|
BIPOLAR DISORDERS
|
Facility
|
IP
|
$12,564.44
|
|
|
Service Code
|
APR-DRG 7534
|
| Min. Negotiated Rate |
$11,966.14 |
| Max. Negotiated Rate |
$12,564.44 |
| Rate for Payer: BCBS Complete |
$12,564.44
|
| Rate for Payer: Mclaren Medicaid |
$11,966.14
|
| Rate for Payer: Meridian Medicaid |
$12,564.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,966.14
|
| Rate for Payer: UHC Medicaid |
$11,966.14
|
| Rate for Payer: UHCCP Medicaid |
$11,966.14
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$72.43
|
|
|
Service Code
|
NDC 81421002103
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.63 |
| Max. Negotiated Rate |
$65.19 |
| Rate for Payer: Aetna Commercial |
$61.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.08
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cofinity Advantage |
$50.70
|
| Rate for Payer: Cofinity Commercial |
$62.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.94
|
| Rate for Payer: Healthscope Commercial |
$65.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.32
|
| Rate for Payer: PHP Commercial |
$61.57
|
| Rate for Payer: Priority Health SBD |
$45.63
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$124.06
|
|
|
Service Code
|
NDC 81421002105
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.76 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: Aetna Medicare |
$62.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.64
|
| Rate for Payer: BCBS Complete |
$49.62
|
| Rate for Payer: Cash Price |
$99.25
|
| Rate for Payer: Cofinity Advantage |
$86.84
|
| Rate for Payer: Cofinity Commercial |
$106.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.25
|
| Rate for Payer: Healthscope Commercial |
$111.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.05
|
| Rate for Payer: PHP Commercial |
$105.45
|
| Rate for Payer: Priority Health SBD |
$78.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.64
|
| Rate for Payer: UHC Core |
$64.64
|
| Rate for Payer: UHC Exchange |
$48.76
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$124.06
|
|
|
Service Code
|
NDC 81421002105
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.16 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.64
|
| Rate for Payer: Cash Price |
$99.25
|
| Rate for Payer: Cofinity Advantage |
$86.84
|
| Rate for Payer: Cofinity Commercial |
$106.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.25
|
| Rate for Payer: Healthscope Commercial |
$111.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.05
|
| Rate for Payer: PHP Commercial |
$105.45
|
| Rate for Payer: Priority Health SBD |
$78.16
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$217.38
|
|
|
Service Code
|
NDC 00574705050
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$195.64 |
| Rate for Payer: Aetna Commercial |
$184.77
|
| Rate for Payer: Aetna Medicare |
$108.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.30
|
| Rate for Payer: BCBS Complete |
$86.95
|
| Rate for Payer: Cash Price |
$173.90
|
| Rate for Payer: Cofinity Advantage |
$152.17
|
| Rate for Payer: Cofinity Commercial |
$186.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.90
|
| Rate for Payer: Healthscope Commercial |
$195.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.03
|
| Rate for Payer: PHP Commercial |
$184.77
|
| Rate for Payer: Priority Health SBD |
$136.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.30
|
| Rate for Payer: UHC Core |
$113.25
|
| Rate for Payer: UHC Exchange |
$85.43
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$72.43
|
|
|
Service Code
|
NDC 81421002103
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.46 |
| Max. Negotiated Rate |
$65.19 |
| Rate for Payer: Aetna Commercial |
$61.57
|
| Rate for Payer: Aetna Medicare |
$36.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.08
|
| Rate for Payer: BCBS Complete |
$28.97
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cofinity Advantage |
$50.70
|
| Rate for Payer: Cofinity Commercial |
$62.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.94
|
| Rate for Payer: Healthscope Commercial |
$65.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.32
|
| Rate for Payer: PHP Commercial |
$61.57
|
| Rate for Payer: Priority Health SBD |
$45.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.08
|
| Rate for Payer: UHC Core |
$37.74
|
| Rate for Payer: UHC Exchange |
$28.46
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$158.18
|
|
|
Service Code
|
NDC 58980041550
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.16 |
| Max. Negotiated Rate |
$142.36 |
| Rate for Payer: Aetna Commercial |
$134.45
|
| Rate for Payer: Aetna Medicare |
$79.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.82
|
| Rate for Payer: BCBS Complete |
$63.27
|
| Rate for Payer: Cash Price |
$126.54
|
| Rate for Payer: Cofinity Advantage |
$110.73
|
| Rate for Payer: Cofinity Commercial |
$136.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.54
|
| Rate for Payer: Healthscope Commercial |
$142.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.64
|
| Rate for Payer: PHP Commercial |
$134.45
|
| Rate for Payer: Priority Health SBD |
$99.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.82
|
| Rate for Payer: UHC Core |
$82.41
|
| Rate for Payer: UHC Exchange |
$62.16
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$217.38
|
|
|
Service Code
|
NDC 00574705050
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.95 |
| Max. Negotiated Rate |
$195.64 |
| Rate for Payer: Aetna Commercial |
$184.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.30
|
| Rate for Payer: Cash Price |
$173.90
|
| Rate for Payer: Cofinity Advantage |
$152.17
|
| Rate for Payer: Cofinity Commercial |
$186.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.90
|
| Rate for Payer: Healthscope Commercial |
$195.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.03
|
| Rate for Payer: PHP Commercial |
$184.77
|
| Rate for Payer: Priority Health SBD |
$136.95
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$158.18
|
|
|
Service Code
|
NDC 58980041550
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.65 |
| Max. Negotiated Rate |
$142.36 |
| Rate for Payer: Aetna Commercial |
$134.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.82
|
| Rate for Payer: Cash Price |
$126.54
|
| Rate for Payer: Cofinity Advantage |
$110.73
|
| Rate for Payer: Cofinity Commercial |
$136.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.54
|
| Rate for Payer: Healthscope Commercial |
$142.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.64
|
| Rate for Payer: PHP Commercial |
$134.45
|
| Rate for Payer: Priority Health SBD |
$99.65
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$6.35
|
|
|
Service Code
|
NDC 00904640761
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cofinity Advantage |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.08
|
| Rate for Payer: Healthscope Commercial |
$5.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.76
|
| Rate for Payer: PHP Commercial |
$5.40
|
| Rate for Payer: Priority Health SBD |
$4.00
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$6.35
|
|
|
Service Code
|
NDC 00904640761
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Medicare |
$3.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: BCBS Complete |
$2.54
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cofinity Advantage |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.08
|
| Rate for Payer: Healthscope Commercial |
$5.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.76
|
| Rate for Payer: PHP Commercial |
$5.40
|
| Rate for Payer: Priority Health SBD |
$4.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.13
|
| Rate for Payer: UHC Core |
$3.31
|
| Rate for Payer: UHC Exchange |
$2.50
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 01490003916
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Advantage |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.63
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health SBD |
$15.65
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$15.40
|
|
|
Service Code
|
NDC 37000003201
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: Aetna Commercial |
$13.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.01
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Cofinity Advantage |
$10.78
|
| Rate for Payer: Cofinity Commercial |
$13.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.32
|
| Rate for Payer: Healthscope Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.55
|
| Rate for Payer: PHP Commercial |
$13.09
|
| Rate for Payer: Priority Health SBD |
$9.70
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$13,790.32
|
|
|
Service Code
|
NDC 01490010048
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,419.60 |
| Max. Negotiated Rate |
$12,411.29 |
| Rate for Payer: Aetna Commercial |
$11,721.77
|
| Rate for Payer: Aetna Medicare |
$6,895.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,963.71
|
| Rate for Payer: BCBS Complete |
$5,516.13
|
| Rate for Payer: Cash Price |
$11,032.26
|
| Rate for Payer: Cofinity Advantage |
$9,653.22
|
| Rate for Payer: Cofinity Commercial |
$11,859.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,032.26
|
| Rate for Payer: Healthscope Commercial |
$12,411.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,032.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,721.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,342.74
|
| Rate for Payer: PHP Commercial |
$11,721.77
|
| Rate for Payer: Priority Health SBD |
$8,687.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,963.71
|
| Rate for Payer: UHC Core |
$7,184.76
|
| Rate for Payer: UHC Exchange |
$5,419.60
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$15.40
|
|
|
Service Code
|
NDC 37000003201
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: Aetna Commercial |
$13.09
|
| Rate for Payer: Aetna Medicare |
$7.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.01
|
| Rate for Payer: BCBS Complete |
$6.16
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Cofinity Advantage |
$10.78
|
| Rate for Payer: Cofinity Commercial |
$13.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.32
|
| Rate for Payer: Healthscope Commercial |
$13.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.55
|
| Rate for Payer: PHP Commercial |
$13.09
|
| Rate for Payer: Priority Health SBD |
$9.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.01
|
| Rate for Payer: UHC Core |
$8.02
|
| Rate for Payer: UHC Exchange |
$6.05
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
NDC 09900000728
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: BCBS Complete |
$1.15
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.87
|
| Rate for Payer: UHC Core |
$1.50
|
| Rate for Payer: UHC Exchange |
$1.13
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$21.48
|
|
|
Service Code
|
NDC 37000003202
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$19.33 |
| Rate for Payer: Aetna Commercial |
$18.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.96
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Advantage |
$15.04
|
| Rate for Payer: Cofinity Commercial |
$18.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$19.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.11
|
| Rate for Payer: PHP Commercial |
$18.26
|
| Rate for Payer: Priority Health SBD |
$13.53
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$13,790.32
|
|
|
Service Code
|
NDC 01490010048
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8,687.90 |
| Max. Negotiated Rate |
$12,411.29 |
| Rate for Payer: Aetna Commercial |
$11,721.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,963.71
|
| Rate for Payer: Cash Price |
$11,032.26
|
| Rate for Payer: Cofinity Advantage |
$9,653.22
|
| Rate for Payer: Cofinity Commercial |
$11,859.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,032.26
|
| Rate for Payer: Healthscope Commercial |
$12,411.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,721.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,342.74
|
| Rate for Payer: PHP Commercial |
$11,721.77
|
| Rate for Payer: Priority Health SBD |
$8,687.90
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$24.84
|
|
|
Service Code
|
NDC 01490003916
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna Medicare |
$12.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: BCBS Complete |
$9.94
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Advantage |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.63
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.15
|
| Rate for Payer: UHC Core |
$12.94
|
| Rate for Payer: UHC Exchange |
$9.76
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$21.48
|
|
|
Service Code
|
NDC 37000003202
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$19.33 |
| Rate for Payer: Aetna Commercial |
$18.26
|
| Rate for Payer: Aetna Medicare |
$10.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.96
|
| Rate for Payer: BCBS Complete |
$8.59
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Advantage |
$15.04
|
| Rate for Payer: Cofinity Commercial |
$18.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$19.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.11
|
| Rate for Payer: PHP Commercial |
$18.26
|
| Rate for Payer: Priority Health SBD |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.96
|
| Rate for Payer: UHC Core |
$11.19
|
| Rate for Payer: UHC Exchange |
$8.44
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
NDC 09900000728
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health SBD |
$1.81
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$415.95
|
|
|
Service Code
|
NDC 52817027010
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.05 |
| Max. Negotiated Rate |
$374.36 |
| Rate for Payer: Aetna Commercial |
$353.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.37
|
| Rate for Payer: Cash Price |
$332.76
|
| Rate for Payer: Cofinity Advantage |
$291.17
|
| Rate for Payer: Cofinity Commercial |
$357.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.76
|
| Rate for Payer: Healthscope Commercial |
$374.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$311.96
|
| Rate for Payer: PHP Commercial |
$353.56
|
| Rate for Payer: Priority Health SBD |
$262.05
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 29300012601
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.37 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Advantage |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health SBD |
$275.37
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$4.57
|
|
|
Service Code
|
NDC 50268012711
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.97
|
| Rate for Payer: Cash Price |
$3.66
|
| Rate for Payer: Cofinity Advantage |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$3.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.66
|
| Rate for Payer: Healthscope Commercial |
$4.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.43
|
| Rate for Payer: PHP Commercial |
$3.88
|
| Rate for Payer: Priority Health SBD |
$2.88
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$5.81
|
|
|
Service Code
|
NDC 60687067911
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Aetna Medicare |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.78
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cofinity Advantage |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$5.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.65
|
| Rate for Payer: Healthscope Commercial |
$5.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.36
|
| Rate for Payer: PHP Commercial |
$4.94
|
| Rate for Payer: Priority Health SBD |
$3.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.78
|
| Rate for Payer: UHC Core |
$3.03
|
| Rate for Payer: UHC Exchange |
$2.28
|
|
