|
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 |
$40.18
|
| 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 |
$40.18
|
| 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 |
$40.18
|
| 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 |
$40.18
|
| 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
|
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 |
$1.90
|
| 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 |
$320.30
|
| 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
|
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
|
|
|
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 |
$3.66
|
| Rate for Payer: Nomi Health Commercial |
$3.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| 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
|
$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
|
IP
|
$4.30
|
|
|
Service Code
|
NDC 51079075901
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: ASR ASR |
$4.17
|
| Rate for Payer: ASR Commercial |
$4.17
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| 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 |
$3.66
|
| Rate for Payer: Nomi Health Commercial |
$3.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.78
|
|
|
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 |
$320.30
|
| 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 50 MG TABLET
|
Facility
|
IP
|
$2.12
|
|
|
Service Code
|
NDC 51079068401
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$1.91
|
| Rate for Payer: ASR ASR |
$2.06
|
| Rate for Payer: ASR Commercial |
$2.06
|
| Rate for Payer: BCBS Trust/PPO |
$1.73
|
| Rate for Payer: BCN Commercial |
$1.64
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$1.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.70
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Healthscope Whirlpool |
$2.06
|
| Rate for Payer: Mclaren Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.80
|
| Rate for Payer: Nomi Health Commercial |
$1.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.87
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
OP
|
$2.12
|
|
|
Service Code
|
NDC 51079068401
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$1.91
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: ASR ASR |
$2.06
|
| Rate for Payer: ASR Commercial |
$2.06
|
| Rate for Payer: BCBS Complete |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$1.74
|
| Rate for Payer: BCN Commercial |
$1.64
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$1.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.70
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Healthscope Whirlpool |
$2.06
|
| Rate for Payer: Mclaren Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.80
|
| Rate for Payer: Nomi Health Commercial |
$1.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.86
|
| Rate for Payer: Priority Health Narrow Network |
$1.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.87
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
NDC 64980037603
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$129.60
|
| Rate for Payer: ASR ASR |
$139.68
|
| Rate for Payer: ASR Commercial |
$139.68
|
| Rate for Payer: BCBS Trust/PPO |
$117.35
|
| Rate for Payer: BCN Commercial |
$111.64
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$135.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.20
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Healthscope Whirlpool |
$139.68
|
| Rate for Payer: Mclaren Commercial |
$129.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.40
|
| Rate for Payer: Nomi Health Commercial |
$118.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.72
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
NDC 64980037603
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$129.60
|
| Rate for Payer: Aetna Medicare |
$72.00
|
| Rate for Payer: ASR ASR |
$139.68
|
| Rate for Payer: ASR Commercial |
$139.68
|
| Rate for Payer: BCBS Complete |
$57.60
|
| Rate for Payer: BCBS Trust/PPO |
$117.92
|
| Rate for Payer: BCN Commercial |
$111.64
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$135.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.20
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Healthscope Whirlpool |
$139.68
|
| Rate for Payer: Mclaren Commercial |
$129.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.40
|
| Rate for Payer: Nomi Health Commercial |
$118.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.17
|
| Rate for Payer: Priority Health Narrow Network |
$100.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.72
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
NDC 68084009711
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna Commercial |
$4.06
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: ASR ASR |
$4.37
|
| Rate for Payer: ASR Commercial |
$4.37
|
| Rate for Payer: BCBS Complete |
$1.80
|
| Rate for Payer: BCBS Trust/PPO |
$3.69
|
| Rate for Payer: BCN Commercial |
$3.50
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cofinity Commercial |
$4.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.61
|
| Rate for Payer: Healthscope Commercial |
$4.51
|
| Rate for Payer: Healthscope Whirlpool |
$4.37
|
| Rate for Payer: Mclaren Commercial |
$4.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.83
|
| Rate for Payer: Nomi Health Commercial |
$3.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.95
|
| Rate for Payer: Priority Health Narrow Network |
$3.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.97
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$411.25
|
|
|
Service Code
|
NDC 00904629061
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$411.25 |
| Rate for Payer: Aetna Commercial |
$370.12
|
| Rate for Payer: Aetna Medicare |
$205.62
|
| Rate for Payer: ASR ASR |
$398.91
|
| Rate for Payer: ASR Commercial |
$398.91
|
| Rate for Payer: BCBS Complete |
$164.50
|
| Rate for Payer: BCBS Trust/PPO |
$336.77
|
| Rate for Payer: BCN Commercial |
$318.84
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$386.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.00
|
| Rate for Payer: Healthscope Commercial |
$411.25
|
| Rate for Payer: Healthscope Whirlpool |
$398.91
|
| Rate for Payer: Mclaren Commercial |
$370.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.56
|
| Rate for Payer: Nomi Health Commercial |
$337.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$360.34
|
| Rate for Payer: Priority Health Narrow Network |
$288.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.90
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$213.85
|
|
|
Service Code
|
NDC 00904629006
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.54 |
| Max. Negotiated Rate |
$213.85 |
| Rate for Payer: Aetna Commercial |
$192.46
|
| Rate for Payer: Aetna Medicare |
$106.92
|
| Rate for Payer: ASR ASR |
$207.43
|
| Rate for Payer: ASR Commercial |
$207.43
|
| Rate for Payer: BCBS Complete |
$85.54
|
| Rate for Payer: BCBS Trust/PPO |
$175.12
|
| Rate for Payer: BCN Commercial |
$165.80
|
| Rate for Payer: Cash Price |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$201.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.08
|
| Rate for Payer: Healthscope Commercial |
$213.85
|
| Rate for Payer: Healthscope Whirlpool |
$207.43
|
| Rate for Payer: Mclaren Commercial |
$192.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.77
|
| Rate for Payer: Nomi Health Commercial |
$175.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.38
|
| Rate for Payer: Priority Health Narrow Network |
$149.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.19
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
NDC 68084009711
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna Commercial |
$4.06
|
| Rate for Payer: ASR ASR |
$4.37
|
| Rate for Payer: ASR Commercial |
$4.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.68
|
| Rate for Payer: BCN Commercial |
$3.50
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cofinity Commercial |
$4.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.61
|
| Rate for Payer: Healthscope Commercial |
$4.51
|
| Rate for Payer: Healthscope Whirlpool |
$4.37
|
| Rate for Payer: Mclaren Commercial |
$4.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.83
|
| Rate for Payer: Nomi Health Commercial |
$3.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.97
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$213.85
|
|
|
Service Code
|
NDC 00904629006
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$213.85 |
| Rate for Payer: Aetna Commercial |
$192.46
|
| Rate for Payer: ASR ASR |
$207.43
|
| Rate for Payer: ASR Commercial |
$207.43
|
| Rate for Payer: BCBS Trust/PPO |
$174.27
|
| Rate for Payer: BCN Commercial |
$165.80
|
| Rate for Payer: Cash Price |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$201.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.08
|
| Rate for Payer: Healthscope Commercial |
$213.85
|
| Rate for Payer: Healthscope Whirlpool |
$207.43
|
| Rate for Payer: Mclaren Commercial |
$192.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.77
|
| Rate for Payer: Nomi Health Commercial |
$175.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.19
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$451.20
|
|
|
Service Code
|
NDC 68084009701
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.48 |
| Max. Negotiated Rate |
$451.20 |
| Rate for Payer: Aetna Commercial |
$406.08
|
| Rate for Payer: Aetna Medicare |
$225.60
|
| Rate for Payer: ASR ASR |
$437.66
|
| Rate for Payer: ASR Commercial |
$437.66
|
| Rate for Payer: BCBS Complete |
$180.48
|
| Rate for Payer: BCBS Trust/PPO |
$369.49
|
| Rate for Payer: BCN Commercial |
$349.82
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$424.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$451.20
|
| Rate for Payer: Healthscope Whirlpool |
$437.66
|
| Rate for Payer: Mclaren Commercial |
$406.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: Nomi Health Commercial |
$369.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$395.34
|
| Rate for Payer: Priority Health Narrow Network |
$316.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.06
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$411.25
|
|
|
Service Code
|
NDC 00904629061
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$267.31 |
| Max. Negotiated Rate |
$411.25 |
| Rate for Payer: Aetna Commercial |
$370.12
|
| Rate for Payer: ASR ASR |
$398.91
|
| Rate for Payer: ASR Commercial |
$398.91
|
| Rate for Payer: BCBS Trust/PPO |
$335.13
|
| Rate for Payer: BCN Commercial |
$318.84
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$386.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.00
|
| Rate for Payer: Healthscope Commercial |
$411.25
|
| Rate for Payer: Healthscope Whirlpool |
$398.91
|
| Rate for Payer: Mclaren Commercial |
$370.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.56
|
| Rate for Payer: Nomi Health Commercial |
$337.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.90
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$4.70
|
|
|
Service Code
|
NDC 50268009311
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna Commercial |
$4.23
|
| Rate for Payer: Aetna Medicare |
$2.35
|
| Rate for Payer: ASR ASR |
$4.56
|
| Rate for Payer: ASR Commercial |
$4.56
|
| Rate for Payer: BCBS Complete |
$1.88
|
| Rate for Payer: BCBS Trust/PPO |
$3.85
|
| Rate for Payer: BCN Commercial |
$3.64
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cofinity Commercial |
$4.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$4.70
|
| Rate for Payer: Healthscope Whirlpool |
$4.56
|
| Rate for Payer: Mclaren Commercial |
$4.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Nomi Health Commercial |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.12
|
| Rate for Payer: Priority Health Narrow Network |
$3.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.14
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$4.70
|
|
|
Service Code
|
NDC 50268009311
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna Commercial |
$4.23
|
| Rate for Payer: ASR ASR |
$4.56
|
| Rate for Payer: ASR Commercial |
$4.56
|
| Rate for Payer: BCBS Trust/PPO |
$3.83
|
| Rate for Payer: BCN Commercial |
$3.64
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cofinity Commercial |
$4.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$4.70
|
| Rate for Payer: Healthscope Whirlpool |
$4.56
|
| Rate for Payer: Mclaren Commercial |
$4.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Nomi Health Commercial |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.14
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$2.22
|
|
|
Service Code
|
NDC 51079020801
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Aetna Medicare |
$1.11
|
| Rate for Payer: ASR ASR |
$2.15
|
| Rate for Payer: ASR Commercial |
$2.15
|
| Rate for Payer: BCBS Complete |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$1.82
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.78
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Healthscope Whirlpool |
$2.15
|
| Rate for Payer: Mclaren Commercial |
$2.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.89
|
| Rate for Payer: Nomi Health Commercial |
$1.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.95
|
| Rate for Payer: Priority Health Narrow Network |
$1.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.95
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$451.20
|
|
|
Service Code
|
NDC 68084009701
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.28 |
| Max. Negotiated Rate |
$451.20 |
| Rate for Payer: Aetna Commercial |
$406.08
|
| Rate for Payer: ASR ASR |
$437.66
|
| Rate for Payer: ASR Commercial |
$437.66
|
| Rate for Payer: BCBS Trust/PPO |
$367.68
|
| Rate for Payer: BCN Commercial |
$349.82
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$424.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$451.20
|
| Rate for Payer: Healthscope Whirlpool |
$437.66
|
| Rate for Payer: Mclaren Commercial |
$406.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: Nomi Health Commercial |
$369.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.06
|
|
