|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$498.06
|
|
|
Service Code
|
NDC 68180016106
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.78 |
| Max. Negotiated Rate |
$448.25 |
| Rate for Payer: Aetna Commercial |
$423.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.74
|
| Rate for Payer: Cash Price |
$398.45
|
| Rate for Payer: Cofinity Commercial |
$348.64
|
| Rate for Payer: Cofinity Commercial |
$428.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.45
|
| Rate for Payer: Healthscope Commercial |
$448.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.35
|
| Rate for Payer: PHP Commercial |
$423.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.74
|
| Rate for Payer: Priority Health SBD |
$313.78
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$219.32
|
|
|
Service Code
|
NDC 00904690904
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.73 |
| Max. Negotiated Rate |
$197.39 |
| Rate for Payer: Aetna Commercial |
$186.42
|
| Rate for Payer: Aetna Medicare |
$109.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.56
|
| Rate for Payer: BCBS Complete |
$87.73
|
| Rate for Payer: Cash Price |
$175.46
|
| Rate for Payer: Cofinity Commercial |
$153.52
|
| Rate for Payer: Cofinity Commercial |
$188.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.46
|
| Rate for Payer: Healthscope Commercial |
$197.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.42
|
| Rate for Payer: PHP Commercial |
$186.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.56
|
| Rate for Payer: Priority Health SBD |
$138.17
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$8.35
|
|
|
Service Code
|
NDC 50268009911
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$7.51 |
| Rate for Payer: Aetna Commercial |
$7.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.43
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Cofinity Commercial |
$5.84
|
| Rate for Payer: Cofinity Commercial |
$7.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$7.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.10
|
| Rate for Payer: PHP Commercial |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.43
|
| Rate for Payer: Priority Health SBD |
$5.26
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$91.34
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.54 |
| Max. Negotiated Rate |
$82.21 |
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: Aetna Medicare |
$45.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.37
|
| Rate for Payer: BCBS Complete |
$36.54
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cofinity Commercial |
$63.94
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.07
|
| Rate for Payer: Healthscope Commercial |
$82.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.37
|
| Rate for Payer: Priority Health SBD |
$57.54
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$91.34
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.54 |
| Max. Negotiated Rate |
$82.21 |
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.37
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cofinity Commercial |
$63.94
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.07
|
| Rate for Payer: Healthscope Commercial |
$82.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.37
|
| Rate for Payer: Priority Health SBD |
$57.54
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS CUSTOM
|
Facility
|
OP
|
$91.34
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.54 |
| Max. Negotiated Rate |
$82.21 |
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: Aetna Medicare |
$45.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.37
|
| Rate for Payer: BCBS Complete |
$36.54
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cofinity Commercial |
$63.94
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.07
|
| Rate for Payer: Healthscope Commercial |
$82.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.37
|
| Rate for Payer: Priority Health SBD |
$57.54
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS CUSTOM
|
Facility
|
IP
|
$91.34
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.54 |
| Max. Negotiated Rate |
$82.21 |
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.37
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cofinity Commercial |
$63.94
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.07
|
| Rate for Payer: Healthscope Commercial |
$82.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.37
|
| Rate for Payer: Priority Health SBD |
$57.54
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$196.28
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.51 |
| Max. Negotiated Rate |
$176.65 |
| Rate for Payer: Aetna Commercial |
$166.84
|
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna Medicare |
$93.27
|
| Rate for Payer: Aetna Medicare |
$98.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.24
|
| Rate for Payer: BCBS Complete |
$78.51
|
| Rate for Payer: BCBS Complete |
$74.61
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cofinity Commercial |
$168.80
|
| Rate for Payer: Cofinity Commercial |
$130.57
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| Rate for Payer: Cofinity Commercial |
$137.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.02
|
| Rate for Payer: Healthscope Commercial |
$176.65
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: PHP Commercial |
$166.84
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.58
|
| Rate for Payer: Priority Health SBD |
$117.51
|
| Rate for Payer: Priority Health SBD |
$123.66
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$186.53
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.51 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna Commercial |
$166.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.58
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cofinity Commercial |
$130.57
|
| Rate for Payer: Cofinity Commercial |
$137.40
|
| Rate for Payer: Cofinity Commercial |
$168.80
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.02
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: Healthscope Commercial |
$176.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.84
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: PHP Commercial |
$166.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.24
|
| Rate for Payer: Priority Health SBD |
$123.66
|
| Rate for Payer: Priority Health SBD |
$117.51
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$186.53
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.51 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.24
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cofinity Commercial |
$130.57
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.22
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.24
|
| Rate for Payer: Priority Health SBD |
$117.51
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$186.53
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.61 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna Medicare |
$93.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.24
|
| Rate for Payer: BCBS Complete |
$74.61
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cofinity Commercial |
$130.57
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.22
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.24
|
| Rate for Payer: Priority Health SBD |
$117.51
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$10.23
|
|
|
Service Code
|
NDC 16784011731
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Medicare |
$5.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.65
|
| Rate for Payer: BCBS Complete |
$4.09
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Cofinity Commercial |
$8.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$9.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.70
|
| Rate for Payer: PHP Commercial |
$8.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.65
|
| Rate for Payer: Priority Health SBD |
$6.44
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$10.92
|
|
|
Service Code
|
NDC 70000054701
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna Commercial |
$9.28
|
| Rate for Payer: Aetna Medicare |
$5.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.10
|
| Rate for Payer: BCBS Complete |
$4.37
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.74
|
| Rate for Payer: Healthscope Commercial |
$9.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.28
|
| Rate for Payer: PHP Commercial |
$9.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.10
|
| Rate for Payer: Priority Health SBD |
$6.88
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$10.46
|
|
|
Service Code
|
NDC 00536126328
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Medicare |
$5.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: BCBS Complete |
$4.18
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.59
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.46
|
|
|
Service Code
|
NDC 00536126328
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.59
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.08
|
|
|
Service Code
|
NDC 61269010556
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$9.07 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.55
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cofinity Commercial |
$7.06
|
| Rate for Payer: Cofinity Commercial |
$8.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.06
|
| Rate for Payer: Healthscope Commercial |
$9.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.57
|
| Rate for Payer: PHP Commercial |
$8.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.55
|
| Rate for Payer: Priority Health SBD |
$6.35
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$15.80
|
|
|
Service Code
|
NDC 14428000944
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Medicare |
$7.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.27
|
| Rate for Payer: BCBS Complete |
$6.32
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$11.06
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.27
|
| Rate for Payer: Priority Health SBD |
$9.95
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$15.80
|
|
|
Service Code
|
NDC 14428000944
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.27
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$11.06
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.27
|
| Rate for Payer: Priority Health SBD |
$9.95
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$10.08
|
|
|
Service Code
|
NDC 61269010556
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$9.07 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna Medicare |
$5.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.55
|
| Rate for Payer: BCBS Complete |
$4.03
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cofinity Commercial |
$7.06
|
| Rate for Payer: Cofinity Commercial |
$8.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.06
|
| Rate for Payer: Healthscope Commercial |
$9.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.57
|
| Rate for Payer: PHP Commercial |
$8.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.55
|
| Rate for Payer: Priority Health SBD |
$6.35
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.23
|
|
|
Service Code
|
NDC 16784011731
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.65
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Cofinity Commercial |
$8.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$9.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.70
|
| Rate for Payer: PHP Commercial |
$8.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.65
|
| Rate for Payer: Priority Health SBD |
$6.44
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.92
|
|
|
Service Code
|
NDC 70000054701
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna Commercial |
$9.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.10
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.74
|
| Rate for Payer: Healthscope Commercial |
$9.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.28
|
| Rate for Payer: PHP Commercial |
$9.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.10
|
| Rate for Payer: Priority Health SBD |
$6.88
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT IN PACKET
|
Facility
|
IP
|
$1.27
|
|
|
Service Code
|
NDC 53329008986
|
| Hospital Charge Code |
113171
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna Commercial |
$1.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.83
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cofinity Commercial |
$0.89
|
| Rate for Payer: Cofinity Commercial |
$1.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$1.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.08
|
| Rate for Payer: PHP Commercial |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.83
|
| Rate for Payer: Priority Health SBD |
$0.80
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT IN PACKET
|
Facility
|
IP
|
$1.27
|
|
|
Service Code
|
NDC 53329008987
|
| Hospital Charge Code |
113171
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna Commercial |
$1.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.83
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cofinity Commercial |
$0.89
|
| Rate for Payer: Cofinity Commercial |
$1.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$1.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.08
|
| Rate for Payer: PHP Commercial |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.83
|
| Rate for Payer: Priority Health SBD |
$0.80
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT IN PACKET
|
Facility
|
OP
|
$1.27
|
|
|
Service Code
|
NDC 53329008987
|
| Hospital Charge Code |
113171
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna Commercial |
$1.08
|
| Rate for Payer: Aetna Medicare |
$0.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.83
|
| Rate for Payer: BCBS Complete |
$0.51
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cofinity Commercial |
$0.89
|
| Rate for Payer: Cofinity Commercial |
$1.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$1.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.08
|
| Rate for Payer: PHP Commercial |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.83
|
| Rate for Payer: Priority Health SBD |
$0.80
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT IN PACKET
|
Facility
|
OP
|
$1.27
|
|
|
Service Code
|
NDC 53329008986
|
| Hospital Charge Code |
113171
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna Commercial |
$1.08
|
| Rate for Payer: Aetna Medicare |
$0.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.83
|
| Rate for Payer: BCBS Complete |
$0.51
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cofinity Commercial |
$0.89
|
| Rate for Payer: Cofinity Commercial |
$1.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$1.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.08
|
| Rate for Payer: PHP Commercial |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.83
|
| Rate for Payer: Priority Health SBD |
$0.80
|
|
