|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$7.89
|
|
|
Service Code
|
NDC 60687080040
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.13
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cofinity Advantage |
$5.52
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.92
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health SBD |
$4.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.13
|
| Rate for Payer: UHC Core |
$4.11
|
| Rate for Payer: UHC Exchange |
$3.10
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$102.65
|
|
|
Service Code
|
NDC 69315050447
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.67 |
| Max. Negotiated Rate |
$92.39 |
| Rate for Payer: Aetna Commercial |
$87.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.72
|
| Rate for Payer: Cash Price |
$82.12
|
| Rate for Payer: Cofinity Advantage |
$71.86
|
| Rate for Payer: Cofinity Commercial |
$88.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.12
|
| Rate for Payer: Healthscope Commercial |
$92.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.99
|
| Rate for Payer: PHP Commercial |
$87.25
|
| Rate for Payer: Priority Health SBD |
$64.67
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$7.86
|
|
|
Service Code
|
NDC 68094059962
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna Commercial |
$6.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.11
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cofinity Advantage |
$5.50
|
| Rate for Payer: Cofinity Commercial |
$6.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.29
|
| Rate for Payer: Healthscope Commercial |
$7.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.89
|
| Rate for Payer: PHP Commercial |
$6.68
|
| Rate for Payer: Priority Health SBD |
$4.95
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$5.10
|
|
|
Service Code
|
NDC 00121478505
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$4.33
|
| Rate for Payer: Aetna Medicare |
$2.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.31
|
| Rate for Payer: BCBS Complete |
$2.04
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cofinity Advantage |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.08
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.83
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: Priority Health SBD |
$3.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.31
|
| Rate for Payer: UHC Core |
$2.66
|
| Rate for Payer: UHC Exchange |
$2.00
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$9.69
|
|
|
Service Code
|
NDC 00121086850
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$8.72 |
| Rate for Payer: Aetna Commercial |
$8.24
|
| Rate for Payer: Aetna Medicare |
$4.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.30
|
| Rate for Payer: BCBS Complete |
$3.88
|
| Rate for Payer: Cash Price |
$7.75
|
| Rate for Payer: Cofinity Advantage |
$6.78
|
| Rate for Payer: Cofinity Commercial |
$8.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.75
|
| Rate for Payer: Healthscope Commercial |
$8.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.27
|
| Rate for Payer: PHP Commercial |
$8.24
|
| Rate for Payer: Priority Health SBD |
$6.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.30
|
| Rate for Payer: UHC Core |
$5.05
|
| Rate for Payer: UHC Exchange |
$3.81
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$7.89
|
|
|
Service Code
|
NDC 60687080017
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.13
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cofinity Advantage |
$5.52
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.92
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health SBD |
$4.97
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$5.10
|
|
|
Service Code
|
NDC 00121478505
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$4.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.31
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cofinity Advantage |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.08
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.83
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: Priority Health SBD |
$3.21
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
NDC 09900001998
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| Rate for Payer: BCBS Complete |
$1.49
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Advantage |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.79
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health SBD |
$2.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.42
|
| Rate for Payer: UHC Core |
$1.94
|
| Rate for Payer: UHC Exchange |
$1.46
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$5.46
|
|
|
Service Code
|
NDC 68094059961
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Aetna Commercial |
$4.64
|
| Rate for Payer: Aetna Medicare |
$2.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.55
|
| Rate for Payer: BCBS Complete |
$2.18
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cofinity Advantage |
$3.82
|
| Rate for Payer: Cofinity Commercial |
$4.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.37
|
| Rate for Payer: Healthscope Commercial |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.09
|
| Rate for Payer: PHP Commercial |
$4.64
|
| Rate for Payer: Priority Health SBD |
$3.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.55
|
| Rate for Payer: UHC Core |
$2.84
|
| Rate for Payer: UHC Exchange |
$2.15
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$41.58
|
|
|
Service Code
|
NDC 60432053760
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$37.42 |
| Rate for Payer: Aetna Commercial |
$35.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.03
|
| Rate for Payer: Cash Price |
$33.26
|
| Rate for Payer: Cofinity Advantage |
$29.11
|
| Rate for Payer: Cofinity Commercial |
$35.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.26
|
| Rate for Payer: Healthscope Commercial |
$37.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.18
|
| Rate for Payer: PHP Commercial |
$35.34
|
| Rate for Payer: Priority Health SBD |
$26.20
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$406.98
|
|
|
Service Code
|
NDC 62135081346
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.94 |
| Max. Negotiated Rate |
$366.28 |
| Rate for Payer: Aetna Commercial |
$345.93
|
| Rate for Payer: Aetna Medicare |
$203.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.54
|
| Rate for Payer: BCBS Complete |
$162.79
|
| Rate for Payer: Cash Price |
$325.58
|
| Rate for Payer: Cofinity Advantage |
$284.89
|
| Rate for Payer: Cofinity Commercial |
$350.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.58
|
| Rate for Payer: Healthscope Commercial |
$366.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$325.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$305.24
|
| Rate for Payer: PHP Commercial |
$345.93
|
| Rate for Payer: Priority Health SBD |
$256.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.54
|
| Rate for Payer: UHC Core |
$212.04
|
| Rate for Payer: UHC Exchange |
$159.94
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$5.49
|
|
|
Service Code
|
NDC 66689003701
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: Aetna Medicare |
$2.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.57
|
| Rate for Payer: BCBS Complete |
$2.20
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cofinity Advantage |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.39
|
| Rate for Payer: Healthscope Commercial |
$4.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.12
|
| Rate for Payer: PHP Commercial |
$4.67
|
| Rate for Payer: Priority Health SBD |
$3.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.57
|
| Rate for Payer: UHC Core |
$2.86
|
| Rate for Payer: UHC Exchange |
$2.16
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 09900001998
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Advantage |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.79
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health SBD |
$2.34
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$4.68
|
|
|
Service Code
|
NDC 00121086840
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.04
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Advantage |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.51
|
| Rate for Payer: PHP Commercial |
$3.98
|
| Rate for Payer: Priority Health SBD |
$2.95
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$39.06
|
|
|
Service Code
|
NDC 69315050460
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.39
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Advantage |
$27.34
|
| Rate for Payer: Cofinity Commercial |
$33.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$35.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.30
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: Priority Health SBD |
$24.61
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$41.58
|
|
|
Service Code
|
NDC 60432053760
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$37.42 |
| Rate for Payer: Aetna Commercial |
$35.34
|
| Rate for Payer: Aetna Medicare |
$20.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.03
|
| Rate for Payer: BCBS Complete |
$16.63
|
| Rate for Payer: Cash Price |
$33.26
|
| Rate for Payer: Cofinity Advantage |
$29.11
|
| Rate for Payer: Cofinity Commercial |
$35.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.26
|
| Rate for Payer: Healthscope Commercial |
$37.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.18
|
| Rate for Payer: PHP Commercial |
$35.34
|
| Rate for Payer: Priority Health SBD |
$26.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.03
|
| Rate for Payer: UHC Core |
$21.66
|
| Rate for Payer: UHC Exchange |
$16.34
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$5.46
|
|
|
Service Code
|
NDC 68094059961
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Aetna Commercial |
$4.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.55
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cofinity Advantage |
$3.82
|
| Rate for Payer: Cofinity Commercial |
$4.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.37
|
| Rate for Payer: Healthscope Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.09
|
| Rate for Payer: PHP Commercial |
$4.64
|
| Rate for Payer: Priority Health SBD |
$3.44
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.70
|
|
|
Service Code
|
NDC 00121086805
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Aetna Commercial |
$7.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.66
|
| Rate for Payer: Cash Price |
$6.96
|
| Rate for Payer: Cofinity Advantage |
$6.09
|
| Rate for Payer: Cofinity Commercial |
$7.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.96
|
| Rate for Payer: Healthscope Commercial |
$7.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.53
|
| Rate for Payer: PHP Commercial |
$7.39
|
| Rate for Payer: Priority Health SBD |
$5.48
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$289.72
|
|
|
Service Code
|
NDC 60432053716
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.52 |
| Max. Negotiated Rate |
$260.75 |
| Rate for Payer: Aetna Commercial |
$246.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.32
|
| Rate for Payer: Cash Price |
$231.78
|
| Rate for Payer: Cofinity Advantage |
$202.80
|
| Rate for Payer: Cofinity Commercial |
$249.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.78
|
| Rate for Payer: Healthscope Commercial |
$260.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.29
|
| Rate for Payer: PHP Commercial |
$246.26
|
| Rate for Payer: Priority Health SBD |
$182.52
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$406.98
|
|
|
Service Code
|
NDC 62135081346
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$366.28 |
| Rate for Payer: Aetna Commercial |
$345.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.54
|
| Rate for Payer: Cash Price |
$325.58
|
| Rate for Payer: Cofinity Advantage |
$284.89
|
| Rate for Payer: Cofinity Commercial |
$350.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.58
|
| Rate for Payer: Healthscope Commercial |
$366.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$305.24
|
| Rate for Payer: PHP Commercial |
$345.93
|
| Rate for Payer: Priority Health SBD |
$256.40
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$102.65
|
|
|
Service Code
|
NDC 69315050447
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.34 |
| Max. Negotiated Rate |
$92.39 |
| Rate for Payer: Aetna Commercial |
$87.25
|
| Rate for Payer: Aetna Medicare |
$51.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.72
|
| Rate for Payer: BCBS Complete |
$41.06
|
| Rate for Payer: Cash Price |
$82.12
|
| Rate for Payer: Cofinity Advantage |
$71.86
|
| Rate for Payer: Cofinity Commercial |
$88.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.12
|
| Rate for Payer: Healthscope Commercial |
$92.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.99
|
| Rate for Payer: PHP Commercial |
$87.25
|
| Rate for Payer: Priority Health SBD |
$64.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.72
|
| Rate for Payer: UHC Core |
$53.48
|
| Rate for Payer: UHC Exchange |
$40.34
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$39.06
|
|
|
Service Code
|
NDC 69315050460
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: Aetna Medicare |
$19.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.39
|
| Rate for Payer: BCBS Complete |
$15.62
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Advantage |
$27.34
|
| Rate for Payer: Cofinity Commercial |
$33.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$35.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.30
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: Priority Health SBD |
$24.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.39
|
| Rate for Payer: UHC Core |
$20.35
|
| Rate for Payer: UHC Exchange |
$15.35
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$7.86
|
|
|
Service Code
|
NDC 68094059962
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna Commercial |
$6.68
|
| Rate for Payer: Aetna Medicare |
$3.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.11
|
| Rate for Payer: BCBS Complete |
$3.14
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cofinity Advantage |
$5.50
|
| Rate for Payer: Cofinity Commercial |
$6.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.29
|
| Rate for Payer: Healthscope Commercial |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.89
|
| Rate for Payer: PHP Commercial |
$6.68
|
| Rate for Payer: Priority Health SBD |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.11
|
| Rate for Payer: UHC Core |
$4.10
|
| Rate for Payer: UHC Exchange |
$3.09
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$7.89
|
|
|
Service Code
|
NDC 60687080040
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.13
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cofinity Advantage |
$5.52
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.92
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health SBD |
$4.97
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$8.70
|
|
|
Service Code
|
NDC 00121086805
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Aetna Commercial |
$7.39
|
| Rate for Payer: Aetna Medicare |
$4.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.66
|
| Rate for Payer: BCBS Complete |
$3.48
|
| Rate for Payer: Cash Price |
$6.96
|
| Rate for Payer: Cofinity Advantage |
$6.09
|
| Rate for Payer: Cofinity Commercial |
$7.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.96
|
| Rate for Payer: Healthscope Commercial |
$7.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.53
|
| Rate for Payer: PHP Commercial |
$7.39
|
| Rate for Payer: Priority Health SBD |
$5.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.66
|
| Rate for Payer: UHC Core |
$4.53
|
| Rate for Payer: UHC Exchange |
$3.42
|
|
