|
ASPIRIN 325 MG TABLET
|
Facility
|
IP
|
$544.50
|
|
|
Service Code
|
NDC 66553000101
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$353.93 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Aetna Commercial |
$462.82
|
| Rate for Payer: BCBS Trust/PPO |
$444.48
|
| Rate for Payer: BCN Commercial |
$420.79
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cofinity Commercial |
$468.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.60
|
| Rate for Payer: Healthscope Commercial |
$490.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$408.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$462.82
|
| Rate for Payer: Nomi Health Commercial |
$446.49
|
| Rate for Payer: PHP Commercial |
$462.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.93
|
| Rate for Payer: Priority Health HMO/PPO |
$473.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$364.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$479.16
|
| Rate for Payer: UHC Core |
$454.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$408.38
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
OP
|
$544.50
|
|
|
Service Code
|
NDC 66553000101
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.32 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Aetna Commercial |
$462.82
|
| Rate for Payer: Aetna Medicare |
$141.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.16
|
| Rate for Payer: BCBS Complete |
$217.80
|
| Rate for Payer: BCBS MAPPO |
$136.12
|
| Rate for Payer: BCBS Trust/PPO |
$447.63
|
| Rate for Payer: BCN Commercial |
$423.35
|
| Rate for Payer: BCN Medicare Advantage |
$136.12
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cofinity Commercial |
$468.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.12
|
| Rate for Payer: Healthscope Commercial |
$490.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$408.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$462.82
|
| Rate for Payer: Nomi Health Commercial |
$446.49
|
| Rate for Payer: PACE Senior Care Partners |
$129.32
|
| Rate for Payer: PACE SWMI |
$136.12
|
| Rate for Payer: PHP Commercial |
$462.82
|
| Rate for Payer: PHP Medicare Advantage |
$136.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.93
|
| Rate for Payer: Priority Health HMO/PPO |
$473.71
|
| Rate for Payer: Priority Health Medicare |
$137.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$364.81
|
| Rate for Payer: Railroad Medicare Medicare |
$136.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$479.16
|
| Rate for Payer: UHC Core |
$454.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.12
|
| Rate for Payer: UHC Exchange |
$136.12
|
| Rate for Payer: UHC Medicare Advantage |
$136.12
|
| Rate for Payer: VA VA |
$136.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$408.38
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
NDC 63739043402
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.55 |
| Max. Negotiated Rate |
$680.40 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Medicare |
$196.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.25
|
| Rate for Payer: BCBS Complete |
$302.40
|
| Rate for Payer: BCBS MAPPO |
$189.00
|
| Rate for Payer: BCBS Trust/PPO |
$621.51
|
| Rate for Payer: BCN Commercial |
$587.79
|
| Rate for Payer: BCN Medicare Advantage |
$189.00
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$650.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.00
|
| Rate for Payer: Healthscope Commercial |
$680.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$567.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.60
|
| Rate for Payer: Nomi Health Commercial |
$619.92
|
| Rate for Payer: PACE Senior Care Partners |
$179.55
|
| Rate for Payer: PACE SWMI |
$189.00
|
| Rate for Payer: PHP Commercial |
$642.60
|
| Rate for Payer: PHP Medicare Advantage |
$189.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health HMO/PPO |
$657.72
|
| Rate for Payer: Priority Health Medicare |
$190.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$506.52
|
| Rate for Payer: Railroad Medicare Medicare |
$189.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$665.28
|
| Rate for Payer: UHC Core |
$631.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.00
|
| Rate for Payer: UHC Exchange |
$189.00
|
| Rate for Payer: UHC Medicare Advantage |
$189.00
|
| Rate for Payer: VA VA |
$189.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$567.00
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
NDC 63739043402
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$680.40 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: BCBS Trust/PPO |
$617.12
|
| Rate for Payer: BCN Commercial |
$584.24
|
| Rate for Payer: Cash Price |
$604.80
|
| 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: Lakeland Regional Health Systems Commercial |
$567.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.60
|
| Rate for Payer: Nomi Health Commercial |
$619.92
|
| Rate for Payer: PHP Commercial |
$642.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health HMO/PPO |
$657.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$506.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$665.28
|
| Rate for Payer: UHC Core |
$631.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$567.00
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
NDC 16103036611
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.85 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Medicare |
$65.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.75
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: BCBS MAPPO |
$63.00
|
| Rate for Payer: BCBS Trust/PPO |
$207.17
|
| Rate for Payer: BCN Commercial |
$195.93
|
| Rate for Payer: BCN Medicare Advantage |
$63.00
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.00
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Nomi Health Commercial |
$206.64
|
| Rate for Payer: PACE Senior Care Partners |
$59.85
|
| Rate for Payer: PACE SWMI |
$63.00
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: PHP Medicare Advantage |
$63.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health HMO/PPO |
$219.24
|
| Rate for Payer: Priority Health Medicare |
$63.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.84
|
| Rate for Payer: Railroad Medicare Medicare |
$63.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.76
|
| Rate for Payer: UHC Core |
$210.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.00
|
| Rate for Payer: UHC Exchange |
$63.00
|
| Rate for Payer: UHC Medicare Advantage |
$63.00
|
| Rate for Payer: VA VA |
$63.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
NDC 00904679430
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$444.60 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: BCBS Trust/PPO |
$558.35
|
| Rate for Payer: BCN Commercial |
$528.60
|
| Rate for Payer: Cash Price |
$547.20
|
| 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: Lakeland Regional Health Systems Commercial |
$513.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.40
|
| Rate for Payer: Nomi Health Commercial |
$560.88
|
| Rate for Payer: PHP Commercial |
$581.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.60
|
| Rate for Payer: Priority Health HMO/PPO |
$595.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$458.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$601.92
|
| Rate for Payer: UHC Core |
$571.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$513.00
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$566.50
|
|
|
Service Code
|
NDC 66553000201
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.54 |
| Max. Negotiated Rate |
$509.85 |
| Rate for Payer: Aetna Commercial |
$481.52
|
| Rate for Payer: Aetna Medicare |
$147.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.03
|
| Rate for Payer: BCBS Complete |
$226.60
|
| Rate for Payer: BCBS MAPPO |
$141.62
|
| Rate for Payer: BCBS Trust/PPO |
$465.72
|
| Rate for Payer: BCN Commercial |
$440.45
|
| Rate for Payer: BCN Medicare Advantage |
$141.62
|
| Rate for Payer: Cash Price |
$453.20
|
| Rate for Payer: Cofinity Commercial |
$487.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.62
|
| Rate for Payer: Healthscope Commercial |
$509.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$424.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.52
|
| Rate for Payer: Nomi Health Commercial |
$464.53
|
| Rate for Payer: PACE Senior Care Partners |
$134.54
|
| Rate for Payer: PACE SWMI |
$141.62
|
| Rate for Payer: PHP Commercial |
$481.52
|
| Rate for Payer: PHP Medicare Advantage |
$141.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.23
|
| Rate for Payer: Priority Health HMO/PPO |
$492.86
|
| Rate for Payer: Priority Health Medicare |
$143.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.56
|
| Rate for Payer: Railroad Medicare Medicare |
$141.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$498.52
|
| Rate for Payer: UHC Core |
$473.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.62
|
| Rate for Payer: UHC Exchange |
$141.62
|
| Rate for Payer: UHC Medicare Advantage |
$141.62
|
| Rate for Payer: VA VA |
$141.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$424.88
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$90.72
|
|
|
Service Code
|
NDC 00904679489
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.55 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Aetna Commercial |
$77.11
|
| Rate for Payer: Aetna Medicare |
$23.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.35
|
| Rate for Payer: BCBS Complete |
$36.29
|
| Rate for Payer: BCBS MAPPO |
$22.68
|
| Rate for Payer: BCBS Trust/PPO |
$74.58
|
| Rate for Payer: BCN Commercial |
$70.53
|
| Rate for Payer: BCN Medicare Advantage |
$22.68
|
| Rate for Payer: Cash Price |
$72.58
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.68
|
| Rate for Payer: Healthscope Commercial |
$81.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.11
|
| Rate for Payer: Nomi Health Commercial |
$74.39
|
| Rate for Payer: PACE Senior Care Partners |
$21.55
|
| Rate for Payer: PACE SWMI |
$22.68
|
| Rate for Payer: PHP Commercial |
$77.11
|
| Rate for Payer: PHP Medicare Advantage |
$22.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.97
|
| Rate for Payer: Priority Health HMO/PPO |
$78.93
|
| Rate for Payer: Priority Health Medicare |
$22.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.78
|
| Rate for Payer: Railroad Medicare Medicare |
$22.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.83
|
| Rate for Payer: UHC Core |
$75.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.68
|
| Rate for Payer: UHC Exchange |
$22.68
|
| Rate for Payer: UHC Medicare Advantage |
$22.68
|
| Rate for Payer: VA VA |
$22.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.04
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
NDC 00904679480
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.74 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna Commercial |
$374.85
|
| Rate for Payer: Aetna Medicare |
$114.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$137.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$137.81
|
| Rate for Payer: BCBS Complete |
$176.40
|
| Rate for Payer: BCBS MAPPO |
$110.25
|
| Rate for Payer: BCBS Trust/PPO |
$362.55
|
| Rate for Payer: BCN Commercial |
$342.88
|
| Rate for Payer: BCN Medicare Advantage |
$110.25
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$379.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.25
|
| Rate for Payer: Healthscope Commercial |
$396.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.85
|
| Rate for Payer: Nomi Health Commercial |
$361.62
|
| Rate for Payer: PACE Senior Care Partners |
$104.74
|
| Rate for Payer: PACE SWMI |
$110.25
|
| Rate for Payer: PHP Commercial |
$374.85
|
| Rate for Payer: PHP Medicare Advantage |
$110.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.65
|
| Rate for Payer: Priority Health HMO/PPO |
$383.67
|
| Rate for Payer: Priority Health Medicare |
$111.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.47
|
| Rate for Payer: Railroad Medicare Medicare |
$110.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.08
|
| Rate for Payer: UHC Core |
$368.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.25
|
| Rate for Payer: UHC Exchange |
$110.25
|
| Rate for Payer: UHC Medicare Advantage |
$110.25
|
| Rate for Payer: VA VA |
$110.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.75
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
NDC 00904679480
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.65 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna Commercial |
$374.85
|
| Rate for Payer: BCBS Trust/PPO |
$359.99
|
| Rate for Payer: BCN Commercial |
$340.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$379.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.80
|
| Rate for Payer: Healthscope Commercial |
$396.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.85
|
| Rate for Payer: Nomi Health Commercial |
$361.62
|
| Rate for Payer: PHP Commercial |
$374.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.65
|
| Rate for Payer: Priority Health HMO/PPO |
$383.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.08
|
| Rate for Payer: UHC Core |
$368.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.75
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
NDC 16103036611
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: BCBS Trust/PPO |
$205.71
|
| Rate for Payer: BCN Commercial |
$194.75
|
| Rate for Payer: Cash Price |
$201.60
|
| 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: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Nomi Health Commercial |
$206.64
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health HMO/PPO |
$219.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.76
|
| Rate for Payer: UHC Core |
$210.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
NDC 00904679430
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.45 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Medicare |
$177.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$213.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$213.75
|
| Rate for Payer: BCBS Complete |
$273.60
|
| Rate for Payer: BCBS MAPPO |
$171.00
|
| Rate for Payer: BCBS Trust/PPO |
$562.32
|
| Rate for Payer: BCN Commercial |
$531.81
|
| Rate for Payer: BCN Medicare Advantage |
$171.00
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cofinity Commercial |
$588.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.00
|
| Rate for Payer: Healthscope Commercial |
$615.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$513.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.40
|
| Rate for Payer: Nomi Health Commercial |
$560.88
|
| Rate for Payer: PACE Senior Care Partners |
$162.45
|
| Rate for Payer: PACE SWMI |
$171.00
|
| Rate for Payer: PHP Commercial |
$581.40
|
| Rate for Payer: PHP Medicare Advantage |
$171.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.60
|
| Rate for Payer: Priority Health HMO/PPO |
$595.08
|
| Rate for Payer: Priority Health Medicare |
$172.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$458.28
|
| Rate for Payer: Railroad Medicare Medicare |
$171.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$601.92
|
| Rate for Payer: UHC Core |
$571.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.00
|
| Rate for Payer: UHC Exchange |
$171.00
|
| Rate for Payer: UHC Medicare Advantage |
$171.00
|
| Rate for Payer: VA VA |
$171.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$513.00
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$566.50
|
|
|
Service Code
|
NDC 66553000201
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$368.23 |
| Max. Negotiated Rate |
$509.85 |
| Rate for Payer: Aetna Commercial |
$481.52
|
| Rate for Payer: BCBS Trust/PPO |
$462.43
|
| Rate for Payer: BCN Commercial |
$437.79
|
| Rate for Payer: Cash Price |
$453.20
|
| Rate for Payer: Cofinity Commercial |
$487.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.20
|
| Rate for Payer: Healthscope Commercial |
$509.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$424.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.52
|
| Rate for Payer: Nomi Health Commercial |
$464.53
|
| Rate for Payer: PHP Commercial |
$481.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.23
|
| Rate for Payer: Priority Health HMO/PPO |
$492.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$498.52
|
| Rate for Payer: UHC Core |
$473.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$424.88
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$90.72
|
|
|
Service Code
|
NDC 00904679489
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.97 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Aetna Commercial |
$77.11
|
| Rate for Payer: BCBS Trust/PPO |
$74.05
|
| Rate for Payer: BCN Commercial |
$70.11
|
| Rate for Payer: Cash Price |
$72.58
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.58
|
| Rate for Payer: Healthscope Commercial |
$81.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.11
|
| Rate for Payer: Nomi Health Commercial |
$74.39
|
| Rate for Payer: PHP Commercial |
$77.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.97
|
| Rate for Payer: Priority Health HMO/PPO |
$78.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.83
|
| Rate for Payer: UHC Core |
$75.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.04
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
OP
|
$58.75
|
|
|
Service Code
|
NDC 00536132601
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: Aetna Medicare |
$15.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.36
|
| Rate for Payer: BCBS Complete |
$23.50
|
| Rate for Payer: BCBS MAPPO |
$14.69
|
| Rate for Payer: BCBS Trust/PPO |
$48.30
|
| Rate for Payer: BCN Commercial |
$45.68
|
| Rate for Payer: BCN Medicare Advantage |
$14.69
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.94
|
| Rate for Payer: Nomi Health Commercial |
$48.17
|
| Rate for Payer: PACE Senior Care Partners |
$13.95
|
| Rate for Payer: PACE SWMI |
$14.69
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: PHP Medicare Advantage |
$14.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.19
|
| Rate for Payer: Priority Health HMO/PPO |
$51.11
|
| Rate for Payer: Priority Health Medicare |
$14.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.36
|
| Rate for Payer: Railroad Medicare Medicare |
$14.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.70
|
| Rate for Payer: UHC Core |
$49.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.69
|
| Rate for Payer: UHC Exchange |
$14.69
|
| Rate for Payer: UHC Medicare Advantage |
$14.69
|
| Rate for Payer: VA VA |
$14.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.06
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
OP
|
$61.10
|
|
|
Service Code
|
NDC 09629513158
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.51 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: Aetna Medicare |
$15.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.09
|
| Rate for Payer: BCBS Complete |
$24.44
|
| Rate for Payer: BCBS MAPPO |
$15.28
|
| Rate for Payer: BCBS Trust/PPO |
$50.23
|
| Rate for Payer: BCN Commercial |
$47.51
|
| Rate for Payer: BCN Medicare Advantage |
$15.28
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: Nomi Health Commercial |
$50.10
|
| Rate for Payer: PACE Senior Care Partners |
$14.51
|
| Rate for Payer: PACE SWMI |
$15.28
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: PHP Medicare Advantage |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| Rate for Payer: Priority Health HMO/PPO |
$53.16
|
| Rate for Payer: Priority Health Medicare |
$15.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.94
|
| Rate for Payer: Railroad Medicare Medicare |
$15.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.77
|
| Rate for Payer: UHC Core |
$51.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.28
|
| Rate for Payer: UHC Exchange |
$15.28
|
| Rate for Payer: UHC Medicare Advantage |
$15.28
|
| Rate for Payer: VA VA |
$15.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.83
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
OP
|
$44.65
|
|
|
Service Code
|
NDC 00904513559
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: Aetna Medicare |
$11.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.95
|
| Rate for Payer: BCBS Complete |
$17.86
|
| Rate for Payer: BCBS MAPPO |
$11.16
|
| Rate for Payer: BCBS Trust/PPO |
$36.71
|
| Rate for Payer: BCN Commercial |
$34.72
|
| Rate for Payer: BCN Medicare Advantage |
$11.16
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$38.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$40.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.95
|
| Rate for Payer: Nomi Health Commercial |
$36.61
|
| Rate for Payer: PACE Senior Care Partners |
$10.60
|
| Rate for Payer: PACE SWMI |
$11.16
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: PHP Medicare Advantage |
$11.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.02
|
| Rate for Payer: Priority Health HMO/PPO |
$38.85
|
| Rate for Payer: Priority Health Medicare |
$11.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.92
|
| Rate for Payer: Railroad Medicare Medicare |
$11.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.29
|
| Rate for Payer: UHC Core |
$37.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.16
|
| Rate for Payer: UHC Exchange |
$11.16
|
| Rate for Payer: UHC Medicare Advantage |
$11.16
|
| Rate for Payer: VA VA |
$11.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.49
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
IP
|
$58.75
|
|
|
Service Code
|
NDC 00536132601
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: BCBS Trust/PPO |
$47.96
|
| Rate for Payer: BCN Commercial |
$45.40
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.94
|
| Rate for Payer: Nomi Health Commercial |
$48.17
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.19
|
| Rate for Payer: Priority Health HMO/PPO |
$51.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.70
|
| Rate for Payer: UHC Core |
$49.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.06
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
IP
|
$44.65
|
|
|
Service Code
|
NDC 00904513559
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.02 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: BCBS Trust/PPO |
$36.45
|
| Rate for Payer: BCN Commercial |
$34.51
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$38.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$40.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.95
|
| Rate for Payer: Nomi Health Commercial |
$36.61
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.02
|
| Rate for Payer: Priority Health HMO/PPO |
$38.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.29
|
| Rate for Payer: UHC Core |
$37.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.49
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
IP
|
$61.10
|
|
|
Service Code
|
NDC 09629513158
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.72 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: BCBS Trust/PPO |
$49.88
|
| Rate for Payer: BCN Commercial |
$47.22
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: Nomi Health Commercial |
$50.10
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| Rate for Payer: Priority Health HMO/PPO |
$53.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.77
|
| Rate for Payer: UHC Core |
$51.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.83
|
|
|
ATENOLOL 12.5 MG CUSTOM TAB
|
Facility
|
IP
|
$1.39
|
|
|
Service Code
|
NDC 09900000308
|
| Hospital Charge Code |
155119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna Commercial |
$1.18
|
| Rate for Payer: BCBS Trust/PPO |
$1.13
|
| Rate for Payer: BCN Commercial |
$1.07
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cofinity Commercial |
$1.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.11
|
| Rate for Payer: Healthscope Commercial |
$1.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.18
|
| Rate for Payer: Nomi Health Commercial |
$1.14
|
| Rate for Payer: PHP Commercial |
$1.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.90
|
| Rate for Payer: Priority Health HMO/PPO |
$1.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.22
|
| Rate for Payer: UHC Core |
$1.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.04
|
|
|
ATENOLOL 12.5 MG CUSTOM TAB
|
Facility
|
OP
|
$1.39
|
|
|
Service Code
|
NDC 09900000308
|
| Hospital Charge Code |
155119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna Commercial |
$1.18
|
| Rate for Payer: Aetna Medicare |
$0.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.43
|
| Rate for Payer: BCBS Complete |
$0.56
|
| Rate for Payer: BCBS MAPPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$1.14
|
| Rate for Payer: BCN Commercial |
$1.08
|
| Rate for Payer: BCN Medicare Advantage |
$0.35
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cofinity Commercial |
$1.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.35
|
| Rate for Payer: Healthscope Commercial |
$1.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.18
|
| Rate for Payer: Nomi Health Commercial |
$1.14
|
| Rate for Payer: PACE Senior Care Partners |
$0.33
|
| Rate for Payer: PACE SWMI |
$0.35
|
| Rate for Payer: PHP Commercial |
$1.18
|
| Rate for Payer: PHP Medicare Advantage |
$0.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.90
|
| Rate for Payer: Priority Health HMO/PPO |
$1.21
|
| Rate for Payer: Priority Health Medicare |
$0.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.93
|
| Rate for Payer: Railroad Medicare Medicare |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.22
|
| Rate for Payer: UHC Core |
$1.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.35
|
| Rate for Payer: UHC Medicare Advantage |
$0.35
|
| Rate for Payer: VA VA |
$0.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.04
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
IP
|
$75.20
|
|
|
Service Code
|
NDC 00093078701
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: BCBS Trust/PPO |
$61.39
|
| Rate for Payer: BCN Commercial |
$58.11
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.16
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.92
|
| Rate for Payer: Nomi Health Commercial |
$61.66
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.88
|
| Rate for Payer: Priority Health HMO/PPO |
$65.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.18
|
| Rate for Payer: UHC Core |
$62.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.40
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
IP
|
$340.75
|
|
|
Service Code
|
NDC 00904718761
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.49 |
| Max. Negotiated Rate |
$306.68 |
| Rate for Payer: Aetna Commercial |
$289.64
|
| Rate for Payer: BCBS Trust/PPO |
$278.15
|
| Rate for Payer: BCN Commercial |
$263.33
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$293.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$306.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.64
|
| Rate for Payer: Nomi Health Commercial |
$279.42
|
| Rate for Payer: PHP Commercial |
$289.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.49
|
| Rate for Payer: Priority Health HMO/PPO |
$296.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.86
|
| Rate for Payer: UHC Core |
$284.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.56
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
IP
|
$430.05
|
|
|
Service Code
|
NDC 51079075920
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.53 |
| Max. Negotiated Rate |
$387.05 |
| Rate for Payer: Aetna Commercial |
$365.54
|
| Rate for Payer: BCBS Trust/PPO |
$351.05
|
| Rate for Payer: BCN Commercial |
$332.34
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Healthscope Commercial |
$387.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.54
|
| Rate for Payer: Nomi Health Commercial |
$352.64
|
| Rate for Payer: PHP Commercial |
$365.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.53
|
| Rate for Payer: Priority Health HMO/PPO |
$374.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.44
|
| Rate for Payer: UHC Core |
$359.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.54
|
|
