|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$155.10
|
|
|
Service Code
|
NDC 65162-188-10
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.60 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: BCBS Trust/PPO |
$119.86
|
| Rate for Payer: BCN Commercial |
$119.86
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.84
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.49
|
| Rate for Payer: UHC Core |
$129.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.32
|
|
|
NAPROXEN 500 MG TABLET
|
Facility
|
IP
|
$408.90
|
|
|
Service Code
|
NDC 63739-403-10
|
| Hospital Charge Code |
5393
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.39 |
| Max. Negotiated Rate |
$368.01 |
| Rate for Payer: Aetna Commercial |
$347.56
|
| Rate for Payer: BCBS Trust/PPO |
$316.00
|
| Rate for Payer: BCN Commercial |
$316.00
|
| Rate for Payer: Cash Price |
$327.12
|
| Rate for Payer: Cofinity Commercial |
$351.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.12
|
| Rate for Payer: Healthscope Commercial |
$368.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$347.56
|
| Rate for Payer: PHP Commercial |
$347.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$355.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.83
|
| Rate for Payer: UHC Core |
$341.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.68
|
|
|
NASAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
IP
|
$3.19
|
|
|
Service Code
|
NDC 9900-0004-01
|
| Hospital Charge Code |
169209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.47
|
| Rate for Payer: BCN Commercial |
$2.47
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$2.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.71
|
| Rate for Payer: PHP Commercial |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.81
|
| Rate for Payer: UHC Core |
$2.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.39
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS
|
Facility
|
IP
|
$153.76
|
|
|
Service Code
|
NDC 24208-790-62
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.78 |
| Max. Negotiated Rate |
$138.38 |
| Rate for Payer: Aetna Commercial |
$130.70
|
| Rate for Payer: BCBS Trust/PPO |
$118.83
|
| Rate for Payer: BCN Commercial |
$118.83
|
| Rate for Payer: Cash Price |
$123.01
|
| Rate for Payer: Cofinity Commercial |
$132.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.01
|
| Rate for Payer: Healthscope Commercial |
$138.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.70
|
| Rate for Payer: PHP Commercial |
$130.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.31
|
| Rate for Payer: UHC Core |
$128.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.32
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$58.60
|
|
|
Service Code
|
NDC 61314-631-36
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna Commercial |
$49.81
|
| Rate for Payer: BCBS Trust/PPO |
$45.29
|
| Rate for Payer: BCN Commercial |
$45.29
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.88
|
| Rate for Payer: Healthscope Commercial |
$52.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.81
|
| Rate for Payer: PHP Commercial |
$49.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.57
|
| Rate for Payer: UHC Core |
$48.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.95
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$9.45
|
|
|
Service Code
|
NDC 0904-0734-31
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: BCBS Trust/PPO |
$7.30
|
| Rate for Payer: BCN Commercial |
$7.30
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$8.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.03
|
| Rate for Payer: PHP Commercial |
$8.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.32
|
| Rate for Payer: UHC Core |
$7.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.09
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$12.15
|
|
|
Service Code
|
NDC 0713-0268-31
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$10.94 |
| Rate for Payer: Aetna Commercial |
$10.33
|
| Rate for Payer: BCBS Trust/PPO |
$9.39
|
| Rate for Payer: BCN Commercial |
$9.39
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cofinity Commercial |
$10.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$10.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.33
|
| Rate for Payer: PHP Commercial |
$10.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.69
|
| Rate for Payer: UHC Core |
$10.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.11
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$3.08
|
|
|
Service Code
|
NDC 45802-143-70
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.62
|
| Rate for Payer: BCBS Trust/PPO |
$2.38
|
| Rate for Payer: BCN Commercial |
$2.38
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.62
|
| Rate for Payer: PHP Commercial |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.71
|
| Rate for Payer: UHC Core |
$2.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.31
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
IP
|
$44.28
|
|
|
Service Code
|
NDC 24208-830-60
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Aetna Commercial |
$37.64
|
| Rate for Payer: BCBS Trust/PPO |
$34.22
|
| Rate for Payer: BCN Commercial |
$34.22
|
| Rate for Payer: Cash Price |
$35.42
|
| Rate for Payer: Cofinity Commercial |
$38.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.42
|
| Rate for Payer: Healthscope Commercial |
$39.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.64
|
| Rate for Payer: PHP Commercial |
$37.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.97
|
| Rate for Payer: UHC Core |
$36.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.21
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
IP
|
$149.49
|
|
|
Service Code
|
NDC 24208-635-62
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.17 |
| Max. Negotiated Rate |
$134.54 |
| Rate for Payer: Aetna Commercial |
$127.07
|
| Rate for Payer: BCBS Trust/PPO |
$115.53
|
| Rate for Payer: BCN Commercial |
$115.53
|
| Rate for Payer: Cash Price |
$119.59
|
| Rate for Payer: Cofinity Commercial |
$128.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.59
|
| Rate for Payer: Healthscope Commercial |
$134.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.07
|
| Rate for Payer: PHP Commercial |
$127.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.55
|
| Rate for Payer: UHC Core |
$124.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.12
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
IP
|
$175.11
|
|
|
Service Code
|
NDC 24208-631-10
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$157.60 |
| Rate for Payer: Aetna Commercial |
$148.84
|
| Rate for Payer: BCBS Trust/PPO |
$135.33
|
| Rate for Payer: BCN Commercial |
$135.33
|
| Rate for Payer: Cash Price |
$140.09
|
| Rate for Payer: Cofinity Commercial |
$150.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.09
|
| Rate for Payer: Healthscope Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.84
|
| Rate for Payer: PHP Commercial |
$148.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.10
|
| Rate for Payer: UHC Core |
$146.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.33
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.01
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
167219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$18.91 |
| Rate for Payer: Aetna Commercial |
$17.86
|
| Rate for Payer: Aetna Commercial |
$20.95
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: BCBS Trust/PPO |
$16.24
|
| Rate for Payer: BCBS Trust/PPO |
$19.05
|
| Rate for Payer: BCBS Trust/PPO |
$20.84
|
| Rate for Payer: BCN Commercial |
$20.84
|
| Rate for Payer: BCN Commercial |
$16.24
|
| Rate for Payer: BCN Commercial |
$19.05
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$16.81
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$18.07
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.72
|
| Rate for Payer: Healthscope Commercial |
$18.91
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.92
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$17.86
|
| Rate for Payer: PHP Commercial |
$20.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.49
|
| Rate for Payer: UHC Core |
$22.52
|
| Rate for Payer: UHC Core |
$17.54
|
| Rate for Payer: UHC Core |
$20.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.49
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL
|
Facility
|
OP
|
$1,329.91
|
|
|
Service Code
|
CPT 64721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,266.58 |
| Max. Negotiated Rate |
$1,329.91 |
| Rate for Payer: BCBS Complete |
$1,329.91
|
| Rate for Payer: Mclaren Medicaid |
$1,266.58
|
| Rate for Payer: Meridian Medicaid |
$1,329.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,266.58
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW
|
Facility
|
OP
|
$1,329.91
|
|
|
Service Code
|
CPT 64718
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,266.58 |
| Max. Negotiated Rate |
$1,329.91 |
| Rate for Payer: BCBS Complete |
$1,329.91
|
| Rate for Payer: Mclaren Medicaid |
$1,266.58
|
| Rate for Payer: Meridian Medicaid |
$1,329.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,266.58
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$222.92
|
|
|
Service Code
|
NDC 50268-584-13
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.96 |
| Max. Negotiated Rate |
$200.63 |
| Rate for Payer: Aetna Commercial |
$189.48
|
| Rate for Payer: BCBS Trust/PPO |
$172.27
|
| Rate for Payer: BCN Commercial |
$172.27
|
| Rate for Payer: Cash Price |
$178.34
|
| Rate for Payer: Cofinity Commercial |
$191.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.34
|
| Rate for Payer: Healthscope Commercial |
$200.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$189.48
|
| Rate for Payer: PHP Commercial |
$189.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.17
|
| Rate for Payer: UHC Core |
$186.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.19
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$7.44
|
|
|
Service Code
|
NDC 50268-584-11
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.32
|
| Rate for Payer: BCBS Trust/PPO |
$5.75
|
| Rate for Payer: BCN Commercial |
$5.75
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Cofinity Commercial |
$6.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.95
|
| Rate for Payer: Healthscope Commercial |
$6.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.32
|
| Rate for Payer: PHP Commercial |
$6.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.55
|
| Rate for Payer: UHC Core |
$6.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.58
|
|
|
NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$50.91
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
12370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$45.82 |
| Rate for Payer: Aetna Commercial |
$43.27
|
| Rate for Payer: BCBS Trust/PPO |
$39.34
|
| Rate for Payer: BCN Commercial |
$39.34
|
| Rate for Payer: Cash Price |
$40.73
|
| Rate for Payer: Cofinity Commercial |
$43.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.73
|
| Rate for Payer: Healthscope Commercial |
$45.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.27
|
| Rate for Payer: PHP Commercial |
$43.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.80
|
| Rate for Payer: UHC Core |
$42.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.18
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$115.12
|
|
|
Service Code
|
NDC 0536-1107-88
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.21 |
| Max. Negotiated Rate |
$103.61 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: BCBS Trust/PPO |
$88.96
|
| Rate for Payer: BCN Commercial |
$88.96
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cofinity Commercial |
$99.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.10
|
| Rate for Payer: Healthscope Commercial |
$103.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.85
|
| Rate for Payer: PHP Commercial |
$97.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.31
|
| Rate for Payer: UHC Core |
$96.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.34
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$107.05
|
|
|
Service Code
|
NDC 0536-5895-88
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$96.34 |
| Rate for Payer: Aetna Commercial |
$90.99
|
| Rate for Payer: BCBS Trust/PPO |
$82.73
|
| Rate for Payer: BCN Commercial |
$82.73
|
| Rate for Payer: Cash Price |
$85.64
|
| Rate for Payer: Cofinity Commercial |
$92.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.64
|
| Rate for Payer: Healthscope Commercial |
$96.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.99
|
| Rate for Payer: PHP Commercial |
$90.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.20
|
| Rate for Payer: UHC Core |
$89.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.29
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$8.23
|
|
|
Service Code
|
NDC 43598-447-71
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: Aetna Commercial |
$7.00
|
| Rate for Payer: BCBS Trust/PPO |
$6.36
|
| Rate for Payer: BCN Commercial |
$6.36
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Cofinity Commercial |
$7.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.58
|
| Rate for Payer: Healthscope Commercial |
$7.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.00
|
| Rate for Payer: PHP Commercial |
$7.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.24
|
| Rate for Payer: UHC Core |
$6.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.17
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$88.31
|
|
|
Service Code
|
NDC 43598-447-74
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$79.48 |
| Rate for Payer: Aetna Commercial |
$75.06
|
| Rate for Payer: BCBS Trust/PPO |
$68.25
|
| Rate for Payer: BCN Commercial |
$68.25
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cofinity Commercial |
$75.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.65
|
| Rate for Payer: Healthscope Commercial |
$79.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.06
|
| Rate for Payer: PHP Commercial |
$75.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.71
|
| Rate for Payer: UHC Core |
$73.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.23
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$120.70
|
|
|
Service Code
|
NDC 60505-7089-0
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.61 |
| Max. Negotiated Rate |
$108.63 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: BCBS Trust/PPO |
$93.28
|
| Rate for Payer: BCN Commercial |
$93.28
|
| Rate for Payer: Cash Price |
$96.56
|
| Rate for Payer: Cofinity Commercial |
$103.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.56
|
| Rate for Payer: Healthscope Commercial |
$108.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.60
|
| Rate for Payer: PHP Commercial |
$102.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.22
|
| Rate for Payer: UHC Core |
$100.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.52
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$8.63
|
|
|
Service Code
|
NDC 60505-7062-0
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$6.67
|
| Rate for Payer: BCN Commercial |
$6.67
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$7.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.34
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.59
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.47
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$88.31
|
|
|
Service Code
|
NDC 43598-448-74
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$79.48 |
| Rate for Payer: Aetna Commercial |
$75.06
|
| Rate for Payer: BCBS Trust/PPO |
$68.25
|
| Rate for Payer: BCN Commercial |
$68.25
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cofinity Commercial |
$75.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.65
|
| Rate for Payer: Healthscope Commercial |
$79.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.06
|
| Rate for Payer: PHP Commercial |
$75.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.71
|
| Rate for Payer: UHC Core |
$73.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.23
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$92.14
|
|
|
Service Code
|
NDC 0536-5896-88
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$82.93 |
| Rate for Payer: Aetna Commercial |
$78.32
|
| Rate for Payer: BCBS Trust/PPO |
$71.21
|
| Rate for Payer: BCN Commercial |
$71.21
|
| Rate for Payer: Cash Price |
$73.71
|
| Rate for Payer: Cofinity Commercial |
$79.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.71
|
| Rate for Payer: Healthscope Commercial |
$82.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.32
|
| Rate for Payer: PHP Commercial |
$78.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.08
|
| Rate for Payer: UHC Core |
$76.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.10
|
|
