|
NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT
|
Facility
|
OP
|
$67.42
|
|
|
Service Code
|
NDC 24208078055
|
| Hospital Charge Code |
38701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$60.68 |
| Rate for Payer: Aetna Commercial |
$57.31
|
| Rate for Payer: Aetna Medicare |
$33.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.82
|
| Rate for Payer: BCBS Complete |
$26.97
|
| Rate for Payer: Cash Price |
$53.94
|
| Rate for Payer: Cofinity Advantage |
$47.19
|
| Rate for Payer: Cofinity Commercial |
$57.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.94
|
| Rate for Payer: Healthscope Commercial |
$60.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.56
|
| Rate for Payer: PHP Commercial |
$57.31
|
| Rate for Payer: Priority Health SBD |
$42.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.82
|
| Rate for Payer: UHC Core |
$35.13
|
| Rate for Payer: UHC Exchange |
$26.50
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
NDC 00810073088
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna Medicare |
$10.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.91
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.79
|
| Rate for Payer: UHC Core |
$11.06
|
| Rate for Payer: UHC Exchange |
$8.34
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$9.58
|
|
|
Service Code
|
NDC 45802014301
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Aetna Commercial |
$8.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.23
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cofinity Advantage |
$6.71
|
| Rate for Payer: Cofinity Commercial |
$8.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.66
|
| Rate for Payer: Healthscope Commercial |
$8.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.18
|
| Rate for Payer: PHP Commercial |
$8.14
|
| Rate for Payer: Priority Health SBD |
$6.04
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
OP
|
$9.58
|
|
|
Service Code
|
NDC 45802014301
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Aetna Commercial |
$8.14
|
| Rate for Payer: Aetna Medicare |
$4.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.23
|
| Rate for Payer: BCBS Complete |
$3.83
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cofinity Advantage |
$6.71
|
| Rate for Payer: Cofinity Commercial |
$8.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.66
|
| Rate for Payer: Healthscope Commercial |
$8.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.18
|
| Rate for Payer: PHP Commercial |
$8.14
|
| Rate for Payer: Priority Health SBD |
$6.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.23
|
| Rate for Payer: UHC Core |
$4.99
|
| Rate for Payer: UHC Exchange |
$3.76
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
NDC 00810073088
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.91
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$240.27
|
|
|
Service Code
|
NDC 57896014314
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.37 |
| Max. Negotiated Rate |
$216.24 |
| Rate for Payer: Aetna Commercial |
$204.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.18
|
| Rate for Payer: Cash Price |
$192.22
|
| Rate for Payer: Cofinity Advantage |
$168.19
|
| Rate for Payer: Cofinity Commercial |
$206.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.22
|
| Rate for Payer: Healthscope Commercial |
$216.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.20
|
| Rate for Payer: PHP Commercial |
$204.23
|
| Rate for Payer: Priority Health SBD |
$151.37
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
OP
|
$399.32
|
|
|
Service Code
|
NDC 00904880567
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.93 |
| Max. Negotiated Rate |
$359.39 |
| Rate for Payer: Aetna Commercial |
$339.42
|
| Rate for Payer: Aetna Medicare |
$199.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.56
|
| Rate for Payer: BCBS Complete |
$159.73
|
| Rate for Payer: Cash Price |
$319.46
|
| Rate for Payer: Cofinity Advantage |
$279.52
|
| Rate for Payer: Cofinity Commercial |
$343.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.46
|
| Rate for Payer: Healthscope Commercial |
$359.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$319.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.49
|
| Rate for Payer: PHP Commercial |
$339.42
|
| Rate for Payer: Priority Health SBD |
$251.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.56
|
| Rate for Payer: UHC Core |
$208.05
|
| Rate for Payer: UHC Exchange |
$156.93
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$517.76
|
|
|
Service Code
|
NDC 47682022335
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$326.19 |
| Max. Negotiated Rate |
$465.98 |
| Rate for Payer: Aetna Commercial |
$440.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.54
|
| Rate for Payer: Cash Price |
$414.21
|
| Rate for Payer: Cofinity Advantage |
$362.43
|
| Rate for Payer: Cofinity Commercial |
$445.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.21
|
| Rate for Payer: Healthscope Commercial |
$465.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.32
|
| Rate for Payer: PHP Commercial |
$440.10
|
| Rate for Payer: Priority Health SBD |
$326.19
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
OP
|
$517.76
|
|
|
Service Code
|
NDC 47682022335
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.48 |
| Max. Negotiated Rate |
$465.98 |
| Rate for Payer: Aetna Commercial |
$440.10
|
| Rate for Payer: Aetna Medicare |
$258.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.54
|
| Rate for Payer: BCBS Complete |
$207.10
|
| Rate for Payer: Cash Price |
$414.21
|
| Rate for Payer: Cofinity Advantage |
$362.43
|
| Rate for Payer: Cofinity Commercial |
$445.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.21
|
| Rate for Payer: Healthscope Commercial |
$465.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$414.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.32
|
| Rate for Payer: PHP Commercial |
$440.10
|
| Rate for Payer: Priority Health SBD |
$326.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.54
|
| Rate for Payer: UHC Core |
$269.75
|
| Rate for Payer: UHC Exchange |
$203.48
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
OP
|
$3.06
|
|
|
Service Code
|
NDC 45802014370
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: Aetna Medicare |
$1.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.99
|
| Rate for Payer: BCBS Complete |
$1.22
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cofinity Advantage |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.45
|
| Rate for Payer: Healthscope Commercial |
$2.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.29
|
| Rate for Payer: PHP Commercial |
$2.60
|
| Rate for Payer: Priority Health SBD |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.99
|
| Rate for Payer: UHC Core |
$1.59
|
| Rate for Payer: UHC Exchange |
$1.20
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$3.06
|
|
|
Service Code
|
NDC 45802014370
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.99
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cofinity Advantage |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.45
|
| Rate for Payer: Healthscope Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.29
|
| Rate for Payer: PHP Commercial |
$2.60
|
| Rate for Payer: Priority Health SBD |
$1.93
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$399.32
|
|
|
Service Code
|
NDC 00904880567
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.57 |
| Max. Negotiated Rate |
$359.39 |
| Rate for Payer: Aetna Commercial |
$339.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.56
|
| Rate for Payer: Cash Price |
$319.46
|
| Rate for Payer: Cofinity Advantage |
$279.52
|
| Rate for Payer: Cofinity Commercial |
$343.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.46
|
| Rate for Payer: Healthscope Commercial |
$359.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.49
|
| Rate for Payer: PHP Commercial |
$339.42
|
| Rate for Payer: Priority Health SBD |
$251.57
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$1.67
|
|
|
Service Code
|
NDC 57896014309
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$1.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.09
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cofinity Advantage |
$1.17
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.34
|
| Rate for Payer: Healthscope Commercial |
$1.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.25
|
| Rate for Payer: PHP Commercial |
$1.42
|
| Rate for Payer: Priority Health SBD |
$1.05
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
OP
|
$1.67
|
|
|
Service Code
|
NDC 57896014309
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: PHP Commercial |
$1.42
|
| Rate for Payer: Aetna Commercial |
$1.42
|
| Rate for Payer: Aetna Medicare |
$0.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.09
|
| Rate for Payer: BCBS Complete |
$0.67
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cofinity Advantage |
$1.17
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.34
|
| Rate for Payer: Healthscope Commercial |
$1.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.25
|
| Rate for Payer: Priority Health SBD |
$1.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.66
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
OP
|
$240.27
|
|
|
Service Code
|
NDC 57896014314
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.43 |
| Max. Negotiated Rate |
$216.24 |
| Rate for Payer: Aetna Commercial |
$204.23
|
| Rate for Payer: Aetna Medicare |
$120.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.18
|
| Rate for Payer: BCBS Complete |
$96.11
|
| Rate for Payer: Cash Price |
$192.22
|
| Rate for Payer: Cofinity Advantage |
$168.19
|
| Rate for Payer: Cofinity Commercial |
$206.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.22
|
| Rate for Payer: Healthscope Commercial |
$216.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.20
|
| Rate for Payer: PHP Commercial |
$204.23
|
| Rate for Payer: Priority Health SBD |
$151.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.18
|
| Rate for Payer: UHC Core |
$125.18
|
| Rate for Payer: UHC Exchange |
$94.43
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 47682022399
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna Commercial |
$3.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.34
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cofinity Advantage |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.88
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.70
|
| Rate for Payer: PHP Commercial |
$3.06
|
| Rate for Payer: Priority Health SBD |
$2.27
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
NDC 47682022399
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna Commercial |
$3.06
|
| Rate for Payer: Aetna Medicare |
$1.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.34
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cofinity Advantage |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.88
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.70
|
| Rate for Payer: PHP Commercial |
$3.06
|
| Rate for Payer: Priority Health SBD |
$2.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.34
|
| Rate for Payer: UHC Core |
$1.88
|
| Rate for Payer: UHC Exchange |
$1.41
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
OP
|
$3.06
|
|
|
Service Code
|
NDC 45802014300
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: Aetna Medicare |
$1.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.99
|
| Rate for Payer: BCBS Complete |
$1.22
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cofinity Advantage |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.45
|
| Rate for Payer: Healthscope Commercial |
$2.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.29
|
| Rate for Payer: PHP Commercial |
$2.60
|
| Rate for Payer: Priority Health SBD |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.99
|
| Rate for Payer: UHC Core |
$1.59
|
| Rate for Payer: UHC Exchange |
$1.20
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$3.06
|
|
|
Service Code
|
NDC 45802014300
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.99
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cofinity Advantage |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.45
|
| Rate for Payer: Healthscope Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.29
|
| Rate for Payer: PHP Commercial |
$2.60
|
| Rate for Payer: Priority Health SBD |
$1.93
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
IP
|
$36.51
|
|
|
Service Code
|
NDC 61314063006
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$32.86 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.73
|
| Rate for Payer: Cash Price |
$29.21
|
| Rate for Payer: Cofinity Advantage |
$25.56
|
| Rate for Payer: Cofinity Commercial |
$31.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.21
|
| Rate for Payer: Healthscope Commercial |
$32.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.38
|
| Rate for Payer: PHP Commercial |
$31.03
|
| Rate for Payer: Priority Health SBD |
$23.00
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
OP
|
$36.51
|
|
|
Service Code
|
NDC 61314063006
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$32.86 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: Aetna Medicare |
$18.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.73
|
| Rate for Payer: BCBS Complete |
$14.60
|
| Rate for Payer: Cash Price |
$29.21
|
| Rate for Payer: Cofinity Advantage |
$25.56
|
| Rate for Payer: Cofinity Commercial |
$31.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.21
|
| Rate for Payer: Healthscope Commercial |
$32.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.38
|
| Rate for Payer: PHP Commercial |
$31.03
|
| Rate for Payer: Priority Health SBD |
$23.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.73
|
| Rate for Payer: UHC Core |
$19.02
|
| Rate for Payer: UHC Exchange |
$14.35
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
OP
|
$51.73
|
|
|
Service Code
|
NDC 24208083060
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$46.56 |
| Rate for Payer: Aetna Commercial |
$43.97
|
| Rate for Payer: Aetna Medicare |
$25.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.62
|
| Rate for Payer: BCBS Complete |
$20.69
|
| Rate for Payer: Cash Price |
$41.38
|
| Rate for Payer: Cofinity Advantage |
$36.21
|
| Rate for Payer: Cofinity Commercial |
$44.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.38
|
| Rate for Payer: Healthscope Commercial |
$46.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.80
|
| Rate for Payer: PHP Commercial |
$43.97
|
| Rate for Payer: Priority Health SBD |
$32.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.62
|
| Rate for Payer: UHC Core |
$26.95
|
| Rate for Payer: UHC Exchange |
$20.33
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
IP
|
$51.73
|
|
|
Service Code
|
NDC 24208083060
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$46.56 |
| Rate for Payer: Aetna Commercial |
$43.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.62
|
| Rate for Payer: Cash Price |
$41.38
|
| Rate for Payer: Cofinity Advantage |
$36.21
|
| Rate for Payer: Cofinity Commercial |
$44.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.38
|
| Rate for Payer: Healthscope Commercial |
$46.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.80
|
| Rate for Payer: PHP Commercial |
$43.97
|
| Rate for Payer: Priority Health SBD |
$32.59
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
IP
|
$157.82
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.43 |
| Max. Negotiated Rate |
$142.04 |
| Rate for Payer: Aetna Commercial |
$134.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.58
|
| Rate for Payer: Cash Price |
$126.26
|
| Rate for Payer: Cofinity Advantage |
$110.47
|
| Rate for Payer: Cofinity Commercial |
$135.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.26
|
| Rate for Payer: Healthscope Commercial |
$142.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.36
|
| Rate for Payer: PHP Commercial |
$134.15
|
| Rate for Payer: Priority Health SBD |
$99.43
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
OP
|
$157.82
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.02 |
| Max. Negotiated Rate |
$142.04 |
| Rate for Payer: Aetna Commercial |
$134.15
|
| Rate for Payer: Aetna Medicare |
$78.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.58
|
| Rate for Payer: BCBS Complete |
$63.13
|
| Rate for Payer: Cash Price |
$126.26
|
| Rate for Payer: Cofinity Advantage |
$110.47
|
| Rate for Payer: Cofinity Commercial |
$135.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.26
|
| Rate for Payer: Healthscope Commercial |
$142.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.36
|
| Rate for Payer: PHP Commercial |
$134.15
|
| Rate for Payer: Priority Health SBD |
$99.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.58
|
| Rate for Payer: UHC Core |
$82.22
|
| Rate for Payer: UHC Exchange |
$62.02
|
|
