|
CAPSAICIN 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$25.25
|
|
|
Service Code
|
NDC 70000054901
|
| Hospital Charge Code |
70403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$25.25 |
| Rate for Payer: Aetna Commercial |
$22.72
|
| Rate for Payer: Aetna Medicare |
$9.34
|
| Rate for Payer: ASR ASR |
$24.49
|
| Rate for Payer: BCBS Complete |
$10.10
|
| Rate for Payer: BCBS Trust/PPO |
$20.81
|
| Rate for Payer: BCN Commercial |
$20.81
|
| Rate for Payer: Cash Price |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$23.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.20
|
| Rate for Payer: Healthscope Commercial |
$24.49
|
| Rate for Payer: Healthscope Whirlpool |
$25.25
|
| Rate for Payer: Mclaren Commercial |
$22.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.46
|
| Rate for Payer: Nomi Health Commercial |
$20.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.12
|
| Rate for Payer: Priority Health Narrow Network |
$17.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.22
|
|
|
CAPSAICIN 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$25.25
|
|
|
Service Code
|
NDC 70000054901
|
| Hospital Charge Code |
70403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$25.25 |
| Rate for Payer: Aetna Commercial |
$22.72
|
| Rate for Payer: ASR ASR |
$24.49
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$20.73
|
| Rate for Payer: Cash Price |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$23.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.20
|
| Rate for Payer: Healthscope Commercial |
$24.49
|
| Rate for Payer: Healthscope Whirlpool |
$25.25
|
| Rate for Payer: Mclaren Commercial |
$22.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.46
|
| Rate for Payer: Nomi Health Commercial |
$20.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.22
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
OP
|
$198.72
|
|
|
Service Code
|
NDC 60687031521
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.53 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$178.85
|
| Rate for Payer: Aetna Medicare |
$73.53
|
| Rate for Payer: ASR ASR |
$192.76
|
| Rate for Payer: BCBS Complete |
$79.49
|
| Rate for Payer: BCBS Trust/PPO |
$163.84
|
| Rate for Payer: BCN Commercial |
$163.84
|
| Rate for Payer: Cash Price |
$158.98
|
| Rate for Payer: Cofinity Commercial |
$186.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.98
|
| Rate for Payer: Healthscope Commercial |
$192.76
|
| Rate for Payer: Healthscope Whirlpool |
$198.72
|
| Rate for Payer: Mclaren Commercial |
$178.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.91
|
| Rate for Payer: Nomi Health Commercial |
$162.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$174.12
|
| Rate for Payer: Priority Health Narrow Network |
$139.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.87
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$6.62
|
|
|
Service Code
|
NDC 60687031511
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: ASR ASR |
$6.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.44
|
| Rate for Payer: BCN Commercial |
$5.44
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cofinity Commercial |
$6.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$6.43
|
| Rate for Payer: Healthscope Whirlpool |
$6.62
|
| Rate for Payer: Mclaren Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.63
|
| Rate for Payer: Nomi Health Commercial |
$5.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.83
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$198.72
|
|
|
Service Code
|
NDC 60687031521
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.04 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$178.85
|
| Rate for Payer: ASR ASR |
$192.76
|
| Rate for Payer: BCBS Trust/PPO |
$163.19
|
| Rate for Payer: BCN Commercial |
$163.19
|
| Rate for Payer: Cash Price |
$158.98
|
| Rate for Payer: Cofinity Commercial |
$186.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.98
|
| Rate for Payer: Healthscope Commercial |
$192.76
|
| Rate for Payer: Healthscope Whirlpool |
$198.72
|
| Rate for Payer: Mclaren Commercial |
$178.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.91
|
| Rate for Payer: Nomi Health Commercial |
$162.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.87
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
OP
|
$6.62
|
|
|
Service Code
|
NDC 60687031511
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: Aetna Medicare |
$2.45
|
| Rate for Payer: ASR ASR |
$6.43
|
| Rate for Payer: BCBS Complete |
$2.65
|
| Rate for Payer: BCBS Trust/PPO |
$5.46
|
| Rate for Payer: BCN Commercial |
$5.46
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cofinity Commercial |
$6.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$6.43
|
| Rate for Payer: Healthscope Whirlpool |
$6.62
|
| Rate for Payer: Mclaren Commercial |
$5.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.63
|
| Rate for Payer: Nomi Health Commercial |
$5.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.80
|
| Rate for Payer: Priority Health Narrow Network |
$4.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.83
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
OP
|
$378.10
|
|
|
Service Code
|
NDC 904385461
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.90 |
| Max. Negotiated Rate |
$378.10 |
| Rate for Payer: Aetna Commercial |
$340.29
|
| Rate for Payer: Aetna Medicare |
$139.90
|
| Rate for Payer: ASR ASR |
$366.76
|
| Rate for Payer: BCBS Complete |
$151.24
|
| Rate for Payer: BCBS Trust/PPO |
$311.74
|
| Rate for Payer: BCN Commercial |
$311.74
|
| Rate for Payer: Cash Price |
$302.48
|
| Rate for Payer: Cofinity Commercial |
$355.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.48
|
| Rate for Payer: Healthscope Commercial |
$366.76
|
| Rate for Payer: Healthscope Whirlpool |
$378.10
|
| Rate for Payer: Mclaren Commercial |
$340.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.38
|
| Rate for Payer: Nomi Health Commercial |
$310.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$331.29
|
| Rate for Payer: Priority Health Narrow Network |
$265.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$332.73
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
OP
|
$3.14
|
|
|
Service Code
|
NDC 51079087001
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna Medicare |
$1.16
|
| Rate for Payer: ASR ASR |
$3.04
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: BCBS Trust/PPO |
$2.58
|
| Rate for Payer: BCN Commercial |
$2.58
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.51
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: Healthscope Whirlpool |
$3.13
|
| Rate for Payer: Mclaren Commercial |
$2.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.66
|
| Rate for Payer: Nomi Health Commercial |
$2.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.75
|
| Rate for Payer: Priority Health Narrow Network |
$2.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.76
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
IP
|
$3.14
|
|
|
Service Code
|
NDC 51079087001
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: ASR ASR |
$3.04
|
| Rate for Payer: BCBS Trust/PPO |
$2.57
|
| Rate for Payer: BCN Commercial |
$2.57
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.51
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: Healthscope Whirlpool |
$3.13
|
| Rate for Payer: Mclaren Commercial |
$2.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.66
|
| Rate for Payer: Nomi Health Commercial |
$2.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.76
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
IP
|
$378.10
|
|
|
Service Code
|
NDC 904385461
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$283.57 |
| Max. Negotiated Rate |
$378.10 |
| Rate for Payer: Aetna Commercial |
$340.29
|
| Rate for Payer: ASR ASR |
$366.76
|
| Rate for Payer: BCBS Trust/PPO |
$310.50
|
| Rate for Payer: BCN Commercial |
$310.50
|
| Rate for Payer: Cash Price |
$302.48
|
| Rate for Payer: Cofinity Commercial |
$355.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.48
|
| Rate for Payer: Healthscope Commercial |
$366.76
|
| Rate for Payer: Healthscope Whirlpool |
$378.10
|
| Rate for Payer: Mclaren Commercial |
$340.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.38
|
| Rate for Payer: Nomi Health Commercial |
$310.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$332.73
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
NDC 75834022101
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.73 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: Aetna Medicare |
$121.73
|
| Rate for Payer: ASR ASR |
$319.13
|
| Rate for Payer: BCBS Complete |
$131.60
|
| Rate for Payer: BCBS Trust/PPO |
$271.26
|
| Rate for Payer: BCN Commercial |
$271.26
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$309.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$319.13
|
| Rate for Payer: Healthscope Whirlpool |
$329.00
|
| Rate for Payer: Mclaren Commercial |
$296.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$263.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$288.27
|
| Rate for Payer: Priority Health Narrow Network |
$230.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.52
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
OP
|
$247.68
|
|
|
Service Code
|
NDC 904617261
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.64 |
| Max. Negotiated Rate |
$247.68 |
| Rate for Payer: Aetna Commercial |
$222.91
|
| Rate for Payer: Aetna Medicare |
$91.64
|
| Rate for Payer: ASR ASR |
$240.25
|
| Rate for Payer: BCBS Complete |
$99.07
|
| Rate for Payer: BCBS Trust/PPO |
$204.21
|
| Rate for Payer: BCN Commercial |
$204.21
|
| Rate for Payer: Cash Price |
$198.14
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.14
|
| Rate for Payer: Healthscope Commercial |
$240.25
|
| Rate for Payer: Healthscope Whirlpool |
$247.68
|
| Rate for Payer: Mclaren Commercial |
$222.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.53
|
| Rate for Payer: Nomi Health Commercial |
$203.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$217.02
|
| Rate for Payer: Priority Health Narrow Network |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.96
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$247.68
|
|
|
Service Code
|
NDC 904617261
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.76 |
| Max. Negotiated Rate |
$247.68 |
| Rate for Payer: Aetna Commercial |
$222.91
|
| Rate for Payer: ASR ASR |
$240.25
|
| Rate for Payer: BCBS Trust/PPO |
$203.39
|
| Rate for Payer: BCN Commercial |
$203.39
|
| Rate for Payer: Cash Price |
$198.14
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.14
|
| Rate for Payer: Healthscope Commercial |
$240.25
|
| Rate for Payer: Healthscope Whirlpool |
$247.68
|
| Rate for Payer: Mclaren Commercial |
$222.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.53
|
| Rate for Payer: Nomi Health Commercial |
$203.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.96
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 75834022101
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.75 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: ASR ASR |
$319.13
|
| Rate for Payer: BCBS Trust/PPO |
$270.17
|
| Rate for Payer: BCN Commercial |
$270.17
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$309.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$319.13
|
| Rate for Payer: Healthscope Whirlpool |
$329.00
|
| Rate for Payer: Mclaren Commercial |
$296.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.52
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$391.72
|
|
|
Service Code
|
NDC 60687058321
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.94 |
| Max. Negotiated Rate |
$391.72 |
| Rate for Payer: Aetna Commercial |
$352.55
|
| Rate for Payer: Aetna Medicare |
$144.94
|
| Rate for Payer: ASR ASR |
$379.97
|
| Rate for Payer: BCBS Complete |
$156.69
|
| Rate for Payer: BCBS Trust/PPO |
$322.97
|
| Rate for Payer: BCN Commercial |
$322.97
|
| Rate for Payer: Cash Price |
$313.38
|
| Rate for Payer: Cofinity Commercial |
$368.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.38
|
| Rate for Payer: Healthscope Commercial |
$379.97
|
| Rate for Payer: Healthscope Whirlpool |
$391.72
|
| Rate for Payer: Mclaren Commercial |
$352.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.96
|
| Rate for Payer: Nomi Health Commercial |
$321.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$293.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$343.22
|
| Rate for Payer: Priority Health Narrow Network |
$274.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$344.71
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$13.06
|
|
|
Service Code
|
NDC 60687058311
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$13.06 |
| Rate for Payer: Aetna Commercial |
$11.75
|
| Rate for Payer: ASR ASR |
$12.67
|
| Rate for Payer: BCBS Trust/PPO |
$10.72
|
| Rate for Payer: BCN Commercial |
$10.72
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Cofinity Commercial |
$12.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.45
|
| Rate for Payer: Healthscope Commercial |
$12.67
|
| Rate for Payer: Healthscope Whirlpool |
$13.06
|
| Rate for Payer: Mclaren Commercial |
$11.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.10
|
| Rate for Payer: Nomi Health Commercial |
$10.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.49
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$391.72
|
|
|
Service Code
|
NDC 60687058321
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.79 |
| Max. Negotiated Rate |
$391.72 |
| Rate for Payer: Aetna Commercial |
$352.55
|
| Rate for Payer: ASR ASR |
$379.97
|
| Rate for Payer: BCBS Trust/PPO |
$321.68
|
| Rate for Payer: BCN Commercial |
$321.68
|
| Rate for Payer: Cash Price |
$313.38
|
| Rate for Payer: Cofinity Commercial |
$368.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.38
|
| Rate for Payer: Healthscope Commercial |
$379.97
|
| Rate for Payer: Healthscope Whirlpool |
$391.72
|
| Rate for Payer: Mclaren Commercial |
$352.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.96
|
| Rate for Payer: Nomi Health Commercial |
$321.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$293.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$344.71
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$13.06
|
|
|
Service Code
|
NDC 60687058311
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$13.06 |
| Rate for Payer: Aetna Commercial |
$11.75
|
| Rate for Payer: Aetna Medicare |
$4.83
|
| Rate for Payer: ASR ASR |
$12.67
|
| Rate for Payer: BCBS Complete |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$10.77
|
| Rate for Payer: BCN Commercial |
$10.77
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Cofinity Commercial |
$12.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.45
|
| Rate for Payer: Healthscope Commercial |
$12.67
|
| Rate for Payer: Healthscope Whirlpool |
$13.06
|
| Rate for Payer: Mclaren Commercial |
$11.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.10
|
| Rate for Payer: Nomi Health Commercial |
$10.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.44
|
| Rate for Payer: Priority Health Narrow Network |
$9.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.49
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$10.33
|
|
|
Service Code
|
NDC 23558076501
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$10.33 |
| Rate for Payer: Aetna Commercial |
$9.30
|
| Rate for Payer: ASR ASR |
$10.02
|
| Rate for Payer: BCBS Trust/PPO |
$8.48
|
| Rate for Payer: BCN Commercial |
$8.48
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$10.02
|
| Rate for Payer: Healthscope Whirlpool |
$10.33
|
| Rate for Payer: Mclaren Commercial |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.78
|
| Rate for Payer: Nomi Health Commercial |
$8.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.09
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$9.99
|
|
|
Service Code
|
NDC 904747835
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$9.99 |
| Rate for Payer: Aetna Commercial |
$8.99
|
| Rate for Payer: ASR ASR |
$9.69
|
| Rate for Payer: BCBS Trust/PPO |
$8.20
|
| Rate for Payer: BCN Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$7.99
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.99
|
| Rate for Payer: Healthscope Commercial |
$9.69
|
| Rate for Payer: Healthscope Whirlpool |
$9.99
|
| Rate for Payer: Mclaren Commercial |
$8.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.49
|
| Rate for Payer: Nomi Health Commercial |
$8.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.79
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$22.37
|
|
|
Service Code
|
NDC 42037010478
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: ASR ASR |
$21.69
|
| Rate for Payer: BCBS Trust/PPO |
$18.37
|
| Rate for Payer: BCN Commercial |
$18.37
|
| Rate for Payer: Cash Price |
$17.89
|
| Rate for Payer: Cofinity Commercial |
$21.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.89
|
| Rate for Payer: Healthscope Commercial |
$21.69
|
| Rate for Payer: Healthscope Whirlpool |
$22.36
|
| Rate for Payer: Mclaren Commercial |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.01
|
| Rate for Payer: Nomi Health Commercial |
$18.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.68
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$22.75
|
|
|
Service Code
|
NDC 78112073623
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: Aetna Medicare |
$8.42
|
| Rate for Payer: ASR ASR |
$22.07
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.76
|
| Rate for Payer: BCN Commercial |
$18.76
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.20
|
| Rate for Payer: Healthscope Commercial |
$22.07
|
| Rate for Payer: Healthscope Whirlpool |
$22.75
|
| Rate for Payer: Mclaren Commercial |
$20.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.34
|
| Rate for Payer: Nomi Health Commercial |
$18.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19.93
|
| Rate for Payer: Priority Health Narrow Network |
$15.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.02
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$10.73
|
|
|
Service Code
|
NDC 904662735
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$10.73 |
| Rate for Payer: Aetna Commercial |
$9.66
|
| Rate for Payer: Aetna Medicare |
$3.97
|
| Rate for Payer: ASR ASR |
$10.41
|
| Rate for Payer: BCBS Complete |
$4.29
|
| Rate for Payer: BCBS Trust/PPO |
$8.85
|
| Rate for Payer: BCN Commercial |
$8.85
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cofinity Commercial |
$10.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.59
|
| Rate for Payer: Healthscope Commercial |
$10.41
|
| Rate for Payer: Healthscope Whirlpool |
$10.73
|
| Rate for Payer: Mclaren Commercial |
$9.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.12
|
| Rate for Payer: Nomi Health Commercial |
$8.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.40
|
| Rate for Payer: Priority Health Narrow Network |
$7.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.45
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$10.33
|
|
|
Service Code
|
NDC 23558076501
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$10.33 |
| Rate for Payer: Aetna Commercial |
$9.30
|
| Rate for Payer: Aetna Medicare |
$3.82
|
| Rate for Payer: ASR ASR |
$10.02
|
| Rate for Payer: BCBS Complete |
$4.13
|
| Rate for Payer: BCBS Trust/PPO |
$8.52
|
| Rate for Payer: BCN Commercial |
$8.52
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$10.02
|
| Rate for Payer: Healthscope Whirlpool |
$10.33
|
| Rate for Payer: Mclaren Commercial |
$9.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.78
|
| Rate for Payer: Nomi Health Commercial |
$8.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.05
|
| Rate for Payer: Priority Health Narrow Network |
$7.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.09
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$22.37
|
|
|
Service Code
|
NDC 42037010478
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Medicare |
$8.28
|
| Rate for Payer: ASR ASR |
$21.69
|
| Rate for Payer: BCBS Complete |
$8.95
|
| Rate for Payer: BCBS Trust/PPO |
$18.44
|
| Rate for Payer: BCN Commercial |
$18.44
|
| Rate for Payer: Cash Price |
$17.89
|
| Rate for Payer: Cofinity Commercial |
$21.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.89
|
| Rate for Payer: Healthscope Commercial |
$21.69
|
| Rate for Payer: Healthscope Whirlpool |
$22.36
|
| Rate for Payer: Mclaren Commercial |
$20.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.01
|
| Rate for Payer: Nomi Health Commercial |
$18.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19.60
|
| Rate for Payer: Priority Health Narrow Network |
$15.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.68
|
|
