|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$2.52
|
|
|
Service Code
|
NDC 51079098501
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Aetna Commercial |
$2.27
|
| Rate for Payer: Aetna Medicare |
$1.26
|
| Rate for Payer: ASR ASR |
$2.44
|
| Rate for Payer: ASR Commercial |
$2.44
|
| Rate for Payer: BCBS Complete |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$2.06
|
| Rate for Payer: BCN Commercial |
$1.95
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.02
|
| Rate for Payer: Healthscope Commercial |
$2.52
|
| Rate for Payer: Healthscope Whirlpool |
$2.44
|
| Rate for Payer: Mclaren Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.14
|
| Rate for Payer: Nomi Health Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.21
|
| Rate for Payer: Priority Health Narrow Network |
$1.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.22
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
IP
|
$209.15
|
|
|
Service Code
|
NDC 00904712261
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.95 |
| Max. Negotiated Rate |
$209.15 |
| Rate for Payer: Aetna Commercial |
$188.24
|
| Rate for Payer: ASR ASR |
$202.88
|
| Rate for Payer: ASR Commercial |
$202.88
|
| Rate for Payer: BCBS Trust/PPO |
$170.44
|
| Rate for Payer: BCN Commercial |
$162.15
|
| Rate for Payer: Cash Price |
$167.32
|
| Rate for Payer: Cofinity Commercial |
$196.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.32
|
| Rate for Payer: Healthscope Commercial |
$209.15
|
| Rate for Payer: Healthscope Whirlpool |
$202.88
|
| Rate for Payer: Mclaren Commercial |
$188.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.78
|
| Rate for Payer: Nomi Health Commercial |
$171.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.05
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$209.15
|
|
|
Service Code
|
NDC 00904712261
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.66 |
| Max. Negotiated Rate |
$209.15 |
| Rate for Payer: Aetna Commercial |
$188.24
|
| Rate for Payer: Aetna Medicare |
$104.58
|
| Rate for Payer: ASR ASR |
$202.88
|
| Rate for Payer: ASR Commercial |
$202.88
|
| Rate for Payer: BCBS Complete |
$83.66
|
| Rate for Payer: BCBS Trust/PPO |
$171.27
|
| Rate for Payer: BCN Commercial |
$162.15
|
| Rate for Payer: Cash Price |
$167.32
|
| Rate for Payer: Cofinity Commercial |
$196.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.32
|
| Rate for Payer: Healthscope Commercial |
$209.15
|
| Rate for Payer: Healthscope Whirlpool |
$202.88
|
| Rate for Payer: Mclaren Commercial |
$188.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.78
|
| Rate for Payer: Nomi Health Commercial |
$171.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.26
|
| Rate for Payer: Priority Health Narrow Network |
$146.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.05
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$8.01
|
|
|
Service Code
|
NDC 50268055311
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$8.01 |
| Rate for Payer: Aetna Commercial |
$7.21
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: ASR ASR |
$7.77
|
| Rate for Payer: ASR Commercial |
$7.77
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS Trust/PPO |
$6.56
|
| Rate for Payer: BCN Commercial |
$6.21
|
| Rate for Payer: Cash Price |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$7.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.41
|
| Rate for Payer: Healthscope Commercial |
$8.01
|
| Rate for Payer: Healthscope Whirlpool |
$7.77
|
| Rate for Payer: Mclaren Commercial |
$7.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.81
|
| Rate for Payer: Nomi Health Commercial |
$6.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.02
|
| Rate for Payer: Priority Health Narrow Network |
$5.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.05
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$240.24
|
|
|
Service Code
|
NDC 50268055313
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$240.24 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: ASR ASR |
$233.03
|
| Rate for Payer: ASR Commercial |
$233.03
|
| Rate for Payer: BCBS Trust/PPO |
$195.77
|
| Rate for Payer: BCN Commercial |
$186.26
|
| Rate for Payer: Cash Price |
$192.19
|
| Rate for Payer: Cofinity Commercial |
$225.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.19
|
| Rate for Payer: Healthscope Commercial |
$240.24
|
| Rate for Payer: Healthscope Whirlpool |
$233.03
|
| Rate for Payer: Mclaren Commercial |
$216.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.20
|
| Rate for Payer: Nomi Health Commercial |
$197.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.41
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$8.01
|
|
|
Service Code
|
NDC 50268055311
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$8.01 |
| Rate for Payer: Aetna Commercial |
$7.21
|
| Rate for Payer: ASR ASR |
$7.77
|
| Rate for Payer: ASR Commercial |
$7.77
|
| Rate for Payer: BCBS Trust/PPO |
$6.53
|
| Rate for Payer: BCN Commercial |
$6.21
|
| Rate for Payer: Cash Price |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$7.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.41
|
| Rate for Payer: Healthscope Commercial |
$8.01
|
| Rate for Payer: Healthscope Whirlpool |
$7.77
|
| Rate for Payer: Mclaren Commercial |
$7.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.81
|
| Rate for Payer: Nomi Health Commercial |
$6.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.05
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$240.24
|
|
|
Service Code
|
NDC 50268055313
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.10 |
| Max. Negotiated Rate |
$240.24 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Medicare |
$120.12
|
| Rate for Payer: ASR ASR |
$233.03
|
| Rate for Payer: ASR Commercial |
$233.03
|
| Rate for Payer: BCBS Complete |
$96.10
|
| Rate for Payer: BCBS Trust/PPO |
$196.73
|
| Rate for Payer: BCN Commercial |
$186.26
|
| Rate for Payer: Cash Price |
$192.19
|
| Rate for Payer: Cofinity Commercial |
$225.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.19
|
| Rate for Payer: Healthscope Commercial |
$240.24
|
| Rate for Payer: Healthscope Whirlpool |
$233.03
|
| Rate for Payer: Mclaren Commercial |
$216.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.20
|
| Rate for Payer: Nomi Health Commercial |
$197.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.50
|
| Rate for Payer: Priority Health Narrow Network |
$168.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.41
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$371.35
|
|
|
Service Code
|
NDC 00904693806
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.54 |
| Max. Negotiated Rate |
$371.35 |
| Rate for Payer: Aetna Commercial |
$334.22
|
| Rate for Payer: Aetna Medicare |
$185.68
|
| Rate for Payer: ASR ASR |
$360.21
|
| Rate for Payer: ASR Commercial |
$360.21
|
| Rate for Payer: BCBS Complete |
$148.54
|
| Rate for Payer: BCBS Trust/PPO |
$304.10
|
| Rate for Payer: BCN Commercial |
$287.91
|
| Rate for Payer: Cash Price |
$297.08
|
| Rate for Payer: Cofinity Commercial |
$349.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.08
|
| Rate for Payer: Healthscope Commercial |
$371.35
|
| Rate for Payer: Healthscope Whirlpool |
$360.21
|
| Rate for Payer: Mclaren Commercial |
$334.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.65
|
| Rate for Payer: Nomi Health Commercial |
$304.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$325.38
|
| Rate for Payer: Priority Health Narrow Network |
$260.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.79
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$371.35
|
|
|
Service Code
|
NDC 00904693806
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.38 |
| Max. Negotiated Rate |
$371.35 |
| Rate for Payer: Aetna Commercial |
$334.22
|
| Rate for Payer: ASR ASR |
$360.21
|
| Rate for Payer: ASR Commercial |
$360.21
|
| Rate for Payer: BCBS Trust/PPO |
$302.61
|
| Rate for Payer: BCN Commercial |
$287.91
|
| Rate for Payer: Cash Price |
$297.08
|
| Rate for Payer: Cofinity Commercial |
$349.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.08
|
| Rate for Payer: Healthscope Commercial |
$371.35
|
| Rate for Payer: Healthscope Whirlpool |
$360.21
|
| Rate for Payer: Mclaren Commercial |
$334.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.65
|
| Rate for Payer: Nomi Health Commercial |
$304.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.79
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$306.25
|
|
|
Service Code
|
NDC 70010014901
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$306.25 |
| Rate for Payer: Aetna Commercial |
$275.62
|
| Rate for Payer: Aetna Medicare |
$153.12
|
| Rate for Payer: ASR ASR |
$297.06
|
| Rate for Payer: ASR Commercial |
$297.06
|
| Rate for Payer: BCBS Complete |
$122.50
|
| Rate for Payer: BCBS Trust/PPO |
$250.79
|
| Rate for Payer: BCN Commercial |
$237.44
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cofinity Commercial |
$287.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.00
|
| Rate for Payer: Healthscope Commercial |
$306.25
|
| Rate for Payer: Healthscope Whirlpool |
$297.06
|
| Rate for Payer: Mclaren Commercial |
$275.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.31
|
| Rate for Payer: Nomi Health Commercial |
$251.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.34
|
| Rate for Payer: Priority Health Narrow Network |
$214.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.50
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$306.25
|
|
|
Service Code
|
NDC 70010014901
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.06 |
| Max. Negotiated Rate |
$306.25 |
| Rate for Payer: Aetna Commercial |
$275.62
|
| Rate for Payer: ASR ASR |
$297.06
|
| Rate for Payer: ASR Commercial |
$297.06
|
| Rate for Payer: BCBS Trust/PPO |
$249.56
|
| Rate for Payer: BCN Commercial |
$237.44
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cofinity Commercial |
$287.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.00
|
| Rate for Payer: Healthscope Commercial |
$306.25
|
| Rate for Payer: Healthscope Whirlpool |
$297.06
|
| Rate for Payer: Mclaren Commercial |
$275.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.31
|
| Rate for Payer: Nomi Health Commercial |
$251.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.50
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE
|
Facility
|
IP
|
$712.60
|
|
|
Service Code
|
NDC 00527155201
|
| Hospital Charge Code |
8922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$463.19 |
| Max. Negotiated Rate |
$712.60 |
| Rate for Payer: Aetna Commercial |
$641.34
|
| Rate for Payer: ASR ASR |
$691.22
|
| Rate for Payer: ASR Commercial |
$691.22
|
| Rate for Payer: BCBS Trust/PPO |
$580.70
|
| Rate for Payer: BCN Commercial |
$552.48
|
| Rate for Payer: Cash Price |
$570.08
|
| Rate for Payer: Cofinity Commercial |
$669.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.08
|
| Rate for Payer: Healthscope Commercial |
$712.60
|
| Rate for Payer: Healthscope Whirlpool |
$691.22
|
| Rate for Payer: Mclaren Commercial |
$641.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.71
|
| Rate for Payer: Nomi Health Commercial |
$584.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$463.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$627.09
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE
|
Facility
|
OP
|
$712.60
|
|
|
Service Code
|
NDC 00527155201
|
| Hospital Charge Code |
8922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$285.04 |
| Max. Negotiated Rate |
$712.60 |
| Rate for Payer: Aetna Commercial |
$641.34
|
| Rate for Payer: Aetna Medicare |
$356.30
|
| Rate for Payer: ASR ASR |
$691.22
|
| Rate for Payer: ASR Commercial |
$691.22
|
| Rate for Payer: BCBS Complete |
$285.04
|
| Rate for Payer: BCBS Trust/PPO |
$583.55
|
| Rate for Payer: BCN Commercial |
$552.48
|
| Rate for Payer: Cash Price |
$570.08
|
| Rate for Payer: Cofinity Commercial |
$669.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.08
|
| Rate for Payer: Healthscope Commercial |
$712.60
|
| Rate for Payer: Healthscope Whirlpool |
$691.22
|
| Rate for Payer: Mclaren Commercial |
$641.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.71
|
| Rate for Payer: Nomi Health Commercial |
$584.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$463.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$624.38
|
| Rate for Payer: Priority Health Narrow Network |
$499.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$627.09
|
|
|
CABOTEGRAVIR ER 600 MG/3 ML-RILPIVIRINE ER 900 MG/3ML IM SUSPENSION,ER
|
Facility
|
OP
|
$17,652.07
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
196915
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.42 |
| Max. Negotiated Rate |
$17,652.07 |
| Rate for Payer: Aetna Commercial |
$15,886.86
|
| Rate for Payer: Aetna Medicare |
$23.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.96
|
| Rate for Payer: ASR ASR |
$17,122.51
|
| Rate for Payer: ASR Commercial |
$17,122.51
|
| Rate for Payer: BCBS Complete |
$13.04
|
| Rate for Payer: BCBS MAPPO |
$23.17
|
| Rate for Payer: BCBS Trust/PPO |
$14,455.28
|
| Rate for Payer: BCN Commercial |
$13,685.65
|
| Rate for Payer: BCN Medicare Advantage |
$23.17
|
| Rate for Payer: Cash Price |
$14,121.66
|
| Rate for Payer: Cash Price |
$14,121.66
|
| Rate for Payer: Cofinity Commercial |
$16,592.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,121.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.17
|
| Rate for Payer: Healthscope Commercial |
$17,652.07
|
| Rate for Payer: Healthscope Whirlpool |
$17,122.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.17
|
| Rate for Payer: Mclaren Commercial |
$15,886.86
|
| Rate for Payer: Mclaren Medicaid |
$12.42
|
| Rate for Payer: Mclaren Medicare |
$23.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.33
|
| Rate for Payer: Meridian Medicaid |
$13.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,004.26
|
| Rate for Payer: Nomi Health Commercial |
$14,474.70
|
| Rate for Payer: PACE Medicare |
$22.01
|
| Rate for Payer: PACE SWMI |
$23.17
|
| Rate for Payer: PHP Commercial |
$25.49
|
| Rate for Payer: PHP Medicaid |
$12.42
|
| Rate for Payer: PHP Medicare Advantage |
$23.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,473.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.00
|
| Rate for Payer: Priority Health Medicare |
$23.17
|
| Rate for Payer: Priority Health Narrow Network |
$19.20
|
| Rate for Payer: Railroad Medicare Medicare |
$23.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,533.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.17
|
| Rate for Payer: UHC Exchange |
$35.91
|
| Rate for Payer: UHC Medicare Advantage |
$23.17
|
| Rate for Payer: UHCCP DNSP |
$23.17
|
| Rate for Payer: UHCCP Medicaid |
$12.42
|
| Rate for Payer: VA VA |
$23.17
|
|
|
CABOTEGRAVIR ER 600 MG/3 ML-RILPIVIRINE ER 900 MG/3ML IM SUSPENSION,ER
|
Facility
|
IP
|
$17,652.07
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
196915
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,473.85 |
| Max. Negotiated Rate |
$17,652.07 |
| Rate for Payer: Aetna Commercial |
$15,886.86
|
| Rate for Payer: ASR ASR |
$17,122.51
|
| Rate for Payer: ASR Commercial |
$17,122.51
|
| Rate for Payer: BCBS Trust/PPO |
$14,384.67
|
| Rate for Payer: BCN Commercial |
$13,685.65
|
| Rate for Payer: Cash Price |
$14,121.66
|
| Rate for Payer: Cofinity Commercial |
$16,592.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,121.66
|
| Rate for Payer: Healthscope Commercial |
$17,652.07
|
| Rate for Payer: Healthscope Whirlpool |
$17,122.51
|
| Rate for Payer: Mclaren Commercial |
$15,886.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,004.26
|
| Rate for Payer: Nomi Health Commercial |
$14,474.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,473.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,533.82
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
OP
|
$137.23
|
|
|
Service Code
|
NDC 49884016111
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.89 |
| Max. Negotiated Rate |
$137.23 |
| Rate for Payer: Aetna Commercial |
$123.51
|
| Rate for Payer: Aetna Medicare |
$68.62
|
| Rate for Payer: ASR ASR |
$133.11
|
| Rate for Payer: ASR Commercial |
$133.11
|
| Rate for Payer: BCBS Complete |
$54.89
|
| Rate for Payer: BCBS Trust/PPO |
$112.38
|
| Rate for Payer: BCN Commercial |
$106.39
|
| Rate for Payer: Cash Price |
$109.79
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.78
|
| Rate for Payer: Healthscope Commercial |
$137.23
|
| Rate for Payer: Healthscope Whirlpool |
$133.11
|
| Rate for Payer: Mclaren Commercial |
$123.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.65
|
| Rate for Payer: Nomi Health Commercial |
$112.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.24
|
| Rate for Payer: Priority Health Narrow Network |
$96.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.76
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
IP
|
$137.23
|
|
|
Service Code
|
NDC 49884016111
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$137.23 |
| Rate for Payer: Aetna Commercial |
$123.51
|
| Rate for Payer: ASR ASR |
$133.11
|
| Rate for Payer: ASR Commercial |
$133.11
|
| Rate for Payer: BCBS Trust/PPO |
$111.83
|
| Rate for Payer: BCN Commercial |
$106.39
|
| Rate for Payer: Cash Price |
$109.79
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.78
|
| Rate for Payer: Healthscope Commercial |
$137.23
|
| Rate for Payer: Healthscope Whirlpool |
$133.11
|
| Rate for Payer: Mclaren Commercial |
$123.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.65
|
| Rate for Payer: Nomi Health Commercial |
$112.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.76
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$2,574.02
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$612.33 |
| Max. Negotiated Rate |
$2,574.02 |
| Rate for Payer: Aetna Commercial |
$2,316.62
|
| Rate for Payer: Aetna Medicare |
$1,142.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,428.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,428.01
|
| Rate for Payer: ASR ASR |
$2,496.80
|
| Rate for Payer: ASR Commercial |
$2,496.80
|
| Rate for Payer: BCBS Complete |
$642.95
|
| Rate for Payer: BCBS MAPPO |
$1,142.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,107.86
|
| Rate for Payer: BCN Commercial |
$1,995.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.41
|
| Rate for Payer: Cash Price |
$2,059.21
|
| Rate for Payer: Cash Price |
$2,059.21
|
| Rate for Payer: Cofinity Commercial |
$2,419.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,059.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.41
|
| Rate for Payer: Healthscope Commercial |
$2,574.02
|
| Rate for Payer: Healthscope Whirlpool |
$2,496.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,142.41
|
| Rate for Payer: Mclaren Commercial |
$2,316.62
|
| Rate for Payer: Mclaren Medicaid |
$612.33
|
| Rate for Payer: Mclaren Medicare |
$1,142.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.53
|
| Rate for Payer: Meridian Medicaid |
$642.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,313.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,187.92
|
| Rate for Payer: Nomi Health Commercial |
$2,110.70
|
| Rate for Payer: PACE Medicare |
$1,085.29
|
| Rate for Payer: PACE SWMI |
$1,142.41
|
| Rate for Payer: PHP Commercial |
$1,256.65
|
| Rate for Payer: PHP Medicaid |
$612.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$612.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,673.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,530.00
|
| Rate for Payer: Priority Health Medicare |
$1,142.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,224.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,142.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,265.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,142.41
|
| Rate for Payer: UHC Exchange |
$1,770.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.41
|
| Rate for Payer: UHCCP DNSP |
$1,142.41
|
| Rate for Payer: UHCCP Medicaid |
$612.33
|
| Rate for Payer: VA VA |
$1,142.41
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$2,574.02
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,673.11 |
| Max. Negotiated Rate |
$2,574.02 |
| Rate for Payer: Aetna Commercial |
$2,316.62
|
| Rate for Payer: ASR ASR |
$2,496.80
|
| Rate for Payer: ASR Commercial |
$2,496.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,097.57
|
| Rate for Payer: BCN Commercial |
$1,995.64
|
| Rate for Payer: Cash Price |
$2,059.21
|
| Rate for Payer: Cofinity Commercial |
$2,419.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,059.22
|
| Rate for Payer: Healthscope Commercial |
$2,574.02
|
| Rate for Payer: Healthscope Whirlpool |
$2,496.80
|
| Rate for Payer: Mclaren Commercial |
$2,316.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,187.92
|
| Rate for Payer: Nomi Health Commercial |
$2,110.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,673.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,265.14
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$63.84
|
|
|
Service Code
|
NDC 23155066203
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$63.84 |
| Rate for Payer: Aetna Commercial |
$57.46
|
| Rate for Payer: ASR ASR |
$61.92
|
| Rate for Payer: ASR Commercial |
$61.92
|
| Rate for Payer: BCBS Trust/PPO |
$52.02
|
| Rate for Payer: BCN Commercial |
$49.50
|
| Rate for Payer: Cash Price |
$51.07
|
| Rate for Payer: Cofinity Commercial |
$60.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.07
|
| Rate for Payer: Healthscope Commercial |
$63.84
|
| Rate for Payer: Healthscope Whirlpool |
$61.92
|
| Rate for Payer: Mclaren Commercial |
$57.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.26
|
| Rate for Payer: Nomi Health Commercial |
$52.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.18
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$63.84
|
|
|
Service Code
|
NDC 23155066203
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.54 |
| Max. Negotiated Rate |
$63.84 |
| Rate for Payer: Aetna Commercial |
$57.46
|
| Rate for Payer: Aetna Medicare |
$31.92
|
| Rate for Payer: ASR ASR |
$61.92
|
| Rate for Payer: ASR Commercial |
$61.92
|
| Rate for Payer: BCBS Complete |
$25.54
|
| Rate for Payer: BCBS Trust/PPO |
$52.28
|
| Rate for Payer: BCN Commercial |
$49.50
|
| Rate for Payer: Cash Price |
$51.07
|
| Rate for Payer: Cofinity Commercial |
$60.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.07
|
| Rate for Payer: Healthscope Commercial |
$63.84
|
| Rate for Payer: Healthscope Whirlpool |
$61.92
|
| Rate for Payer: Mclaren Commercial |
$57.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.26
|
| Rate for Payer: Nomi Health Commercial |
$52.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.94
|
| Rate for Payer: Priority Health Narrow Network |
$44.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.18
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 57896076315
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: ASR ASR |
$183.33
|
| Rate for Payer: ASR Commercial |
$183.33
|
| Rate for Payer: BCBS Trust/PPO |
$154.02
|
| Rate for Payer: BCN Commercial |
$146.53
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$177.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Healthscope Whirlpool |
$183.33
|
| Rate for Payer: Mclaren Commercial |
$170.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Nomi Health Commercial |
$154.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.32
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$151.20
|
|
|
Service Code
|
NDC 00536100715
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna Commercial |
$136.08
|
| Rate for Payer: ASR ASR |
$146.66
|
| Rate for Payer: ASR Commercial |
$146.66
|
| Rate for Payer: BCBS Trust/PPO |
$123.21
|
| Rate for Payer: BCN Commercial |
$117.23
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Commercial |
$142.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$151.20
|
| Rate for Payer: Healthscope Whirlpool |
$146.66
|
| Rate for Payer: Mclaren Commercial |
$136.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.52
|
| Rate for Payer: Nomi Health Commercial |
$123.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.06
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$151.20
|
|
|
Service Code
|
NDC 00536100715
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna Commercial |
$136.08
|
| Rate for Payer: Aetna Medicare |
$75.60
|
| Rate for Payer: ASR ASR |
$146.66
|
| Rate for Payer: ASR Commercial |
$146.66
|
| Rate for Payer: BCBS Complete |
$60.48
|
| Rate for Payer: BCBS Trust/PPO |
$123.82
|
| Rate for Payer: BCN Commercial |
$117.23
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Commercial |
$142.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$151.20
|
| Rate for Payer: Healthscope Whirlpool |
$146.66
|
| Rate for Payer: Mclaren Commercial |
$136.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.52
|
| Rate for Payer: Nomi Health Commercial |
$123.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.48
|
| Rate for Payer: Priority Health Narrow Network |
$105.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.06
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$577.50
|
|
|
Service Code
|
NDC 66553000401
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$577.50 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Aetna Medicare |
$288.75
|
| Rate for Payer: ASR ASR |
$560.18
|
| Rate for Payer: ASR Commercial |
$560.18
|
| Rate for Payer: BCBS Complete |
$231.00
|
| Rate for Payer: BCBS Trust/PPO |
$472.91
|
| Rate for Payer: BCN Commercial |
$447.74
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cofinity Commercial |
$542.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.00
|
| Rate for Payer: Healthscope Commercial |
$577.50
|
| Rate for Payer: Healthscope Whirlpool |
$560.18
|
| Rate for Payer: Mclaren Commercial |
$519.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.88
|
| Rate for Payer: Nomi Health Commercial |
$473.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$506.01
|
| Rate for Payer: Priority Health Narrow Network |
$404.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$508.20
|
|
