|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
IP
|
$25.38
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna Commercial |
$22.84
|
| Rate for Payer: ASR ASR |
$24.62
|
| Rate for Payer: BCBS Trust/PPO |
$20.84
|
| Rate for Payer: BCN Commercial |
$20.84
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cofinity Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.30
|
| Rate for Payer: Healthscope Commercial |
$24.62
|
| Rate for Payer: Healthscope Whirlpool |
$25.38
|
| Rate for Payer: Mclaren Commercial |
$22.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.57
|
| Rate for Payer: Nomi Health Commercial |
$20.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.33
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
OP
|
$100.62
|
|
|
Service Code
|
NDC 65042636
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.23 |
| Max. Negotiated Rate |
$100.62 |
| Rate for Payer: Aetna Commercial |
$90.56
|
| Rate for Payer: Aetna Medicare |
$37.23
|
| Rate for Payer: ASR ASR |
$97.60
|
| Rate for Payer: BCBS Complete |
$40.25
|
| Rate for Payer: BCBS Trust/PPO |
$82.96
|
| Rate for Payer: BCN Commercial |
$82.96
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cofinity Commercial |
$94.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.50
|
| Rate for Payer: Healthscope Commercial |
$97.60
|
| Rate for Payer: Healthscope Whirlpool |
$100.62
|
| Rate for Payer: Mclaren Commercial |
$90.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.53
|
| Rate for Payer: Nomi Health Commercial |
$82.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$88.16
|
| Rate for Payer: Priority Health Narrow Network |
$70.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.55
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
|
OP
|
$72.85
|
|
|
Service Code
|
NDC 904052361
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$72.85 |
| Rate for Payer: Aetna Commercial |
$65.56
|
| Rate for Payer: Aetna Medicare |
$26.95
|
| Rate for Payer: ASR ASR |
$70.66
|
| Rate for Payer: BCBS Complete |
$29.14
|
| Rate for Payer: BCBS Trust/PPO |
$60.06
|
| Rate for Payer: BCN Commercial |
$60.06
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Commercial |
$68.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$70.66
|
| Rate for Payer: Healthscope Whirlpool |
$72.85
|
| Rate for Payer: Mclaren Commercial |
$65.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: Nomi Health Commercial |
$59.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$63.83
|
| Rate for Payer: Priority Health Narrow Network |
$51.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.11
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
|
IP
|
$72.85
|
|
|
Service Code
|
NDC 904052361
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$72.85 |
| Rate for Payer: Aetna Commercial |
$65.56
|
| Rate for Payer: ASR ASR |
$70.66
|
| Rate for Payer: BCBS Trust/PPO |
$59.82
|
| Rate for Payer: BCN Commercial |
$59.82
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Commercial |
$68.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$70.66
|
| Rate for Payer: Healthscope Whirlpool |
$72.85
|
| Rate for Payer: Mclaren Commercial |
$65.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: Nomi Health Commercial |
$59.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.11
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$42.77
|
|
|
Service Code
|
NDC 574703412
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.08 |
| Max. Negotiated Rate |
$42.77 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: ASR ASR |
$41.49
|
| Rate for Payer: BCBS Trust/PPO |
$35.13
|
| Rate for Payer: BCN Commercial |
$35.13
|
| Rate for Payer: Cash Price |
$34.22
|
| Rate for Payer: Cofinity Commercial |
$40.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.22
|
| Rate for Payer: Healthscope Commercial |
$41.49
|
| Rate for Payer: Healthscope Whirlpool |
$42.77
|
| Rate for Payer: Mclaren Commercial |
$38.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.36
|
| Rate for Payer: Nomi Health Commercial |
$35.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.64
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$42.77
|
|
|
Service Code
|
NDC 574703412
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$42.77 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Aetna Medicare |
$15.83
|
| Rate for Payer: ASR ASR |
$41.49
|
| Rate for Payer: BCBS Complete |
$17.11
|
| Rate for Payer: BCBS Trust/PPO |
$35.27
|
| Rate for Payer: BCN Commercial |
$35.27
|
| Rate for Payer: Cash Price |
$34.22
|
| Rate for Payer: Cofinity Commercial |
$40.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.22
|
| Rate for Payer: Healthscope Commercial |
$41.49
|
| Rate for Payer: Healthscope Whirlpool |
$42.77
|
| Rate for Payer: Mclaren Commercial |
$38.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.36
|
| Rate for Payer: Nomi Health Commercial |
$35.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.48
|
| Rate for Payer: Priority Health Narrow Network |
$29.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.64
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
OP
|
$94.50
|
|
|
Service Code
|
NDC 57896090101
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.97 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$85.05
|
| Rate for Payer: Aetna Medicare |
$34.97
|
| Rate for Payer: ASR ASR |
$91.67
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS Trust/PPO |
$77.92
|
| Rate for Payer: BCN Commercial |
$77.92
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$88.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.60
|
| Rate for Payer: Healthscope Commercial |
$91.67
|
| Rate for Payer: Healthscope Whirlpool |
$94.50
|
| Rate for Payer: Mclaren Commercial |
$85.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.33
|
| Rate for Payer: Nomi Health Commercial |
$77.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$82.80
|
| Rate for Payer: Priority Health Narrow Network |
$66.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.16
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
OP
|
$94.50
|
|
|
Service Code
|
NDC 536105429
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.97 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$85.05
|
| Rate for Payer: Aetna Medicare |
$34.97
|
| Rate for Payer: ASR ASR |
$91.67
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS Trust/PPO |
$77.92
|
| Rate for Payer: BCN Commercial |
$77.92
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$88.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.60
|
| Rate for Payer: Healthscope Commercial |
$91.67
|
| Rate for Payer: Healthscope Whirlpool |
$94.50
|
| Rate for Payer: Mclaren Commercial |
$85.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.33
|
| Rate for Payer: Nomi Health Commercial |
$77.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$82.80
|
| Rate for Payer: Priority Health Narrow Network |
$66.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.16
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
IP
|
$94.50
|
|
|
Service Code
|
NDC 57896090101
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.88 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$85.05
|
| Rate for Payer: ASR ASR |
$91.67
|
| Rate for Payer: BCBS Trust/PPO |
$77.60
|
| Rate for Payer: BCN Commercial |
$77.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$88.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.60
|
| Rate for Payer: Healthscope Commercial |
$91.67
|
| Rate for Payer: Healthscope Whirlpool |
$94.50
|
| Rate for Payer: Mclaren Commercial |
$85.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.33
|
| Rate for Payer: Nomi Health Commercial |
$77.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.16
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
IP
|
$94.50
|
|
|
Service Code
|
NDC 536105429
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.88 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$85.05
|
| Rate for Payer: ASR ASR |
$91.67
|
| Rate for Payer: BCBS Trust/PPO |
$77.60
|
| Rate for Payer: BCN Commercial |
$77.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$88.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.60
|
| Rate for Payer: Healthscope Commercial |
$91.67
|
| Rate for Payer: Healthscope Whirlpool |
$94.50
|
| Rate for Payer: Mclaren Commercial |
$85.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.33
|
| Rate for Payer: Nomi Health Commercial |
$77.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.16
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
NDC 16103036611
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.24 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: Aetna Medicare |
$93.24
|
| Rate for Payer: ASR ASR |
$244.44
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: BCBS Trust/PPO |
$207.77
|
| Rate for Payer: BCN Commercial |
$207.77
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$244.44
|
| Rate for Payer: Healthscope Whirlpool |
$252.00
|
| Rate for Payer: Mclaren Commercial |
$226.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Nomi Health Commercial |
$206.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$220.80
|
| Rate for Payer: Priority Health Narrow Network |
$176.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.76
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
NDC 63739043402
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.72 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$680.40
|
| Rate for Payer: Aetna Medicare |
$279.72
|
| Rate for Payer: ASR ASR |
$733.32
|
| Rate for Payer: BCBS Complete |
$302.40
|
| Rate for Payer: BCBS Trust/PPO |
$623.32
|
| Rate for Payer: BCN Commercial |
$623.32
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$710.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.80
|
| Rate for Payer: Healthscope Commercial |
$733.32
|
| Rate for Payer: Healthscope Whirlpool |
$756.00
|
| Rate for Payer: Mclaren Commercial |
$680.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$604.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.60
|
| Rate for Payer: Nomi Health Commercial |
$619.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$567.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$662.41
|
| Rate for Payer: Priority Health Narrow Network |
$529.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$665.28
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
NDC 904679480
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.48 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$453.60
|
| Rate for Payer: Aetna Medicare |
$186.48
|
| Rate for Payer: ASR ASR |
$488.88
|
| Rate for Payer: BCBS Complete |
$201.60
|
| Rate for Payer: BCBS Trust/PPO |
$415.55
|
| Rate for Payer: BCN Commercial |
$415.55
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cofinity Commercial |
$473.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.20
|
| Rate for Payer: Healthscope Commercial |
$488.88
|
| Rate for Payer: Healthscope Whirlpool |
$504.00
|
| Rate for Payer: Mclaren Commercial |
$453.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$403.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.40
|
| Rate for Payer: Nomi Health Commercial |
$413.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$441.60
|
| Rate for Payer: Priority Health Narrow Network |
$353.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$443.52
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$676.50
|
|
|
Service Code
|
NDC 66553000201
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.31 |
| Max. Negotiated Rate |
$676.50 |
| Rate for Payer: Aetna Commercial |
$608.85
|
| Rate for Payer: Aetna Medicare |
$250.31
|
| Rate for Payer: ASR ASR |
$656.21
|
| Rate for Payer: BCBS Complete |
$270.60
|
| Rate for Payer: BCBS Trust/PPO |
$557.77
|
| Rate for Payer: BCN Commercial |
$557.77
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cofinity Commercial |
$635.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.20
|
| Rate for Payer: Healthscope Commercial |
$656.21
|
| Rate for Payer: Healthscope Whirlpool |
$676.50
|
| Rate for Payer: Mclaren Commercial |
$608.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$541.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$575.02
|
| Rate for Payer: Nomi Health Commercial |
$554.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$592.75
|
| Rate for Payer: Priority Health Narrow Network |
$474.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$595.32
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
NDC 904679480
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$453.60
|
| Rate for Payer: ASR ASR |
$488.88
|
| Rate for Payer: BCBS Trust/PPO |
$413.88
|
| Rate for Payer: BCN Commercial |
$413.88
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cofinity Commercial |
$473.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.20
|
| Rate for Payer: Healthscope Commercial |
$488.88
|
| Rate for Payer: Healthscope Whirlpool |
$504.00
|
| Rate for Payer: Mclaren Commercial |
$453.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.40
|
| Rate for Payer: Nomi Health Commercial |
$413.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$443.52
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
NDC 16103036611
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: ASR ASR |
$244.44
|
| Rate for Payer: BCBS Trust/PPO |
$206.94
|
| Rate for Payer: BCN Commercial |
$206.94
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$244.44
|
| Rate for Payer: Healthscope Whirlpool |
$252.00
|
| Rate for Payer: Mclaren Commercial |
$226.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Nomi Health Commercial |
$206.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.76
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$45.36
|
|
|
Service Code
|
NDC 904404073
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.02 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: ASR ASR |
$44.00
|
| Rate for Payer: BCBS Trust/PPO |
$37.25
|
| Rate for Payer: BCN Commercial |
$37.25
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cofinity Commercial |
$42.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.29
|
| Rate for Payer: Healthscope Commercial |
$44.00
|
| Rate for Payer: Healthscope Whirlpool |
$45.36
|
| Rate for Payer: Mclaren Commercial |
$40.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.56
|
| Rate for Payer: Nomi Health Commercial |
$37.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.92
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
NDC 904679430
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$513.00 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna Commercial |
$615.60
|
| Rate for Payer: ASR ASR |
$663.48
|
| Rate for Payer: BCBS Trust/PPO |
$561.70
|
| Rate for Payer: BCN Commercial |
$561.70
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cofinity Commercial |
$642.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.20
|
| Rate for Payer: Healthscope Commercial |
$663.48
|
| Rate for Payer: Healthscope Whirlpool |
$684.00
|
| Rate for Payer: Mclaren Commercial |
$615.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.40
|
| Rate for Payer: Nomi Health Commercial |
$560.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$601.92
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
NDC 904679430
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.08 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna Commercial |
$615.60
|
| Rate for Payer: Aetna Medicare |
$253.08
|
| Rate for Payer: ASR ASR |
$663.48
|
| Rate for Payer: BCBS Complete |
$273.60
|
| Rate for Payer: BCBS Trust/PPO |
$563.96
|
| Rate for Payer: BCN Commercial |
$563.96
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cofinity Commercial |
$642.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.20
|
| Rate for Payer: Healthscope Commercial |
$663.48
|
| Rate for Payer: Healthscope Whirlpool |
$684.00
|
| Rate for Payer: Mclaren Commercial |
$615.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.40
|
| Rate for Payer: Nomi Health Commercial |
$560.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$599.32
|
| Rate for Payer: Priority Health Narrow Network |
$479.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$601.92
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$676.50
|
|
|
Service Code
|
NDC 66553000201
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$507.38 |
| Max. Negotiated Rate |
$676.50 |
| Rate for Payer: Aetna Commercial |
$608.85
|
| Rate for Payer: ASR ASR |
$656.21
|
| Rate for Payer: BCBS Trust/PPO |
$555.54
|
| Rate for Payer: BCN Commercial |
$555.54
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cofinity Commercial |
$635.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.20
|
| Rate for Payer: Healthscope Commercial |
$656.21
|
| Rate for Payer: Healthscope Whirlpool |
$676.50
|
| Rate for Payer: Mclaren Commercial |
$608.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$575.02
|
| Rate for Payer: Nomi Health Commercial |
$554.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$595.32
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
NDC 63739043402
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$567.00 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$680.40
|
| Rate for Payer: ASR ASR |
$733.32
|
| Rate for Payer: BCBS Trust/PPO |
$620.83
|
| Rate for Payer: BCN Commercial |
$620.83
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$710.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.80
|
| Rate for Payer: Healthscope Commercial |
$733.32
|
| Rate for Payer: Healthscope Whirlpool |
$756.00
|
| Rate for Payer: Mclaren Commercial |
$680.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.60
|
| Rate for Payer: Nomi Health Commercial |
$619.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$567.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$665.28
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$45.36
|
|
|
Service Code
|
NDC 904404073
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.78 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: Aetna Medicare |
$16.78
|
| Rate for Payer: ASR ASR |
$44.00
|
| Rate for Payer: BCBS Complete |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$37.40
|
| Rate for Payer: BCN Commercial |
$37.40
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cofinity Commercial |
$42.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.29
|
| Rate for Payer: Healthscope Commercial |
$44.00
|
| Rate for Payer: Healthscope Whirlpool |
$45.36
|
| Rate for Payer: Mclaren Commercial |
$40.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.56
|
| Rate for Payer: Nomi Health Commercial |
$37.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.74
|
| Rate for Payer: Priority Health Narrow Network |
$31.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.92
|
|
|
ASTHMA
|
Facility
|
IP
|
$10,684.83
|
|
|
Service Code
|
APR-DRG 1414
|
| Min. Negotiated Rate |
$9,660.37 |
| Max. Negotiated Rate |
$10,684.83 |
| Rate for Payer: BCBS Complete |
$10,684.83
|
| Rate for Payer: Mclaren Medicaid |
$10,176.03
|
| Rate for Payer: Meridian Medicaid |
$10,684.83
|
| Rate for Payer: PHP Medicaid |
$9,660.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,176.03
|
| Rate for Payer: UHC Medicaid |
$10,176.03
|
| Rate for Payer: UHCCP Medicaid |
$10,176.03
|
|
|
ASTHMA
|
Facility
|
IP
|
$5,447.32
|
|
|
Service Code
|
APR-DRG 1413
|
| Min. Negotiated Rate |
$4,925.03 |
| Max. Negotiated Rate |
$5,447.32 |
| Rate for Payer: BCBS Complete |
$5,447.32
|
| Rate for Payer: Mclaren Medicaid |
$5,187.92
|
| Rate for Payer: Meridian Medicaid |
$5,447.32
|
| Rate for Payer: PHP Medicaid |
$4,925.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,187.92
|
| Rate for Payer: UHC Medicaid |
$5,187.92
|
| Rate for Payer: UHCCP Medicaid |
$5,187.92
|
|
|
ASTHMA
|
Facility
|
IP
|
$2,972.70
|
|
|
Service Code
|
APR-DRG 1411
|
| Min. Negotiated Rate |
$2,687.68 |
| Max. Negotiated Rate |
$2,972.70 |
| Rate for Payer: BCBS Complete |
$2,972.70
|
| Rate for Payer: Mclaren Medicaid |
$2,831.14
|
| Rate for Payer: Meridian Medicaid |
$2,972.70
|
| Rate for Payer: PHP Medicaid |
$2,687.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,831.14
|
| Rate for Payer: UHC Medicaid |
$2,831.14
|
| Rate for Payer: UHCCP Medicaid |
$2,831.14
|
|
