|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$6.35
|
|
|
Service Code
|
NDC 904640761
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna Commercial |
$5.71
|
| Rate for Payer: ASR ASR |
$6.15
|
| Rate for Payer: BCBS Trust/PPO |
$5.21
|
| Rate for Payer: BCN Commercial |
$5.21
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cofinity Commercial |
$5.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.08
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Healthscope Whirlpool |
$6.34
|
| Rate for Payer: Mclaren Commercial |
$5.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.39
|
| Rate for Payer: Nomi Health Commercial |
$5.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.58
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$12.80
|
|
|
Service Code
|
NDC 536128636
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$12.80 |
| Rate for Payer: Aetna Commercial |
$11.52
|
| Rate for Payer: ASR ASR |
$12.41
|
| Rate for Payer: BCBS Trust/PPO |
$10.51
|
| Rate for Payer: BCN Commercial |
$10.51
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Cofinity Commercial |
$12.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.24
|
| Rate for Payer: Healthscope Commercial |
$12.41
|
| Rate for Payer: Healthscope Whirlpool |
$12.80
|
| Rate for Payer: Mclaren Commercial |
$11.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.88
|
| Rate for Payer: Nomi Health Commercial |
$10.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.26
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.50
|
|
|
Service Code
|
NDC 87701041163
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Aetna Commercial |
$7.65
|
| Rate for Payer: ASR ASR |
$8.24
|
| Rate for Payer: BCBS Trust/PPO |
$6.98
|
| Rate for Payer: BCN Commercial |
$6.98
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$7.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Healthscope Commercial |
$8.24
|
| Rate for Payer: Healthscope Whirlpool |
$8.50
|
| Rate for Payer: Mclaren Commercial |
$7.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: Nomi Health Commercial |
$6.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.48
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$8.50
|
|
|
Service Code
|
NDC 87701041163
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Aetna Commercial |
$7.65
|
| Rate for Payer: Aetna Medicare |
$3.14
|
| Rate for Payer: ASR ASR |
$8.24
|
| Rate for Payer: BCBS Complete |
$3.40
|
| Rate for Payer: BCBS Trust/PPO |
$7.00
|
| Rate for Payer: BCN Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$7.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Healthscope Commercial |
$8.24
|
| Rate for Payer: Healthscope Whirlpool |
$8.50
|
| Rate for Payer: Mclaren Commercial |
$7.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: Nomi Health Commercial |
$6.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.44
|
| Rate for Payer: Priority Health Narrow Network |
$5.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.48
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$12.80
|
|
|
Service Code
|
NDC 536128636
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$12.80 |
| Rate for Payer: Aetna Commercial |
$11.52
|
| Rate for Payer: Aetna Medicare |
$4.74
|
| Rate for Payer: ASR ASR |
$12.41
|
| Rate for Payer: BCBS Complete |
$5.12
|
| Rate for Payer: BCBS Trust/PPO |
$10.55
|
| Rate for Payer: BCN Commercial |
$10.55
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Cofinity Commercial |
$12.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.24
|
| Rate for Payer: Healthscope Commercial |
$12.41
|
| Rate for Payer: Healthscope Whirlpool |
$12.80
|
| Rate for Payer: Mclaren Commercial |
$11.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.88
|
| Rate for Payer: Nomi Health Commercial |
$10.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.21
|
| Rate for Payer: Priority Health Narrow Network |
$8.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.26
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$9.03
|
|
|
Service Code
|
NDC 70000004401
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$9.03 |
| Rate for Payer: Aetna Commercial |
$8.12
|
| Rate for Payer: Aetna Medicare |
$3.34
|
| Rate for Payer: ASR ASR |
$8.76
|
| Rate for Payer: BCBS Complete |
$3.61
|
| Rate for Payer: BCBS Trust/PPO |
$7.44
|
| Rate for Payer: BCN Commercial |
$7.44
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cofinity Commercial |
$8.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.22
|
| Rate for Payer: Healthscope Commercial |
$8.76
|
| Rate for Payer: Healthscope Whirlpool |
$9.03
|
| Rate for Payer: Mclaren Commercial |
$8.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.67
|
| Rate for Payer: Nomi Health Commercial |
$7.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.91
|
| Rate for Payer: Priority Health Narrow Network |
$6.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.94
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$9.03
|
|
|
Service Code
|
NDC 70000004401
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$9.03 |
| Rate for Payer: Aetna Commercial |
$8.12
|
| Rate for Payer: ASR ASR |
$8.76
|
| Rate for Payer: BCBS Trust/PPO |
$7.41
|
| Rate for Payer: BCN Commercial |
$7.41
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cofinity Commercial |
$8.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.22
|
| Rate for Payer: Healthscope Commercial |
$8.76
|
| Rate for Payer: Healthscope Whirlpool |
$9.03
|
| Rate for Payer: Mclaren Commercial |
$8.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.67
|
| Rate for Payer: Nomi Health Commercial |
$7.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.94
|
|
|
BISOPROLOL FUMARATE 2.5 MG CUSTOM TAB
|
Facility
|
IP
|
$87.42
|
|
|
Service Code
|
NDC 9900000003
|
| Hospital Charge Code |
150723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.56 |
| Max. Negotiated Rate |
$87.42 |
| Rate for Payer: Aetna Commercial |
$78.68
|
| Rate for Payer: ASR ASR |
$84.80
|
| Rate for Payer: BCBS Trust/PPO |
$71.79
|
| Rate for Payer: BCN Commercial |
$71.79
|
| Rate for Payer: Cash Price |
$69.94
|
| Rate for Payer: Cofinity Commercial |
$82.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.94
|
| Rate for Payer: Healthscope Commercial |
$84.80
|
| Rate for Payer: Healthscope Whirlpool |
$87.42
|
| Rate for Payer: Mclaren Commercial |
$78.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.31
|
| Rate for Payer: Nomi Health Commercial |
$71.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.93
|
|
|
BISOPROLOL FUMARATE 2.5 MG CUSTOM TAB
|
Facility
|
OP
|
$87.42
|
|
|
Service Code
|
NDC 9900000003
|
| Hospital Charge Code |
150723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.35 |
| Max. Negotiated Rate |
$87.42 |
| Rate for Payer: Aetna Commercial |
$78.68
|
| Rate for Payer: Aetna Medicare |
$32.35
|
| Rate for Payer: ASR ASR |
$84.80
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS Trust/PPO |
$72.08
|
| Rate for Payer: BCN Commercial |
$72.08
|
| Rate for Payer: Cash Price |
$69.94
|
| Rate for Payer: Cofinity Commercial |
$82.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.94
|
| Rate for Payer: Healthscope Commercial |
$84.80
|
| Rate for Payer: Healthscope Whirlpool |
$87.42
|
| Rate for Payer: Mclaren Commercial |
$78.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.31
|
| Rate for Payer: Nomi Health Commercial |
$71.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$76.60
|
| Rate for Payer: Priority Health Narrow Network |
$61.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.93
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$228.24
|
|
|
Service Code
|
NDC 50268012715
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.18 |
| Max. Negotiated Rate |
$228.24 |
| Rate for Payer: Aetna Commercial |
$205.42
|
| Rate for Payer: ASR ASR |
$221.39
|
| Rate for Payer: BCBS Trust/PPO |
$187.43
|
| Rate for Payer: BCN Commercial |
$187.43
|
| Rate for Payer: Cash Price |
$182.59
|
| Rate for Payer: Cofinity Commercial |
$214.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.59
|
| Rate for Payer: Healthscope Commercial |
$221.39
|
| Rate for Payer: Healthscope Whirlpool |
$228.24
|
| Rate for Payer: Mclaren Commercial |
$205.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.00
|
| Rate for Payer: Nomi Health Commercial |
$187.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.85
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$5.80
|
|
|
Service Code
|
NDC 60687067911
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Aetna Commercial |
$5.22
|
| Rate for Payer: ASR ASR |
$5.63
|
| Rate for Payer: BCBS Trust/PPO |
$4.77
|
| Rate for Payer: BCN Commercial |
$4.77
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$5.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.63
|
| Rate for Payer: Healthscope Whirlpool |
$5.80
|
| Rate for Payer: Mclaren Commercial |
$5.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.11
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 29300012601
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$327.82 |
| Max. Negotiated Rate |
$437.10 |
| Rate for Payer: Aetna Commercial |
$393.39
|
| Rate for Payer: ASR ASR |
$423.99
|
| Rate for Payer: BCBS Trust/PPO |
$358.95
|
| Rate for Payer: BCN Commercial |
$358.95
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$410.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$423.99
|
| Rate for Payer: Healthscope Whirlpool |
$437.10
|
| Rate for Payer: Mclaren Commercial |
$393.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.65
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$4.57
|
|
|
Service Code
|
NDC 50268012711
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna Commercial |
$4.11
|
| Rate for Payer: ASR ASR |
$4.43
|
| Rate for Payer: BCBS Trust/PPO |
$3.75
|
| Rate for Payer: BCN Commercial |
$3.75
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Cofinity Commercial |
$4.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.65
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Healthscope Whirlpool |
$4.57
|
| Rate for Payer: Mclaren Commercial |
$4.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.88
|
| Rate for Payer: Nomi Health Commercial |
$3.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.02
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$228.24
|
|
|
Service Code
|
NDC 50268012715
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$228.24 |
| Rate for Payer: Aetna Commercial |
$205.42
|
| Rate for Payer: Aetna Medicare |
$84.45
|
| Rate for Payer: ASR ASR |
$221.39
|
| Rate for Payer: BCBS Complete |
$91.30
|
| Rate for Payer: BCBS Trust/PPO |
$188.18
|
| Rate for Payer: BCN Commercial |
$188.18
|
| Rate for Payer: Cash Price |
$182.59
|
| Rate for Payer: Cofinity Commercial |
$214.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.59
|
| Rate for Payer: Healthscope Commercial |
$221.39
|
| Rate for Payer: Healthscope Whirlpool |
$228.24
|
| Rate for Payer: Mclaren Commercial |
$205.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.00
|
| Rate for Payer: Nomi Health Commercial |
$187.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$199.98
|
| Rate for Payer: Priority Health Narrow Network |
$160.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.85
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$4.57
|
|
|
Service Code
|
NDC 50268012711
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna Commercial |
$4.11
|
| Rate for Payer: Aetna Medicare |
$1.69
|
| Rate for Payer: ASR ASR |
$4.43
|
| Rate for Payer: BCBS Complete |
$1.83
|
| Rate for Payer: BCBS Trust/PPO |
$3.76
|
| Rate for Payer: BCN Commercial |
$3.76
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Cofinity Commercial |
$4.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.65
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Healthscope Whirlpool |
$4.57
|
| Rate for Payer: Mclaren Commercial |
$4.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.88
|
| Rate for Payer: Nomi Health Commercial |
$3.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.00
|
| Rate for Payer: Priority Health Narrow Network |
$3.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.02
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$174.10
|
|
|
Service Code
|
NDC 60687067921
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.57 |
| Max. Negotiated Rate |
$174.10 |
| Rate for Payer: Aetna Commercial |
$156.69
|
| Rate for Payer: ASR ASR |
$168.87
|
| Rate for Payer: BCBS Trust/PPO |
$142.97
|
| Rate for Payer: BCN Commercial |
$142.97
|
| Rate for Payer: Cash Price |
$139.28
|
| Rate for Payer: Cofinity Commercial |
$163.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.28
|
| Rate for Payer: Healthscope Commercial |
$168.87
|
| Rate for Payer: Healthscope Whirlpool |
$174.10
|
| Rate for Payer: Mclaren Commercial |
$156.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.98
|
| Rate for Payer: Nomi Health Commercial |
$142.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.20
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 29300012601
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.73 |
| Max. Negotiated Rate |
$437.10 |
| Rate for Payer: Aetna Commercial |
$393.39
|
| Rate for Payer: Aetna Medicare |
$161.73
|
| Rate for Payer: ASR ASR |
$423.99
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: BCBS Trust/PPO |
$360.39
|
| Rate for Payer: BCN Commercial |
$360.39
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$410.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$423.99
|
| Rate for Payer: Healthscope Whirlpool |
$437.10
|
| Rate for Payer: Mclaren Commercial |
$393.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health Narrow Network |
$306.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.65
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$174.10
|
|
|
Service Code
|
NDC 60687067921
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.42 |
| Max. Negotiated Rate |
$174.10 |
| Rate for Payer: Aetna Commercial |
$156.69
|
| Rate for Payer: Aetna Medicare |
$64.42
|
| Rate for Payer: ASR ASR |
$168.87
|
| Rate for Payer: BCBS Complete |
$69.64
|
| Rate for Payer: BCBS Trust/PPO |
$143.54
|
| Rate for Payer: BCN Commercial |
$143.54
|
| Rate for Payer: Cash Price |
$139.28
|
| Rate for Payer: Cofinity Commercial |
$163.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.28
|
| Rate for Payer: Healthscope Commercial |
$168.87
|
| Rate for Payer: Healthscope Whirlpool |
$174.10
|
| Rate for Payer: Mclaren Commercial |
$156.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.98
|
| Rate for Payer: Nomi Health Commercial |
$142.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$152.54
|
| Rate for Payer: Priority Health Narrow Network |
$122.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.20
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$5.80
|
|
|
Service Code
|
NDC 60687067911
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Aetna Commercial |
$5.22
|
| Rate for Payer: Aetna Medicare |
$2.15
|
| Rate for Payer: ASR ASR |
$5.63
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: BCBS Trust/PPO |
$4.79
|
| Rate for Payer: BCN Commercial |
$4.79
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$5.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.63
|
| Rate for Payer: Healthscope Whirlpool |
$5.80
|
| Rate for Payer: Mclaren Commercial |
$5.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.09
|
| Rate for Payer: Priority Health Narrow Network |
$4.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.11
|
|
|
BONE DISEASES AND ARTHROPATHIES WITH MCC
|
Facility
|
IP
|
$17,809.61
|
|
|
Service Code
|
MSDRG 553
|
| Min. Negotiated Rate |
$10,534.96 |
| Max. Negotiated Rate |
$17,809.61 |
| Rate for Payer: Aetna Medicare |
$11,089.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,861.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,861.79
|
| Rate for Payer: BCBS MAPPO |
$11,089.43
|
| Rate for Payer: BCN Medicare Advantage |
$11,089.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,089.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,089.43
|
| Rate for Payer: Mclaren Medicare |
$11,089.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,643.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,752.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,198.37
|
| Rate for Payer: PACE Medicare |
$10,534.96
|
| Rate for Payer: PACE SWMI |
$11,089.43
|
| Rate for Payer: PHP Commercial |
$12,198.37
|
| Rate for Payer: PHP Medicare Advantage |
$11,089.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17,809.61
|
| Rate for Payer: Priority Health Medicare |
$11,089.43
|
| Rate for Payer: Priority Health Narrow Network |
$14,247.69
|
| Rate for Payer: Railroad Medicare Medicare |
$11,089.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,089.43
|
| Rate for Payer: UHC Exchange |
$17,188.62
|
| Rate for Payer: UHCCP DNSP |
$11,089.43
|
| Rate for Payer: VA VA |
$11,089.43
|
|
|
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC
|
Facility
|
IP
|
$11,984.94
|
|
|
Service Code
|
MSDRG 554
|
| Min. Negotiated Rate |
$7,345.61 |
| Max. Negotiated Rate |
$11,984.94 |
| Rate for Payer: Aetna Medicare |
$7,732.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,665.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,665.27
|
| Rate for Payer: BCBS MAPPO |
$7,732.22
|
| Rate for Payer: BCN Medicare Advantage |
$7,732.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,732.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,732.22
|
| Rate for Payer: Mclaren Medicare |
$7,732.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,118.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,892.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,505.44
|
| Rate for Payer: PACE Medicare |
$7,345.61
|
| Rate for Payer: PACE SWMI |
$7,732.22
|
| Rate for Payer: PHP Commercial |
$8,505.44
|
| Rate for Payer: PHP Medicare Advantage |
$7,732.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,404.58
|
| Rate for Payer: Priority Health Medicare |
$7,732.22
|
| Rate for Payer: Priority Health Narrow Network |
$9,123.66
|
| Rate for Payer: Railroad Medicare Medicare |
$7,732.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,732.22
|
| Rate for Payer: UHC Exchange |
$11,984.94
|
| Rate for Payer: UHCCP DNSP |
$7,732.22
|
| Rate for Payer: VA VA |
$7,732.22
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$4,343.80
|
|
|
Service Code
|
APR-DRG 1322
|
| Min. Negotiated Rate |
$3,927.31 |
| Max. Negotiated Rate |
$4,343.80 |
| Rate for Payer: BCBS Complete |
$4,343.80
|
| Rate for Payer: Mclaren Medicaid |
$4,136.95
|
| Rate for Payer: Meridian Medicaid |
$4,343.80
|
| Rate for Payer: PHP Medicaid |
$3,927.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,136.95
|
| Rate for Payer: UHC Medicaid |
$4,136.95
|
| Rate for Payer: UHCCP Medicaid |
$4,136.95
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$3,143.27
|
|
|
Service Code
|
APR-DRG 1321
|
| Min. Negotiated Rate |
$2,841.89 |
| Max. Negotiated Rate |
$3,143.27 |
| Rate for Payer: BCBS Complete |
$3,143.27
|
| Rate for Payer: Mclaren Medicaid |
$2,993.59
|
| Rate for Payer: Meridian Medicaid |
$3,143.27
|
| Rate for Payer: PHP Medicaid |
$2,841.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,993.59
|
| Rate for Payer: UHC Medicaid |
$2,993.59
|
| Rate for Payer: UHCCP Medicaid |
$2,993.59
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$7,270.72
|
|
|
Service Code
|
APR-DRG 1323
|
| Min. Negotiated Rate |
$6,573.60 |
| Max. Negotiated Rate |
$7,270.72 |
| Rate for Payer: BCBS Complete |
$7,270.72
|
| Rate for Payer: Mclaren Medicaid |
$6,924.50
|
| Rate for Payer: Meridian Medicaid |
$7,270.72
|
| Rate for Payer: PHP Medicaid |
$6,573.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,924.50
|
| Rate for Payer: UHC Medicaid |
$6,924.50
|
| Rate for Payer: UHCCP Medicaid |
$6,924.50
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$9,054.34
|
|
|
Service Code
|
APR-DRG 1324
|
| Min. Negotiated Rate |
$8,186.21 |
| Max. Negotiated Rate |
$9,054.34 |
| Rate for Payer: BCBS Complete |
$9,054.34
|
| Rate for Payer: Mclaren Medicaid |
$8,623.18
|
| Rate for Payer: Meridian Medicaid |
$9,054.34
|
| Rate for Payer: PHP Medicaid |
$8,186.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,623.18
|
| Rate for Payer: UHC Medicaid |
$8,623.18
|
| Rate for Payer: UHCCP Medicaid |
$8,623.18
|
|
