|
BISOPROLOL FUMARATE 2.5 MG CUSTOM TAB
|
Facility
|
IP
|
$75.81
|
|
|
Service Code
|
NDC 09900000003
|
| Hospital Charge Code |
150723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.28 |
| Max. Negotiated Rate |
$75.81 |
| Rate for Payer: Aetna Commercial |
$68.23
|
| Rate for Payer: ASR ASR |
$73.54
|
| Rate for Payer: ASR Commercial |
$73.54
|
| Rate for Payer: BCBS Trust/PPO |
$61.78
|
| Rate for Payer: BCN Commercial |
$58.78
|
| Rate for Payer: Cash Price |
$60.65
|
| Rate for Payer: Cofinity Commercial |
$71.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.65
|
| Rate for Payer: Healthscope Commercial |
$75.81
|
| Rate for Payer: Healthscope Whirlpool |
$73.54
|
| Rate for Payer: Mclaren Commercial |
$68.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.44
|
| Rate for Payer: Nomi Health Commercial |
$62.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.71
|
|
|
BISOPROLOL FUMARATE 2.5 MG CUSTOM TAB
|
Facility
|
OP
|
$75.81
|
|
|
Service Code
|
NDC 09900000003
|
| Hospital Charge Code |
150723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$75.81 |
| Rate for Payer: Aetna Commercial |
$68.23
|
| Rate for Payer: Aetna Medicare |
$37.90
|
| Rate for Payer: ASR ASR |
$73.54
|
| Rate for Payer: ASR Commercial |
$73.54
|
| Rate for Payer: BCBS Complete |
$30.32
|
| Rate for Payer: BCBS Trust/PPO |
$62.08
|
| Rate for Payer: BCN Commercial |
$58.78
|
| Rate for Payer: Cash Price |
$60.65
|
| Rate for Payer: Cofinity Commercial |
$71.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.65
|
| Rate for Payer: Healthscope Commercial |
$75.81
|
| Rate for Payer: Healthscope Whirlpool |
$73.54
|
| Rate for Payer: Mclaren Commercial |
$68.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.44
|
| Rate for Payer: Nomi Health Commercial |
$62.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.42
|
| Rate for Payer: Priority Health Narrow Network |
$53.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.71
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$236.16
|
|
|
Service Code
|
NDC 50268012715
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$236.16 |
| Rate for Payer: Aetna Commercial |
$212.54
|
| Rate for Payer: Aetna Medicare |
$118.08
|
| Rate for Payer: ASR ASR |
$229.08
|
| Rate for Payer: ASR Commercial |
$229.08
|
| Rate for Payer: BCBS Complete |
$94.46
|
| Rate for Payer: BCBS Trust/PPO |
$193.39
|
| Rate for Payer: BCN Commercial |
$183.09
|
| Rate for Payer: Cash Price |
$188.93
|
| Rate for Payer: Cofinity Commercial |
$221.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.93
|
| Rate for Payer: Healthscope Commercial |
$236.16
|
| Rate for Payer: Healthscope Whirlpool |
$229.08
|
| Rate for Payer: Mclaren Commercial |
$212.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.74
|
| Rate for Payer: Nomi Health Commercial |
$193.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.92
|
| Rate for Payer: Priority Health Narrow Network |
$165.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.82
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$4.72
|
|
|
Service Code
|
NDC 50268012711
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna Commercial |
$4.25
|
| Rate for Payer: ASR ASR |
$4.58
|
| Rate for Payer: ASR Commercial |
$4.58
|
| Rate for Payer: BCBS Trust/PPO |
$3.85
|
| Rate for Payer: BCN Commercial |
$3.66
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cofinity Commercial |
$4.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.78
|
| Rate for Payer: Healthscope Commercial |
$4.72
|
| Rate for Payer: Healthscope Whirlpool |
$4.58
|
| Rate for Payer: Mclaren Commercial |
$4.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.01
|
| Rate for Payer: Nomi Health Commercial |
$3.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.15
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$5.80
|
|
|
Service Code
|
NDC 60687067911
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Aetna Commercial |
$5.22
|
| Rate for Payer: ASR ASR |
$5.63
|
| Rate for Payer: ASR Commercial |
$5.63
|
| Rate for Payer: BCBS Trust/PPO |
$4.73
|
| Rate for Payer: BCN Commercial |
$4.50
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$5.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.80
|
| Rate for Payer: Healthscope Whirlpool |
$5.63
|
| Rate for Payer: Mclaren Commercial |
$5.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.10
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$173.95
|
|
|
Service Code
|
NDC 60687067921
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.07 |
| Max. Negotiated Rate |
$173.95 |
| Rate for Payer: Aetna Commercial |
$156.56
|
| Rate for Payer: ASR ASR |
$168.73
|
| Rate for Payer: ASR Commercial |
$168.73
|
| Rate for Payer: BCBS Trust/PPO |
$141.75
|
| Rate for Payer: BCN Commercial |
$134.86
|
| Rate for Payer: Cash Price |
$139.16
|
| Rate for Payer: Cofinity Commercial |
$163.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.16
|
| Rate for Payer: Healthscope Commercial |
$173.95
|
| Rate for Payer: Healthscope Whirlpool |
$168.73
|
| Rate for Payer: Mclaren Commercial |
$156.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.86
|
| Rate for Payer: Nomi Health Commercial |
$142.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.08
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
NDC 29300012601
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.00 |
| Max. Negotiated Rate |
$470.00 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Aetna Medicare |
$235.00
|
| Rate for Payer: ASR ASR |
$455.90
|
| Rate for Payer: ASR Commercial |
$455.90
|
| Rate for Payer: BCBS Complete |
$188.00
|
| Rate for Payer: BCBS Trust/PPO |
$384.88
|
| Rate for Payer: BCN Commercial |
$364.39
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$441.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Healthscope Commercial |
$470.00
|
| Rate for Payer: Healthscope Whirlpool |
$455.90
|
| Rate for Payer: Mclaren Commercial |
$423.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: Nomi Health Commercial |
$385.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$411.81
|
| Rate for Payer: Priority Health Narrow Network |
$329.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$413.60
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$236.16
|
|
|
Service Code
|
NDC 50268012715
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.50 |
| Max. Negotiated Rate |
$236.16 |
| Rate for Payer: Aetna Commercial |
$212.54
|
| Rate for Payer: ASR ASR |
$229.08
|
| Rate for Payer: ASR Commercial |
$229.08
|
| Rate for Payer: BCBS Trust/PPO |
$192.45
|
| Rate for Payer: BCN Commercial |
$183.09
|
| Rate for Payer: Cash Price |
$188.93
|
| Rate for Payer: Cofinity Commercial |
$221.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.93
|
| Rate for Payer: Healthscope Commercial |
$236.16
|
| Rate for Payer: Healthscope Whirlpool |
$229.08
|
| Rate for Payer: Mclaren Commercial |
$212.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.74
|
| Rate for Payer: Nomi Health Commercial |
$193.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.82
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$173.95
|
|
|
Service Code
|
NDC 60687067921
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.58 |
| Max. Negotiated Rate |
$173.95 |
| Rate for Payer: Aetna Commercial |
$156.56
|
| Rate for Payer: Aetna Medicare |
$86.98
|
| Rate for Payer: ASR ASR |
$168.73
|
| Rate for Payer: ASR Commercial |
$168.73
|
| Rate for Payer: BCBS Complete |
$69.58
|
| Rate for Payer: BCBS Trust/PPO |
$142.45
|
| Rate for Payer: BCN Commercial |
$134.86
|
| Rate for Payer: Cash Price |
$139.16
|
| Rate for Payer: Cofinity Commercial |
$163.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.16
|
| Rate for Payer: Healthscope Commercial |
$173.95
|
| Rate for Payer: Healthscope Whirlpool |
$168.73
|
| Rate for Payer: Mclaren Commercial |
$156.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.86
|
| Rate for Payer: Nomi Health Commercial |
$142.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.41
|
| Rate for Payer: Priority Health Narrow Network |
$121.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.08
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$5.80
|
|
|
Service Code
|
NDC 60687067911
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Aetna Commercial |
$5.22
|
| Rate for Payer: Aetna Medicare |
$2.90
|
| Rate for Payer: ASR ASR |
$5.63
|
| Rate for Payer: ASR Commercial |
$5.63
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: BCBS Trust/PPO |
$4.75
|
| Rate for Payer: BCN Commercial |
$4.50
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$5.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.80
|
| Rate for Payer: Healthscope Whirlpool |
$5.63
|
| Rate for Payer: Mclaren Commercial |
$5.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.08
|
| Rate for Payer: Priority Health Narrow Network |
$4.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.10
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$4.72
|
|
|
Service Code
|
NDC 50268012711
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna Commercial |
$4.25
|
| Rate for Payer: Aetna Medicare |
$2.36
|
| Rate for Payer: ASR ASR |
$4.58
|
| Rate for Payer: ASR Commercial |
$4.58
|
| Rate for Payer: BCBS Complete |
$1.89
|
| Rate for Payer: BCBS Trust/PPO |
$3.87
|
| Rate for Payer: BCN Commercial |
$3.66
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cofinity Commercial |
$4.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.78
|
| Rate for Payer: Healthscope Commercial |
$4.72
|
| Rate for Payer: Healthscope Whirlpool |
$4.58
|
| Rate for Payer: Mclaren Commercial |
$4.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.01
|
| Rate for Payer: Nomi Health Commercial |
$3.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.14
|
| Rate for Payer: Priority Health Narrow Network |
$3.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.15
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
NDC 29300012601
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$305.50 |
| Max. Negotiated Rate |
$470.00 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: ASR ASR |
$455.90
|
| Rate for Payer: ASR Commercial |
$455.90
|
| Rate for Payer: BCBS Trust/PPO |
$383.00
|
| Rate for Payer: BCN Commercial |
$364.39
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$441.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Healthscope Commercial |
$470.00
|
| Rate for Payer: Healthscope Whirlpool |
$455.90
|
| Rate for Payer: Mclaren Commercial |
$423.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: Nomi Health Commercial |
$385.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$413.60
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
NDC 82182032105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.60 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: ASR ASR |
$391.88
|
| Rate for Payer: ASR Commercial |
$391.88
|
| Rate for Payer: BCBS Trust/PPO |
$329.22
|
| Rate for Payer: BCN Commercial |
$313.22
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cofinity Commercial |
$379.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.20
|
| Rate for Payer: Healthscope Commercial |
$404.00
|
| Rate for Payer: Healthscope Whirlpool |
$391.88
|
| Rate for Payer: Mclaren Commercial |
$363.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.40
|
| Rate for Payer: Nomi Health Commercial |
$331.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.52
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$1,264.59
|
|
|
Service Code
|
NDC 00023932110
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$505.84 |
| Max. Negotiated Rate |
$1,264.59 |
| Rate for Payer: Aetna Commercial |
$1,138.13
|
| Rate for Payer: Aetna Medicare |
$632.30
|
| Rate for Payer: ASR ASR |
$1,226.65
|
| Rate for Payer: ASR Commercial |
$1,226.65
|
| Rate for Payer: BCBS Complete |
$505.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,035.57
|
| Rate for Payer: BCN Commercial |
$980.44
|
| Rate for Payer: Cash Price |
$1,011.67
|
| Rate for Payer: Cofinity Commercial |
$1,188.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,011.67
|
| Rate for Payer: Healthscope Commercial |
$1,264.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,226.65
|
| Rate for Payer: Mclaren Commercial |
$1,138.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,074.90
|
| Rate for Payer: Nomi Health Commercial |
$1,036.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,108.03
|
| Rate for Payer: Priority Health Narrow Network |
$886.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,112.84
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$1,264.59
|
|
|
Service Code
|
NDC 00023932110
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$821.98 |
| Max. Negotiated Rate |
$1,264.59 |
| Rate for Payer: Aetna Commercial |
$1,138.13
|
| Rate for Payer: ASR ASR |
$1,226.65
|
| Rate for Payer: ASR Commercial |
$1,226.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.51
|
| Rate for Payer: BCN Commercial |
$980.44
|
| Rate for Payer: Cash Price |
$1,011.67
|
| Rate for Payer: Cofinity Commercial |
$1,188.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,011.67
|
| Rate for Payer: Healthscope Commercial |
$1,264.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,226.65
|
| Rate for Payer: Mclaren Commercial |
$1,138.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,074.90
|
| Rate for Payer: Nomi Health Commercial |
$1,036.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,112.84
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$632.59
|
|
|
Service Code
|
NDC 00023932105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.04 |
| Max. Negotiated Rate |
$632.59 |
| Rate for Payer: Aetna Commercial |
$569.33
|
| Rate for Payer: Aetna Medicare |
$316.30
|
| Rate for Payer: ASR ASR |
$613.61
|
| Rate for Payer: ASR Commercial |
$613.61
|
| Rate for Payer: BCBS Complete |
$253.04
|
| Rate for Payer: BCBS Trust/PPO |
$518.03
|
| Rate for Payer: BCN Commercial |
$490.45
|
| Rate for Payer: Cash Price |
$506.07
|
| Rate for Payer: Cofinity Commercial |
$594.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.07
|
| Rate for Payer: Healthscope Commercial |
$632.59
|
| Rate for Payer: Healthscope Whirlpool |
$613.61
|
| Rate for Payer: Mclaren Commercial |
$569.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.70
|
| Rate for Payer: Nomi Health Commercial |
$518.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$411.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$554.28
|
| Rate for Payer: Priority Health Narrow Network |
$443.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$556.68
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$632.59
|
|
|
Service Code
|
NDC 00023932105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$411.18 |
| Max. Negotiated Rate |
$632.59 |
| Rate for Payer: Aetna Commercial |
$569.33
|
| Rate for Payer: ASR ASR |
$613.61
|
| Rate for Payer: ASR Commercial |
$613.61
|
| Rate for Payer: BCBS Trust/PPO |
$515.50
|
| Rate for Payer: BCN Commercial |
$490.45
|
| Rate for Payer: Cash Price |
$506.07
|
| Rate for Payer: Cofinity Commercial |
$594.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.07
|
| Rate for Payer: Healthscope Commercial |
$632.59
|
| Rate for Payer: Healthscope Whirlpool |
$613.61
|
| Rate for Payer: Mclaren Commercial |
$569.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.70
|
| Rate for Payer: Nomi Health Commercial |
$518.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$411.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$556.68
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
NDC 82182032105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.60 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Aetna Medicare |
$202.00
|
| Rate for Payer: ASR ASR |
$391.88
|
| Rate for Payer: ASR Commercial |
$391.88
|
| Rate for Payer: BCBS Complete |
$161.60
|
| Rate for Payer: BCBS Trust/PPO |
$330.84
|
| Rate for Payer: BCN Commercial |
$313.22
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cofinity Commercial |
$379.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.20
|
| Rate for Payer: Healthscope Commercial |
$404.00
|
| Rate for Payer: Healthscope Whirlpool |
$391.88
|
| Rate for Payer: Mclaren Commercial |
$363.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.40
|
| Rate for Payer: Nomi Health Commercial |
$331.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.98
|
| Rate for Payer: Priority Health Narrow Network |
$283.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.52
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 70069023201
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR Commercial |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.06
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 70069023201
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR Commercial |
$14.36
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.12
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.97
|
| Rate for Payer: Priority Health Narrow Network |
$10.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
OP
|
$7.88
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$7.88 |
| Rate for Payer: Aetna Commercial |
$7.09
|
| Rate for Payer: Aetna Commercial |
$28.91
|
| Rate for Payer: Aetna Commercial |
$10.89
|
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Medicare |
$16.06
|
| Rate for Payer: Aetna Medicare |
$6.05
|
| Rate for Payer: Aetna Medicare |
$8.60
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: ASR ASR |
$11.74
|
| Rate for Payer: ASR ASR |
$16.68
|
| Rate for Payer: ASR ASR |
$31.16
|
| Rate for Payer: ASR ASR |
$7.64
|
| Rate for Payer: ASR Commercial |
$11.74
|
| Rate for Payer: ASR Commercial |
$31.16
|
| Rate for Payer: ASR Commercial |
$7.64
|
| Rate for Payer: ASR Commercial |
$16.68
|
| Rate for Payer: BCBS Complete |
$12.85
|
| Rate for Payer: BCBS Complete |
$3.15
|
| Rate for Payer: BCBS Complete |
$4.84
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Trust/PPO |
$6.45
|
| Rate for Payer: BCBS Trust/PPO |
$14.09
|
| Rate for Payer: BCBS Trust/PPO |
$9.91
|
| Rate for Payer: BCBS Trust/PPO |
$26.30
|
| Rate for Payer: BCN Commercial |
$9.38
|
| Rate for Payer: BCN Commercial |
$6.11
|
| Rate for Payer: BCN Commercial |
$13.34
|
| Rate for Payer: BCN Commercial |
$24.90
|
| Rate for Payer: Cash Price |
$25.69
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cash Price |
$25.69
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$11.37
|
| Rate for Payer: Cofinity Commercial |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$7.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Healthscope Commercial |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$12.10
|
| Rate for Payer: Healthscope Commercial |
$32.12
|
| Rate for Payer: Healthscope Whirlpool |
$16.68
|
| Rate for Payer: Healthscope Whirlpool |
$11.74
|
| Rate for Payer: Healthscope Whirlpool |
$31.16
|
| Rate for Payer: Healthscope Whirlpool |
$7.64
|
| Rate for Payer: Mclaren Commercial |
$28.91
|
| Rate for Payer: Mclaren Commercial |
$7.09
|
| Rate for Payer: Mclaren Commercial |
$10.89
|
| Rate for Payer: Mclaren Commercial |
$15.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.70
|
| Rate for Payer: Nomi Health Commercial |
$14.10
|
| Rate for Payer: Nomi Health Commercial |
$26.34
|
| Rate for Payer: Nomi Health Commercial |
$6.46
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.24
|
| Rate for Payer: Priority Health Narrow Network |
$0.99
|
| Rate for Payer: Priority Health Narrow Network |
$0.99
|
| Rate for Payer: Priority Health Narrow Network |
$0.99
|
| Rate for Payer: Priority Health Narrow Network |
$0.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.14
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$32.12
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$32.12 |
| Rate for Payer: Aetna Commercial |
$28.91
|
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$7.09
|
| Rate for Payer: Aetna Commercial |
$10.89
|
| Rate for Payer: ASR ASR |
$11.74
|
| Rate for Payer: ASR ASR |
$31.16
|
| Rate for Payer: ASR ASR |
$16.68
|
| Rate for Payer: ASR ASR |
$7.64
|
| Rate for Payer: ASR Commercial |
$31.16
|
| Rate for Payer: ASR Commercial |
$7.64
|
| Rate for Payer: ASR Commercial |
$16.68
|
| Rate for Payer: ASR Commercial |
$11.74
|
| Rate for Payer: BCBS Trust/PPO |
$6.42
|
| Rate for Payer: BCBS Trust/PPO |
$9.86
|
| Rate for Payer: BCBS Trust/PPO |
$14.02
|
| Rate for Payer: BCBS Trust/PPO |
$26.17
|
| Rate for Payer: BCN Commercial |
$6.11
|
| Rate for Payer: BCN Commercial |
$9.38
|
| Rate for Payer: BCN Commercial |
$24.90
|
| Rate for Payer: BCN Commercial |
$13.34
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cash Price |
$25.69
|
| Rate for Payer: Cofinity Commercial |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$7.41
|
| Rate for Payer: Cofinity Commercial |
$11.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Healthscope Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$12.10
|
| Rate for Payer: Healthscope Commercial |
$32.12
|
| Rate for Payer: Healthscope Commercial |
$7.88
|
| Rate for Payer: Healthscope Whirlpool |
$7.64
|
| Rate for Payer: Healthscope Whirlpool |
$16.68
|
| Rate for Payer: Healthscope Whirlpool |
$31.16
|
| Rate for Payer: Healthscope Whirlpool |
$11.74
|
| Rate for Payer: Mclaren Commercial |
$28.91
|
| Rate for Payer: Mclaren Commercial |
$7.09
|
| Rate for Payer: Mclaren Commercial |
$15.48
|
| Rate for Payer: Mclaren Commercial |
$10.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.28
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: Nomi Health Commercial |
$6.46
|
| Rate for Payer: Nomi Health Commercial |
$26.34
|
| Rate for Payer: Nomi Health Commercial |
$14.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.65
|
|
|
BUDESONIDE 180 MCG/ACTUATION BREATH ACTIVATED POWDER INHALER
|
Facility
|
IP
|
$861.28
|
|
|
Service Code
|
NDC 00186091612
|
| Hospital Charge Code |
96977
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$559.83 |
| Max. Negotiated Rate |
$861.28 |
| Rate for Payer: Aetna Commercial |
$775.15
|
| Rate for Payer: ASR ASR |
$835.44
|
| Rate for Payer: ASR Commercial |
$835.44
|
| Rate for Payer: BCBS Trust/PPO |
$701.86
|
| Rate for Payer: BCN Commercial |
$667.75
|
| Rate for Payer: Cash Price |
$689.02
|
| Rate for Payer: Cofinity Commercial |
$809.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.02
|
| Rate for Payer: Healthscope Commercial |
$861.28
|
| Rate for Payer: Healthscope Whirlpool |
$835.44
|
| Rate for Payer: Mclaren Commercial |
$775.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$732.09
|
| Rate for Payer: Nomi Health Commercial |
$706.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$559.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$757.93
|
|
|
BUDESONIDE 180 MCG/ACTUATION BREATH ACTIVATED POWDER INHALER
|
Facility
|
OP
|
$861.28
|
|
|
Service Code
|
NDC 00186091612
|
| Hospital Charge Code |
96977
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$344.51 |
| Max. Negotiated Rate |
$861.28 |
| Rate for Payer: Aetna Commercial |
$775.15
|
| Rate for Payer: Aetna Medicare |
$430.64
|
| Rate for Payer: ASR ASR |
$835.44
|
| Rate for Payer: ASR Commercial |
$835.44
|
| Rate for Payer: BCBS Complete |
$344.51
|
| Rate for Payer: BCBS Trust/PPO |
$705.30
|
| Rate for Payer: BCN Commercial |
$667.75
|
| Rate for Payer: Cash Price |
$689.02
|
| Rate for Payer: Cofinity Commercial |
$809.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.02
|
| Rate for Payer: Healthscope Commercial |
$861.28
|
| Rate for Payer: Healthscope Whirlpool |
$835.44
|
| Rate for Payer: Mclaren Commercial |
$775.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$732.09
|
| Rate for Payer: Nomi Health Commercial |
$706.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$559.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$754.65
|
| Rate for Payer: Priority Health Narrow Network |
$603.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$757.93
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$198.66
|
|
|
Service Code
|
NDC 00186037028
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.13 |
| Max. Negotiated Rate |
$198.66 |
| Rate for Payer: Aetna Commercial |
$178.79
|
| Rate for Payer: ASR ASR |
$192.70
|
| Rate for Payer: ASR Commercial |
$192.70
|
| Rate for Payer: BCBS Trust/PPO |
$161.89
|
| Rate for Payer: BCN Commercial |
$154.02
|
| Rate for Payer: Cash Price |
$158.93
|
| Rate for Payer: Cofinity Commercial |
$186.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.93
|
| Rate for Payer: Healthscope Commercial |
$198.66
|
| Rate for Payer: Healthscope Whirlpool |
$192.70
|
| Rate for Payer: Mclaren Commercial |
$178.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.86
|
| Rate for Payer: Nomi Health Commercial |
$162.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.82
|
|
