|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
NDC 65162083366
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.85
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Advantage |
$34.30
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.75
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: Priority Health SBD |
$30.87
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$41.65
|
|
|
Service Code
|
NDC 00536129497
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.24 |
| Max. Negotiated Rate |
$37.48 |
| Rate for Payer: Aetna Commercial |
$35.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.07
|
| Rate for Payer: Cash Price |
$33.32
|
| Rate for Payer: Cofinity Advantage |
$29.16
|
| Rate for Payer: Cofinity Commercial |
$35.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.32
|
| Rate for Payer: Healthscope Commercial |
$37.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.24
|
| Rate for Payer: PHP Commercial |
$35.40
|
| Rate for Payer: Priority Health SBD |
$26.24
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$14.85
|
|
|
Service Code
|
NDC 76282066339
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$13.37 |
| Rate for Payer: Aetna Commercial |
$12.62
|
| Rate for Payer: Aetna Medicare |
$7.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cofinity Advantage |
$10.39
|
| Rate for Payer: Cofinity Commercial |
$12.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.88
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: PHP Commercial |
$12.62
|
| Rate for Payer: Priority Health SBD |
$9.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.65
|
| Rate for Payer: UHC Core |
$7.74
|
| Rate for Payer: UHC Exchange |
$5.84
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
NDC 69097052444
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.85
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Advantage |
$34.30
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.75
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: Priority Health SBD |
$30.87
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$68.60
|
|
|
Service Code
|
NDC 00067815203
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.22 |
| Max. Negotiated Rate |
$61.74 |
| Rate for Payer: Aetna Commercial |
$58.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.59
|
| Rate for Payer: Cash Price |
$54.88
|
| Rate for Payer: Cofinity Advantage |
$48.02
|
| Rate for Payer: Cofinity Commercial |
$59.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.88
|
| Rate for Payer: Healthscope Commercial |
$61.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.45
|
| Rate for Payer: PHP Commercial |
$58.31
|
| Rate for Payer: Priority Health SBD |
$43.22
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$54.25
|
|
|
Service Code
|
NDC 41167057403
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.18 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna Commercial |
$46.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.26
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cofinity Advantage |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$46.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.40
|
| Rate for Payer: Healthscope Commercial |
$48.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.69
|
| Rate for Payer: PHP Commercial |
$46.11
|
| Rate for Payer: Priority Health SBD |
$34.18
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$32.90
|
|
|
Service Code
|
NDC 57896014001
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$29.61 |
| Rate for Payer: Aetna Commercial |
$27.96
|
| Rate for Payer: Aetna Medicare |
$16.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.39
|
| Rate for Payer: BCBS Complete |
$13.16
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Advantage |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$28.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$29.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.68
|
| Rate for Payer: PHP Commercial |
$27.96
|
| Rate for Payer: Priority Health SBD |
$20.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.39
|
| Rate for Payer: UHC Core |
$17.14
|
| Rate for Payer: UHC Exchange |
$12.93
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$14.85
|
|
|
Service Code
|
NDC 76282066339
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$13.37 |
| Rate for Payer: Aetna Commercial |
$12.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cofinity Advantage |
$10.39
|
| Rate for Payer: Cofinity Commercial |
$12.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.88
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: PHP Commercial |
$12.62
|
| Rate for Payer: Priority Health SBD |
$9.36
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$21.15
|
|
|
Service Code
|
NDC 69097072044
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Aetna Commercial |
$17.98
|
| Rate for Payer: Aetna Medicare |
$10.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.75
|
| Rate for Payer: BCBS Complete |
$8.46
|
| Rate for Payer: Cash Price |
$16.92
|
| Rate for Payer: Cofinity Advantage |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$18.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.92
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.86
|
| Rate for Payer: PHP Commercial |
$17.98
|
| Rate for Payer: Priority Health SBD |
$13.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.75
|
| Rate for Payer: UHC Core |
$11.02
|
| Rate for Payer: UHC Exchange |
$8.31
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
NDC 45802016000
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.85
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Advantage |
$34.30
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.75
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: Priority Health SBD |
$30.87
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
NDC 25866059361
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Advantage |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.00
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: Priority Health SBD |
$35.28
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$39.90
|
|
|
Service Code
|
NDC 45802095301
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$35.91 |
| Rate for Payer: Aetna Commercial |
$33.91
|
| Rate for Payer: Aetna Medicare |
$19.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.93
|
| Rate for Payer: BCBS Complete |
$15.96
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: Cofinity Advantage |
$27.93
|
| Rate for Payer: Cofinity Commercial |
$34.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.92
|
| Rate for Payer: Healthscope Commercial |
$35.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.93
|
| Rate for Payer: PHP Commercial |
$33.91
|
| Rate for Payer: Priority Health SBD |
$25.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.93
|
| Rate for Payer: UHC Core |
$20.79
|
| Rate for Payer: UHC Exchange |
$15.68
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$26.95
|
|
|
Service Code
|
NDC 70000055502
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.98 |
| Max. Negotiated Rate |
$24.25 |
| Rate for Payer: Aetna Commercial |
$22.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.52
|
| Rate for Payer: Cash Price |
$21.56
|
| Rate for Payer: Cofinity Advantage |
$18.86
|
| Rate for Payer: Cofinity Commercial |
$23.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.56
|
| Rate for Payer: Healthscope Commercial |
$24.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.21
|
| Rate for Payer: PHP Commercial |
$22.91
|
| Rate for Payer: Priority Health SBD |
$16.98
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$26.95
|
|
|
Service Code
|
NDC 70000055502
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$24.25 |
| Rate for Payer: Aetna Commercial |
$22.91
|
| Rate for Payer: Aetna Medicare |
$13.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.52
|
| Rate for Payer: BCBS Complete |
$10.78
|
| Rate for Payer: Cash Price |
$21.56
|
| Rate for Payer: Cofinity Advantage |
$18.86
|
| Rate for Payer: Cofinity Commercial |
$23.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.56
|
| Rate for Payer: Healthscope Commercial |
$24.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.21
|
| Rate for Payer: PHP Commercial |
$22.91
|
| Rate for Payer: Priority Health SBD |
$16.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.52
|
| Rate for Payer: UHC Core |
$14.04
|
| Rate for Payer: UHC Exchange |
$10.59
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$54.25
|
|
|
Service Code
|
NDC 41167057403
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna Commercial |
$46.11
|
| Rate for Payer: Aetna Medicare |
$27.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.26
|
| Rate for Payer: BCBS Complete |
$21.70
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cofinity Advantage |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$46.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.40
|
| Rate for Payer: Healthscope Commercial |
$48.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.69
|
| Rate for Payer: PHP Commercial |
$46.11
|
| Rate for Payer: Priority Health SBD |
$34.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.26
|
| Rate for Payer: UHC Core |
$28.26
|
| Rate for Payer: UHC Exchange |
$21.32
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$41.65
|
|
|
Service Code
|
NDC 00536129497
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$37.48 |
| Rate for Payer: Aetna Commercial |
$35.40
|
| Rate for Payer: Aetna Medicare |
$20.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.07
|
| Rate for Payer: BCBS Complete |
$16.66
|
| Rate for Payer: Cash Price |
$33.32
|
| Rate for Payer: Cofinity Advantage |
$29.16
|
| Rate for Payer: Cofinity Commercial |
$35.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.32
|
| Rate for Payer: Healthscope Commercial |
$37.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.24
|
| Rate for Payer: PHP Commercial |
$35.40
|
| Rate for Payer: Priority Health SBD |
$26.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.07
|
| Rate for Payer: UHC Core |
$21.70
|
| Rate for Payer: UHC Exchange |
$16.37
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$32.90
|
|
|
Service Code
|
NDC 57896014001
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$29.61 |
| Rate for Payer: Aetna Commercial |
$27.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.39
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Advantage |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$28.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.68
|
| Rate for Payer: PHP Commercial |
$27.96
|
| Rate for Payer: Priority Health SBD |
$20.73
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$31.15
|
|
|
Service Code
|
NDC 43598097710
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$28.04 |
| Rate for Payer: Aetna Commercial |
$26.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.25
|
| Rate for Payer: Cash Price |
$24.92
|
| Rate for Payer: Cofinity Advantage |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$26.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.92
|
| Rate for Payer: Healthscope Commercial |
$28.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.36
|
| Rate for Payer: PHP Commercial |
$26.48
|
| Rate for Payer: Priority Health SBD |
$19.62
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
NDC 65162083366
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.85
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Advantage |
$34.30
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.75
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: Priority Health SBD |
$30.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.85
|
| Rate for Payer: UHC Core |
$25.53
|
| Rate for Payer: UHC Exchange |
$19.26
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$31.15
|
|
|
Service Code
|
NDC 43598097710
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$28.04 |
| Rate for Payer: Aetna Commercial |
$26.48
|
| Rate for Payer: Aetna Medicare |
$15.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.25
|
| Rate for Payer: BCBS Complete |
$12.46
|
| Rate for Payer: Cash Price |
$24.92
|
| Rate for Payer: Cofinity Advantage |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$26.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.92
|
| Rate for Payer: Healthscope Commercial |
$28.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.36
|
| Rate for Payer: PHP Commercial |
$26.48
|
| Rate for Payer: Priority Health SBD |
$19.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.25
|
| Rate for Payer: UHC Core |
$16.23
|
| Rate for Payer: UHC Exchange |
$12.24
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
NDC 69097052444
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.85
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Advantage |
$34.30
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.75
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: Priority Health SBD |
$30.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.85
|
| Rate for Payer: UHC Core |
$25.53
|
| Rate for Payer: UHC Exchange |
$19.26
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
NDC 45802016000
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.85
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Advantage |
$34.30
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.75
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: Priority Health SBD |
$30.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.85
|
| Rate for Payer: UHC Core |
$25.53
|
| Rate for Payer: UHC Exchange |
$19.26
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
NDC 25866059361
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.01 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.40
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Advantage |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.00
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: Priority Health SBD |
$35.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.40
|
| Rate for Payer: UHC Core |
$29.18
|
| Rate for Payer: UHC Exchange |
$22.01
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$68.60
|
|
|
Service Code
|
NDC 00067815203
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.96 |
| Max. Negotiated Rate |
$61.74 |
| Rate for Payer: Aetna Commercial |
$58.31
|
| Rate for Payer: Aetna Medicare |
$34.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.59
|
| Rate for Payer: BCBS Complete |
$27.44
|
| Rate for Payer: Cash Price |
$54.88
|
| Rate for Payer: Cofinity Advantage |
$48.02
|
| Rate for Payer: Cofinity Commercial |
$59.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.88
|
| Rate for Payer: Healthscope Commercial |
$61.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.45
|
| Rate for Payer: PHP Commercial |
$58.31
|
| Rate for Payer: Priority Health SBD |
$43.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.59
|
| Rate for Payer: UHC Core |
$35.74
|
| Rate for Payer: UHC Exchange |
$26.96
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$21.15
|
|
|
Service Code
|
NDC 69097072044
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Aetna Commercial |
$17.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.75
|
| Rate for Payer: Cash Price |
$16.92
|
| Rate for Payer: Cofinity Advantage |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$18.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.92
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.86
|
| Rate for Payer: PHP Commercial |
$17.98
|
| Rate for Payer: Priority Health SBD |
$13.32
|
|
