|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 49884046564
|
| Hospital Charge Code |
9588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: ASR ASR |
$4.16
|
| Rate for Payer: ASR Commercial |
$4.16
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.33
|
| Rate for Payer: Cash Price |
$3.43
|
| Rate for Payer: Cofinity Commercial |
$4.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.43
|
| Rate for Payer: Healthscope Commercial |
$4.29
|
| Rate for Payer: Healthscope Whirlpool |
$4.16
|
| Rate for Payer: Mclaren Commercial |
$3.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Nomi Health Commercial |
$3.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.78
|
|
|
CHONDROITIN-SOD HYALURON 3 %-4 %(0.5 ML)1 %(0.55 ML)INTRAOCULAR SYRING
|
Facility
|
OP
|
$345.53
|
|
|
Service Code
|
NDC 08065183150
|
| Hospital Charge Code |
28917
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$138.21 |
| Max. Negotiated Rate |
$345.53 |
| Rate for Payer: Aetna Commercial |
$310.98
|
| Rate for Payer: Aetna Medicare |
$172.76
|
| Rate for Payer: ASR ASR |
$335.16
|
| Rate for Payer: ASR Commercial |
$335.16
|
| Rate for Payer: BCBS Complete |
$138.21
|
| Rate for Payer: BCBS Trust/PPO |
$282.95
|
| Rate for Payer: BCN Commercial |
$267.89
|
| Rate for Payer: Cash Price |
$276.43
|
| Rate for Payer: Cofinity Commercial |
$324.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.42
|
| Rate for Payer: Healthscope Commercial |
$345.53
|
| Rate for Payer: Healthscope Whirlpool |
$335.16
|
| Rate for Payer: Mclaren Commercial |
$310.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.70
|
| Rate for Payer: Nomi Health Commercial |
$283.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$302.75
|
| Rate for Payer: Priority Health Narrow Network |
$242.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.07
|
|
|
CHONDROITIN-SOD HYALURON 3 %-4 %(0.5 ML)1 %(0.55 ML)INTRAOCULAR SYRING
|
Facility
|
IP
|
$345.53
|
|
|
Service Code
|
NDC 08065183150
|
| Hospital Charge Code |
28917
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$224.59 |
| Max. Negotiated Rate |
$345.53 |
| Rate for Payer: Aetna Commercial |
$310.98
|
| Rate for Payer: ASR ASR |
$335.16
|
| Rate for Payer: ASR Commercial |
$335.16
|
| Rate for Payer: BCBS Trust/PPO |
$281.57
|
| Rate for Payer: BCN Commercial |
$267.89
|
| Rate for Payer: Cash Price |
$276.43
|
| Rate for Payer: Cofinity Commercial |
$324.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.42
|
| Rate for Payer: Healthscope Commercial |
$345.53
|
| Rate for Payer: Healthscope Whirlpool |
$335.16
|
| Rate for Payer: Mclaren Commercial |
$310.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.70
|
| Rate for Payer: Nomi Health Commercial |
$283.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.07
|
|
|
CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE
|
Facility
|
OP
|
$218.01
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
28923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$141.71 |
| Max. Negotiated Rate |
$986.71 |
| Rate for Payer: Aetna Commercial |
$196.21
|
| Rate for Payer: Aetna Medicare |
$636.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$795.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$795.74
|
| Rate for Payer: ASR ASR |
$211.47
|
| Rate for Payer: ASR Commercial |
$211.47
|
| Rate for Payer: BCBS Complete |
$358.27
|
| Rate for Payer: BCBS MAPPO |
$636.59
|
| Rate for Payer: BCBS Trust/PPO |
$178.53
|
| Rate for Payer: BCN Commercial |
$169.02
|
| Rate for Payer: BCN Medicare Advantage |
$636.59
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cofinity Commercial |
$204.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$636.59
|
| Rate for Payer: Healthscope Commercial |
$218.01
|
| Rate for Payer: Healthscope Whirlpool |
$211.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$636.59
|
| Rate for Payer: Mclaren Commercial |
$196.21
|
| Rate for Payer: Mclaren Medicaid |
$341.21
|
| Rate for Payer: Mclaren Medicare |
$636.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$668.42
|
| Rate for Payer: Meridian Medicaid |
$358.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$732.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.31
|
| Rate for Payer: Nomi Health Commercial |
$178.77
|
| Rate for Payer: PACE Medicare |
$604.76
|
| Rate for Payer: PACE SWMI |
$636.59
|
| Rate for Payer: PHP Commercial |
$700.25
|
| Rate for Payer: PHP Medicaid |
$341.21
|
| Rate for Payer: PHP Medicare Advantage |
$636.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$341.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.02
|
| Rate for Payer: Priority Health Medicare |
$636.59
|
| Rate for Payer: Priority Health Narrow Network |
$152.83
|
| Rate for Payer: Railroad Medicare Medicare |
$636.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$636.59
|
| Rate for Payer: UHC Exchange |
$986.71
|
| Rate for Payer: UHC Medicare Advantage |
$636.59
|
| Rate for Payer: UHCCP DNSP |
$636.59
|
| Rate for Payer: UHCCP Medicaid |
$341.21
|
| Rate for Payer: VA VA |
$636.59
|
|
|
CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$218.01
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
28923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$141.71 |
| Max. Negotiated Rate |
$218.01 |
| Rate for Payer: Aetna Commercial |
$196.21
|
| Rate for Payer: ASR ASR |
$211.47
|
| Rate for Payer: ASR Commercial |
$211.47
|
| Rate for Payer: BCBS Trust/PPO |
$177.66
|
| Rate for Payer: BCN Commercial |
$169.02
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cofinity Commercial |
$204.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.41
|
| Rate for Payer: Healthscope Commercial |
$218.01
|
| Rate for Payer: Healthscope Whirlpool |
$211.47
|
| Rate for Payer: Mclaren Commercial |
$196.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.31
|
| Rate for Payer: Nomi Health Commercial |
$178.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.85
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$302.71
|
|
|
Service Code
|
NDC 72485062513
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.76 |
| Max. Negotiated Rate |
$302.71 |
| Rate for Payer: Aetna Commercial |
$272.44
|
| Rate for Payer: ASR ASR |
$293.63
|
| Rate for Payer: ASR Commercial |
$293.63
|
| Rate for Payer: BCBS Trust/PPO |
$246.68
|
| Rate for Payer: BCN Commercial |
$234.69
|
| Rate for Payer: Cash Price |
$242.17
|
| Rate for Payer: Cofinity Commercial |
$284.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.17
|
| Rate for Payer: Healthscope Commercial |
$302.71
|
| Rate for Payer: Healthscope Whirlpool |
$293.63
|
| Rate for Payer: Mclaren Commercial |
$272.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.30
|
| Rate for Payer: Nomi Health Commercial |
$248.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.38
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$729.72
|
|
|
Service Code
|
NDC 00781618667
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$474.32 |
| Max. Negotiated Rate |
$729.72 |
| Rate for Payer: Aetna Commercial |
$656.75
|
| Rate for Payer: ASR ASR |
$707.83
|
| Rate for Payer: ASR Commercial |
$707.83
|
| Rate for Payer: BCBS Trust/PPO |
$594.65
|
| Rate for Payer: BCN Commercial |
$565.75
|
| Rate for Payer: Cash Price |
$583.78
|
| Rate for Payer: Cofinity Commercial |
$685.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.78
|
| Rate for Payer: Healthscope Commercial |
$729.72
|
| Rate for Payer: Healthscope Whirlpool |
$707.83
|
| Rate for Payer: Mclaren Commercial |
$656.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.26
|
| Rate for Payer: Nomi Health Commercial |
$598.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$642.15
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$729.72
|
|
|
Service Code
|
NDC 00781618667
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$291.89 |
| Max. Negotiated Rate |
$729.72 |
| Rate for Payer: Aetna Commercial |
$656.75
|
| Rate for Payer: Aetna Medicare |
$364.86
|
| Rate for Payer: ASR ASR |
$707.83
|
| Rate for Payer: ASR Commercial |
$707.83
|
| Rate for Payer: BCBS Complete |
$291.89
|
| Rate for Payer: BCBS Trust/PPO |
$597.57
|
| Rate for Payer: BCN Commercial |
$565.75
|
| Rate for Payer: Cash Price |
$583.78
|
| Rate for Payer: Cofinity Commercial |
$685.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.78
|
| Rate for Payer: Healthscope Commercial |
$729.72
|
| Rate for Payer: Healthscope Whirlpool |
$707.83
|
| Rate for Payer: Mclaren Commercial |
$656.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.26
|
| Rate for Payer: Nomi Health Commercial |
$598.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$639.38
|
| Rate for Payer: Priority Health Narrow Network |
$511.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$642.15
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$302.71
|
|
|
Service Code
|
NDC 72485062513
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.08 |
| Max. Negotiated Rate |
$302.71 |
| Rate for Payer: Aetna Commercial |
$272.44
|
| Rate for Payer: Aetna Medicare |
$151.35
|
| Rate for Payer: ASR ASR |
$293.63
|
| Rate for Payer: ASR Commercial |
$293.63
|
| Rate for Payer: BCBS Complete |
$121.08
|
| Rate for Payer: BCBS Trust/PPO |
$247.89
|
| Rate for Payer: BCN Commercial |
$234.69
|
| Rate for Payer: Cash Price |
$242.17
|
| Rate for Payer: Cofinity Commercial |
$284.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.17
|
| Rate for Payer: Healthscope Commercial |
$302.71
|
| Rate for Payer: Healthscope Whirlpool |
$293.63
|
| Rate for Payer: Mclaren Commercial |
$272.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.30
|
| Rate for Payer: Nomi Health Commercial |
$248.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.23
|
| Rate for Payer: Priority Health Narrow Network |
$212.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.38
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$399.94
|
|
|
Service Code
|
NDC 43598032675
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.98 |
| Max. Negotiated Rate |
$399.94 |
| Rate for Payer: Aetna Commercial |
$359.95
|
| Rate for Payer: Aetna Medicare |
$199.97
|
| Rate for Payer: ASR ASR |
$387.94
|
| Rate for Payer: ASR Commercial |
$387.94
|
| Rate for Payer: BCBS Complete |
$159.98
|
| Rate for Payer: BCBS Trust/PPO |
$327.51
|
| Rate for Payer: BCN Commercial |
$310.07
|
| Rate for Payer: Cash Price |
$319.96
|
| Rate for Payer: Cofinity Commercial |
$375.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.95
|
| Rate for Payer: Healthscope Commercial |
$399.94
|
| Rate for Payer: Healthscope Whirlpool |
$387.94
|
| Rate for Payer: Mclaren Commercial |
$359.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.95
|
| Rate for Payer: Nomi Health Commercial |
$327.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$350.43
|
| Rate for Payer: Priority Health Narrow Network |
$280.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$351.95
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$399.94
|
|
|
Service Code
|
NDC 43598032675
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.96 |
| Max. Negotiated Rate |
$399.94 |
| Rate for Payer: Aetna Commercial |
$359.95
|
| Rate for Payer: ASR ASR |
$387.94
|
| Rate for Payer: ASR Commercial |
$387.94
|
| Rate for Payer: BCBS Trust/PPO |
$325.91
|
| Rate for Payer: BCN Commercial |
$310.07
|
| Rate for Payer: Cash Price |
$319.96
|
| Rate for Payer: Cofinity Commercial |
$375.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.95
|
| Rate for Payer: Healthscope Commercial |
$399.94
|
| Rate for Payer: Healthscope Whirlpool |
$387.94
|
| Rate for Payer: Mclaren Commercial |
$359.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.95
|
| Rate for Payer: Nomi Health Commercial |
$327.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$351.95
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$24.50
|
|
|
Service Code
|
NDC 17478071425
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: ASR ASR |
$23.77
|
| Rate for Payer: ASR Commercial |
$23.77
|
| Rate for Payer: BCBS Trust/PPO |
$19.97
|
| Rate for Payer: BCN Commercial |
$18.99
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cofinity Commercial |
$23.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.60
|
| Rate for Payer: Healthscope Commercial |
$24.50
|
| Rate for Payer: Healthscope Whirlpool |
$23.77
|
| Rate for Payer: Mclaren Commercial |
$22.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.82
|
| Rate for Payer: Nomi Health Commercial |
$20.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.56
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$21.51
|
|
|
Service Code
|
NDC 69315030802
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$21.51 |
| Rate for Payer: Aetna Commercial |
$19.36
|
| Rate for Payer: ASR ASR |
$20.86
|
| Rate for Payer: ASR Commercial |
$20.86
|
| Rate for Payer: BCBS Trust/PPO |
$17.53
|
| Rate for Payer: BCN Commercial |
$16.68
|
| Rate for Payer: Cash Price |
$17.21
|
| Rate for Payer: Cofinity Commercial |
$20.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.21
|
| Rate for Payer: Healthscope Commercial |
$21.51
|
| Rate for Payer: Healthscope Whirlpool |
$20.86
|
| Rate for Payer: Mclaren Commercial |
$19.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.28
|
| Rate for Payer: Nomi Health Commercial |
$17.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.93
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$34.20
|
|
|
Service Code
|
NDC 61314065625
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna Commercial |
$30.78
|
| Rate for Payer: ASR ASR |
$33.17
|
| Rate for Payer: ASR Commercial |
$33.17
|
| Rate for Payer: BCBS Trust/PPO |
$27.87
|
| Rate for Payer: BCN Commercial |
$26.52
|
| Rate for Payer: Cash Price |
$27.36
|
| Rate for Payer: Cofinity Commercial |
$32.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.36
|
| Rate for Payer: Healthscope Commercial |
$34.20
|
| Rate for Payer: Healthscope Whirlpool |
$33.17
|
| Rate for Payer: Mclaren Commercial |
$30.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.07
|
| Rate for Payer: Nomi Health Commercial |
$28.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.10
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$21.51
|
|
|
Service Code
|
NDC 69315030802
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$21.51 |
| Rate for Payer: Aetna Commercial |
$19.36
|
| Rate for Payer: Aetna Medicare |
$10.76
|
| Rate for Payer: ASR ASR |
$20.86
|
| Rate for Payer: ASR Commercial |
$20.86
|
| Rate for Payer: BCBS Complete |
$8.60
|
| Rate for Payer: BCBS Trust/PPO |
$17.61
|
| Rate for Payer: BCN Commercial |
$16.68
|
| Rate for Payer: Cash Price |
$17.21
|
| Rate for Payer: Cofinity Commercial |
$20.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.21
|
| Rate for Payer: Healthscope Commercial |
$21.51
|
| Rate for Payer: Healthscope Whirlpool |
$20.86
|
| Rate for Payer: Mclaren Commercial |
$19.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.28
|
| Rate for Payer: Nomi Health Commercial |
$17.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.85
|
| Rate for Payer: Priority Health Narrow Network |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.93
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$24.50
|
|
|
Service Code
|
NDC 17478071425
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna Medicare |
$12.25
|
| Rate for Payer: ASR ASR |
$23.77
|
| Rate for Payer: ASR Commercial |
$23.77
|
| Rate for Payer: BCBS Complete |
$9.80
|
| Rate for Payer: BCBS Trust/PPO |
$20.06
|
| Rate for Payer: BCN Commercial |
$18.99
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cofinity Commercial |
$23.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.60
|
| Rate for Payer: Healthscope Commercial |
$24.50
|
| Rate for Payer: Healthscope Whirlpool |
$23.77
|
| Rate for Payer: Mclaren Commercial |
$22.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.82
|
| Rate for Payer: Nomi Health Commercial |
$20.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.47
|
| Rate for Payer: Priority Health Narrow Network |
$17.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.56
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$34.20
|
|
|
Service Code
|
NDC 61314065625
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna Commercial |
$30.78
|
| Rate for Payer: Aetna Medicare |
$17.10
|
| Rate for Payer: ASR ASR |
$33.17
|
| Rate for Payer: ASR Commercial |
$33.17
|
| Rate for Payer: BCBS Complete |
$13.68
|
| Rate for Payer: BCBS Trust/PPO |
$28.01
|
| Rate for Payer: BCN Commercial |
$26.52
|
| Rate for Payer: Cash Price |
$27.36
|
| Rate for Payer: Cofinity Commercial |
$32.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.36
|
| Rate for Payer: Healthscope Commercial |
$34.20
|
| Rate for Payer: Healthscope Whirlpool |
$33.17
|
| Rate for Payer: Mclaren Commercial |
$30.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.07
|
| Rate for Payer: Nomi Health Commercial |
$28.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.97
|
| Rate for Payer: Priority Health Narrow Network |
$23.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.10
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 00143992801
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.30 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$412.43
|
| Rate for Payer: Aetna Medicare |
$229.12
|
| Rate for Payer: ASR ASR |
$444.50
|
| Rate for Payer: ASR Commercial |
$444.50
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: BCBS Trust/PPO |
$375.26
|
| Rate for Payer: BCN Commercial |
$355.28
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$430.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$458.25
|
| Rate for Payer: Healthscope Whirlpool |
$444.50
|
| Rate for Payer: Mclaren Commercial |
$412.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$401.52
|
| Rate for Payer: Priority Health Narrow Network |
$321.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.26
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 00143992801
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.86 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$412.43
|
| Rate for Payer: ASR ASR |
$444.50
|
| Rate for Payer: ASR Commercial |
$444.50
|
| Rate for Payer: BCBS Trust/PPO |
$373.43
|
| Rate for Payer: BCN Commercial |
$355.28
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$430.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$458.25
|
| Rate for Payer: Healthscope Whirlpool |
$444.50
|
| Rate for Payer: Mclaren Commercial |
$412.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.26
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$13.16
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Aetna Commercial |
$11.84
|
| Rate for Payer: ASR ASR |
$12.77
|
| Rate for Payer: ASR Commercial |
$12.77
|
| Rate for Payer: BCBS Trust/PPO |
$10.72
|
| Rate for Payer: BCN Commercial |
$10.20
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$12.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$13.16
|
| Rate for Payer: Healthscope Whirlpool |
$12.77
|
| Rate for Payer: Mclaren Commercial |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.19
|
| Rate for Payer: Nomi Health Commercial |
$10.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.58
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$13.16
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Aetna Commercial |
$11.84
|
| Rate for Payer: Aetna Medicare |
$6.58
|
| Rate for Payer: ASR ASR |
$12.77
|
| Rate for Payer: ASR Commercial |
$12.77
|
| Rate for Payer: BCBS Complete |
$5.26
|
| Rate for Payer: BCBS Trust/PPO |
$10.78
|
| Rate for Payer: BCN Commercial |
$10.20
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$12.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$13.16
|
| Rate for Payer: Healthscope Whirlpool |
$12.77
|
| Rate for Payer: Mclaren Commercial |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.19
|
| Rate for Payer: Nomi Health Commercial |
$10.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$9.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.58
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$28.19
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
1743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$28.19 |
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: Aetna Medicare |
$14.10
|
| Rate for Payer: ASR ASR |
$27.34
|
| Rate for Payer: ASR Commercial |
$27.34
|
| Rate for Payer: BCBS Complete |
$11.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.08
|
| Rate for Payer: BCN Commercial |
$21.86
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Healthscope Commercial |
$28.19
|
| Rate for Payer: Healthscope Whirlpool |
$27.34
|
| Rate for Payer: Mclaren Commercial |
$25.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.96
|
| Rate for Payer: Nomi Health Commercial |
$23.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.70
|
| Rate for Payer: Priority Health Narrow Network |
$19.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.81
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$28.19
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
1743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$28.19 |
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: ASR ASR |
$27.34
|
| Rate for Payer: ASR Commercial |
$27.34
|
| Rate for Payer: BCBS Trust/PPO |
$22.97
|
| Rate for Payer: BCN Commercial |
$21.86
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Healthscope Commercial |
$28.19
|
| Rate for Payer: Healthscope Whirlpool |
$27.34
|
| Rate for Payer: Mclaren Commercial |
$25.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.96
|
| Rate for Payer: Nomi Health Commercial |
$23.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.81
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$42.72
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.09 |
| Max. Negotiated Rate |
$42.72 |
| Rate for Payer: Aetna Commercial |
$38.45
|
| Rate for Payer: Aetna Medicare |
$21.36
|
| Rate for Payer: ASR ASR |
$41.44
|
| Rate for Payer: ASR Commercial |
$41.44
|
| Rate for Payer: BCBS Complete |
$17.09
|
| Rate for Payer: BCBS Trust/PPO |
$34.98
|
| Rate for Payer: BCN Commercial |
$33.12
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.18
|
| Rate for Payer: Healthscope Commercial |
$42.72
|
| Rate for Payer: Healthscope Whirlpool |
$41.44
|
| Rate for Payer: Mclaren Commercial |
$38.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.31
|
| Rate for Payer: Nomi Health Commercial |
$35.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.43
|
| Rate for Payer: Priority Health Narrow Network |
$29.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.59
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$42.72
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.77 |
| Max. Negotiated Rate |
$42.72 |
| Rate for Payer: Aetna Commercial |
$38.45
|
| Rate for Payer: ASR ASR |
$41.44
|
| Rate for Payer: ASR Commercial |
$41.44
|
| Rate for Payer: BCBS Trust/PPO |
$34.81
|
| Rate for Payer: BCN Commercial |
$33.12
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.18
|
| Rate for Payer: Healthscope Commercial |
$42.72
|
| Rate for Payer: Healthscope Whirlpool |
$41.44
|
| Rate for Payer: Mclaren Commercial |
$38.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.31
|
| Rate for Payer: Nomi Health Commercial |
$35.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.59
|
|
