|
NADOLOL 40 MG TABLET
|
Facility
|
OP
|
$359.97
|
|
|
Service Code
|
NDC 60687031325
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.19 |
| Max. Negotiated Rate |
$359.97 |
| Rate for Payer: Aetna Commercial |
$323.98
|
| Rate for Payer: Aetna Medicare |
$133.19
|
| Rate for Payer: ASR ASR |
$349.17
|
| Rate for Payer: BCBS Complete |
$143.99
|
| Rate for Payer: BCBS Trust/PPO |
$296.80
|
| Rate for Payer: BCN Commercial |
$296.80
|
| Rate for Payer: Cash Price |
$287.98
|
| Rate for Payer: Cofinity Commercial |
$338.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.98
|
| Rate for Payer: Healthscope Commercial |
$349.17
|
| Rate for Payer: Healthscope Whirlpool |
$359.97
|
| Rate for Payer: Mclaren Commercial |
$323.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.98
|
| Rate for Payer: Nomi Health Commercial |
$295.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$315.41
|
| Rate for Payer: Priority Health Narrow Network |
$252.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.78
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
IP
|
$359.97
|
|
|
Service Code
|
NDC 60687031325
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.98 |
| Max. Negotiated Rate |
$359.97 |
| Rate for Payer: Aetna Commercial |
$323.98
|
| Rate for Payer: ASR ASR |
$349.17
|
| Rate for Payer: BCBS Trust/PPO |
$295.61
|
| Rate for Payer: BCN Commercial |
$295.61
|
| Rate for Payer: Cash Price |
$287.98
|
| Rate for Payer: Cofinity Commercial |
$338.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.98
|
| Rate for Payer: Healthscope Commercial |
$349.17
|
| Rate for Payer: Healthscope Whirlpool |
$359.97
|
| Rate for Payer: Mclaren Commercial |
$323.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.98
|
| Rate for Payer: Nomi Health Commercial |
$295.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.78
|
|
|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$21.34
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$21.34 |
| Rate for Payer: Aetna Commercial |
$19.20
|
| Rate for Payer: Aetna Commercial |
$19.34
|
| Rate for Payer: Aetna Commercial |
$20.69
|
| Rate for Payer: Aetna Medicare |
$7.95
|
| Rate for Payer: Aetna Medicare |
$7.89
|
| Rate for Payer: Aetna Medicare |
$8.50
|
| Rate for Payer: ASR ASR |
$22.30
|
| Rate for Payer: ASR ASR |
$20.69
|
| Rate for Payer: ASR ASR |
$20.85
|
| Rate for Payer: BCBS Complete |
$8.53
|
| Rate for Payer: BCBS Complete |
$9.19
|
| Rate for Payer: BCBS Complete |
$8.60
|
| Rate for Payer: BCBS Trust/PPO |
$17.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.72
|
| Rate for Payer: BCBS Trust/PPO |
$18.95
|
| Rate for Payer: BCN Commercial |
$17.59
|
| Rate for Payer: BCN Commercial |
$17.72
|
| Rate for Payer: BCN Commercial |
$18.95
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Cash Price |
$17.07
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Cash Price |
$18.39
|
| Rate for Payer: Cash Price |
$18.39
|
| Rate for Payer: Cash Price |
$17.07
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$20.05
|
| Rate for Payer: Cofinity Commercial |
$21.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.19
|
| Rate for Payer: Healthscope Commercial |
$22.30
|
| Rate for Payer: Healthscope Commercial |
$20.69
|
| Rate for Payer: Healthscope Commercial |
$20.85
|
| Rate for Payer: Healthscope Whirlpool |
$21.49
|
| Rate for Payer: Healthscope Whirlpool |
$21.34
|
| Rate for Payer: Healthscope Whirlpool |
$22.98
|
| Rate for Payer: Mclaren Commercial |
$20.69
|
| Rate for Payer: Mclaren Commercial |
$19.34
|
| Rate for Payer: Mclaren Commercial |
$19.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.13
|
| Rate for Payer: Nomi Health Commercial |
$18.85
|
| Rate for Payer: Nomi Health Commercial |
$17.49
|
| Rate for Payer: Nomi Health Commercial |
$17.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.05
|
| Rate for Payer: Priority Health Narrow Network |
$0.05
|
| Rate for Payer: Priority Health Narrow Network |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.77
|
|
|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$21.34
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$21.34 |
| Rate for Payer: Aetna Commercial |
$19.20
|
| Rate for Payer: Aetna Commercial |
$20.69
|
| Rate for Payer: Aetna Commercial |
$19.34
|
| Rate for Payer: ASR ASR |
$22.30
|
| Rate for Payer: ASR ASR |
$20.69
|
| Rate for Payer: ASR ASR |
$20.85
|
| Rate for Payer: BCBS Trust/PPO |
$18.88
|
| Rate for Payer: BCBS Trust/PPO |
$17.52
|
| Rate for Payer: BCBS Trust/PPO |
$17.65
|
| Rate for Payer: BCN Commercial |
$17.65
|
| Rate for Payer: BCN Commercial |
$17.52
|
| Rate for Payer: BCN Commercial |
$18.88
|
| Rate for Payer: Cash Price |
$18.39
|
| Rate for Payer: Cash Price |
$17.07
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Cofinity Commercial |
$20.05
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$21.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.19
|
| Rate for Payer: Healthscope Commercial |
$20.85
|
| Rate for Payer: Healthscope Commercial |
$20.69
|
| Rate for Payer: Healthscope Commercial |
$22.30
|
| Rate for Payer: Healthscope Whirlpool |
$21.49
|
| Rate for Payer: Healthscope Whirlpool |
$22.98
|
| Rate for Payer: Healthscope Whirlpool |
$21.34
|
| Rate for Payer: Mclaren Commercial |
$19.34
|
| Rate for Payer: Mclaren Commercial |
$19.20
|
| Rate for Payer: Mclaren Commercial |
$20.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.13
|
| Rate for Payer: Nomi Health Commercial |
$17.62
|
| Rate for Payer: Nomi Health Commercial |
$17.49
|
| Rate for Payer: Nomi Health Commercial |
$18.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.77
|
|
|
NAFCILLIN 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$21.34
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$21.34 |
| Rate for Payer: Aetna Commercial |
$19.20
|
| Rate for Payer: Aetna Medicare |
$7.89
|
| Rate for Payer: ASR ASR |
$20.69
|
| Rate for Payer: BCBS Complete |
$8.53
|
| Rate for Payer: BCBS Trust/PPO |
$17.59
|
| Rate for Payer: BCN Commercial |
$17.59
|
| Rate for Payer: Cash Price |
$17.07
|
| Rate for Payer: Cash Price |
$17.07
|
| Rate for Payer: Cofinity Commercial |
$20.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.07
|
| Rate for Payer: Healthscope Commercial |
$20.69
|
| Rate for Payer: Healthscope Whirlpool |
$21.34
|
| Rate for Payer: Mclaren Commercial |
$19.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.13
|
| Rate for Payer: Nomi Health Commercial |
$17.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.77
|
|
|
NAFCILLIN 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$21.34
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$21.34 |
| Rate for Payer: Aetna Commercial |
$19.20
|
| Rate for Payer: ASR ASR |
$20.69
|
| Rate for Payer: BCBS Trust/PPO |
$17.52
|
| Rate for Payer: BCN Commercial |
$17.52
|
| Rate for Payer: Cash Price |
$17.07
|
| Rate for Payer: Cofinity Commercial |
$20.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.07
|
| Rate for Payer: Healthscope Commercial |
$20.69
|
| Rate for Payer: Healthscope Whirlpool |
$21.34
|
| Rate for Payer: Mclaren Commercial |
$19.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.13
|
| Rate for Payer: Nomi Health Commercial |
$17.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.77
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$18.79
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$18.79 |
| Rate for Payer: Aetna Commercial |
$16.91
|
| Rate for Payer: Aetna Medicare |
$6.95
|
| Rate for Payer: ASR ASR |
$18.22
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: BCBS Trust/PPO |
$15.49
|
| Rate for Payer: BCN Commercial |
$15.49
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cofinity Commercial |
$17.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.03
|
| Rate for Payer: Healthscope Commercial |
$18.22
|
| Rate for Payer: Healthscope Whirlpool |
$18.79
|
| Rate for Payer: Mclaren Commercial |
$16.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.97
|
| Rate for Payer: Nomi Health Commercial |
$15.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.53
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$18.79
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$18.79 |
| Rate for Payer: Aetna Commercial |
$16.91
|
| Rate for Payer: ASR ASR |
$18.22
|
| Rate for Payer: BCBS Trust/PPO |
$15.43
|
| Rate for Payer: BCN Commercial |
$15.43
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cofinity Commercial |
$17.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.03
|
| Rate for Payer: Healthscope Commercial |
$18.22
|
| Rate for Payer: Healthscope Whirlpool |
$18.79
|
| Rate for Payer: Mclaren Commercial |
$16.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.97
|
| Rate for Payer: Nomi Health Commercial |
$15.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.53
|
|
|
NALOXONE 0.4 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$63.57
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
163714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.68 |
| Max. Negotiated Rate |
$63.57 |
| Rate for Payer: Aetna Commercial |
$57.21
|
| Rate for Payer: ASR ASR |
$61.66
|
| Rate for Payer: BCBS Trust/PPO |
$52.20
|
| Rate for Payer: BCN Commercial |
$52.20
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cofinity Commercial |
$59.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$61.66
|
| Rate for Payer: Healthscope Whirlpool |
$63.57
|
| Rate for Payer: Mclaren Commercial |
$57.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Nomi Health Commercial |
$52.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.94
|
|
|
NALOXONE 0.4 MG/ML INJECTION (CODE)
|
Facility
|
OP
|
$63.57
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
163714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$63.57 |
| Rate for Payer: Aetna Commercial |
$57.21
|
| Rate for Payer: Aetna Medicare |
$23.52
|
| Rate for Payer: ASR ASR |
$61.66
|
| Rate for Payer: BCBS Complete |
$25.43
|
| Rate for Payer: BCBS Trust/PPO |
$52.41
|
| Rate for Payer: BCN Commercial |
$52.41
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cofinity Commercial |
$59.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$61.66
|
| Rate for Payer: Healthscope Whirlpool |
$63.57
|
| Rate for Payer: Mclaren Commercial |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Nomi Health Commercial |
$52.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.94
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$27.88
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
5373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.91 |
| Max. Negotiated Rate |
$27.88 |
| Rate for Payer: Aetna Commercial |
$25.09
|
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Commercial |
$57.21
|
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: ASR ASR |
$61.66
|
| Rate for Payer: ASR ASR |
$27.04
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: ASR ASR |
$16.74
|
| Rate for Payer: BCBS Trust/PPO |
$22.89
|
| Rate for Payer: BCBS Trust/PPO |
$14.17
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCBS Trust/PPO |
$52.20
|
| Rate for Payer: BCN Commercial |
$14.17
|
| Rate for Payer: BCN Commercial |
$52.20
|
| Rate for Payer: BCN Commercial |
$16.99
|
| Rate for Payer: BCN Commercial |
$22.89
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$22.30
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$26.20
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Cofinity Commercial |
$59.75
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.81
|
| Rate for Payer: Healthscope Commercial |
$27.04
|
| Rate for Payer: Healthscope Commercial |
$16.74
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Healthscope Commercial |
$61.66
|
| Rate for Payer: Healthscope Whirlpool |
$27.88
|
| Rate for Payer: Healthscope Whirlpool |
$63.57
|
| Rate for Payer: Healthscope Whirlpool |
$17.26
|
| Rate for Payer: Healthscope Whirlpool |
$20.69
|
| Rate for Payer: Mclaren Commercial |
$15.53
|
| Rate for Payer: Mclaren Commercial |
$57.21
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$25.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.67
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$52.13
|
| Rate for Payer: Nomi Health Commercial |
$22.86
|
| Rate for Payer: Nomi Health Commercial |
$14.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.94
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$63.57
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
5373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$63.57 |
| Rate for Payer: Aetna Commercial |
$57.21
|
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Commercial |
$25.09
|
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Medicare |
$6.39
|
| Rate for Payer: Aetna Medicare |
$23.52
|
| Rate for Payer: Aetna Medicare |
$10.31
|
| Rate for Payer: Aetna Medicare |
$7.66
|
| Rate for Payer: ASR ASR |
$27.04
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: ASR ASR |
$16.74
|
| Rate for Payer: ASR ASR |
$61.66
|
| Rate for Payer: BCBS Complete |
$11.15
|
| Rate for Payer: BCBS Complete |
$6.90
|
| Rate for Payer: BCBS Complete |
$25.43
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$17.06
|
| Rate for Payer: BCBS Trust/PPO |
$52.41
|
| Rate for Payer: BCBS Trust/PPO |
$22.98
|
| Rate for Payer: BCBS Trust/PPO |
$14.23
|
| Rate for Payer: BCN Commercial |
$52.41
|
| Rate for Payer: BCN Commercial |
$22.98
|
| Rate for Payer: BCN Commercial |
$14.23
|
| Rate for Payer: BCN Commercial |
$17.06
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Cash Price |
$22.30
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$22.30
|
| Rate for Payer: Cofinity Commercial |
$59.75
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Cofinity Commercial |
$26.20
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.30
|
| Rate for Payer: Healthscope Commercial |
$61.66
|
| Rate for Payer: Healthscope Commercial |
$16.74
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Healthscope Commercial |
$27.04
|
| Rate for Payer: Healthscope Whirlpool |
$17.26
|
| Rate for Payer: Healthscope Whirlpool |
$27.88
|
| Rate for Payer: Healthscope Whirlpool |
$63.57
|
| Rate for Payer: Healthscope Whirlpool |
$20.69
|
| Rate for Payer: Mclaren Commercial |
$25.09
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$15.53
|
| Rate for Payer: Mclaren Commercial |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Nomi Health Commercial |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$22.86
|
| Rate for Payer: Nomi Health Commercial |
$52.13
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$86.91
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
5374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$86.91 |
| Rate for Payer: Aetna Commercial |
$78.22
|
| Rate for Payer: Aetna Commercial |
$50.02
|
| Rate for Payer: Aetna Commercial |
$58.67
|
| Rate for Payer: Aetna Commercial |
$42.41
|
| Rate for Payer: Aetna Medicare |
$17.43
|
| Rate for Payer: Aetna Medicare |
$32.16
|
| Rate for Payer: Aetna Medicare |
$24.12
|
| Rate for Payer: Aetna Medicare |
$20.56
|
| Rate for Payer: ASR ASR |
$63.23
|
| Rate for Payer: ASR ASR |
$53.91
|
| Rate for Payer: ASR ASR |
$45.70
|
| Rate for Payer: ASR ASR |
$84.30
|
| Rate for Payer: BCBS Complete |
$26.07
|
| Rate for Payer: BCBS Complete |
$18.85
|
| Rate for Payer: BCBS Complete |
$34.76
|
| Rate for Payer: BCBS Complete |
$22.23
|
| Rate for Payer: BCBS Trust/PPO |
$45.83
|
| Rate for Payer: BCBS Trust/PPO |
$71.66
|
| Rate for Payer: BCBS Trust/PPO |
$53.74
|
| Rate for Payer: BCBS Trust/PPO |
$38.85
|
| Rate for Payer: BCN Commercial |
$71.66
|
| Rate for Payer: BCN Commercial |
$53.74
|
| Rate for Payer: BCN Commercial |
$38.85
|
| Rate for Payer: BCN Commercial |
$45.83
|
| Rate for Payer: Cash Price |
$37.69
|
| Rate for Payer: Cash Price |
$52.15
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cash Price |
$37.69
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cash Price |
$52.15
|
| Rate for Payer: Cofinity Commercial |
$81.69
|
| Rate for Payer: Cofinity Commercial |
$44.29
|
| Rate for Payer: Cofinity Commercial |
$61.27
|
| Rate for Payer: Cofinity Commercial |
$52.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.15
|
| Rate for Payer: Healthscope Commercial |
$84.30
|
| Rate for Payer: Healthscope Commercial |
$45.70
|
| Rate for Payer: Healthscope Commercial |
$53.91
|
| Rate for Payer: Healthscope Commercial |
$63.23
|
| Rate for Payer: Healthscope Whirlpool |
$47.12
|
| Rate for Payer: Healthscope Whirlpool |
$65.18
|
| Rate for Payer: Healthscope Whirlpool |
$86.91
|
| Rate for Payer: Healthscope Whirlpool |
$55.58
|
| Rate for Payer: Mclaren Commercial |
$58.67
|
| Rate for Payer: Mclaren Commercial |
$50.02
|
| Rate for Payer: Mclaren Commercial |
$42.41
|
| Rate for Payer: Mclaren Commercial |
$78.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.87
|
| Rate for Payer: Nomi Health Commercial |
$38.64
|
| Rate for Payer: Nomi Health Commercial |
$53.45
|
| Rate for Payer: Nomi Health Commercial |
$71.27
|
| Rate for Payer: Nomi Health Commercial |
$45.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.91
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$65.18
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
5374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.89 |
| Max. Negotiated Rate |
$65.18 |
| Rate for Payer: Aetna Commercial |
$58.67
|
| Rate for Payer: Aetna Commercial |
$50.02
|
| Rate for Payer: Aetna Commercial |
$78.22
|
| Rate for Payer: Aetna Commercial |
$42.41
|
| Rate for Payer: ASR ASR |
$84.30
|
| Rate for Payer: ASR ASR |
$63.23
|
| Rate for Payer: ASR ASR |
$53.91
|
| Rate for Payer: ASR ASR |
$45.70
|
| Rate for Payer: BCBS Trust/PPO |
$53.53
|
| Rate for Payer: BCBS Trust/PPO |
$38.69
|
| Rate for Payer: BCBS Trust/PPO |
$45.64
|
| Rate for Payer: BCBS Trust/PPO |
$71.37
|
| Rate for Payer: BCN Commercial |
$38.69
|
| Rate for Payer: BCN Commercial |
$71.37
|
| Rate for Payer: BCN Commercial |
$45.64
|
| Rate for Payer: BCN Commercial |
$53.53
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cash Price |
$52.15
|
| Rate for Payer: Cash Price |
$37.69
|
| Rate for Payer: Cofinity Commercial |
$61.27
|
| Rate for Payer: Cofinity Commercial |
$44.29
|
| Rate for Payer: Cofinity Commercial |
$81.69
|
| Rate for Payer: Cofinity Commercial |
$52.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.69
|
| Rate for Payer: Healthscope Commercial |
$63.23
|
| Rate for Payer: Healthscope Commercial |
$45.70
|
| Rate for Payer: Healthscope Commercial |
$53.91
|
| Rate for Payer: Healthscope Commercial |
$84.30
|
| Rate for Payer: Healthscope Whirlpool |
$65.18
|
| Rate for Payer: Healthscope Whirlpool |
$86.91
|
| Rate for Payer: Healthscope Whirlpool |
$47.12
|
| Rate for Payer: Healthscope Whirlpool |
$55.58
|
| Rate for Payer: Mclaren Commercial |
$42.41
|
| Rate for Payer: Mclaren Commercial |
$78.22
|
| Rate for Payer: Mclaren Commercial |
$50.02
|
| Rate for Payer: Mclaren Commercial |
$58.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.05
|
| Rate for Payer: Nomi Health Commercial |
$45.58
|
| Rate for Payer: Nomi Health Commercial |
$71.27
|
| Rate for Payer: Nomi Health Commercial |
$53.45
|
| Rate for Payer: Nomi Health Commercial |
$38.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.48
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
OP
|
$471.36
|
|
|
Service Code
|
NDC 47335032688
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.40 |
| Max. Negotiated Rate |
$471.36 |
| Rate for Payer: Aetna Commercial |
$424.22
|
| Rate for Payer: Aetna Medicare |
$174.40
|
| Rate for Payer: ASR ASR |
$457.22
|
| Rate for Payer: BCBS Complete |
$188.54
|
| Rate for Payer: BCBS Trust/PPO |
$388.64
|
| Rate for Payer: BCN Commercial |
$388.64
|
| Rate for Payer: Cash Price |
$377.09
|
| Rate for Payer: Cofinity Commercial |
$443.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.09
|
| Rate for Payer: Healthscope Commercial |
$457.22
|
| Rate for Payer: Healthscope Whirlpool |
$471.36
|
| Rate for Payer: Mclaren Commercial |
$424.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$377.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.66
|
| Rate for Payer: Nomi Health Commercial |
$386.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$353.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$413.01
|
| Rate for Payer: Priority Health Narrow Network |
$330.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$414.80
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
IP
|
$471.36
|
|
|
Service Code
|
NDC 47335032688
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$353.52 |
| Max. Negotiated Rate |
$471.36 |
| Rate for Payer: Aetna Commercial |
$424.22
|
| Rate for Payer: ASR ASR |
$457.22
|
| Rate for Payer: BCBS Trust/PPO |
$387.08
|
| Rate for Payer: BCN Commercial |
$387.08
|
| Rate for Payer: Cash Price |
$377.09
|
| Rate for Payer: Cofinity Commercial |
$443.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.09
|
| Rate for Payer: Healthscope Commercial |
$457.22
|
| Rate for Payer: Healthscope Whirlpool |
$471.36
|
| Rate for Payer: Mclaren Commercial |
$424.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.66
|
| Rate for Payer: Nomi Health Commercial |
$386.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$353.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$414.80
|
|
|
NALTREXONE ER 380 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
OP
|
$6,671.68
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
76527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$6,671.68 |
| Rate for Payer: Aetna Commercial |
$6,004.51
|
| Rate for Payer: Aetna Medicare |
$4.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.31
|
| Rate for Payer: ASR ASR |
$6,471.53
|
| Rate for Payer: BCBS Complete |
$2.33
|
| Rate for Payer: BCBS MAPPO |
$4.25
|
| Rate for Payer: BCBS Trust/PPO |
$5,500.80
|
| Rate for Payer: BCN Commercial |
$5,500.80
|
| Rate for Payer: BCN Medicare Advantage |
$4.25
|
| Rate for Payer: Cash Price |
$5,337.34
|
| Rate for Payer: Cash Price |
$5,337.34
|
| Rate for Payer: Cofinity Commercial |
$6,271.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,337.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.25
|
| Rate for Payer: Healthscope Commercial |
$6,471.53
|
| Rate for Payer: Healthscope Whirlpool |
$6,671.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.25
|
| Rate for Payer: Mclaren Commercial |
$6,004.51
|
| Rate for Payer: Mclaren Medicaid |
$4.25
|
| Rate for Payer: Mclaren Medicare |
$4.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.46
|
| Rate for Payer: Meridian Medicaid |
$2.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,670.93
|
| Rate for Payer: Nomi Health Commercial |
$5,470.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,003.76
|
| Rate for Payer: PACE Medicare |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.25
|
| Rate for Payer: PHP Commercial |
$4.67
|
| Rate for Payer: PHP Medicaid |
$2.28
|
| Rate for Payer: PHP Medicare Advantage |
$4.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.40
|
| Rate for Payer: Priority Health Medicare |
$4.25
|
| Rate for Payer: Priority Health Narrow Network |
$3.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,871.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.25
|
| Rate for Payer: UHC Exchange |
$6.59
|
| Rate for Payer: UHC Medicaid |
$2.22
|
| Rate for Payer: UHCCP DNSP |
$4.25
|
| Rate for Payer: UHCCP Medicaid |
$2.22
|
| Rate for Payer: VA VA |
$4.25
|
|
|
NALTREXONE ER 380 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
IP
|
$6,671.68
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
76527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,003.76 |
| Max. Negotiated Rate |
$6,671.68 |
| Rate for Payer: Aetna Commercial |
$6,004.51
|
| Rate for Payer: ASR ASR |
$6,471.53
|
| Rate for Payer: BCBS Trust/PPO |
$5,478.78
|
| Rate for Payer: BCN Commercial |
$5,478.78
|
| Rate for Payer: Cash Price |
$5,337.34
|
| Rate for Payer: Cofinity Commercial |
$6,271.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,337.34
|
| Rate for Payer: Healthscope Commercial |
$6,471.53
|
| Rate for Payer: Healthscope Whirlpool |
$6,671.68
|
| Rate for Payer: Mclaren Commercial |
$6,004.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,670.93
|
| Rate for Payer: Nomi Health Commercial |
$5,470.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,003.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,871.08
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$229.13
|
|
|
Service Code
|
NDC 50268059415
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.84 |
| Max. Negotiated Rate |
$229.12 |
| Rate for Payer: Aetna Commercial |
$206.21
|
| Rate for Payer: ASR ASR |
$222.25
|
| Rate for Payer: BCBS Trust/PPO |
$188.16
|
| Rate for Payer: BCN Commercial |
$188.16
|
| Rate for Payer: Cash Price |
$183.30
|
| Rate for Payer: Cofinity Commercial |
$215.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.30
|
| Rate for Payer: Healthscope Commercial |
$222.25
|
| Rate for Payer: Healthscope Whirlpool |
$229.12
|
| Rate for Payer: Mclaren Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.76
|
| Rate for Payer: Nomi Health Commercial |
$187.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.63
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$4.58
|
|
|
Service Code
|
NDC 50268059411
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: ASR ASR |
$4.45
|
| Rate for Payer: BCBS Trust/PPO |
$3.76
|
| Rate for Payer: BCN Commercial |
$3.76
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.45
|
| Rate for Payer: Healthscope Whirlpool |
$4.58
|
| Rate for Payer: Mclaren Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.03
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$229.13
|
|
|
Service Code
|
NDC 50268059415
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.78 |
| Max. Negotiated Rate |
$229.12 |
| Rate for Payer: Aetna Commercial |
$206.21
|
| Rate for Payer: Aetna Medicare |
$84.78
|
| Rate for Payer: ASR ASR |
$222.25
|
| Rate for Payer: BCBS Complete |
$91.65
|
| Rate for Payer: BCBS Trust/PPO |
$188.91
|
| Rate for Payer: BCN Commercial |
$188.91
|
| Rate for Payer: Cash Price |
$183.30
|
| Rate for Payer: Cofinity Commercial |
$215.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.30
|
| Rate for Payer: Healthscope Commercial |
$222.25
|
| Rate for Payer: Healthscope Whirlpool |
$229.12
|
| Rate for Payer: Mclaren Commercial |
$206.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.76
|
| Rate for Payer: Nomi Health Commercial |
$187.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$200.76
|
| Rate for Payer: Priority Health Narrow Network |
$160.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.63
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$4.58
|
|
|
Service Code
|
NDC 50268059411
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: ASR ASR |
$4.45
|
| Rate for Payer: BCBS Complete |
$1.83
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.78
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.45
|
| Rate for Payer: Healthscope Whirlpool |
$4.58
|
| Rate for Payer: Mclaren Commercial |
$4.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.02
|
| Rate for Payer: Priority Health Narrow Network |
$3.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.03
|
|
|
NASAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
IP
|
$3.19
|
|
|
Service Code
|
NDC 9900000401
|
| Hospital Charge Code |
169209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: ASR ASR |
$3.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$3.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Healthscope Whirlpool |
$3.19
|
| Rate for Payer: Mclaren Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.71
|
| Rate for Payer: Nomi Health Commercial |
$2.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.81
|
|
|
NASAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
OP
|
$3.19
|
|
|
Service Code
|
NDC 9900000401
|
| Hospital Charge Code |
169209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: Aetna Medicare |
$1.18
|
| Rate for Payer: ASR ASR |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.63
|
| Rate for Payer: BCN Commercial |
$2.63
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$3.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Healthscope Whirlpool |
$3.19
|
| Rate for Payer: Mclaren Commercial |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.71
|
| Rate for Payer: Nomi Health Commercial |
$2.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.80
|
| Rate for Payer: Priority Health Narrow Network |
$2.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.81
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS
|
Facility
|
OP
|
$167.13
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.84 |
| Max. Negotiated Rate |
$167.12 |
| Rate for Payer: Aetna Commercial |
$150.41
|
| Rate for Payer: Aetna Medicare |
$61.84
|
| Rate for Payer: ASR ASR |
$162.11
|
| Rate for Payer: BCBS Complete |
$66.85
|
| Rate for Payer: BCBS Trust/PPO |
$137.79
|
| Rate for Payer: BCN Commercial |
$137.79
|
| Rate for Payer: Cash Price |
$133.70
|
| Rate for Payer: Cofinity Commercial |
$157.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.70
|
| Rate for Payer: Healthscope Commercial |
$162.11
|
| Rate for Payer: Healthscope Whirlpool |
$167.12
|
| Rate for Payer: Mclaren Commercial |
$150.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.06
|
| Rate for Payer: Nomi Health Commercial |
$137.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$146.43
|
| Rate for Payer: Priority Health Narrow Network |
$117.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.07
|
|
