|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$192.52
|
|
|
Service Code
|
NDC 69918073510
|
| 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
|
OP
|
$252.93
|
|
|
Service Code
|
NDC 69097052131
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.58 |
| Max. Negotiated Rate |
$227.64 |
| Rate for Payer: Aetna American Axle |
$164.40
|
| Rate for Payer: Aetna Commercial |
$214.99
|
| Rate for Payer: Aetna Medicare |
$126.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.40
|
| Rate for Payer: BCBS Complete |
$101.17
|
| 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: MI Amish Medical Board Commercial |
$202.34
|
| 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: UHC All Payor (Choice/PPO) |
$164.40
|
| Rate for Payer: UHC Core |
$131.78
|
| Rate for Payer: UHC Exchange |
$99.40
|
| Rate for Payer: UMR Bronson Commercial |
$93.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.70
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$281.28
|
|
|
Service Code
|
NDC 68084008201
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.76 |
| Max. Negotiated Rate |
$253.15 |
| Rate for Payer: Aetna American Axle |
$182.83
|
| Rate for Payer: Aetna Commercial |
$239.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.83
|
| Rate for Payer: Cash Price |
$225.02
|
| Rate for Payer: Cofinity Advantage |
$196.90
|
| Rate for Payer: Cofinity Commercial |
$241.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.02
|
| Rate for Payer: Healthscope Commercial |
$253.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.96
|
| Rate for Payer: PHP Commercial |
$239.09
|
| Rate for Payer: Priority Health SBD |
$177.21
|
| Rate for Payer: UMR Bronson Commercial |
$123.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.96
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$412.97
|
|
|
Service Code
|
NDC 43353013960
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.71 |
| Max. Negotiated Rate |
$371.67 |
| Rate for Payer: Aetna American Axle |
$268.43
|
| Rate for Payer: Aetna Commercial |
$351.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.43
|
| Rate for Payer: Cash Price |
$330.38
|
| Rate for Payer: Cofinity Advantage |
$289.08
|
| Rate for Payer: Cofinity Commercial |
$355.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.38
|
| Rate for Payer: Healthscope Commercial |
$371.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.73
|
| Rate for Payer: PHP Commercial |
$351.02
|
| Rate for Payer: Priority Health SBD |
$260.17
|
| Rate for Payer: UMR Bronson Commercial |
$181.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.73
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$465.50
|
|
|
Service Code
|
NDC 00781155601
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.24 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna American Axle |
$302.57
|
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: Aetna Medicare |
$232.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.57
|
| Rate for Payer: BCBS Complete |
$186.20
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Advantage |
$325.85
|
| Rate for Payer: Cofinity Commercial |
$400.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Healthscope Commercial |
$418.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.12
|
| Rate for Payer: PHP Commercial |
$395.68
|
| Rate for Payer: Priority Health SBD |
$293.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.57
|
| Rate for Payer: UHC Core |
$242.53
|
| Rate for Payer: UHC Exchange |
$182.94
|
| Rate for Payer: UMR Bronson Commercial |
$172.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.12
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$262.08
|
|
|
Service Code
|
NDC 63739056910
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.97 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Aetna American Axle |
$170.35
|
| Rate for Payer: Aetna Commercial |
$222.77
|
| Rate for Payer: Aetna Medicare |
$131.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.35
|
| Rate for Payer: BCBS Complete |
$104.83
|
| Rate for Payer: Cash Price |
$209.66
|
| Rate for Payer: Cofinity Advantage |
$183.46
|
| Rate for Payer: Cofinity Commercial |
$225.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.66
|
| Rate for Payer: Healthscope Commercial |
$235.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.56
|
| Rate for Payer: PHP Commercial |
$222.77
|
| Rate for Payer: Priority Health SBD |
$165.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.35
|
| Rate for Payer: UHC Core |
$136.54
|
| Rate for Payer: UHC Exchange |
$103.00
|
| Rate for Payer: UMR Bronson Commercial |
$96.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.56
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$386.88
|
|
|
Service Code
|
NDC 49884002101
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.23 |
| Max. Negotiated Rate |
$348.19 |
| Rate for Payer: Aetna American Axle |
$251.47
|
| Rate for Payer: Aetna Commercial |
$328.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.47
|
| Rate for Payer: Cash Price |
$309.50
|
| Rate for Payer: Cofinity Advantage |
$270.82
|
| Rate for Payer: Cofinity Commercial |
$332.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.50
|
| Rate for Payer: Healthscope Commercial |
$348.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.16
|
| Rate for Payer: PHP Commercial |
$328.85
|
| Rate for Payer: Priority Health SBD |
$243.73
|
| Rate for Payer: UMR Bronson Commercial |
$170.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.16
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$412.97
|
|
|
Service Code
|
NDC 43353013960
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$371.67 |
| Rate for Payer: Aetna American Axle |
$268.43
|
| Rate for Payer: Aetna Commercial |
$351.02
|
| Rate for Payer: Aetna Medicare |
$206.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.43
|
| Rate for Payer: BCBS Complete |
$165.19
|
| Rate for Payer: Cash Price |
$330.38
|
| Rate for Payer: Cofinity Advantage |
$289.08
|
| Rate for Payer: Cofinity Commercial |
$355.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.38
|
| Rate for Payer: Healthscope Commercial |
$371.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$330.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.73
|
| Rate for Payer: PHP Commercial |
$351.02
|
| Rate for Payer: Priority Health SBD |
$260.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.43
|
| Rate for Payer: UHC Core |
$215.16
|
| Rate for Payer: UHC Exchange |
$162.30
|
| Rate for Payer: UMR Bronson Commercial |
$152.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.73
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
NDC 68084008211
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna American Axle |
$1.83
|
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.83
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Advantage |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.40
|
| Rate for Payer: Priority Health SBD |
$1.78
|
| Rate for Payer: UMR Bronson Commercial |
$1.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.12
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$281.28
|
|
|
Service Code
|
NDC 68084008201
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.07 |
| Max. Negotiated Rate |
$253.15 |
| Rate for Payer: Aetna American Axle |
$182.83
|
| Rate for Payer: Aetna Commercial |
$239.09
|
| Rate for Payer: Aetna Medicare |
$140.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.83
|
| Rate for Payer: BCBS Complete |
$112.51
|
| Rate for Payer: Cash Price |
$225.02
|
| Rate for Payer: Cofinity Advantage |
$196.90
|
| Rate for Payer: Cofinity Commercial |
$241.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.02
|
| Rate for Payer: Healthscope Commercial |
$253.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.96
|
| Rate for Payer: PHP Commercial |
$239.09
|
| Rate for Payer: Priority Health SBD |
$177.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.83
|
| Rate for Payer: UHC Core |
$146.55
|
| Rate for Payer: UHC Exchange |
$110.54
|
| Rate for Payer: UMR Bronson Commercial |
$104.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.96
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$255.84
|
|
|
Service Code
|
NDC 00904661961
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.57 |
| Max. Negotiated Rate |
$230.26 |
| Rate for Payer: Aetna American Axle |
$166.30
|
| Rate for Payer: Aetna Commercial |
$217.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.30
|
| Rate for Payer: Cash Price |
$204.67
|
| Rate for Payer: Cofinity Advantage |
$179.09
|
| Rate for Payer: Cofinity Commercial |
$220.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.67
|
| Rate for Payer: Healthscope Commercial |
$230.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.88
|
| Rate for Payer: PHP Commercial |
$217.46
|
| Rate for Payer: Priority Health SBD |
$161.18
|
| Rate for Payer: UMR Bronson Commercial |
$112.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.88
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$255.84
|
|
|
Service Code
|
NDC 00904661961
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$230.26 |
| Rate for Payer: Aetna American Axle |
$166.30
|
| Rate for Payer: Aetna Commercial |
$217.46
|
| Rate for Payer: Aetna Medicare |
$127.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.30
|
| Rate for Payer: BCBS Complete |
$102.34
|
| Rate for Payer: Cash Price |
$204.67
|
| Rate for Payer: Cofinity Advantage |
$179.09
|
| Rate for Payer: Cofinity Commercial |
$220.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.67
|
| Rate for Payer: Healthscope Commercial |
$230.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.88
|
| Rate for Payer: PHP Commercial |
$217.46
|
| Rate for Payer: Priority Health SBD |
$161.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.30
|
| Rate for Payer: UHC Core |
$133.29
|
| Rate for Payer: UHC Exchange |
$100.55
|
| Rate for Payer: UMR Bronson Commercial |
$94.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.88
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
NDC 68084008211
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna American Axle |
$1.83
|
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna Medicare |
$1.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.83
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Advantage |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.40
|
| Rate for Payer: Priority Health SBD |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.83
|
| Rate for Payer: UHC Core |
$1.47
|
| Rate for Payer: UHC Exchange |
$1.11
|
| Rate for Payer: UMR Bronson Commercial |
$1.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.12
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$465.50
|
|
|
Service Code
|
NDC 00781155601
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.82 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna American Axle |
$302.57
|
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.57
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Advantage |
$325.85
|
| Rate for Payer: Cofinity Commercial |
$400.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Healthscope Commercial |
$418.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.12
|
| Rate for Payer: PHP Commercial |
$395.68
|
| Rate for Payer: Priority Health SBD |
$293.26
|
| Rate for Payer: UMR Bronson Commercial |
$204.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.12
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$262.08
|
|
|
Service Code
|
NDC 63739056910
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.32 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Aetna American Axle |
$170.35
|
| Rate for Payer: Aetna Commercial |
$222.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.35
|
| Rate for Payer: Cash Price |
$209.66
|
| Rate for Payer: Cofinity Advantage |
$183.46
|
| Rate for Payer: Cofinity Commercial |
$225.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.66
|
| Rate for Payer: Healthscope Commercial |
$235.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.56
|
| Rate for Payer: PHP Commercial |
$222.77
|
| Rate for Payer: Priority Health SBD |
$165.11
|
| Rate for Payer: UMR Bronson Commercial |
$115.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.56
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$386.88
|
|
|
Service Code
|
NDC 49884002101
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.15 |
| Max. Negotiated Rate |
$348.19 |
| Rate for Payer: Aetna American Axle |
$251.47
|
| Rate for Payer: Aetna Commercial |
$328.85
|
| Rate for Payer: Aetna Medicare |
$193.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.47
|
| Rate for Payer: BCBS Complete |
$154.75
|
| Rate for Payer: Cash Price |
$309.50
|
| Rate for Payer: Cofinity Advantage |
$270.82
|
| Rate for Payer: Cofinity Commercial |
$332.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.50
|
| Rate for Payer: Healthscope Commercial |
$348.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.16
|
| Rate for Payer: PHP Commercial |
$328.85
|
| Rate for Payer: Priority Health SBD |
$243.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.47
|
| Rate for Payer: UHC Core |
$201.56
|
| Rate for Payer: UHC Exchange |
$152.04
|
| Rate for Payer: UMR Bronson Commercial |
$143.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.16
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
IP
|
$360.48
|
|
|
Service Code
|
NDC 68084008301
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.61 |
| Max. Negotiated Rate |
$324.43 |
| Rate for Payer: Aetna American Axle |
$234.31
|
| Rate for Payer: Aetna Commercial |
$306.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.31
|
| Rate for Payer: Cash Price |
$288.38
|
| Rate for Payer: Cofinity Advantage |
$252.34
|
| Rate for Payer: Cofinity Commercial |
$310.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.38
|
| Rate for Payer: Healthscope Commercial |
$324.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.36
|
| Rate for Payer: PHP Commercial |
$306.41
|
| Rate for Payer: Priority Health SBD |
$227.10
|
| Rate for Payer: UMR Bronson Commercial |
$158.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.36
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
OP
|
$360.48
|
|
|
Service Code
|
NDC 68084008301
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.38 |
| Max. Negotiated Rate |
$324.43 |
| Rate for Payer: Aetna American Axle |
$234.31
|
| Rate for Payer: Aetna Commercial |
$306.41
|
| Rate for Payer: Aetna Medicare |
$180.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.31
|
| Rate for Payer: BCBS Complete |
$144.19
|
| Rate for Payer: Cash Price |
$288.38
|
| Rate for Payer: Cofinity Advantage |
$252.34
|
| Rate for Payer: Cofinity Commercial |
$310.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.38
|
| Rate for Payer: Healthscope Commercial |
$324.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$288.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.36
|
| Rate for Payer: PHP Commercial |
$306.41
|
| Rate for Payer: Priority Health SBD |
$227.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.31
|
| Rate for Payer: UHC Core |
$187.81
|
| Rate for Payer: UHC Exchange |
$141.67
|
| Rate for Payer: UMR Bronson Commercial |
$133.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.36
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
OP
|
$3.61
|
|
|
Service Code
|
NDC 68084008311
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna American Axle |
$2.35
|
| Rate for Payer: Aetna Commercial |
$3.07
|
| Rate for Payer: Aetna Medicare |
$1.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.35
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cofinity Advantage |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.89
|
| Rate for Payer: Healthscope Commercial |
$3.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.71
|
| Rate for Payer: PHP Commercial |
$3.07
|
| Rate for Payer: Priority Health SBD |
$2.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.35
|
| Rate for Payer: UHC Core |
$1.88
|
| Rate for Payer: UHC Exchange |
$1.42
|
| Rate for Payer: UMR Bronson Commercial |
$1.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.71
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
IP
|
$3.61
|
|
|
Service Code
|
NDC 68084008311
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna American Axle |
$2.35
|
| Rate for Payer: Aetna Commercial |
$3.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.35
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cofinity Advantage |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.89
|
| Rate for Payer: Healthscope Commercial |
$3.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.71
|
| Rate for Payer: PHP Commercial |
$3.07
|
| Rate for Payer: Priority Health SBD |
$2.27
|
| Rate for Payer: UMR Bronson Commercial |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.71
|
|
|
ISOSORBIDE MONONITRATE 20 MG TABLET
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 00228262011
|
| Hospital Charge Code |
10357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.68 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Advantage |
$274.71
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UMR Bronson Commercial |
$172.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
ISOSORBIDE MONONITRATE 20 MG TABLET
|
Facility
|
OP
|
$392.45
|
|
|
Service Code
|
NDC 00228262011
|
| Hospital Charge Code |
10357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.21 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna Medicare |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: BCBS Complete |
$156.98
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Advantage |
$274.71
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.09
|
| Rate for Payer: UHC Core |
$204.47
|
| Rate for Payer: UHC Exchange |
$154.23
|
| Rate for Payer: UMR Bronson Commercial |
$145.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
ISOSORBIDE MONONITRATE 20 MG TABLET
|
Facility
|
IP
|
$1,242.09
|
|
|
Service Code
|
NDC 81665010310
|
| Hospital Charge Code |
10357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$546.52 |
| Max. Negotiated Rate |
$1,117.88 |
| Rate for Payer: Aetna American Axle |
$807.36
|
| Rate for Payer: Aetna Commercial |
$1,055.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.36
|
| Rate for Payer: Cash Price |
$993.67
|
| Rate for Payer: Cofinity Advantage |
$869.46
|
| Rate for Payer: Cofinity Commercial |
$1,068.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$993.67
|
| Rate for Payer: Healthscope Commercial |
$1,117.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$869.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$931.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,055.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$931.57
|
| Rate for Payer: PHP Commercial |
$1,055.78
|
| Rate for Payer: Priority Health SBD |
$782.52
|
| Rate for Payer: UMR Bronson Commercial |
$546.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$931.57
|
|
|
ISOSORBIDE MONONITRATE 20 MG TABLET
|
Facility
|
OP
|
$1,242.09
|
|
|
Service Code
|
NDC 81665010310
|
| Hospital Charge Code |
10357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$459.57 |
| Max. Negotiated Rate |
$1,117.88 |
| Rate for Payer: Aetna American Axle |
$807.36
|
| Rate for Payer: Aetna Commercial |
$1,055.78
|
| Rate for Payer: Aetna Medicare |
$621.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.36
|
| Rate for Payer: BCBS Complete |
$496.84
|
| Rate for Payer: Cash Price |
$993.67
|
| Rate for Payer: Cofinity Advantage |
$869.46
|
| Rate for Payer: Cofinity Commercial |
$1,068.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$993.67
|
| Rate for Payer: Healthscope Commercial |
$1,117.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$869.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$931.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$993.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,055.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$931.57
|
| Rate for Payer: PHP Commercial |
$1,055.78
|
| Rate for Payer: Priority Health SBD |
$782.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$807.36
|
| Rate for Payer: UHC Core |
$647.13
|
| Rate for Payer: UHC Exchange |
$488.14
|
| Rate for Payer: UMR Bronson Commercial |
$459.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$931.57
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$263.20
|
|
|
Service Code
|
NDC 13668010401
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.38 |
| Max. Negotiated Rate |
$236.88 |
| Rate for Payer: Aetna American Axle |
$171.08
|
| Rate for Payer: Aetna Commercial |
$223.72
|
| Rate for Payer: Aetna Medicare |
$131.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.08
|
| Rate for Payer: BCBS Complete |
$105.28
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cofinity Advantage |
$184.24
|
| Rate for Payer: Cofinity Commercial |
$226.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.56
|
| Rate for Payer: Healthscope Commercial |
$236.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.40
|
| Rate for Payer: PHP Commercial |
$223.72
|
| Rate for Payer: Priority Health SBD |
$165.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.08
|
| Rate for Payer: UHC Core |
$137.13
|
| Rate for Payer: UHC Exchange |
$103.44
|
| Rate for Payer: UMR Bronson Commercial |
$97.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.40
|
|
