|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$22.15
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$19.93 |
| Rate for Payer: Aetna Commercial |
$18.83
|
| Rate for Payer: Aetna Commercial |
$15.97
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.21
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$17.72
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cofinity Advantage |
$15.51
|
| Rate for Payer: Cofinity Advantage |
$13.15
|
| Rate for Payer: Cofinity Advantage |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Commercial |
$16.16
|
| Rate for Payer: Cofinity Commercial |
$19.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$19.93
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.61
|
| Rate for Payer: PHP Commercial |
$15.97
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$18.83
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: Priority Health SBD |
$11.84
|
| Rate for Payer: Priority Health SBD |
$13.95
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$18.79
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$16.91 |
| Rate for Payer: Aetna Commercial |
$15.97
|
| Rate for Payer: Aetna Commercial |
$18.83
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Medicare |
$9.39
|
| Rate for Payer: Aetna Medicare |
$11.07
|
| Rate for Payer: Aetna Medicare |
$46.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: BCBS Complete |
$37.25
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: BCBS Complete |
$8.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cash Price |
$17.72
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$17.72
|
| Rate for Payer: Cofinity Advantage |
$15.51
|
| Rate for Payer: Cofinity Advantage |
$13.15
|
| Rate for Payer: Cofinity Advantage |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$16.16
|
| Rate for Payer: Cofinity Commercial |
$19.05
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.03
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Healthscope Commercial |
$19.93
|
| Rate for Payer: Healthscope Commercial |
$16.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.84
|
| Rate for Payer: PHP Commercial |
$15.97
|
| Rate for Payer: PHP Commercial |
$18.83
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: Priority Health SBD |
$11.84
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: Priority Health SBD |
$13.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
|
|
NAFCILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$93.12
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.67 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cofinity Advantage |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.84
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: Priority Health SBD |
$58.67
|
|
|
NAFCILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$93.12
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Cofinity Advantage |
$65.18
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Medicare |
$46.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: BCBS Complete |
$37.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.84
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
|
|
NALOXEGOL 12.5 MG TABLET
|
Facility
|
OP
|
$1,361.97
|
|
|
Service Code
|
NDC 57841130001
|
| Hospital Charge Code |
173967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$535.25 |
| Max. Negotiated Rate |
$1,225.77 |
| Rate for Payer: Aetna Commercial |
$1,157.67
|
| Rate for Payer: Aetna Medicare |
$680.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.28
|
| Rate for Payer: BCBS Complete |
$544.79
|
| Rate for Payer: Cash Price |
$1,089.58
|
| Rate for Payer: Cofinity Advantage |
$953.38
|
| Rate for Payer: Cofinity Commercial |
$1,171.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.58
|
| Rate for Payer: Healthscope Commercial |
$1,225.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,089.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,021.48
|
| Rate for Payer: PHP Commercial |
$1,157.67
|
| Rate for Payer: Priority Health SBD |
$858.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$885.28
|
| Rate for Payer: UHC Core |
$709.59
|
| Rate for Payer: UHC Exchange |
$535.25
|
|
|
NALOXEGOL 12.5 MG TABLET
|
Facility
|
IP
|
$1,576.76
|
|
|
Service Code
|
NDC 82625880101
|
| Hospital Charge Code |
173967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$993.36 |
| Max. Negotiated Rate |
$1,419.08 |
| Rate for Payer: Aetna Commercial |
$1,340.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.89
|
| Rate for Payer: Cash Price |
$1,261.41
|
| Rate for Payer: Cofinity Advantage |
$1,103.73
|
| Rate for Payer: Cofinity Commercial |
$1,356.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.41
|
| Rate for Payer: Healthscope Commercial |
$1,419.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.57
|
| Rate for Payer: PHP Commercial |
$1,340.25
|
| Rate for Payer: Priority Health SBD |
$993.36
|
|
|
NALOXEGOL 12.5 MG TABLET
|
Facility
|
OP
|
$1,576.76
|
|
|
Service Code
|
NDC 82625880101
|
| Hospital Charge Code |
173967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$619.67 |
| Max. Negotiated Rate |
$1,419.08 |
| Rate for Payer: Aetna Commercial |
$1,340.25
|
| Rate for Payer: Aetna Medicare |
$788.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.89
|
| Rate for Payer: BCBS Complete |
$630.70
|
| Rate for Payer: Cash Price |
$1,261.41
|
| Rate for Payer: Cofinity Advantage |
$1,103.73
|
| Rate for Payer: Cofinity Commercial |
$1,356.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.41
|
| Rate for Payer: Healthscope Commercial |
$1,419.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,261.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.57
|
| Rate for Payer: PHP Commercial |
$1,340.25
|
| Rate for Payer: Priority Health SBD |
$993.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,024.89
|
| Rate for Payer: UHC Core |
$821.49
|
| Rate for Payer: UHC Exchange |
$619.67
|
|
|
NALOXEGOL 12.5 MG TABLET
|
Facility
|
IP
|
$1,361.97
|
|
|
Service Code
|
NDC 57841130001
|
| Hospital Charge Code |
173967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$858.04 |
| Max. Negotiated Rate |
$1,225.77 |
| Rate for Payer: Aetna Commercial |
$1,157.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.28
|
| Rate for Payer: Cash Price |
$1,089.58
|
| Rate for Payer: Cofinity Advantage |
$953.38
|
| Rate for Payer: Cofinity Commercial |
$1,171.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.58
|
| Rate for Payer: Healthscope Commercial |
$1,225.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,021.48
|
| Rate for Payer: PHP Commercial |
$1,157.67
|
| Rate for Payer: Priority Health SBD |
$858.04
|
|
|
NALOXEGOL 25 MG TABLET
|
Facility
|
IP
|
$1,361.97
|
|
|
Service Code
|
NDC 57841130101
|
| Hospital Charge Code |
173968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$858.04 |
| Max. Negotiated Rate |
$1,225.77 |
| Rate for Payer: Aetna Commercial |
$1,157.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.28
|
| Rate for Payer: Cash Price |
$1,089.58
|
| Rate for Payer: Cofinity Advantage |
$953.38
|
| Rate for Payer: Cofinity Commercial |
$1,171.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.58
|
| Rate for Payer: Healthscope Commercial |
$1,225.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,021.48
|
| Rate for Payer: PHP Commercial |
$1,157.67
|
| Rate for Payer: Priority Health SBD |
$858.04
|
|
|
NALOXEGOL 25 MG TABLET
|
Facility
|
IP
|
$4,404.11
|
|
|
Service Code
|
NDC 57841130103
|
| Hospital Charge Code |
173968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,774.59 |
| Max. Negotiated Rate |
$3,963.70 |
| Rate for Payer: Aetna Commercial |
$3,743.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,862.67
|
| Rate for Payer: Cash Price |
$3,523.29
|
| Rate for Payer: Cofinity Advantage |
$3,082.88
|
| Rate for Payer: Cofinity Commercial |
$3,787.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,523.29
|
| Rate for Payer: Healthscope Commercial |
$3,963.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,743.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,303.08
|
| Rate for Payer: PHP Commercial |
$3,743.49
|
| Rate for Payer: Priority Health SBD |
$2,774.59
|
|
|
NALOXEGOL 25 MG TABLET
|
Facility
|
IP
|
$1,576.76
|
|
|
Service Code
|
NDC 82625880201
|
| Hospital Charge Code |
173968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$993.36 |
| Max. Negotiated Rate |
$1,419.08 |
| Rate for Payer: Aetna Commercial |
$1,340.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.89
|
| Rate for Payer: Cash Price |
$1,261.41
|
| Rate for Payer: Cofinity Advantage |
$1,103.73
|
| Rate for Payer: Cofinity Commercial |
$1,356.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.41
|
| Rate for Payer: Healthscope Commercial |
$1,419.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.57
|
| Rate for Payer: PHP Commercial |
$1,340.25
|
| Rate for Payer: Priority Health SBD |
$993.36
|
|
|
NALOXEGOL 25 MG TABLET
|
Facility
|
OP
|
$1,361.97
|
|
|
Service Code
|
NDC 57841130101
|
| Hospital Charge Code |
173968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$535.25 |
| Max. Negotiated Rate |
$1,225.77 |
| Rate for Payer: Aetna Commercial |
$1,157.67
|
| Rate for Payer: Aetna Medicare |
$680.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.28
|
| Rate for Payer: BCBS Complete |
$544.79
|
| Rate for Payer: Cash Price |
$1,089.58
|
| Rate for Payer: Cofinity Advantage |
$953.38
|
| Rate for Payer: Cofinity Commercial |
$1,171.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.58
|
| Rate for Payer: Healthscope Commercial |
$1,225.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,089.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,021.48
|
| Rate for Payer: PHP Commercial |
$1,157.67
|
| Rate for Payer: Priority Health SBD |
$858.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$885.28
|
| Rate for Payer: UHC Core |
$709.59
|
| Rate for Payer: UHC Exchange |
$535.25
|
|
|
NALOXEGOL 25 MG TABLET
|
Facility
|
OP
|
$1,576.76
|
|
|
Service Code
|
NDC 82625880201
|
| Hospital Charge Code |
173968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$619.67 |
| Max. Negotiated Rate |
$1,419.08 |
| Rate for Payer: Aetna Commercial |
$1,340.25
|
| Rate for Payer: Aetna Medicare |
$788.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.89
|
| Rate for Payer: BCBS Complete |
$630.70
|
| Rate for Payer: Cash Price |
$1,261.41
|
| Rate for Payer: Cofinity Advantage |
$1,103.73
|
| Rate for Payer: Cofinity Commercial |
$1,356.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.41
|
| Rate for Payer: Healthscope Commercial |
$1,419.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,261.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.57
|
| Rate for Payer: PHP Commercial |
$1,340.25
|
| Rate for Payer: Priority Health SBD |
$993.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,024.89
|
| Rate for Payer: UHC Core |
$821.49
|
| Rate for Payer: UHC Exchange |
$619.67
|
|
|
NALOXEGOL 25 MG TABLET
|
Facility
|
OP
|
$4,404.11
|
|
|
Service Code
|
NDC 57841130103
|
| Hospital Charge Code |
173968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,730.82 |
| Max. Negotiated Rate |
$3,963.70 |
| Rate for Payer: Aetna Commercial |
$3,743.49
|
| Rate for Payer: Aetna Medicare |
$2,202.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,862.67
|
| Rate for Payer: BCBS Complete |
$1,761.64
|
| Rate for Payer: Cash Price |
$3,523.29
|
| Rate for Payer: Cofinity Advantage |
$3,082.88
|
| Rate for Payer: Cofinity Commercial |
$3,787.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,523.29
|
| Rate for Payer: Healthscope Commercial |
$3,963.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,523.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,743.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,303.08
|
| Rate for Payer: PHP Commercial |
$3,743.49
|
| Rate for Payer: Priority Health SBD |
$2,774.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,862.67
|
| Rate for Payer: UHC Core |
$2,294.54
|
| Rate for Payer: UHC Exchange |
$1,730.82
|
|
|
NALOXONE 0.4 MG/ML INJECTION (CODE)
|
Facility
|
OP
|
$63.57
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
163714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$57.21 |
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Medicare |
$31.79
|
| Rate for Payer: Aetna Medicare |
$10.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.32
|
| Rate for Payer: BCBS Complete |
$25.43
|
| Rate for Payer: BCBS Complete |
$8.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cofinity Advantage |
$14.02
|
| Rate for Payer: Cofinity Advantage |
$44.50
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.68
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health SBD |
$12.62
|
| Rate for Payer: Priority Health SBD |
$40.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
|
|
NALOXONE 0.4 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$20.03
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
163714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.32
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cofinity Advantage |
$14.02
|
| Rate for Payer: Cofinity Advantage |
$44.50
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.68
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: Priority Health SBD |
$12.62
|
| Rate for Payer: Priority Health SBD |
$40.05
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$20.03
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
5373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Aetna Medicare |
$10.02
|
| Rate for Payer: Aetna Medicare |
$31.79
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: BCBS Complete |
$25.43
|
| Rate for Payer: BCBS Complete |
$8.01
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cofinity Advantage |
$44.50
|
| Rate for Payer: Cofinity Advantage |
$11.82
|
| Rate for Payer: Cofinity Advantage |
$14.49
|
| Rate for Payer: Cofinity Advantage |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$14.52
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.68
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: PHP Commercial |
$14.35
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: Priority Health SBD |
$40.05
|
| Rate for Payer: Priority Health SBD |
$12.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$20.70
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
5373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cofinity Advantage |
$14.49
|
| Rate for Payer: Cofinity Advantage |
$11.82
|
| Rate for Payer: Cofinity Advantage |
$44.50
|
| Rate for Payer: Cofinity Advantage |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$14.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: Healthscope Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.02
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: PHP Commercial |
$14.35
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: Priority Health SBD |
$12.62
|
| Rate for Payer: Priority Health SBD |
$40.05
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: Priority Health SBD |
$10.63
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$70.26
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
5374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.26 |
| Max. Negotiated Rate |
$63.23 |
| Rate for Payer: Aetna Commercial |
$59.72
|
| Rate for Payer: Aetna Commercial |
$34.81
|
| Rate for Payer: Aetna Commercial |
$73.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.62
|
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Cash Price |
$56.21
|
| Rate for Payer: Cash Price |
$32.76
|
| Rate for Payer: Cofinity Advantage |
$49.18
|
| Rate for Payer: Cofinity Advantage |
$28.66
|
| Rate for Payer: Cofinity Advantage |
$60.70
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$35.22
|
| Rate for Payer: Cofinity Commercial |
$60.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.37
|
| Rate for Payer: Healthscope Commercial |
$36.85
|
| Rate for Payer: Healthscope Commercial |
$63.23
|
| Rate for Payer: Healthscope Commercial |
$78.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.70
|
| Rate for Payer: PHP Commercial |
$34.81
|
| Rate for Payer: PHP Commercial |
$73.70
|
| Rate for Payer: PHP Commercial |
$59.72
|
| Rate for Payer: Priority Health SBD |
$54.63
|
| Rate for Payer: Priority Health SBD |
$25.80
|
| Rate for Payer: Priority Health SBD |
$44.26
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$40.95
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
5374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$36.85 |
| Rate for Payer: Aetna Commercial |
$34.81
|
| Rate for Payer: Aetna Commercial |
$59.72
|
| Rate for Payer: Aetna Commercial |
$73.70
|
| Rate for Payer: Aetna Medicare |
$20.48
|
| Rate for Payer: Aetna Medicare |
$35.13
|
| Rate for Payer: Aetna Medicare |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.36
|
| Rate for Payer: BCBS Complete |
$34.68
|
| Rate for Payer: BCBS Complete |
$16.38
|
| Rate for Payer: BCBS Complete |
$28.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Cash Price |
$32.76
|
| Rate for Payer: Cash Price |
$32.76
|
| Rate for Payer: Cash Price |
$56.21
|
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Cash Price |
$56.21
|
| Rate for Payer: Cofinity Advantage |
$49.18
|
| Rate for Payer: Cofinity Advantage |
$28.66
|
| Rate for Payer: Cofinity Advantage |
$60.70
|
| Rate for Payer: Cofinity Commercial |
$35.22
|
| Rate for Payer: Cofinity Commercial |
$60.42
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.76
|
| Rate for Payer: Healthscope Commercial |
$78.04
|
| Rate for Payer: Healthscope Commercial |
$63.23
|
| Rate for Payer: Healthscope Commercial |
$36.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.03
|
| Rate for Payer: PHP Commercial |
$34.81
|
| Rate for Payer: PHP Commercial |
$59.72
|
| Rate for Payer: PHP Commercial |
$73.70
|
| Rate for Payer: Priority Health SBD |
$25.80
|
| Rate for Payer: Priority Health SBD |
$54.63
|
| Rate for Payer: Priority Health SBD |
$44.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
IP
|
$116.50
|
|
|
Service Code
|
NDC 51224020630
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.39 |
| Max. Negotiated Rate |
$104.85 |
| Rate for Payer: Aetna Commercial |
$99.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.72
|
| Rate for Payer: Cash Price |
$93.20
|
| Rate for Payer: Cofinity Advantage |
$81.55
|
| Rate for Payer: Cofinity Commercial |
$100.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.20
|
| Rate for Payer: Healthscope Commercial |
$104.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.38
|
| Rate for Payer: PHP Commercial |
$99.03
|
| Rate for Payer: Priority Health SBD |
$73.39
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
IP
|
$285.50
|
|
|
Service Code
|
NDC 68084029121
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.87 |
| Max. Negotiated Rate |
$256.95 |
| Rate for Payer: Aetna Commercial |
$242.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.57
|
| Rate for Payer: Cash Price |
$228.40
|
| Rate for Payer: Cofinity Advantage |
$199.85
|
| Rate for Payer: Cofinity Commercial |
$245.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.40
|
| Rate for Payer: Healthscope Commercial |
$256.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.12
|
| Rate for Payer: PHP Commercial |
$242.68
|
| Rate for Payer: Priority Health SBD |
$179.87
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
OP
|
$252.42
|
|
|
Service Code
|
NDC 68094085362
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.20 |
| Max. Negotiated Rate |
$227.18 |
| Rate for Payer: Aetna Commercial |
$214.56
|
| Rate for Payer: Aetna Medicare |
$126.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.07
|
| Rate for Payer: BCBS Complete |
$100.97
|
| Rate for Payer: Cash Price |
$201.94
|
| Rate for Payer: Cofinity Advantage |
$176.69
|
| Rate for Payer: Cofinity Commercial |
$217.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.94
|
| Rate for Payer: Healthscope Commercial |
$227.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.31
|
| Rate for Payer: PHP Commercial |
$214.56
|
| Rate for Payer: Priority Health SBD |
$159.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.07
|
| Rate for Payer: UHC Core |
$131.51
|
| Rate for Payer: UHC Exchange |
$99.20
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
OP
|
$285.50
|
|
|
Service Code
|
NDC 68084029121
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$256.95 |
| Rate for Payer: Aetna Commercial |
$242.68
|
| Rate for Payer: Aetna Medicare |
$142.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.57
|
| Rate for Payer: BCBS Complete |
$114.20
|
| Rate for Payer: Cash Price |
$228.40
|
| Rate for Payer: Cofinity Advantage |
$199.85
|
| Rate for Payer: Cofinity Commercial |
$245.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.40
|
| Rate for Payer: Healthscope Commercial |
$256.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.12
|
| Rate for Payer: PHP Commercial |
$242.68
|
| Rate for Payer: Priority Health SBD |
$179.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.57
|
| Rate for Payer: UHC Core |
$148.75
|
| Rate for Payer: UHC Exchange |
$112.20
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
OP
|
$238.90
|
|
|
Service Code
|
NDC 00904703604
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.89 |
| Max. Negotiated Rate |
$215.01 |
| Rate for Payer: Aetna Commercial |
$203.06
|
| Rate for Payer: Aetna Medicare |
$119.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.28
|
| Rate for Payer: BCBS Complete |
$95.56
|
| Rate for Payer: Cash Price |
$191.12
|
| Rate for Payer: Cofinity Advantage |
$167.23
|
| Rate for Payer: Cofinity Commercial |
$205.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.12
|
| Rate for Payer: Healthscope Commercial |
$215.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.18
|
| Rate for Payer: PHP Commercial |
$203.06
|
| Rate for Payer: Priority Health SBD |
$150.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.28
|
| Rate for Payer: UHC Core |
$124.47
|
| Rate for Payer: UHC Exchange |
$93.89
|
|
