|
IRBESARTAN 150 MG TABLET
|
Facility
|
IP
|
$790.21
|
|
|
Service Code
|
NDC 24585130
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$592.66 |
| Max. Negotiated Rate |
$790.21 |
| Rate for Payer: Aetna Commercial |
$711.19
|
| Rate for Payer: ASR ASR |
$766.50
|
| Rate for Payer: BCBS Trust/PPO |
$648.92
|
| Rate for Payer: BCN Commercial |
$648.92
|
| Rate for Payer: Cash Price |
$632.17
|
| Rate for Payer: Cofinity Commercial |
$742.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.17
|
| Rate for Payer: Healthscope Commercial |
$766.50
|
| Rate for Payer: Healthscope Whirlpool |
$790.21
|
| Rate for Payer: Mclaren Commercial |
$711.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.68
|
| Rate for Payer: Nomi Health Commercial |
$647.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$592.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$695.38
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
IP
|
$79.67
|
|
|
Service Code
|
NDC 43547037503
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.75 |
| Max. Negotiated Rate |
$79.67 |
| Rate for Payer: Aetna Commercial |
$71.70
|
| Rate for Payer: ASR ASR |
$77.28
|
| Rate for Payer: BCBS Trust/PPO |
$65.42
|
| Rate for Payer: BCN Commercial |
$65.42
|
| Rate for Payer: Cash Price |
$63.73
|
| Rate for Payer: Cofinity Commercial |
$74.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.73
|
| Rate for Payer: Healthscope Commercial |
$77.28
|
| Rate for Payer: Healthscope Whirlpool |
$79.67
|
| Rate for Payer: Mclaren Commercial |
$71.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.72
|
| Rate for Payer: Nomi Health Commercial |
$65.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.11
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
OP
|
$67.68
|
|
|
Service Code
|
NDC 43547027803
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.04 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$60.91
|
| Rate for Payer: Aetna Medicare |
$25.04
|
| Rate for Payer: ASR ASR |
$65.65
|
| Rate for Payer: BCBS Complete |
$27.07
|
| Rate for Payer: BCBS Trust/PPO |
$55.80
|
| Rate for Payer: BCN Commercial |
$55.80
|
| Rate for Payer: Cash Price |
$54.14
|
| Rate for Payer: Cofinity Commercial |
$63.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.14
|
| Rate for Payer: Healthscope Commercial |
$65.65
|
| Rate for Payer: Healthscope Whirlpool |
$67.68
|
| Rate for Payer: Mclaren Commercial |
$60.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.53
|
| Rate for Payer: Nomi Health Commercial |
$55.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$59.30
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.56
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$169.77
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$169.77 |
| Rate for Payer: Aetna Commercial |
$152.79
|
| Rate for Payer: Aetna Medicare |
$18.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.64
|
| Rate for Payer: ASR ASR |
$164.67
|
| Rate for Payer: BCBS Complete |
$9.95
|
| Rate for Payer: BCBS MAPPO |
$18.11
|
| Rate for Payer: BCBS Trust/PPO |
$139.97
|
| Rate for Payer: BCN Commercial |
$139.97
|
| Rate for Payer: BCN Medicare Advantage |
$18.11
|
| Rate for Payer: Cash Price |
$135.81
|
| Rate for Payer: Cash Price |
$135.81
|
| Rate for Payer: Cofinity Commercial |
$159.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.11
|
| Rate for Payer: Healthscope Commercial |
$164.67
|
| Rate for Payer: Healthscope Whirlpool |
$169.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.11
|
| Rate for Payer: Mclaren Commercial |
$152.79
|
| Rate for Payer: Mclaren Medicaid |
$18.11
|
| Rate for Payer: Mclaren Medicare |
$18.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.02
|
| Rate for Payer: Meridian Medicaid |
$9.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.30
|
| Rate for Payer: Nomi Health Commercial |
$139.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.33
|
| Rate for Payer: PACE Medicare |
$17.20
|
| Rate for Payer: PACE SWMI |
$18.11
|
| Rate for Payer: PHP Commercial |
$19.92
|
| Rate for Payer: PHP Medicaid |
$9.71
|
| Rate for Payer: PHP Medicare Advantage |
$18.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.76
|
| Rate for Payer: Priority Health Medicare |
$18.11
|
| Rate for Payer: Priority Health Narrow Network |
$15.01
|
| Rate for Payer: Railroad Medicare Medicare |
$18.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.11
|
| Rate for Payer: UHC Exchange |
$28.07
|
| Rate for Payer: UHC Medicaid |
$9.47
|
| Rate for Payer: UHCCP DNSP |
$18.11
|
| Rate for Payer: UHCCP Medicaid |
$9.47
|
| Rate for Payer: VA VA |
$18.11
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$169.77
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.33 |
| Max. Negotiated Rate |
$169.77 |
| Rate for Payer: Aetna Commercial |
$152.79
|
| Rate for Payer: ASR ASR |
$164.67
|
| Rate for Payer: BCBS Trust/PPO |
$139.41
|
| Rate for Payer: BCN Commercial |
$139.41
|
| Rate for Payer: Cash Price |
$135.81
|
| Rate for Payer: Cofinity Commercial |
$159.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.81
|
| Rate for Payer: Healthscope Commercial |
$164.67
|
| Rate for Payer: Healthscope Whirlpool |
$169.77
|
| Rate for Payer: Mclaren Commercial |
$152.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.30
|
| Rate for Payer: Nomi Health Commercial |
$139.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.40
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$70.38
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.78 |
| Max. Negotiated Rate |
$70.38 |
| Rate for Payer: Aetna Commercial |
$63.34
|
| Rate for Payer: Aetna Commercial |
$89.81
|
| Rate for Payer: ASR ASR |
$96.80
|
| Rate for Payer: ASR ASR |
$68.27
|
| Rate for Payer: BCBS Trust/PPO |
$81.95
|
| Rate for Payer: BCBS Trust/PPO |
$57.79
|
| Rate for Payer: BCN Commercial |
$81.95
|
| Rate for Payer: BCN Commercial |
$57.79
|
| Rate for Payer: Cash Price |
$79.83
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$66.15
|
| Rate for Payer: Cofinity Commercial |
$93.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.30
|
| Rate for Payer: Healthscope Commercial |
$68.27
|
| Rate for Payer: Healthscope Commercial |
$96.80
|
| Rate for Payer: Healthscope Whirlpool |
$99.79
|
| Rate for Payer: Healthscope Whirlpool |
$70.38
|
| Rate for Payer: Mclaren Commercial |
$89.81
|
| Rate for Payer: Mclaren Commercial |
$63.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.82
|
| Rate for Payer: Nomi Health Commercial |
$81.83
|
| Rate for Payer: Nomi Health Commercial |
$57.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.82
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$99.79
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$99.79 |
| Rate for Payer: Aetna Commercial |
$89.81
|
| Rate for Payer: Aetna Commercial |
$63.34
|
| Rate for Payer: Aetna Medicare |
$26.04
|
| Rate for Payer: Aetna Medicare |
$36.92
|
| Rate for Payer: ASR ASR |
$96.80
|
| Rate for Payer: ASR ASR |
$68.27
|
| Rate for Payer: BCBS Complete |
$28.15
|
| Rate for Payer: BCBS Complete |
$39.92
|
| Rate for Payer: BCBS Trust/PPO |
$82.28
|
| Rate for Payer: BCBS Trust/PPO |
$58.03
|
| Rate for Payer: BCN Commercial |
$58.03
|
| Rate for Payer: BCN Commercial |
$82.28
|
| Rate for Payer: Cash Price |
$79.83
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cash Price |
$79.83
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$66.15
|
| Rate for Payer: Cofinity Commercial |
$93.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.30
|
| Rate for Payer: Healthscope Commercial |
$96.80
|
| Rate for Payer: Healthscope Commercial |
$68.27
|
| Rate for Payer: Healthscope Whirlpool |
$99.79
|
| Rate for Payer: Healthscope Whirlpool |
$70.38
|
| Rate for Payer: Mclaren Commercial |
$89.81
|
| Rate for Payer: Mclaren Commercial |
$63.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.82
|
| Rate for Payer: Nomi Health Commercial |
$57.71
|
| Rate for Payer: Nomi Health Commercial |
$81.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.24
|
| Rate for Payer: Priority Health Narrow Network |
$0.19
|
| Rate for Payer: Priority Health Narrow Network |
$0.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.82
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC
|
Facility
|
IP
|
$24,141.82
|
|
|
Service Code
|
MSDRG 062
|
| Min. Negotiated Rate |
$13,688.06 |
| Max. Negotiated Rate |
$24,141.82 |
| Rate for Payer: Aetna Medicare |
$14,408.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,010.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,010.60
|
| Rate for Payer: BCBS MAPPO |
$14,408.48
|
| Rate for Payer: BCN Medicare Advantage |
$14,408.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,408.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,408.48
|
| Rate for Payer: Mclaren Medicare |
$14,408.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,128.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,569.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,849.33
|
| Rate for Payer: PACE Medicare |
$13,688.06
|
| Rate for Payer: PACE SWMI |
$14,408.48
|
| Rate for Payer: PHP Commercial |
$15,849.33
|
| Rate for Payer: PHP Medicare Advantage |
$14,408.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$24,141.82
|
| Rate for Payer: Priority Health Medicare |
$14,408.48
|
| Rate for Payer: Priority Health Narrow Network |
$19,313.46
|
| Rate for Payer: Railroad Medicare Medicare |
$14,408.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,408.48
|
| Rate for Payer: UHC Exchange |
$22,333.14
|
| Rate for Payer: UHCCP DNSP |
$14,408.48
|
| Rate for Payer: VA VA |
$14,408.48
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC
|
Facility
|
IP
|
$37,879.25
|
|
|
Service Code
|
MSDRG 061
|
| Min. Negotiated Rate |
$20,528.55 |
| Max. Negotiated Rate |
$37,879.25 |
| Rate for Payer: Aetna Medicare |
$21,609.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,011.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,011.25
|
| Rate for Payer: BCBS MAPPO |
$21,609.00
|
| Rate for Payer: BCN Medicare Advantage |
$21,609.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,609.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$21,609.00
|
| Rate for Payer: Mclaren Medicare |
$21,609.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,689.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,850.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$23,769.90
|
| Rate for Payer: PACE Medicare |
$20,528.55
|
| Rate for Payer: PACE SWMI |
$21,609.00
|
| Rate for Payer: PHP Commercial |
$23,769.90
|
| Rate for Payer: PHP Medicare Advantage |
$21,609.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37,879.25
|
| Rate for Payer: Priority Health Medicare |
$21,609.00
|
| Rate for Payer: Priority Health Narrow Network |
$30,303.40
|
| Rate for Payer: Railroad Medicare Medicare |
$21,609.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,609.00
|
| Rate for Payer: UHC Exchange |
$33,493.95
|
| Rate for Payer: UHCCP DNSP |
$21,609.00
|
| Rate for Payer: VA VA |
$21,609.00
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC
|
Facility
|
IP
|
$19,286.53
|
|
|
Service Code
|
MSDRG 063
|
| Min. Negotiated Rate |
$11,270.38 |
| Max. Negotiated Rate |
$19,286.53 |
| Rate for Payer: Aetna Medicare |
$11,863.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,829.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,829.45
|
| Rate for Payer: BCBS MAPPO |
$11,863.56
|
| Rate for Payer: BCN Medicare Advantage |
$11,863.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,863.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,863.56
|
| Rate for Payer: Mclaren Medicare |
$11,863.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,456.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,643.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,049.92
|
| Rate for Payer: PACE Medicare |
$11,270.38
|
| Rate for Payer: PACE SWMI |
$11,863.56
|
| Rate for Payer: PHP Commercial |
$13,049.92
|
| Rate for Payer: PHP Medicare Advantage |
$11,863.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19,286.53
|
| Rate for Payer: Priority Health Medicare |
$11,863.56
|
| Rate for Payer: Priority Health Narrow Network |
$15,429.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11,863.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,863.56
|
| Rate for Payer: UHC Exchange |
$18,388.52
|
| Rate for Payer: UHCCP DNSP |
$11,863.56
|
| Rate for Payer: VA VA |
$11,863.56
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$3.30
|
|
|
Service Code
|
NDC 50268044811
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna Commercial |
$2.97
|
| Rate for Payer: ASR ASR |
$3.20
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.71
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.64
|
| Rate for Payer: Healthscope Commercial |
$3.20
|
| Rate for Payer: Healthscope Whirlpool |
$3.30
|
| Rate for Payer: Mclaren Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.80
|
| Rate for Payer: Nomi Health Commercial |
$2.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.90
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$164.88
|
|
|
Service Code
|
NDC 50268044815
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.66 |
| Max. Negotiated Rate |
$164.88 |
| Rate for Payer: Aetna Commercial |
$148.39
|
| Rate for Payer: ASR ASR |
$159.93
|
| Rate for Payer: BCBS Trust/PPO |
$135.40
|
| Rate for Payer: BCN Commercial |
$135.40
|
| Rate for Payer: Cash Price |
$131.90
|
| Rate for Payer: Cofinity Commercial |
$154.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.90
|
| Rate for Payer: Healthscope Commercial |
$159.93
|
| Rate for Payer: Healthscope Whirlpool |
$164.88
|
| Rate for Payer: Mclaren Commercial |
$148.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.15
|
| Rate for Payer: Nomi Health Commercial |
$135.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.09
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$3.30
|
|
|
Service Code
|
NDC 50268044811
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna Commercial |
$2.97
|
| Rate for Payer: Aetna Medicare |
$1.22
|
| Rate for Payer: ASR ASR |
$3.20
|
| Rate for Payer: BCBS Complete |
$1.32
|
| Rate for Payer: BCBS Trust/PPO |
$2.72
|
| Rate for Payer: BCN Commercial |
$2.72
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.64
|
| Rate for Payer: Healthscope Commercial |
$3.20
|
| Rate for Payer: Healthscope Whirlpool |
$3.30
|
| Rate for Payer: Mclaren Commercial |
$2.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.80
|
| Rate for Payer: Nomi Health Commercial |
$2.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.89
|
| Rate for Payer: Priority Health Narrow Network |
$2.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.90
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$164.88
|
|
|
Service Code
|
NDC 50268044815
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.01 |
| Max. Negotiated Rate |
$164.88 |
| Rate for Payer: Aetna Commercial |
$148.39
|
| Rate for Payer: Aetna Medicare |
$61.01
|
| Rate for Payer: ASR ASR |
$159.93
|
| Rate for Payer: BCBS Complete |
$65.95
|
| Rate for Payer: BCBS Trust/PPO |
$135.94
|
| Rate for Payer: BCN Commercial |
$135.94
|
| Rate for Payer: Cash Price |
$131.90
|
| Rate for Payer: Cofinity Commercial |
$154.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.90
|
| Rate for Payer: Healthscope Commercial |
$159.93
|
| Rate for Payer: Healthscope Whirlpool |
$164.88
|
| Rate for Payer: Mclaren Commercial |
$148.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.15
|
| Rate for Payer: Nomi Health Commercial |
$135.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$144.47
|
| Rate for Payer: Priority Health Narrow Network |
$115.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.09
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
OP
|
$327.84
|
|
|
Service Code
|
NDC 904662061
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.30 |
| Max. Negotiated Rate |
$327.84 |
| Rate for Payer: Aetna Commercial |
$295.06
|
| Rate for Payer: Aetna Medicare |
$121.30
|
| Rate for Payer: ASR ASR |
$318.00
|
| Rate for Payer: BCBS Complete |
$131.14
|
| Rate for Payer: BCBS Trust/PPO |
$270.30
|
| Rate for Payer: BCN Commercial |
$270.30
|
| Rate for Payer: Cash Price |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$308.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.27
|
| Rate for Payer: Healthscope Commercial |
$318.00
|
| Rate for Payer: Healthscope Whirlpool |
$327.84
|
| Rate for Payer: Mclaren Commercial |
$295.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$262.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.66
|
| Rate for Payer: Nomi Health Commercial |
$268.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$287.25
|
| Rate for Payer: Priority Health Narrow Network |
$229.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.50
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
IP
|
$327.84
|
|
|
Service Code
|
NDC 904662061
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.88 |
| Max. Negotiated Rate |
$327.84 |
| Rate for Payer: Aetna Commercial |
$295.06
|
| Rate for Payer: ASR ASR |
$318.00
|
| Rate for Payer: BCBS Trust/PPO |
$269.22
|
| Rate for Payer: BCN Commercial |
$269.22
|
| Rate for Payer: Cash Price |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$308.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.27
|
| Rate for Payer: Healthscope Commercial |
$318.00
|
| Rate for Payer: Healthscope Whirlpool |
$327.84
|
| Rate for Payer: Mclaren Commercial |
$295.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.66
|
| Rate for Payer: Nomi Health Commercial |
$268.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.50
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
OP
|
$360.48
|
|
|
Service Code
|
NDC 68084008301
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.38 |
| Max. Negotiated Rate |
$360.48 |
| Rate for Payer: Aetna Commercial |
$324.43
|
| Rate for Payer: Aetna Medicare |
$133.38
|
| Rate for Payer: ASR ASR |
$349.67
|
| Rate for Payer: BCBS Complete |
$144.19
|
| Rate for Payer: BCBS Trust/PPO |
$297.22
|
| Rate for Payer: BCN Commercial |
$297.22
|
| Rate for Payer: Cash Price |
$288.38
|
| Rate for Payer: Cofinity Commercial |
$338.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.38
|
| Rate for Payer: Healthscope Commercial |
$349.67
|
| Rate for Payer: Healthscope Whirlpool |
$360.48
|
| Rate for Payer: Mclaren Commercial |
$324.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$288.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.41
|
| Rate for Payer: Nomi Health Commercial |
$295.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$315.85
|
| Rate for Payer: Priority Health Narrow Network |
$252.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$317.22
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
IP
|
$360.48
|
|
|
Service Code
|
NDC 68084008301
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.36 |
| Max. Negotiated Rate |
$360.48 |
| Rate for Payer: Aetna Commercial |
$324.43
|
| Rate for Payer: ASR ASR |
$349.67
|
| Rate for Payer: BCBS Trust/PPO |
$296.03
|
| Rate for Payer: BCN Commercial |
$296.03
|
| Rate for Payer: Cash Price |
$288.38
|
| Rate for Payer: Cofinity Commercial |
$338.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.38
|
| Rate for Payer: Healthscope Commercial |
$349.67
|
| Rate for Payer: Healthscope Whirlpool |
$360.48
|
| Rate for Payer: Mclaren Commercial |
$324.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.41
|
| Rate for Payer: Nomi Health Commercial |
$295.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$317.22
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
OP
|
$3.61
|
|
|
Service Code
|
NDC 68084008311
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: ASR ASR |
$3.50
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: BCBS Trust/PPO |
$2.97
|
| Rate for Payer: BCN Commercial |
$2.97
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$3.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.88
|
| Rate for Payer: Healthscope Commercial |
$3.50
|
| Rate for Payer: Healthscope Whirlpool |
$3.60
|
| Rate for Payer: Mclaren Commercial |
$3.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.06
|
| Rate for Payer: Nomi Health Commercial |
$2.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.16
|
| Rate for Payer: Priority Health Narrow Network |
$2.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.17
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
IP
|
$3.61
|
|
|
Service Code
|
NDC 68084008311
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: ASR ASR |
$3.50
|
| Rate for Payer: BCBS Trust/PPO |
$2.96
|
| Rate for Payer: BCN Commercial |
$2.96
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$3.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.88
|
| Rate for Payer: Healthscope Commercial |
$3.50
|
| Rate for Payer: Healthscope Whirlpool |
$3.60
|
| Rate for Payer: Mclaren Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.06
|
| Rate for Payer: Nomi Health Commercial |
$2.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.17
|
|
|
ISOSORBIDE MONONITRATE 20 MG TABLET
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 228262011
|
| Hospital Charge Code |
10357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.34 |
| Max. Negotiated Rate |
$392.45 |
| Rate for Payer: Aetna Commercial |
$353.20
|
| Rate for Payer: ASR ASR |
$380.68
|
| Rate for Payer: BCBS Trust/PPO |
$322.28
|
| Rate for Payer: BCN Commercial |
$322.28
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$368.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$380.68
|
| Rate for Payer: Healthscope Whirlpool |
$392.45
|
| Rate for Payer: Mclaren Commercial |
$353.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Nomi Health Commercial |
$321.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$345.36
|
|
|
ISOSORBIDE MONONITRATE 20 MG TABLET
|
Facility
|
OP
|
$392.45
|
|
|
Service Code
|
NDC 228262011
|
| Hospital Charge Code |
10357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.21 |
| Max. Negotiated Rate |
$392.45 |
| Rate for Payer: Aetna Commercial |
$353.20
|
| Rate for Payer: Aetna Medicare |
$145.21
|
| Rate for Payer: ASR ASR |
$380.68
|
| Rate for Payer: BCBS Complete |
$156.98
|
| Rate for Payer: BCBS Trust/PPO |
$323.58
|
| Rate for Payer: BCN Commercial |
$323.58
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$368.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$380.68
|
| Rate for Payer: Healthscope Whirlpool |
$392.45
|
| Rate for Payer: Mclaren Commercial |
$353.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Nomi Health Commercial |
$321.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$343.86
|
| Rate for Payer: Priority Health Narrow Network |
$275.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$345.36
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$245.10
|
|
|
Service Code
|
NDC 904644961
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.82 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Aetna Commercial |
$220.59
|
| Rate for Payer: ASR ASR |
$237.75
|
| Rate for Payer: BCBS Trust/PPO |
$201.28
|
| Rate for Payer: BCN Commercial |
$201.28
|
| Rate for Payer: Cash Price |
$196.08
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.08
|
| Rate for Payer: Healthscope Commercial |
$237.75
|
| Rate for Payer: Healthscope Whirlpool |
$245.10
|
| Rate for Payer: Mclaren Commercial |
$220.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.34
|
| Rate for Payer: Nomi Health Commercial |
$200.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.69
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$245.10
|
|
|
Service Code
|
NDC 904644961
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.69 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Aetna Commercial |
$220.59
|
| Rate for Payer: Aetna Medicare |
$90.69
|
| Rate for Payer: ASR ASR |
$237.75
|
| Rate for Payer: BCBS Complete |
$98.04
|
| Rate for Payer: BCBS Trust/PPO |
$202.08
|
| Rate for Payer: BCN Commercial |
$202.08
|
| Rate for Payer: Cash Price |
$196.08
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.08
|
| Rate for Payer: Healthscope Commercial |
$237.75
|
| Rate for Payer: Healthscope Whirlpool |
$245.10
|
| Rate for Payer: Mclaren Commercial |
$220.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.34
|
| Rate for Payer: Nomi Health Commercial |
$200.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$214.76
|
| Rate for Payer: Priority Health Narrow Network |
$171.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.69
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$292.60
|
|
|
Service Code
|
NDC 904645061
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.26 |
| Max. Negotiated Rate |
$292.60 |
| Rate for Payer: Aetna Commercial |
$263.34
|
| Rate for Payer: Aetna Medicare |
$108.26
|
| Rate for Payer: ASR ASR |
$283.82
|
| Rate for Payer: BCBS Complete |
$117.04
|
| Rate for Payer: BCBS Trust/PPO |
$241.25
|
| Rate for Payer: BCN Commercial |
$241.25
|
| Rate for Payer: Cash Price |
$234.08
|
| Rate for Payer: Cofinity Commercial |
$275.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.08
|
| Rate for Payer: Healthscope Commercial |
$283.82
|
| Rate for Payer: Healthscope Whirlpool |
$292.60
|
| Rate for Payer: Mclaren Commercial |
$263.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.71
|
| Rate for Payer: Nomi Health Commercial |
$239.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$256.38
|
| Rate for Payer: Priority Health Narrow Network |
$205.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.49
|
|
