|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$189.21
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.99 |
| Max. Negotiated Rate |
$189.21 |
| Rate for Payer: Aetna Commercial |
$170.29
|
| Rate for Payer: Aetna Commercial |
$138.17
|
| Rate for Payer: ASR ASR |
$148.91
|
| Rate for Payer: ASR ASR |
$183.53
|
| Rate for Payer: ASR Commercial |
$148.91
|
| Rate for Payer: ASR Commercial |
$183.53
|
| Rate for Payer: BCBS Trust/PPO |
$125.10
|
| Rate for Payer: BCBS Trust/PPO |
$154.19
|
| Rate for Payer: BCN Commercial |
$146.69
|
| Rate for Payer: BCN Commercial |
$119.02
|
| Rate for Payer: Cash Price |
$151.37
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cofinity Commercial |
$144.31
|
| Rate for Payer: Cofinity Commercial |
$177.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.37
|
| Rate for Payer: Healthscope Commercial |
$153.52
|
| Rate for Payer: Healthscope Commercial |
$189.21
|
| Rate for Payer: Healthscope Whirlpool |
$183.53
|
| Rate for Payer: Healthscope Whirlpool |
$148.91
|
| Rate for Payer: Mclaren Commercial |
$138.17
|
| Rate for Payer: Mclaren Commercial |
$170.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.49
|
| Rate for Payer: Nomi Health Commercial |
$155.15
|
| Rate for Payer: Nomi Health Commercial |
$125.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.50
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$153.52
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.41 |
| Max. Negotiated Rate |
$153.52 |
| Rate for Payer: Aetna Commercial |
$138.17
|
| Rate for Payer: Aetna Commercial |
$170.29
|
| Rate for Payer: Aetna Medicare |
$76.76
|
| Rate for Payer: Aetna Medicare |
$94.61
|
| Rate for Payer: ASR ASR |
$148.91
|
| Rate for Payer: ASR ASR |
$183.53
|
| Rate for Payer: ASR Commercial |
$183.53
|
| Rate for Payer: ASR Commercial |
$148.91
|
| Rate for Payer: BCBS Complete |
$61.41
|
| Rate for Payer: BCBS Complete |
$75.68
|
| Rate for Payer: BCBS Trust/PPO |
$125.72
|
| Rate for Payer: BCBS Trust/PPO |
$154.94
|
| Rate for Payer: BCN Commercial |
$146.69
|
| Rate for Payer: BCN Commercial |
$119.02
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cash Price |
$151.37
|
| Rate for Payer: Cofinity Commercial |
$144.31
|
| Rate for Payer: Cofinity Commercial |
$177.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.37
|
| Rate for Payer: Healthscope Commercial |
$153.52
|
| Rate for Payer: Healthscope Commercial |
$189.21
|
| Rate for Payer: Healthscope Whirlpool |
$148.91
|
| Rate for Payer: Healthscope Whirlpool |
$183.53
|
| Rate for Payer: Mclaren Commercial |
$138.17
|
| Rate for Payer: Mclaren Commercial |
$170.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.49
|
| Rate for Payer: Nomi Health Commercial |
$125.89
|
| Rate for Payer: Nomi Health Commercial |
$155.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.79
|
| Rate for Payer: Priority Health Narrow Network |
$132.64
|
| Rate for Payer: Priority Health Narrow Network |
$107.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.10
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,879.90
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
181631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.35 |
| Max. Negotiated Rate |
$9,879.90 |
| Rate for Payer: Aetna Commercial |
$8,891.91
|
| Rate for Payer: Aetna Medicare |
$39.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.79
|
| Rate for Payer: ASR ASR |
$9,583.50
|
| Rate for Payer: ASR Commercial |
$9,583.50
|
| Rate for Payer: BCBS Complete |
$22.42
|
| Rate for Payer: BCBS MAPPO |
$39.83
|
| Rate for Payer: BCBS Trust/PPO |
$8,090.65
|
| Rate for Payer: BCN Commercial |
$7,659.89
|
| Rate for Payer: BCN Medicare Advantage |
$39.83
|
| Rate for Payer: Cash Price |
$7,903.92
|
| Rate for Payer: Cash Price |
$7,903.92
|
| Rate for Payer: Cofinity Commercial |
$9,287.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,903.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.83
|
| Rate for Payer: Healthscope Commercial |
$9,879.90
|
| Rate for Payer: Healthscope Whirlpool |
$9,583.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$39.83
|
| Rate for Payer: Mclaren Commercial |
$8,891.91
|
| Rate for Payer: Mclaren Medicaid |
$21.35
|
| Rate for Payer: Mclaren Medicare |
$39.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.82
|
| Rate for Payer: Meridian Medicaid |
$22.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,397.92
|
| Rate for Payer: Nomi Health Commercial |
$8,101.52
|
| Rate for Payer: PACE Medicare |
$37.84
|
| Rate for Payer: PACE SWMI |
$39.83
|
| Rate for Payer: PHP Commercial |
$43.81
|
| Rate for Payer: PHP Medicaid |
$21.35
|
| Rate for Payer: PHP Medicare Advantage |
$39.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,421.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,656.77
|
| Rate for Payer: Priority Health Medicare |
$39.83
|
| Rate for Payer: Priority Health Narrow Network |
$6,925.81
|
| Rate for Payer: Railroad Medicare Medicare |
$39.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,694.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.83
|
| Rate for Payer: UHC Exchange |
$61.74
|
| Rate for Payer: UHC Medicare Advantage |
$39.83
|
| Rate for Payer: UHCCP DNSP |
$39.83
|
| Rate for Payer: UHCCP Medicaid |
$21.35
|
| Rate for Payer: VA VA |
$39.83
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,879.90
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
181631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,421.94 |
| Max. Negotiated Rate |
$9,879.90 |
| Rate for Payer: Aetna Commercial |
$8,891.91
|
| Rate for Payer: ASR ASR |
$9,583.50
|
| Rate for Payer: ASR Commercial |
$9,583.50
|
| Rate for Payer: BCBS Trust/PPO |
$8,051.13
|
| Rate for Payer: BCN Commercial |
$7,659.89
|
| Rate for Payer: Cash Price |
$7,903.92
|
| Rate for Payer: Cofinity Commercial |
$9,287.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,903.92
|
| Rate for Payer: Healthscope Commercial |
$9,879.90
|
| Rate for Payer: Healthscope Whirlpool |
$9,583.50
|
| Rate for Payer: Mclaren Commercial |
$8,891.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,397.92
|
| Rate for Payer: Nomi Health Commercial |
$8,101.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,421.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,694.31
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$58.82
|
|
|
Service Code
|
NDC 70000045102
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.23 |
| Max. Negotiated Rate |
$58.82 |
| Rate for Payer: Aetna Commercial |
$52.94
|
| Rate for Payer: ASR ASR |
$57.06
|
| Rate for Payer: ASR Commercial |
$57.06
|
| Rate for Payer: BCBS Trust/PPO |
$47.93
|
| Rate for Payer: BCN Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$47.06
|
| Rate for Payer: Cofinity Commercial |
$55.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.06
|
| Rate for Payer: Healthscope Commercial |
$58.82
|
| Rate for Payer: Healthscope Whirlpool |
$57.06
|
| Rate for Payer: Mclaren Commercial |
$52.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.00
|
| Rate for Payer: Nomi Health Commercial |
$48.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.76
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$58.82
|
|
|
Service Code
|
NDC 70000045102
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$58.82 |
| Rate for Payer: Aetna Commercial |
$52.94
|
| Rate for Payer: Aetna Medicare |
$29.41
|
| Rate for Payer: ASR ASR |
$57.06
|
| Rate for Payer: ASR Commercial |
$57.06
|
| Rate for Payer: BCBS Complete |
$23.53
|
| Rate for Payer: BCBS Trust/PPO |
$48.17
|
| Rate for Payer: BCN Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$47.06
|
| Rate for Payer: Cofinity Commercial |
$55.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.06
|
| Rate for Payer: Healthscope Commercial |
$58.82
|
| Rate for Payer: Healthscope Whirlpool |
$57.06
|
| Rate for Payer: Mclaren Commercial |
$52.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.00
|
| Rate for Payer: Nomi Health Commercial |
$48.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.54
|
| Rate for Payer: Priority Health Narrow Network |
$41.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.76
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$25.88
|
|
|
Service Code
|
NDC 00574705012
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$25.88 |
| Rate for Payer: Aetna Commercial |
$23.29
|
| Rate for Payer: Aetna Medicare |
$12.94
|
| Rate for Payer: ASR ASR |
$25.10
|
| Rate for Payer: ASR Commercial |
$25.10
|
| Rate for Payer: BCBS Complete |
$10.35
|
| Rate for Payer: BCBS Trust/PPO |
$21.19
|
| Rate for Payer: BCN Commercial |
$20.06
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cofinity Commercial |
$24.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.70
|
| Rate for Payer: Healthscope Commercial |
$25.88
|
| Rate for Payer: Healthscope Whirlpool |
$25.10
|
| Rate for Payer: Mclaren Commercial |
$23.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.00
|
| Rate for Payer: Nomi Health Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.68
|
| Rate for Payer: Priority Health Narrow Network |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.77
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$25.88
|
|
|
Service Code
|
NDC 00574705012
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.82 |
| Max. Negotiated Rate |
$25.88 |
| Rate for Payer: Aetna Commercial |
$23.29
|
| Rate for Payer: ASR ASR |
$25.10
|
| Rate for Payer: ASR Commercial |
$25.10
|
| Rate for Payer: BCBS Trust/PPO |
$21.09
|
| Rate for Payer: BCN Commercial |
$20.06
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cofinity Commercial |
$24.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.70
|
| Rate for Payer: Healthscope Commercial |
$25.88
|
| Rate for Payer: Healthscope Whirlpool |
$25.10
|
| Rate for Payer: Mclaren Commercial |
$23.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.00
|
| Rate for Payer: Nomi Health Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.77
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$5.88
|
|
|
Service Code
|
NDC 00904640761
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$5.88 |
| Rate for Payer: Aetna Commercial |
$5.29
|
| Rate for Payer: ASR ASR |
$5.70
|
| Rate for Payer: ASR Commercial |
$5.70
|
| Rate for Payer: BCBS Trust/PPO |
$4.79
|
| Rate for Payer: BCN Commercial |
$4.56
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cofinity Commercial |
$5.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.70
|
| Rate for Payer: Healthscope Commercial |
$5.88
|
| Rate for Payer: Healthscope Whirlpool |
$5.70
|
| Rate for Payer: Mclaren Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.00
|
| Rate for Payer: Nomi Health Commercial |
$4.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.17
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$5.88
|
|
|
Service Code
|
NDC 00904640761
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$5.88 |
| Rate for Payer: Aetna Commercial |
$5.29
|
| Rate for Payer: Aetna Medicare |
$2.94
|
| Rate for Payer: ASR ASR |
$5.70
|
| Rate for Payer: ASR Commercial |
$5.70
|
| Rate for Payer: BCBS Complete |
$2.35
|
| Rate for Payer: BCBS Trust/PPO |
$4.82
|
| Rate for Payer: BCN Commercial |
$4.56
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cofinity Commercial |
$5.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.70
|
| Rate for Payer: Healthscope Commercial |
$5.88
|
| Rate for Payer: Healthscope Whirlpool |
$5.70
|
| Rate for Payer: Mclaren Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.00
|
| Rate for Payer: Nomi Health Commercial |
$4.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.15
|
| Rate for Payer: Priority Health Narrow Network |
$4.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.17
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
NDC 70000004401
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$9.91 |
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Aetna Medicare |
$4.96
|
| Rate for Payer: ASR ASR |
$9.61
|
| Rate for Payer: ASR Commercial |
$9.61
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$8.12
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.93
|
| Rate for Payer: Cofinity Commercial |
$9.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.93
|
| Rate for Payer: Healthscope Commercial |
$9.91
|
| Rate for Payer: Healthscope Whirlpool |
$9.61
|
| Rate for Payer: Mclaren Commercial |
$8.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.42
|
| Rate for Payer: Nomi Health Commercial |
$8.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.68
|
| Rate for Payer: Priority Health Narrow Network |
$6.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.72
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$8.50
|
|
|
Service Code
|
NDC 87701041163
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Aetna Commercial |
$7.65
|
| Rate for Payer: Aetna Medicare |
$4.25
|
| Rate for Payer: ASR ASR |
$8.24
|
| Rate for Payer: ASR Commercial |
$8.24
|
| Rate for Payer: BCBS Complete |
$3.40
|
| Rate for Payer: BCBS Trust/PPO |
$6.96
|
| Rate for Payer: BCN Commercial |
$6.59
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$7.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Healthscope Commercial |
$8.50
|
| Rate for Payer: Healthscope Whirlpool |
$8.24
|
| Rate for Payer: Mclaren Commercial |
$7.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: Nomi Health Commercial |
$6.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.45
|
| Rate for Payer: Priority Health Narrow Network |
$5.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.48
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$10.66
|
|
|
Service Code
|
NDC 00536128636
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$10.66 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: Aetna Medicare |
$5.33
|
| Rate for Payer: ASR ASR |
$10.34
|
| Rate for Payer: ASR Commercial |
$10.34
|
| Rate for Payer: BCBS Complete |
$4.26
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| Rate for Payer: BCN Commercial |
$8.26
|
| Rate for Payer: Cash Price |
$8.53
|
| Rate for Payer: Cofinity Commercial |
$10.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.53
|
| Rate for Payer: Healthscope Commercial |
$10.66
|
| Rate for Payer: Healthscope Whirlpool |
$10.34
|
| Rate for Payer: Mclaren Commercial |
$9.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.06
|
| Rate for Payer: Nomi Health Commercial |
$8.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.34
|
| Rate for Payer: Priority Health Narrow Network |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.38
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$9.91
|
|
|
Service Code
|
NDC 70000004401
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$9.91 |
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: ASR ASR |
$9.61
|
| Rate for Payer: ASR Commercial |
$9.61
|
| Rate for Payer: BCBS Trust/PPO |
$8.08
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.93
|
| Rate for Payer: Cofinity Commercial |
$9.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.93
|
| Rate for Payer: Healthscope Commercial |
$9.91
|
| Rate for Payer: Healthscope Whirlpool |
$9.61
|
| Rate for Payer: Mclaren Commercial |
$8.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.42
|
| Rate for Payer: Nomi Health Commercial |
$8.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.72
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.50
|
|
|
Service Code
|
NDC 87701041163
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Aetna Commercial |
$7.65
|
| Rate for Payer: ASR ASR |
$8.24
|
| Rate for Payer: ASR Commercial |
$8.24
|
| Rate for Payer: BCBS Trust/PPO |
$6.93
|
| Rate for Payer: BCN Commercial |
$6.59
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$7.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Healthscope Commercial |
$8.50
|
| Rate for Payer: Healthscope Whirlpool |
$8.24
|
| Rate for Payer: Mclaren Commercial |
$7.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: Nomi Health Commercial |
$6.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.48
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$10.66
|
|
|
Service Code
|
NDC 00536128636
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$10.66 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: ASR ASR |
$10.34
|
| Rate for Payer: ASR Commercial |
$10.34
|
| Rate for Payer: BCBS Trust/PPO |
$8.69
|
| Rate for Payer: BCN Commercial |
$8.26
|
| Rate for Payer: Cash Price |
$8.53
|
| Rate for Payer: Cofinity Commercial |
$10.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.53
|
| Rate for Payer: Healthscope Commercial |
$10.66
|
| Rate for Payer: Healthscope Whirlpool |
$10.34
|
| Rate for Payer: Mclaren Commercial |
$9.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.06
|
| Rate for Payer: Nomi Health Commercial |
$8.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.38
|
|
|
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 |
$37.91
|
| 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
|
$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
|
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
|
$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
|
$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
|
|
|
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 |
$86.97
|
| 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
|
|
