|
IRBESARTAN 150 MG TABLET
|
Facility
|
IP
|
$79.67
|
|
|
Service Code
|
NDC 43547037503
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.79 |
| Max. Negotiated Rate |
$79.67 |
| Rate for Payer: Aetna Commercial |
$71.70
|
| Rate for Payer: ASR ASR |
$77.28
|
| Rate for Payer: ASR Commercial |
$77.28
|
| Rate for Payer: BCBS Trust/PPO |
$64.92
|
| Rate for Payer: BCN Commercial |
$61.77
|
| Rate for Payer: Cash Price |
$63.73
|
| Rate for Payer: Cofinity Commercial |
$74.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.74
|
| Rate for Payer: Healthscope Commercial |
$79.67
|
| Rate for Payer: Healthscope Whirlpool |
$77.28
|
| 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: Priority Health Cigna Priority Health |
$51.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.11
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
OP
|
$79.67
|
|
|
Service Code
|
NDC 43547037503
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.87 |
| Max. Negotiated Rate |
$79.67 |
| Rate for Payer: Aetna Commercial |
$71.70
|
| Rate for Payer: Aetna Medicare |
$39.84
|
| Rate for Payer: ASR ASR |
$77.28
|
| Rate for Payer: ASR Commercial |
$77.28
|
| Rate for Payer: BCBS Complete |
$31.87
|
| Rate for Payer: BCBS Trust/PPO |
$65.24
|
| Rate for Payer: BCN Commercial |
$61.77
|
| Rate for Payer: Cash Price |
$63.73
|
| Rate for Payer: Cofinity Commercial |
$74.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.74
|
| Rate for Payer: Healthscope Commercial |
$79.67
|
| Rate for Payer: Healthscope Whirlpool |
$77.28
|
| 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: Priority Health Cigna Priority Health |
$51.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.81
|
| Rate for Payer: Priority Health Narrow Network |
$55.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.11
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
IP
|
$790.21
|
|
|
Service Code
|
NDC 00024585130
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$513.64 |
| Max. Negotiated Rate |
$790.21 |
| Rate for Payer: Aetna Commercial |
$711.19
|
| Rate for Payer: ASR ASR |
$766.50
|
| Rate for Payer: ASR Commercial |
$766.50
|
| Rate for Payer: BCBS Trust/PPO |
$643.94
|
| Rate for Payer: BCN Commercial |
$612.65
|
| 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 |
$790.21
|
| Rate for Payer: Healthscope Whirlpool |
$766.50
|
| 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: Priority Health Cigna Priority Health |
$513.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$695.38
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
OP
|
$67.68
|
|
|
Service Code
|
NDC 43547027803
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$60.91
|
| Rate for Payer: Aetna Medicare |
$33.84
|
| Rate for Payer: ASR ASR |
$65.65
|
| Rate for Payer: ASR Commercial |
$65.65
|
| Rate for Payer: BCBS Complete |
$27.07
|
| Rate for Payer: BCBS Trust/PPO |
$55.42
|
| Rate for Payer: BCN Commercial |
$52.47
|
| 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 |
$67.68
|
| Rate for Payer: Healthscope Whirlpool |
$65.65
|
| Rate for Payer: Mclaren Commercial |
$60.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.53
|
| Rate for Payer: Nomi Health Commercial |
$55.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.99
|
| Rate for Payer: 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
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
IP
|
$67.68
|
|
|
Service Code
|
NDC 43547027803
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.99 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$60.91
|
| Rate for Payer: ASR ASR |
$65.65
|
| Rate for Payer: ASR Commercial |
$65.65
|
| Rate for Payer: BCBS Trust/PPO |
$55.15
|
| Rate for Payer: BCN Commercial |
$52.47
|
| 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 |
$67.68
|
| Rate for Payer: Healthscope Whirlpool |
$65.65
|
| Rate for Payer: Mclaren Commercial |
$60.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.53
|
| Rate for Payer: Nomi Health Commercial |
$55.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.56
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
OP
|
$790.21
|
|
|
Service Code
|
NDC 00024585130
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$316.08 |
| Max. Negotiated Rate |
$790.21 |
| Rate for Payer: Aetna Commercial |
$711.19
|
| Rate for Payer: Aetna Medicare |
$395.11
|
| Rate for Payer: ASR ASR |
$766.50
|
| Rate for Payer: ASR Commercial |
$766.50
|
| Rate for Payer: BCBS Complete |
$316.08
|
| Rate for Payer: BCBS Trust/PPO |
$647.10
|
| Rate for Payer: BCN Commercial |
$612.65
|
| 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 |
$790.21
|
| Rate for Payer: Healthscope Whirlpool |
$766.50
|
| 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: Priority Health Cigna Priority Health |
$513.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$692.38
|
| Rate for Payer: Priority Health Narrow Network |
$553.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$695.38
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$161.68
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$161.68 |
| Rate for Payer: Aetna Commercial |
$145.51
|
| Rate for Payer: ASR ASR |
$156.83
|
| Rate for Payer: ASR Commercial |
$156.83
|
| Rate for Payer: BCBS Trust/PPO |
$131.75
|
| Rate for Payer: BCN Commercial |
$125.35
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cofinity Commercial |
$151.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.34
|
| Rate for Payer: Healthscope Commercial |
$161.68
|
| Rate for Payer: Healthscope Whirlpool |
$156.83
|
| Rate for Payer: Mclaren Commercial |
$145.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.43
|
| Rate for Payer: Nomi Health Commercial |
$132.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.28
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$161.68
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$161.68 |
| Rate for Payer: Aetna Commercial |
$145.51
|
| 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 |
$156.83
|
| Rate for Payer: ASR Commercial |
$156.83
|
| Rate for Payer: BCBS Complete |
$10.19
|
| Rate for Payer: BCBS MAPPO |
$18.11
|
| Rate for Payer: BCBS Trust/PPO |
$132.40
|
| Rate for Payer: BCN Commercial |
$125.35
|
| Rate for Payer: BCN Medicare Advantage |
$18.11
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cofinity Commercial |
$151.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.11
|
| Rate for Payer: Healthscope Commercial |
$161.68
|
| Rate for Payer: Healthscope Whirlpool |
$156.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.11
|
| Rate for Payer: Mclaren Commercial |
$145.51
|
| Rate for Payer: Mclaren Medicaid |
$9.71
|
| 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 |
$10.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.43
|
| Rate for Payer: Nomi Health Commercial |
$132.58
|
| 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 |
$9.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.66
|
| Rate for Payer: Priority Health Medicare |
$18.11
|
| Rate for Payer: Priority Health Narrow Network |
$113.34
|
| Rate for Payer: Railroad Medicare Medicare |
$18.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.11
|
| Rate for Payer: UHC Exchange |
$28.07
|
| Rate for Payer: UHC Medicare Advantage |
$18.11
|
| Rate for Payer: UHCCP DNSP |
$18.11
|
| Rate for Payer: UHCCP Medicaid |
$9.71
|
| Rate for Payer: VA VA |
$18.11
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$154.04
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.13 |
| Max. Negotiated Rate |
$154.04 |
| Rate for Payer: Aetna Commercial |
$138.64
|
| Rate for Payer: ASR ASR |
$149.42
|
| Rate for Payer: ASR Commercial |
$149.42
|
| Rate for Payer: BCBS Trust/PPO |
$125.53
|
| Rate for Payer: BCN Commercial |
$119.43
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cofinity Commercial |
$144.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.23
|
| Rate for Payer: Healthscope Commercial |
$154.04
|
| Rate for Payer: Healthscope Whirlpool |
$149.42
|
| Rate for Payer: Mclaren Commercial |
$138.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.93
|
| Rate for Payer: Nomi Health Commercial |
$126.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.56
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$154.04
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.62 |
| Max. Negotiated Rate |
$154.04 |
| Rate for Payer: Aetna Commercial |
$138.64
|
| Rate for Payer: Aetna Medicare |
$77.02
|
| Rate for Payer: ASR ASR |
$149.42
|
| Rate for Payer: ASR Commercial |
$149.42
|
| Rate for Payer: BCBS Complete |
$61.62
|
| Rate for Payer: BCBS Trust/PPO |
$126.14
|
| Rate for Payer: BCN Commercial |
$119.43
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cofinity Commercial |
$144.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.23
|
| Rate for Payer: Healthscope Commercial |
$154.04
|
| Rate for Payer: Healthscope Whirlpool |
$149.42
|
| Rate for Payer: Mclaren Commercial |
$138.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.93
|
| Rate for Payer: Nomi Health Commercial |
$126.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.97
|
| Rate for Payer: Priority Health Narrow Network |
$107.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.56
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
IP
|
$329.28
|
|
|
Service Code
|
NDC 68084008301
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.03 |
| Max. Negotiated Rate |
$329.28 |
| Rate for Payer: Aetna Commercial |
$296.35
|
| Rate for Payer: ASR ASR |
$319.40
|
| Rate for Payer: ASR Commercial |
$319.40
|
| Rate for Payer: BCBS Trust/PPO |
$268.33
|
| Rate for Payer: BCN Commercial |
$255.29
|
| Rate for Payer: Cash Price |
$263.42
|
| Rate for Payer: Cofinity Commercial |
$309.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.42
|
| Rate for Payer: Healthscope Commercial |
$329.28
|
| Rate for Payer: Healthscope Whirlpool |
$319.40
|
| Rate for Payer: Mclaren Commercial |
$296.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.89
|
| Rate for Payer: Nomi Health Commercial |
$270.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.77
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
OP
|
$242.88
|
|
|
Service Code
|
NDC 00904662061
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.15 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$218.59
|
| Rate for Payer: Aetna Medicare |
$121.44
|
| Rate for Payer: ASR ASR |
$235.59
|
| Rate for Payer: ASR Commercial |
$235.59
|
| Rate for Payer: BCBS Complete |
$97.15
|
| Rate for Payer: BCBS Trust/PPO |
$198.89
|
| Rate for Payer: BCN Commercial |
$188.30
|
| Rate for Payer: Cash Price |
$194.30
|
| Rate for Payer: Cofinity Commercial |
$228.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.30
|
| Rate for Payer: Healthscope Commercial |
$242.88
|
| Rate for Payer: Healthscope Whirlpool |
$235.59
|
| Rate for Payer: Mclaren Commercial |
$218.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.45
|
| Rate for Payer: Nomi Health Commercial |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.81
|
| Rate for Payer: Priority Health Narrow Network |
$170.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.73
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
IP
|
$242.88
|
|
|
Service Code
|
NDC 00904662061
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.87 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$218.59
|
| Rate for Payer: ASR ASR |
$235.59
|
| Rate for Payer: ASR Commercial |
$235.59
|
| Rate for Payer: BCBS Trust/PPO |
$197.92
|
| Rate for Payer: BCN Commercial |
$188.30
|
| Rate for Payer: Cash Price |
$194.30
|
| Rate for Payer: Cofinity Commercial |
$228.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.30
|
| Rate for Payer: Healthscope Commercial |
$242.88
|
| Rate for Payer: Healthscope Whirlpool |
$235.59
|
| Rate for Payer: Mclaren Commercial |
$218.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.45
|
| Rate for Payer: Nomi Health Commercial |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.73
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
OP
|
$329.28
|
|
|
Service Code
|
NDC 68084008301
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.71 |
| Max. Negotiated Rate |
$329.28 |
| Rate for Payer: Aetna Commercial |
$296.35
|
| Rate for Payer: Aetna Medicare |
$164.64
|
| Rate for Payer: ASR ASR |
$319.40
|
| Rate for Payer: ASR Commercial |
$319.40
|
| Rate for Payer: BCBS Complete |
$131.71
|
| Rate for Payer: BCBS Trust/PPO |
$269.65
|
| Rate for Payer: BCN Commercial |
$255.29
|
| Rate for Payer: Cash Price |
$263.42
|
| Rate for Payer: Cofinity Commercial |
$309.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.42
|
| Rate for Payer: Healthscope Commercial |
$329.28
|
| Rate for Payer: Healthscope Whirlpool |
$319.40
|
| Rate for Payer: Mclaren Commercial |
$296.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.89
|
| Rate for Payer: Nomi Health Commercial |
$270.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.52
|
| Rate for Payer: Priority Health Narrow Network |
$230.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.77
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
OP
|
$3.29
|
|
|
Service Code
|
NDC 68084008311
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna Medicare |
$1.65
|
| Rate for Payer: ASR ASR |
$3.19
|
| Rate for Payer: ASR Commercial |
$3.19
|
| Rate for Payer: BCBS Complete |
$1.32
|
| Rate for Payer: BCBS Trust/PPO |
$2.69
|
| Rate for Payer: BCN Commercial |
$2.55
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.63
|
| Rate for Payer: Healthscope Commercial |
$3.29
|
| Rate for Payer: Healthscope Whirlpool |
$3.19
|
| Rate for Payer: Mclaren Commercial |
$2.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.80
|
| Rate for Payer: Nomi Health Commercial |
$2.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.88
|
| Rate for Payer: Priority Health Narrow Network |
$2.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.90
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
IP
|
$3.29
|
|
|
Service Code
|
NDC 68084008311
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: ASR ASR |
$3.19
|
| Rate for Payer: ASR Commercial |
$3.19
|
| Rate for Payer: BCBS Trust/PPO |
$2.68
|
| Rate for Payer: BCN Commercial |
$2.55
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.63
|
| Rate for Payer: Healthscope Commercial |
$3.29
|
| Rate for Payer: Healthscope Whirlpool |
$3.19
|
| Rate for Payer: Mclaren Commercial |
$2.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.80
|
| Rate for Payer: Nomi Health Commercial |
$2.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.90
|
|
|
ISOSORBIDE MONONITRATE 20 MG TABLET
|
Facility
|
OP
|
$392.45
|
|
|
Service Code
|
NDC 00228262011
|
| Hospital Charge Code |
10357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.98 |
| Max. Negotiated Rate |
$392.45 |
| Rate for Payer: Aetna Commercial |
$353.20
|
| Rate for Payer: Aetna Medicare |
$196.22
|
| Rate for Payer: ASR ASR |
$380.68
|
| Rate for Payer: ASR Commercial |
$380.68
|
| Rate for Payer: BCBS Complete |
$156.98
|
| Rate for Payer: BCBS Trust/PPO |
$321.38
|
| Rate for Payer: BCN Commercial |
$304.27
|
| 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 |
$392.45
|
| Rate for Payer: Healthscope Whirlpool |
$380.68
|
| 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: Priority Health Cigna Priority Health |
$255.09
|
| Rate for Payer: 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 20 MG TABLET
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 00228262011
|
| Hospital Charge Code |
10357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.09 |
| Max. Negotiated Rate |
$392.45 |
| Rate for Payer: Aetna Commercial |
$353.20
|
| Rate for Payer: ASR ASR |
$380.68
|
| Rate for Payer: ASR Commercial |
$380.68
|
| Rate for Payer: BCBS Trust/PPO |
$319.81
|
| Rate for Payer: BCN Commercial |
$304.27
|
| 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 |
$392.45
|
| Rate for Payer: Healthscope Whirlpool |
$380.68
|
| 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: Priority Health Cigna Priority Health |
$255.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$345.36
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$464.55
|
|
|
Service Code
|
NDC 68084059101
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$301.96 |
| Max. Negotiated Rate |
$464.55 |
| Rate for Payer: Aetna Commercial |
$418.10
|
| Rate for Payer: ASR ASR |
$450.61
|
| Rate for Payer: ASR Commercial |
$450.61
|
| Rate for Payer: BCBS Trust/PPO |
$378.56
|
| Rate for Payer: BCN Commercial |
$360.17
|
| Rate for Payer: Cash Price |
$371.64
|
| Rate for Payer: Cofinity Commercial |
$436.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.64
|
| Rate for Payer: Healthscope Commercial |
$464.55
|
| Rate for Payer: Healthscope Whirlpool |
$450.61
|
| Rate for Payer: Mclaren Commercial |
$418.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.87
|
| Rate for Payer: Nomi Health Commercial |
$380.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$408.80
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4.65
|
|
|
Service Code
|
NDC 68084059111
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna Medicare |
$2.33
|
| Rate for Payer: ASR ASR |
$4.51
|
| Rate for Payer: ASR Commercial |
$4.51
|
| Rate for Payer: BCBS Complete |
$1.86
|
| Rate for Payer: BCBS Trust/PPO |
$3.81
|
| Rate for Payer: BCN Commercial |
$3.61
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cofinity Commercial |
$4.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.72
|
| Rate for Payer: Healthscope Commercial |
$4.65
|
| Rate for Payer: Healthscope Whirlpool |
$4.51
|
| Rate for Payer: Mclaren Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.95
|
| Rate for Payer: Nomi Health Commercial |
$3.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.07
|
| Rate for Payer: Priority Health Narrow Network |
$3.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.09
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4.65
|
|
|
Service Code
|
NDC 68084059111
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: ASR ASR |
$4.51
|
| Rate for Payer: ASR Commercial |
$4.51
|
| Rate for Payer: BCBS Trust/PPO |
$3.79
|
| Rate for Payer: BCN Commercial |
$3.61
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cofinity Commercial |
$4.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.72
|
| Rate for Payer: Healthscope Commercial |
$4.65
|
| Rate for Payer: Healthscope Whirlpool |
$4.51
|
| Rate for Payer: Mclaren Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.95
|
| Rate for Payer: Nomi Health Commercial |
$3.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.09
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$248.90
|
|
|
Service Code
|
NDC 00904644961
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.56 |
| Max. Negotiated Rate |
$248.90 |
| Rate for Payer: Aetna Commercial |
$224.01
|
| Rate for Payer: Aetna Medicare |
$124.45
|
| Rate for Payer: ASR ASR |
$241.43
|
| Rate for Payer: ASR Commercial |
$241.43
|
| Rate for Payer: BCBS Complete |
$99.56
|
| Rate for Payer: BCBS Trust/PPO |
$203.82
|
| Rate for Payer: BCN Commercial |
$192.97
|
| Rate for Payer: Cash Price |
$199.12
|
| Rate for Payer: Cofinity Commercial |
$233.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.12
|
| Rate for Payer: Healthscope Commercial |
$248.90
|
| Rate for Payer: Healthscope Whirlpool |
$241.43
|
| Rate for Payer: Mclaren Commercial |
$224.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.56
|
| Rate for Payer: Nomi Health Commercial |
$204.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.09
|
| Rate for Payer: Priority Health Narrow Network |
$174.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.03
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$248.90
|
|
|
Service Code
|
NDC 00904644961
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.78 |
| Max. Negotiated Rate |
$248.90 |
| Rate for Payer: Aetna Commercial |
$224.01
|
| Rate for Payer: ASR ASR |
$241.43
|
| Rate for Payer: ASR Commercial |
$241.43
|
| Rate for Payer: BCBS Trust/PPO |
$202.83
|
| Rate for Payer: BCN Commercial |
$192.97
|
| Rate for Payer: Cash Price |
$199.12
|
| Rate for Payer: Cofinity Commercial |
$233.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.12
|
| Rate for Payer: Healthscope Commercial |
$248.90
|
| Rate for Payer: Healthscope Whirlpool |
$241.43
|
| Rate for Payer: Mclaren Commercial |
$224.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.56
|
| Rate for Payer: Nomi Health Commercial |
$204.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.03
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$464.55
|
|
|
Service Code
|
NDC 68084059101
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.82 |
| Max. Negotiated Rate |
$464.55 |
| Rate for Payer: Aetna Commercial |
$418.10
|
| Rate for Payer: Aetna Medicare |
$232.28
|
| Rate for Payer: ASR ASR |
$450.61
|
| Rate for Payer: ASR Commercial |
$450.61
|
| Rate for Payer: BCBS Complete |
$185.82
|
| Rate for Payer: BCBS Trust/PPO |
$380.42
|
| Rate for Payer: BCN Commercial |
$360.17
|
| Rate for Payer: Cash Price |
$371.64
|
| Rate for Payer: Cofinity Commercial |
$436.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.64
|
| Rate for Payer: Healthscope Commercial |
$464.55
|
| Rate for Payer: Healthscope Whirlpool |
$450.61
|
| Rate for Payer: Mclaren Commercial |
$418.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.87
|
| Rate for Payer: Nomi Health Commercial |
$380.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$407.04
|
| Rate for Payer: Priority Health Narrow Network |
$325.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$408.80
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$294.50
|
|
|
Service Code
|
NDC 00904645061
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.43 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Aetna Commercial |
$265.05
|
| Rate for Payer: ASR ASR |
$285.67
|
| Rate for Payer: ASR Commercial |
$285.67
|
| Rate for Payer: BCBS Trust/PPO |
$239.99
|
| Rate for Payer: BCN Commercial |
$228.33
|
| Rate for Payer: Cash Price |
$235.60
|
| Rate for Payer: Cofinity Commercial |
$276.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.60
|
| Rate for Payer: Healthscope Commercial |
$294.50
|
| Rate for Payer: Healthscope Whirlpool |
$285.67
|
| Rate for Payer: Mclaren Commercial |
$265.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.32
|
| Rate for Payer: Nomi Health Commercial |
$241.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.16
|
|
