|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$86.49
|
|
|
Service Code
|
NDC 536589688
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$86.49 |
| Rate for Payer: Aetna Commercial |
$77.84
|
| Rate for Payer: Aetna Medicare |
$32.00
|
| Rate for Payer: ASR ASR |
$83.89
|
| Rate for Payer: BCBS Complete |
$34.59
|
| Rate for Payer: BCBS Trust/PPO |
$71.31
|
| Rate for Payer: BCN Commercial |
$71.31
|
| Rate for Payer: Cash Price |
$69.19
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.19
|
| Rate for Payer: Healthscope Commercial |
$83.89
|
| Rate for Payer: Healthscope Whirlpool |
$86.49
|
| Rate for Payer: Mclaren Commercial |
$77.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.51
|
| Rate for Payer: Nomi Health Commercial |
$70.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$75.78
|
| Rate for Payer: Priority Health Narrow Network |
$60.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.11
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$107.12
|
|
|
Service Code
|
NDC 536110888
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.63 |
| Max. Negotiated Rate |
$107.12 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Medicare |
$39.63
|
| Rate for Payer: ASR ASR |
$103.90
|
| Rate for Payer: BCBS Complete |
$42.85
|
| Rate for Payer: BCBS Trust/PPO |
$88.32
|
| Rate for Payer: BCN Commercial |
$88.32
|
| Rate for Payer: Cash Price |
$85.69
|
| Rate for Payer: Cofinity Commercial |
$100.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.69
|
| Rate for Payer: Healthscope Commercial |
$103.90
|
| Rate for Payer: Healthscope Whirlpool |
$107.12
|
| Rate for Payer: Mclaren Commercial |
$96.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.05
|
| Rate for Payer: Nomi Health Commercial |
$87.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$93.86
|
| Rate for Payer: Priority Health Narrow Network |
$75.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.26
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$86.49
|
|
|
Service Code
|
NDC 536589688
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$86.49 |
| Rate for Payer: Aetna Commercial |
$77.84
|
| Rate for Payer: ASR ASR |
$83.89
|
| Rate for Payer: BCBS Trust/PPO |
$71.02
|
| Rate for Payer: BCN Commercial |
$71.02
|
| Rate for Payer: Cash Price |
$69.19
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.19
|
| Rate for Payer: Healthscope Commercial |
$83.89
|
| Rate for Payer: Healthscope Whirlpool |
$86.49
|
| Rate for Payer: Mclaren Commercial |
$77.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.51
|
| Rate for Payer: Nomi Health Commercial |
$70.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.11
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$107.12
|
|
|
Service Code
|
NDC 536110888
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.34 |
| Max. Negotiated Rate |
$107.12 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: ASR ASR |
$103.90
|
| Rate for Payer: BCBS Trust/PPO |
$87.96
|
| Rate for Payer: BCN Commercial |
$87.96
|
| Rate for Payer: Cash Price |
$85.69
|
| Rate for Payer: Cofinity Commercial |
$100.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.69
|
| Rate for Payer: Healthscope Commercial |
$103.90
|
| Rate for Payer: Healthscope Whirlpool |
$107.12
|
| Rate for Payer: Mclaren Commercial |
$96.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.05
|
| Rate for Payer: Nomi Health Commercial |
$87.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.26
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$270.86
|
|
|
Service Code
|
NDC 536123981
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.22 |
| Max. Negotiated Rate |
$270.86 |
| Rate for Payer: Aetna Commercial |
$243.78
|
| Rate for Payer: Aetna Medicare |
$100.22
|
| Rate for Payer: ASR ASR |
$262.74
|
| Rate for Payer: BCBS Complete |
$108.35
|
| Rate for Payer: BCBS Trust/PPO |
$223.33
|
| Rate for Payer: BCN Commercial |
$223.33
|
| Rate for Payer: Cash Price |
$216.69
|
| Rate for Payer: Cofinity Commercial |
$254.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.69
|
| Rate for Payer: Healthscope Commercial |
$262.74
|
| Rate for Payer: Healthscope Whirlpool |
$270.86
|
| Rate for Payer: Mclaren Commercial |
$243.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.23
|
| Rate for Payer: Nomi Health Commercial |
$222.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$237.33
|
| Rate for Payer: Priority Health Narrow Network |
$189.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.36
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$99.52
|
|
|
Service Code
|
NDC 45802008901
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.82 |
| Max. Negotiated Rate |
$99.52 |
| Rate for Payer: Aetna Commercial |
$89.57
|
| Rate for Payer: Aetna Medicare |
$36.82
|
| Rate for Payer: ASR ASR |
$96.54
|
| Rate for Payer: BCBS Complete |
$39.81
|
| Rate for Payer: BCBS Trust/PPO |
$82.06
|
| Rate for Payer: BCN Commercial |
$82.06
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cofinity Commercial |
$93.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.62
|
| Rate for Payer: Healthscope Commercial |
$96.54
|
| Rate for Payer: Healthscope Whirlpool |
$99.52
|
| Rate for Payer: Mclaren Commercial |
$89.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.59
|
| Rate for Payer: Nomi Health Commercial |
$81.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$87.20
|
| Rate for Payer: Priority Health Narrow Network |
$69.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.58
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$270.86
|
|
|
Service Code
|
NDC 536123981
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.15 |
| Max. Negotiated Rate |
$270.86 |
| Rate for Payer: Aetna Commercial |
$243.78
|
| Rate for Payer: ASR ASR |
$262.74
|
| Rate for Payer: BCBS Trust/PPO |
$222.43
|
| Rate for Payer: BCN Commercial |
$222.43
|
| Rate for Payer: Cash Price |
$216.69
|
| Rate for Payer: Cofinity Commercial |
$254.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.69
|
| Rate for Payer: Healthscope Commercial |
$262.74
|
| Rate for Payer: Healthscope Whirlpool |
$270.86
|
| Rate for Payer: Mclaren Commercial |
$243.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.23
|
| Rate for Payer: Nomi Health Commercial |
$222.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.36
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$64.90
|
|
|
Service Code
|
NDC 135050804
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.67 |
| Max. Negotiated Rate |
$64.90 |
| Rate for Payer: Aetna Commercial |
$58.41
|
| Rate for Payer: ASR ASR |
$62.95
|
| Rate for Payer: BCBS Trust/PPO |
$53.29
|
| Rate for Payer: BCN Commercial |
$53.29
|
| Rate for Payer: Cash Price |
$51.92
|
| Rate for Payer: Cofinity Commercial |
$61.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.92
|
| Rate for Payer: Healthscope Commercial |
$62.95
|
| Rate for Payer: Healthscope Whirlpool |
$64.90
|
| Rate for Payer: Mclaren Commercial |
$58.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.16
|
| Rate for Payer: Nomi Health Commercial |
$53.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.11
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$99.52
|
|
|
Service Code
|
NDC 45802008901
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.64 |
| Max. Negotiated Rate |
$99.52 |
| Rate for Payer: Aetna Commercial |
$89.57
|
| Rate for Payer: ASR ASR |
$96.54
|
| Rate for Payer: BCBS Trust/PPO |
$81.73
|
| Rate for Payer: BCN Commercial |
$81.73
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cofinity Commercial |
$93.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.62
|
| Rate for Payer: Healthscope Commercial |
$96.54
|
| Rate for Payer: Healthscope Whirlpool |
$99.52
|
| Rate for Payer: Mclaren Commercial |
$89.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.59
|
| Rate for Payer: Nomi Health Commercial |
$81.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.58
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$64.90
|
|
|
Service Code
|
NDC 135050804
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$64.90 |
| Rate for Payer: Aetna Commercial |
$58.41
|
| Rate for Payer: Aetna Medicare |
$24.01
|
| Rate for Payer: ASR ASR |
$62.95
|
| Rate for Payer: BCBS Complete |
$25.96
|
| Rate for Payer: BCBS Trust/PPO |
$53.51
|
| Rate for Payer: BCN Commercial |
$53.51
|
| Rate for Payer: Cash Price |
$51.92
|
| Rate for Payer: Cofinity Commercial |
$61.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.92
|
| Rate for Payer: Healthscope Commercial |
$62.95
|
| Rate for Payer: Healthscope Whirlpool |
$64.90
|
| Rate for Payer: Mclaren Commercial |
$58.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.16
|
| Rate for Payer: Nomi Health Commercial |
$53.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$56.86
|
| Rate for Payer: Priority Health Narrow Network |
$45.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.11
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$298.57
|
|
|
Service Code
|
NDC 45802008902
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.92 |
| Max. Negotiated Rate |
$298.57 |
| Rate for Payer: Aetna Commercial |
$268.71
|
| Rate for Payer: ASR ASR |
$289.61
|
| Rate for Payer: BCBS Trust/PPO |
$245.18
|
| Rate for Payer: BCN Commercial |
$245.18
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cofinity Commercial |
$280.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.85
|
| Rate for Payer: Healthscope Commercial |
$289.61
|
| Rate for Payer: Healthscope Whirlpool |
$298.57
|
| Rate for Payer: Mclaren Commercial |
$268.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.78
|
| Rate for Payer: Nomi Health Commercial |
$244.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.74
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$298.57
|
|
|
Service Code
|
NDC 45802008902
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.47 |
| Max. Negotiated Rate |
$298.57 |
| Rate for Payer: Aetna Commercial |
$268.71
|
| Rate for Payer: Aetna Medicare |
$110.47
|
| Rate for Payer: ASR ASR |
$289.61
|
| Rate for Payer: BCBS Complete |
$119.43
|
| Rate for Payer: BCBS Trust/PPO |
$246.17
|
| Rate for Payer: BCN Commercial |
$246.17
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cofinity Commercial |
$280.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.85
|
| Rate for Payer: Healthscope Commercial |
$289.61
|
| Rate for Payer: Healthscope Whirlpool |
$298.57
|
| Rate for Payer: Mclaren Commercial |
$268.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$238.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.78
|
| Rate for Payer: Nomi Health Commercial |
$244.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$261.60
|
| Rate for Payer: Priority Health Narrow Network |
$209.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.74
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$336.30
|
|
|
Service Code
|
NDC 23155019401
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.22 |
| Max. Negotiated Rate |
$336.30 |
| Rate for Payer: Aetna Commercial |
$302.67
|
| Rate for Payer: ASR ASR |
$326.21
|
| Rate for Payer: BCBS Trust/PPO |
$276.17
|
| Rate for Payer: BCN Commercial |
$276.17
|
| Rate for Payer: Cash Price |
$269.04
|
| Rate for Payer: Cofinity Commercial |
$316.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.04
|
| Rate for Payer: Healthscope Commercial |
$326.21
|
| Rate for Payer: Healthscope Whirlpool |
$336.30
|
| Rate for Payer: Mclaren Commercial |
$302.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.86
|
| Rate for Payer: Nomi Health Commercial |
$275.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.94
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
OP
|
$336.30
|
|
|
Service Code
|
NDC 23155019401
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.43 |
| Max. Negotiated Rate |
$336.30 |
| Rate for Payer: Aetna Commercial |
$302.67
|
| Rate for Payer: Aetna Medicare |
$124.43
|
| Rate for Payer: ASR ASR |
$326.21
|
| Rate for Payer: BCBS Complete |
$134.52
|
| Rate for Payer: BCBS Trust/PPO |
$277.28
|
| Rate for Payer: BCN Commercial |
$277.28
|
| Rate for Payer: Cash Price |
$269.04
|
| Rate for Payer: Cofinity Commercial |
$316.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.04
|
| Rate for Payer: Healthscope Commercial |
$326.21
|
| Rate for Payer: Healthscope Whirlpool |
$336.30
|
| Rate for Payer: Mclaren Commercial |
$302.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.86
|
| Rate for Payer: Nomi Health Commercial |
$275.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$294.67
|
| Rate for Payer: Priority Health Narrow Network |
$235.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.94
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$207.10
|
|
|
Service Code
|
NDC 59651029701
|
| Hospital Charge Code |
37662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.32 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Aetna Commercial |
$186.39
|
| Rate for Payer: ASR ASR |
$200.89
|
| Rate for Payer: BCBS Trust/PPO |
$170.07
|
| Rate for Payer: BCN Commercial |
$170.07
|
| Rate for Payer: Cash Price |
$165.68
|
| Rate for Payer: Cofinity Commercial |
$194.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.68
|
| Rate for Payer: Healthscope Commercial |
$200.89
|
| Rate for Payer: Healthscope Whirlpool |
$207.10
|
| Rate for Payer: Mclaren Commercial |
$186.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.03
|
| Rate for Payer: Nomi Health Commercial |
$169.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.25
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$207.10
|
|
|
Service Code
|
NDC 59651029701
|
| Hospital Charge Code |
37662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.63 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Aetna Commercial |
$186.39
|
| Rate for Payer: Aetna Medicare |
$76.63
|
| Rate for Payer: ASR ASR |
$200.89
|
| Rate for Payer: BCBS Complete |
$82.84
|
| Rate for Payer: BCBS Trust/PPO |
$170.75
|
| Rate for Payer: BCN Commercial |
$170.75
|
| Rate for Payer: Cash Price |
$165.68
|
| Rate for Payer: Cofinity Commercial |
$194.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.68
|
| Rate for Payer: Healthscope Commercial |
$200.89
|
| Rate for Payer: Healthscope Whirlpool |
$207.10
|
| Rate for Payer: Mclaren Commercial |
$186.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.03
|
| Rate for Payer: Nomi Health Commercial |
$169.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$181.46
|
| Rate for Payer: Priority Health Narrow Network |
$145.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.25
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
OP
|
$375.25
|
|
|
Service Code
|
NDC 70756041111
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.84 |
| Max. Negotiated Rate |
$375.25 |
| Rate for Payer: Aetna Commercial |
$337.73
|
| Rate for Payer: Aetna Medicare |
$138.84
|
| Rate for Payer: ASR ASR |
$363.99
|
| Rate for Payer: BCBS Complete |
$150.10
|
| Rate for Payer: BCBS Trust/PPO |
$309.39
|
| Rate for Payer: BCN Commercial |
$309.39
|
| Rate for Payer: Cash Price |
$300.20
|
| Rate for Payer: Cofinity Commercial |
$352.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.20
|
| Rate for Payer: Healthscope Commercial |
$363.99
|
| Rate for Payer: Healthscope Whirlpool |
$375.25
|
| Rate for Payer: Mclaren Commercial |
$337.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.96
|
| Rate for Payer: Nomi Health Commercial |
$307.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$328.79
|
| Rate for Payer: Priority Health Narrow Network |
$263.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.22
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
IP
|
$375.25
|
|
|
Service Code
|
NDC 70756041111
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.44 |
| Max. Negotiated Rate |
$375.25 |
| Rate for Payer: Aetna Commercial |
$337.73
|
| Rate for Payer: ASR ASR |
$363.99
|
| Rate for Payer: BCBS Trust/PPO |
$308.16
|
| Rate for Payer: BCN Commercial |
$308.16
|
| Rate for Payer: Cash Price |
$300.20
|
| Rate for Payer: Cofinity Commercial |
$352.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.20
|
| Rate for Payer: Healthscope Commercial |
$363.99
|
| Rate for Payer: Healthscope Whirlpool |
$375.25
|
| Rate for Payer: Mclaren Commercial |
$337.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.96
|
| Rate for Payer: Nomi Health Commercial |
$307.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.22
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$447.33
|
|
|
Service Code
|
NDC 50268062515
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.51 |
| Max. Negotiated Rate |
$447.33 |
| Rate for Payer: Aetna Commercial |
$402.60
|
| Rate for Payer: Aetna Medicare |
$165.51
|
| Rate for Payer: ASR ASR |
$433.91
|
| Rate for Payer: BCBS Complete |
$178.93
|
| Rate for Payer: BCBS Trust/PPO |
$368.82
|
| Rate for Payer: BCN Commercial |
$368.82
|
| Rate for Payer: Cash Price |
$357.86
|
| Rate for Payer: Cofinity Commercial |
$420.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.86
|
| Rate for Payer: Healthscope Commercial |
$433.91
|
| Rate for Payer: Healthscope Whirlpool |
$447.33
|
| Rate for Payer: Mclaren Commercial |
$402.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$357.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.23
|
| Rate for Payer: Nomi Health Commercial |
$366.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$391.95
|
| Rate for Payer: Priority Health Narrow Network |
$313.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.65
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$8.95
|
|
|
Service Code
|
NDC 50268062511
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$8.95 |
| Rate for Payer: Aetna Commercial |
$8.05
|
| Rate for Payer: Aetna Medicare |
$3.31
|
| Rate for Payer: ASR ASR |
$8.68
|
| Rate for Payer: BCBS Complete |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$7.38
|
| Rate for Payer: BCN Commercial |
$7.38
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Cofinity Commercial |
$8.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.16
|
| Rate for Payer: Healthscope Commercial |
$8.68
|
| Rate for Payer: Healthscope Whirlpool |
$8.95
|
| Rate for Payer: Mclaren Commercial |
$8.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.60
|
| Rate for Payer: Nomi Health Commercial |
$7.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.84
|
| Rate for Payer: Priority Health Narrow Network |
$6.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.87
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$881.34
|
|
|
Service Code
|
NDC 68084044601
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$326.10 |
| Max. Negotiated Rate |
$881.34 |
| Rate for Payer: Aetna Commercial |
$793.21
|
| Rate for Payer: Aetna Medicare |
$326.10
|
| Rate for Payer: ASR ASR |
$854.90
|
| Rate for Payer: BCBS Complete |
$352.54
|
| Rate for Payer: BCBS Trust/PPO |
$726.66
|
| Rate for Payer: BCN Commercial |
$726.66
|
| Rate for Payer: Cash Price |
$705.07
|
| Rate for Payer: Cofinity Commercial |
$828.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.07
|
| Rate for Payer: Healthscope Commercial |
$854.90
|
| Rate for Payer: Healthscope Whirlpool |
$881.34
|
| Rate for Payer: Mclaren Commercial |
$793.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$705.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.14
|
| Rate for Payer: Nomi Health Commercial |
$722.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$661.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$772.23
|
| Rate for Payer: Priority Health Narrow Network |
$617.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$775.58
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$11.12
|
|
|
Service Code
|
NDC 51079034801
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$11.12 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Aetna Medicare |
$4.11
|
| Rate for Payer: ASR ASR |
$10.79
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: BCBS Trust/PPO |
$9.17
|
| Rate for Payer: BCN Commercial |
$9.17
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$10.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.79
|
| Rate for Payer: Healthscope Whirlpool |
$11.12
|
| Rate for Payer: Mclaren Commercial |
$10.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: Nomi Health Commercial |
$9.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.74
|
| Rate for Payer: Priority Health Narrow Network |
$7.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.78
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$282.24
|
|
|
Service Code
|
NDC 47781030301
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.43 |
| Max. Negotiated Rate |
$282.24 |
| Rate for Payer: Aetna Commercial |
$254.02
|
| Rate for Payer: Aetna Medicare |
$104.43
|
| Rate for Payer: ASR ASR |
$273.77
|
| Rate for Payer: BCBS Complete |
$112.90
|
| Rate for Payer: BCBS Trust/PPO |
$232.71
|
| Rate for Payer: BCN Commercial |
$232.71
|
| Rate for Payer: Cash Price |
$225.79
|
| Rate for Payer: Cofinity Commercial |
$265.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.79
|
| Rate for Payer: Healthscope Commercial |
$273.77
|
| Rate for Payer: Healthscope Whirlpool |
$282.24
|
| Rate for Payer: Mclaren Commercial |
$254.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.90
|
| Rate for Payer: Nomi Health Commercial |
$231.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$247.30
|
| Rate for Payer: Priority Health Narrow Network |
$197.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.37
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$447.33
|
|
|
Service Code
|
NDC 50268062515
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$335.50 |
| Max. Negotiated Rate |
$447.33 |
| Rate for Payer: Aetna Commercial |
$402.60
|
| Rate for Payer: ASR ASR |
$433.91
|
| Rate for Payer: BCBS Trust/PPO |
$367.35
|
| Rate for Payer: BCN Commercial |
$367.35
|
| Rate for Payer: Cash Price |
$357.86
|
| Rate for Payer: Cofinity Commercial |
$420.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.86
|
| Rate for Payer: Healthscope Commercial |
$433.91
|
| Rate for Payer: Healthscope Whirlpool |
$447.33
|
| Rate for Payer: Mclaren Commercial |
$402.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.23
|
| Rate for Payer: Nomi Health Commercial |
$366.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.65
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$11.12
|
|
|
Service Code
|
NDC 51079034801
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$11.12 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: ASR ASR |
$10.79
|
| Rate for Payer: BCBS Trust/PPO |
$9.13
|
| Rate for Payer: BCN Commercial |
$9.13
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$10.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.79
|
| Rate for Payer: Healthscope Whirlpool |
$11.12
|
| Rate for Payer: Mclaren Commercial |
$10.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: Nomi Health Commercial |
$9.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.78
|
|
