|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$5.46
|
|
|
Service Code
|
NDC 0406-8315-23
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Aetna Commercial |
$4.64
|
| Rate for Payer: BCBS Trust/PPO |
$4.22
|
| Rate for Payer: BCN Commercial |
$4.22
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cofinity Commercial |
$4.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.37
|
| Rate for Payer: Healthscope Commercial |
$4.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.64
|
| Rate for Payer: PHP Commercial |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.80
|
| Rate for Payer: UHC Core |
$4.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.10
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
NDC 0904-6558-61
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$431.20 |
| Max. Negotiated Rate |
$636.30 |
| Rate for Payer: Aetna Commercial |
$600.95
|
| Rate for Payer: BCBS Trust/PPO |
$546.37
|
| Rate for Payer: BCN Commercial |
$546.37
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cofinity Commercial |
$608.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.60
|
| Rate for Payer: Healthscope Commercial |
$636.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$530.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$600.95
|
| Rate for Payer: PHP Commercial |
$600.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$615.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$431.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$622.16
|
| Rate for Payer: UHC Core |
$590.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$530.25
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$635.25
|
|
|
Service Code
|
NDC 42858-802-01
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$387.44 |
| Max. Negotiated Rate |
$571.72 |
| Rate for Payer: Aetna Commercial |
$539.96
|
| Rate for Payer: BCBS Trust/PPO |
$490.92
|
| Rate for Payer: BCN Commercial |
$490.92
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cofinity Commercial |
$546.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.20
|
| Rate for Payer: Healthscope Commercial |
$571.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$476.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$539.96
|
| Rate for Payer: PHP Commercial |
$539.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$552.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$387.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$559.02
|
| Rate for Payer: UHC Core |
$530.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$476.44
|
|
|
MORPHINE INHALATION (VARIABLE DOSE)
|
Facility
|
IP
|
$11.68
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
300139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Commercial |
$9.03
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.93
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.28
|
| Rate for Payer: UHC Core |
$9.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
MORPHINE VARIABLE DOSE
|
Facility
|
IP
|
$11.68
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Commercial |
$9.03
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.93
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.28
|
| Rate for Payer: UHC Core |
$9.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$187.20
|
|
|
Service Code
|
NDC 8068116000
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$168.48 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: BCBS Trust/PPO |
$144.67
|
| Rate for Payer: BCN Commercial |
$144.67
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Cofinity Commercial |
$160.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.76
|
| Rate for Payer: Healthscope Commercial |
$168.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$159.12
|
| Rate for Payer: PHP Commercial |
$159.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.74
|
| Rate for Payer: UHC Core |
$156.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.40
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
NDC 904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.78 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: BCBS Trust/PPO |
$139.10
|
| Rate for Payer: BCN Commercial |
$139.10
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$275.60
|
|
|
Service Code
|
NDC 4098522368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.09 |
| Max. Negotiated Rate |
$248.04 |
| Rate for Payer: Aetna Commercial |
$234.26
|
| Rate for Payer: BCBS Trust/PPO |
$212.98
|
| Rate for Payer: BCN Commercial |
$212.98
|
| Rate for Payer: Cash Price |
$220.48
|
| Rate for Payer: Cofinity Commercial |
$237.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.48
|
| Rate for Payer: Healthscope Commercial |
$248.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.26
|
| Rate for Payer: PHP Commercial |
$234.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.53
|
| Rate for Payer: UHC Core |
$230.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.70
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$29.96
|
|
|
Service Code
|
NDC 45802-112-22
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.27 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: BCBS Trust/PPO |
$23.15
|
| Rate for Payer: BCN Commercial |
$23.15
|
| Rate for Payer: Cash Price |
$23.97
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.97
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.47
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.36
|
| Rate for Payer: UHC Core |
$25.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.47
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$20.20
|
|
|
Service Code
|
NDC 51672-1312-0
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Aetna Commercial |
$17.17
|
| Rate for Payer: BCBS Trust/PPO |
$15.61
|
| Rate for Payer: BCN Commercial |
$15.61
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Cofinity Commercial |
$17.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.16
|
| Rate for Payer: Healthscope Commercial |
$18.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.17
|
| Rate for Payer: PHP Commercial |
$17.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.78
|
| Rate for Payer: UHC Core |
$16.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.15
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$249.21
|
|
|
Service Code
|
NDC 54643-5650-2
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$151.99 |
| Max. Negotiated Rate |
$224.29 |
| Rate for Payer: Aetna Commercial |
$211.83
|
| Rate for Payer: BCBS Trust/PPO |
$192.59
|
| Rate for Payer: BCN Commercial |
$192.59
|
| Rate for Payer: Cash Price |
$199.37
|
| Rate for Payer: Cofinity Commercial |
$214.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.37
|
| Rate for Payer: Healthscope Commercial |
$224.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.83
|
| Rate for Payer: PHP Commercial |
$211.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.30
|
| Rate for Payer: UHC Core |
$208.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.91
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.78
|
|
|
Service Code
|
NDC 54643-9007-1
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Aetna Commercial |
$28.71
|
| Rate for Payer: BCBS Trust/PPO |
$26.11
|
| Rate for Payer: BCN Commercial |
$26.11
|
| Rate for Payer: Cash Price |
$27.02
|
| Rate for Payer: Cofinity Commercial |
$29.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.02
|
| Rate for Payer: Healthscope Commercial |
$30.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.71
|
| Rate for Payer: PHP Commercial |
$28.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.73
|
| Rate for Payer: UHC Core |
$28.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.34
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.78
|
|
|
Service Code
|
NDC 54643-5649-1
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Aetna Commercial |
$28.71
|
| Rate for Payer: BCBS Trust/PPO |
$26.11
|
| Rate for Payer: BCN Commercial |
$26.11
|
| Rate for Payer: Cash Price |
$27.02
|
| Rate for Payer: Cofinity Commercial |
$29.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.02
|
| Rate for Payer: Healthscope Commercial |
$30.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.71
|
| Rate for Payer: PHP Commercial |
$28.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.73
|
| Rate for Payer: UHC Core |
$28.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.34
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE
|
Facility
|
IP
|
$448.85
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
15113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$273.75 |
| Max. Negotiated Rate |
$403.96 |
| Rate for Payer: Aetna Commercial |
$381.52
|
| Rate for Payer: Aetna Commercial |
$314.92
|
| Rate for Payer: BCBS Trust/PPO |
$346.87
|
| Rate for Payer: BCBS Trust/PPO |
$286.32
|
| Rate for Payer: BCN Commercial |
$346.87
|
| Rate for Payer: BCN Commercial |
$286.32
|
| Rate for Payer: Cash Price |
$359.08
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Cofinity Commercial |
$386.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Healthscope Commercial |
$403.96
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$314.92
|
| Rate for Payer: PHP Commercial |
$314.92
|
| Rate for Payer: PHP Commercial |
$381.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$322.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.99
|
| Rate for Payer: UHC Core |
$374.79
|
| Rate for Payer: UHC Core |
$309.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.64
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$24.09
|
|
|
Service Code
|
NDC 55150-123-16
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: BCBS Trust/PPO |
$18.62
|
| Rate for Payer: BCN Commercial |
$18.62
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.48
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.20
|
| Rate for Payer: UHC Core |
$20.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$23.97
|
|
|
Service Code
|
NDC 44567-222-10
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$21.57 |
| Rate for Payer: Aetna Commercial |
$20.37
|
| Rate for Payer: BCBS Trust/PPO |
$18.52
|
| Rate for Payer: BCN Commercial |
$18.52
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cofinity Commercial |
$20.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.18
|
| Rate for Payer: Healthscope Commercial |
$21.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.37
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.09
|
| Rate for Payer: UHC Core |
$20.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.98
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$32.29
|
|
|
Service Code
|
NDC 67850-032-10
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$29.06 |
| Rate for Payer: Aetna Commercial |
$27.45
|
| Rate for Payer: BCBS Trust/PPO |
$24.95
|
| Rate for Payer: BCN Commercial |
$24.95
|
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Cofinity Commercial |
$27.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.83
|
| Rate for Payer: Healthscope Commercial |
$29.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.45
|
| Rate for Payer: PHP Commercial |
$27.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.42
|
| Rate for Payer: UHC Core |
$26.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.22
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$93.12
|
|
|
Service Code
|
NDC 25021-140-10
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.79 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: BCBS Trust/PPO |
$71.96
|
| Rate for Payer: BCN Commercial |
$71.96
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.15
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.95
|
| Rate for Payer: UHC Core |
$77.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.84
|
|
|
NALOXONE 0.4 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$63.57
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
163714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$57.21 |
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: BCBS Trust/PPO |
$49.13
|
| Rate for Payer: BCN Commercial |
$49.13
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.03
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.94
|
| Rate for Payer: UHC Core |
$53.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.68
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$18.21
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$16.04
|
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: BCBS Trust/PPO |
$49.13
|
| Rate for Payer: BCBS Trust/PPO |
$14.58
|
| Rate for Payer: BCBS Trust/PPO |
$14.07
|
| Rate for Payer: BCN Commercial |
$49.13
|
| Rate for Payer: BCN Commercial |
$14.07
|
| Rate for Payer: BCN Commercial |
$14.58
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$16.23
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.04
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: PHP Commercial |
$16.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.94
|
| Rate for Payer: UHC Core |
$15.76
|
| Rate for Payer: UHC Core |
$53.08
|
| Rate for Payer: UHC Core |
$15.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.15
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$46.18
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.17 |
| Max. Negotiated Rate |
$41.56 |
| Rate for Payer: Aetna Commercial |
$39.25
|
| Rate for Payer: Aetna Commercial |
$47.78
|
| Rate for Payer: Aetna Commercial |
$73.70
|
| Rate for Payer: BCBS Trust/PPO |
$67.01
|
| Rate for Payer: BCBS Trust/PPO |
$43.44
|
| Rate for Payer: BCBS Trust/PPO |
$35.69
|
| Rate for Payer: BCN Commercial |
$35.69
|
| Rate for Payer: BCN Commercial |
$67.01
|
| Rate for Payer: BCN Commercial |
$43.44
|
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cash Price |
$36.94
|
| Rate for Payer: Cofinity Commercial |
$48.34
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$39.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.97
|
| Rate for Payer: Healthscope Commercial |
$41.56
|
| Rate for Payer: Healthscope Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$78.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.70
|
| Rate for Payer: PHP Commercial |
$47.78
|
| Rate for Payer: PHP Commercial |
$39.25
|
| Rate for Payer: PHP Commercial |
$73.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.30
|
| Rate for Payer: UHC Core |
$72.40
|
| Rate for Payer: UHC Core |
$38.56
|
| Rate for Payer: UHC Core |
$46.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.03
|
|
|
NALTREXONE ER 380 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
IP
|
$4,883.94
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
76527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,978.72 |
| Max. Negotiated Rate |
$4,395.55 |
| Rate for Payer: Aetna Commercial |
$4,151.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,774.31
|
| Rate for Payer: BCN Commercial |
$3,774.31
|
| Rate for Payer: Cash Price |
$3,907.15
|
| Rate for Payer: Cofinity Commercial |
$4,200.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,907.15
|
| Rate for Payer: Healthscope Commercial |
$4,395.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,662.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,151.35
|
| Rate for Payer: PHP Commercial |
$4,151.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,418.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,249.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,978.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,297.87
|
| Rate for Payer: UHC Core |
$4,078.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,662.96
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$209.15
|
|
|
Service Code
|
NDC 50268-594-15
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.56 |
| Max. Negotiated Rate |
$188.24 |
| Rate for Payer: Aetna Commercial |
$177.78
|
| Rate for Payer: BCBS Trust/PPO |
$161.63
|
| Rate for Payer: BCN Commercial |
$161.63
|
| Rate for Payer: Cash Price |
$167.32
|
| Rate for Payer: Cofinity Commercial |
$179.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.32
|
| Rate for Payer: Healthscope Commercial |
$188.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.78
|
| Rate for Payer: PHP Commercial |
$177.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.05
|
| Rate for Payer: UHC Core |
$174.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.86
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$4.19
|
|
|
Service Code
|
NDC 50268-594-11
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: BCBS Trust/PPO |
$3.24
|
| Rate for Payer: BCN Commercial |
$3.24
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cofinity Commercial |
$3.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.35
|
| Rate for Payer: Healthscope Commercial |
$3.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.56
|
| Rate for Payer: PHP Commercial |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.69
|
| Rate for Payer: UHC Core |
$3.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.14
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 68462-188-01
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.23 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: BCBS Trust/PPO |
$143.47
|
| Rate for Payer: BCN Commercial |
$143.47
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.80
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.37
|
| Rate for Payer: UHC Core |
$155.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
