|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
OP
|
$377.64
|
|
|
Service Code
|
CPT 20610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$377.64 |
| Rate for Payer: Aetna Medicare |
$263.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$263.27
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$289.60
|
| Rate for Payer: PHP Medicaid |
$144.01
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$377.64
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$302.11
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
ARTHROSCOPY
|
Facility
IP
|
$17,028.41
|
|
|
Service Code
|
MS-DRG 509
|
| Min. Negotiated Rate |
$12,584.54 |
| Max. Negotiated Rate |
$17,028.41 |
| Rate for Payer: Aetna Medicare |
$13,246.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,558.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,558.60
|
| Rate for Payer: BCBS MAPPO |
$13,246.88
|
| Rate for Payer: BCN Medicare Advantage |
$13,246.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,246.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,246.88
|
| Rate for Payer: Mclaren Medicare |
$13,246.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,909.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,233.91
|
| Rate for Payer: PACE Medicare |
$12,584.54
|
| Rate for Payer: PACE SWMI |
$13,246.88
|
| Rate for Payer: PHP Commercial |
$14,571.57
|
| Rate for Payer: PHP Medicare Advantage |
$13,246.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,028.41
|
| Rate for Payer: Priority Health Medicare |
$13,246.88
|
| Rate for Payer: Priority Health Narrow Network |
$13,622.73
|
| Rate for Payer: Railroad Medicare Medicare |
$13,246.88
|
| Rate for Payer: UHC Medicare Advantage |
$13,644.29
|
| Rate for Payer: VA VA |
$13,246.88
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
IP
|
$25.38
|
|
|
Service Code
|
NDC 57896-181-05
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.77 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna Commercial |
$22.84
|
| Rate for Payer: ASR ASR |
$24.62
|
| Rate for Payer: BCBS Trust/PPO |
$19.68
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cofinity Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.30
|
| Rate for Payer: Healthscope Commercial |
$25.38
|
| Rate for Payer: Healthscope Whirlpool |
$24.62
|
| Rate for Payer: Mclaren Commercial |
$22.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.33
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
IP
|
$68.15
|
|
|
Service Code
|
NDC 904052361
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.70 |
| Max. Negotiated Rate |
$68.15 |
| Rate for Payer: Aetna Commercial |
$61.34
|
| Rate for Payer: ASR ASR |
$66.11
|
| Rate for Payer: BCBS Trust/PPO |
$52.84
|
| Rate for Payer: BCN Commercial |
$52.84
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Commercial |
$64.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.52
|
| Rate for Payer: Healthscope Commercial |
$68.15
|
| Rate for Payer: Healthscope Whirlpool |
$66.11
|
| Rate for Payer: Mclaren Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.97
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$36.42
|
|
|
Service Code
|
NDC 0574-7034-12
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.49 |
| Max. Negotiated Rate |
$36.42 |
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: ASR ASR |
$35.33
|
| Rate for Payer: BCBS Trust/PPO |
$28.24
|
| Rate for Payer: BCN Commercial |
$28.24
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.14
|
| Rate for Payer: Healthscope Commercial |
$36.42
|
| Rate for Payer: Healthscope Whirlpool |
$35.33
|
| Rate for Payer: Mclaren Commercial |
$32.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.05
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
IP
|
$511.50
|
|
|
Service Code
|
NDC 66553-001-01
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$358.05 |
| Max. Negotiated Rate |
$511.50 |
| Rate for Payer: Aetna Commercial |
$460.35
|
| Rate for Payer: ASR ASR |
$496.16
|
| Rate for Payer: BCBS Trust/PPO |
$396.57
|
| Rate for Payer: BCN Commercial |
$396.57
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cofinity Commercial |
$480.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.20
|
| Rate for Payer: Healthscope Commercial |
$511.50
|
| Rate for Payer: Healthscope Whirlpool |
$496.16
|
| Rate for Payer: Mclaren Commercial |
$460.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$450.12
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
IP
|
$88.20
|
|
|
Service Code
|
NDC 57896-901-01
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.74 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: ASR ASR |
$85.55
|
| Rate for Payer: BCBS Trust/PPO |
$68.38
|
| Rate for Payer: BCN Commercial |
$68.38
|
| Rate for Payer: Cash Price |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$82.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.56
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Healthscope Whirlpool |
$85.55
|
| Rate for Payer: Mclaren Commercial |
$79.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.62
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$1,134.00
|
|
|
Service Code
|
NDC 63739-434-01
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$793.80 |
| Max. Negotiated Rate |
$1,134.00 |
| Rate for Payer: Aetna Commercial |
$1,020.60
|
| Rate for Payer: ASR ASR |
$1,099.98
|
| Rate for Payer: BCBS Trust/PPO |
$879.19
|
| Rate for Payer: BCN Commercial |
$879.19
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cofinity Commercial |
$1,065.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$907.20
|
| Rate for Payer: Healthscope Commercial |
$1,134.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,099.98
|
| Rate for Payer: Mclaren Commercial |
$1,020.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$963.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$997.92
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$744.00
|
|
|
Service Code
|
NDC 63739-434-02
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$520.80 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: ASR ASR |
$721.68
|
| Rate for Payer: BCBS Trust/PPO |
$576.82
|
| Rate for Payer: BCN Commercial |
$576.82
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cofinity Commercial |
$699.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$595.20
|
| Rate for Payer: Healthscope Commercial |
$744.00
|
| Rate for Payer: Healthscope Whirlpool |
$721.68
|
| Rate for Payer: Mclaren Commercial |
$669.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$632.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$520.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$654.72
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$441.00
|
|
|
Service Code
|
NDC 0904-6794-80
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.70 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna Commercial |
$396.90
|
| Rate for Payer: ASR ASR |
$427.77
|
| Rate for Payer: BCBS Trust/PPO |
$341.91
|
| Rate for Payer: BCN Commercial |
$341.91
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$414.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.80
|
| Rate for Payer: Healthscope Commercial |
$441.00
|
| Rate for Payer: Healthscope Whirlpool |
$427.77
|
| Rate for Payer: Mclaren Commercial |
$396.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$374.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$388.08
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$544.50
|
|
|
Service Code
|
NDC 66553-002-01
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$381.15 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Aetna Commercial |
$490.05
|
| Rate for Payer: ASR ASR |
$528.16
|
| Rate for Payer: BCBS Trust/PPO |
$422.15
|
| Rate for Payer: BCN Commercial |
$422.15
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cofinity Commercial |
$511.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.60
|
| Rate for Payer: Healthscope Commercial |
$544.50
|
| Rate for Payer: Healthscope Whirlpool |
$528.16
|
| Rate for Payer: Mclaren Commercial |
$490.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$462.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$479.16
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$45.36
|
|
|
Service Code
|
NDC 0904-4040-73
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: ASR ASR |
$44.00
|
| Rate for Payer: BCBS Trust/PPO |
$35.17
|
| Rate for Payer: BCN Commercial |
$35.17
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cofinity Commercial |
$42.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.29
|
| Rate for Payer: Healthscope Commercial |
$45.36
|
| Rate for Payer: Healthscope Whirlpool |
$44.00
|
| Rate for Payer: Mclaren Commercial |
$40.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.92
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
IP
|
$44.65
|
|
|
Service Code
|
NDC 0904-5135-59
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.26 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Aetna Commercial |
$40.18
|
| Rate for Payer: ASR ASR |
$43.31
|
| Rate for Payer: BCBS Trust/PPO |
$34.62
|
| Rate for Payer: BCN Commercial |
$34.62
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$41.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$44.65
|
| Rate for Payer: Healthscope Whirlpool |
$43.31
|
| Rate for Payer: Mclaren Commercial |
$40.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.29
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
IP
|
$340.75
|
|
|
Service Code
|
NDC 0904-7187-61
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.52 |
| Max. Negotiated Rate |
$340.75 |
| Rate for Payer: Aetna Commercial |
$306.68
|
| Rate for Payer: ASR ASR |
$330.53
|
| Rate for Payer: BCBS Trust/PPO |
$264.18
|
| Rate for Payer: BCN Commercial |
$264.18
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$320.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$340.75
|
| Rate for Payer: Healthscope Whirlpool |
$330.53
|
| Rate for Payer: Mclaren Commercial |
$306.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.86
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
IP
|
$3.81
|
|
|
Service Code
|
NDC 51079-759-01
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: ASR ASR |
$3.70
|
| Rate for Payer: BCBS Trust/PPO |
$2.95
|
| Rate for Payer: BCN Commercial |
$2.95
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Healthscope Whirlpool |
$3.70
|
| Rate for Payer: Mclaren Commercial |
$3.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.35
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
NDC 51079-684-01
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: ASR ASR |
$1.94
|
| Rate for Payer: BCBS Trust/PPO |
$1.55
|
| Rate for Payer: BCN Commercial |
$1.55
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$2.00
|
| Rate for Payer: Healthscope Whirlpool |
$1.94
|
| Rate for Payer: Mclaren Commercial |
$1.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.76
|
|
|
ATHEROSCLEROSIS WITH MCC
|
Facility
IP
|
$14,394.92
|
|
|
Service Code
|
MS-DRG 302
|
| Min. Negotiated Rate |
$10,613.98 |
| Max. Negotiated Rate |
$14,394.92 |
| Rate for Payer: Aetna Medicare |
$11,172.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,965.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,965.76
|
| Rate for Payer: BCBS MAPPO |
$11,172.61
|
| Rate for Payer: BCN Medicare Advantage |
$11,172.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,172.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,172.61
|
| Rate for Payer: Mclaren Medicare |
$11,172.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,731.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,848.50
|
| Rate for Payer: PACE Medicare |
$10,613.98
|
| Rate for Payer: PACE SWMI |
$11,172.61
|
| Rate for Payer: PHP Commercial |
$12,289.87
|
| Rate for Payer: PHP Medicare Advantage |
$11,172.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,394.92
|
| Rate for Payer: Priority Health Medicare |
$11,172.61
|
| Rate for Payer: Priority Health Narrow Network |
$11,515.94
|
| Rate for Payer: Railroad Medicare Medicare |
$11,172.61
|
| Rate for Payer: UHC Medicare Advantage |
$11,507.79
|
| Rate for Payer: VA VA |
$11,172.61
|
|
|
ATHEROSCLEROSIS WITHOUT MCC
|
Facility
IP
|
$9,065.85
|
|
|
Service Code
|
MS-DRG 303
|
| Min. Negotiated Rate |
$6,760.00 |
| Max. Negotiated Rate |
$9,065.85 |
| Rate for Payer: Aetna Medicare |
$7,252.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,065.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,065.85
|
| Rate for Payer: BCBS MAPPO |
$7,252.68
|
| Rate for Payer: BCN Medicare Advantage |
$7,252.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,252.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,252.68
|
| Rate for Payer: Mclaren Medicare |
$7,252.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,615.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,340.58
|
| Rate for Payer: PACE Medicare |
$6,890.05
|
| Rate for Payer: PACE SWMI |
$7,252.68
|
| Rate for Payer: PHP Commercial |
$7,977.95
|
| Rate for Payer: PHP Medicare Advantage |
$7,252.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,450.00
|
| Rate for Payer: Priority Health Medicare |
$7,252.68
|
| Rate for Payer: Priority Health Narrow Network |
$6,760.00
|
| Rate for Payer: Railroad Medicare Medicare |
$7,252.68
|
| Rate for Payer: UHC Medicare Advantage |
$7,470.26
|
| Rate for Payer: VA VA |
$7,252.68
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$2.74
|
|
|
Service Code
|
NDC 51079-208-01
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: ASR ASR |
$2.66
|
| Rate for Payer: BCBS Trust/PPO |
$2.12
|
| Rate for Payer: BCN Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Healthscope Whirlpool |
$2.66
|
| Rate for Payer: Mclaren Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.41
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$2.60
|
|
|
Service Code
|
NDC 50268-093-11
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$2.34
|
| Rate for Payer: ASR ASR |
$2.52
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Healthscope Whirlpool |
$2.52
|
| Rate for Payer: Mclaren Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.29
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$130.15
|
|
|
Service Code
|
NDC 50268-093-15
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.10 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Aetna Commercial |
$117.14
|
| Rate for Payer: ASR ASR |
$126.25
|
| Rate for Payer: BCBS Trust/PPO |
$100.91
|
| Rate for Payer: BCN Commercial |
$100.91
|
| Rate for Payer: Cash Price |
$104.12
|
| Rate for Payer: Cofinity Commercial |
$122.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.12
|
| Rate for Payer: Healthscope Commercial |
$130.15
|
| Rate for Payer: Healthscope Whirlpool |
$126.25
|
| Rate for Payer: Mclaren Commercial |
$117.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.53
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$4.28
|
|
|
Service Code
|
NDC 68084-097-11
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: ASR ASR |
$4.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.42
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Healthscope Whirlpool |
$4.15
|
| Rate for Payer: Mclaren Commercial |
$3.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.77
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$210.32
|
|
|
Service Code
|
NDC 0904-6290-06
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.22 |
| Max. Negotiated Rate |
$210.32 |
| Rate for Payer: Aetna Commercial |
$189.29
|
| Rate for Payer: ASR ASR |
$204.01
|
| Rate for Payer: BCBS Trust/PPO |
$163.06
|
| Rate for Payer: BCN Commercial |
$163.06
|
| Rate for Payer: Cash Price |
$168.26
|
| Rate for Payer: Cofinity Commercial |
$197.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.26
|
| Rate for Payer: Healthscope Commercial |
$210.32
|
| Rate for Payer: Healthscope Whirlpool |
$204.01
|
| Rate for Payer: Mclaren Commercial |
$189.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.08
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$427.70
|
|
|
Service Code
|
NDC 68084-097-01
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.39 |
| Max. Negotiated Rate |
$427.70 |
| Rate for Payer: Aetna Commercial |
$384.93
|
| Rate for Payer: ASR ASR |
$414.87
|
| Rate for Payer: BCBS Trust/PPO |
$331.60
|
| Rate for Payer: BCN Commercial |
$331.60
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$402.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$427.70
|
| Rate for Payer: Healthscope Whirlpool |
$414.87
|
| Rate for Payer: Mclaren Commercial |
$384.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.38
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$406.55
|
|
|
Service Code
|
NDC 0904-6290-61
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.58 |
| Max. Negotiated Rate |
$406.55 |
| Rate for Payer: Aetna Commercial |
$365.90
|
| Rate for Payer: ASR ASR |
$394.35
|
| Rate for Payer: BCBS Trust/PPO |
$315.20
|
| Rate for Payer: BCN Commercial |
$315.20
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cofinity Commercial |
$382.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.24
|
| Rate for Payer: Healthscope Commercial |
$406.55
|
| Rate for Payer: Healthscope Whirlpool |
$394.35
|
| Rate for Payer: Mclaren Commercial |
$365.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.76
|
|
