|
ISRADIPINE 5 MG CAPSULE
|
Facility
|
IP
|
$786.62
|
|
|
Service Code
|
NDC 16252054001
|
| Hospital Charge Code |
10363
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$346.11 |
| Max. Negotiated Rate |
$707.96 |
| Rate for Payer: Aetna American Axle |
$511.30
|
| Rate for Payer: Aetna Commercial |
$668.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$511.30
|
| Rate for Payer: Cash Price |
$629.30
|
| Rate for Payer: Cofinity Advantage |
$550.63
|
| Rate for Payer: Cofinity Commercial |
$676.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$629.30
|
| Rate for Payer: Healthscope Commercial |
$707.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$550.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$589.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$589.97
|
| Rate for Payer: PHP Commercial |
$668.63
|
| Rate for Payer: Priority Health SBD |
$495.57
|
| Rate for Payer: UMR Bronson Commercial |
$346.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$589.97
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
OP
|
$142.85
|
|
|
Service Code
|
NDC 13668046330
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$128.56 |
| Rate for Payer: Aetna American Axle |
$92.85
|
| Rate for Payer: Aetna Commercial |
$121.42
|
| Rate for Payer: Aetna Medicare |
$71.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.85
|
| Rate for Payer: BCBS Complete |
$57.14
|
| Rate for Payer: Cash Price |
$114.28
|
| Rate for Payer: Cofinity Advantage |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$122.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.28
|
| Rate for Payer: Healthscope Commercial |
$128.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.14
|
| Rate for Payer: PHP Commercial |
$121.42
|
| Rate for Payer: Priority Health SBD |
$90.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.85
|
| Rate for Payer: UHC Core |
$74.42
|
| Rate for Payer: UHC Exchange |
$56.14
|
| Rate for Payer: UMR Bronson Commercial |
$52.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.14
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$142.85
|
|
|
Service Code
|
NDC 13668046330
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.85 |
| Max. Negotiated Rate |
$128.56 |
| Rate for Payer: Aetna American Axle |
$92.85
|
| Rate for Payer: Aetna Commercial |
$121.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.85
|
| Rate for Payer: Cash Price |
$114.28
|
| Rate for Payer: Cofinity Advantage |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$122.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.28
|
| Rate for Payer: Healthscope Commercial |
$128.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.14
|
| Rate for Payer: PHP Commercial |
$121.42
|
| Rate for Payer: Priority Health SBD |
$90.00
|
| Rate for Payer: UMR Bronson Commercial |
$62.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.14
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
OP
|
$9.28
|
|
|
Service Code
|
NDC 50268045011
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Aetna American Axle |
$6.03
|
| Rate for Payer: Aetna Commercial |
$7.89
|
| Rate for Payer: Aetna Medicare |
$4.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.03
|
| Rate for Payer: BCBS Complete |
$3.71
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Cofinity Advantage |
$6.50
|
| Rate for Payer: Cofinity Commercial |
$7.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.42
|
| Rate for Payer: Healthscope Commercial |
$8.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.96
|
| Rate for Payer: PHP Commercial |
$7.89
|
| Rate for Payer: Priority Health SBD |
$5.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.03
|
| Rate for Payer: UHC Core |
$4.83
|
| Rate for Payer: UHC Exchange |
$3.65
|
| Rate for Payer: UMR Bronson Commercial |
$3.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.96
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$223.20
|
|
|
Service Code
|
NDC 67877045430
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.21 |
| Max. Negotiated Rate |
$200.88 |
| Rate for Payer: Aetna American Axle |
$145.08
|
| Rate for Payer: Aetna Commercial |
$189.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.08
|
| Rate for Payer: Cash Price |
$178.56
|
| Rate for Payer: Cofinity Advantage |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$191.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.56
|
| Rate for Payer: Healthscope Commercial |
$200.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.40
|
| Rate for Payer: PHP Commercial |
$189.72
|
| Rate for Payer: Priority Health SBD |
$140.62
|
| Rate for Payer: UMR Bronson Commercial |
$98.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.40
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$185.45
|
|
|
Service Code
|
NDC 50268045012
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$166.91 |
| Rate for Payer: Aetna American Axle |
$120.54
|
| Rate for Payer: Aetna Commercial |
$157.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.54
|
| Rate for Payer: Cash Price |
$148.36
|
| Rate for Payer: Cofinity Advantage |
$129.81
|
| Rate for Payer: Cofinity Commercial |
$159.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.36
|
| Rate for Payer: Healthscope Commercial |
$166.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.09
|
| Rate for Payer: PHP Commercial |
$157.63
|
| Rate for Payer: Priority Health SBD |
$116.83
|
| Rate for Payer: UMR Bronson Commercial |
$81.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.09
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
OP
|
$185.45
|
|
|
Service Code
|
NDC 50268045012
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.62 |
| Max. Negotiated Rate |
$166.91 |
| Rate for Payer: Aetna American Axle |
$120.54
|
| Rate for Payer: Aetna Commercial |
$157.63
|
| Rate for Payer: Aetna Medicare |
$92.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.54
|
| Rate for Payer: BCBS Complete |
$74.18
|
| Rate for Payer: Cash Price |
$148.36
|
| Rate for Payer: Cofinity Advantage |
$129.81
|
| Rate for Payer: Cofinity Commercial |
$159.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.36
|
| Rate for Payer: Healthscope Commercial |
$166.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.09
|
| Rate for Payer: PHP Commercial |
$157.63
|
| Rate for Payer: Priority Health SBD |
$116.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.54
|
| Rate for Payer: UHC Core |
$96.62
|
| Rate for Payer: UHC Exchange |
$72.88
|
| Rate for Payer: UMR Bronson Commercial |
$68.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.09
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
OP
|
$223.20
|
|
|
Service Code
|
NDC 67877045430
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.58 |
| Max. Negotiated Rate |
$200.88 |
| Rate for Payer: Aetna American Axle |
$145.08
|
| Rate for Payer: Aetna Commercial |
$189.72
|
| Rate for Payer: Aetna Medicare |
$111.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.08
|
| Rate for Payer: BCBS Complete |
$89.28
|
| Rate for Payer: Cash Price |
$178.56
|
| Rate for Payer: Cofinity Advantage |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$191.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.56
|
| Rate for Payer: Healthscope Commercial |
$200.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$178.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.40
|
| Rate for Payer: PHP Commercial |
$189.72
|
| Rate for Payer: Priority Health SBD |
$140.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.08
|
| Rate for Payer: UHC Core |
$116.29
|
| Rate for Payer: UHC Exchange |
$87.72
|
| Rate for Payer: UMR Bronson Commercial |
$82.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.40
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$766.13
|
|
|
Service Code
|
NDC 10147170003
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$337.10 |
| Max. Negotiated Rate |
$689.52 |
| Rate for Payer: Aetna American Axle |
$497.98
|
| Rate for Payer: Aetna Commercial |
$651.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.98
|
| Rate for Payer: Cash Price |
$612.90
|
| Rate for Payer: Cofinity Advantage |
$536.29
|
| Rate for Payer: Cofinity Commercial |
$658.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.90
|
| Rate for Payer: Healthscope Commercial |
$689.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$651.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$574.60
|
| Rate for Payer: PHP Commercial |
$651.21
|
| Rate for Payer: Priority Health SBD |
$482.66
|
| Rate for Payer: UMR Bronson Commercial |
$337.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.60
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$9.28
|
|
|
Service Code
|
NDC 50268045011
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Aetna American Axle |
$6.03
|
| Rate for Payer: Aetna Commercial |
$7.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.03
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Cofinity Advantage |
$6.50
|
| Rate for Payer: Cofinity Commercial |
$7.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.42
|
| Rate for Payer: Healthscope Commercial |
$8.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.96
|
| Rate for Payer: PHP Commercial |
$7.89
|
| Rate for Payer: Priority Health SBD |
$5.85
|
| Rate for Payer: UMR Bronson Commercial |
$4.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.96
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
OP
|
$766.13
|
|
|
Service Code
|
NDC 10147170003
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$283.47 |
| Max. Negotiated Rate |
$689.52 |
| Rate for Payer: Aetna American Axle |
$497.98
|
| Rate for Payer: Aetna Commercial |
$651.21
|
| Rate for Payer: Aetna Medicare |
$383.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.98
|
| Rate for Payer: BCBS Complete |
$306.45
|
| Rate for Payer: Cash Price |
$612.90
|
| Rate for Payer: Cofinity Advantage |
$536.29
|
| Rate for Payer: Cofinity Commercial |
$658.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.90
|
| Rate for Payer: Healthscope Commercial |
$689.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$612.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$651.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$574.60
|
| Rate for Payer: PHP Commercial |
$651.21
|
| Rate for Payer: Priority Health SBD |
$482.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$497.98
|
| Rate for Payer: UHC Core |
$399.15
|
| Rate for Payer: UHC Exchange |
$301.09
|
| Rate for Payer: UMR Bronson Commercial |
$283.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.60
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,181.60
|
|
|
Service Code
|
NDC 50458029515
|
| Hospital Charge Code |
19928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$519.90 |
| Max. Negotiated Rate |
$1,063.44 |
| Rate for Payer: Aetna American Axle |
$768.04
|
| Rate for Payer: Aetna Commercial |
$1,004.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$768.04
|
| Rate for Payer: Cash Price |
$945.28
|
| Rate for Payer: Cofinity Advantage |
$827.12
|
| Rate for Payer: Cofinity Commercial |
$1,016.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$945.28
|
| Rate for Payer: Healthscope Commercial |
$1,063.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$827.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$886.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,004.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$886.20
|
| Rate for Payer: PHP Commercial |
$1,004.36
|
| Rate for Payer: Priority Health SBD |
$744.41
|
| Rate for Payer: UMR Bronson Commercial |
$519.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$886.20
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$726.48
|
|
|
Service Code
|
NDC 31722000631
|
| Hospital Charge Code |
19928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.80 |
| Max. Negotiated Rate |
$653.83 |
| Rate for Payer: Aetna American Axle |
$472.21
|
| Rate for Payer: Aetna Commercial |
$617.51
|
| Rate for Payer: Aetna Medicare |
$363.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$472.21
|
| Rate for Payer: BCBS Complete |
$290.59
|
| Rate for Payer: Cash Price |
$581.18
|
| Rate for Payer: Cofinity Advantage |
$508.54
|
| Rate for Payer: Cofinity Commercial |
$624.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$581.18
|
| Rate for Payer: Healthscope Commercial |
$653.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$508.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$544.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$581.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$617.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$544.86
|
| Rate for Payer: PHP Commercial |
$617.51
|
| Rate for Payer: Priority Health SBD |
$457.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$472.21
|
| Rate for Payer: UHC Core |
$378.50
|
| Rate for Payer: UHC Exchange |
$285.51
|
| Rate for Payer: UMR Bronson Commercial |
$268.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$544.86
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$726.48
|
|
|
Service Code
|
NDC 31722000631
|
| Hospital Charge Code |
19928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$319.65 |
| Max. Negotiated Rate |
$653.83 |
| Rate for Payer: Aetna American Axle |
$472.21
|
| Rate for Payer: Aetna Commercial |
$617.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$472.21
|
| Rate for Payer: Cash Price |
$581.18
|
| Rate for Payer: Cofinity Advantage |
$508.54
|
| Rate for Payer: Cofinity Commercial |
$624.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$581.18
|
| Rate for Payer: Healthscope Commercial |
$653.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$508.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$544.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$617.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$544.86
|
| Rate for Payer: PHP Commercial |
$617.51
|
| Rate for Payer: Priority Health SBD |
$457.68
|
| Rate for Payer: UMR Bronson Commercial |
$319.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$544.86
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$1,181.60
|
|
|
Service Code
|
NDC 50458029515
|
| Hospital Charge Code |
19928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$437.19 |
| Max. Negotiated Rate |
$1,063.44 |
| Rate for Payer: Aetna American Axle |
$768.04
|
| Rate for Payer: Aetna Commercial |
$1,004.36
|
| Rate for Payer: Aetna Medicare |
$590.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$768.04
|
| Rate for Payer: BCBS Complete |
$472.64
|
| Rate for Payer: Cash Price |
$945.28
|
| Rate for Payer: Cofinity Advantage |
$827.12
|
| Rate for Payer: Cofinity Commercial |
$1,016.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$945.28
|
| Rate for Payer: Healthscope Commercial |
$1,063.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$827.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$886.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$945.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,004.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$886.20
|
| Rate for Payer: PHP Commercial |
$1,004.36
|
| Rate for Payer: Priority Health SBD |
$744.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$768.04
|
| Rate for Payer: UHC Core |
$615.61
|
| Rate for Payer: UHC Exchange |
$464.37
|
| Rate for Payer: UMR Bronson Commercial |
$437.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$886.20
|
|
|
IVABRADINE 5 MG TABLET
|
Facility
|
OP
|
$464.65
|
|
|
Service Code
|
NDC 62332067960
|
| Hospital Charge Code |
161508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.92 |
| Max. Negotiated Rate |
$418.19 |
| Rate for Payer: Aetna American Axle |
$302.02
|
| Rate for Payer: Aetna Commercial |
$394.95
|
| Rate for Payer: Aetna Medicare |
$232.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.02
|
| Rate for Payer: BCBS Complete |
$185.86
|
| Rate for Payer: Cash Price |
$371.72
|
| Rate for Payer: Cofinity Advantage |
$325.25
|
| Rate for Payer: Cofinity Commercial |
$399.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.72
|
| Rate for Payer: Healthscope Commercial |
$418.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$371.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.49
|
| Rate for Payer: PHP Commercial |
$394.95
|
| Rate for Payer: Priority Health SBD |
$292.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.02
|
| Rate for Payer: UHC Core |
$242.08
|
| Rate for Payer: UHC Exchange |
$182.61
|
| Rate for Payer: UMR Bronson Commercial |
$171.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.49
|
|
|
IVABRADINE 5 MG TABLET
|
Facility
|
IP
|
$464.65
|
|
|
Service Code
|
NDC 62332067960
|
| Hospital Charge Code |
161508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.45 |
| Max. Negotiated Rate |
$418.19 |
| Rate for Payer: Aetna American Axle |
$302.02
|
| Rate for Payer: Aetna Commercial |
$394.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.02
|
| Rate for Payer: Cash Price |
$371.72
|
| Rate for Payer: Cofinity Advantage |
$325.25
|
| Rate for Payer: Cofinity Commercial |
$399.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.72
|
| Rate for Payer: Healthscope Commercial |
$418.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.49
|
| Rate for Payer: PHP Commercial |
$394.95
|
| Rate for Payer: Priority Health SBD |
$292.73
|
| Rate for Payer: UMR Bronson Commercial |
$204.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.49
|
|
|
IVABRADINE 5 MG TABLET
|
Facility
|
IP
|
$239.91
|
|
|
Service Code
|
NDC 50742036260
|
| Hospital Charge Code |
161508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.56 |
| Max. Negotiated Rate |
$215.92 |
| Rate for Payer: Aetna American Axle |
$155.94
|
| Rate for Payer: Aetna Commercial |
$203.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.94
|
| Rate for Payer: Cash Price |
$191.93
|
| Rate for Payer: Cofinity Advantage |
$167.94
|
| Rate for Payer: Cofinity Commercial |
$206.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.93
|
| Rate for Payer: Healthscope Commercial |
$215.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.93
|
| Rate for Payer: PHP Commercial |
$203.92
|
| Rate for Payer: Priority Health SBD |
$151.14
|
| Rate for Payer: UMR Bronson Commercial |
$105.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.93
|
|
|
IVABRADINE 5 MG TABLET
|
Facility
|
OP
|
$2,153.85
|
|
|
Service Code
|
NDC 55513080060
|
| Hospital Charge Code |
161508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$796.92 |
| Max. Negotiated Rate |
$1,938.46 |
| Rate for Payer: Aetna American Axle |
$1,400.00
|
| Rate for Payer: Aetna Commercial |
$1,830.77
|
| Rate for Payer: Aetna Medicare |
$1,076.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,400.00
|
| Rate for Payer: BCBS Complete |
$861.54
|
| Rate for Payer: Cash Price |
$1,723.08
|
| Rate for Payer: Cofinity Advantage |
$1,507.69
|
| Rate for Payer: Cofinity Commercial |
$1,852.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,723.08
|
| Rate for Payer: Healthscope Commercial |
$1,938.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,507.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,615.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,723.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,830.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,615.39
|
| Rate for Payer: PHP Commercial |
$1,830.77
|
| Rate for Payer: Priority Health SBD |
$1,356.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,400.00
|
| Rate for Payer: UHC Core |
$1,122.16
|
| Rate for Payer: UHC Exchange |
$846.46
|
| Rate for Payer: UMR Bronson Commercial |
$796.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,615.39
|
|
|
IVABRADINE 5 MG TABLET
|
Facility
|
OP
|
$239.91
|
|
|
Service Code
|
NDC 50742036260
|
| Hospital Charge Code |
161508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.77 |
| Max. Negotiated Rate |
$215.92 |
| Rate for Payer: Aetna American Axle |
$155.94
|
| Rate for Payer: Aetna Commercial |
$203.92
|
| Rate for Payer: Aetna Medicare |
$119.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.94
|
| Rate for Payer: BCBS Complete |
$95.96
|
| Rate for Payer: Cash Price |
$191.93
|
| Rate for Payer: Cofinity Advantage |
$167.94
|
| Rate for Payer: Cofinity Commercial |
$206.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.93
|
| Rate for Payer: Healthscope Commercial |
$215.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.93
|
| Rate for Payer: PHP Commercial |
$203.92
|
| Rate for Payer: Priority Health SBD |
$151.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.94
|
| Rate for Payer: UHC Core |
$124.99
|
| Rate for Payer: UHC Exchange |
$94.28
|
| Rate for Payer: UMR Bronson Commercial |
$88.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.93
|
|
|
IVABRADINE 5 MG TABLET
|
Facility
|
IP
|
$2,153.85
|
|
|
Service Code
|
NDC 55513080060
|
| Hospital Charge Code |
161508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$947.69 |
| Max. Negotiated Rate |
$1,938.46 |
| Rate for Payer: Aetna American Axle |
$1,400.00
|
| Rate for Payer: Aetna Commercial |
$1,830.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,723.08
|
| Rate for Payer: Cofinity Advantage |
$1,507.69
|
| Rate for Payer: Cofinity Commercial |
$1,852.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,723.08
|
| Rate for Payer: Healthscope Commercial |
$1,938.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,507.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,615.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,830.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,615.39
|
| Rate for Payer: PHP Commercial |
$1,830.77
|
| Rate for Payer: Priority Health SBD |
$1,356.93
|
| Rate for Payer: UMR Bronson Commercial |
$947.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,615.39
|
|
|
IVERMECTIN 3 MG TABLET
|
Facility
|
IP
|
$320.20
|
|
|
Service Code
|
NDC 00006003220
|
| Hospital Charge Code |
25820
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.89 |
| Max. Negotiated Rate |
$288.18 |
| Rate for Payer: Aetna American Axle |
$208.13
|
| Rate for Payer: Aetna Commercial |
$272.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.13
|
| Rate for Payer: Cash Price |
$256.16
|
| Rate for Payer: Cofinity Advantage |
$224.14
|
| Rate for Payer: Cofinity Commercial |
$275.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.16
|
| Rate for Payer: Healthscope Commercial |
$288.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.15
|
| Rate for Payer: PHP Commercial |
$272.17
|
| Rate for Payer: Priority Health SBD |
$201.73
|
| Rate for Payer: UMR Bronson Commercial |
$140.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.15
|
|
|
IVERMECTIN 3 MG TABLET
|
Facility
|
OP
|
$320.20
|
|
|
Service Code
|
NDC 00006003220
|
| Hospital Charge Code |
25820
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.47 |
| Max. Negotiated Rate |
$288.18 |
| Rate for Payer: Aetna American Axle |
$208.13
|
| Rate for Payer: Aetna Commercial |
$272.17
|
| Rate for Payer: Aetna Medicare |
$160.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.13
|
| Rate for Payer: BCBS Complete |
$128.08
|
| Rate for Payer: Cash Price |
$256.16
|
| Rate for Payer: Cofinity Advantage |
$224.14
|
| Rate for Payer: Cofinity Commercial |
$275.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.16
|
| Rate for Payer: Healthscope Commercial |
$288.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.15
|
| Rate for Payer: PHP Commercial |
$272.17
|
| Rate for Payer: Priority Health SBD |
$201.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.13
|
| Rate for Payer: UHC Core |
$166.82
|
| Rate for Payer: UHC Exchange |
$125.84
|
| Rate for Payer: UMR Bronson Commercial |
$118.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.15
|
|
|
IXABEPILONE 15 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,045.38
|
|
|
Service Code
|
HCPCS J9207
|
| Hospital Charge Code |
88652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.09 |
| Max. Negotiated Rate |
$8,140.84 |
| Rate for Payer: Aetna American Axle |
$5,879.50
|
| Rate for Payer: Aetna Commercial |
$7,688.57
|
| Rate for Payer: Aetna Medicare |
$145.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,879.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$174.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$174.69
|
| Rate for Payer: BCBS Complete |
$76.75
|
| Rate for Payer: BCBS MAPPO |
$139.75
|
| Rate for Payer: BCBS Trust/PPO |
$453.87
|
| Rate for Payer: BCN Commercial |
$453.87
|
| Rate for Payer: BCN Medicare Advantage |
$139.75
|
| Rate for Payer: Cash Price |
$7,236.30
|
| Rate for Payer: Cash Price |
$7,236.30
|
| Rate for Payer: Cofinity Advantage |
$6,331.77
|
| Rate for Payer: Cofinity Commercial |
$7,779.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,236.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.75
|
| Rate for Payer: Healthscope Commercial |
$8,140.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,331.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,784.03
|
| Rate for Payer: Mclaren Medicaid |
$139.75
|
| Rate for Payer: Mclaren Medicare |
$139.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.74
|
| Rate for Payer: Meridian Medicaid |
$146.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$153.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,688.57
|
| Rate for Payer: Nomi Health Commercial |
$419.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,784.03
|
| Rate for Payer: PACE Medicare |
$132.76
|
| Rate for Payer: PACE SWMI |
$139.75
|
| Rate for Payer: PHP Commercial |
$7,688.57
|
| Rate for Payer: PHP Medicare Advantage |
$139.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$439.08
|
| Rate for Payer: Priority Health Medicare |
$139.75
|
| Rate for Payer: Priority Health SBD |
$5,698.59
|
| Rate for Payer: Priority Health Tiered Network |
$351.26
|
| Rate for Payer: Railroad Medicare Medicare |
$139.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.97
|
| Rate for Payer: UHC Core |
$230.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$139.75
|
| Rate for Payer: UHC Exchange |
$230.97
|
| Rate for Payer: UHC Medicaid |
$73.09
|
| Rate for Payer: UHCCP Medicaid |
$73.09
|
| Rate for Payer: UMR Bronson Commercial |
$3,346.79
|
| Rate for Payer: VA VA |
$139.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,784.03
|
|
|
IXABEPILONE 15 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,045.38
|
|
|
Service Code
|
HCPCS J9207
|
| Hospital Charge Code |
88652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,979.97 |
| Max. Negotiated Rate |
$8,140.84 |
| Rate for Payer: Aetna American Axle |
$5,879.50
|
| Rate for Payer: Aetna Commercial |
$7,688.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,879.50
|
| Rate for Payer: Cash Price |
$7,236.30
|
| Rate for Payer: Cofinity Advantage |
$6,331.77
|
| Rate for Payer: Cofinity Commercial |
$7,779.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,236.30
|
| Rate for Payer: Healthscope Commercial |
$8,140.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,331.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,784.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,688.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,784.03
|
| Rate for Payer: PHP Commercial |
$7,688.57
|
| Rate for Payer: Priority Health SBD |
$5,698.59
|
| Rate for Payer: UMR Bronson Commercial |
$3,979.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,784.03
|
|
