|
ISONIAZID 300 MG TABLET
|
Facility
|
OP
|
$394.80
|
|
|
Service Code
|
NDC 00555007102
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.08 |
| Max. Negotiated Rate |
$355.32 |
| Rate for Payer: Aetna American Axle |
$256.62
|
| Rate for Payer: Aetna Commercial |
$335.58
|
| Rate for Payer: Aetna Medicare |
$197.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.62
|
| Rate for Payer: BCBS Complete |
$157.92
|
| Rate for Payer: Cash Price |
$315.84
|
| Rate for Payer: Cofinity Advantage |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.84
|
| Rate for Payer: Healthscope Commercial |
$355.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$315.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.10
|
| Rate for Payer: PHP Commercial |
$335.58
|
| Rate for Payer: Priority Health SBD |
$248.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.62
|
| Rate for Payer: UHC Core |
$205.69
|
| Rate for Payer: UHC Exchange |
$155.16
|
| Rate for Payer: UMR Bronson Commercial |
$146.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.10
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
IP
|
$1,004.92
|
|
|
Service Code
|
NDC 64950021710
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$442.16 |
| Max. Negotiated Rate |
$904.43 |
| Rate for Payer: Aetna American Axle |
$653.20
|
| Rate for Payer: Aetna Commercial |
$854.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.20
|
| Rate for Payer: Cash Price |
$803.94
|
| Rate for Payer: Cofinity Advantage |
$703.44
|
| Rate for Payer: Cofinity Commercial |
$864.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$803.94
|
| Rate for Payer: Healthscope Commercial |
$904.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$703.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$753.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$854.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$753.69
|
| Rate for Payer: PHP Commercial |
$854.18
|
| Rate for Payer: Priority Health SBD |
$633.10
|
| Rate for Payer: UMR Bronson Commercial |
$442.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$753.69
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
OP
|
$426.72
|
|
|
Service Code
|
NDC 60687055301
|
| Hospital Charge Code |
4027
|
|
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 Advantage |
$298.70
|
| Rate for Payer: Cofinity Commercial |
$366.98
|
| 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: MI Amish Medical Board Commercial |
$341.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.04
|
| Rate for Payer: PHP Commercial |
$362.71
|
| Rate for Payer: Priority Health SBD |
$268.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.37
|
| Rate for Payer: UHC Core |
$222.32
|
| Rate for Payer: UHC Exchange |
$167.70
|
| Rate for Payer: UMR Bronson Commercial |
$157.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.04
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
OP
|
$1,004.92
|
|
|
Service Code
|
NDC 64950021710
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$371.82 |
| Max. Negotiated Rate |
$904.43 |
| Rate for Payer: Aetna American Axle |
$653.20
|
| Rate for Payer: Aetna Commercial |
$854.18
|
| Rate for Payer: Aetna Medicare |
$502.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.20
|
| Rate for Payer: BCBS Complete |
$401.97
|
| Rate for Payer: Cash Price |
$803.94
|
| Rate for Payer: Cofinity Advantage |
$703.44
|
| Rate for Payer: Cofinity Commercial |
$864.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$803.94
|
| Rate for Payer: Healthscope Commercial |
$904.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$703.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$753.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$803.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$854.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$753.69
|
| Rate for Payer: PHP Commercial |
$854.18
|
| Rate for Payer: Priority Health SBD |
$633.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$653.20
|
| Rate for Payer: UHC Core |
$523.56
|
| Rate for Payer: UHC Exchange |
$394.93
|
| Rate for Payer: UMR Bronson Commercial |
$371.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$753.69
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
IP
|
$426.72
|
|
|
Service Code
|
NDC 60687055301
|
| Hospital Charge Code |
4027
|
|
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 Advantage |
$298.70
|
| Rate for Payer: Cofinity Commercial |
$366.98
|
| 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: Opus (Opus Packaging Group) HMA |
$320.04
|
| Rate for Payer: PHP Commercial |
$362.71
|
| 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
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
OP
|
$1,118.51
|
|
|
Service Code
|
NDC 81665010810
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$413.85 |
| Max. Negotiated Rate |
$1,006.66 |
| Rate for Payer: Aetna American Axle |
$727.03
|
| Rate for Payer: Aetna Commercial |
$950.73
|
| Rate for Payer: Aetna Medicare |
$559.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$727.03
|
| Rate for Payer: BCBS Complete |
$447.40
|
| Rate for Payer: Cash Price |
$894.81
|
| Rate for Payer: Cofinity Advantage |
$782.96
|
| Rate for Payer: Cofinity Commercial |
$961.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$894.81
|
| Rate for Payer: Healthscope Commercial |
$1,006.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$782.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$838.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$894.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$950.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$838.88
|
| Rate for Payer: PHP Commercial |
$950.73
|
| Rate for Payer: Priority Health SBD |
$704.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.03
|
| Rate for Payer: UHC Core |
$582.74
|
| Rate for Payer: UHC Exchange |
$439.57
|
| Rate for Payer: UMR Bronson Commercial |
$413.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$838.88
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
IP
|
$394.80
|
|
|
Service Code
|
NDC 00555007102
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.71 |
| Max. Negotiated Rate |
$355.32 |
| Rate for Payer: Aetna American Axle |
$256.62
|
| Rate for Payer: Aetna Commercial |
$335.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.62
|
| Rate for Payer: Cash Price |
$315.84
|
| Rate for Payer: Cofinity Advantage |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.84
|
| Rate for Payer: Healthscope Commercial |
$355.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.10
|
| Rate for Payer: PHP Commercial |
$335.58
|
| Rate for Payer: Priority Health SBD |
$248.72
|
| Rate for Payer: UMR Bronson Commercial |
$173.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.10
|
|
|
ISOPROPYL ALCOHOL 70 % SOLUTION
|
Facility
|
OP
|
$17.03
|
|
|
Service Code
|
NDC 00869081043
|
| Hospital Charge Code |
16013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Aetna American Axle |
$11.07
|
| Rate for Payer: Aetna Commercial |
$14.48
|
| Rate for Payer: Aetna Medicare |
$8.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: BCBS Complete |
$6.81
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cofinity Advantage |
$11.92
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Healthscope Commercial |
$15.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.77
|
| Rate for Payer: PHP Commercial |
$14.48
|
| Rate for Payer: Priority Health SBD |
$10.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.07
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Exchange |
$6.69
|
| Rate for Payer: UMR Bronson Commercial |
$6.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.77
|
|
|
ISOPROPYL ALCOHOL 70 % SOLUTION
|
Facility
|
IP
|
$17.03
|
|
|
Service Code
|
NDC 00869081043
|
| Hospital Charge Code |
16013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Aetna American Axle |
$11.07
|
| Rate for Payer: Aetna Commercial |
$14.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cofinity Advantage |
$11.92
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Healthscope Commercial |
$15.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.77
|
| Rate for Payer: PHP Commercial |
$14.48
|
| Rate for Payer: Priority Health SBD |
$10.73
|
| Rate for Payer: UMR Bronson Commercial |
$7.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.77
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$192.52
|
|
|
Service Code
|
NDC 69918073501
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.71 |
| Max. Negotiated Rate |
$173.27 |
| Rate for Payer: Aetna American Axle |
$125.14
|
| Rate for Payer: Aetna Commercial |
$163.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.14
|
| Rate for Payer: Cash Price |
$154.02
|
| Rate for Payer: Cofinity Advantage |
$134.76
|
| Rate for Payer: Cofinity Commercial |
$165.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.02
|
| Rate for Payer: Healthscope Commercial |
$173.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.39
|
| Rate for Payer: PHP Commercial |
$163.64
|
| Rate for Payer: Priority Health SBD |
$121.29
|
| Rate for Payer: UMR Bronson Commercial |
$84.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.39
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$217.93
|
|
|
Service Code
|
NDC 23155066043
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.89 |
| Max. Negotiated Rate |
$196.14 |
| Rate for Payer: Aetna American Axle |
$141.65
|
| Rate for Payer: Aetna Commercial |
$185.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.65
|
| Rate for Payer: Cash Price |
$174.34
|
| Rate for Payer: Cofinity Advantage |
$152.55
|
| Rate for Payer: Cofinity Commercial |
$187.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.34
|
| Rate for Payer: Healthscope Commercial |
$196.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.45
|
| Rate for Payer: PHP Commercial |
$185.24
|
| Rate for Payer: Priority Health SBD |
$137.30
|
| Rate for Payer: UMR Bronson Commercial |
$95.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.45
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$190.63
|
|
|
Service Code
|
NDC 69918073101
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.53 |
| Max. Negotiated Rate |
$171.57 |
| Rate for Payer: Aetna American Axle |
$123.91
|
| Rate for Payer: Aetna Commercial |
$162.04
|
| Rate for Payer: Aetna Medicare |
$95.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.91
|
| Rate for Payer: BCBS Complete |
$76.25
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cofinity Advantage |
$133.44
|
| Rate for Payer: Cofinity Commercial |
$163.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.50
|
| Rate for Payer: Healthscope Commercial |
$171.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.97
|
| Rate for Payer: PHP Commercial |
$162.04
|
| Rate for Payer: Priority Health SBD |
$120.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.91
|
| Rate for Payer: UHC Core |
$99.32
|
| Rate for Payer: UHC Exchange |
$74.92
|
| Rate for Payer: UMR Bronson Commercial |
$70.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.97
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$192.52
|
|
|
Service Code
|
NDC 69918073501
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.23 |
| Max. Negotiated Rate |
$173.27 |
| Rate for Payer: Aetna American Axle |
$125.14
|
| Rate for Payer: Aetna Commercial |
$163.64
|
| Rate for Payer: Aetna Medicare |
$96.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.14
|
| Rate for Payer: BCBS Complete |
$77.01
|
| Rate for Payer: Cash Price |
$154.02
|
| Rate for Payer: Cofinity Advantage |
$134.76
|
| Rate for Payer: Cofinity Commercial |
$165.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.02
|
| Rate for Payer: Healthscope Commercial |
$173.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.39
|
| Rate for Payer: PHP Commercial |
$163.64
|
| Rate for Payer: Priority Health SBD |
$121.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.14
|
| Rate for Payer: UHC Core |
$100.30
|
| Rate for Payer: UHC Exchange |
$75.66
|
| Rate for Payer: UMR Bronson Commercial |
$71.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.39
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$217.93
|
|
|
Service Code
|
NDC 23155066031
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.89 |
| Max. Negotiated Rate |
$196.14 |
| Rate for Payer: Aetna American Axle |
$141.65
|
| Rate for Payer: Aetna Commercial |
$185.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.65
|
| Rate for Payer: Cash Price |
$174.34
|
| Rate for Payer: Cofinity Advantage |
$152.55
|
| Rate for Payer: Cofinity Commercial |
$187.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.34
|
| Rate for Payer: Healthscope Commercial |
$196.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.45
|
| Rate for Payer: PHP Commercial |
$185.24
|
| Rate for Payer: Priority Health SBD |
$137.30
|
| Rate for Payer: UMR Bronson Commercial |
$95.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.45
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$349.29
|
|
|
Service Code
|
NDC 70121160407
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$153.69 |
| Max. Negotiated Rate |
$314.36 |
| Rate for Payer: Aetna American Axle |
$227.04
|
| Rate for Payer: Aetna Commercial |
$296.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.04
|
| Rate for Payer: Cash Price |
$279.43
|
| Rate for Payer: Cofinity Advantage |
$244.50
|
| Rate for Payer: Cofinity Commercial |
$300.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.43
|
| Rate for Payer: Healthscope Commercial |
$314.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$244.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.97
|
| Rate for Payer: PHP Commercial |
$296.90
|
| Rate for Payer: Priority Health SBD |
$220.05
|
| Rate for Payer: UMR Bronson Commercial |
$153.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.97
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$190.63
|
|
|
Service Code
|
NDC 69918073110
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.53 |
| Max. Negotiated Rate |
$171.57 |
| Rate for Payer: Aetna American Axle |
$123.91
|
| Rate for Payer: Aetna Commercial |
$162.04
|
| Rate for Payer: Aetna Medicare |
$95.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.91
|
| Rate for Payer: BCBS Complete |
$76.25
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cofinity Advantage |
$133.44
|
| Rate for Payer: Cofinity Commercial |
$163.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.50
|
| Rate for Payer: Healthscope Commercial |
$171.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.97
|
| Rate for Payer: PHP Commercial |
$162.04
|
| Rate for Payer: Priority Health SBD |
$120.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.91
|
| Rate for Payer: UHC Core |
$99.32
|
| Rate for Payer: UHC Exchange |
$74.92
|
| Rate for Payer: UMR Bronson Commercial |
$70.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.97
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$349.29
|
|
|
Service Code
|
NDC 70121160401
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$129.24 |
| Max. Negotiated Rate |
$314.36 |
| Rate for Payer: Aetna American Axle |
$227.04
|
| Rate for Payer: Aetna Commercial |
$296.90
|
| Rate for Payer: Aetna Medicare |
$174.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.04
|
| Rate for Payer: BCBS Complete |
$139.72
|
| Rate for Payer: Cash Price |
$279.43
|
| Rate for Payer: Cofinity Advantage |
$244.50
|
| Rate for Payer: Cofinity Commercial |
$300.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.43
|
| Rate for Payer: Healthscope Commercial |
$314.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$244.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$279.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.97
|
| Rate for Payer: PHP Commercial |
$296.90
|
| Rate for Payer: Priority Health SBD |
$220.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.04
|
| Rate for Payer: UHC Core |
$181.98
|
| Rate for Payer: UHC Exchange |
$137.27
|
| Rate for Payer: UMR Bronson Commercial |
$129.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.97
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$217.93
|
|
|
Service Code
|
NDC 23155066031
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$80.63 |
| Max. Negotiated Rate |
$196.14 |
| Rate for Payer: Aetna American Axle |
$141.65
|
| Rate for Payer: Aetna Commercial |
$185.24
|
| Rate for Payer: Aetna Medicare |
$108.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.65
|
| Rate for Payer: BCBS Complete |
$87.17
|
| Rate for Payer: Cash Price |
$174.34
|
| Rate for Payer: Cofinity Advantage |
$152.55
|
| Rate for Payer: Cofinity Commercial |
$187.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.34
|
| Rate for Payer: Healthscope Commercial |
$196.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.45
|
| Rate for Payer: PHP Commercial |
$185.24
|
| Rate for Payer: Priority Health SBD |
$137.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.65
|
| Rate for Payer: UHC Core |
$113.54
|
| Rate for Payer: UHC Exchange |
$85.65
|
| Rate for Payer: UMR Bronson Commercial |
$80.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.45
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$349.29
|
|
|
Service Code
|
NDC 70121160407
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$129.24 |
| Max. Negotiated Rate |
$314.36 |
| Rate for Payer: Aetna American Axle |
$227.04
|
| Rate for Payer: Aetna Commercial |
$296.90
|
| Rate for Payer: Aetna Medicare |
$174.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.04
|
| Rate for Payer: BCBS Complete |
$139.72
|
| Rate for Payer: Cash Price |
$279.43
|
| Rate for Payer: Cofinity Advantage |
$244.50
|
| Rate for Payer: Cofinity Commercial |
$300.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.43
|
| Rate for Payer: Healthscope Commercial |
$314.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$244.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$279.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.97
|
| Rate for Payer: PHP Commercial |
$296.90
|
| Rate for Payer: Priority Health SBD |
$220.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.04
|
| Rate for Payer: UHC Core |
$181.98
|
| Rate for Payer: UHC Exchange |
$137.27
|
| Rate for Payer: UMR Bronson Commercial |
$129.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.97
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$192.52
|
|
|
Service Code
|
NDC 69918073510
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.23 |
| Max. Negotiated Rate |
$173.27 |
| Rate for Payer: Aetna American Axle |
$125.14
|
| Rate for Payer: Aetna Commercial |
$163.64
|
| Rate for Payer: Aetna Medicare |
$96.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.14
|
| Rate for Payer: BCBS Complete |
$77.01
|
| Rate for Payer: Cash Price |
$154.02
|
| Rate for Payer: Cofinity Advantage |
$134.76
|
| Rate for Payer: Cofinity Commercial |
$165.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.02
|
| Rate for Payer: Healthscope Commercial |
$173.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.39
|
| Rate for Payer: PHP Commercial |
$163.64
|
| Rate for Payer: Priority Health SBD |
$121.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.14
|
| Rate for Payer: UHC Core |
$100.30
|
| Rate for Payer: UHC Exchange |
$75.66
|
| Rate for Payer: UMR Bronson Commercial |
$71.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.39
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$252.93
|
|
|
Service Code
|
NDC 69097052131
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$111.29 |
| Max. Negotiated Rate |
$227.64 |
| Rate for Payer: Aetna American Axle |
$164.40
|
| Rate for Payer: Aetna Commercial |
$214.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.40
|
| Rate for Payer: Cash Price |
$202.34
|
| Rate for Payer: Cofinity Advantage |
$177.05
|
| Rate for Payer: Cofinity Commercial |
$217.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.34
|
| Rate for Payer: Healthscope Commercial |
$227.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.70
|
| Rate for Payer: PHP Commercial |
$214.99
|
| Rate for Payer: Priority Health SBD |
$159.35
|
| Rate for Payer: UMR Bronson Commercial |
$111.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.70
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$190.63
|
|
|
Service Code
|
NDC 69918073110
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.88 |
| Max. Negotiated Rate |
$171.57 |
| Rate for Payer: Aetna American Axle |
$123.91
|
| Rate for Payer: Aetna Commercial |
$162.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.91
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cofinity Advantage |
$133.44
|
| Rate for Payer: Cofinity Commercial |
$163.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.50
|
| Rate for Payer: Healthscope Commercial |
$171.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.97
|
| Rate for Payer: PHP Commercial |
$162.04
|
| Rate for Payer: Priority Health SBD |
$120.10
|
| Rate for Payer: UMR Bronson Commercial |
$83.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.97
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$190.63
|
|
|
Service Code
|
NDC 69918073101
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.88 |
| Max. Negotiated Rate |
$171.57 |
| Rate for Payer: Aetna American Axle |
$123.91
|
| Rate for Payer: Aetna Commercial |
$162.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.91
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cofinity Advantage |
$133.44
|
| Rate for Payer: Cofinity Commercial |
$163.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.50
|
| Rate for Payer: Healthscope Commercial |
$171.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.97
|
| Rate for Payer: PHP Commercial |
$162.04
|
| Rate for Payer: Priority Health SBD |
$120.10
|
| Rate for Payer: UMR Bronson Commercial |
$83.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.97
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$217.93
|
|
|
Service Code
|
NDC 23155066043
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$80.63 |
| Max. Negotiated Rate |
$196.14 |
| Rate for Payer: Aetna American Axle |
$141.65
|
| Rate for Payer: Aetna Commercial |
$185.24
|
| Rate for Payer: Aetna Medicare |
$108.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.65
|
| Rate for Payer: BCBS Complete |
$87.17
|
| Rate for Payer: Cash Price |
$174.34
|
| Rate for Payer: Cofinity Advantage |
$152.55
|
| Rate for Payer: Cofinity Commercial |
$187.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.34
|
| Rate for Payer: Healthscope Commercial |
$196.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.45
|
| Rate for Payer: PHP Commercial |
$185.24
|
| Rate for Payer: Priority Health SBD |
$137.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.65
|
| Rate for Payer: UHC Core |
$113.54
|
| Rate for Payer: UHC Exchange |
$85.65
|
| Rate for Payer: UMR Bronson Commercial |
$80.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.45
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$349.29
|
|
|
Service Code
|
NDC 70121160401
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$153.69 |
| Max. Negotiated Rate |
$314.36 |
| Rate for Payer: Aetna American Axle |
$227.04
|
| Rate for Payer: Aetna Commercial |
$296.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.04
|
| Rate for Payer: Cash Price |
$279.43
|
| Rate for Payer: Cofinity Advantage |
$244.50
|
| Rate for Payer: Cofinity Commercial |
$300.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.43
|
| Rate for Payer: Healthscope Commercial |
$314.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$244.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.97
|
| Rate for Payer: PHP Commercial |
$296.90
|
| Rate for Payer: Priority Health SBD |
$220.05
|
| Rate for Payer: UMR Bronson Commercial |
$153.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.97
|
|
