|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$19.51
|
|
|
Service Code
|
NDC 68462029817
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$19.51 |
| Rate for Payer: Aetna Commercial |
$17.56
|
| Rate for Payer: ASR ASR |
$18.92
|
| Rate for Payer: ASR Commercial |
$18.92
|
| Rate for Payer: BCBS Trust/PPO |
$15.90
|
| Rate for Payer: BCN Commercial |
$15.13
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$19.51
|
| Rate for Payer: Healthscope Whirlpool |
$18.92
|
| Rate for Payer: Mclaren Commercial |
$17.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: Nomi Health Commercial |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.17
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$25.67
|
|
|
Service Code
|
NDC 00168025815
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$25.67 |
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Aetna Medicare |
$12.84
|
| Rate for Payer: ASR ASR |
$24.90
|
| Rate for Payer: ASR Commercial |
$24.90
|
| Rate for Payer: BCBS Complete |
$10.27
|
| Rate for Payer: BCBS Trust/PPO |
$21.02
|
| Rate for Payer: BCN Commercial |
$19.90
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Commercial |
$24.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Healthscope Commercial |
$25.67
|
| Rate for Payer: Healthscope Whirlpool |
$24.90
|
| Rate for Payer: Mclaren Commercial |
$23.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.82
|
| Rate for Payer: Nomi Health Commercial |
$21.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.49
|
| Rate for Payer: Priority Health Narrow Network |
$17.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.59
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$32.92
|
|
|
Service Code
|
NDC 00472037915
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$32.92 |
| Rate for Payer: Aetna Commercial |
$29.63
|
| Rate for Payer: ASR ASR |
$31.93
|
| Rate for Payer: ASR Commercial |
$31.93
|
| Rate for Payer: BCBS Trust/PPO |
$26.83
|
| Rate for Payer: BCN Commercial |
$25.52
|
| Rate for Payer: Cash Price |
$26.33
|
| Rate for Payer: Cofinity Commercial |
$30.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.34
|
| Rate for Payer: Healthscope Commercial |
$32.92
|
| Rate for Payer: Healthscope Whirlpool |
$31.93
|
| Rate for Payer: Mclaren Commercial |
$29.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.98
|
| Rate for Payer: Nomi Health Commercial |
$26.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.97
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$19.51
|
|
|
Service Code
|
NDC 68462029817
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$19.51 |
| Rate for Payer: Aetna Commercial |
$17.56
|
| Rate for Payer: Aetna Medicare |
$9.76
|
| Rate for Payer: ASR ASR |
$18.92
|
| Rate for Payer: ASR Commercial |
$18.92
|
| Rate for Payer: BCBS Complete |
$7.80
|
| Rate for Payer: BCBS Trust/PPO |
$15.98
|
| Rate for Payer: BCN Commercial |
$15.13
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$19.51
|
| Rate for Payer: Healthscope Whirlpool |
$18.92
|
| Rate for Payer: Mclaren Commercial |
$17.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: Nomi Health Commercial |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.09
|
| Rate for Payer: Priority Health Narrow Network |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.17
|
|
|
COENZYME Q10 50 MG CAPSULE
|
Facility
|
OP
|
$166.03
|
|
|
Service Code
|
NDC 96295014213
|
| Hospital Charge Code |
35228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.41 |
| Max. Negotiated Rate |
$166.03 |
| Rate for Payer: Aetna Commercial |
$149.43
|
| Rate for Payer: Aetna Medicare |
$83.02
|
| Rate for Payer: ASR ASR |
$161.05
|
| Rate for Payer: ASR Commercial |
$161.05
|
| Rate for Payer: BCBS Complete |
$66.41
|
| Rate for Payer: BCBS Trust/PPO |
$135.96
|
| Rate for Payer: BCN Commercial |
$128.72
|
| Rate for Payer: Cash Price |
$132.82
|
| Rate for Payer: Cofinity Commercial |
$156.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.82
|
| Rate for Payer: Healthscope Commercial |
$166.03
|
| Rate for Payer: Healthscope Whirlpool |
$161.05
|
| Rate for Payer: Mclaren Commercial |
$149.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.13
|
| Rate for Payer: Nomi Health Commercial |
$136.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.48
|
| Rate for Payer: Priority Health Narrow Network |
$116.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.11
|
|
|
COENZYME Q10 50 MG CAPSULE
|
Facility
|
IP
|
$166.03
|
|
|
Service Code
|
NDC 96295014213
|
| Hospital Charge Code |
35228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.92 |
| Max. Negotiated Rate |
$166.03 |
| Rate for Payer: Aetna Commercial |
$149.43
|
| Rate for Payer: ASR ASR |
$161.05
|
| Rate for Payer: ASR Commercial |
$161.05
|
| Rate for Payer: BCBS Trust/PPO |
$135.30
|
| Rate for Payer: BCN Commercial |
$128.72
|
| Rate for Payer: Cash Price |
$132.82
|
| Rate for Payer: Cofinity Commercial |
$156.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.82
|
| Rate for Payer: Healthscope Commercial |
$166.03
|
| Rate for Payer: Healthscope Whirlpool |
$161.05
|
| Rate for Payer: Mclaren Commercial |
$149.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.13
|
| Rate for Payer: Nomi Health Commercial |
$136.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.11
|
|
|
COLCHICINE 0.6 MG CAPSULE
|
Facility
|
IP
|
$20.45
|
|
|
Service Code
|
NDC 60687035895
|
| Hospital Charge Code |
172731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$20.45 |
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: ASR ASR |
$19.84
|
| Rate for Payer: ASR Commercial |
$19.84
|
| Rate for Payer: BCBS Trust/PPO |
$16.66
|
| Rate for Payer: BCN Commercial |
$15.85
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$19.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.36
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: Healthscope Whirlpool |
$19.84
|
| Rate for Payer: Mclaren Commercial |
$18.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.38
|
| Rate for Payer: Nomi Health Commercial |
$16.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.00
|
|
|
COLCHICINE 0.6 MG CAPSULE
|
Facility
|
IP
|
$613.50
|
|
|
Service Code
|
NDC 60687035825
|
| Hospital Charge Code |
172731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$398.77 |
| Max. Negotiated Rate |
$613.50 |
| Rate for Payer: Aetna Commercial |
$552.15
|
| Rate for Payer: ASR ASR |
$595.10
|
| Rate for Payer: ASR Commercial |
$595.10
|
| Rate for Payer: BCBS Trust/PPO |
$499.94
|
| Rate for Payer: BCN Commercial |
$475.65
|
| Rate for Payer: Cash Price |
$490.80
|
| Rate for Payer: Cofinity Commercial |
$576.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$490.80
|
| Rate for Payer: Healthscope Commercial |
$613.50
|
| Rate for Payer: Healthscope Whirlpool |
$595.10
|
| Rate for Payer: Mclaren Commercial |
$552.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$521.48
|
| Rate for Payer: Nomi Health Commercial |
$503.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$539.88
|
|
|
COLCHICINE 0.6 MG CAPSULE
|
Facility
|
IP
|
$484.29
|
|
|
Service Code
|
NDC 00904673204
|
| Hospital Charge Code |
172731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.79 |
| Max. Negotiated Rate |
$484.29 |
| Rate for Payer: Aetna Commercial |
$435.86
|
| Rate for Payer: ASR ASR |
$469.76
|
| Rate for Payer: ASR Commercial |
$469.76
|
| Rate for Payer: BCBS Trust/PPO |
$394.65
|
| Rate for Payer: BCN Commercial |
$375.47
|
| Rate for Payer: Cash Price |
$387.43
|
| Rate for Payer: Cofinity Commercial |
$455.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.43
|
| Rate for Payer: Healthscope Commercial |
$484.29
|
| Rate for Payer: Healthscope Whirlpool |
$469.76
|
| Rate for Payer: Mclaren Commercial |
$435.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.65
|
| Rate for Payer: Nomi Health Commercial |
$397.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.18
|
|
|
COLCHICINE 0.6 MG CAPSULE
|
Facility
|
OP
|
$484.29
|
|
|
Service Code
|
NDC 00904673204
|
| Hospital Charge Code |
172731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.72 |
| Max. Negotiated Rate |
$484.29 |
| Rate for Payer: Aetna Commercial |
$435.86
|
| Rate for Payer: Aetna Medicare |
$242.15
|
| Rate for Payer: ASR ASR |
$469.76
|
| Rate for Payer: ASR Commercial |
$469.76
|
| Rate for Payer: BCBS Complete |
$193.72
|
| Rate for Payer: BCBS Trust/PPO |
$396.59
|
| Rate for Payer: BCN Commercial |
$375.47
|
| Rate for Payer: Cash Price |
$387.43
|
| Rate for Payer: Cofinity Commercial |
$455.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.43
|
| Rate for Payer: Healthscope Commercial |
$484.29
|
| Rate for Payer: Healthscope Whirlpool |
$469.76
|
| Rate for Payer: Mclaren Commercial |
$435.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.65
|
| Rate for Payer: Nomi Health Commercial |
$397.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$424.33
|
| Rate for Payer: Priority Health Narrow Network |
$339.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.18
|
|
|
COLCHICINE 0.6 MG CAPSULE
|
Facility
|
OP
|
$613.50
|
|
|
Service Code
|
NDC 60687035825
|
| Hospital Charge Code |
172731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.40 |
| Max. Negotiated Rate |
$613.50 |
| Rate for Payer: Aetna Commercial |
$552.15
|
| Rate for Payer: Aetna Medicare |
$306.75
|
| Rate for Payer: ASR ASR |
$595.10
|
| Rate for Payer: ASR Commercial |
$595.10
|
| Rate for Payer: BCBS Complete |
$245.40
|
| Rate for Payer: BCBS Trust/PPO |
$502.40
|
| Rate for Payer: BCN Commercial |
$475.65
|
| Rate for Payer: Cash Price |
$490.80
|
| Rate for Payer: Cofinity Commercial |
$576.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$490.80
|
| Rate for Payer: Healthscope Commercial |
$613.50
|
| Rate for Payer: Healthscope Whirlpool |
$595.10
|
| Rate for Payer: Mclaren Commercial |
$552.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$521.48
|
| Rate for Payer: Nomi Health Commercial |
$503.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$537.55
|
| Rate for Payer: Priority Health Narrow Network |
$430.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$539.88
|
|
|
COLCHICINE 0.6 MG CAPSULE
|
Facility
|
OP
|
$20.45
|
|
|
Service Code
|
NDC 60687035895
|
| Hospital Charge Code |
172731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$20.45 |
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: Aetna Medicare |
$10.22
|
| Rate for Payer: ASR ASR |
$19.84
|
| Rate for Payer: ASR Commercial |
$19.84
|
| Rate for Payer: BCBS Complete |
$8.18
|
| Rate for Payer: BCBS Trust/PPO |
$16.75
|
| Rate for Payer: BCN Commercial |
$15.85
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$19.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.36
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: Healthscope Whirlpool |
$19.84
|
| Rate for Payer: Mclaren Commercial |
$18.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.38
|
| Rate for Payer: Nomi Health Commercial |
$16.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.92
|
| Rate for Payer: Priority Health Narrow Network |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.00
|
|
|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
IP
|
$407.23
|
|
|
Service Code
|
NDC 00115521116
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$264.70 |
| Max. Negotiated Rate |
$407.23 |
| Rate for Payer: Aetna Commercial |
$366.51
|
| Rate for Payer: ASR ASR |
$395.01
|
| Rate for Payer: ASR Commercial |
$395.01
|
| Rate for Payer: BCBS Trust/PPO |
$331.85
|
| Rate for Payer: BCN Commercial |
$315.73
|
| Rate for Payer: Cash Price |
$325.79
|
| Rate for Payer: Cofinity Commercial |
$382.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.78
|
| Rate for Payer: Healthscope Commercial |
$407.23
|
| Rate for Payer: Healthscope Whirlpool |
$395.01
|
| Rate for Payer: Mclaren Commercial |
$366.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.15
|
| Rate for Payer: Nomi Health Commercial |
$333.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$358.36
|
|
|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
OP
|
$407.23
|
|
|
Service Code
|
NDC 00115521116
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.89 |
| Max. Negotiated Rate |
$407.23 |
| Rate for Payer: Aetna Commercial |
$366.51
|
| Rate for Payer: Aetna Medicare |
$203.62
|
| Rate for Payer: ASR ASR |
$395.01
|
| Rate for Payer: ASR Commercial |
$395.01
|
| Rate for Payer: BCBS Complete |
$162.89
|
| Rate for Payer: BCBS Trust/PPO |
$333.48
|
| Rate for Payer: BCN Commercial |
$315.73
|
| Rate for Payer: Cash Price |
$325.79
|
| Rate for Payer: Cofinity Commercial |
$382.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.78
|
| Rate for Payer: Healthscope Commercial |
$407.23
|
| Rate for Payer: Healthscope Whirlpool |
$395.01
|
| Rate for Payer: Mclaren Commercial |
$366.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.15
|
| Rate for Payer: Nomi Health Commercial |
$333.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$356.81
|
| Rate for Payer: Priority Health Narrow Network |
$285.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$358.36
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
NDC 50484001030
|
| Hospital Charge Code |
9682
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$385.60 |
| Max. Negotiated Rate |
$964.00 |
| Rate for Payer: Aetna Commercial |
$867.60
|
| Rate for Payer: Aetna Medicare |
$482.00
|
| Rate for Payer: ASR ASR |
$935.08
|
| Rate for Payer: ASR Commercial |
$935.08
|
| Rate for Payer: BCBS Complete |
$385.60
|
| Rate for Payer: BCBS Trust/PPO |
$789.42
|
| Rate for Payer: BCN Commercial |
$747.39
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cofinity Commercial |
$906.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.20
|
| Rate for Payer: Healthscope Commercial |
$964.00
|
| Rate for Payer: Healthscope Whirlpool |
$935.08
|
| Rate for Payer: Mclaren Commercial |
$867.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.40
|
| Rate for Payer: Nomi Health Commercial |
$790.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$844.66
|
| Rate for Payer: Priority Health Narrow Network |
$675.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$848.32
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
NDC 50484001030
|
| Hospital Charge Code |
9682
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$626.60 |
| Max. Negotiated Rate |
$964.00 |
| Rate for Payer: Aetna Commercial |
$867.60
|
| Rate for Payer: ASR ASR |
$935.08
|
| Rate for Payer: ASR Commercial |
$935.08
|
| Rate for Payer: BCBS Trust/PPO |
$785.56
|
| Rate for Payer: BCN Commercial |
$747.39
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cofinity Commercial |
$906.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.20
|
| Rate for Payer: Healthscope Commercial |
$964.00
|
| Rate for Payer: Healthscope Whirlpool |
$935.08
|
| Rate for Payer: Mclaren Commercial |
$867.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.40
|
| Rate for Payer: Nomi Health Commercial |
$790.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$848.32
|
|
|
COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL
|
Facility
|
IP
|
$164.60
|
|
|
Service Code
|
NDC 39328001416
|
| Hospital Charge Code |
176500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.99 |
| Max. Negotiated Rate |
$164.60 |
| Rate for Payer: Aetna Commercial |
$148.14
|
| Rate for Payer: ASR ASR |
$159.66
|
| Rate for Payer: ASR Commercial |
$159.66
|
| Rate for Payer: BCBS Trust/PPO |
$134.13
|
| Rate for Payer: BCN Commercial |
$127.61
|
| Rate for Payer: Cash Price |
$131.68
|
| Rate for Payer: Cofinity Commercial |
$154.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.68
|
| Rate for Payer: Healthscope Commercial |
$164.60
|
| Rate for Payer: Healthscope Whirlpool |
$159.66
|
| Rate for Payer: Mclaren Commercial |
$148.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.91
|
| Rate for Payer: Nomi Health Commercial |
$134.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.85
|
|
|
COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL
|
Facility
|
OP
|
$164.60
|
|
|
Service Code
|
NDC 39328001416
|
| Hospital Charge Code |
176500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$164.60 |
| Rate for Payer: Aetna Commercial |
$148.14
|
| Rate for Payer: Aetna Medicare |
$82.30
|
| Rate for Payer: ASR ASR |
$159.66
|
| Rate for Payer: ASR Commercial |
$159.66
|
| Rate for Payer: BCBS Complete |
$65.84
|
| Rate for Payer: BCBS Trust/PPO |
$134.79
|
| Rate for Payer: BCN Commercial |
$127.61
|
| Rate for Payer: Cash Price |
$131.68
|
| Rate for Payer: Cofinity Commercial |
$154.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.68
|
| Rate for Payer: Healthscope Commercial |
$164.60
|
| Rate for Payer: Healthscope Whirlpool |
$159.66
|
| Rate for Payer: Mclaren Commercial |
$148.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.91
|
| Rate for Payer: Nomi Health Commercial |
$134.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.22
|
| Rate for Payer: Priority Health Narrow Network |
$115.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.85
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
IP
|
$1,572.69
|
|
|
Service Code
|
NDC 00046087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,022.25 |
| Max. Negotiated Rate |
$1,572.69 |
| Rate for Payer: Aetna Commercial |
$1,415.42
|
| Rate for Payer: ASR ASR |
$1,525.51
|
| Rate for Payer: ASR Commercial |
$1,525.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,281.59
|
| Rate for Payer: BCN Commercial |
$1,219.31
|
| Rate for Payer: Cash Price |
$1,258.15
|
| Rate for Payer: Cofinity Commercial |
$1,478.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,258.15
|
| Rate for Payer: Healthscope Commercial |
$1,572.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,525.51
|
| Rate for Payer: Mclaren Commercial |
$1,415.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,336.79
|
| Rate for Payer: Nomi Health Commercial |
$1,289.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,022.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,383.97
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
OP
|
$1,572.69
|
|
|
Service Code
|
NDC 00046087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$629.08 |
| Max. Negotiated Rate |
$1,572.69 |
| Rate for Payer: Aetna Commercial |
$1,415.42
|
| Rate for Payer: Aetna Medicare |
$786.35
|
| Rate for Payer: ASR ASR |
$1,525.51
|
| Rate for Payer: ASR Commercial |
$1,525.51
|
| Rate for Payer: BCBS Complete |
$629.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,287.88
|
| Rate for Payer: BCN Commercial |
$1,219.31
|
| Rate for Payer: Cash Price |
$1,258.15
|
| Rate for Payer: Cofinity Commercial |
$1,478.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,258.15
|
| Rate for Payer: Healthscope Commercial |
$1,572.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,525.51
|
| Rate for Payer: Mclaren Commercial |
$1,415.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,336.79
|
| Rate for Payer: Nomi Health Commercial |
$1,289.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,022.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,377.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,102.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,383.97
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET
|
Facility
|
OP
|
$2,551.15
|
|
|
Service Code
|
NDC 00046110281
|
| Hospital Charge Code |
9974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,020.46 |
| Max. Negotiated Rate |
$2,551.15 |
| Rate for Payer: Aetna Commercial |
$2,296.03
|
| Rate for Payer: Aetna Medicare |
$1,275.58
|
| Rate for Payer: ASR ASR |
$2,474.62
|
| Rate for Payer: ASR Commercial |
$2,474.62
|
| Rate for Payer: BCBS Complete |
$1,020.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,089.14
|
| Rate for Payer: BCN Commercial |
$1,977.91
|
| Rate for Payer: Cash Price |
$2,040.92
|
| Rate for Payer: Cofinity Commercial |
$2,398.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.92
|
| Rate for Payer: Healthscope Commercial |
$2,551.15
|
| Rate for Payer: Healthscope Whirlpool |
$2,474.62
|
| Rate for Payer: Mclaren Commercial |
$2,296.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.48
|
| Rate for Payer: Nomi Health Commercial |
$2,091.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,235.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,788.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,245.01
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET
|
Facility
|
IP
|
$2,551.15
|
|
|
Service Code
|
NDC 00046110281
|
| Hospital Charge Code |
9974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,658.25 |
| Max. Negotiated Rate |
$2,551.15 |
| Rate for Payer: Aetna Commercial |
$2,296.03
|
| Rate for Payer: ASR ASR |
$2,474.62
|
| Rate for Payer: ASR Commercial |
$2,474.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,078.93
|
| Rate for Payer: BCN Commercial |
$1,977.91
|
| Rate for Payer: Cash Price |
$2,040.92
|
| Rate for Payer: Cofinity Commercial |
$2,398.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.92
|
| Rate for Payer: Healthscope Commercial |
$2,551.15
|
| Rate for Payer: Healthscope Whirlpool |
$2,474.62
|
| Rate for Payer: Mclaren Commercial |
$2,296.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.48
|
| Rate for Payer: Nomi Health Commercial |
$2,091.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,245.01
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$1,175.87
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$764.32 |
| Max. Negotiated Rate |
$1,175.87 |
| Rate for Payer: Aetna Commercial |
$1,058.28
|
| Rate for Payer: ASR ASR |
$1,140.59
|
| Rate for Payer: ASR Commercial |
$1,140.59
|
| Rate for Payer: BCBS Trust/PPO |
$958.22
|
| Rate for Payer: BCN Commercial |
$911.65
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cofinity Commercial |
$1,105.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.70
|
| Rate for Payer: Healthscope Commercial |
$1,175.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,140.59
|
| Rate for Payer: Mclaren Commercial |
$1,058.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.49
|
| Rate for Payer: Nomi Health Commercial |
$964.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,034.77
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$1,175.87
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$210.14 |
| Max. Negotiated Rate |
$1,175.87 |
| Rate for Payer: Aetna Commercial |
$1,058.28
|
| Rate for Payer: Aetna Medicare |
$392.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$490.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$490.07
|
| Rate for Payer: ASR ASR |
$1,140.59
|
| Rate for Payer: ASR Commercial |
$1,140.59
|
| Rate for Payer: BCBS Complete |
$220.65
|
| Rate for Payer: BCBS MAPPO |
$392.06
|
| Rate for Payer: BCBS Trust/PPO |
$962.92
|
| Rate for Payer: BCN Commercial |
$911.65
|
| Rate for Payer: BCN Medicare Advantage |
$392.06
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cofinity Commercial |
$1,105.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.06
|
| Rate for Payer: Healthscope Commercial |
$1,175.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,140.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$392.06
|
| Rate for Payer: Mclaren Commercial |
$1,058.28
|
| Rate for Payer: Mclaren Medicaid |
$210.14
|
| Rate for Payer: Mclaren Medicare |
$392.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.66
|
| Rate for Payer: Meridian Medicaid |
$220.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.49
|
| Rate for Payer: Nomi Health Commercial |
$964.21
|
| Rate for Payer: PACE Medicare |
$372.46
|
| Rate for Payer: PACE SWMI |
$392.06
|
| Rate for Payer: PHP Commercial |
$431.27
|
| Rate for Payer: PHP Medicaid |
$210.14
|
| Rate for Payer: PHP Medicare Advantage |
$392.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,030.30
|
| Rate for Payer: Priority Health Medicare |
$392.06
|
| Rate for Payer: Priority Health Narrow Network |
$824.28
|
| Rate for Payer: Railroad Medicare Medicare |
$392.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,034.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.06
|
| Rate for Payer: UHC Exchange |
$607.69
|
| Rate for Payer: UHC Medicare Advantage |
$392.06
|
| Rate for Payer: UHCCP DNSP |
$392.06
|
| Rate for Payer: UHCCP Medicaid |
$210.14
|
| Rate for Payer: VA VA |
$392.06
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$223.85
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.54 |
| Max. Negotiated Rate |
$223.85 |
| Rate for Payer: Aetna Commercial |
$201.47
|
| Rate for Payer: Aetna Commercial |
$261.98
|
| Rate for Payer: Aetna Commercial |
$74.49
|
| Rate for Payer: Aetna Medicare |
$145.54
|
| Rate for Payer: Aetna Medicare |
$41.38
|
| Rate for Payer: Aetna Medicare |
$111.92
|
| Rate for Payer: ASR ASR |
$282.36
|
| Rate for Payer: ASR ASR |
$217.13
|
| Rate for Payer: ASR ASR |
$80.29
|
| Rate for Payer: ASR Commercial |
$80.29
|
| Rate for Payer: ASR Commercial |
$282.36
|
| Rate for Payer: ASR Commercial |
$217.13
|
| Rate for Payer: BCBS Complete |
$89.54
|
| Rate for Payer: BCBS Complete |
$116.44
|
| Rate for Payer: BCBS Complete |
$33.11
|
| Rate for Payer: BCBS Trust/PPO |
$183.31
|
| Rate for Payer: BCBS Trust/PPO |
$238.37
|
| Rate for Payer: BCBS Trust/PPO |
$67.78
|
| Rate for Payer: BCN Commercial |
$64.17
|
| Rate for Payer: BCN Commercial |
$173.55
|
| Rate for Payer: BCN Commercial |
$225.68
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cash Price |
$179.08
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$77.80
|
| Rate for Payer: Cofinity Commercial |
$210.42
|
| Rate for Payer: Cofinity Commercial |
$273.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$223.85
|
| Rate for Payer: Healthscope Commercial |
$291.09
|
| Rate for Payer: Healthscope Commercial |
$82.77
|
| Rate for Payer: Healthscope Whirlpool |
$282.36
|
| Rate for Payer: Healthscope Whirlpool |
$217.13
|
| Rate for Payer: Healthscope Whirlpool |
$80.29
|
| Rate for Payer: Mclaren Commercial |
$201.47
|
| Rate for Payer: Mclaren Commercial |
$261.98
|
| Rate for Payer: Mclaren Commercial |
$74.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Nomi Health Commercial |
$183.56
|
| Rate for Payer: Nomi Health Commercial |
$238.69
|
| Rate for Payer: Nomi Health Commercial |
$67.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.52
|
| Rate for Payer: Priority Health Narrow Network |
$58.02
|
| Rate for Payer: Priority Health Narrow Network |
$156.92
|
| Rate for Payer: Priority Health Narrow Network |
$204.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.84
|
|
