|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$448.29
|
|
|
Service Code
|
CPT 20610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.02 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$404.07
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$323.26
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
IP
|
$25.38
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna Commercial |
$22.84
|
| Rate for Payer: ASR ASR |
$24.62
|
| Rate for Payer: ASR Commercial |
$24.62
|
| Rate for Payer: BCBS Trust/PPO |
$20.68
|
| Rate for Payer: BCN Commercial |
$19.68
|
| 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 |
$25.38
|
| Rate for Payer: Healthscope Whirlpool |
$24.62
|
| 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: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.33
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
IP
|
$100.62
|
|
|
Service Code
|
NDC 00065042636
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$100.62 |
| Rate for Payer: Aetna Commercial |
$90.56
|
| Rate for Payer: ASR ASR |
$97.60
|
| Rate for Payer: ASR Commercial |
$97.60
|
| Rate for Payer: BCBS Trust/PPO |
$82.00
|
| Rate for Payer: BCN Commercial |
$78.01
|
| 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 |
$100.62
|
| Rate for Payer: Healthscope Whirlpool |
$97.60
|
| Rate for Payer: Mclaren Commercial |
$90.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.53
|
| Rate for Payer: Nomi Health Commercial |
$82.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.55
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
OP
|
$25.38
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna Commercial |
$22.84
|
| Rate for Payer: Aetna Medicare |
$12.69
|
| Rate for Payer: ASR ASR |
$24.62
|
| Rate for Payer: ASR Commercial |
$24.62
|
| Rate for Payer: BCBS Complete |
$10.15
|
| Rate for Payer: BCBS Trust/PPO |
$20.78
|
| Rate for Payer: BCN Commercial |
$19.68
|
| 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 |
$25.38
|
| Rate for Payer: Healthscope Whirlpool |
$24.62
|
| 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: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.24
|
| Rate for Payer: Priority Health Narrow Network |
$17.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.33
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
OP
|
$100.62
|
|
|
Service Code
|
NDC 00065042636
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$100.62 |
| Rate for Payer: Aetna Commercial |
$90.56
|
| Rate for Payer: Aetna Medicare |
$50.31
|
| Rate for Payer: ASR ASR |
$97.60
|
| Rate for Payer: ASR Commercial |
$97.60
|
| Rate for Payer: BCBS Complete |
$40.25
|
| Rate for Payer: BCBS Trust/PPO |
$82.40
|
| Rate for Payer: BCN Commercial |
$78.01
|
| 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 |
$100.62
|
| Rate for Payer: Healthscope Whirlpool |
$97.60
|
| Rate for Payer: Mclaren Commercial |
$90.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.53
|
| Rate for Payer: Nomi Health Commercial |
$82.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.40
|
| Rate for Payer: 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
|
$70.50
|
|
|
Service Code
|
NDC 00904052361
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna Commercial |
$63.45
|
| Rate for Payer: Aetna Medicare |
$35.25
|
| Rate for Payer: ASR ASR |
$68.38
|
| Rate for Payer: ASR Commercial |
$68.38
|
| Rate for Payer: BCBS Complete |
$28.20
|
| Rate for Payer: BCBS Trust/PPO |
$57.73
|
| Rate for Payer: BCN Commercial |
$54.66
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$66.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$70.50
|
| Rate for Payer: Healthscope Whirlpool |
$68.38
|
| Rate for Payer: Mclaren Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Nomi Health Commercial |
$57.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.77
|
| Rate for Payer: Priority Health Narrow Network |
$49.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.04
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 00904052361
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.82 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna Commercial |
$63.45
|
| Rate for Payer: ASR ASR |
$68.38
|
| Rate for Payer: ASR Commercial |
$68.38
|
| Rate for Payer: BCBS Trust/PPO |
$57.45
|
| Rate for Payer: BCN Commercial |
$54.66
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$66.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$70.50
|
| Rate for Payer: Healthscope Whirlpool |
$68.38
|
| Rate for Payer: Mclaren Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Nomi Health Commercial |
$57.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.04
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$39.78
|
|
|
Service Code
|
NDC 00574703412
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.86 |
| Max. Negotiated Rate |
$39.78 |
| Rate for Payer: Aetna Commercial |
$35.80
|
| Rate for Payer: ASR ASR |
$38.59
|
| Rate for Payer: ASR Commercial |
$38.59
|
| Rate for Payer: BCBS Trust/PPO |
$32.42
|
| Rate for Payer: BCN Commercial |
$30.84
|
| Rate for Payer: Cash Price |
$31.83
|
| Rate for Payer: Cofinity Commercial |
$37.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$39.78
|
| Rate for Payer: Healthscope Whirlpool |
$38.59
|
| Rate for Payer: Mclaren Commercial |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.81
|
| Rate for Payer: Nomi Health Commercial |
$32.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.01
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$39.78
|
|
|
Service Code
|
NDC 00574703412
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$39.78 |
| Rate for Payer: Aetna Commercial |
$35.80
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: ASR ASR |
$38.59
|
| Rate for Payer: ASR Commercial |
$38.59
|
| Rate for Payer: BCBS Complete |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$32.58
|
| Rate for Payer: BCN Commercial |
$30.84
|
| Rate for Payer: Cash Price |
$31.83
|
| Rate for Payer: Cofinity Commercial |
$37.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$39.78
|
| Rate for Payer: Healthscope Whirlpool |
$38.59
|
| Rate for Payer: Mclaren Commercial |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.81
|
| Rate for Payer: Nomi Health Commercial |
$32.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.86
|
| Rate for Payer: Priority Health Narrow Network |
$27.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.01
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
IP
|
$544.50
|
|
|
Service Code
|
NDC 66553000101
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$353.92 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Aetna Commercial |
$490.05
|
| Rate for Payer: ASR ASR |
$528.16
|
| Rate for Payer: ASR Commercial |
$528.16
|
| Rate for Payer: BCBS Trust/PPO |
$443.71
|
| Rate for Payer: BCN Commercial |
$422.15
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cofinity Commercial |
$511.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.60
|
| Rate for Payer: Healthscope Commercial |
$544.50
|
| Rate for Payer: Healthscope Whirlpool |
$528.16
|
| Rate for Payer: Mclaren Commercial |
$490.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$462.82
|
| Rate for Payer: Nomi Health Commercial |
$446.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$479.16
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
IP
|
$94.50
|
|
|
Service Code
|
NDC 57896090101
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.42 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$85.05
|
| Rate for Payer: ASR ASR |
$91.66
|
| Rate for Payer: ASR Commercial |
$91.66
|
| Rate for Payer: BCBS Trust/PPO |
$77.01
|
| Rate for Payer: BCN Commercial |
$73.27
|
| 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 |
$94.50
|
| Rate for Payer: Healthscope Whirlpool |
$91.66
|
| Rate for Payer: Mclaren Commercial |
$85.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.32
|
| Rate for Payer: Nomi Health Commercial |
$77.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.16
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
OP
|
$94.50
|
|
|
Service Code
|
NDC 57896090101
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$85.05
|
| Rate for Payer: Aetna Medicare |
$47.25
|
| Rate for Payer: ASR ASR |
$91.66
|
| Rate for Payer: ASR Commercial |
$91.66
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS Trust/PPO |
$77.39
|
| Rate for Payer: BCN Commercial |
$73.27
|
| 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 |
$94.50
|
| Rate for Payer: Healthscope Whirlpool |
$91.66
|
| Rate for Payer: Mclaren Commercial |
$85.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.32
|
| Rate for Payer: Nomi Health Commercial |
$77.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.42
|
| Rate for Payer: 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
|
$544.50
|
|
|
Service Code
|
NDC 66553000101
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.80 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Aetna Commercial |
$490.05
|
| Rate for Payer: Aetna Medicare |
$272.25
|
| Rate for Payer: ASR ASR |
$528.16
|
| Rate for Payer: ASR Commercial |
$528.16
|
| Rate for Payer: BCBS Complete |
$217.80
|
| Rate for Payer: BCBS Trust/PPO |
$445.89
|
| Rate for Payer: BCN Commercial |
$422.15
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cofinity Commercial |
$511.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.60
|
| Rate for Payer: Healthscope Commercial |
$544.50
|
| Rate for Payer: Healthscope Whirlpool |
$528.16
|
| Rate for Payer: Mclaren Commercial |
$490.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$462.82
|
| Rate for Payer: Nomi Health Commercial |
$446.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.09
|
| Rate for Payer: Priority Health Narrow Network |
$381.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$479.16
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
NDC 63739043402
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$680.40
|
| Rate for Payer: ASR ASR |
$733.32
|
| Rate for Payer: ASR Commercial |
$733.32
|
| Rate for Payer: BCBS Trust/PPO |
$616.06
|
| Rate for Payer: BCN Commercial |
$586.13
|
| 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 |
$756.00
|
| Rate for Payer: Healthscope Whirlpool |
$733.32
|
| 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: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$665.28
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$566.50
|
|
|
Service Code
|
NDC 66553000201
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.60 |
| Max. Negotiated Rate |
$566.50 |
| Rate for Payer: Aetna Commercial |
$509.85
|
| Rate for Payer: Aetna Medicare |
$283.25
|
| Rate for Payer: ASR ASR |
$549.50
|
| Rate for Payer: ASR Commercial |
$549.50
|
| Rate for Payer: BCBS Complete |
$226.60
|
| Rate for Payer: BCBS Trust/PPO |
$463.91
|
| Rate for Payer: BCN Commercial |
$439.21
|
| Rate for Payer: Cash Price |
$453.20
|
| Rate for Payer: Cofinity Commercial |
$532.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.20
|
| Rate for Payer: Healthscope Commercial |
$566.50
|
| Rate for Payer: Healthscope Whirlpool |
$549.50
|
| Rate for Payer: Mclaren Commercial |
$509.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.52
|
| Rate for Payer: Nomi Health Commercial |
$464.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$496.37
|
| Rate for Payer: Priority Health Narrow Network |
$397.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$498.52
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$45.36
|
|
|
Service Code
|
NDC 00904404073
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: Aetna Medicare |
$22.68
|
| Rate for Payer: ASR ASR |
$44.00
|
| Rate for Payer: ASR Commercial |
$44.00
|
| Rate for Payer: BCBS Complete |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$37.15
|
| Rate for Payer: BCN Commercial |
$35.17
|
| 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 |
$45.36
|
| Rate for Payer: Healthscope Whirlpool |
$44.00
|
| 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: Priority Health Cigna Priority Health |
$29.48
|
| Rate for Payer: 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
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
NDC 00904679430
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$444.60 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna Commercial |
$615.60
|
| Rate for Payer: ASR ASR |
$663.48
|
| Rate for Payer: ASR Commercial |
$663.48
|
| Rate for Payer: BCBS Trust/PPO |
$557.39
|
| Rate for Payer: BCN Commercial |
$530.31
|
| 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 |
$684.00
|
| Rate for Payer: Healthscope Whirlpool |
$663.48
|
| 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: Priority Health Cigna Priority Health |
$444.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$601.92
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
NDC 00904679480
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna Commercial |
$396.90
|
| Rate for Payer: Aetna Medicare |
$220.50
|
| Rate for Payer: ASR ASR |
$427.77
|
| Rate for Payer: ASR Commercial |
$427.77
|
| Rate for Payer: BCBS Complete |
$176.40
|
| Rate for Payer: BCBS Trust/PPO |
$361.13
|
| Rate for Payer: BCN Commercial |
$341.91
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$414.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.80
|
| Rate for Payer: Healthscope Commercial |
$441.00
|
| Rate for Payer: Healthscope Whirlpool |
$427.77
|
| Rate for Payer: Mclaren Commercial |
$396.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.85
|
| Rate for Payer: Nomi Health Commercial |
$361.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$386.40
|
| Rate for Payer: Priority Health Narrow Network |
$309.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$388.08
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$45.36
|
|
|
Service Code
|
NDC 00904404073
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: ASR ASR |
$44.00
|
| Rate for Payer: ASR Commercial |
$44.00
|
| Rate for Payer: BCBS Trust/PPO |
$36.96
|
| Rate for Payer: BCN Commercial |
$35.17
|
| 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 |
$45.36
|
| Rate for Payer: Healthscope Whirlpool |
$44.00
|
| 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: Priority Health Cigna Priority Health |
$29.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.92
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
NDC 00904679480
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.65 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna Commercial |
$396.90
|
| Rate for Payer: ASR ASR |
$427.77
|
| Rate for Payer: ASR Commercial |
$427.77
|
| Rate for Payer: BCBS Trust/PPO |
$359.37
|
| Rate for Payer: BCN Commercial |
$341.91
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$414.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.80
|
| Rate for Payer: Healthscope Commercial |
$441.00
|
| Rate for Payer: Healthscope Whirlpool |
$427.77
|
| Rate for Payer: Mclaren Commercial |
$396.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.85
|
| Rate for Payer: Nomi Health Commercial |
$361.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$388.08
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
NDC 16103036611
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: ASR ASR |
$244.44
|
| Rate for Payer: ASR Commercial |
$244.44
|
| Rate for Payer: BCBS Trust/PPO |
$205.35
|
| Rate for Payer: BCN Commercial |
$195.38
|
| 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 |
$252.00
|
| Rate for Payer: Healthscope Whirlpool |
$244.44
|
| 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: Priority Health Cigna Priority Health |
$163.80
|
| 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 |
$302.40 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$680.40
|
| Rate for Payer: Aetna Medicare |
$378.00
|
| Rate for Payer: ASR ASR |
$733.32
|
| Rate for Payer: ASR Commercial |
$733.32
|
| Rate for Payer: BCBS Complete |
$302.40
|
| Rate for Payer: BCBS Trust/PPO |
$619.09
|
| Rate for Payer: BCN Commercial |
$586.13
|
| 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 |
$756.00
|
| Rate for Payer: Healthscope Whirlpool |
$733.32
|
| 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: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: 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
|
$252.00
|
|
|
Service Code
|
NDC 16103036611
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: Aetna Medicare |
$126.00
|
| Rate for Payer: ASR ASR |
$244.44
|
| Rate for Payer: ASR Commercial |
$244.44
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: BCBS Trust/PPO |
$206.36
|
| Rate for Payer: BCN Commercial |
$195.38
|
| 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 |
$252.00
|
| Rate for Payer: Healthscope Whirlpool |
$244.44
|
| 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: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: 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
|
$684.00
|
|
|
Service Code
|
NDC 00904679430
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.60 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna Commercial |
$615.60
|
| Rate for Payer: Aetna Medicare |
$342.00
|
| Rate for Payer: ASR ASR |
$663.48
|
| Rate for Payer: ASR Commercial |
$663.48
|
| Rate for Payer: BCBS Complete |
$273.60
|
| Rate for Payer: BCBS Trust/PPO |
$560.13
|
| Rate for Payer: BCN Commercial |
$530.31
|
| 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 |
$684.00
|
| Rate for Payer: Healthscope Whirlpool |
$663.48
|
| 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: Priority Health Cigna Priority Health |
$444.60
|
| Rate for Payer: 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
|
$566.50
|
|
|
Service Code
|
NDC 66553000201
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$368.22 |
| Max. Negotiated Rate |
$566.50 |
| Rate for Payer: Aetna Commercial |
$509.85
|
| Rate for Payer: ASR ASR |
$549.50
|
| Rate for Payer: ASR Commercial |
$549.50
|
| Rate for Payer: BCBS Trust/PPO |
$461.64
|
| Rate for Payer: BCN Commercial |
$439.21
|
| Rate for Payer: Cash Price |
$453.20
|
| Rate for Payer: Cofinity Commercial |
$532.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.20
|
| Rate for Payer: Healthscope Commercial |
$566.50
|
| Rate for Payer: Healthscope Whirlpool |
$549.50
|
| Rate for Payer: Mclaren Commercial |
$509.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.52
|
| Rate for Payer: Nomi Health Commercial |
$464.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$498.52
|
|
