|
NAPROSYN/375MG/TAB
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
60633494
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.90
|
|
|
NAPROSYN/375MG/TAB
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
60633494
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare Advantage |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.53
|
| Rate for Payer: Cigna Commercial |
$3.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.80
|
| Rate for Payer: Oxford Commercial |
$1.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.16
|
|
|
NAPROSYN/375MG/TAB
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
60635876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare Advantage |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.53
|
| Rate for Payer: Cigna Commercial |
$3.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.80
|
| Rate for Payer: Oxford Commercial |
$1.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.16
|
|
|
NAPROSYN/500MG/TAB
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
60633496
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare Advantage |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.53
|
| Rate for Payer: Cigna Commercial |
$3.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.80
|
| Rate for Payer: Oxford Commercial |
$1.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.16
|
|
|
NAPROSYN/500MG/TAB
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
60633495
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.90
|
|
|
NAPROSYN/500MG/TAB
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
60633495
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare Advantage |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.53
|
| Rate for Payer: Cigna Commercial |
$3.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.80
|
| Rate for Payer: Oxford Commercial |
$1.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.16
|
|
|
NAPROSYN/500MG/TAB
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
60633496
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.90
|
|
|
NAPROSYN SUSP/16OZ
|
Facility
|
OP
|
$190.00
|
|
| Hospital Charge Code |
60634611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna Commercial |
$72.20
|
| Rate for Payer: Aetna Medicare Advantage |
$57.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$48.45
|
| Rate for Payer: Cigna Commercial |
$95.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$57.00
|
| Rate for Payer: Oxford Commercial |
$38.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.04
|
|
|
NAPROSYN SUSP/16OZ
|
Facility
|
IP
|
$190.00
|
|
| Hospital Charge Code |
60634611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.50
|
|
|
NAPROXEN 250 MG TAB
|
Facility
|
OP
|
$5.23
|
|
|
Service Code
|
NDC 31722034001
|
| Hospital Charge Code |
60627691
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna Commercial |
$1.99
|
| Rate for Payer: Aetna Medicare Advantage |
$1.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.33
|
| Rate for Payer: Cigna Commercial |
$2.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.57
|
| Rate for Payer: Oxford Commercial |
$1.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.05
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.14
|
|
|
NAPROXEN 250 MG TAB
|
Facility
|
IP
|
$5.23
|
|
|
Service Code
|
NDC 31722034001
|
| Hospital Charge Code |
60627691
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.78
|
|
|
NAPROXEN 375 MG TAB
|
Facility
|
OP
|
$7.10
|
|
|
Service Code
|
NDC 31722034101
|
| Hospital Charge Code |
60627693
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna Medicare Advantage |
$2.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.81
|
| Rate for Payer: Cigna Commercial |
$3.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.13
|
| Rate for Payer: Oxford Commercial |
$1.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.42
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.19
|
|
|
NAPROXEN 375 MG TAB
|
Facility
|
IP
|
$7.10
|
|
|
Service Code
|
NDC 31722034101
|
| Hospital Charge Code |
60627693
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.06
|
|
|
NAPROXEN 500MG TAB
|
Facility
|
OP
|
$8.98
|
|
|
Service Code
|
NDC 68084012701
|
| Hospital Charge Code |
6063943144
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Aetna Medicare Advantage |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.29
|
| Rate for Payer: Cigna Commercial |
$4.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.69
|
| Rate for Payer: Oxford Commercial |
$1.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.24
|
|
|
NAPROXEN 500MG TAB
|
Facility
|
IP
|
$8.98
|
|
|
Service Code
|
NDC 68084012701
|
| Hospital Charge Code |
6063943144
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.35
|
|
|
NAPROXEN ORAL SUSP
|
Facility
|
OP
|
$356.85
|
|
| Hospital Charge Code |
60627692
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$178.43 |
| Rate for Payer: Aetna Commercial |
$135.60
|
| Rate for Payer: Aetna Medicare Advantage |
$107.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$91.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$91.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$91.00
|
| Rate for Payer: Cigna Commercial |
$178.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$107.06
|
| Rate for Payer: Oxford Commercial |
$71.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$71.37
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.46
|
|
|
NAPROXEN ORAL SUSP
|
Facility
|
IP
|
$356.85
|
|
| Hospital Charge Code |
60627692
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.53 |
| Max. Negotiated Rate |
$53.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.53
|
|
|
NAPROXEN TAB 250MG
|
Facility
|
OP
|
$1.95
|
|
| Hospital Charge Code |
6024244
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna Commercial |
$0.74
|
| Rate for Payer: Aetna Medicare Advantage |
$0.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.59
|
| Rate for Payer: Oxford Commercial |
$0.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.39
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.05
|
|
|
NAPROXEN TAB 250MG
|
Facility
|
IP
|
$1.95
|
|
| Hospital Charge Code |
6024244
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
|
|
NAPROXEN TAB 375MG
|
Facility
|
OP
|
$1.95
|
|
| Hospital Charge Code |
6024236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna Commercial |
$0.74
|
| Rate for Payer: Aetna Medicare Advantage |
$0.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.59
|
| Rate for Payer: Oxford Commercial |
$0.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.39
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.05
|
|
|
NAPROXEN TAB 375MG
|
Facility
|
IP
|
$1.95
|
|
| Hospital Charge Code |
6024236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
|
|
NAPROXEN TAB 500MG
|
Facility
|
OP
|
$10.25
|
|
| Hospital Charge Code |
60627694
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare Advantage |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.61
|
| Rate for Payer: Cigna Commercial |
$5.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.08
|
| Rate for Payer: Oxford Commercial |
$2.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.05
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.27
|
|
|
NAPROXEN TAB 500MG
|
Facility
|
IP
|
$10.25
|
|
| Hospital Charge Code |
60627694
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.54
|
|
|
NAPSIN-A-IHC
|
Facility
|
IP
|
$2,164.00
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
4016883425
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$324.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$324.60
|
|
|
NAPSIN-A-IHC
|
Facility
|
OP
|
$2,164.00
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
4016883425
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$57.35 |
| Max. Negotiated Rate |
$730.60 |
| Rate for Payer: Aetna Commercial |
$550.53
|
| Rate for Payer: Aetna Medicare Advantage |
$655.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$730.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$730.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$202.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$730.60
|
| Rate for Payer: Cigna Commercial |
$405.73
|
| Rate for Payer: Cigna Medicare Advantage |
$202.40
|
| Rate for Payer: Clover Medicare Advantage |
$192.28
|
| Rate for Payer: EmblemHealth Commercial |
$607.20
|
| Rate for Payer: Humana Medicare Advantage |
$208.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$202.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$649.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$324.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$86.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$57.35
|
|