|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$1,242.09
|
|
|
Service Code
|
NDC 59762201206
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$782.52 |
| Max. Negotiated Rate |
$1,117.88 |
| Rate for Payer: Aetna Commercial |
$1,055.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.36
|
| Rate for Payer: Cash Price |
$993.67
|
| Rate for Payer: Cofinity Advantage |
$869.46
|
| Rate for Payer: Cofinity Commercial |
$1,068.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$993.67
|
| Rate for Payer: Healthscope Commercial |
$1,117.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,055.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$931.57
|
| Rate for Payer: PHP Commercial |
$1,055.78
|
| Rate for Payer: Priority Health SBD |
$782.52
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$207.02
|
|
|
Service Code
|
NDC 59762201201
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.42 |
| Max. Negotiated Rate |
$186.32 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.56
|
| Rate for Payer: Cash Price |
$165.62
|
| Rate for Payer: Cofinity Advantage |
$144.91
|
| Rate for Payer: Cofinity Commercial |
$178.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.62
|
| Rate for Payer: Healthscope Commercial |
$186.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.26
|
| Rate for Payer: PHP Commercial |
$175.97
|
| Rate for Payer: Priority Health SBD |
$130.42
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$1,239.50
|
|
|
Service Code
|
NDC 62332019831
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$780.88 |
| Max. Negotiated Rate |
$1,115.55 |
| Rate for Payer: Aetna Commercial |
$1,053.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.67
|
| Rate for Payer: Cash Price |
$991.60
|
| Rate for Payer: Cofinity Advantage |
$867.65
|
| Rate for Payer: Cofinity Commercial |
$1,065.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.60
|
| Rate for Payer: Healthscope Commercial |
$1,115.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$929.62
|
| Rate for Payer: PHP Commercial |
$1,053.58
|
| Rate for Payer: Priority Health SBD |
$780.88
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$1,239.50
|
|
|
Service Code
|
NDC 62332019831
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$487.12 |
| Max. Negotiated Rate |
$1,115.55 |
| Rate for Payer: Aetna Commercial |
$1,053.58
|
| Rate for Payer: Aetna Medicare |
$619.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.67
|
| Rate for Payer: BCBS Complete |
$495.80
|
| Rate for Payer: Cash Price |
$991.60
|
| Rate for Payer: Cofinity Advantage |
$867.65
|
| Rate for Payer: Cofinity Commercial |
$1,065.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.60
|
| Rate for Payer: Healthscope Commercial |
$1,115.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$991.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$929.62
|
| Rate for Payer: PHP Commercial |
$1,053.58
|
| Rate for Payer: Priority Health SBD |
$780.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$805.67
|
| Rate for Payer: UHC Core |
$645.78
|
| Rate for Payer: UHC Exchange |
$487.12
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$207.02
|
|
|
Service Code
|
NDC 59762201201
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$186.32 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna Medicare |
$103.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.56
|
| Rate for Payer: BCBS Complete |
$82.81
|
| Rate for Payer: Cash Price |
$165.62
|
| Rate for Payer: Cofinity Advantage |
$144.91
|
| Rate for Payer: Cofinity Commercial |
$178.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.62
|
| Rate for Payer: Healthscope Commercial |
$186.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.26
|
| Rate for Payer: PHP Commercial |
$175.97
|
| Rate for Payer: Priority Health SBD |
$130.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.56
|
| Rate for Payer: UHC Core |
$107.86
|
| Rate for Payer: UHC Exchange |
$81.36
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$109.56
|
|
|
Service Code
|
NDC 62332019810
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.06 |
| Max. Negotiated Rate |
$98.60 |
| Rate for Payer: Aetna Commercial |
$93.13
|
| Rate for Payer: Aetna Medicare |
$54.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.21
|
| Rate for Payer: BCBS Complete |
$43.82
|
| Rate for Payer: Cash Price |
$87.65
|
| Rate for Payer: Cofinity Advantage |
$76.69
|
| Rate for Payer: Cofinity Commercial |
$94.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.65
|
| Rate for Payer: Healthscope Commercial |
$98.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.17
|
| Rate for Payer: PHP Commercial |
$93.13
|
| Rate for Payer: Priority Health SBD |
$69.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.21
|
| Rate for Payer: UHC Core |
$57.08
|
| Rate for Payer: UHC Exchange |
$43.06
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$1,242.09
|
|
|
Service Code
|
NDC 59762201206
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$488.14 |
| Max. Negotiated Rate |
$1,117.88 |
| Rate for Payer: Aetna Commercial |
$1,055.78
|
| Rate for Payer: Aetna Medicare |
$621.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.36
|
| Rate for Payer: BCBS Complete |
$496.84
|
| Rate for Payer: Cash Price |
$993.67
|
| Rate for Payer: Cofinity Advantage |
$869.46
|
| Rate for Payer: Cofinity Commercial |
$1,068.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$993.67
|
| Rate for Payer: Healthscope Commercial |
$1,117.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$993.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,055.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$931.57
|
| Rate for Payer: PHP Commercial |
$1,055.78
|
| Rate for Payer: Priority Health SBD |
$782.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$807.36
|
| Rate for Payer: UHC Core |
$647.13
|
| Rate for Payer: UHC Exchange |
$488.14
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$1,052.95
|
|
|
Service Code
|
NDC 51991035860
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$413.81 |
| Max. Negotiated Rate |
$947.65 |
| Rate for Payer: Aetna Commercial |
$895.01
|
| Rate for Payer: Aetna Medicare |
$526.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.42
|
| Rate for Payer: BCBS Complete |
$421.18
|
| Rate for Payer: Cash Price |
$842.36
|
| Rate for Payer: Cofinity Advantage |
$737.07
|
| Rate for Payer: Cofinity Commercial |
$905.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.36
|
| Rate for Payer: Healthscope Commercial |
$947.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$842.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$895.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$789.71
|
| Rate for Payer: PHP Commercial |
$895.01
|
| Rate for Payer: Priority Health SBD |
$663.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.42
|
| Rate for Payer: UHC Core |
$548.59
|
| Rate for Payer: UHC Exchange |
$413.81
|
|
|
ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$6,735.82
|
|
|
Service Code
|
CPT 51102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,058.40 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.40
|
| Rate for Payer: BCN Commercial |
$1,058.40
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Mclaren Medicaid |
$1,089.34
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE
|
Facility
|
OP
|
$215.14
|
|
|
Service Code
|
NDC 68462040560
|
| Hospital Charge Code |
27644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.55 |
| Max. Negotiated Rate |
$193.63 |
| Rate for Payer: Aetna Commercial |
$182.87
|
| Rate for Payer: Aetna Medicare |
$107.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.84
|
| Rate for Payer: BCBS Complete |
$86.06
|
| Rate for Payer: Cash Price |
$172.11
|
| Rate for Payer: Cofinity Advantage |
$150.60
|
| Rate for Payer: Cofinity Commercial |
$185.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.11
|
| Rate for Payer: Healthscope Commercial |
$193.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.35
|
| Rate for Payer: PHP Commercial |
$182.87
|
| Rate for Payer: Priority Health SBD |
$135.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.84
|
| Rate for Payer: UHC Core |
$112.09
|
| Rate for Payer: UHC Exchange |
$84.55
|
|
|
ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE
|
Facility
|
OP
|
$643.51
|
|
|
Service Code
|
NDC 00904705699
|
| Hospital Charge Code |
27644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.90 |
| Max. Negotiated Rate |
$579.16 |
| Rate for Payer: Aetna Commercial |
$546.98
|
| Rate for Payer: Aetna Medicare |
$321.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.28
|
| Rate for Payer: BCBS Complete |
$257.40
|
| Rate for Payer: Cash Price |
$514.81
|
| Rate for Payer: Cofinity Advantage |
$450.46
|
| Rate for Payer: Cofinity Commercial |
$553.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.81
|
| Rate for Payer: Healthscope Commercial |
$579.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$514.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.63
|
| Rate for Payer: PHP Commercial |
$546.98
|
| Rate for Payer: Priority Health SBD |
$405.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.28
|
| Rate for Payer: UHC Core |
$335.27
|
| Rate for Payer: UHC Exchange |
$252.90
|
|
|
ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE
|
Facility
|
IP
|
$215.14
|
|
|
Service Code
|
NDC 68462040560
|
| Hospital Charge Code |
27644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.54 |
| Max. Negotiated Rate |
$193.63 |
| Rate for Payer: Aetna Commercial |
$182.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.84
|
| Rate for Payer: Cash Price |
$172.11
|
| Rate for Payer: Cofinity Advantage |
$150.60
|
| Rate for Payer: Cofinity Commercial |
$185.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.11
|
| Rate for Payer: Healthscope Commercial |
$193.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.35
|
| Rate for Payer: PHP Commercial |
$182.87
|
| Rate for Payer: Priority Health SBD |
$135.54
|
|
|
ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE
|
Facility
|
IP
|
$643.51
|
|
|
Service Code
|
NDC 00904705699
|
| Hospital Charge Code |
27644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$405.41 |
| Max. Negotiated Rate |
$579.16 |
| Rate for Payer: Aetna Commercial |
$546.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.28
|
| Rate for Payer: Cash Price |
$514.81
|
| Rate for Payer: Cofinity Advantage |
$450.46
|
| Rate for Payer: Cofinity Commercial |
$553.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.81
|
| Rate for Payer: Healthscope Commercial |
$579.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.63
|
| Rate for Payer: PHP Commercial |
$546.98
|
| Rate for Payer: Priority Health SBD |
$405.41
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$42.78
|
|
|
Service Code
|
NDC 00574703412
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Aetna Commercial |
$36.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.81
|
| Rate for Payer: Cash Price |
$34.22
|
| Rate for Payer: Cofinity Advantage |
$29.95
|
| Rate for Payer: Cofinity Commercial |
$36.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.22
|
| Rate for Payer: Healthscope Commercial |
$38.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.09
|
| Rate for Payer: PHP Commercial |
$36.36
|
| Rate for Payer: Priority Health SBD |
$26.95
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$42.78
|
|
|
Service Code
|
NDC 00574703412
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.81 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Aetna Commercial |
$36.36
|
| Rate for Payer: Aetna Medicare |
$21.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.81
|
| Rate for Payer: BCBS Complete |
$17.11
|
| Rate for Payer: Cash Price |
$34.22
|
| Rate for Payer: Cofinity Advantage |
$29.95
|
| Rate for Payer: Cofinity Commercial |
$36.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.22
|
| Rate for Payer: Healthscope Commercial |
$38.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.09
|
| Rate for Payer: PHP Commercial |
$36.36
|
| Rate for Payer: Priority Health SBD |
$26.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.81
|
| Rate for Payer: UHC Core |
$22.29
|
| Rate for Payer: UHC Exchange |
$16.81
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
OP
|
$654.50
|
|
|
Service Code
|
NDC 66553000101
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.22 |
| Max. Negotiated Rate |
$589.05 |
| Rate for Payer: Aetna Commercial |
$556.33
|
| Rate for Payer: Aetna Medicare |
$327.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.43
|
| Rate for Payer: BCBS Complete |
$261.80
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Cofinity Advantage |
$458.15
|
| Rate for Payer: Cofinity Commercial |
$562.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.60
|
| Rate for Payer: Healthscope Commercial |
$589.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$523.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$490.88
|
| Rate for Payer: PHP Commercial |
$556.33
|
| Rate for Payer: Priority Health SBD |
$412.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$425.43
|
| Rate for Payer: UHC Core |
$340.99
|
| Rate for Payer: UHC Exchange |
$257.22
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
IP
|
$654.50
|
|
|
Service Code
|
NDC 66553000101
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$412.33 |
| Max. Negotiated Rate |
$589.05 |
| Rate for Payer: Aetna Commercial |
$556.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.43
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Cofinity Advantage |
$458.15
|
| Rate for Payer: Cofinity Commercial |
$562.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.60
|
| Rate for Payer: Healthscope Commercial |
$589.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$490.88
|
| Rate for Payer: PHP Commercial |
$556.33
|
| Rate for Payer: Priority Health SBD |
$412.33
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$1.17
|
|
|
Service Code
|
NDC 77333004925
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna Commercial |
$0.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.76
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cofinity Advantage |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$1.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.94
|
| Rate for Payer: Healthscope Commercial |
$1.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.88
|
| Rate for Payer: PHP Commercial |
$0.99
|
| Rate for Payer: Priority Health SBD |
$0.74
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$47.63
|
|
|
Service Code
|
NDC 57896091136
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$42.87 |
| Rate for Payer: Aetna Commercial |
$40.49
|
| Rate for Payer: Aetna Medicare |
$23.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.96
|
| Rate for Payer: BCBS Complete |
$19.05
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Cofinity Advantage |
$33.34
|
| Rate for Payer: Cofinity Commercial |
$40.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.10
|
| Rate for Payer: Healthscope Commercial |
$42.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.72
|
| Rate for Payer: PHP Commercial |
$40.49
|
| Rate for Payer: Priority Health SBD |
$30.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.96
|
| Rate for Payer: UHC Core |
$24.82
|
| Rate for Payer: UHC Exchange |
$18.72
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$174.90
|
|
|
Service Code
|
NDC 77333004920
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.19 |
| Max. Negotiated Rate |
$157.41 |
| Rate for Payer: Aetna Commercial |
$148.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.69
|
| Rate for Payer: Cash Price |
$139.92
|
| Rate for Payer: Cofinity Advantage |
$122.43
|
| Rate for Payer: Cofinity Commercial |
$150.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.92
|
| Rate for Payer: Healthscope Commercial |
$157.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.18
|
| Rate for Payer: PHP Commercial |
$148.66
|
| Rate for Payer: Priority Health SBD |
$110.19
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
NDC 00904679480
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.07 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna Commercial |
$428.40
|
| Rate for Payer: Aetna Medicare |
$252.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.60
|
| Rate for Payer: BCBS Complete |
$201.60
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cofinity Advantage |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$433.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.20
|
| Rate for Payer: Healthscope Commercial |
$453.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$403.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.00
|
| Rate for Payer: PHP Commercial |
$428.40
|
| Rate for Payer: Priority Health SBD |
$317.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.60
|
| Rate for Payer: UHC Core |
$262.58
|
| Rate for Payer: UHC Exchange |
$198.07
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$676.50
|
|
|
Service Code
|
NDC 66553000201
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$426.19 |
| Max. Negotiated Rate |
$608.85 |
| Rate for Payer: Aetna Commercial |
$575.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.73
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cofinity Advantage |
$473.55
|
| Rate for Payer: Cofinity Commercial |
$581.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.20
|
| Rate for Payer: Healthscope Commercial |
$608.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$575.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.38
|
| Rate for Payer: PHP Commercial |
$575.02
|
| Rate for Payer: Priority Health SBD |
$426.19
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
NDC 00904679430
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.81 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Medicare |
$342.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.60
|
| Rate for Payer: BCBS Complete |
$273.60
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cofinity Advantage |
$478.80
|
| Rate for Payer: Cofinity Commercial |
$588.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.20
|
| Rate for Payer: Healthscope Commercial |
$615.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.00
|
| Rate for Payer: PHP Commercial |
$581.40
|
| Rate for Payer: Priority Health SBD |
$430.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$444.60
|
| Rate for Payer: UHC Core |
$356.36
|
| Rate for Payer: UHC Exchange |
$268.81
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
NDC 16103036611
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.04 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Medicare |
$126.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.80
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Advantage |
$176.40
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.00
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health SBD |
$158.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.80
|
| Rate for Payer: UHC Core |
$131.29
|
| Rate for Payer: UHC Exchange |
$99.04
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
NDC 63739043402
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$476.28 |
| Max. Negotiated Rate |
$680.40 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$491.40
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cofinity Advantage |
$529.20
|
| Rate for Payer: Cofinity Commercial |
$650.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.80
|
| Rate for Payer: Healthscope Commercial |
$680.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$567.00
|
| Rate for Payer: PHP Commercial |
$642.60
|
| Rate for Payer: Priority Health SBD |
$476.28
|
|
