|
ISONIAZID 300 MG TABLET
|
Facility
|
IP
|
$4.27
|
|
|
Service Code
|
NDC 60687055311
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Aetna American Axle |
$2.78
|
| Rate for Payer: Aetna Commercial |
$3.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.78
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cofinity Commercial |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.42
|
| Rate for Payer: Healthscope Commercial |
$3.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.63
|
| Rate for Payer: PHP Commercial |
$3.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.78
|
| Rate for Payer: Priority Health SBD |
$2.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.20
|
|
|
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 Commercial |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.36
|
| 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: PHP Commercial |
$335.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.62
|
| 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
|
|
|
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 Commercial |
$298.70
|
| Rate for Payer: Cofinity Commercial |
$366.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.70
|
| 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: PHP Commercial |
$362.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.37
|
| Rate for Payer: Priority Health SBD |
$268.83
|
| 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
|
$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 Commercial |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.36
|
| 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: PHP Commercial |
$335.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.62
|
| Rate for Payer: Priority Health SBD |
$248.72
|
| Rate for Payer: UMR Bronson Commercial |
$146.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.10
|
|
|
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 Commercial |
$11.92
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.92
|
| 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: PHP Commercial |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.07
|
| 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
|
|
|
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 Commercial |
$11.92
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.92
|
| 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: PHP Commercial |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.07
|
| Rate for Payer: Priority Health SBD |
$10.73
|
| Rate for Payer: UMR Bronson Commercial |
$6.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.77
|
|
|
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 Commercial |
$133.44
|
| Rate for Payer: Cofinity Commercial |
$163.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.44
|
| 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: PHP Commercial |
$162.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.91
|
| 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
|
$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 |
$126.46
|
| 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 Commercial |
$177.05
|
| Rate for Payer: Cofinity Commercial |
$217.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.05
|
| 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: PHP Commercial |
$214.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.40
|
| Rate for Payer: Priority Health SBD |
$159.35
|
| Rate for Payer: UMR Bronson Commercial |
$93.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.70
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$246.94
|
|
|
Service Code
|
NDC 70121160401
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.65 |
| Max. Negotiated Rate |
$222.25 |
| Rate for Payer: Aetna American Axle |
$160.51
|
| Rate for Payer: Aetna Commercial |
$209.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.51
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Cofinity Commercial |
$212.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.55
|
| Rate for Payer: Healthscope Commercial |
$222.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.90
|
| Rate for Payer: PHP Commercial |
$209.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.51
|
| Rate for Payer: Priority Health SBD |
$155.57
|
| Rate for Payer: UMR Bronson Commercial |
$108.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.20
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$246.94
|
|
|
Service Code
|
NDC 70121160407
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.65 |
| Max. Negotiated Rate |
$222.25 |
| Rate for Payer: Aetna American Axle |
$160.51
|
| Rate for Payer: Aetna Commercial |
$209.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.51
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Cofinity Commercial |
$212.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.55
|
| Rate for Payer: Healthscope Commercial |
$222.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.90
|
| Rate for Payer: PHP Commercial |
$209.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.51
|
| Rate for Payer: Priority Health SBD |
$155.57
|
| Rate for Payer: UMR Bronson Commercial |
$108.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.20
|
|
|
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 Commercial |
$134.76
|
| Rate for Payer: Cofinity Commercial |
$165.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.76
|
| 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: PHP Commercial |
$163.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.14
|
| 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
|
$180.06
|
|
|
Service Code
|
NDC 23155066031
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.23 |
| Max. Negotiated Rate |
$162.05 |
| Rate for Payer: Aetna American Axle |
$117.04
|
| Rate for Payer: Aetna Commercial |
$153.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.04
|
| Rate for Payer: Cash Price |
$144.05
|
| Rate for Payer: Cofinity Commercial |
$126.04
|
| Rate for Payer: Cofinity Commercial |
$154.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.05
|
| Rate for Payer: Healthscope Commercial |
$162.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.05
|
| Rate for Payer: PHP Commercial |
$153.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.04
|
| Rate for Payer: Priority Health SBD |
$113.44
|
| Rate for Payer: UMR Bronson Commercial |
$79.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.04
|
|
|
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 |
$95.32
|
| 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 Commercial |
$133.44
|
| Rate for Payer: Cofinity Commercial |
$163.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.44
|
| 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: PHP Commercial |
$162.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.91
|
| Rate for Payer: Priority Health SBD |
$120.10
|
| 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
|
$180.06
|
|
|
Service Code
|
NDC 23155066043
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$162.05 |
| Rate for Payer: Aetna American Axle |
$117.04
|
| Rate for Payer: Aetna Commercial |
$153.05
|
| Rate for Payer: Aetna Medicare |
$90.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.04
|
| Rate for Payer: BCBS Complete |
$72.02
|
| Rate for Payer: Cash Price |
$144.05
|
| Rate for Payer: Cofinity Commercial |
$126.04
|
| Rate for Payer: Cofinity Commercial |
$154.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.05
|
| Rate for Payer: Healthscope Commercial |
$162.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.05
|
| Rate for Payer: PHP Commercial |
$153.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.04
|
| Rate for Payer: Priority Health SBD |
$113.44
|
| Rate for Payer: UMR Bronson Commercial |
$66.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.04
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$479.41
|
|
|
Service Code
|
NDC 68682043305
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$210.94 |
| Max. Negotiated Rate |
$431.47 |
| Rate for Payer: Aetna American Axle |
$311.62
|
| Rate for Payer: Aetna Commercial |
$407.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.62
|
| Rate for Payer: Cash Price |
$383.53
|
| Rate for Payer: Cofinity Commercial |
$335.59
|
| Rate for Payer: Cofinity Commercial |
$412.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$335.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.53
|
| Rate for Payer: Healthscope Commercial |
$431.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$335.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.50
|
| Rate for Payer: PHP Commercial |
$407.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.62
|
| Rate for Payer: Priority Health SBD |
$302.03
|
| Rate for Payer: UMR Bronson Commercial |
$210.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.56
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$479.41
|
|
|
Service Code
|
NDC 68682043305
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$177.38 |
| Max. Negotiated Rate |
$431.47 |
| Rate for Payer: Aetna American Axle |
$311.62
|
| Rate for Payer: Aetna Commercial |
$407.50
|
| Rate for Payer: Aetna Medicare |
$239.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.62
|
| Rate for Payer: BCBS Complete |
$191.76
|
| Rate for Payer: Cash Price |
$383.53
|
| Rate for Payer: Cofinity Commercial |
$335.59
|
| Rate for Payer: Cofinity Commercial |
$412.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$335.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.53
|
| Rate for Payer: Healthscope Commercial |
$431.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$335.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.50
|
| Rate for Payer: PHP Commercial |
$407.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.62
|
| Rate for Payer: Priority Health SBD |
$302.03
|
| Rate for Payer: UMR Bronson Commercial |
$177.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.56
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$2,148.48
|
|
|
Service Code
|
NDC 00187433001
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$945.33 |
| Max. Negotiated Rate |
$1,933.63 |
| Rate for Payer: Aetna American Axle |
$1,396.51
|
| Rate for Payer: Aetna Commercial |
$1,826.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,396.51
|
| Rate for Payer: Cash Price |
$1,718.78
|
| Rate for Payer: Cofinity Commercial |
$1,503.94
|
| Rate for Payer: Cofinity Commercial |
$1,847.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,503.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,718.78
|
| Rate for Payer: Healthscope Commercial |
$1,933.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,503.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,611.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,826.21
|
| Rate for Payer: PHP Commercial |
$1,826.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.51
|
| Rate for Payer: Priority Health SBD |
$1,353.54
|
| Rate for Payer: UMR Bronson Commercial |
$945.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,611.36
|
|
|
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 Commercial |
$134.76
|
| Rate for Payer: Cofinity Commercial |
$165.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.76
|
| 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: PHP Commercial |
$163.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.14
|
| Rate for Payer: Priority Health SBD |
$121.29
|
| 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
|
$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 Commercial |
$133.44
|
| Rate for Payer: Cofinity Commercial |
$163.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.44
|
| 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: PHP Commercial |
$162.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.91
|
| 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
|
$246.94
|
|
|
Service Code
|
NDC 70121160401
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.37 |
| Max. Negotiated Rate |
$222.25 |
| Rate for Payer: Aetna American Axle |
$160.51
|
| Rate for Payer: Aetna Commercial |
$209.90
|
| Rate for Payer: Aetna Medicare |
$123.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.51
|
| Rate for Payer: BCBS Complete |
$98.78
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Cofinity Commercial |
$212.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.55
|
| Rate for Payer: Healthscope Commercial |
$222.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.90
|
| Rate for Payer: PHP Commercial |
$209.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.51
|
| Rate for Payer: Priority Health SBD |
$155.57
|
| Rate for Payer: UMR Bronson Commercial |
$91.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.20
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$246.94
|
|
|
Service Code
|
NDC 70121160407
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.37 |
| Max. Negotiated Rate |
$222.25 |
| Rate for Payer: Aetna American Axle |
$160.51
|
| Rate for Payer: Aetna Commercial |
$209.90
|
| Rate for Payer: Aetna Medicare |
$123.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.51
|
| Rate for Payer: BCBS Complete |
$98.78
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Cofinity Commercial |
$212.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.55
|
| Rate for Payer: Healthscope Commercial |
$222.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.90
|
| Rate for Payer: PHP Commercial |
$209.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.51
|
| Rate for Payer: Priority Health SBD |
$155.57
|
| Rate for Payer: UMR Bronson Commercial |
$91.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.20
|
|
|
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 |
$95.32
|
| 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 Commercial |
$133.44
|
| Rate for Payer: Cofinity Commercial |
$163.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.44
|
| 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: PHP Commercial |
$162.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.91
|
| Rate for Payer: Priority Health SBD |
$120.10
|
| 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
|
IP
|
$180.06
|
|
|
Service Code
|
NDC 23155066043
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.23 |
| Max. Negotiated Rate |
$162.05 |
| Rate for Payer: Aetna American Axle |
$117.04
|
| Rate for Payer: Aetna Commercial |
$153.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.04
|
| Rate for Payer: Cash Price |
$144.05
|
| Rate for Payer: Cofinity Commercial |
$126.04
|
| Rate for Payer: Cofinity Commercial |
$154.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.05
|
| Rate for Payer: Healthscope Commercial |
$162.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.05
|
| Rate for Payer: PHP Commercial |
$153.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.04
|
| Rate for Payer: Priority Health SBD |
$113.44
|
| Rate for Payer: UMR Bronson Commercial |
$79.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.04
|
|
|
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 Commercial |
$134.76
|
| Rate for Payer: Cofinity Commercial |
$165.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.76
|
| 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: PHP Commercial |
$163.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.14
|
| Rate for Payer: Priority Health SBD |
$121.29
|
| 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
|
$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 Commercial |
$134.76
|
| Rate for Payer: Cofinity Commercial |
$165.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.76
|
| 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: PHP Commercial |
$163.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.14
|
| 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
|
|
