|
ATORVASTATIN 80 MG TABLET
|
Facility
|
IP
|
$114.57
|
|
|
Service Code
|
NDC 00904629304
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.18 |
| Max. Negotiated Rate |
$103.11 |
| Rate for Payer: Aetna Commercial |
$97.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.47
|
| Rate for Payer: Cash Price |
$91.66
|
| Rate for Payer: Cofinity Commercial |
$80.20
|
| Rate for Payer: Cofinity Commercial |
$98.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.66
|
| Rate for Payer: Healthscope Commercial |
$103.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.38
|
| Rate for Payer: PHP Commercial |
$97.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.47
|
| Rate for Payer: Priority Health SBD |
$72.18
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 51079021101
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Aetna Medicare |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.73
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.36
|
| Rate for Payer: Healthscope Commercial |
$3.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.57
|
| Rate for Payer: PHP Commercial |
$3.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.73
|
| Rate for Payer: Priority Health SBD |
$2.65
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
IP
|
$196.70
|
|
|
Service Code
|
NDC 69097094705
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.92 |
| Max. Negotiated Rate |
$177.03 |
| Rate for Payer: Aetna Commercial |
$167.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.86
|
| Rate for Payer: Cash Price |
$157.36
|
| Rate for Payer: Cofinity Commercial |
$137.69
|
| Rate for Payer: Cofinity Commercial |
$169.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.36
|
| Rate for Payer: Healthscope Commercial |
$177.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.20
|
| Rate for Payer: PHP Commercial |
$167.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.86
|
| Rate for Payer: Priority Health SBD |
$123.92
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
OP
|
$196.70
|
|
|
Service Code
|
NDC 69097094705
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.68 |
| Max. Negotiated Rate |
$177.03 |
| Rate for Payer: Aetna Commercial |
$167.20
|
| Rate for Payer: Aetna Medicare |
$98.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.86
|
| Rate for Payer: BCBS Complete |
$78.68
|
| Rate for Payer: Cash Price |
$157.36
|
| Rate for Payer: Cofinity Commercial |
$137.69
|
| Rate for Payer: Cofinity Commercial |
$169.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.36
|
| Rate for Payer: Healthscope Commercial |
$177.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.20
|
| Rate for Payer: PHP Commercial |
$167.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.86
|
| Rate for Payer: Priority Health SBD |
$123.92
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
IP
|
$5,723.61
|
|
|
Service Code
|
NDC 00071015823
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,605.87 |
| Max. Negotiated Rate |
$5,151.25 |
| Rate for Payer: Aetna Commercial |
$4,865.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,720.35
|
| Rate for Payer: Cash Price |
$4,578.89
|
| Rate for Payer: Cofinity Commercial |
$4,006.53
|
| Rate for Payer: Cofinity Commercial |
$4,922.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,006.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,578.89
|
| Rate for Payer: Healthscope Commercial |
$5,151.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,865.07
|
| Rate for Payer: PHP Commercial |
$4,865.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,720.35
|
| Rate for Payer: Priority Health SBD |
$3,605.87
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
OP
|
$125.97
|
|
|
Service Code
|
NDC 51079021103
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$113.37 |
| Rate for Payer: Aetna Commercial |
$107.07
|
| Rate for Payer: Aetna Medicare |
$62.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.88
|
| Rate for Payer: BCBS Complete |
$50.39
|
| Rate for Payer: Cash Price |
$100.78
|
| Rate for Payer: Cofinity Commercial |
$108.33
|
| Rate for Payer: Cofinity Commercial |
$88.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.78
|
| Rate for Payer: Healthscope Commercial |
$113.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.07
|
| Rate for Payer: PHP Commercial |
$107.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.88
|
| Rate for Payer: Priority Health SBD |
$79.36
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
IP
|
$129.11
|
|
|
Service Code
|
NDC 68084059025
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.34 |
| Max. Negotiated Rate |
$116.20 |
| Rate for Payer: Aetna Commercial |
$109.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.92
|
| Rate for Payer: Cash Price |
$103.29
|
| Rate for Payer: Cofinity Commercial |
$111.03
|
| Rate for Payer: Cofinity Commercial |
$90.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.29
|
| Rate for Payer: Healthscope Commercial |
$116.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.74
|
| Rate for Payer: PHP Commercial |
$109.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.92
|
| Rate for Payer: Priority Health SBD |
$81.34
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
IP
|
$125.97
|
|
|
Service Code
|
NDC 51079021103
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.36 |
| Max. Negotiated Rate |
$113.37 |
| Rate for Payer: Aetna Commercial |
$107.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.88
|
| Rate for Payer: Cash Price |
$100.78
|
| Rate for Payer: Cofinity Commercial |
$108.33
|
| Rate for Payer: Cofinity Commercial |
$88.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.78
|
| Rate for Payer: Healthscope Commercial |
$113.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.07
|
| Rate for Payer: PHP Commercial |
$107.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.88
|
| Rate for Payer: Priority Health SBD |
$79.36
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
OP
|
$5,723.61
|
|
|
Service Code
|
NDC 00071015823
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,289.44 |
| Max. Negotiated Rate |
$5,151.25 |
| Rate for Payer: Aetna Commercial |
$4,865.07
|
| Rate for Payer: Aetna Medicare |
$2,861.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,720.35
|
| Rate for Payer: BCBS Complete |
$2,289.44
|
| Rate for Payer: Cash Price |
$4,578.89
|
| Rate for Payer: Cofinity Commercial |
$4,006.53
|
| Rate for Payer: Cofinity Commercial |
$4,922.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,006.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,578.89
|
| Rate for Payer: Healthscope Commercial |
$5,151.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,865.07
|
| Rate for Payer: PHP Commercial |
$4,865.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,720.35
|
| Rate for Payer: Priority Health SBD |
$3,605.87
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
OP
|
$129.11
|
|
|
Service Code
|
NDC 68084059025
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.64 |
| Max. Negotiated Rate |
$116.20 |
| Rate for Payer: Aetna Commercial |
$109.74
|
| Rate for Payer: Aetna Medicare |
$64.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.92
|
| Rate for Payer: BCBS Complete |
$51.64
|
| Rate for Payer: Cash Price |
$103.29
|
| Rate for Payer: Cofinity Commercial |
$111.03
|
| Rate for Payer: Cofinity Commercial |
$90.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.29
|
| Rate for Payer: Healthscope Commercial |
$116.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.74
|
| Rate for Payer: PHP Commercial |
$109.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.92
|
| Rate for Payer: Priority Health SBD |
$81.34
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 51079021101
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.73
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.36
|
| Rate for Payer: Healthscope Commercial |
$3.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.57
|
| Rate for Payer: PHP Commercial |
$3.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.73
|
| Rate for Payer: Priority Health SBD |
$2.65
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
IP
|
$304.56
|
|
|
Service Code
|
NDC 00378395377
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.87 |
| Max. Negotiated Rate |
$274.10 |
| Rate for Payer: Aetna Commercial |
$258.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.96
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cofinity Commercial |
$213.19
|
| Rate for Payer: Cofinity Commercial |
$261.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.65
|
| Rate for Payer: Healthscope Commercial |
$274.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.88
|
| Rate for Payer: PHP Commercial |
$258.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.96
|
| Rate for Payer: Priority Health SBD |
$191.87
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$42.99
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.08 |
| Max. Negotiated Rate |
$38.69 |
| Rate for Payer: Aetna Commercial |
$36.54
|
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Aetna Commercial |
$23.99
|
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.94
|
| Rate for Payer: Cash Price |
$34.39
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cash Price |
$22.58
|
| Rate for Payer: Cash Price |
$57.25
|
| Rate for Payer: Cofinity Commercial |
$61.54
|
| Rate for Payer: Cofinity Commercial |
$50.09
|
| Rate for Payer: Cofinity Commercial |
$30.09
|
| Rate for Payer: Cofinity Commercial |
$24.27
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Commercial |
$36.97
|
| Rate for Payer: Cofinity Commercial |
$19.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.58
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Healthscope Commercial |
$25.40
|
| Rate for Payer: Healthscope Commercial |
$38.69
|
| Rate for Payer: Healthscope Commercial |
$64.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$36.54
|
| Rate for Payer: PHP Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$23.99
|
| Rate for Payer: PHP Commercial |
$60.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health SBD |
$17.78
|
| Rate for Payer: Priority Health SBD |
$27.08
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: Priority Health SBD |
$45.08
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$71.56
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Aetna Commercial |
$23.99
|
| Rate for Payer: Aetna Commercial |
$36.54
|
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: Aetna Medicare |
$14.11
|
| Rate for Payer: Aetna Medicare |
$35.78
|
| Rate for Payer: Aetna Medicare |
$14.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: BCBS Complete |
$11.98
|
| Rate for Payer: BCBS Complete |
$11.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cash Price |
$22.58
|
| Rate for Payer: Cash Price |
$34.39
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cash Price |
$34.39
|
| Rate for Payer: Cash Price |
$57.25
|
| Rate for Payer: Cash Price |
$57.25
|
| Rate for Payer: Cash Price |
$22.58
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$19.75
|
| Rate for Payer: Cofinity Commercial |
$24.27
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Commercial |
$30.09
|
| Rate for Payer: Cofinity Commercial |
$36.97
|
| Rate for Payer: Cofinity Commercial |
$50.09
|
| Rate for Payer: Cofinity Commercial |
$61.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Healthscope Commercial |
$64.40
|
| Rate for Payer: Healthscope Commercial |
$38.69
|
| Rate for Payer: Healthscope Commercial |
$25.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.83
|
| Rate for Payer: PHP Commercial |
$60.83
|
| Rate for Payer: PHP Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$36.54
|
| Rate for Payer: PHP Commercial |
$23.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health SBD |
$45.08
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: Priority Health SBD |
$17.78
|
| Rate for Payer: Priority Health SBD |
$27.08
|
|
|
ATROPINE 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$29.95
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
163701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Commercial |
$36.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.94
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cash Price |
$34.39
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$30.09
|
| Rate for Payer: Cofinity Commercial |
$36.97
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.39
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Healthscope Commercial |
$38.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.54
|
| Rate for Payer: PHP Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$36.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health SBD |
$27.08
|
| Rate for Payer: Priority Health SBD |
$18.87
|
|
|
ATROPINE 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
OP
|
$29.95
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
163701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Commercial |
$36.54
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: Aetna Medicare |
$14.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.94
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Complete |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$34.39
|
| Rate for Payer: Cash Price |
$34.39
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$36.97
|
| Rate for Payer: Cofinity Commercial |
$30.09
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.39
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Healthscope Commercial |
$38.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$36.54
|
| Rate for Payer: PHP Commercial |
$25.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.94
|
| Rate for Payer: Priority Health SBD |
$27.08
|
| Rate for Payer: Priority Health SBD |
$18.87
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$123.18
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$110.86 |
| Rate for Payer: Aetna Commercial |
$104.70
|
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Medicare |
$9.23
|
| Rate for Payer: Aetna Medicare |
$61.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.00
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS Complete |
$49.27
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cash Price |
$98.54
|
| Rate for Payer: Cash Price |
$98.54
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cofinity Commercial |
$86.23
|
| Rate for Payer: Cofinity Commercial |
$105.93
|
| Rate for Payer: Cofinity Commercial |
$12.92
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.77
|
| Rate for Payer: Healthscope Commercial |
$16.61
|
| Rate for Payer: Healthscope Commercial |
$110.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.70
|
| Rate for Payer: PHP Commercial |
$15.69
|
| Rate for Payer: PHP Commercial |
$104.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.07
|
| Rate for Payer: Priority Health SBD |
$11.63
|
| Rate for Payer: Priority Health SBD |
$77.60
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$18.46
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$16.61 |
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Commercial |
$104.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.00
|
| Rate for Payer: Cash Price |
$98.54
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Cofinity Commercial |
$12.92
|
| Rate for Payer: Cofinity Commercial |
$105.93
|
| Rate for Payer: Cofinity Commercial |
$86.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.77
|
| Rate for Payer: Healthscope Commercial |
$16.61
|
| Rate for Payer: Healthscope Commercial |
$110.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.69
|
| Rate for Payer: PHP Commercial |
$15.69
|
| Rate for Payer: PHP Commercial |
$104.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.00
|
| Rate for Payer: Priority Health SBD |
$77.60
|
| Rate for Payer: Priority Health SBD |
$11.63
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.02
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health SBD |
$11.66
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
OP
|
$18.46
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$16.61 |
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$9.25
|
| Rate for Payer: Aetna Medicare |
$9.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.02
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Cofinity Commercial |
$12.92
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$16.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.69
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.00
|
| Rate for Payer: Priority Health SBD |
$11.66
|
| Rate for Payer: Priority Health SBD |
$11.63
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$122.08
|
|
|
Service Code
|
NDC 17478021505
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.83 |
| Max. Negotiated Rate |
$109.87 |
| Rate for Payer: Aetna Commercial |
$103.77
|
| Rate for Payer: Aetna Medicare |
$61.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.35
|
| Rate for Payer: BCBS Complete |
$48.83
|
| Rate for Payer: Cash Price |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$104.99
|
| Rate for Payer: Cofinity Commercial |
$85.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.66
|
| Rate for Payer: Healthscope Commercial |
$109.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.77
|
| Rate for Payer: PHP Commercial |
$103.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.35
|
| Rate for Payer: Priority Health SBD |
$76.91
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$122.08
|
|
|
Service Code
|
NDC 17478021505
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.91 |
| Max. Negotiated Rate |
$109.87 |
| Rate for Payer: Aetna Commercial |
$103.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.35
|
| Rate for Payer: Cash Price |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$104.99
|
| Rate for Payer: Cofinity Commercial |
$85.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.66
|
| Rate for Payer: Healthscope Commercial |
$109.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.77
|
| Rate for Payer: PHP Commercial |
$103.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.35
|
| Rate for Payer: Priority Health SBD |
$76.91
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$153.23
|
|
|
Service Code
|
NDC 60219174903
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.53 |
| Max. Negotiated Rate |
$137.91 |
| Rate for Payer: Aetna Commercial |
$130.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.60
|
| Rate for Payer: Cash Price |
$122.58
|
| Rate for Payer: Cofinity Commercial |
$107.26
|
| Rate for Payer: Cofinity Commercial |
$131.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.58
|
| Rate for Payer: Healthscope Commercial |
$137.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.25
|
| Rate for Payer: PHP Commercial |
$130.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.60
|
| Rate for Payer: Priority Health SBD |
$96.53
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$187.36
|
|
|
Service Code
|
NDC 00065081701
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.04 |
| Max. Negotiated Rate |
$168.62 |
| Rate for Payer: Aetna Commercial |
$159.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.78
|
| Rate for Payer: Cash Price |
$149.89
|
| Rate for Payer: Cofinity Commercial |
$131.15
|
| Rate for Payer: Cofinity Commercial |
$161.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.89
|
| Rate for Payer: Healthscope Commercial |
$168.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.26
|
| Rate for Payer: PHP Commercial |
$159.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.78
|
| Rate for Payer: Priority Health SBD |
$118.04
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$161.25
|
|
|
Service Code
|
NDC 00065030355
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$145.12 |
| Rate for Payer: Aetna Commercial |
$137.06
|
| Rate for Payer: Aetna Medicare |
$80.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.81
|
| Rate for Payer: BCBS Complete |
$64.50
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cofinity Commercial |
$112.88
|
| Rate for Payer: Cofinity Commercial |
$138.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.00
|
| Rate for Payer: Healthscope Commercial |
$145.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.06
|
| Rate for Payer: PHP Commercial |
$137.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.81
|
| Rate for Payer: Priority Health SBD |
$101.59
|
|
