|
NUTREN 2.0 CONTINUOUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 98716006230
|
| Hospital Charge Code |
168944
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 2.0 CONTINUOUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 98716006230
|
| Hospital Charge Code |
168944
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 2.0 CYCLIC FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 98716006230
|
| Hospital Charge Code |
200085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 2.0 CYCLIC FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 98716006230
|
| Hospital Charge Code |
200085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 2.0 INTERMITTENT FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 98716006230
|
| Hospital Charge Code |
200084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 2.0 INTERMITTENT FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 98716006230
|
| Hospital Charge Code |
200084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM
|
Facility
|
IP
|
$42.53
|
|
|
Service Code
|
NDC 51672128902
|
| Hospital Charge Code |
5749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Aetna Commercial |
$38.27
|
| Rate for Payer: ASR ASR |
$41.25
|
| Rate for Payer: BCBS Trust/PPO |
$34.92
|
| Rate for Payer: BCN Commercial |
$34.92
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Cofinity Commercial |
$39.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.02
|
| Rate for Payer: Healthscope Commercial |
$41.25
|
| Rate for Payer: Healthscope Whirlpool |
$42.52
|
| Rate for Payer: Mclaren Commercial |
$38.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.15
|
| Rate for Payer: Nomi Health Commercial |
$34.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.42
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM
|
Facility
|
OP
|
$65.10
|
|
|
Service Code
|
NDC 713067831
|
| Hospital Charge Code |
5749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$65.10 |
| Rate for Payer: Aetna Commercial |
$58.59
|
| Rate for Payer: Aetna Medicare |
$24.09
|
| Rate for Payer: ASR ASR |
$63.15
|
| Rate for Payer: BCBS Complete |
$26.04
|
| Rate for Payer: BCBS Trust/PPO |
$53.67
|
| Rate for Payer: BCN Commercial |
$53.67
|
| Rate for Payer: Cash Price |
$52.08
|
| Rate for Payer: Cofinity Commercial |
$61.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.08
|
| Rate for Payer: Healthscope Commercial |
$63.15
|
| Rate for Payer: Healthscope Whirlpool |
$65.10
|
| Rate for Payer: Mclaren Commercial |
$58.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.34
|
| Rate for Payer: Nomi Health Commercial |
$53.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$57.04
|
| Rate for Payer: Priority Health Narrow Network |
$45.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.29
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM
|
Facility
|
IP
|
$65.10
|
|
|
Service Code
|
NDC 713067831
|
| Hospital Charge Code |
5749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.83 |
| Max. Negotiated Rate |
$65.10 |
| Rate for Payer: Aetna Commercial |
$58.59
|
| Rate for Payer: ASR ASR |
$63.15
|
| Rate for Payer: BCBS Trust/PPO |
$53.46
|
| Rate for Payer: BCN Commercial |
$53.46
|
| Rate for Payer: Cash Price |
$52.08
|
| Rate for Payer: Cofinity Commercial |
$61.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.08
|
| Rate for Payer: Healthscope Commercial |
$63.15
|
| Rate for Payer: Healthscope Whirlpool |
$65.10
|
| Rate for Payer: Mclaren Commercial |
$58.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.34
|
| Rate for Payer: Nomi Health Commercial |
$53.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.29
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM
|
Facility
|
OP
|
$18.16
|
|
|
Service Code
|
NDC 45802005935
|
| Hospital Charge Code |
5749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$18.16 |
| Rate for Payer: Aetna Commercial |
$16.34
|
| Rate for Payer: Aetna Medicare |
$6.72
|
| Rate for Payer: ASR ASR |
$17.61
|
| Rate for Payer: BCBS Complete |
$7.26
|
| Rate for Payer: BCBS Trust/PPO |
$14.97
|
| Rate for Payer: BCN Commercial |
$14.97
|
| Rate for Payer: Cash Price |
$14.53
|
| Rate for Payer: Cofinity Commercial |
$17.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.53
|
| Rate for Payer: Healthscope Commercial |
$17.61
|
| Rate for Payer: Healthscope Whirlpool |
$18.16
|
| Rate for Payer: Mclaren Commercial |
$16.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.43
|
| Rate for Payer: Nomi Health Commercial |
$14.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.91
|
| Rate for Payer: Priority Health Narrow Network |
$12.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.98
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM
|
Facility
|
OP
|
$42.53
|
|
|
Service Code
|
NDC 51672128902
|
| Hospital Charge Code |
5749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Aetna Commercial |
$38.27
|
| Rate for Payer: Aetna Medicare |
$15.73
|
| Rate for Payer: ASR ASR |
$41.25
|
| Rate for Payer: BCBS Complete |
$17.01
|
| Rate for Payer: BCBS Trust/PPO |
$35.06
|
| Rate for Payer: BCN Commercial |
$35.06
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Cofinity Commercial |
$39.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.02
|
| Rate for Payer: Healthscope Commercial |
$41.25
|
| Rate for Payer: Healthscope Whirlpool |
$42.52
|
| Rate for Payer: Mclaren Commercial |
$38.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.15
|
| Rate for Payer: Nomi Health Commercial |
$34.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.26
|
| Rate for Payer: Priority Health Narrow Network |
$29.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.42
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM
|
Facility
|
OP
|
$25.52
|
|
|
Service Code
|
NDC 45802005911
|
| Hospital Charge Code |
5749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$25.52 |
| Rate for Payer: Aetna Commercial |
$22.96
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: ASR ASR |
$24.75
|
| Rate for Payer: BCBS Complete |
$10.21
|
| Rate for Payer: BCBS Trust/PPO |
$21.04
|
| Rate for Payer: BCN Commercial |
$21.04
|
| Rate for Payer: Cash Price |
$20.41
|
| Rate for Payer: Cofinity Commercial |
$23.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.41
|
| Rate for Payer: Healthscope Commercial |
$24.75
|
| Rate for Payer: Healthscope Whirlpool |
$25.52
|
| Rate for Payer: Mclaren Commercial |
$22.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.69
|
| Rate for Payer: Nomi Health Commercial |
$20.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.36
|
| Rate for Payer: Priority Health Narrow Network |
$17.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.45
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM
|
Facility
|
IP
|
$18.16
|
|
|
Service Code
|
NDC 45802005935
|
| Hospital Charge Code |
5749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.62 |
| Max. Negotiated Rate |
$18.16 |
| Rate for Payer: Aetna Commercial |
$16.34
|
| Rate for Payer: ASR ASR |
$17.61
|
| Rate for Payer: BCBS Trust/PPO |
$14.91
|
| Rate for Payer: BCN Commercial |
$14.91
|
| Rate for Payer: Cash Price |
$14.53
|
| Rate for Payer: Cofinity Commercial |
$17.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.53
|
| Rate for Payer: Healthscope Commercial |
$17.61
|
| Rate for Payer: Healthscope Whirlpool |
$18.16
|
| Rate for Payer: Mclaren Commercial |
$16.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.43
|
| Rate for Payer: Nomi Health Commercial |
$14.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.98
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM
|
Facility
|
IP
|
$25.52
|
|
|
Service Code
|
NDC 45802005911
|
| Hospital Charge Code |
5749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$25.52 |
| Rate for Payer: Aetna Commercial |
$22.96
|
| Rate for Payer: ASR ASR |
$24.75
|
| Rate for Payer: BCBS Trust/PPO |
$20.95
|
| Rate for Payer: BCN Commercial |
$20.95
|
| Rate for Payer: Cash Price |
$20.41
|
| Rate for Payer: Cofinity Commercial |
$23.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.41
|
| Rate for Payer: Healthscope Commercial |
$24.75
|
| Rate for Payer: Healthscope Whirlpool |
$25.52
|
| Rate for Payer: Mclaren Commercial |
$22.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.69
|
| Rate for Payer: Nomi Health Commercial |
$20.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.45
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$7.17
|
|
|
Service Code
|
NDC 904727641
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Aetna Commercial |
$6.45
|
| Rate for Payer: ASR ASR |
$6.95
|
| Rate for Payer: BCBS Trust/PPO |
$5.89
|
| Rate for Payer: BCN Commercial |
$5.89
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cofinity Commercial |
$6.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$6.95
|
| Rate for Payer: Healthscope Whirlpool |
$7.17
|
| Rate for Payer: Mclaren Commercial |
$6.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Nomi Health Commercial |
$5.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.31
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$9.69
|
|
|
Service Code
|
NDC 121086850
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna Medicare |
$3.59
|
| Rate for Payer: ASR ASR |
$9.40
|
| Rate for Payer: BCBS Complete |
$3.88
|
| Rate for Payer: BCBS Trust/PPO |
$7.99
|
| Rate for Payer: BCN Commercial |
$7.99
|
| Rate for Payer: Cash Price |
$7.75
|
| Rate for Payer: Cofinity Commercial |
$9.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.75
|
| Rate for Payer: Healthscope Commercial |
$9.40
|
| Rate for Payer: Healthscope Whirlpool |
$9.69
|
| Rate for Payer: Mclaren Commercial |
$8.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.24
|
| Rate for Payer: Nomi Health Commercial |
$7.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.49
|
| Rate for Payer: Priority Health Narrow Network |
$6.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.53
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$7.17
|
|
|
Service Code
|
NDC 904727641
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Aetna Commercial |
$6.45
|
| Rate for Payer: Aetna Medicare |
$2.65
|
| Rate for Payer: ASR ASR |
$6.95
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS Trust/PPO |
$5.91
|
| Rate for Payer: BCN Commercial |
$5.91
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cofinity Commercial |
$6.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$6.95
|
| Rate for Payer: Healthscope Whirlpool |
$7.17
|
| Rate for Payer: Mclaren Commercial |
$6.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Nomi Health Commercial |
$5.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.28
|
| Rate for Payer: Priority Health Narrow Network |
$5.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.31
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$7.17
|
|
|
Service Code
|
NDC 904727670
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Aetna Commercial |
$6.45
|
| Rate for Payer: ASR ASR |
$6.95
|
| Rate for Payer: BCBS Trust/PPO |
$5.89
|
| Rate for Payer: BCN Commercial |
$5.89
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cofinity Commercial |
$6.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$6.95
|
| Rate for Payer: Healthscope Whirlpool |
$7.17
|
| Rate for Payer: Mclaren Commercial |
$6.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Nomi Health Commercial |
$5.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.31
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$9.90
|
|
|
Service Code
|
NDC 68094059959
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: Aetna Medicare |
$3.66
|
| Rate for Payer: ASR ASR |
$9.60
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$8.16
|
| Rate for Payer: BCN Commercial |
$8.16
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.60
|
| Rate for Payer: Healthscope Whirlpool |
$9.90
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.41
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.67
|
| Rate for Payer: Priority Health Narrow Network |
$6.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$9.69
|
|
|
Service Code
|
NDC 121086850
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: ASR ASR |
$9.40
|
| Rate for Payer: BCBS Trust/PPO |
$7.96
|
| Rate for Payer: BCN Commercial |
$7.96
|
| Rate for Payer: Cash Price |
$7.75
|
| Rate for Payer: Cofinity Commercial |
$9.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.75
|
| Rate for Payer: Healthscope Commercial |
$9.40
|
| Rate for Payer: Healthscope Whirlpool |
$9.69
|
| Rate for Payer: Mclaren Commercial |
$8.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.24
|
| Rate for Payer: Nomi Health Commercial |
$7.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.53
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$9.90
|
|
|
Service Code
|
NDC 68094059959
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: ASR ASR |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$8.13
|
| Rate for Payer: BCN Commercial |
$8.13
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.60
|
| Rate for Payer: Healthscope Whirlpool |
$9.90
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.41
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$8.70
|
|
|
Service Code
|
NDC 121086805
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Aetna Commercial |
$7.83
|
| Rate for Payer: Aetna Medicare |
$3.22
|
| Rate for Payer: ASR ASR |
$8.44
|
| Rate for Payer: BCBS Complete |
$3.48
|
| Rate for Payer: BCBS Trust/PPO |
$7.17
|
| Rate for Payer: BCN Commercial |
$7.17
|
| Rate for Payer: Cash Price |
$6.96
|
| Rate for Payer: Cofinity Commercial |
$8.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.96
|
| Rate for Payer: Healthscope Commercial |
$8.44
|
| Rate for Payer: Healthscope Whirlpool |
$8.70
|
| Rate for Payer: Mclaren Commercial |
$7.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.39
|
| Rate for Payer: Nomi Health Commercial |
$7.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.62
|
| Rate for Payer: Priority Health Narrow Network |
$6.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.66
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$7.17
|
|
|
Service Code
|
NDC 904727670
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Aetna Commercial |
$6.45
|
| Rate for Payer: Aetna Medicare |
$2.65
|
| Rate for Payer: ASR ASR |
$6.95
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS Trust/PPO |
$5.91
|
| Rate for Payer: BCN Commercial |
$5.91
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cofinity Commercial |
$6.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$6.95
|
| Rate for Payer: Healthscope Whirlpool |
$7.17
|
| Rate for Payer: Mclaren Commercial |
$6.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Nomi Health Commercial |
$5.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.28
|
| Rate for Payer: Priority Health Narrow Network |
$5.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.31
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.70
|
|
|
Service Code
|
NDC 121086805
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Aetna Commercial |
$7.83
|
| Rate for Payer: ASR ASR |
$8.44
|
| Rate for Payer: BCBS Trust/PPO |
$7.14
|
| Rate for Payer: BCN Commercial |
$7.14
|
| Rate for Payer: Cash Price |
$6.96
|
| Rate for Payer: Cofinity Commercial |
$8.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.96
|
| Rate for Payer: Healthscope Commercial |
$8.44
|
| Rate for Payer: Healthscope Whirlpool |
$8.70
|
| Rate for Payer: Mclaren Commercial |
$7.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.39
|
| Rate for Payer: Nomi Health Commercial |
$7.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.66
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$95.76
|
|
|
Service Code
|
NDC 51672126302
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.43 |
| Max. Negotiated Rate |
$95.76 |
| Rate for Payer: Aetna Commercial |
$86.18
|
| Rate for Payer: Aetna Medicare |
$35.43
|
| Rate for Payer: ASR ASR |
$92.89
|
| Rate for Payer: BCBS Complete |
$38.30
|
| Rate for Payer: BCBS Trust/PPO |
$78.95
|
| Rate for Payer: BCN Commercial |
$78.95
|
| Rate for Payer: Cash Price |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$90.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.61
|
| Rate for Payer: Healthscope Commercial |
$92.89
|
| Rate for Payer: Healthscope Whirlpool |
$95.76
|
| Rate for Payer: Mclaren Commercial |
$86.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: Nomi Health Commercial |
$78.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$83.90
|
| Rate for Payer: Priority Health Narrow Network |
$67.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.27
|
|
