|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$182.88
|
|
|
Service Code
|
NDC 50268060415
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.87 |
| Max. Negotiated Rate |
$164.59 |
| Rate for Payer: Aetna Commercial |
$155.45
|
| Rate for Payer: BCBS Trust/PPO |
$149.28
|
| Rate for Payer: BCN Commercial |
$141.33
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$157.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.30
|
| Rate for Payer: Healthscope Commercial |
$164.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.45
|
| Rate for Payer: Nomi Health Commercial |
$149.96
|
| Rate for Payer: PHP Commercial |
$155.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.87
|
| Rate for Payer: Priority Health HMO/PPO |
$159.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.93
|
| Rate for Payer: UHC Core |
$152.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.16
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$3.66
|
|
|
Service Code
|
NDC 50268060411
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna Commercial |
$3.11
|
| Rate for Payer: BCBS Trust/PPO |
$2.99
|
| Rate for Payer: BCN Commercial |
$2.83
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$3.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.11
|
| Rate for Payer: Nomi Health Commercial |
$3.00
|
| Rate for Payer: PHP Commercial |
$3.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.38
|
| Rate for Payer: Priority Health HMO/PPO |
$3.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.22
|
| Rate for Payer: UHC Core |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.74
|
|
|
NOVASOURCE RENAL CONTINUOUS FEED
|
Facility
|
OP
|
$6.83
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
168945
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: Aetna Medicare |
$1.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.13
|
| Rate for Payer: BCBS Complete |
$2.73
|
| Rate for Payer: BCBS MAPPO |
$1.71
|
| Rate for Payer: BCBS Trust/PPO |
$5.61
|
| Rate for Payer: BCN Commercial |
$5.31
|
| Rate for Payer: BCN Medicare Advantage |
$1.71
|
| 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: Health Alliance Plan Medicare Advantage |
$1.71
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.81
|
| Rate for Payer: Nomi Health Commercial |
$5.60
|
| Rate for Payer: PACE Senior Care Partners |
$1.62
|
| Rate for Payer: PACE SWMI |
$1.71
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: PHP Medicare Advantage |
$1.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.44
|
| Rate for Payer: Priority Health HMO/PPO |
$5.94
|
| Rate for Payer: Priority Health Medicare |
$1.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.01
|
| Rate for Payer: UHC Core |
$5.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.71
|
| Rate for Payer: UHC Exchange |
$1.71
|
| Rate for Payer: UHC Medicare Advantage |
$1.71
|
| Rate for Payer: VA VA |
$1.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
NOVASOURCE RENAL CONTINUOUS FEED
|
Facility
|
IP
|
$6.83
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
168945
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: BCBS Trust/PPO |
$5.58
|
| 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 Commercial |
$5.81
|
| Rate for Payer: Nomi Health Commercial |
$5.60
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.44
|
| Rate for Payer: Priority Health HMO/PPO |
$5.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.58
|
| 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
|
OP
|
$6.83
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
200086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: Aetna Medicare |
$1.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.13
|
| Rate for Payer: BCBS Complete |
$2.73
|
| Rate for Payer: BCBS MAPPO |
$1.71
|
| Rate for Payer: BCBS Trust/PPO |
$5.61
|
| Rate for Payer: BCN Commercial |
$5.31
|
| Rate for Payer: BCN Medicare Advantage |
$1.71
|
| 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: Health Alliance Plan Medicare Advantage |
$1.71
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.81
|
| Rate for Payer: Nomi Health Commercial |
$5.60
|
| Rate for Payer: PACE Senior Care Partners |
$1.62
|
| Rate for Payer: PACE SWMI |
$1.71
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: PHP Medicare Advantage |
$1.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.44
|
| Rate for Payer: Priority Health HMO/PPO |
$5.94
|
| Rate for Payer: Priority Health Medicare |
$1.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.01
|
| Rate for Payer: UHC Core |
$5.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.71
|
| Rate for Payer: UHC Exchange |
$1.71
|
| Rate for Payer: UHC Medicare Advantage |
$1.71
|
| Rate for Payer: VA VA |
$1.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
NOVASOURCE RENAL INTERMITTENT FEED
|
Facility
|
IP
|
$6.83
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
200086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: BCBS Trust/PPO |
$5.58
|
| 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 Commercial |
$5.81
|
| Rate for Payer: Nomi Health Commercial |
$5.60
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.44
|
| Rate for Payer: Priority Health HMO/PPO |
$5.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.58
|
| 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
|
$26.00
|
|
|
Service Code
|
HCPCS RN001
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM
|
Facility
|
OP
|
$24.99
|
|
|
Service Code
|
NDC 45802005911
|
| Hospital Charge Code |
5749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$22.49 |
| Rate for Payer: Aetna Commercial |
$21.24
|
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.81
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS MAPPO |
$6.25
|
| Rate for Payer: BCBS Trust/PPO |
$20.54
|
| Rate for Payer: BCN Commercial |
$19.43
|
| Rate for Payer: BCN Medicare Advantage |
$6.25
|
| Rate for Payer: Cash Price |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$21.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$22.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.24
|
| Rate for Payer: Nomi Health Commercial |
$20.49
|
| Rate for Payer: PACE Senior Care Partners |
$5.94
|
| Rate for Payer: PACE SWMI |
$6.25
|
| Rate for Payer: PHP Commercial |
$21.24
|
| Rate for Payer: PHP Medicare Advantage |
$6.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.24
|
| Rate for Payer: Priority Health HMO/PPO |
$21.74
|
| Rate for Payer: Priority Health Medicare |
$6.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.99
|
| Rate for Payer: UHC Core |
$20.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.25
|
| Rate for Payer: UHC Exchange |
$6.25
|
| Rate for Payer: UHC Medicare Advantage |
$6.25
|
| Rate for Payer: VA VA |
$6.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.74
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM
|
Facility
|
IP
|
$24.99
|
|
|
Service Code
|
NDC 45802005911
|
| Hospital Charge Code |
5749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.24 |
| Max. Negotiated Rate |
$22.49 |
| Rate for Payer: Aetna Commercial |
$21.24
|
| Rate for Payer: BCBS Trust/PPO |
$20.40
|
| Rate for Payer: BCN Commercial |
$19.31
|
| Rate for Payer: Cash Price |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$21.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.99
|
| Rate for Payer: Healthscope Commercial |
$22.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.24
|
| Rate for Payer: Nomi Health Commercial |
$20.49
|
| Rate for Payer: PHP Commercial |
$21.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.24
|
| Rate for Payer: Priority Health HMO/PPO |
$21.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.99
|
| Rate for Payer: UHC Core |
$20.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.74
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$68.25
|
|
|
Service Code
|
NDC 00168000730
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.21 |
| Max. Negotiated Rate |
$61.42 |
| Rate for Payer: Aetna Commercial |
$58.01
|
| Rate for Payer: Aetna Medicare |
$17.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.33
|
| Rate for Payer: BCBS Complete |
$27.30
|
| Rate for Payer: BCBS MAPPO |
$17.06
|
| Rate for Payer: BCBS Trust/PPO |
$56.11
|
| Rate for Payer: BCN Commercial |
$53.06
|
| Rate for Payer: BCN Medicare Advantage |
$17.06
|
| 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: Health Alliance Plan Medicare Advantage |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$61.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.01
|
| Rate for Payer: Nomi Health Commercial |
$55.96
|
| Rate for Payer: PACE Senior Care Partners |
$16.21
|
| Rate for Payer: PACE SWMI |
$17.06
|
| Rate for Payer: PHP Commercial |
$58.01
|
| Rate for Payer: PHP Medicare Advantage |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.36
|
| Rate for Payer: Priority Health HMO/PPO |
$59.38
|
| Rate for Payer: Priority Health Medicare |
$17.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.73
|
| Rate for Payer: Railroad Medicare Medicare |
$17.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.06
|
| Rate for Payer: UHC Core |
$56.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.06
|
| Rate for Payer: UHC Exchange |
$17.06
|
| Rate for Payer: UHC Medicare Advantage |
$17.06
|
| Rate for Payer: VA VA |
$17.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.19
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$67.62
|
|
|
Service Code
|
NDC 00472016630
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$60.86 |
| Rate for Payer: Aetna Commercial |
$57.48
|
| Rate for Payer: BCBS Trust/PPO |
$55.20
|
| 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 Commercial |
$57.48
|
| Rate for Payer: Nomi Health Commercial |
$55.45
|
| Rate for Payer: PHP Commercial |
$57.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.95
|
| Rate for Payer: Priority Health HMO/PPO |
$58.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.31
|
| 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
|
OP
|
$67.62
|
|
|
Service Code
|
NDC 00472016630
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$60.86 |
| Rate for Payer: Aetna Commercial |
$57.48
|
| Rate for Payer: Aetna Medicare |
$17.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.13
|
| Rate for Payer: BCBS Complete |
$27.05
|
| Rate for Payer: BCBS MAPPO |
$16.90
|
| Rate for Payer: BCBS Trust/PPO |
$55.59
|
| Rate for Payer: BCN Commercial |
$52.57
|
| Rate for Payer: BCN Medicare Advantage |
$16.90
|
| 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: Health Alliance Plan Medicare Advantage |
$16.90
|
| Rate for Payer: Healthscope Commercial |
$60.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.48
|
| Rate for Payer: Nomi Health Commercial |
$55.45
|
| Rate for Payer: PACE Senior Care Partners |
$16.06
|
| Rate for Payer: PACE SWMI |
$16.90
|
| Rate for Payer: PHP Commercial |
$57.48
|
| Rate for Payer: PHP Medicare Advantage |
$16.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.95
|
| Rate for Payer: Priority Health HMO/PPO |
$58.83
|
| Rate for Payer: Priority Health Medicare |
$17.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.31
|
| Rate for Payer: Railroad Medicare Medicare |
$16.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.51
|
| Rate for Payer: UHC Core |
$56.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.90
|
| Rate for Payer: UHC Exchange |
$16.90
|
| Rate for Payer: UHC Medicare Advantage |
$16.90
|
| Rate for Payer: VA VA |
$16.90
|
| 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 00168000730
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.36 |
| Max. Negotiated Rate |
$61.42 |
| Rate for Payer: Aetna Commercial |
$58.01
|
| Rate for Payer: BCBS Trust/PPO |
$55.71
|
| 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 Commercial |
$58.01
|
| Rate for Payer: Nomi Health Commercial |
$55.96
|
| Rate for Payer: PHP Commercial |
$58.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.36
|
| Rate for Payer: Priority Health HMO/PPO |
$59.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.73
|
| 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/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$36.02
|
|
|
Service Code
|
NDC 00713068631
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$32.42 |
| Rate for Payer: Aetna Commercial |
$30.62
|
| Rate for Payer: Aetna Medicare |
$9.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.26
|
| Rate for Payer: BCBS Complete |
$14.41
|
| Rate for Payer: BCBS MAPPO |
$9.00
|
| Rate for Payer: BCBS Trust/PPO |
$29.61
|
| Rate for Payer: BCN Commercial |
$28.01
|
| Rate for Payer: BCN Medicare Advantage |
$9.00
|
| Rate for Payer: Cash Price |
$28.82
|
| Rate for Payer: Cofinity Commercial |
$30.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.00
|
| Rate for Payer: Healthscope Commercial |
$32.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.62
|
| Rate for Payer: Nomi Health Commercial |
$29.54
|
| Rate for Payer: PACE Senior Care Partners |
$8.55
|
| Rate for Payer: PACE SWMI |
$9.00
|
| Rate for Payer: PHP Commercial |
$30.62
|
| Rate for Payer: PHP Medicare Advantage |
$9.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.41
|
| Rate for Payer: Priority Health HMO/PPO |
$31.34
|
| Rate for Payer: Priority Health Medicare |
$9.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.13
|
| Rate for Payer: Railroad Medicare Medicare |
$9.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.70
|
| Rate for Payer: UHC Core |
$30.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.00
|
| Rate for Payer: UHC Exchange |
$9.00
|
| Rate for Payer: UHC Medicare Advantage |
$9.00
|
| Rate for Payer: VA VA |
$9.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.02
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$36.02
|
|
|
Service Code
|
NDC 00713068631
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.41 |
| Max. Negotiated Rate |
$32.42 |
| Rate for Payer: Aetna Commercial |
$30.62
|
| Rate for Payer: BCBS Trust/PPO |
$29.40
|
| Rate for Payer: BCN Commercial |
$27.84
|
| Rate for Payer: Cash Price |
$28.82
|
| Rate for Payer: Cofinity Commercial |
$30.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.82
|
| Rate for Payer: Healthscope Commercial |
$32.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.62
|
| Rate for Payer: Nomi Health Commercial |
$29.54
|
| Rate for Payer: PHP Commercial |
$30.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.41
|
| Rate for Payer: Priority Health HMO/PPO |
$31.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.70
|
| Rate for Payer: UHC Core |
$30.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.02
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$6.48
|
|
|
Service Code
|
NDC 00121086805
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna Commercial |
$5.51
|
| Rate for Payer: Aetna Medicare |
$1.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.02
|
| Rate for Payer: BCBS Complete |
$2.59
|
| Rate for Payer: BCBS MAPPO |
$1.62
|
| Rate for Payer: BCBS Trust/PPO |
$5.33
|
| Rate for Payer: BCN Commercial |
$5.04
|
| Rate for Payer: BCN Medicare Advantage |
$1.62
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cofinity Commercial |
$5.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.62
|
| Rate for Payer: Healthscope Commercial |
$5.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.51
|
| Rate for Payer: Nomi Health Commercial |
$5.31
|
| Rate for Payer: PACE Senior Care Partners |
$1.54
|
| Rate for Payer: PACE SWMI |
$1.62
|
| Rate for Payer: PHP Commercial |
$5.51
|
| Rate for Payer: PHP Medicare Advantage |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.21
|
| Rate for Payer: Priority Health HMO/PPO |
$5.64
|
| Rate for Payer: Priority Health Medicare |
$1.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.34
|
| Rate for Payer: Railroad Medicare Medicare |
$1.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.70
|
| Rate for Payer: UHC Core |
$5.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.62
|
| Rate for Payer: UHC Exchange |
$1.62
|
| Rate for Payer: UHC Medicare Advantage |
$1.62
|
| Rate for Payer: VA VA |
$1.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.86
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$6.48
|
|
|
Service Code
|
NDC 00121086800
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna Commercial |
$5.51
|
| Rate for Payer: Aetna Medicare |
$1.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.02
|
| Rate for Payer: BCBS Complete |
$2.59
|
| Rate for Payer: BCBS MAPPO |
$1.62
|
| Rate for Payer: BCBS Trust/PPO |
$5.33
|
| Rate for Payer: BCN Commercial |
$5.04
|
| Rate for Payer: BCN Medicare Advantage |
$1.62
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cofinity Commercial |
$5.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.62
|
| Rate for Payer: Healthscope Commercial |
$5.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.51
|
| Rate for Payer: Nomi Health Commercial |
$5.31
|
| Rate for Payer: PACE Senior Care Partners |
$1.54
|
| Rate for Payer: PACE SWMI |
$1.62
|
| Rate for Payer: PHP Commercial |
$5.51
|
| Rate for Payer: PHP Medicare Advantage |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.21
|
| Rate for Payer: Priority Health HMO/PPO |
$5.64
|
| Rate for Payer: Priority Health Medicare |
$1.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.34
|
| Rate for Payer: Railroad Medicare Medicare |
$1.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.70
|
| Rate for Payer: UHC Core |
$5.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.62
|
| Rate for Payer: UHC Exchange |
$1.62
|
| Rate for Payer: UHC Medicare Advantage |
$1.62
|
| Rate for Payer: VA VA |
$1.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.86
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 00904727641
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$1.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.43
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS MAPPO |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.77
|
| Rate for Payer: BCN Commercial |
$3.57
|
| Rate for Payer: BCN Medicare Advantage |
$1.15
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.15
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: PACE Senior Care Partners |
$1.09
|
| Rate for Payer: PACE SWMI |
$1.15
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: PHP Medicare Advantage |
$1.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Medicare |
$1.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.15
|
| Rate for Payer: UHC Exchange |
$1.15
|
| Rate for Payer: UHC Medicare Advantage |
$1.15
|
| Rate for Payer: VA VA |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$5.49
|
|
|
Service Code
|
NDC 66689003701
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: Aetna Medicare |
$1.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.72
|
| Rate for Payer: BCBS Complete |
$2.20
|
| Rate for Payer: BCBS MAPPO |
$1.37
|
| Rate for Payer: BCBS Trust/PPO |
$4.51
|
| Rate for Payer: BCN Commercial |
$4.27
|
| Rate for Payer: BCN Medicare Advantage |
$1.37
|
| 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: Health Alliance Plan Medicare Advantage |
$1.37
|
| Rate for Payer: Healthscope Commercial |
$4.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.67
|
| Rate for Payer: Nomi Health Commercial |
$4.50
|
| Rate for Payer: PACE Senior Care Partners |
$1.30
|
| Rate for Payer: PACE SWMI |
$1.37
|
| Rate for Payer: PHP Commercial |
$4.67
|
| Rate for Payer: PHP Medicare Advantage |
$1.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.57
|
| Rate for Payer: Priority Health HMO/PPO |
$4.78
|
| Rate for Payer: Priority Health Medicare |
$1.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.68
|
| Rate for Payer: Railroad Medicare Medicare |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.83
|
| Rate for Payer: UHC Core |
$4.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UHC Medicare Advantage |
$1.37
|
| Rate for Payer: VA VA |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.12
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 00904727670
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$1.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.43
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS MAPPO |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.77
|
| Rate for Payer: BCN Commercial |
$3.57
|
| Rate for Payer: BCN Medicare Advantage |
$1.15
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.15
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: PACE Senior Care Partners |
$1.09
|
| Rate for Payer: PACE SWMI |
$1.15
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: PHP Medicare Advantage |
$1.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Medicare |
$1.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.15
|
| Rate for Payer: UHC Exchange |
$1.15
|
| Rate for Payer: UHC Medicare Advantage |
$1.15
|
| Rate for Payer: VA VA |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 00904727641
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.75
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$6.48
|
|
|
Service Code
|
NDC 00121086805
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna Commercial |
$5.51
|
| Rate for Payer: BCBS Trust/PPO |
$5.29
|
| Rate for Payer: BCN Commercial |
$5.01
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cofinity Commercial |
$5.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$5.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.51
|
| Rate for Payer: Nomi Health Commercial |
$5.31
|
| Rate for Payer: PHP Commercial |
$5.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.21
|
| Rate for Payer: Priority Health HMO/PPO |
$5.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.70
|
| Rate for Payer: UHC Core |
$5.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.86
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 00904727670
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.75
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$6.48
|
|
|
Service Code
|
NDC 00121086800
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna Commercial |
$5.51
|
| Rate for Payer: BCBS Trust/PPO |
$5.29
|
| Rate for Payer: BCN Commercial |
$5.01
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cofinity Commercial |
$5.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$5.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.51
|
| Rate for Payer: Nomi Health Commercial |
$5.31
|
| Rate for Payer: PHP Commercial |
$5.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.21
|
| Rate for Payer: Priority Health HMO/PPO |
$5.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.70
|
| Rate for Payer: UHC Core |
$5.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.86
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$5.49
|
|
|
Service Code
|
NDC 66689003701
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: BCBS Trust/PPO |
$4.48
|
| 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 Commercial |
$4.67
|
| Rate for Payer: Nomi Health Commercial |
$4.50
|
| Rate for Payer: PHP Commercial |
$4.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.57
|
| Rate for Payer: Priority Health HMO/PPO |
$4.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.68
|
| 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
|
|
