|
CHLORDIAZEPOXIDE 25 MG CAPSULE
|
Facility
|
OP
|
$1,880.00
|
|
|
Service Code
|
NDC 00555015904
|
| Hospital Charge Code |
1623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$738.84 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Aetna Commercial |
$1,598.00
|
| Rate for Payer: Aetna Medicare |
$940.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,222.00
|
| Rate for Payer: BCBS Complete |
$752.00
|
| Rate for Payer: Cash Price |
$1,504.00
|
| Rate for Payer: Cofinity Advantage |
$1,316.00
|
| Rate for Payer: Cofinity Commercial |
$1,616.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,504.00
|
| Rate for Payer: Healthscope Commercial |
$1,692.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,504.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,598.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,410.00
|
| Rate for Payer: PHP Commercial |
$1,598.00
|
| Rate for Payer: Priority Health SBD |
$1,184.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,222.00
|
| Rate for Payer: UHC Core |
$979.48
|
| Rate for Payer: UHC Exchange |
$738.84
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE
|
Facility
|
IP
|
$4.70
|
|
|
Service Code
|
NDC 51079014101
|
| Hospital Charge Code |
1623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.06
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cofinity Advantage |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$4.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$4.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.52
|
| Rate for Payer: PHP Commercial |
$4.00
|
| Rate for Payer: Priority Health SBD |
$2.96
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE
|
Facility
|
OP
|
$4.70
|
|
|
Service Code
|
NDC 51079014101
|
| Hospital Charge Code |
1623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Aetna Medicare |
$2.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.06
|
| Rate for Payer: BCBS Complete |
$1.88
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cofinity Advantage |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$4.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$4.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.52
|
| Rate for Payer: PHP Commercial |
$4.00
|
| Rate for Payer: Priority Health SBD |
$2.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.06
|
| Rate for Payer: UHC Core |
$2.45
|
| Rate for Payer: UHC Exchange |
$1.85
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE
|
Facility
|
IP
|
$1,880.00
|
|
|
Service Code
|
NDC 00555015904
|
| Hospital Charge Code |
1623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,184.40 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Aetna Commercial |
$1,598.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,222.00
|
| Rate for Payer: Cash Price |
$1,504.00
|
| Rate for Payer: Cofinity Advantage |
$1,316.00
|
| Rate for Payer: Cofinity Commercial |
$1,616.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,504.00
|
| Rate for Payer: Healthscope Commercial |
$1,692.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,598.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,410.00
|
| Rate for Payer: PHP Commercial |
$1,598.00
|
| Rate for Payer: Priority Health SBD |
$1,184.40
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE
|
Facility
|
IP
|
$469.30
|
|
|
Service Code
|
NDC 51079014120
|
| Hospital Charge Code |
1623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$295.66 |
| Max. Negotiated Rate |
$422.37 |
| Rate for Payer: Aetna Commercial |
$398.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.05
|
| Rate for Payer: Cash Price |
$375.44
|
| Rate for Payer: Cofinity Advantage |
$328.51
|
| Rate for Payer: Cofinity Commercial |
$403.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.44
|
| Rate for Payer: Healthscope Commercial |
$422.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.98
|
| Rate for Payer: PHP Commercial |
$398.90
|
| Rate for Payer: Priority Health SBD |
$295.66
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE
|
Facility
|
OP
|
$385.40
|
|
|
Service Code
|
NDC 00555015902
|
| Hospital Charge Code |
1623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.46 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna Medicare |
$192.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: BCBS Complete |
$154.16
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Advantage |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$308.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.05
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health SBD |
$242.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.51
|
| Rate for Payer: UHC Core |
$200.79
|
| Rate for Payer: UHC Exchange |
$151.46
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE
|
Facility
|
OP
|
$469.30
|
|
|
Service Code
|
NDC 51079014120
|
| Hospital Charge Code |
1623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.43 |
| Max. Negotiated Rate |
$422.37 |
| Rate for Payer: Aetna Commercial |
$398.90
|
| Rate for Payer: Aetna Medicare |
$234.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.05
|
| Rate for Payer: BCBS Complete |
$187.72
|
| Rate for Payer: Cash Price |
$375.44
|
| Rate for Payer: Cofinity Advantage |
$328.51
|
| Rate for Payer: Cofinity Commercial |
$403.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.44
|
| Rate for Payer: Healthscope Commercial |
$422.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$375.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.98
|
| Rate for Payer: PHP Commercial |
$398.90
|
| Rate for Payer: Priority Health SBD |
$295.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.05
|
| Rate for Payer: UHC Core |
$244.51
|
| Rate for Payer: UHC Exchange |
$184.43
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE
|
Facility
|
IP
|
$385.40
|
|
|
Service Code
|
NDC 00555015902
|
| Hospital Charge Code |
1623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.80 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Advantage |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.05
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health SBD |
$242.80
|
|
|
CHLORDIAZEPOXIDE 5 MG CAPSULE
|
Facility
|
IP
|
$465.30
|
|
|
Service Code
|
NDC 00555015802
|
| Hospital Charge Code |
1624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.14 |
| Max. Negotiated Rate |
$418.77 |
| Rate for Payer: Aetna Commercial |
$395.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.44
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cofinity Advantage |
$325.71
|
| Rate for Payer: Cofinity Commercial |
$400.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.24
|
| Rate for Payer: Healthscope Commercial |
$418.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.98
|
| Rate for Payer: PHP Commercial |
$395.50
|
| Rate for Payer: Priority Health SBD |
$293.14
|
|
|
CHLORDIAZEPOXIDE 5 MG CAPSULE
|
Facility
|
OP
|
$465.30
|
|
|
Service Code
|
NDC 00555015802
|
| Hospital Charge Code |
1624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.86 |
| Max. Negotiated Rate |
$418.77 |
| Rate for Payer: Aetna Commercial |
$395.50
|
| Rate for Payer: Aetna Medicare |
$232.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.44
|
| Rate for Payer: BCBS Complete |
$186.12
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cofinity Advantage |
$325.71
|
| Rate for Payer: Cofinity Commercial |
$400.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.24
|
| Rate for Payer: Healthscope Commercial |
$418.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.98
|
| Rate for Payer: PHP Commercial |
$395.50
|
| Rate for Payer: Priority Health SBD |
$293.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.44
|
| Rate for Payer: UHC Core |
$242.42
|
| Rate for Payer: UHC Exchange |
$182.86
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$233.43
|
|
|
Service Code
|
NDC 48878062001
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.74 |
| Max. Negotiated Rate |
$210.09 |
| Rate for Payer: Aetna Commercial |
$198.42
|
| Rate for Payer: Aetna Medicare |
$116.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.73
|
| Rate for Payer: BCBS Complete |
$93.37
|
| Rate for Payer: Cash Price |
$186.74
|
| Rate for Payer: Cofinity Advantage |
$163.40
|
| Rate for Payer: Cofinity Commercial |
$200.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.74
|
| Rate for Payer: Healthscope Commercial |
$210.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.07
|
| Rate for Payer: PHP Commercial |
$198.42
|
| Rate for Payer: Priority Health SBD |
$147.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.73
|
| Rate for Payer: UHC Core |
$121.62
|
| Rate for Payer: UHC Exchange |
$91.74
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$88.93
|
|
|
Service Code
|
NDC 00116200116
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.95 |
| Max. Negotiated Rate |
$80.04 |
| Rate for Payer: Aetna Commercial |
$75.59
|
| Rate for Payer: Aetna Medicare |
$44.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.80
|
| Rate for Payer: BCBS Complete |
$35.57
|
| Rate for Payer: Cash Price |
$71.14
|
| Rate for Payer: Cofinity Advantage |
$62.25
|
| Rate for Payer: Cofinity Commercial |
$76.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.14
|
| Rate for Payer: Healthscope Commercial |
$80.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.70
|
| Rate for Payer: PHP Commercial |
$75.59
|
| Rate for Payer: Priority Health SBD |
$56.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.80
|
| Rate for Payer: UHC Core |
$46.33
|
| Rate for Payer: UHC Exchange |
$34.95
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$25.03
|
|
|
Service Code
|
NDC 81033051250
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Aetna Commercial |
$21.28
|
| Rate for Payer: Aetna Medicare |
$12.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.27
|
| Rate for Payer: BCBS Complete |
$10.01
|
| Rate for Payer: Cash Price |
$20.02
|
| Rate for Payer: Cofinity Advantage |
$17.52
|
| Rate for Payer: Cofinity Commercial |
$21.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$22.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.77
|
| Rate for Payer: PHP Commercial |
$21.28
|
| Rate for Payer: Priority Health SBD |
$15.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.27
|
| Rate for Payer: UHC Core |
$13.04
|
| Rate for Payer: UHC Exchange |
$9.84
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$25.03
|
|
|
Service Code
|
NDC 81033051215
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Aetna Commercial |
$21.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.27
|
| Rate for Payer: Cash Price |
$20.02
|
| Rate for Payer: Cofinity Advantage |
$17.52
|
| Rate for Payer: Cofinity Commercial |
$21.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$22.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.77
|
| Rate for Payer: PHP Commercial |
$21.28
|
| Rate for Payer: Priority Health SBD |
$15.77
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$25.74
|
|
|
Service Code
|
NDC 69339013815
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$23.17 |
| Rate for Payer: Aetna Commercial |
$21.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.73
|
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Cofinity Advantage |
$18.02
|
| Rate for Payer: Cofinity Commercial |
$22.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.59
|
| Rate for Payer: Healthscope Commercial |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.30
|
| Rate for Payer: PHP Commercial |
$21.88
|
| Rate for Payer: Priority Health SBD |
$16.22
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$23.27
|
|
|
Service Code
|
NDC 63739005274
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$20.94 |
| Rate for Payer: Aetna Commercial |
$19.78
|
| Rate for Payer: Aetna Medicare |
$11.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.13
|
| Rate for Payer: BCBS Complete |
$9.31
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cofinity Advantage |
$16.29
|
| Rate for Payer: Cofinity Commercial |
$20.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Healthscope Commercial |
$20.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.45
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: Priority Health SBD |
$14.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.13
|
| Rate for Payer: UHC Core |
$12.12
|
| Rate for Payer: UHC Exchange |
$9.15
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$25.03
|
|
|
Service Code
|
NDC 63739005269
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Aetna Commercial |
$21.28
|
| Rate for Payer: Aetna Medicare |
$12.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.27
|
| Rate for Payer: BCBS Complete |
$10.01
|
| Rate for Payer: Cash Price |
$20.02
|
| Rate for Payer: Cofinity Advantage |
$17.52
|
| Rate for Payer: Cofinity Commercial |
$21.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$22.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.77
|
| Rate for Payer: PHP Commercial |
$21.28
|
| Rate for Payer: Priority Health SBD |
$15.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.27
|
| Rate for Payer: UHC Core |
$13.04
|
| Rate for Payer: UHC Exchange |
$9.84
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$25.03
|
|
|
Service Code
|
NDC 81033051215
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Aetna Commercial |
$21.28
|
| Rate for Payer: Aetna Medicare |
$12.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.27
|
| Rate for Payer: BCBS Complete |
$10.01
|
| Rate for Payer: Cash Price |
$20.02
|
| Rate for Payer: Cofinity Advantage |
$17.52
|
| Rate for Payer: Cofinity Commercial |
$21.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$22.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.77
|
| Rate for Payer: PHP Commercial |
$21.28
|
| Rate for Payer: Priority Health SBD |
$15.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.27
|
| Rate for Payer: UHC Core |
$13.04
|
| Rate for Payer: UHC Exchange |
$9.84
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$3.88
|
|
|
Service Code
|
NDC 09900000023
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Advantage |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.91
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: Priority Health SBD |
$2.44
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$25.74
|
|
|
Service Code
|
NDC 69339013817
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$23.17 |
| Rate for Payer: Aetna Commercial |
$21.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.73
|
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Cofinity Advantage |
$18.02
|
| Rate for Payer: Cofinity Commercial |
$22.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.59
|
| Rate for Payer: Healthscope Commercial |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.30
|
| Rate for Payer: PHP Commercial |
$21.88
|
| Rate for Payer: Priority Health SBD |
$16.22
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$25.74
|
|
|
Service Code
|
NDC 69339013815
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$23.17 |
| Rate for Payer: Aetna Commercial |
$21.88
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.73
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Cofinity Advantage |
$18.02
|
| Rate for Payer: Cofinity Commercial |
$22.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.59
|
| Rate for Payer: Healthscope Commercial |
$23.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.30
|
| Rate for Payer: PHP Commercial |
$21.88
|
| Rate for Payer: Priority Health SBD |
$16.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.73
|
| Rate for Payer: UHC Core |
$13.41
|
| Rate for Payer: UHC Exchange |
$10.12
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$25.74
|
|
|
Service Code
|
NDC 69339013817
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$23.17 |
| Rate for Payer: Aetna Commercial |
$21.88
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.73
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Cofinity Advantage |
$18.02
|
| Rate for Payer: Cofinity Commercial |
$22.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.59
|
| Rate for Payer: Healthscope Commercial |
$23.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.30
|
| Rate for Payer: PHP Commercial |
$21.88
|
| Rate for Payer: Priority Health SBD |
$16.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.73
|
| Rate for Payer: UHC Core |
$13.41
|
| Rate for Payer: UHC Exchange |
$10.12
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$88.93
|
|
|
Service Code
|
NDC 00116200116
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.03 |
| Max. Negotiated Rate |
$80.04 |
| Rate for Payer: Aetna Commercial |
$75.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.80
|
| Rate for Payer: Cash Price |
$71.14
|
| Rate for Payer: Cofinity Advantage |
$62.25
|
| Rate for Payer: Cofinity Commercial |
$76.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.14
|
| Rate for Payer: Healthscope Commercial |
$80.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.70
|
| Rate for Payer: PHP Commercial |
$75.59
|
| Rate for Payer: Priority Health SBD |
$56.03
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 09900000023
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna Medicare |
$1.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Advantage |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.91
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: Priority Health SBD |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.52
|
| Rate for Payer: UHC Core |
$2.02
|
| Rate for Payer: UHC Exchange |
$1.52
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$233.43
|
|
|
Service Code
|
NDC 48878062001
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.06 |
| Max. Negotiated Rate |
$210.09 |
| Rate for Payer: Aetna Commercial |
$198.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.73
|
| Rate for Payer: Cash Price |
$186.74
|
| Rate for Payer: Cofinity Advantage |
$163.40
|
| Rate for Payer: Cofinity Commercial |
$200.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.74
|
| Rate for Payer: Healthscope Commercial |
$210.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.07
|
| Rate for Payer: PHP Commercial |
$198.42
|
| Rate for Payer: Priority Health SBD |
$147.06
|
|
