|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
IP
|
$45.71
|
|
|
Service Code
|
NDC 24208083060
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$41.14 |
| Rate for Payer: Aetna Commercial |
$38.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.71
|
| Rate for Payer: Cash Price |
$36.57
|
| Rate for Payer: Cofinity Commercial |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$39.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.57
|
| Rate for Payer: Healthscope Commercial |
$41.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.85
|
| Rate for Payer: PHP Commercial |
$38.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.71
|
| Rate for Payer: Priority Health SBD |
$28.80
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
IP
|
$153.76
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.87 |
| Max. Negotiated Rate |
$138.38 |
| Rate for Payer: Aetna Commercial |
$130.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.94
|
| Rate for Payer: Cash Price |
$123.01
|
| Rate for Payer: Cofinity Commercial |
$107.63
|
| Rate for Payer: Cofinity Commercial |
$132.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.01
|
| Rate for Payer: Healthscope Commercial |
$138.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.70
|
| Rate for Payer: PHP Commercial |
$130.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.94
|
| Rate for Payer: Priority Health SBD |
$96.87
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
OP
|
$153.76
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$138.38 |
| Rate for Payer: Aetna Commercial |
$130.70
|
| Rate for Payer: Aetna Medicare |
$76.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.94
|
| Rate for Payer: BCBS Complete |
$61.50
|
| Rate for Payer: Cash Price |
$123.01
|
| Rate for Payer: Cofinity Commercial |
$107.63
|
| Rate for Payer: Cofinity Commercial |
$132.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.01
|
| Rate for Payer: Healthscope Commercial |
$138.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.70
|
| Rate for Payer: PHP Commercial |
$130.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.94
|
| Rate for Payer: Priority Health SBD |
$96.87
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
OP
|
$189.84
|
|
|
Service Code
|
NDC 24208063110
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.94 |
| Max. Negotiated Rate |
$170.86 |
| Rate for Payer: Aetna Commercial |
$161.36
|
| Rate for Payer: Aetna Medicare |
$94.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.40
|
| Rate for Payer: BCBS Complete |
$75.94
|
| Rate for Payer: Cash Price |
$151.87
|
| Rate for Payer: Cofinity Commercial |
$132.89
|
| Rate for Payer: Cofinity Commercial |
$163.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.87
|
| Rate for Payer: Healthscope Commercial |
$170.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.36
|
| Rate for Payer: PHP Commercial |
$161.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.40
|
| Rate for Payer: Priority Health SBD |
$119.60
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
IP
|
$189.84
|
|
|
Service Code
|
NDC 24208063110
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$170.86 |
| Rate for Payer: Aetna Commercial |
$161.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.40
|
| Rate for Payer: Cash Price |
$151.87
|
| Rate for Payer: Cofinity Commercial |
$132.89
|
| Rate for Payer: Cofinity Commercial |
$163.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.87
|
| Rate for Payer: Healthscope Commercial |
$170.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.36
|
| Rate for Payer: PHP Commercial |
$161.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.40
|
| Rate for Payer: Priority Health SBD |
$119.60
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.97
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
167219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$24.27 |
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$63.33
|
| Rate for Payer: Aetna Commercial |
$20.77
|
| Rate for Payer: Aetna Commercial |
$18.77
|
| Rate for Payer: Aetna Commercial |
$13.15
|
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: Aetna Commercial |
$21.20
|
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Medicare |
$10.96
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: Aetna Medicare |
$11.04
|
| Rate for Payer: Aetna Medicare |
$37.25
|
| Rate for Payer: Aetna Medicare |
$8.26
|
| Rate for Payer: Aetna Medicare |
$7.74
|
| Rate for Payer: Aetna Medicare |
$12.22
|
| Rate for Payer: Aetna Medicare |
$12.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.89
|
| Rate for Payer: BCBS Complete |
$8.83
|
| Rate for Payer: BCBS Complete |
$6.60
|
| Rate for Payer: BCBS Complete |
$29.80
|
| Rate for Payer: BCBS Complete |
$8.76
|
| Rate for Payer: BCBS Complete |
$6.19
|
| Rate for Payer: BCBS Complete |
$9.78
|
| Rate for Payer: BCBS Complete |
$9.98
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Cash Price |
$19.55
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cash Price |
$19.95
|
| Rate for Payer: Cash Price |
$59.60
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cofinity Commercial |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Cofinity Commercial |
$10.83
|
| Rate for Payer: Cofinity Commercial |
$18.99
|
| Rate for Payer: Cofinity Commercial |
$21.02
|
| Rate for Payer: Cofinity Commercial |
$64.07
|
| Rate for Payer: Cofinity Commercial |
$52.15
|
| Rate for Payer: Cofinity Commercial |
$21.45
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$17.11
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.60
|
| Rate for Payer: Healthscope Commercial |
$22.00
|
| Rate for Payer: Healthscope Commercial |
$67.05
|
| Rate for Payer: Healthscope Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$13.92
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Healthscope Commercial |
$19.72
|
| Rate for Payer: Healthscope Commercial |
$22.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.33
|
| Rate for Payer: PHP Commercial |
$20.77
|
| Rate for Payer: PHP Commercial |
$63.33
|
| Rate for Payer: PHP Commercial |
$21.20
|
| Rate for Payer: PHP Commercial |
$13.15
|
| Rate for Payer: PHP Commercial |
$18.77
|
| Rate for Payer: PHP Commercial |
$14.03
|
| Rate for Payer: PHP Commercial |
$18.62
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.89
|
| Rate for Payer: Priority Health SBD |
$13.80
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: Priority Health SBD |
$9.75
|
| Rate for Payer: Priority Health SBD |
$46.94
|
| Rate for Payer: Priority Health SBD |
$10.40
|
| Rate for Payer: Priority Health SBD |
$13.91
|
| Rate for Payer: Priority Health SBD |
$15.40
|
| Rate for Payer: Priority Health SBD |
$15.71
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.97
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
167219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$24.27 |
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$21.20
|
| Rate for Payer: Aetna Commercial |
$20.77
|
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: Aetna Commercial |
$13.15
|
| Rate for Payer: Aetna Commercial |
$18.77
|
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Commercial |
$63.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.73
|
| Rate for Payer: Cash Price |
$19.55
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cash Price |
$19.95
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$59.60
|
| Rate for Payer: Cofinity Commercial |
$10.83
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Cofinity Commercial |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$18.99
|
| Rate for Payer: Cofinity Commercial |
$17.11
|
| Rate for Payer: Cofinity Commercial |
$21.02
|
| Rate for Payer: Cofinity Commercial |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$21.45
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$52.15
|
| Rate for Payer: Cofinity Commercial |
$64.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$22.00
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Healthscope Commercial |
$13.92
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$19.72
|
| Rate for Payer: Healthscope Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$67.05
|
| Rate for Payer: Healthscope Commercial |
$22.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.62
|
| Rate for Payer: PHP Commercial |
$18.62
|
| Rate for Payer: PHP Commercial |
$18.77
|
| Rate for Payer: PHP Commercial |
$20.77
|
| Rate for Payer: PHP Commercial |
$21.20
|
| Rate for Payer: PHP Commercial |
$63.33
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$13.15
|
| Rate for Payer: PHP Commercial |
$14.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.21
|
| Rate for Payer: Priority Health SBD |
$15.40
|
| Rate for Payer: Priority Health SBD |
$13.80
|
| Rate for Payer: Priority Health SBD |
$9.75
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: Priority Health SBD |
$46.94
|
| Rate for Payer: Priority Health SBD |
$13.91
|
| Rate for Payer: Priority Health SBD |
$10.40
|
| Rate for Payer: Priority Health SBD |
$15.71
|
|
|
NETARSUDIL 0.02 % EYE DROPS
|
Facility
|
IP
|
$1,087.73
|
|
|
Service Code
|
NDC 70727049725
|
| Hospital Charge Code |
186103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$685.27 |
| Max. Negotiated Rate |
$978.96 |
| Rate for Payer: Aetna Commercial |
$924.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$707.02
|
| Rate for Payer: Cash Price |
$870.18
|
| Rate for Payer: Cofinity Commercial |
$761.41
|
| Rate for Payer: Cofinity Commercial |
$935.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$761.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.18
|
| Rate for Payer: Healthscope Commercial |
$978.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$924.57
|
| Rate for Payer: PHP Commercial |
$924.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.02
|
| Rate for Payer: Priority Health SBD |
$685.27
|
|
|
NETARSUDIL 0.02 % EYE DROPS
|
Facility
|
OP
|
$1,087.73
|
|
|
Service Code
|
NDC 70727049725
|
| Hospital Charge Code |
186103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$435.09 |
| Max. Negotiated Rate |
$978.96 |
| Rate for Payer: Aetna Commercial |
$924.57
|
| Rate for Payer: Aetna Medicare |
$543.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$707.02
|
| Rate for Payer: BCBS Complete |
$435.09
|
| Rate for Payer: Cash Price |
$870.18
|
| Rate for Payer: Cofinity Commercial |
$761.41
|
| Rate for Payer: Cofinity Commercial |
$935.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$761.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.18
|
| Rate for Payer: Healthscope Commercial |
$978.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$924.57
|
| Rate for Payer: PHP Commercial |
$924.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.02
|
| Rate for Payer: Priority Health SBD |
$685.27
|
|
|
NEURECTOMY, INTRINSIC MUSCULATURE OF FOOT
|
Facility
|
OP
|
$5,360.98
|
|
|
Service Code
|
CPT 28055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,072.23
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL
|
Facility
|
OP
|
$5,360.98
|
|
|
Service Code
|
CPT 64721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,072.23
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW
|
Facility
|
OP
|
$5,360.98
|
|
|
Service Code
|
CPT 64718
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,072.23
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT WRIST
|
Facility
|
OP
|
$5,360.98
|
|
|
Service Code
|
CPT 64719
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,072.23
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, OPEN; OTHER THAN SPECIFIED
|
Facility
|
OP
|
$5,360.98
|
|
|
Service Code
|
CPT 64708
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,072.23
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$8.64
|
|
|
Service Code
|
NDC 50268058411
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.62
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$6.05
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.62
|
| Rate for Payer: Priority Health SBD |
$5.44
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$259.06
|
|
|
Service Code
|
NDC 50268058413
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.62 |
| Max. Negotiated Rate |
$233.15 |
| Rate for Payer: Aetna Commercial |
$220.20
|
| Rate for Payer: Aetna Medicare |
$129.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.39
|
| Rate for Payer: BCBS Complete |
$103.62
|
| Rate for Payer: Cash Price |
$207.25
|
| Rate for Payer: Cofinity Commercial |
$181.34
|
| Rate for Payer: Cofinity Commercial |
$222.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.25
|
| Rate for Payer: Healthscope Commercial |
$233.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.20
|
| Rate for Payer: PHP Commercial |
$220.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.39
|
| Rate for Payer: Priority Health SBD |
$163.21
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$259.06
|
|
|
Service Code
|
NDC 50268058413
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.21 |
| Max. Negotiated Rate |
$233.15 |
| Rate for Payer: Aetna Commercial |
$220.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.39
|
| Rate for Payer: Cash Price |
$207.25
|
| Rate for Payer: Cofinity Commercial |
$181.34
|
| Rate for Payer: Cofinity Commercial |
$222.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.25
|
| Rate for Payer: Healthscope Commercial |
$233.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.20
|
| Rate for Payer: PHP Commercial |
$220.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.39
|
| Rate for Payer: Priority Health SBD |
$163.21
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$8.64
|
|
|
Service Code
|
NDC 50268058411
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Medicare |
$4.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.62
|
| Rate for Payer: BCBS Complete |
$3.46
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$6.05
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.62
|
| Rate for Payer: Priority Health SBD |
$5.44
|
|
|
NICARDIPINE 20 MG CAPSULE
|
Facility
|
OP
|
$707.96
|
|
|
Service Code
|
NDC 42806050109
|
| Hospital Charge Code |
10712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$283.18 |
| Max. Negotiated Rate |
$637.16 |
| Rate for Payer: Aetna Commercial |
$601.77
|
| Rate for Payer: Aetna Medicare |
$353.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.17
|
| Rate for Payer: BCBS Complete |
$283.18
|
| Rate for Payer: Cash Price |
$566.37
|
| Rate for Payer: Cofinity Commercial |
$495.57
|
| Rate for Payer: Cofinity Commercial |
$608.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$495.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.37
|
| Rate for Payer: Healthscope Commercial |
$637.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.77
|
| Rate for Payer: PHP Commercial |
$601.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.17
|
| Rate for Payer: Priority Health SBD |
$446.01
|
|
|
NICARDIPINE 20 MG CAPSULE
|
Facility
|
IP
|
$714.96
|
|
|
Service Code
|
NDC 00378102077
|
| Hospital Charge Code |
10712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$450.42 |
| Max. Negotiated Rate |
$643.46 |
| Rate for Payer: Aetna Commercial |
$607.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.72
|
| Rate for Payer: Cash Price |
$571.97
|
| Rate for Payer: Cofinity Commercial |
$500.47
|
| Rate for Payer: Cofinity Commercial |
$614.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$500.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.97
|
| Rate for Payer: Healthscope Commercial |
$643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.72
|
| Rate for Payer: PHP Commercial |
$607.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.72
|
| Rate for Payer: Priority Health SBD |
$450.42
|
|
|
NICARDIPINE 20 MG CAPSULE
|
Facility
|
OP
|
$714.96
|
|
|
Service Code
|
NDC 00378102077
|
| Hospital Charge Code |
10712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$285.98 |
| Max. Negotiated Rate |
$643.46 |
| Rate for Payer: Aetna Commercial |
$607.72
|
| Rate for Payer: Aetna Medicare |
$357.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.72
|
| Rate for Payer: BCBS Complete |
$285.98
|
| Rate for Payer: Cash Price |
$571.97
|
| Rate for Payer: Cofinity Commercial |
$500.47
|
| Rate for Payer: Cofinity Commercial |
$614.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$500.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.97
|
| Rate for Payer: Healthscope Commercial |
$643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.72
|
| Rate for Payer: PHP Commercial |
$607.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.72
|
| Rate for Payer: Priority Health SBD |
$450.42
|
|
|
NICARDIPINE 20 MG CAPSULE
|
Facility
|
IP
|
$707.96
|
|
|
Service Code
|
NDC 42806050109
|
| Hospital Charge Code |
10712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$446.01 |
| Max. Negotiated Rate |
$637.16 |
| Rate for Payer: Aetna Commercial |
$601.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.17
|
| Rate for Payer: Cash Price |
$566.37
|
| Rate for Payer: Cofinity Commercial |
$495.57
|
| Rate for Payer: Cofinity Commercial |
$608.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$495.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.37
|
| Rate for Payer: Healthscope Commercial |
$637.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.77
|
| Rate for Payer: PHP Commercial |
$601.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.17
|
| Rate for Payer: Priority Health SBD |
$446.01
|
|
|
NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$51.76
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
12370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$46.58 |
| Rate for Payer: Aetna Commercial |
$44.00
|
| Rate for Payer: Aetna Commercial |
$40.97
|
| Rate for Payer: Aetna Medicare |
$24.10
|
| Rate for Payer: Aetna Medicare |
$25.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.33
|
| Rate for Payer: BCBS Complete |
$20.70
|
| Rate for Payer: BCBS Complete |
$19.28
|
| Rate for Payer: Cash Price |
$41.41
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cofinity Commercial |
$44.51
|
| Rate for Payer: Cofinity Commercial |
$33.74
|
| Rate for Payer: Cofinity Commercial |
$41.45
|
| Rate for Payer: Cofinity Commercial |
$36.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.41
|
| Rate for Payer: Healthscope Commercial |
$46.58
|
| Rate for Payer: Healthscope Commercial |
$43.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.97
|
| Rate for Payer: PHP Commercial |
$44.00
|
| Rate for Payer: PHP Commercial |
$40.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.64
|
| Rate for Payer: Priority Health SBD |
$30.37
|
| Rate for Payer: Priority Health SBD |
$32.61
|
|
|
NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$51.76
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
12370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$46.58 |
| Rate for Payer: Aetna Commercial |
$44.00
|
| Rate for Payer: Aetna Commercial |
$40.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.64
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cash Price |
$41.41
|
| Rate for Payer: Cofinity Commercial |
$41.45
|
| Rate for Payer: Cofinity Commercial |
$44.51
|
| Rate for Payer: Cofinity Commercial |
$36.23
|
| Rate for Payer: Cofinity Commercial |
$33.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.41
|
| Rate for Payer: Healthscope Commercial |
$43.38
|
| Rate for Payer: Healthscope Commercial |
$46.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.97
|
| Rate for Payer: PHP Commercial |
$40.97
|
| Rate for Payer: PHP Commercial |
$44.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.64
|
| Rate for Payer: Priority Health SBD |
$30.37
|
| Rate for Payer: Priority Health SBD |
$32.61
|
|
|
NICARDIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$789.55
|
|
|
Service Code
|
NDC 00378143077
|
| Hospital Charge Code |
10713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$315.82 |
| Max. Negotiated Rate |
$710.60 |
| Rate for Payer: Aetna Commercial |
$671.12
|
| Rate for Payer: Aetna Medicare |
$394.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.21
|
| Rate for Payer: BCBS Complete |
$315.82
|
| Rate for Payer: Cash Price |
$631.64
|
| Rate for Payer: Cofinity Commercial |
$552.68
|
| Rate for Payer: Cofinity Commercial |
$679.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$552.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$631.64
|
| Rate for Payer: Healthscope Commercial |
$710.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.12
|
| Rate for Payer: PHP Commercial |
$671.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.21
|
| Rate for Payer: Priority Health SBD |
$497.42
|
|
