|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
NDC 69097052444
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: BCBS Trust/PPO |
$40.00
|
| Rate for Payer: BCN Commercial |
$37.87
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.65
|
| Rate for Payer: Nomi Health Commercial |
$40.18
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health HMO/PPO |
$42.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.12
|
| Rate for Payer: UHC Core |
$40.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.75
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
NDC 25866059361
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Medicare |
$14.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.50
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS MAPPO |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.04
|
| Rate for Payer: BCN Commercial |
$43.54
|
| Rate for Payer: BCN Medicare Advantage |
$14.00
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.00
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.60
|
| Rate for Payer: Nomi Health Commercial |
$45.92
|
| Rate for Payer: PACE Senior Care Partners |
$13.30
|
| Rate for Payer: PACE SWMI |
$14.00
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: PHP Medicare Advantage |
$14.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health HMO/PPO |
$48.72
|
| Rate for Payer: Priority Health Medicare |
$14.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.52
|
| Rate for Payer: Railroad Medicare Medicare |
$14.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.28
|
| Rate for Payer: UHC Core |
$46.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.00
|
| Rate for Payer: UHC Exchange |
$14.00
|
| Rate for Payer: UHC Medicare Advantage |
$14.00
|
| Rate for Payer: VA VA |
$14.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.00
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$26.95
|
|
|
Service Code
|
NDC 09629513975
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$24.26 |
| Rate for Payer: Aetna Commercial |
$22.91
|
| Rate for Payer: Aetna Medicare |
$7.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.42
|
| Rate for Payer: BCBS Complete |
$10.78
|
| Rate for Payer: BCBS MAPPO |
$6.74
|
| Rate for Payer: BCBS Trust/PPO |
$22.16
|
| Rate for Payer: BCN Commercial |
$20.95
|
| Rate for Payer: BCN Medicare Advantage |
$6.74
|
| Rate for Payer: Cash Price |
$21.56
|
| Rate for Payer: Cofinity Commercial |
$23.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.74
|
| Rate for Payer: Healthscope Commercial |
$24.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.91
|
| Rate for Payer: Nomi Health Commercial |
$22.10
|
| Rate for Payer: PACE Senior Care Partners |
$6.40
|
| Rate for Payer: PACE SWMI |
$6.74
|
| Rate for Payer: PHP Commercial |
$22.91
|
| Rate for Payer: PHP Medicare Advantage |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.52
|
| Rate for Payer: Priority Health HMO/PPO |
$23.45
|
| Rate for Payer: Priority Health Medicare |
$6.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.06
|
| Rate for Payer: Railroad Medicare Medicare |
$6.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.72
|
| Rate for Payer: UHC Core |
$22.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.74
|
| Rate for Payer: UHC Exchange |
$6.74
|
| Rate for Payer: UHC Medicare Advantage |
$6.74
|
| Rate for Payer: VA VA |
$6.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.21
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
NDC 65162083366
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: BCBS Trust/PPO |
$40.00
|
| Rate for Payer: BCN Commercial |
$37.87
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.65
|
| Rate for Payer: Nomi Health Commercial |
$40.18
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health HMO/PPO |
$42.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.12
|
| Rate for Payer: UHC Core |
$40.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.75
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$39.90
|
|
|
Service Code
|
NDC 45802095301
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.94 |
| Max. Negotiated Rate |
$35.91 |
| Rate for Payer: Aetna Commercial |
$33.92
|
| Rate for Payer: BCBS Trust/PPO |
$32.57
|
| Rate for Payer: BCN Commercial |
$30.83
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: Cofinity Commercial |
$34.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.92
|
| Rate for Payer: Healthscope Commercial |
$35.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.92
|
| Rate for Payer: Nomi Health Commercial |
$32.72
|
| Rate for Payer: PHP Commercial |
$33.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.94
|
| Rate for Payer: Priority Health HMO/PPO |
$34.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.11
|
| Rate for Payer: UHC Core |
$33.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.92
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
NDC 25866059361
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: BCBS Trust/PPO |
$45.71
|
| Rate for Payer: BCN Commercial |
$43.28
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.60
|
| Rate for Payer: Nomi Health Commercial |
$45.92
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health HMO/PPO |
$48.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.28
|
| Rate for Payer: UHC Core |
$46.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.00
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
NDC 65162083366
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.64 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: Aetna Medicare |
$12.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.31
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS MAPPO |
$12.25
|
| Rate for Payer: BCBS Trust/PPO |
$40.28
|
| Rate for Payer: BCN Commercial |
$38.10
|
| Rate for Payer: BCN Medicare Advantage |
$12.25
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.25
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.65
|
| Rate for Payer: Nomi Health Commercial |
$40.18
|
| Rate for Payer: PACE Senior Care Partners |
$11.64
|
| Rate for Payer: PACE SWMI |
$12.25
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: PHP Medicare Advantage |
$12.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health HMO/PPO |
$42.63
|
| Rate for Payer: Priority Health Medicare |
$12.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.12
|
| Rate for Payer: UHC Core |
$40.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.25
|
| Rate for Payer: UHC Exchange |
$12.25
|
| Rate for Payer: UHC Medicare Advantage |
$12.25
|
| Rate for Payer: VA VA |
$12.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.75
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$63.35
|
|
|
Service Code
|
NDC 00067815203
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.18 |
| Max. Negotiated Rate |
$57.02 |
| Rate for Payer: Aetna Commercial |
$53.85
|
| Rate for Payer: BCBS Trust/PPO |
$51.71
|
| Rate for Payer: BCN Commercial |
$48.96
|
| Rate for Payer: Cash Price |
$50.68
|
| Rate for Payer: Cofinity Commercial |
$54.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.68
|
| Rate for Payer: Healthscope Commercial |
$57.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.85
|
| Rate for Payer: Nomi Health Commercial |
$51.95
|
| Rate for Payer: PHP Commercial |
$53.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.18
|
| Rate for Payer: Priority Health HMO/PPO |
$55.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.75
|
| Rate for Payer: UHC Core |
$52.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.51
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$31.15
|
|
|
Service Code
|
NDC 69097072044
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$28.04 |
| Rate for Payer: Aetna Commercial |
$26.48
|
| Rate for Payer: BCBS Trust/PPO |
$25.43
|
| Rate for Payer: BCN Commercial |
$24.07
|
| Rate for Payer: Cash Price |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$26.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.92
|
| Rate for Payer: Healthscope Commercial |
$28.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.48
|
| Rate for Payer: Nomi Health Commercial |
$25.54
|
| Rate for Payer: PHP Commercial |
$26.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.25
|
| Rate for Payer: Priority Health HMO/PPO |
$27.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.41
|
| Rate for Payer: UHC Core |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.36
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
NDC 69097052444
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.64 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: Aetna Medicare |
$12.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.31
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS MAPPO |
$12.25
|
| Rate for Payer: BCBS Trust/PPO |
$40.28
|
| Rate for Payer: BCN Commercial |
$38.10
|
| Rate for Payer: BCN Medicare Advantage |
$12.25
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.25
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.65
|
| Rate for Payer: Nomi Health Commercial |
$40.18
|
| Rate for Payer: PACE Senior Care Partners |
$11.64
|
| Rate for Payer: PACE SWMI |
$12.25
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: PHP Medicare Advantage |
$12.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health HMO/PPO |
$42.63
|
| Rate for Payer: Priority Health Medicare |
$12.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.12
|
| Rate for Payer: UHC Core |
$40.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.25
|
| Rate for Payer: UHC Exchange |
$12.25
|
| Rate for Payer: UHC Medicare Advantage |
$12.25
|
| Rate for Payer: VA VA |
$12.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.75
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$26.95
|
|
|
Service Code
|
NDC 09629513975
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$24.26 |
| Rate for Payer: Aetna Commercial |
$22.91
|
| Rate for Payer: BCBS Trust/PPO |
$22.00
|
| Rate for Payer: BCN Commercial |
$20.83
|
| Rate for Payer: Cash Price |
$21.56
|
| Rate for Payer: Cofinity Commercial |
$23.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.56
|
| Rate for Payer: Healthscope Commercial |
$24.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.91
|
| Rate for Payer: Nomi Health Commercial |
$22.10
|
| Rate for Payer: PHP Commercial |
$22.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.52
|
| Rate for Payer: Priority Health HMO/PPO |
$23.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.72
|
| Rate for Payer: UHC Core |
$22.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.21
|
|
|
DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$258.03
|
|
|
Service Code
|
NDC 61442010260
|
| Hospital Charge Code |
15340
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.28 |
| Max. Negotiated Rate |
$232.23 |
| Rate for Payer: Aetna Commercial |
$219.33
|
| Rate for Payer: Aetna Medicare |
$67.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.63
|
| Rate for Payer: BCBS Complete |
$103.21
|
| Rate for Payer: BCBS MAPPO |
$64.51
|
| Rate for Payer: BCBS Trust/PPO |
$212.13
|
| Rate for Payer: BCN Commercial |
$200.62
|
| Rate for Payer: BCN Medicare Advantage |
$64.51
|
| Rate for Payer: Cash Price |
$206.42
|
| Rate for Payer: Cofinity Commercial |
$221.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.51
|
| Rate for Payer: Healthscope Commercial |
$232.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.33
|
| Rate for Payer: Nomi Health Commercial |
$211.58
|
| Rate for Payer: PACE Senior Care Partners |
$61.28
|
| Rate for Payer: PACE SWMI |
$64.51
|
| Rate for Payer: PHP Commercial |
$219.33
|
| Rate for Payer: PHP Medicare Advantage |
$64.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.72
|
| Rate for Payer: Priority Health HMO/PPO |
$224.49
|
| Rate for Payer: Priority Health Medicare |
$65.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.88
|
| Rate for Payer: Railroad Medicare Medicare |
$64.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.07
|
| Rate for Payer: UHC Core |
$215.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.51
|
| Rate for Payer: UHC Exchange |
$64.51
|
| Rate for Payer: UHC Medicare Advantage |
$64.51
|
| Rate for Payer: VA VA |
$64.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.52
|
|
|
DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$258.03
|
|
|
Service Code
|
NDC 61442010260
|
| Hospital Charge Code |
15340
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.72 |
| Max. Negotiated Rate |
$232.23 |
| Rate for Payer: Aetna Commercial |
$219.33
|
| Rate for Payer: BCBS Trust/PPO |
$210.63
|
| Rate for Payer: BCN Commercial |
$199.41
|
| Rate for Payer: Cash Price |
$206.42
|
| Rate for Payer: Cofinity Commercial |
$221.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.42
|
| Rate for Payer: Healthscope Commercial |
$232.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.33
|
| Rate for Payer: Nomi Health Commercial |
$211.58
|
| Rate for Payer: PHP Commercial |
$219.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.72
|
| Rate for Payer: Priority Health HMO/PPO |
$224.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.07
|
| Rate for Payer: UHC Core |
$215.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.52
|
|
|
DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$3.61
|
|
|
Service Code
|
NDC 51079022401
|
| Hospital Charge Code |
15341
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$3.07
|
| Rate for Payer: Aetna Medicare |
$0.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.13
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: BCBS MAPPO |
$0.90
|
| Rate for Payer: BCBS Trust/PPO |
$2.97
|
| Rate for Payer: BCN Commercial |
$2.81
|
| Rate for Payer: BCN Medicare Advantage |
$0.90
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.90
|
| Rate for Payer: Healthscope Commercial |
$3.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.07
|
| Rate for Payer: Nomi Health Commercial |
$2.96
|
| Rate for Payer: PACE Senior Care Partners |
$0.86
|
| Rate for Payer: PACE SWMI |
$0.90
|
| Rate for Payer: PHP Commercial |
$3.07
|
| Rate for Payer: PHP Medicare Advantage |
$0.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.35
|
| Rate for Payer: Priority Health HMO/PPO |
$3.14
|
| Rate for Payer: Priority Health Medicare |
$0.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.42
|
| Rate for Payer: Railroad Medicare Medicare |
$0.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.18
|
| Rate for Payer: UHC Core |
$3.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.90
|
| Rate for Payer: UHC Exchange |
$0.90
|
| Rate for Payer: UHC Medicare Advantage |
$0.90
|
| Rate for Payer: VA VA |
$0.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.71
|
|
|
DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$3.61
|
|
|
Service Code
|
NDC 51079022401
|
| Hospital Charge Code |
15341
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$2.95
|
| Rate for Payer: BCN Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.89
|
| Rate for Payer: Healthscope Commercial |
$3.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.07
|
| Rate for Payer: Nomi Health Commercial |
$2.96
|
| Rate for Payer: PHP Commercial |
$3.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.35
|
| Rate for Payer: Priority Health HMO/PPO |
$3.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.18
|
| Rate for Payer: UHC Core |
$3.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.71
|
|
|
DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
NDC 51079022420
|
| Hospital Charge Code |
15341
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.74 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: Aetna Medicare |
$93.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.81
|
| Rate for Payer: BCBS Complete |
$144.40
|
| Rate for Payer: BCBS MAPPO |
$90.25
|
| Rate for Payer: BCBS Trust/PPO |
$296.78
|
| Rate for Payer: BCN Commercial |
$280.68
|
| Rate for Payer: BCN Medicare Advantage |
$90.25
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$310.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.25
|
| Rate for Payer: Healthscope Commercial |
$324.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.85
|
| Rate for Payer: Nomi Health Commercial |
$296.02
|
| Rate for Payer: PACE Senior Care Partners |
$85.74
|
| Rate for Payer: PACE SWMI |
$90.25
|
| Rate for Payer: PHP Commercial |
$306.85
|
| Rate for Payer: PHP Medicare Advantage |
$90.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
| Rate for Payer: Priority Health HMO/PPO |
$314.07
|
| Rate for Payer: Priority Health Medicare |
$91.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.87
|
| Rate for Payer: Railroad Medicare Medicare |
$90.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.68
|
| Rate for Payer: UHC Core |
$301.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.25
|
| Rate for Payer: UHC Exchange |
$90.25
|
| Rate for Payer: UHC Medicare Advantage |
$90.25
|
| Rate for Payer: VA VA |
$90.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.75
|
|
|
DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$145.23
|
|
|
Service Code
|
NDC 61442010360
|
| Hospital Charge Code |
15341
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$130.71 |
| Rate for Payer: Aetna Commercial |
$123.45
|
| Rate for Payer: BCBS Trust/PPO |
$118.55
|
| Rate for Payer: BCN Commercial |
$112.23
|
| Rate for Payer: Cash Price |
$116.18
|
| Rate for Payer: Cofinity Commercial |
$124.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.18
|
| Rate for Payer: Healthscope Commercial |
$130.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.45
|
| Rate for Payer: Nomi Health Commercial |
$119.09
|
| Rate for Payer: PHP Commercial |
$123.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.40
|
| Rate for Payer: Priority Health HMO/PPO |
$126.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.80
|
| Rate for Payer: UHC Core |
$121.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.92
|
|
|
DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
NDC 68084033311
|
| Hospital Charge Code |
15341
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: Aetna Medicare |
$1.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.41
|
| Rate for Payer: BCBS Complete |
$1.80
|
| Rate for Payer: BCBS MAPPO |
$1.13
|
| Rate for Payer: BCBS Trust/PPO |
$3.71
|
| Rate for Payer: BCN Commercial |
$3.51
|
| Rate for Payer: BCN Medicare Advantage |
$1.13
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.13
|
| Rate for Payer: Healthscope Commercial |
$4.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.83
|
| Rate for Payer: Nomi Health Commercial |
$3.70
|
| Rate for Payer: PACE Senior Care Partners |
$1.07
|
| Rate for Payer: PACE SWMI |
$1.13
|
| Rate for Payer: PHP Commercial |
$3.83
|
| Rate for Payer: PHP Medicare Advantage |
$1.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.93
|
| Rate for Payer: Priority Health HMO/PPO |
$3.92
|
| Rate for Payer: Priority Health Medicare |
$1.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.97
|
| Rate for Payer: UHC Core |
$3.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.13
|
| Rate for Payer: UHC Exchange |
$1.13
|
| Rate for Payer: UHC Medicare Advantage |
$1.13
|
| Rate for Payer: VA VA |
$1.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.38
|
|
|
DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$450.30
|
|
|
Service Code
|
NDC 68084033301
|
| Hospital Charge Code |
15341
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.70 |
| Max. Negotiated Rate |
$405.27 |
| Rate for Payer: Aetna Commercial |
$382.76
|
| Rate for Payer: BCBS Trust/PPO |
$367.58
|
| Rate for Payer: BCN Commercial |
$347.99
|
| Rate for Payer: Cash Price |
$360.24
|
| Rate for Payer: Cofinity Commercial |
$387.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.24
|
| Rate for Payer: Healthscope Commercial |
$405.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.76
|
| Rate for Payer: Nomi Health Commercial |
$369.25
|
| Rate for Payer: PHP Commercial |
$382.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.70
|
| Rate for Payer: Priority Health HMO/PPO |
$391.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$301.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.26
|
| Rate for Payer: UHC Core |
$376.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.72
|
|
|
DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$145.23
|
|
|
Service Code
|
NDC 61442010360
|
| Hospital Charge Code |
15341
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.49 |
| Max. Negotiated Rate |
$130.71 |
| Rate for Payer: Aetna Commercial |
$123.45
|
| Rate for Payer: Aetna Medicare |
$37.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.38
|
| Rate for Payer: BCBS Complete |
$58.09
|
| Rate for Payer: BCBS MAPPO |
$36.31
|
| Rate for Payer: BCBS Trust/PPO |
$119.39
|
| Rate for Payer: BCN Commercial |
$112.92
|
| Rate for Payer: BCN Medicare Advantage |
$36.31
|
| Rate for Payer: Cash Price |
$116.18
|
| Rate for Payer: Cofinity Commercial |
$124.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.31
|
| Rate for Payer: Healthscope Commercial |
$130.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.45
|
| Rate for Payer: Nomi Health Commercial |
$119.09
|
| Rate for Payer: PACE Senior Care Partners |
$34.49
|
| Rate for Payer: PACE SWMI |
$36.31
|
| Rate for Payer: PHP Commercial |
$123.45
|
| Rate for Payer: PHP Medicare Advantage |
$36.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.40
|
| Rate for Payer: Priority Health HMO/PPO |
$126.35
|
| Rate for Payer: Priority Health Medicare |
$36.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.30
|
| Rate for Payer: Railroad Medicare Medicare |
$36.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.80
|
| Rate for Payer: UHC Core |
$121.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.31
|
| Rate for Payer: UHC Exchange |
$36.31
|
| Rate for Payer: UHC Medicare Advantage |
$36.31
|
| Rate for Payer: VA VA |
$36.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.92
|
|
|
DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
NDC 51079022420
|
| Hospital Charge Code |
15341
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.65 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: BCBS Trust/PPO |
$294.68
|
| Rate for Payer: BCN Commercial |
$278.98
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$310.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.80
|
| Rate for Payer: Healthscope Commercial |
$324.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.85
|
| Rate for Payer: Nomi Health Commercial |
$296.02
|
| Rate for Payer: PHP Commercial |
$306.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
| Rate for Payer: Priority Health HMO/PPO |
$314.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.68
|
| Rate for Payer: UHC Core |
$301.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.75
|
|
|
DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$450.30
|
|
|
Service Code
|
NDC 68084033301
|
| Hospital Charge Code |
15341
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$405.27 |
| Rate for Payer: Aetna Commercial |
$382.76
|
| Rate for Payer: Aetna Medicare |
$117.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.72
|
| Rate for Payer: BCBS Complete |
$180.12
|
| Rate for Payer: BCBS MAPPO |
$112.58
|
| Rate for Payer: BCBS Trust/PPO |
$370.19
|
| Rate for Payer: BCN Commercial |
$350.11
|
| Rate for Payer: BCN Medicare Advantage |
$112.58
|
| Rate for Payer: Cash Price |
$360.24
|
| Rate for Payer: Cofinity Commercial |
$387.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.58
|
| Rate for Payer: Healthscope Commercial |
$405.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.76
|
| Rate for Payer: Nomi Health Commercial |
$369.25
|
| Rate for Payer: PACE Senior Care Partners |
$106.95
|
| Rate for Payer: PACE SWMI |
$112.58
|
| Rate for Payer: PHP Commercial |
$382.76
|
| Rate for Payer: PHP Medicare Advantage |
$112.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.70
|
| Rate for Payer: Priority Health HMO/PPO |
$391.76
|
| Rate for Payer: Priority Health Medicare |
$113.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$301.70
|
| Rate for Payer: Railroad Medicare Medicare |
$112.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.26
|
| Rate for Payer: UHC Core |
$376.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.58
|
| Rate for Payer: UHC Exchange |
$112.58
|
| Rate for Payer: UHC Medicare Advantage |
$112.58
|
| Rate for Payer: VA VA |
$112.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.72
|
|
|
DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
NDC 68084033311
|
| Hospital Charge Code |
15341
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: BCBS Trust/PPO |
$3.68
|
| Rate for Payer: BCN Commercial |
$3.49
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.61
|
| Rate for Payer: Healthscope Commercial |
$4.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.83
|
| Rate for Payer: Nomi Health Commercial |
$3.70
|
| Rate for Payer: PHP Commercial |
$3.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.93
|
| Rate for Payer: Priority Health HMO/PPO |
$3.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.97
|
| Rate for Payer: UHC Core |
$3.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.38
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$381.90
|
|
|
Service Code
|
NDC 51079011820
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.24 |
| Max. Negotiated Rate |
$343.71 |
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: BCBS Trust/PPO |
$311.74
|
| Rate for Payer: BCN Commercial |
$295.13
|
| Rate for Payer: Cash Price |
$305.52
|
| Rate for Payer: Cofinity Commercial |
$328.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.52
|
| Rate for Payer: Healthscope Commercial |
$343.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.62
|
| Rate for Payer: Nomi Health Commercial |
$313.16
|
| Rate for Payer: PHP Commercial |
$324.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.24
|
| Rate for Payer: Priority Health HMO/PPO |
$332.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$255.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.07
|
| Rate for Payer: UHC Core |
$318.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.42
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$437.95
|
|
|
Service Code
|
NDC 60687036901
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.67 |
| Max. Negotiated Rate |
$394.16 |
| Rate for Payer: Aetna Commercial |
$372.26
|
| Rate for Payer: BCBS Trust/PPO |
$357.50
|
| Rate for Payer: BCN Commercial |
$338.45
|
| Rate for Payer: Cash Price |
$350.36
|
| Rate for Payer: Cofinity Commercial |
$376.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.36
|
| Rate for Payer: Healthscope Commercial |
$394.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.26
|
| Rate for Payer: Nomi Health Commercial |
$359.12
|
| Rate for Payer: PHP Commercial |
$372.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.67
|
| Rate for Payer: Priority Health HMO/PPO |
$381.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.40
|
| Rate for Payer: UHC Core |
$365.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.46
|
|
