|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$2,148.48
|
|
|
Service Code
|
NDC 00187433001
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$794.94 |
| 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 Medicare |
$1,074.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,396.51
|
| Rate for Payer: BCBS Complete |
$859.39
|
| 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 |
$794.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,611.36
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$252.93
|
|
|
Service Code
|
NDC 69097052131
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$111.29 |
| Max. Negotiated Rate |
$227.64 |
| Rate for Payer: Aetna American Axle |
$164.40
|
| Rate for Payer: Aetna Commercial |
$214.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.40
|
| Rate for Payer: Cash Price |
$202.34
|
| Rate for Payer: Cofinity 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 |
$111.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.70
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$180.06
|
|
|
Service Code
|
NDC 23155066031
|
| 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
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$2.56
|
|
|
Service Code
|
NDC 68084008211
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.66
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$0.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.92
|
|
|
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 Commercial |
$183.46
|
| Rate for Payer: Cofinity Commercial |
$225.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.46
|
| 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: PHP Commercial |
$222.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.35
|
| Rate for Payer: Priority Health SBD |
$165.11
|
| 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
|
$428.45
|
|
|
Service Code
|
NDC 00904661961
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.52 |
| Max. Negotiated Rate |
$385.60 |
| Rate for Payer: Aetna American Axle |
$278.49
|
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.49
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$299.92
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$385.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: Priority Health SBD |
$269.92
|
| Rate for Payer: UMR Bronson Commercial |
$188.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$428.45
|
|
|
Service Code
|
NDC 00904661961
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.53 |
| Max. Negotiated Rate |
$385.60 |
| Rate for Payer: Aetna American Axle |
$278.49
|
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna Medicare |
$214.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.49
|
| Rate for Payer: BCBS Complete |
$171.38
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$299.92
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$385.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: Priority Health SBD |
$269.92
|
| Rate for Payer: UMR Bronson Commercial |
$158.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
|
|
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 Commercial |
$183.46
|
| Rate for Payer: Cofinity Commercial |
$225.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.46
|
| 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: PHP Commercial |
$222.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.35
|
| 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
|
$255.84
|
|
|
Service Code
|
NDC 68084008201
|
| 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 Commercial |
$179.09
|
| Rate for Payer: Cofinity Commercial |
$220.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.09
|
| 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: PHP Commercial |
$217.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.30
|
| Rate for Payer: Priority Health SBD |
$161.18
|
| 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
|
$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 Commercial |
$270.82
|
| Rate for Payer: Cofinity Commercial |
$332.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.82
|
| 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: PHP Commercial |
$328.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.47
|
| Rate for Payer: Priority Health SBD |
$243.73
|
| Rate for Payer: UMR Bronson Commercial |
$143.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.16
|
|
|
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 Commercial |
$270.82
|
| Rate for Payer: Cofinity Commercial |
$332.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.82
|
| 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: PHP Commercial |
$328.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.47
|
| 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
|
IP
|
$2.56
|
|
|
Service Code
|
NDC 68084008211
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.66
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.92
|
|
|
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 |
$206.48
|
| 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 Commercial |
$289.08
|
| Rate for Payer: Cofinity Commercial |
$355.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.08
|
| 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: PHP Commercial |
$351.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.43
|
| Rate for Payer: Priority Health SBD |
$260.17
|
| 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
|
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 |
$302.58
|
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: Aetna Medicare |
$232.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.58
|
| Rate for Payer: BCBS Complete |
$186.20
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Commercial |
$325.85
|
| Rate for Payer: Cofinity Commercial |
$400.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$325.85
|
| 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: PHP Commercial |
$395.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.58
|
| Rate for Payer: Priority Health SBD |
$293.26
|
| 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
|
IP
|
$255.84
|
|
|
Service Code
|
NDC 68084008201
|
| 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 Commercial |
$179.09
|
| Rate for Payer: Cofinity Commercial |
$220.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.09
|
| 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: PHP Commercial |
$217.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.30
|
| 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
|
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 |
$302.58
|
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.58
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Commercial |
$325.85
|
| Rate for Payer: Cofinity Commercial |
$400.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$325.85
|
| 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: PHP Commercial |
$395.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.58
|
| 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
|
$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 Commercial |
$289.08
|
| Rate for Payer: Cofinity Commercial |
$355.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.08
|
| 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: PHP Commercial |
$351.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.43
|
| 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 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 Commercial |
$274.72
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.72
|
| 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 |
$274.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.09
|
| 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 Commercial |
$274.72
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.72
|
| 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 |
$274.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.09
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| 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
|
$451.25
|
|
|
Service Code
|
NDC 62175010701
|
| Hospital Charge Code |
10357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.55 |
| Max. Negotiated Rate |
$406.12 |
| Rate for Payer: Aetna American Axle |
$293.31
|
| Rate for Payer: Aetna Commercial |
$383.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.31
|
| Rate for Payer: Cash Price |
$361.00
|
| Rate for Payer: Cofinity Commercial |
$315.88
|
| Rate for Payer: Cofinity Commercial |
$388.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.00
|
| Rate for Payer: Healthscope Commercial |
$406.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.56
|
| Rate for Payer: PHP Commercial |
$383.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.31
|
| Rate for Payer: Priority Health SBD |
$284.29
|
| Rate for Payer: UMR Bronson Commercial |
$198.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.44
|
|
|
ISOSORBIDE MONONITRATE 20 MG TABLET
|
Facility
|
OP
|
$451.25
|
|
|
Service Code
|
NDC 62175010701
|
| Hospital Charge Code |
10357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.96 |
| Max. Negotiated Rate |
$406.12 |
| Rate for Payer: Aetna American Axle |
$293.31
|
| Rate for Payer: Aetna Commercial |
$383.56
|
| Rate for Payer: Aetna Medicare |
$225.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.31
|
| Rate for Payer: BCBS Complete |
$180.50
|
| Rate for Payer: Cash Price |
$361.00
|
| Rate for Payer: Cofinity Commercial |
$315.88
|
| Rate for Payer: Cofinity Commercial |
$388.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.00
|
| Rate for Payer: Healthscope Commercial |
$406.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.56
|
| Rate for Payer: PHP Commercial |
$383.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.31
|
| Rate for Payer: Priority Health SBD |
$284.29
|
| Rate for Payer: UMR Bronson Commercial |
$166.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.44
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$248.90
|
|
|
Service Code
|
NDC 00904644961
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.52 |
| Max. Negotiated Rate |
$224.01 |
| Rate for Payer: Aetna American Axle |
$161.78
|
| Rate for Payer: Aetna Commercial |
$211.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.78
|
| Rate for Payer: Cash Price |
$199.12
|
| Rate for Payer: Cofinity Commercial |
$174.23
|
| Rate for Payer: Cofinity Commercial |
$214.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.12
|
| Rate for Payer: Healthscope Commercial |
$224.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.56
|
| Rate for Payer: PHP Commercial |
$211.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.78
|
| Rate for Payer: Priority Health SBD |
$156.81
|
| Rate for Payer: UMR Bronson Commercial |
$109.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.68
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 23155051901
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.63 |
| Max. Negotiated Rate |
$412.42 |
| Rate for Payer: Aetna American Axle |
$297.86
|
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.86
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$320.78
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: Priority Health SBD |
$288.70
|
| Rate for Payer: UMR Bronson Commercial |
$201.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$248.90
|
|
|
Service Code
|
NDC 00904644961
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.09 |
| Max. Negotiated Rate |
$224.01 |
| Rate for Payer: Aetna American Axle |
$161.78
|
| Rate for Payer: Aetna Commercial |
$211.56
|
| Rate for Payer: Aetna Medicare |
$124.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.78
|
| Rate for Payer: BCBS Complete |
$99.56
|
| Rate for Payer: Cash Price |
$199.12
|
| Rate for Payer: Cofinity Commercial |
$174.23
|
| Rate for Payer: Cofinity Commercial |
$214.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.12
|
| Rate for Payer: Healthscope Commercial |
$224.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.56
|
| Rate for Payer: PHP Commercial |
$211.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.78
|
| Rate for Payer: Priority Health SBD |
$156.81
|
| Rate for Payer: UMR Bronson Commercial |
$92.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.68
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$263.20
|
|
|
Service Code
|
NDC 13668010401
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.81 |
| Max. Negotiated Rate |
$236.88 |
| Rate for Payer: Aetna American Axle |
$171.08
|
| Rate for Payer: Aetna Commercial |
$223.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.08
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cofinity Commercial |
$184.24
|
| Rate for Payer: Cofinity Commercial |
$226.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.24
|
| 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: Multiplan/Beech St/PHCS Commercial |
$223.72
|
| Rate for Payer: PHP Commercial |
$223.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.08
|
| Rate for Payer: Priority Health SBD |
$165.82
|
| Rate for Payer: UMR Bronson Commercial |
$115.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.40
|
|
