|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
NDC 09900001926
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna American Axle |
$0.38
|
| Rate for Payer: Aetna Commercial |
$0.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.38
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cofinity Advantage |
$0.41
|
| Rate for Payer: Cofinity Commercial |
$0.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.47
|
| Rate for Payer: Healthscope Commercial |
$0.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.44
|
| Rate for Payer: PHP Commercial |
$0.50
|
| Rate for Payer: Priority Health SBD |
$0.37
|
| Rate for Payer: UMR Bronson Commercial |
$0.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.44
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$21.74
|
|
|
Service Code
|
NDC 00904674817
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$19.57 |
| Rate for Payer: Aetna American Axle |
$14.13
|
| Rate for Payer: Aetna Commercial |
$18.48
|
| Rate for Payer: Aetna Medicare |
$10.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.13
|
| Rate for Payer: BCBS Complete |
$8.70
|
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: Cofinity Advantage |
$15.22
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.39
|
| Rate for Payer: Healthscope Commercial |
$19.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.30
|
| Rate for Payer: PHP Commercial |
$18.48
|
| Rate for Payer: Priority Health SBD |
$13.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.13
|
| Rate for Payer: UHC Core |
$11.33
|
| Rate for Payer: UHC Exchange |
$8.54
|
| Rate for Payer: UMR Bronson Commercial |
$8.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.30
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$6.35
|
|
|
Service Code
|
NDC 00904640761
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Aetna American Axle |
$4.13
|
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cofinity Advantage |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.08
|
| Rate for Payer: Healthscope Commercial |
$5.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.76
|
| Rate for Payer: PHP Commercial |
$5.40
|
| Rate for Payer: Priority Health SBD |
$4.00
|
| Rate for Payer: UMR Bronson Commercial |
$2.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.76
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$21.74
|
|
|
Service Code
|
NDC 00904674817
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$19.57 |
| Rate for Payer: Aetna American Axle |
$14.13
|
| Rate for Payer: Aetna Commercial |
$18.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.13
|
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: Cofinity Advantage |
$15.22
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.39
|
| Rate for Payer: Healthscope Commercial |
$19.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.30
|
| Rate for Payer: PHP Commercial |
$18.48
|
| Rate for Payer: Priority Health SBD |
$13.70
|
| Rate for Payer: UMR Bronson Commercial |
$9.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.30
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$12.93
|
|
|
Service Code
|
NDC 50844060756
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Aetna American Axle |
$8.40
|
| Rate for Payer: Aetna Commercial |
$10.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.40
|
| Rate for Payer: Cash Price |
$10.34
|
| Rate for Payer: Cofinity Advantage |
$9.05
|
| Rate for Payer: Cofinity Commercial |
$11.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.34
|
| Rate for Payer: Healthscope Commercial |
$11.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.70
|
| Rate for Payer: PHP Commercial |
$10.99
|
| Rate for Payer: Priority Health SBD |
$8.15
|
| Rate for Payer: UMR Bronson Commercial |
$5.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.70
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$6.35
|
|
|
Service Code
|
NDC 00904640761
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Aetna American Axle |
$4.13
|
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Medicare |
$3.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: BCBS Complete |
$2.54
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cofinity Advantage |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.08
|
| Rate for Payer: Healthscope Commercial |
$5.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.76
|
| Rate for Payer: PHP Commercial |
$5.40
|
| Rate for Payer: Priority Health SBD |
$4.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.13
|
| Rate for Payer: UHC Core |
$3.31
|
| Rate for Payer: UHC Exchange |
$2.50
|
| Rate for Payer: UMR Bronson Commercial |
$2.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.76
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$12.93
|
|
|
Service Code
|
NDC 50844060756
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Aetna American Axle |
$8.40
|
| Rate for Payer: Aetna Commercial |
$10.99
|
| Rate for Payer: Aetna Medicare |
$6.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.40
|
| Rate for Payer: BCBS Complete |
$5.17
|
| Rate for Payer: Cash Price |
$10.34
|
| Rate for Payer: Cofinity Advantage |
$9.05
|
| Rate for Payer: Cofinity Commercial |
$11.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.34
|
| Rate for Payer: Healthscope Commercial |
$11.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.70
|
| Rate for Payer: PHP Commercial |
$10.99
|
| Rate for Payer: Priority Health SBD |
$8.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.40
|
| Rate for Payer: UHC Core |
$6.74
|
| Rate for Payer: UHC Exchange |
$5.08
|
| Rate for Payer: UMR Bronson Commercial |
$4.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.70
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
NDC 09900001926
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna American Axle |
$0.38
|
| Rate for Payer: Aetna Commercial |
$0.50
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.38
|
| Rate for Payer: BCBS Complete |
$0.24
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cofinity Advantage |
$0.41
|
| Rate for Payer: Cofinity Commercial |
$0.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.47
|
| Rate for Payer: Healthscope Commercial |
$0.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.44
|
| Rate for Payer: PHP Commercial |
$0.50
|
| Rate for Payer: Priority Health SBD |
$0.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.38
|
| Rate for Payer: UHC Core |
$0.31
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UMR Bronson Commercial |
$0.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.44
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$10.62
|
|
|
Service Code
|
NDC 70000069801
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Aetna American Axle |
$6.90
|
| Rate for Payer: Aetna Commercial |
$9.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.90
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cofinity Advantage |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$9.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$9.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PHP Commercial |
$9.03
|
| Rate for Payer: Priority Health SBD |
$6.69
|
| Rate for Payer: UMR Bronson Commercial |
$4.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.96
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$21.24
|
|
|
Service Code
|
NDC 01490003956
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Aetna American Axle |
$13.81
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$10.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: BCBS Complete |
$8.50
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Advantage |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.93
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.81
|
| Rate for Payer: UHC Core |
$11.07
|
| Rate for Payer: UHC Exchange |
$8.35
|
| Rate for Payer: UMR Bronson Commercial |
$7.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.93
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$21.33
|
|
|
Service Code
|
NDC 01490003908
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna American Axle |
$13.86
|
| Rate for Payer: Aetna Commercial |
$18.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.86
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cofinity Advantage |
$14.93
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$19.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.00
|
| Rate for Payer: PHP Commercial |
$18.13
|
| Rate for Payer: Priority Health SBD |
$13.44
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.00
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$12.80
|
|
|
Service Code
|
NDC 00536128636
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$11.52 |
| Rate for Payer: Aetna American Axle |
$8.32
|
| Rate for Payer: Aetna Commercial |
$10.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.32
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Cofinity Advantage |
$8.96
|
| Rate for Payer: Cofinity Commercial |
$11.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.24
|
| Rate for Payer: Healthscope Commercial |
$11.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.60
|
| Rate for Payer: PHP Commercial |
$10.88
|
| Rate for Payer: Priority Health SBD |
$8.06
|
| Rate for Payer: UMR Bronson Commercial |
$5.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.60
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$12.80
|
|
|
Service Code
|
NDC 00536128636
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$11.52 |
| Rate for Payer: Aetna American Axle |
$8.32
|
| Rate for Payer: Aetna Commercial |
$10.88
|
| Rate for Payer: Aetna Medicare |
$6.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.32
|
| Rate for Payer: BCBS Complete |
$5.12
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Cofinity Advantage |
$8.96
|
| Rate for Payer: Cofinity Commercial |
$11.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.24
|
| Rate for Payer: Healthscope Commercial |
$11.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.60
|
| Rate for Payer: PHP Commercial |
$10.88
|
| Rate for Payer: Priority Health SBD |
$8.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.32
|
| Rate for Payer: UHC Core |
$6.67
|
| Rate for Payer: UHC Exchange |
$5.03
|
| Rate for Payer: UMR Bronson Commercial |
$4.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.60
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$10.62
|
|
|
Service Code
|
NDC 70000069801
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Aetna American Axle |
$6.90
|
| Rate for Payer: Aetna Commercial |
$9.03
|
| Rate for Payer: Aetna Medicare |
$5.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.90
|
| Rate for Payer: BCBS Complete |
$4.25
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cofinity Advantage |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$9.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$9.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PHP Commercial |
$9.03
|
| Rate for Payer: Priority Health SBD |
$6.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.90
|
| Rate for Payer: UHC Core |
$5.53
|
| Rate for Payer: UHC Exchange |
$4.17
|
| Rate for Payer: UMR Bronson Commercial |
$3.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.96
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$21.24
|
|
|
Service Code
|
NDC 01490003956
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Aetna American Axle |
$13.81
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Advantage |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.93
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.38
|
| Rate for Payer: UMR Bronson Commercial |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.93
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$21.33
|
|
|
Service Code
|
NDC 01490003908
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna American Axle |
$13.86
|
| Rate for Payer: Aetna Commercial |
$18.13
|
| Rate for Payer: Aetna Medicare |
$10.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.86
|
| Rate for Payer: BCBS Complete |
$8.53
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cofinity Advantage |
$14.93
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$19.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.00
|
| Rate for Payer: PHP Commercial |
$18.13
|
| Rate for Payer: Priority Health SBD |
$13.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.86
|
| Rate for Payer: UHC Core |
$11.11
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UMR Bronson Commercial |
$7.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.00
|
|
|
BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
IP
|
$271.70
|
|
|
Service Code
|
NDC 00378050501
|
| Hospital Charge Code |
18289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$244.53 |
| Rate for Payer: Aetna American Axle |
$176.60
|
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.60
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Advantage |
$190.19
|
| Rate for Payer: Cofinity Commercial |
$233.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$244.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.78
|
| Rate for Payer: PHP Commercial |
$230.94
|
| Rate for Payer: Priority Health SBD |
$171.17
|
| Rate for Payer: UMR Bronson Commercial |
$119.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.78
|
|
|
BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
OP
|
$271.70
|
|
|
Service Code
|
NDC 00378050501
|
| Hospital Charge Code |
18289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$244.53 |
| Rate for Payer: Aetna American Axle |
$176.60
|
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: Aetna Medicare |
$135.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.60
|
| Rate for Payer: BCBS Complete |
$108.68
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Advantage |
$190.19
|
| Rate for Payer: Cofinity Commercial |
$233.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$244.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.78
|
| Rate for Payer: PHP Commercial |
$230.94
|
| Rate for Payer: Priority Health SBD |
$171.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.60
|
| Rate for Payer: UHC Core |
$141.56
|
| Rate for Payer: UHC Exchange |
$106.78
|
| Rate for Payer: UMR Bronson Commercial |
$100.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.78
|
|
|
BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
IP
|
$128.25
|
|
|
Service Code
|
NDC 29300018913
|
| Hospital Charge Code |
18289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.43 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna American Axle |
$83.36
|
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Advantage |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.60
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.19
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: Priority Health SBD |
$80.80
|
| Rate for Payer: UMR Bronson Commercial |
$56.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.19
|
|
|
BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
OP
|
$90.29
|
|
|
Service Code
|
NDC 00093324356
|
| Hospital Charge Code |
18289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.41 |
| Max. Negotiated Rate |
$81.26 |
| Rate for Payer: Aetna American Axle |
$58.69
|
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Medicare |
$45.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.69
|
| Rate for Payer: BCBS Complete |
$36.12
|
| Rate for Payer: Cash Price |
$72.23
|
| Rate for Payer: Cofinity Advantage |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$77.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.23
|
| Rate for Payer: Healthscope Commercial |
$81.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.72
|
| Rate for Payer: PHP Commercial |
$76.75
|
| Rate for Payer: Priority Health SBD |
$56.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.69
|
| Rate for Payer: UHC Core |
$47.04
|
| Rate for Payer: UHC Exchange |
$35.48
|
| Rate for Payer: UMR Bronson Commercial |
$33.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.72
|
|
|
BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
IP
|
$90.29
|
|
|
Service Code
|
NDC 00093324356
|
| Hospital Charge Code |
18289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.73 |
| Max. Negotiated Rate |
$81.26 |
| Rate for Payer: Aetna American Axle |
$58.69
|
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.69
|
| Rate for Payer: Cash Price |
$72.23
|
| Rate for Payer: Cofinity Advantage |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$77.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.23
|
| Rate for Payer: Healthscope Commercial |
$81.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.72
|
| Rate for Payer: PHP Commercial |
$76.75
|
| Rate for Payer: Priority Health SBD |
$56.88
|
| Rate for Payer: UMR Bronson Commercial |
$39.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.72
|
|
|
BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
OP
|
$128.25
|
|
|
Service Code
|
NDC 29300018913
|
| Hospital Charge Code |
18289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna American Axle |
$83.36
|
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: Aetna Medicare |
$64.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: BCBS Complete |
$51.30
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Advantage |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.60
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.19
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: Priority Health SBD |
$80.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.36
|
| Rate for Payer: UHC Core |
$66.82
|
| Rate for Payer: UHC Exchange |
$50.40
|
| Rate for Payer: UMR Bronson Commercial |
$47.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.19
|
|
|
BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
OP
|
$128.25
|
|
|
Service Code
|
NDC 29300018713
|
| Hospital Charge Code |
18291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna American Axle |
$83.36
|
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: Aetna Medicare |
$64.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: BCBS Complete |
$51.30
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Advantage |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.60
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.19
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: Priority Health SBD |
$80.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.36
|
| Rate for Payer: UHC Core |
$66.82
|
| Rate for Payer: UHC Exchange |
$50.40
|
| Rate for Payer: UMR Bronson Commercial |
$47.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.19
|
|
|
BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
IP
|
$375.25
|
|
|
Service Code
|
NDC 29300018701
|
| Hospital Charge Code |
18291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$337.73 |
| Rate for Payer: Aetna American Axle |
$243.91
|
| Rate for Payer: Aetna Commercial |
$318.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.91
|
| Rate for Payer: Cash Price |
$300.20
|
| Rate for Payer: Cofinity Advantage |
$262.68
|
| Rate for Payer: Cofinity Commercial |
$322.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.20
|
| Rate for Payer: Healthscope Commercial |
$337.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.44
|
| Rate for Payer: PHP Commercial |
$318.96
|
| Rate for Payer: Priority Health SBD |
$236.41
|
| Rate for Payer: UMR Bronson Commercial |
$165.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.44
|
|
|
BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET
|
Facility
|
IP
|
$128.25
|
|
|
Service Code
|
NDC 29300018713
|
| Hospital Charge Code |
18291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.43 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna American Axle |
$83.36
|
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Advantage |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.60
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.19
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: Priority Health SBD |
$80.80
|
| Rate for Payer: UMR Bronson Commercial |
$56.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.19
|
|
