|
ASPIRIN 325 MG TABLET
|
Facility
|
IP
|
$544.50
|
|
|
Service Code
|
NDC 66553000101
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$353.93 |
| 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 |
$353.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$479.16
|
|
|
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 |
$91.67
|
| Rate for Payer: ASR Commercial |
$91.67
|
| 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 |
$91.67
|
| Rate for Payer: Mclaren Commercial |
$85.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.33
|
| Rate for Payer: Nomi Health Commercial |
$77.49
|
| Rate for Payer: 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
|
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 |
$91.67
|
| Rate for Payer: ASR Commercial |
$91.67
|
| 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 |
$91.67
|
| Rate for Payer: Mclaren Commercial |
$85.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.33
|
| Rate for Payer: Nomi Health Commercial |
$77.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.42
|
| 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 |
$353.93
|
| 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
|
$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
|
$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
|
$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
|
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
|
$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
|
$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 |
$368.23
|
| 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
|
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
|
$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
|
IP
|
$566.50
|
|
|
Service Code
|
NDC 66553000201
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$368.23 |
| 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 |
$368.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$498.52
|
|
|
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-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
OP
|
$44.65
|
|
|
Service Code
|
NDC 00904513559
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.86 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Aetna Commercial |
$40.19
|
| Rate for Payer: Aetna Medicare |
$22.32
|
| Rate for Payer: ASR ASR |
$43.31
|
| Rate for Payer: ASR Commercial |
$43.31
|
| Rate for Payer: BCBS Complete |
$17.86
|
| Rate for Payer: BCBS Trust/PPO |
$36.56
|
| Rate for Payer: BCN Commercial |
$34.62
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$41.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$44.65
|
| Rate for Payer: Healthscope Whirlpool |
$43.31
|
| Rate for Payer: Mclaren Commercial |
$40.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.95
|
| Rate for Payer: Nomi Health Commercial |
$36.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.12
|
| Rate for Payer: Priority Health Narrow Network |
$31.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.29
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
IP
|
$44.65
|
|
|
Service Code
|
NDC 00904513559
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.02 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Aetna Commercial |
$40.19
|
| Rate for Payer: ASR ASR |
$43.31
|
| Rate for Payer: ASR Commercial |
$43.31
|
| Rate for Payer: BCBS Trust/PPO |
$36.39
|
| Rate for Payer: BCN Commercial |
$34.62
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$41.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$44.65
|
| Rate for Payer: Healthscope Whirlpool |
$43.31
|
| Rate for Payer: Mclaren Commercial |
$40.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.95
|
| Rate for Payer: Nomi Health Commercial |
$36.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.29
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
IP
|
$380.70
|
|
|
Service Code
|
NDC 60687060501
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.46 |
| Max. Negotiated Rate |
$380.70 |
| Rate for Payer: Aetna Commercial |
$342.63
|
| Rate for Payer: ASR ASR |
$369.28
|
| Rate for Payer: ASR Commercial |
$369.28
|
| Rate for Payer: BCBS Trust/PPO |
$310.23
|
| Rate for Payer: BCN Commercial |
$295.16
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Commercial |
$357.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.56
|
| Rate for Payer: Healthscope Commercial |
$380.70
|
| Rate for Payer: Healthscope Whirlpool |
$369.28
|
| Rate for Payer: Mclaren Commercial |
$342.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.60
|
| Rate for Payer: Nomi Health Commercial |
$312.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.02
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$380.70
|
|
|
Service Code
|
NDC 60687060501
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.28 |
| Max. Negotiated Rate |
$380.70 |
| Rate for Payer: Aetna Commercial |
$342.63
|
| Rate for Payer: Aetna Medicare |
$190.35
|
| Rate for Payer: ASR ASR |
$369.28
|
| Rate for Payer: ASR Commercial |
$369.28
|
| Rate for Payer: BCBS Complete |
$152.28
|
| Rate for Payer: BCBS Trust/PPO |
$311.76
|
| Rate for Payer: BCN Commercial |
$295.16
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Commercial |
$357.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.56
|
| Rate for Payer: Healthscope Commercial |
$380.70
|
| Rate for Payer: Healthscope Whirlpool |
$369.28
|
| Rate for Payer: Mclaren Commercial |
$342.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.60
|
| Rate for Payer: Nomi Health Commercial |
$312.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$333.57
|
| Rate for Payer: Priority Health Narrow Network |
$266.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.02
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$340.75
|
|
|
Service Code
|
NDC 00904718761
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.30 |
| Max. Negotiated Rate |
$340.75 |
| Rate for Payer: Aetna Commercial |
$306.68
|
| Rate for Payer: Aetna Medicare |
$170.38
|
| Rate for Payer: ASR ASR |
$330.53
|
| Rate for Payer: ASR Commercial |
$330.53
|
| Rate for Payer: BCBS Complete |
$136.30
|
| Rate for Payer: BCBS Trust/PPO |
$279.04
|
| Rate for Payer: BCN Commercial |
$264.18
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$320.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$340.75
|
| Rate for Payer: Healthscope Whirlpool |
$330.53
|
| Rate for Payer: Mclaren Commercial |
$306.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.64
|
| Rate for Payer: Nomi Health Commercial |
$279.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.57
|
| Rate for Payer: Priority Health Narrow Network |
$238.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.86
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$3.81
|
|
|
Service Code
|
NDC 60687060511
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Aetna Medicare |
$1.91
|
| Rate for Payer: ASR ASR |
$3.70
|
| Rate for Payer: ASR Commercial |
$3.70
|
| Rate for Payer: BCBS Complete |
$1.52
|
| Rate for Payer: BCBS Trust/PPO |
$3.12
|
| Rate for Payer: BCN Commercial |
$2.95
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Healthscope Whirlpool |
$3.70
|
| Rate for Payer: Mclaren Commercial |
$3.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.24
|
| Rate for Payer: Nomi Health Commercial |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.34
|
| Rate for Payer: Priority Health Narrow Network |
$2.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.35
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
IP
|
$340.75
|
|
|
Service Code
|
NDC 00904718761
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.49 |
| Max. Negotiated Rate |
$340.75 |
| Rate for Payer: Aetna Commercial |
$306.68
|
| Rate for Payer: ASR ASR |
$330.53
|
| Rate for Payer: ASR Commercial |
$330.53
|
| Rate for Payer: BCBS Trust/PPO |
$277.68
|
| Rate for Payer: BCN Commercial |
$264.18
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$320.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$340.75
|
| Rate for Payer: Healthscope Whirlpool |
$330.53
|
| Rate for Payer: Mclaren Commercial |
$306.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.64
|
| Rate for Payer: Nomi Health Commercial |
$279.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.86
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 51079075901
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Aetna Medicare |
$2.15
|
| Rate for Payer: ASR ASR |
$4.17
|
| Rate for Payer: ASR Commercial |
$4.17
|
| Rate for Payer: BCBS Complete |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$3.52
|
| Rate for Payer: BCN Commercial |
$3.33
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$4.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$4.30
|
| Rate for Payer: Healthscope Whirlpool |
$4.17
|
| Rate for Payer: Mclaren Commercial |
$3.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Nomi Health Commercial |
$3.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.77
|
| Rate for Payer: Priority Health Narrow Network |
$3.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.78
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
IP
|
$3.81
|
|
|
Service Code
|
NDC 60687060511
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: ASR ASR |
$3.70
|
| Rate for Payer: ASR Commercial |
$3.70
|
| Rate for Payer: BCBS Trust/PPO |
$3.10
|
| Rate for Payer: BCN Commercial |
$2.95
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Healthscope Whirlpool |
$3.70
|
| Rate for Payer: Mclaren Commercial |
$3.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.24
|
| Rate for Payer: Nomi Health Commercial |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.35
|
|
