|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$70.67
|
|
|
Service Code
|
NDC 68462-639-25
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$63.60 |
| Rate for Payer: Aetna Commercial |
$60.07
|
| Rate for Payer: BCBS Trust/PPO |
$54.61
|
| Rate for Payer: BCN Commercial |
$54.61
|
| Rate for Payer: Cash Price |
$56.54
|
| Rate for Payer: Cofinity Commercial |
$60.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.54
|
| Rate for Payer: Healthscope Commercial |
$63.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.07
|
| Rate for Payer: PHP Commercial |
$60.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.19
|
| Rate for Payer: UHC Core |
$59.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.00
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$132.46
|
|
|
Service Code
|
NDC 0071-0418-13
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.79 |
| Max. Negotiated Rate |
$119.21 |
| Rate for Payer: Aetna Commercial |
$112.59
|
| Rate for Payer: BCBS Trust/PPO |
$102.37
|
| Rate for Payer: BCN Commercial |
$102.37
|
| Rate for Payer: Cash Price |
$105.97
|
| Rate for Payer: Cofinity Commercial |
$113.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.97
|
| Rate for Payer: Healthscope Commercial |
$119.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.59
|
| Rate for Payer: PHP Commercial |
$112.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.56
|
| Rate for Payer: UHC Core |
$110.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.34
|
|
|
NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$87.21
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
15859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.19 |
| Max. Negotiated Rate |
$78.49 |
| Rate for Payer: Aetna Commercial |
$74.13
|
| Rate for Payer: BCBS Trust/PPO |
$67.40
|
| Rate for Payer: BCN Commercial |
$67.40
|
| Rate for Payer: Cash Price |
$69.77
|
| Rate for Payer: Cofinity Commercial |
$75.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.77
|
| Rate for Payer: Healthscope Commercial |
$78.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.13
|
| Rate for Payer: PHP Commercial |
$74.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.74
|
| Rate for Payer: UHC Core |
$72.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.41
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.11
|
|
|
Service Code
|
NDC 51991-983-17
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: BCBS Trust/PPO |
$19.41
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Cofinity Commercial |
$21.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.09
|
| Rate for Payer: Healthscope Commercial |
$22.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.34
|
| Rate for Payer: PHP Commercial |
$21.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.10
|
| Rate for Payer: UHC Core |
$20.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.83
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.46
|
|
|
Service Code
|
NDC 0143-9318-10
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$22.91 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.68
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.37
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.37
|
| Rate for Payer: Healthscope Commercial |
$22.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.64
|
| Rate for Payer: PHP Commercial |
$21.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.40
|
| Rate for Payer: UHC Core |
$21.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.10
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$107.05
|
|
|
Service Code
|
NDC 0409-3375-04
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.11
|
|
|
Service Code
|
NDC 51991-983-99
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: BCBS Trust/PPO |
$19.41
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Cofinity Commercial |
$21.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.09
|
| Rate for Payer: Healthscope Commercial |
$22.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.34
|
| Rate for Payer: PHP Commercial |
$21.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.10
|
| Rate for Payer: UHC Core |
$20.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.83
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.59
|
|
|
Service Code
|
NDC 0703-1153-01
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.49 |
| Max. Negotiated Rate |
$67.13 |
| Rate for Payer: Aetna Commercial |
$63.40
|
| Rate for Payer: BCBS Trust/PPO |
$57.64
|
| Rate for Payer: BCN Commercial |
$57.64
|
| Rate for Payer: Cash Price |
$59.67
|
| Rate for Payer: Cofinity Commercial |
$64.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.67
|
| Rate for Payer: Healthscope Commercial |
$67.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.40
|
| Rate for Payer: PHP Commercial |
$63.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.64
|
| Rate for Payer: UHC Core |
$62.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.94
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.59
|
|
|
Service Code
|
NDC 0703-1153-03
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.49 |
| Max. Negotiated Rate |
$67.13 |
| Rate for Payer: Aetna Commercial |
$63.40
|
| Rate for Payer: BCBS Trust/PPO |
$57.64
|
| Rate for Payer: BCN Commercial |
$57.64
|
| Rate for Payer: Cash Price |
$59.67
|
| Rate for Payer: Cofinity Commercial |
$64.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.67
|
| Rate for Payer: Healthscope Commercial |
$67.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.40
|
| Rate for Payer: PHP Commercial |
$63.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.64
|
| Rate for Payer: UHC Core |
$62.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.94
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.46
|
|
|
Service Code
|
NDC 0143-9318-01
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$22.91 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.68
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.37
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.37
|
| Rate for Payer: Healthscope Commercial |
$22.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.64
|
| Rate for Payer: PHP Commercial |
$21.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.40
|
| Rate for Payer: UHC Core |
$21.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.10
|
|
|
NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) IN DEXTROSE 5 % IV
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
NDC 0338-0108-20
|
| Hospital Charge Code |
119792
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$24.30 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$20.87
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$23.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.60
|
| Rate for Payer: Healthscope Commercial |
$24.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.95
|
| Rate for Payer: PHP Commercial |
$22.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.76
|
| Rate for Payer: UHC Core |
$22.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.25
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$202.10
|
|
|
Service Code
|
NDC 51672-4002-1
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.26 |
| Max. Negotiated Rate |
$181.89 |
| Rate for Payer: Aetna Commercial |
$171.78
|
| Rate for Payer: BCBS Trust/PPO |
$156.18
|
| Rate for Payer: BCN Commercial |
$156.18
|
| Rate for Payer: Cash Price |
$161.68
|
| Rate for Payer: Cofinity Commercial |
$173.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.68
|
| Rate for Payer: Healthscope Commercial |
$181.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.78
|
| Rate for Payer: PHP Commercial |
$171.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.85
|
| Rate for Payer: UHC Core |
$168.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.58
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$161.98
|
|
|
Service Code
|
NDC 50268-604-15
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.79 |
| Max. Negotiated Rate |
$145.78 |
| Rate for Payer: Aetna Commercial |
$137.68
|
| Rate for Payer: BCBS Trust/PPO |
$125.18
|
| Rate for Payer: BCN Commercial |
$125.18
|
| Rate for Payer: Cash Price |
$129.58
|
| Rate for Payer: Cofinity Commercial |
$139.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.58
|
| Rate for Payer: Healthscope Commercial |
$145.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.68
|
| Rate for Payer: PHP Commercial |
$137.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.54
|
| Rate for Payer: UHC Core |
$135.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.48
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
NDC 50268-604-11
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.50
|
| Rate for Payer: BCN Commercial |
$2.50
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.75
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.85
|
| Rate for Payer: UHC Core |
$2.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.43
|
|
|
NOVASOURCE RENAL CONTINUOUS FEED
|
Facility
|
IP
|
$6.83
|
|
|
Service Code
|
NDC 4390035111
|
| Hospital Charge Code |
168945
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: BCBS Trust/PPO |
$5.28
|
| Rate for Payer: BCN Commercial |
$5.28
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.81
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.01
|
| Rate for Payer: UHC Core |
$5.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
NOVASOURCE RENAL INTERMITTENT FEED
|
Facility
|
IP
|
$6.83
|
|
|
Service Code
|
NDC 4390035111
|
| Hospital Charge Code |
200086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: BCBS Trust/PPO |
$5.28
|
| Rate for Payer: BCN Commercial |
$5.28
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.81
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.01
|
| Rate for Payer: UHC Core |
$5.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
NURSING CASE MANAGEMENT
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS RN001
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM
|
Facility
|
IP
|
$26.87
|
|
|
Service Code
|
NDC 45802-059-11
|
| Hospital Charge Code |
5749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$24.18 |
| Rate for Payer: Aetna Commercial |
$22.84
|
| Rate for Payer: BCBS Trust/PPO |
$20.77
|
| Rate for Payer: BCN Commercial |
$20.77
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$23.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.50
|
| Rate for Payer: Healthscope Commercial |
$24.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.84
|
| Rate for Payer: PHP Commercial |
$22.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.65
|
| Rate for Payer: UHC Core |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.15
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$24.03
|
|
|
Service Code
|
NDC 0713-0686-31
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$21.63 |
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: BCBS Trust/PPO |
$18.57
|
| Rate for Payer: BCN Commercial |
$18.57
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.22
|
| Rate for Payer: Healthscope Commercial |
$21.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.43
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.15
|
| Rate for Payer: UHC Core |
$20.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.02
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$67.62
|
|
|
Service Code
|
NDC 0472-0166-30
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.24 |
| Max. Negotiated Rate |
$60.86 |
| Rate for Payer: Aetna Commercial |
$57.48
|
| Rate for Payer: BCBS Trust/PPO |
$52.26
|
| Rate for Payer: BCN Commercial |
$52.26
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$58.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.48
|
| Rate for Payer: PHP Commercial |
$57.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.51
|
| Rate for Payer: UHC Core |
$56.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.72
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$68.25
|
|
|
Service Code
|
NDC 0168-0007-30
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$61.42 |
| Rate for Payer: Aetna Commercial |
$58.01
|
| Rate for Payer: BCBS Trust/PPO |
$52.74
|
| Rate for Payer: BCN Commercial |
$52.74
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$58.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.60
|
| Rate for Payer: Healthscope Commercial |
$61.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.01
|
| Rate for Payer: PHP Commercial |
$58.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.06
|
| Rate for Payer: UHC Core |
$56.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.19
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$6.84
|
|
|
Service Code
|
NDC 0121-0868-05
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$6.16 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: BCBS Trust/PPO |
$5.29
|
| Rate for Payer: BCN Commercial |
$5.29
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$5.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.47
|
| Rate for Payer: Healthscope Commercial |
$6.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.81
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.02
|
| Rate for Payer: UHC Core |
$5.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.13
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$6.84
|
|
|
Service Code
|
NDC 0121-0868-00
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$6.16 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: BCBS Trust/PPO |
$5.29
|
| Rate for Payer: BCN Commercial |
$5.29
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$5.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.47
|
| Rate for Payer: Healthscope Commercial |
$6.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.81
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.02
|
| Rate for Payer: UHC Core |
$5.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.13
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$5.49
|
|
|
Service Code
|
NDC 66689-037-01
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: BCBS Trust/PPO |
$4.24
|
| Rate for Payer: BCN Commercial |
$4.24
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.39
|
| Rate for Payer: Healthscope Commercial |
$4.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.67
|
| Rate for Payer: PHP Commercial |
$4.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.83
|
| Rate for Payer: UHC Core |
$4.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.12
|
|
|
NYSTATIN-TETRACYCLN-HC-DIPHENHYD 1.2 GRAM-1.5 GRAM-0.06 GRAM MOUTHWASH
|
Facility
|
IP
|
$9.72
|
|
|
Service Code
|
NDC 9900-0007-08
|
| Hospital Charge Code |
107723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$8.75 |
| Rate for Payer: Aetna Commercial |
$8.26
|
| Rate for Payer: BCBS Trust/PPO |
$7.51
|
| Rate for Payer: BCN Commercial |
$7.51
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$8.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$8.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.26
|
| Rate for Payer: PHP Commercial |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.55
|
| Rate for Payer: UHC Core |
$8.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.29
|
|
