Rate for Payer: PHP Commercial |
$193.76
|
| Rate for Payer: Priority Health SBD |
$143.61
|
| Rate for Payer: UMR Bronson Commercial |
$100.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.96
|
|
|
AMLODIPINE 2.5 MG TABLET
|
Facility
|
OP
|
$227.95
|
|
|
Service Code
|
NDC 00904636961
|
| Hospital Charge Code |
9070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.34 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna American Axle |
$148.17
|
| Rate for Payer: Aetna Commercial |
$193.76
|
| Rate for Payer: Aetna Medicare |
$113.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.17
|
| Rate for Payer: BCBS Complete |
$91.18
|
| Rate for Payer: Cash Price |
$182.36
|
| Rate for Payer: Cofinity Advantage |
$159.56
|
| Rate for Payer: Cofinity Commercial |
$196.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.36
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.96
|
| Rate for Payer: PHP Commercial |
$193.76
|
| Rate for Payer: Priority Health SBD |
$143.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.17
|
| Rate for Payer: UHC Core |
$118.76
|
| Rate for Payer: UHC Exchange |
$89.58
|
| Rate for Payer: UMR Bronson Commercial |
$84.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.96
|
|
|
AMLODIPINE 5 MG TABLET
|
Facility
|
OP
|
$183.30
|
|
|
Service Code
|
NDC 51079045120
|
| Hospital Charge Code |
9071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.82 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna American Axle |
$119.14
|
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna Medicare |
$91.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.14
|
| Rate for Payer: BCBS Complete |
$73.32
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Advantage |
$128.31
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health SBD |
$115.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.14
|
| Rate for Payer: UHC Core |
$95.50
|
| Rate for Payer: UHC Exchange |
$72.04
|
| Rate for Payer: UMR Bronson Commercial |
$67.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
AMLODIPINE 5 MG TABLET
|
Facility
|
IP
|
$1.84
|
|
|
Service Code
|
NDC 51079045101
|
| Hospital Charge Code |
9071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Aetna American Axle |
$1.20
|
| Rate for Payer: Aetna Commercial |
$1.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.20
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Cofinity Advantage |
$1.29
|
| Rate for Payer: Cofinity Commercial |
$1.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.47
|
| Rate for Payer: Healthscope Commercial |
$1.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.38
|
| Rate for Payer: PHP Commercial |
$1.56
|
| Rate for Payer: Priority Health SBD |
$1.16
|
| Rate for Payer: UMR Bronson Commercial |
$0.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.38
|
|
|
AMLODIPINE 5 MG TABLET
|
Facility
|
OP
|
$195.05
|
|
|
Service Code
|
NDC 00904637061
|
| Hospital Charge Code |
9071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.17 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna American Axle |
$126.78
|
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$97.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: BCBS Complete |
$78.02
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Advantage |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.78
|
| Rate for Payer: UHC Core |
$101.62
|
| Rate for Payer: UHC Exchange |
$76.65
|
| Rate for Payer: UMR Bronson Commercial |
$72.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
AMLODIPINE 5 MG TABLET
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
NDC 00904637061
|
| Hospital Charge Code |
9071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna American Axle |
$126.78
|
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Advantage |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UMR Bronson Commercial |
$85.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
AMLODIPINE 5 MG TABLET
|
Facility
|
OP
|
$1.84
|
|
|
Service Code
|
NDC 51079045101
|
| Hospital Charge Code |
9071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Aetna American Axle |
$1.20
|
| Rate for Payer: Aetna Commercial |
$1.56
|
| Rate for Payer: Aetna Medicare |
$0.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.20
|
| Rate for Payer: BCBS Complete |
$0.74
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Cofinity Advantage |
$1.29
|
| Rate for Payer: Cofinity Commercial |
$1.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.47
|
| Rate for Payer: Healthscope Commercial |
$1.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.38
|
| Rate for Payer: PHP Commercial |
$1.56
|
| Rate for Payer: Priority Health SBD |
$1.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.20
|
| Rate for Payer: UHC Core |
$0.96
|
| Rate for Payer: UHC Exchange |
$0.72
|
| Rate for Payer: UMR Bronson Commercial |
$0.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.38
|
|
|
AMLODIPINE 5 MG TABLET
|
Facility
|
IP
|
$183.30
|
|
|
Service Code
|
NDC 51079045120
|
| Hospital Charge Code |
9071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.65 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna American Axle |
$119.14
|
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.14
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Advantage |
$128.31
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health SBD |
$115.48
|
| Rate for Payer: UMR Bronson Commercial |
$80.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
AMLODIPINE BENZOATE 1 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$2,201.13
|
|
|
Service Code
|
NDC 52652500101
|
| Hospital Charge Code |
190812
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$968.50 |
| Max. Negotiated Rate |
$1,981.02 |
| Rate for Payer: Aetna American Axle |
$1,430.73
|
| Rate for Payer: Aetna Commercial |
$1,870.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,430.73
|
| Rate for Payer: Cash Price |
$1,760.90
|
| Rate for Payer: Cofinity Advantage |
$1,540.79
|
| Rate for Payer: Cofinity Commercial |
$1,892.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,760.90
|
| Rate for Payer: Healthscope Commercial |
$1,981.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,540.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,650.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,870.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,650.85
|
| Rate for Payer: PHP Commercial |
$1,870.96
|
| Rate for Payer: Priority Health SBD |
$1,386.71
|
| Rate for Payer: UMR Bronson Commercial |
$968.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,650.85
|
|
|
AMLODIPINE BENZOATE 1 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$2,201.13
|
|
|
Service Code
|
NDC 52652500101
|
| Hospital Charge Code |
190812
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$814.42 |
| Max. Negotiated Rate |
$1,981.02 |
| Rate for Payer: Aetna American Axle |
$1,430.73
|
| Rate for Payer: Aetna Commercial |
$1,870.96
|
| Rate for Payer: Aetna Medicare |
$1,100.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,430.73
|
| Rate for Payer: BCBS Complete |
$880.45
|
| Rate for Payer: Cash Price |
$1,760.90
|
| Rate for Payer: Cofinity Advantage |
$1,540.79
|
| Rate for Payer: Cofinity Commercial |
$1,892.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,760.90
|
| Rate for Payer: Healthscope Commercial |
$1,981.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,540.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,650.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,760.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,870.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,650.85
|
| Rate for Payer: PHP Commercial |
$1,870.96
|
| Rate for Payer: Priority Health SBD |
$1,386.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,430.73
|
| Rate for Payer: UHC Core |
$1,146.79
|
| Rate for Payer: UHC Exchange |
$865.04
|
| Rate for Payer: UMR Bronson Commercial |
$814.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,650.85
|
|
|
AMMONIUM LACTATE 12 % LOTION
|
Facility
|
OP
|
$20.25
|
|
|
Service Code
|
NDC 00904598426
|
| Hospital Charge Code |
10380
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Aetna American Axle |
$13.16
|
| Rate for Payer: Aetna Commercial |
$17.21
|
| Rate for Payer: Aetna Medicare |
$10.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.16
|
| Rate for Payer: BCBS Complete |
$8.10
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cofinity Advantage |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$17.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.20
|
| Rate for Payer: Healthscope Commercial |
$18.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.19
|
| Rate for Payer: PHP Commercial |
$17.21
|
| Rate for Payer: Priority Health SBD |
$12.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.16
|
| Rate for Payer: UHC Core |
$10.55
|
| Rate for Payer: UHC Exchange |
$7.96
|
| Rate for Payer: UMR Bronson Commercial |
$7.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.19
|
|
|
AMMONIUM LACTATE 12 % LOTION
|
Facility
|
OP
|
$27.81
|
|
|
Service Code
|
NDC 45802052555
|
| Hospital Charge Code |
10380
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$25.03 |
| Rate for Payer: Aetna American Axle |
$18.08
|
| Rate for Payer: Aetna Commercial |
$23.64
|
| Rate for Payer: Aetna Medicare |
$13.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.08
|
| Rate for Payer: BCBS Complete |
$11.12
|
| Rate for Payer: Cash Price |
$22.25
|
| Rate for Payer: Cofinity Advantage |
$19.47
|
| Rate for Payer: Cofinity Commercial |
$23.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.25
|
| Rate for Payer: Healthscope Commercial |
$25.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.86
|
| Rate for Payer: PHP Commercial |
$23.64
|
| Rate for Payer: Priority Health SBD |
$17.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$14.49
|
| Rate for Payer: UHC Exchange |
$10.93
|
| Rate for Payer: UMR Bronson Commercial |
$10.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.86
|
|
|
AMMONIUM LACTATE 12 % LOTION
|
Facility
|
OP
|
$33.08
|
|
|
Service Code
|
NDC 63044048409
|
| Hospital Charge Code |
10380
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$29.77 |
| Rate for Payer: Aetna American Axle |
$21.50
|
| Rate for Payer: Aetna Commercial |
$28.12
|
| Rate for Payer: Aetna Medicare |
$16.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.50
|
| Rate for Payer: BCBS Complete |
$13.23
|
| Rate for Payer: Cash Price |
$26.46
|
| Rate for Payer: Cofinity Advantage |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$28.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.46
|
| Rate for Payer: Healthscope Commercial |
$29.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.81
|
| Rate for Payer: PHP Commercial |
$28.12
|
| Rate for Payer: Priority Health SBD |
$20.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.50
|
| Rate for Payer: UHC Core |
$17.23
|
| Rate for Payer: UHC Exchange |
$13.00
|
| Rate for Payer: UMR Bronson Commercial |
$12.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.81
|
|
|
AMMONIUM LACTATE 12 % LOTION
|
Facility
|
IP
|
$33.08
|
|
|
Service Code
|
NDC 63044048409
|
| Hospital Charge Code |
10380
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$29.77 |
| Rate for Payer: Aetna American Axle |
$21.50
|
| Rate for Payer: Aetna Commercial |
$28.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.50
|
| Rate for Payer: Cash Price |
$26.46
|
| Rate for Payer: Cofinity Advantage |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$28.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.46
|
| Rate for Payer: Healthscope Commercial |
$29.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.81
|
| Rate for Payer: PHP Commercial |
$28.12
|
| Rate for Payer: Priority Health SBD |
$20.84
|
| Rate for Payer: UMR Bronson Commercial |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.81
|
|
|
AMMONIUM LACTATE 12 % LOTION
|
Facility
|
IP
|
$20.25
|
|
|
Service Code
|
NDC 00904598426
|
| Hospital Charge Code |
10380
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Aetna American Axle |
$13.16
|
| Rate for Payer: Aetna Commercial |
$17.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.16
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cofinity Advantage |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$17.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.20
|
| Rate for Payer: Healthscope Commercial |
$18.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.19
|
| Rate for Payer: PHP Commercial |
$17.21
|
| Rate for Payer: Priority Health SBD |
$12.76
|
| Rate for Payer: UMR Bronson Commercial |
$8.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.19
|
|
|
AMMONIUM LACTATE 12 % LOTION
|
Facility
|
IP
|
$27.81
|
|
|
Service Code
|
NDC 45802052555
|
| Hospital Charge Code |
10380
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$25.03 |
| Rate for Payer: Aetna American Axle |
$18.08
|
| Rate for Payer: Aetna Commercial |
$23.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.08
|
| Rate for Payer: Cash Price |
$22.25
|
| Rate for Payer: Cofinity Advantage |
$19.47
|
| Rate for Payer: Cofinity Commercial |
$23.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.25
|
| Rate for Payer: Healthscope Commercial |
$25.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.86
|
| Rate for Payer: PHP Commercial |
$23.64
|
| Rate for Payer: Priority Health SBD |
$17.52
|
| Rate for Payer: UMR Bronson Commercial |
$12.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.86
|
|
|
AMMONIUM LACTATE 12 % LOTION
|
Facility
|
IP
|
$65.37
|
|
|
Service Code
|
NDC 45802041954
|
| Hospital Charge Code |
10380
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.76 |
| Max. Negotiated Rate |
$58.83 |
| Rate for Payer: Aetna American Axle |
$42.49
|
| Rate for Payer: Aetna Commercial |
$55.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.49
|
| Rate for Payer: Cash Price |
$52.30
|
| Rate for Payer: Cofinity Advantage |
$45.76
|
| Rate for Payer: Cofinity Commercial |
$56.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.30
|
| Rate for Payer: Healthscope Commercial |
$58.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.03
|
| Rate for Payer: PHP Commercial |
$55.56
|
| Rate for Payer: Priority Health SBD |
$41.18
|
| Rate for Payer: UMR Bronson Commercial |
$28.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.03
|
|
|
AMMONIUM LACTATE 12 % LOTION
|
Facility
|
OP
|
$65.37
|
|
|
Service Code
|
NDC 45802041954
|
| Hospital Charge Code |
10380
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.19 |
| Max. Negotiated Rate |
$58.83 |
| Rate for Payer: Aetna American Axle |
$42.49
|
| Rate for Payer: Aetna Commercial |
$55.56
|
| Rate for Payer: Aetna Medicare |
$32.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.49
|
| Rate for Payer: BCBS Complete |
$26.15
|
| Rate for Payer: Cash Price |
$52.30
|
| Rate for Payer: Cofinity Advantage |
$45.76
|
| Rate for Payer: Cofinity Commercial |
$56.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.30
|
| Rate for Payer: Healthscope Commercial |
$58.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.03
|
| Rate for Payer: PHP Commercial |
$55.56
|
| Rate for Payer: Priority Health SBD |
$41.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.49
|
| Rate for Payer: UHC Core |
$34.06
|
| Rate for Payer: UHC Exchange |
$25.69
|
| Rate for Payer: UMR Bronson Commercial |
$24.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.03
|
|
|
AMOBARBITAL 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$2,537.06
|
|
|
Service Code
|
HCPCS J0300
|
| Hospital Charge Code |
9075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$2,283.35 |
| Rate for Payer: Aetna American Axle |
$1,649.09
|
| Rate for Payer: Aetna Commercial |
$2,156.50
|
| Rate for Payer: Aetna Medicare |
$1,268.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,649.09
|
| Rate for Payer: BCBS Complete |
$1,014.82
|
| Rate for Payer: BCBS Trust/PPO |
$591.39
|
| Rate for Payer: BCN Commercial |
$591.39
|
| Rate for Payer: Cash Price |
$2,029.65
|
| Rate for Payer: Cash Price |
$2,029.65
|
| Rate for Payer: Cofinity Advantage |
$1,775.94
|
| Rate for Payer: Cofinity Commercial |
$2,181.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,029.65
|
| Rate for Payer: Healthscope Commercial |
$2,283.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,775.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,902.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,029.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,156.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,902.80
|
| Rate for Payer: PHP Commercial |
$2,156.50
|
| Rate for Payer: Priority Health SBD |
$1,598.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.29
|
| Rate for Payer: UHC Core |
$19.29
|
| Rate for Payer: UHC Exchange |
$19.29
|
| Rate for Payer: UMR Bronson Commercial |
$938.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,902.80
|
|
|
AMOBARBITAL 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$2,537.06
|
|
|
Service Code
|
HCPCS J0300
|
| Hospital Charge Code |
9075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,116.31 |
| Max. Negotiated Rate |
$2,283.35 |
| Rate for Payer: Aetna American Axle |
$1,649.09
|
| Rate for Payer: Aetna Commercial |
$2,156.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,649.09
|
| Rate for Payer: Cash Price |
$2,029.65
|
| Rate for Payer: Cofinity Advantage |
$1,775.94
|
| Rate for Payer: Cofinity Commercial |
$2,181.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,029.65
|
| Rate for Payer: Healthscope Commercial |
$2,283.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,775.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,902.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,156.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,902.80
|
| Rate for Payer: PHP Commercial |
$2,156.50
|
| Rate for Payer: Priority Health SBD |
$1,598.35
|
| Rate for Payer: UMR Bronson Commercial |
$1,116.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,902.80
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$109.28
|
|
|
Service Code
|
NDC 65862070755
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$98.35 |
| Rate for Payer: Aetna American Axle |
$71.03
|
| Rate for Payer: Aetna Commercial |
$92.89
|
| Rate for Payer: Aetna Medicare |
$54.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.03
|
| Rate for Payer: BCBS Complete |
$43.71
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity Advantage |
$76.50
|
| Rate for Payer: Cofinity Commercial |
$93.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.42
|
| Rate for Payer: Healthscope Commercial |
$98.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.96
|
| Rate for Payer: PHP Commercial |
$92.89
|
| Rate for Payer: Priority Health SBD |
$68.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.03
|
| Rate for Payer: UHC Core |
$56.93
|
| Rate for Payer: UHC Exchange |
$42.95
|
| Rate for Payer: UMR Bronson Commercial |
$40.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.96
|
|
