|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$36.43
|
|
|
Service Code
|
NDC 0574-7034-12
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.22 |
| Max. Negotiated Rate |
$32.79 |
| Rate for Payer: Aetna Commercial |
$30.97
|
| Rate for Payer: BCBS Trust/PPO |
$28.15
|
| Rate for Payer: BCN Commercial |
$28.15
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cofinity Commercial |
$31.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.14
|
| Rate for Payer: Healthscope Commercial |
$32.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.97
|
| Rate for Payer: PHP Commercial |
$30.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.06
|
| Rate for Payer: UHC Core |
$30.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.32
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
IP
|
$511.50
|
|
|
Service Code
|
NDC 66553-001-01
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$311.96 |
| Max. Negotiated Rate |
$460.35 |
| Rate for Payer: Aetna Commercial |
$434.78
|
| Rate for Payer: BCBS Trust/PPO |
$395.29
|
| Rate for Payer: BCN Commercial |
$395.29
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cofinity Commercial |
$439.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.20
|
| Rate for Payer: Healthscope Commercial |
$460.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.78
|
| Rate for Payer: PHP Commercial |
$434.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$445.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$450.12
|
| Rate for Payer: UHC Core |
$427.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.62
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$90.72
|
|
|
Service Code
|
NDC 0904-6794-89
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.33 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Aetna Commercial |
$77.11
|
| Rate for Payer: BCBS Trust/PPO |
$70.11
|
| 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 Multiplan/Beech St/PHCS |
$77.11
|
| Rate for Payer: PHP Commercial |
$77.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.33
|
| 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 81 MG CHEWABLE TABLET
|
Facility
IP
|
$544.50
|
|
|
Service Code
|
NDC 66553-002-01
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$332.09 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Aetna Commercial |
$462.82
|
| Rate for Payer: BCBS Trust/PPO |
$420.79
|
| 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 Multiplan/Beech St/PHCS |
$462.82
|
| Rate for Payer: PHP Commercial |
$462.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$473.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$332.09
|
| 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 81 MG CHEWABLE TABLET
|
Facility
IP
|
$441.00
|
|
|
Service Code
|
NDC 0904-6794-80
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.97 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna Commercial |
$374.85
|
| Rate for Payer: BCBS Trust/PPO |
$340.80
|
| 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 Multiplan/Beech St/PHCS |
$374.85
|
| Rate for Payer: PHP Commercial |
$374.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$383.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.97
|
| 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 16103-366-11
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.69 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: BCBS Trust/PPO |
$194.75
|
| 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 Multiplan/Beech St/PHCS |
$214.20
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.69
|
| 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
IP
|
$744.00
|
|
|
Service Code
|
NDC 63739-434-02
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$669.60 |
| Rate for Payer: Aetna Commercial |
$632.40
|
| Rate for Payer: BCBS Trust/PPO |
$574.96
|
| Rate for Payer: BCN Commercial |
$574.96
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cofinity Commercial |
$639.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$595.20
|
| Rate for Payer: Healthscope Commercial |
$669.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$558.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$632.40
|
| Rate for Payer: PHP Commercial |
$632.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$520.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$647.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$453.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$654.72
|
| Rate for Payer: UHC Core |
$621.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$558.00
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$672.00
|
|
|
Service Code
|
NDC 0904-6794-30
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$409.85 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna Commercial |
$571.20
|
| Rate for Payer: BCBS Trust/PPO |
$519.32
|
| Rate for Payer: BCN Commercial |
$519.32
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cofinity Commercial |
$577.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.60
|
| Rate for Payer: Healthscope Commercial |
$604.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$571.20
|
| Rate for Payer: PHP Commercial |
$571.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$584.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$409.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$591.36
|
| Rate for Payer: UHC Core |
$561.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.00
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$1,134.00
|
|
|
Service Code
|
NDC 63739-434-01
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$691.63 |
| Max. Negotiated Rate |
$1,020.60 |
| Rate for Payer: Aetna Commercial |
$963.90
|
| Rate for Payer: BCBS Trust/PPO |
$876.36
|
| Rate for Payer: BCN Commercial |
$876.36
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cofinity Commercial |
$975.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$907.20
|
| Rate for Payer: Healthscope Commercial |
$1,020.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$850.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$963.90
|
| Rate for Payer: PHP Commercial |
$963.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$986.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$691.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$997.92
|
| Rate for Payer: UHC Core |
$946.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$850.50
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
IP
|
$61.10
|
|
|
Service Code
|
NDC 96295-13158
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.26 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: BCBS Trust/PPO |
$47.22
|
| 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 |
$45.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.94
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.26
|
| 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 |
$45.82
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
IP
|
$44.65
|
|
|
Service Code
|
NDC 0904-5135-59
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.23 |
| Max. Negotiated Rate |
$40.18 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: BCBS Trust/PPO |
$34.51
|
| 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 |
$40.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.95
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.23
|
| 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
|
|
|
ATENOLOL 12.5 MG CUSTOM TAB
|
Facility
IP
|
$1.39
|
|
|
Service Code
|
NDC 9900-0003-08
|
| Hospital Charge Code |
155119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna Commercial |
$1.18
|
| Rate for Payer: BCBS Trust/PPO |
$1.07
|
| 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 Multiplan/Beech St/PHCS |
$1.18
|
| Rate for Payer: PHP Commercial |
$1.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.85
|
| 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 25 MG TABLET
|
Facility
IP
|
$3.81
|
|
|
Service Code
|
NDC 51079-759-01
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: BCBS Trust/PPO |
$2.94
|
| Rate for Payer: BCN Commercial |
$2.94
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cofinity Commercial |
$3.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$3.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.24
|
| Rate for Payer: PHP Commercial |
$3.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.35
|
| Rate for Payer: UHC Core |
$3.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.86
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
IP
|
$340.75
|
|
|
Service Code
|
NDC 0904-7187-61
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.82 |
| Max. Negotiated Rate |
$306.68 |
| Rate for Payer: Aetna Commercial |
$289.64
|
| Rate for Payer: BCBS Trust/PPO |
$263.33
|
| Rate for Payer: BCN Commercial |
$263.33
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$293.04
|
| 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 Multiplan/Beech St/PHCS |
$289.64
|
| Rate for Payer: PHP Commercial |
$289.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.82
|
| 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
|
$380.70
|
|
|
Service Code
|
NDC 51079-759-20
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.19 |
| Max. Negotiated Rate |
$342.63 |
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: BCBS Trust/PPO |
$294.20
|
| Rate for Payer: BCN Commercial |
$294.20
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Commercial |
$327.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.56
|
| Rate for Payer: Healthscope Commercial |
$342.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.60
|
| Rate for Payer: PHP Commercial |
$323.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.02
|
| Rate for Payer: UHC Core |
$317.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.52
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
IP
|
$75.20
|
|
|
Service Code
|
NDC 0093-0787-01
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.86 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: BCBS Trust/PPO |
$58.11
|
| 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 Multiplan/Beech St/PHCS |
$63.92
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.86
|
| 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 50 MG TABLET
|
Facility
IP
|
$728.50
|
|
|
Service Code
|
NDC 0093-0752-10
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$444.31 |
| Max. Negotiated Rate |
$655.65 |
| Rate for Payer: Aetna Commercial |
$619.22
|
| Rate for Payer: BCBS Trust/PPO |
$562.98
|
| Rate for Payer: BCN Commercial |
$562.98
|
| Rate for Payer: Cash Price |
$582.80
|
| Rate for Payer: Cofinity Commercial |
$626.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.80
|
| Rate for Payer: Healthscope Commercial |
$655.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$619.22
|
| Rate for Payer: PHP Commercial |
$619.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$509.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$444.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.08
|
| Rate for Payer: UHC Core |
$608.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.38
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
NDC 51079-684-01
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna Commercial |
$1.70
|
| Rate for Payer: BCBS Trust/PPO |
$1.55
|
| Rate for Payer: BCN Commercial |
$1.55
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$1.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.70
|
| Rate for Payer: PHP Commercial |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.76
|
| Rate for Payer: UHC Core |
$1.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.50
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$273.60
|
|
|
Service Code
|
NDC 51079-208-20
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.87 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: BCBS Trust/PPO |
$211.44
|
| Rate for Payer: BCN Commercial |
$211.44
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.56
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.77
|
| Rate for Payer: UHC Core |
$228.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$2.74
|
|
|
Service Code
|
NDC 51079-208-01
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: BCBS Trust/PPO |
$2.12
|
| Rate for Payer: BCN Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.41
|
| Rate for Payer: UHC Core |
$2.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$406.55
|
|
|
Service Code
|
NDC 0904-6290-61
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.95 |
| Max. Negotiated Rate |
$365.90 |
| Rate for Payer: Aetna Commercial |
$345.57
|
| Rate for Payer: BCBS Trust/PPO |
$314.18
|
| Rate for Payer: BCN Commercial |
$314.18
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cofinity Commercial |
$349.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.24
|
| Rate for Payer: Healthscope Commercial |
$365.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.57
|
| Rate for Payer: PHP Commercial |
$345.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.76
|
| Rate for Payer: UHC Core |
$339.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.91
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
IP
|
$2.50
|
|
|
Service Code
|
NDC 51079-209-01
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: BCBS Trust/PPO |
$1.93
|
| Rate for Payer: BCN Commercial |
$1.93
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$2.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.00
|
| Rate for Payer: Healthscope Commercial |
$2.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.20
|
| Rate for Payer: UHC Core |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.88
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
IP
|
$205.20
|
|
|
Service Code
|
NDC 0904-6291-61
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.15 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$158.58
|
| Rate for Payer: BCN Commercial |
$158.58
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$174.42
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.58
|
| Rate for Payer: UHC Core |
$171.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
IP
|
$2.10
|
|
|
Service Code
|
NDC 68084-098-11
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: BCBS Trust/PPO |
$1.62
|
| Rate for Payer: BCN Commercial |
$1.62
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.68
|
| Rate for Payer: Healthscope Commercial |
$1.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.78
|
| Rate for Payer: PHP Commercial |
$1.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.85
|
| Rate for Payer: UHC Core |
$1.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.58
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
IP
|
$209.95
|
|
|
Service Code
|
NDC 68084-098-01
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$188.96 |
| Rate for Payer: Aetna Commercial |
$178.46
|
| Rate for Payer: BCBS Trust/PPO |
$162.25
|
| Rate for Payer: BCN Commercial |
$162.25
|
| Rate for Payer: Cash Price |
$167.96
|
| Rate for Payer: Cofinity Commercial |
$180.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.96
|
| Rate for Payer: Healthscope Commercial |
$188.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.46
|
| Rate for Payer: PHP Commercial |
$178.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.76
|
| Rate for Payer: UHC Core |
$175.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.46
|
|
