|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$95.76
|
|
|
Service Code
|
NDC 68462031435
|
| 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
|
|
|
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
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$95.76
|
|
|
Service Code
|
NDC 68462031435
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.82 |
| Max. Negotiated Rate |
$95.76 |
| Rate for Payer: Aetna Commercial |
$86.18
|
| Rate for Payer: ASR ASR |
$92.89
|
| Rate for Payer: BCBS Trust/PPO |
$78.64
|
| Rate for Payer: BCN Commercial |
$78.64
|
| 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: 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: UHC All Payor (Choice/PPO) + Core |
$84.27
|
|
|
OB/GYN SPEC KZOO ONLY - NITROUS OXIDE ADMIN
|
Professional
|
Both
|
$63.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.25
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$5,237.51
|
|
|
Service Code
|
APR-DRG 7623
|
| Min. Negotiated Rate |
$4,735.34 |
| Max. Negotiated Rate |
$5,237.51 |
| Rate for Payer: BCBS Complete |
$5,237.51
|
| Rate for Payer: Mclaren Medicaid |
$4,988.11
|
| Rate for Payer: Meridian Medicaid |
$5,237.51
|
| Rate for Payer: PHP Medicaid |
$4,735.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,988.11
|
| Rate for Payer: UHC Medicaid |
$4,988.11
|
| Rate for Payer: UHCCP Medicaid |
$4,988.11
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$3,560.16
|
|
|
Service Code
|
APR-DRG 7622
|
| Min. Negotiated Rate |
$3,218.81 |
| Max. Negotiated Rate |
$3,560.16 |
| Rate for Payer: BCBS Complete |
$3,560.16
|
| Rate for Payer: Mclaren Medicaid |
$3,390.63
|
| Rate for Payer: Meridian Medicaid |
$3,560.16
|
| Rate for Payer: PHP Medicaid |
$3,218.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,390.63
|
| Rate for Payer: UHC Medicaid |
$3,390.63
|
| Rate for Payer: UHCCP Medicaid |
$3,390.63
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$6,549.21
|
|
|
Service Code
|
APR-DRG 7624
|
| Min. Negotiated Rate |
$5,921.27 |
| Max. Negotiated Rate |
$6,549.21 |
| Rate for Payer: BCBS Complete |
$6,549.21
|
| Rate for Payer: Mclaren Medicaid |
$6,237.34
|
| Rate for Payer: Meridian Medicaid |
$6,549.21
|
| Rate for Payer: PHP Medicaid |
$5,921.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,237.34
|
| Rate for Payer: UHC Medicaid |
$6,237.34
|
| Rate for Payer: UHCCP Medicaid |
$6,237.34
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$2,846.27
|
|
|
Service Code
|
APR-DRG 7621
|
| Min. Negotiated Rate |
$2,573.37 |
| Max. Negotiated Rate |
$2,846.27 |
| Rate for Payer: BCBS Complete |
$2,846.27
|
| Rate for Payer: Mclaren Medicaid |
$2,710.74
|
| Rate for Payer: Meridian Medicaid |
$2,846.27
|
| Rate for Payer: PHP Medicaid |
$2,573.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,710.74
|
| Rate for Payer: UHC Medicaid |
$2,710.74
|
| Rate for Payer: UHCCP Medicaid |
$2,710.74
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$51.55
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$51.55 |
| Rate for Payer: Aetna Commercial |
$46.39
|
| Rate for Payer: Aetna Commercial |
$16.10
|
| Rate for Payer: Aetna Commercial |
$22.58
|
| Rate for Payer: Aetna Commercial |
$18.25
|
| Rate for Payer: Aetna Commercial |
$20.03
|
| Rate for Payer: Aetna Commercial |
$15.54
|
| Rate for Payer: Aetna Medicare |
$8.24
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: Aetna Medicare |
$9.28
|
| Rate for Payer: Aetna Medicare |
$19.07
|
| Rate for Payer: Aetna Medicare |
$6.39
|
| Rate for Payer: ASR ASR |
$17.36
|
| Rate for Payer: ASR ASR |
$50.00
|
| Rate for Payer: ASR ASR |
$24.33
|
| Rate for Payer: ASR ASR |
$16.75
|
| Rate for Payer: ASR ASR |
$19.67
|
| Rate for Payer: ASR ASR |
$21.59
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Complete |
$6.91
|
| Rate for Payer: BCBS Complete |
$10.03
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS Complete |
$20.62
|
| Rate for Payer: BCBS Complete |
$8.11
|
| Rate for Payer: BCBS Trust/PPO |
$20.68
|
| Rate for Payer: BCBS Trust/PPO |
$18.35
|
| Rate for Payer: BCBS Trust/PPO |
$16.72
|
| Rate for Payer: BCBS Trust/PPO |
$14.24
|
| Rate for Payer: BCBS Trust/PPO |
$14.75
|
| Rate for Payer: BCBS Trust/PPO |
$42.50
|
| Rate for Payer: BCN Commercial |
$42.50
|
| Rate for Payer: BCN Commercial |
$14.75
|
| Rate for Payer: BCN Commercial |
$14.24
|
| Rate for Payer: BCN Commercial |
$16.72
|
| Rate for Payer: BCN Commercial |
$20.68
|
| Rate for Payer: BCN Commercial |
$18.35
|
| Rate for Payer: Cash Price |
$20.07
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cash Price |
$20.07
|
| Rate for Payer: Cash Price |
$41.24
|
| Rate for Payer: Cash Price |
$41.24
|
| Rate for Payer: Cofinity Commercial |
$16.24
|
| Rate for Payer: Cofinity Commercial |
$48.45
|
| Rate for Payer: Cofinity Commercial |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$23.58
|
| Rate for Payer: Cofinity Commercial |
$20.92
|
| Rate for Payer: Cofinity Commercial |
$19.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.22
|
| Rate for Payer: Healthscope Commercial |
$19.67
|
| Rate for Payer: Healthscope Commercial |
$21.59
|
| Rate for Payer: Healthscope Commercial |
$16.75
|
| Rate for Payer: Healthscope Commercial |
$17.36
|
| Rate for Payer: Healthscope Commercial |
$24.33
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$22.26
|
| Rate for Payer: Healthscope Whirlpool |
$17.89
|
| Rate for Payer: Healthscope Whirlpool |
$17.27
|
| Rate for Payer: Healthscope Whirlpool |
$20.28
|
| Rate for Payer: Healthscope Whirlpool |
$25.09
|
| Rate for Payer: Healthscope Whirlpool |
$51.55
|
| Rate for Payer: Mclaren Commercial |
$16.10
|
| Rate for Payer: Mclaren Commercial |
$46.39
|
| Rate for Payer: Mclaren Commercial |
$22.58
|
| Rate for Payer: Mclaren Commercial |
$15.54
|
| Rate for Payer: Mclaren Commercial |
$18.25
|
| Rate for Payer: Mclaren Commercial |
$20.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.68
|
| Rate for Payer: Nomi Health Commercial |
$14.16
|
| Rate for Payer: Nomi Health Commercial |
$20.57
|
| Rate for Payer: Nomi Health Commercial |
$18.25
|
| Rate for Payer: Nomi Health Commercial |
$16.63
|
| Rate for Payer: Nomi Health Commercial |
$42.27
|
| Rate for Payer: Nomi Health Commercial |
$14.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.68
|
| Rate for Payer: Priority Health Narrow Network |
$0.54
|
| Rate for Payer: Priority Health Narrow Network |
$0.54
|
| Rate for Payer: Priority Health Narrow Network |
$0.54
|
| Rate for Payer: Priority Health Narrow Network |
$0.54
|
| Rate for Payer: Priority Health Narrow Network |
$0.54
|
| Rate for Payer: Priority Health Narrow Network |
$0.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.36
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$17.27
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$17.27 |
| Rate for Payer: Aetna Commercial |
$15.54
|
| Rate for Payer: Aetna Commercial |
$16.10
|
| Rate for Payer: Aetna Commercial |
$22.58
|
| Rate for Payer: Aetna Commercial |
$20.03
|
| Rate for Payer: Aetna Commercial |
$46.39
|
| Rate for Payer: Aetna Commercial |
$18.25
|
| Rate for Payer: ASR ASR |
$19.67
|
| Rate for Payer: ASR ASR |
$16.75
|
| Rate for Payer: ASR ASR |
$24.33
|
| Rate for Payer: ASR ASR |
$17.36
|
| Rate for Payer: ASR ASR |
$21.59
|
| Rate for Payer: ASR ASR |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$14.18
|
| Rate for Payer: BCBS Trust/PPO |
$18.28
|
| Rate for Payer: BCBS Trust/PPO |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$42.33
|
| Rate for Payer: BCBS Trust/PPO |
$20.60
|
| Rate for Payer: BCBS Trust/PPO |
$14.69
|
| Rate for Payer: BCN Commercial |
$20.60
|
| Rate for Payer: BCN Commercial |
$14.18
|
| Rate for Payer: BCN Commercial |
$42.33
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: BCN Commercial |
$14.69
|
| Rate for Payer: BCN Commercial |
$18.28
|
| Rate for Payer: Cash Price |
$20.07
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$41.24
|
| Rate for Payer: Cofinity Commercial |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$20.92
|
| Rate for Payer: Cofinity Commercial |
$16.24
|
| Rate for Payer: Cofinity Commercial |
$19.06
|
| Rate for Payer: Cofinity Commercial |
$23.58
|
| Rate for Payer: Cofinity Commercial |
$48.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.24
|
| Rate for Payer: Healthscope Commercial |
$16.75
|
| Rate for Payer: Healthscope Commercial |
$21.59
|
| Rate for Payer: Healthscope Commercial |
$17.36
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Commercial |
$19.67
|
| Rate for Payer: Healthscope Commercial |
$24.33
|
| Rate for Payer: Healthscope Whirlpool |
$20.28
|
| Rate for Payer: Healthscope Whirlpool |
$22.26
|
| Rate for Payer: Healthscope Whirlpool |
$17.89
|
| Rate for Payer: Healthscope Whirlpool |
$25.09
|
| Rate for Payer: Healthscope Whirlpool |
$17.27
|
| Rate for Payer: Healthscope Whirlpool |
$51.55
|
| Rate for Payer: Mclaren Commercial |
$22.58
|
| Rate for Payer: Mclaren Commercial |
$46.39
|
| Rate for Payer: Mclaren Commercial |
$18.25
|
| Rate for Payer: Mclaren Commercial |
$15.54
|
| Rate for Payer: Mclaren Commercial |
$16.10
|
| Rate for Payer: Mclaren Commercial |
$20.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.32
|
| Rate for Payer: Nomi Health Commercial |
$14.67
|
| Rate for Payer: Nomi Health Commercial |
$18.25
|
| Rate for Payer: Nomi Health Commercial |
$14.16
|
| Rate for Payer: Nomi Health Commercial |
$20.57
|
| Rate for Payer: Nomi Health Commercial |
$42.27
|
| Rate for Payer: Nomi Health Commercial |
$16.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.07
|
|
|
OFLOXACIN 0.3 % EAR DROPS
|
Facility
|
OP
|
$418.50
|
|
|
Service Code
|
NDC 24208041005
|
| Hospital Charge Code |
22257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.84 |
| Max. Negotiated Rate |
$418.50 |
| Rate for Payer: Aetna Commercial |
$376.65
|
| Rate for Payer: Aetna Medicare |
$154.84
|
| Rate for Payer: ASR ASR |
$405.94
|
| Rate for Payer: BCBS Complete |
$167.40
|
| Rate for Payer: BCBS Trust/PPO |
$345.05
|
| Rate for Payer: BCN Commercial |
$345.05
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cofinity Commercial |
$393.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.80
|
| Rate for Payer: Healthscope Commercial |
$405.94
|
| Rate for Payer: Healthscope Whirlpool |
$418.50
|
| Rate for Payer: Mclaren Commercial |
$376.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$334.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.72
|
| Rate for Payer: Nomi Health Commercial |
$343.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$313.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$366.69
|
| Rate for Payer: Priority Health Narrow Network |
$293.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$368.28
|
|
|
OFLOXACIN 0.3 % EAR DROPS
|
Facility
|
IP
|
$211.58
|
|
|
Service Code
|
NDC 60505036301
|
| Hospital Charge Code |
22257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.68 |
| Max. Negotiated Rate |
$211.57 |
| Rate for Payer: Aetna Commercial |
$190.42
|
| Rate for Payer: ASR ASR |
$205.23
|
| Rate for Payer: BCBS Trust/PPO |
$173.75
|
| Rate for Payer: BCN Commercial |
$173.75
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Cofinity Commercial |
$198.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.26
|
| Rate for Payer: Healthscope Commercial |
$205.23
|
| Rate for Payer: Healthscope Whirlpool |
$211.57
|
| Rate for Payer: Mclaren Commercial |
$190.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.84
|
| Rate for Payer: Nomi Health Commercial |
$173.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.19
|
|
|
OFLOXACIN 0.3 % EAR DROPS
|
Facility
|
OP
|
$211.58
|
|
|
Service Code
|
NDC 60505036301
|
| Hospital Charge Code |
22257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.28 |
| Max. Negotiated Rate |
$211.57 |
| Rate for Payer: Aetna Commercial |
$190.42
|
| Rate for Payer: Aetna Medicare |
$78.28
|
| Rate for Payer: ASR ASR |
$205.23
|
| Rate for Payer: BCBS Complete |
$84.63
|
| Rate for Payer: BCBS Trust/PPO |
$174.44
|
| Rate for Payer: BCN Commercial |
$174.44
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Cofinity Commercial |
$198.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.26
|
| Rate for Payer: Healthscope Commercial |
$205.23
|
| Rate for Payer: Healthscope Whirlpool |
$211.57
|
| Rate for Payer: Mclaren Commercial |
$190.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.84
|
| Rate for Payer: Nomi Health Commercial |
$173.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$185.38
|
| Rate for Payer: Priority Health Narrow Network |
$148.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.19
|
|
|
OFLOXACIN 0.3 % EAR DROPS
|
Facility
|
IP
|
$418.50
|
|
|
Service Code
|
NDC 24208041005
|
| Hospital Charge Code |
22257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.87 |
| Max. Negotiated Rate |
$418.50 |
| Rate for Payer: Aetna Commercial |
$376.65
|
| Rate for Payer: ASR ASR |
$405.94
|
| Rate for Payer: BCBS Trust/PPO |
$343.67
|
| Rate for Payer: BCN Commercial |
$343.67
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cofinity Commercial |
$393.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.80
|
| Rate for Payer: Healthscope Commercial |
$405.94
|
| Rate for Payer: Healthscope Whirlpool |
$418.50
|
| Rate for Payer: Mclaren Commercial |
$376.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.72
|
| Rate for Payer: Nomi Health Commercial |
$343.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$313.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$368.28
|
|
|
OFLOXACIN 0.3 % EAR DROPS
|
Facility
|
OP
|
$25.11
|
|
|
Service Code
|
NDC 70069068601
|
| Hospital Charge Code |
22257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna Commercial |
$22.60
|
| Rate for Payer: Aetna Medicare |
$9.29
|
| Rate for Payer: ASR ASR |
$24.36
|
| Rate for Payer: BCBS Complete |
$10.04
|
| Rate for Payer: BCBS Trust/PPO |
$20.70
|
| Rate for Payer: BCN Commercial |
$20.70
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Cofinity Commercial |
$23.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.09
|
| Rate for Payer: Healthscope Commercial |
$24.36
|
| Rate for Payer: Healthscope Whirlpool |
$25.11
|
| Rate for Payer: Mclaren Commercial |
$22.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.34
|
| Rate for Payer: Nomi Health Commercial |
$20.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.00
|
| Rate for Payer: Priority Health Narrow Network |
$17.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.10
|
|
|
OFLOXACIN 0.3 % EAR DROPS
|
Facility
|
IP
|
$25.11
|
|
|
Service Code
|
NDC 70069068601
|
| Hospital Charge Code |
22257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna Commercial |
$22.60
|
| Rate for Payer: ASR ASR |
$24.36
|
| Rate for Payer: BCBS Trust/PPO |
$20.62
|
| Rate for Payer: BCN Commercial |
$20.62
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Cofinity Commercial |
$23.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.09
|
| Rate for Payer: Healthscope Commercial |
$24.36
|
| Rate for Payer: Healthscope Whirlpool |
$25.11
|
| Rate for Payer: Mclaren Commercial |
$22.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.34
|
| Rate for Payer: Nomi Health Commercial |
$20.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.10
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$97.65
|
|
|
Service Code
|
NDC 64980051501
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna Medicare |
$36.13
|
| Rate for Payer: ASR ASR |
$94.72
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS Trust/PPO |
$80.51
|
| Rate for Payer: BCN Commercial |
$80.51
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$91.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$94.72
|
| Rate for Payer: Healthscope Whirlpool |
$97.65
|
| Rate for Payer: Mclaren Commercial |
$87.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Nomi Health Commercial |
$80.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$85.56
|
| Rate for Payer: Priority Health Narrow Network |
$68.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.93
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$66.54
|
|
|
Service Code
|
NDC 24208043405
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.90 |
| Max. Negotiated Rate |
$66.53 |
| Rate for Payer: Aetna Commercial |
$59.88
|
| Rate for Payer: ASR ASR |
$64.54
|
| Rate for Payer: BCBS Trust/PPO |
$54.64
|
| Rate for Payer: BCN Commercial |
$54.64
|
| Rate for Payer: Cash Price |
$53.23
|
| Rate for Payer: Cofinity Commercial |
$62.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.23
|
| Rate for Payer: Healthscope Commercial |
$64.54
|
| Rate for Payer: Healthscope Whirlpool |
$66.53
|
| Rate for Payer: Mclaren Commercial |
$59.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.55
|
| Rate for Payer: Nomi Health Commercial |
$54.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.55
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$403.83
|
|
|
Service Code
|
NDC 11980077905
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$302.87 |
| Max. Negotiated Rate |
$403.83 |
| Rate for Payer: Aetna Commercial |
$363.45
|
| Rate for Payer: ASR ASR |
$391.72
|
| Rate for Payer: BCBS Trust/PPO |
$331.63
|
| Rate for Payer: BCN Commercial |
$331.63
|
| Rate for Payer: Cash Price |
$323.06
|
| Rate for Payer: Cofinity Commercial |
$379.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.06
|
| Rate for Payer: Healthscope Commercial |
$391.72
|
| Rate for Payer: Healthscope Whirlpool |
$403.83
|
| Rate for Payer: Mclaren Commercial |
$363.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.26
|
| Rate for Payer: Nomi Health Commercial |
$331.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$302.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.37
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$48.83
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna Commercial |
$43.94
|
| Rate for Payer: Aetna Medicare |
$18.07
|
| Rate for Payer: ASR ASR |
$47.36
|
| Rate for Payer: BCBS Complete |
$19.53
|
| Rate for Payer: BCBS Trust/PPO |
$40.26
|
| Rate for Payer: BCN Commercial |
$40.26
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$45.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$47.36
|
| Rate for Payer: Healthscope Whirlpool |
$48.83
|
| Rate for Payer: Mclaren Commercial |
$43.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.50
|
| Rate for Payer: Nomi Health Commercial |
$40.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$42.78
|
| Rate for Payer: Priority Health Narrow Network |
$34.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.97
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$403.83
|
|
|
Service Code
|
NDC 11980077905
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.42 |
| Max. Negotiated Rate |
$403.83 |
| Rate for Payer: Aetna Commercial |
$363.45
|
| Rate for Payer: Aetna Medicare |
$149.42
|
| Rate for Payer: ASR ASR |
$391.72
|
| Rate for Payer: BCBS Complete |
$161.53
|
| Rate for Payer: BCBS Trust/PPO |
$332.96
|
| Rate for Payer: BCN Commercial |
$332.96
|
| Rate for Payer: Cash Price |
$323.06
|
| Rate for Payer: Cofinity Commercial |
$379.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.06
|
| Rate for Payer: Healthscope Commercial |
$391.72
|
| Rate for Payer: Healthscope Whirlpool |
$403.83
|
| Rate for Payer: Mclaren Commercial |
$363.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.26
|
| Rate for Payer: Nomi Health Commercial |
$331.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$302.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$353.84
|
| Rate for Payer: Priority Health Narrow Network |
$283.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.37
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$31.29
|
|
|
Service Code
|
NDC 70756060730
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.47 |
| Max. Negotiated Rate |
$31.29 |
| Rate for Payer: Aetna Commercial |
$28.16
|
| Rate for Payer: ASR ASR |
$30.35
|
| Rate for Payer: BCBS Trust/PPO |
$25.70
|
| Rate for Payer: BCN Commercial |
$25.70
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cofinity Commercial |
$29.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.03
|
| Rate for Payer: Healthscope Commercial |
$30.35
|
| Rate for Payer: Healthscope Whirlpool |
$31.29
|
| Rate for Payer: Mclaren Commercial |
$28.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.60
|
| Rate for Payer: Nomi Health Commercial |
$25.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.54
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$97.65
|
|
|
Service Code
|
NDC 64980051501
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.24 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: ASR ASR |
$94.72
|
| Rate for Payer: BCBS Trust/PPO |
$80.19
|
| Rate for Payer: BCN Commercial |
$80.19
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$91.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$94.72
|
| Rate for Payer: Healthscope Whirlpool |
$97.65
|
| Rate for Payer: Mclaren Commercial |
$87.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Nomi Health Commercial |
$80.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.93
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$66.54
|
|
|
Service Code
|
NDC 24208043405
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$66.53 |
| Rate for Payer: Aetna Commercial |
$59.88
|
| Rate for Payer: Aetna Medicare |
$24.62
|
| Rate for Payer: ASR ASR |
$64.54
|
| Rate for Payer: BCBS Complete |
$26.61
|
| Rate for Payer: BCBS Trust/PPO |
$54.86
|
| Rate for Payer: BCN Commercial |
$54.86
|
| Rate for Payer: Cash Price |
$53.23
|
| Rate for Payer: Cofinity Commercial |
$62.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.23
|
| Rate for Payer: Healthscope Commercial |
$64.54
|
| Rate for Payer: Healthscope Whirlpool |
$66.53
|
| Rate for Payer: Mclaren Commercial |
$59.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.55
|
| Rate for Payer: Nomi Health Commercial |
$54.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58.30
|
| Rate for Payer: Priority Health Narrow Network |
$46.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.55
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$31.29
|
|
|
Service Code
|
NDC 70756060730
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$31.29 |
| Rate for Payer: Aetna Commercial |
$28.16
|
| Rate for Payer: Aetna Medicare |
$11.58
|
| Rate for Payer: ASR ASR |
$30.35
|
| Rate for Payer: BCBS Complete |
$12.52
|
| Rate for Payer: BCBS Trust/PPO |
$25.80
|
| Rate for Payer: BCN Commercial |
$25.80
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cofinity Commercial |
$29.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.03
|
| Rate for Payer: Healthscope Commercial |
$30.35
|
| Rate for Payer: Healthscope Whirlpool |
$31.29
|
| Rate for Payer: Mclaren Commercial |
$28.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.60
|
| Rate for Payer: Nomi Health Commercial |
$25.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27.42
|
| Rate for Payer: Priority Health Narrow Network |
$21.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.54
|
|
