|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$24.09
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$24.09 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: ASR ASR |
$23.37
|
| Rate for Payer: ASR Commercial |
$23.37
|
| Rate for Payer: BCBS Trust/PPO |
$19.63
|
| Rate for Payer: BCN Commercial |
$18.68
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$22.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$24.09
|
| Rate for Payer: Healthscope Whirlpool |
$23.37
|
| Rate for Payer: Mclaren Commercial |
$21.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.20
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$24.09 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: ASR ASR |
$23.37
|
| Rate for Payer: ASR Commercial |
$23.37
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.73
|
| Rate for Payer: BCN Commercial |
$18.68
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$22.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$24.09
|
| Rate for Payer: Healthscope Whirlpool |
$23.37
|
| Rate for Payer: Mclaren Commercial |
$21.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.22
|
| Rate for Payer: Priority Health Narrow Network |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.20
|
|
|
NALOXONE 0.4 MG/ML INJECTION (CODE)
|
Facility
|
OP
|
$63.57
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
163714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$63.57 |
| Rate for Payer: Aetna Commercial |
$57.21
|
| Rate for Payer: Aetna Medicare |
$31.78
|
| Rate for Payer: ASR ASR |
$61.66
|
| Rate for Payer: ASR Commercial |
$61.66
|
| Rate for Payer: BCBS Complete |
$25.43
|
| Rate for Payer: BCBS Trust/PPO |
$52.06
|
| Rate for Payer: BCN Commercial |
$49.29
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cofinity Commercial |
$59.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$63.57
|
| Rate for Payer: Healthscope Whirlpool |
$61.66
|
| 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: Priority Health Cigna Priority Health |
$41.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.56
|
| Rate for Payer: Priority Health Narrow Network |
$7.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.94
|
|
|
NALOXONE 0.4 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$63.57
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
163714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$63.57 |
| Rate for Payer: Aetna Commercial |
$57.21
|
| Rate for Payer: ASR ASR |
$61.66
|
| Rate for Payer: ASR Commercial |
$61.66
|
| Rate for Payer: BCBS Trust/PPO |
$51.80
|
| Rate for Payer: BCN Commercial |
$49.29
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cofinity Commercial |
$59.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$63.57
|
| Rate for Payer: Healthscope Whirlpool |
$61.66
|
| 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: Priority Health Cigna Priority Health |
$41.32
|
| 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 J2310
|
| Hospital Charge Code |
5373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.12 |
| Max. Negotiated Rate |
$27.88 |
| Rate for Payer: Aetna Commercial |
$25.09
|
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Commercial |
$57.21
|
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: ASR ASR |
$18.30
|
| Rate for Payer: ASR ASR |
$27.04
|
| Rate for Payer: ASR ASR |
$18.96
|
| Rate for Payer: ASR ASR |
$61.66
|
| Rate for Payer: ASR Commercial |
$27.04
|
| Rate for Payer: ASR Commercial |
$61.66
|
| Rate for Payer: ASR Commercial |
$18.96
|
| Rate for Payer: ASR Commercial |
$18.30
|
| Rate for Payer: BCBS Trust/PPO |
$51.80
|
| Rate for Payer: BCBS Trust/PPO |
$15.38
|
| Rate for Payer: BCBS Trust/PPO |
$15.93
|
| Rate for Payer: BCBS Trust/PPO |
$22.72
|
| Rate for Payer: BCN Commercial |
$49.29
|
| Rate for Payer: BCN Commercial |
$14.63
|
| Rate for Payer: BCN Commercial |
$21.62
|
| Rate for Payer: BCN Commercial |
$15.16
|
| Rate for Payer: Cash Price |
$15.64
|
| Rate for Payer: Cash Price |
$15.09
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$22.30
|
| Rate for Payer: Cofinity Commercial |
$26.21
|
| Rate for Payer: Cofinity Commercial |
$18.38
|
| Rate for Payer: Cofinity Commercial |
$59.76
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.30
|
| Rate for Payer: Healthscope Commercial |
$19.55
|
| Rate for Payer: Healthscope Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$27.88
|
| Rate for Payer: Healthscope Commercial |
$63.57
|
| Rate for Payer: Healthscope Whirlpool |
$61.66
|
| Rate for Payer: Healthscope Whirlpool |
$18.96
|
| Rate for Payer: Healthscope Whirlpool |
$27.04
|
| Rate for Payer: Healthscope Whirlpool |
$18.30
|
| Rate for Payer: Mclaren Commercial |
$25.09
|
| Rate for Payer: Mclaren Commercial |
$57.21
|
| Rate for Payer: Mclaren Commercial |
$17.60
|
| Rate for Payer: Mclaren Commercial |
$16.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.04
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Nomi Health Commercial |
$52.13
|
| Rate for Payer: Nomi Health Commercial |
$22.86
|
| Rate for Payer: Nomi Health Commercial |
$16.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$63.57
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$63.57 |
| Rate for Payer: Aetna Commercial |
$57.21
|
| Rate for Payer: Aetna Commercial |
$25.09
|
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Medicare |
$13.94
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: Aetna Medicare |
$9.78
|
| Rate for Payer: Aetna Medicare |
$31.78
|
| Rate for Payer: ASR ASR |
$18.30
|
| Rate for Payer: ASR ASR |
$18.96
|
| Rate for Payer: ASR ASR |
$27.04
|
| Rate for Payer: ASR ASR |
$61.66
|
| Rate for Payer: ASR Commercial |
$18.30
|
| Rate for Payer: ASR Commercial |
$27.04
|
| Rate for Payer: ASR Commercial |
$61.66
|
| Rate for Payer: ASR Commercial |
$18.96
|
| Rate for Payer: BCBS Complete |
$11.15
|
| Rate for Payer: BCBS Complete |
$25.43
|
| Rate for Payer: BCBS Complete |
$7.55
|
| Rate for Payer: BCBS Complete |
$7.82
|
| Rate for Payer: BCBS Trust/PPO |
$52.06
|
| Rate for Payer: BCBS Trust/PPO |
$16.01
|
| Rate for Payer: BCBS Trust/PPO |
$15.45
|
| Rate for Payer: BCBS Trust/PPO |
$22.83
|
| Rate for Payer: BCN Commercial |
$14.63
|
| Rate for Payer: BCN Commercial |
$49.29
|
| Rate for Payer: BCN Commercial |
$15.16
|
| Rate for Payer: BCN Commercial |
$21.62
|
| Rate for Payer: Cash Price |
$22.30
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$15.09
|
| Rate for Payer: Cash Price |
$15.64
|
| Rate for Payer: Cash Price |
$15.64
|
| Rate for Payer: Cash Price |
$15.09
|
| Rate for Payer: Cash Price |
$22.30
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cofinity Commercial |
$18.38
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Cofinity Commercial |
$26.21
|
| Rate for Payer: Cofinity Commercial |
$59.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$63.57
|
| Rate for Payer: Healthscope Commercial |
$19.55
|
| Rate for Payer: Healthscope Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$27.88
|
| Rate for Payer: Healthscope Whirlpool |
$18.96
|
| Rate for Payer: Healthscope Whirlpool |
$18.30
|
| Rate for Payer: Healthscope Whirlpool |
$27.04
|
| Rate for Payer: Healthscope Whirlpool |
$61.66
|
| Rate for Payer: Mclaren Commercial |
$25.09
|
| Rate for Payer: Mclaren Commercial |
$57.21
|
| Rate for Payer: Mclaren Commercial |
$16.98
|
| Rate for Payer: Mclaren Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Nomi Health Commercial |
$16.03
|
| Rate for Payer: Nomi Health Commercial |
$22.86
|
| Rate for Payer: Nomi Health Commercial |
$52.13
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.56
|
| Rate for Payer: Priority Health Narrow Network |
$7.65
|
| Rate for Payer: Priority Health Narrow Network |
$7.65
|
| Rate for Payer: Priority Health Narrow Network |
$7.65
|
| Rate for Payer: Priority Health Narrow Network |
$7.65
|
| 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 |
$16.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.20
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$47.12
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$47.12 |
| Rate for Payer: Aetna Commercial |
$42.41
|
| Rate for Payer: Aetna Commercial |
$78.22
|
| Rate for Payer: Aetna Commercial |
$50.02
|
| Rate for Payer: Aetna Medicare |
$43.46
|
| Rate for Payer: Aetna Medicare |
$23.56
|
| Rate for Payer: Aetna Medicare |
$27.79
|
| Rate for Payer: ASR ASR |
$53.91
|
| Rate for Payer: ASR ASR |
$45.71
|
| Rate for Payer: ASR ASR |
$84.30
|
| Rate for Payer: ASR Commercial |
$53.91
|
| Rate for Payer: ASR Commercial |
$45.71
|
| Rate for Payer: ASR Commercial |
$84.30
|
| Rate for Payer: BCBS Complete |
$18.85
|
| Rate for Payer: BCBS Complete |
$22.23
|
| Rate for Payer: BCBS Complete |
$34.76
|
| Rate for Payer: BCBS Trust/PPO |
$71.17
|
| Rate for Payer: BCBS Trust/PPO |
$38.59
|
| Rate for Payer: BCBS Trust/PPO |
$45.51
|
| Rate for Payer: BCN Commercial |
$43.09
|
| Rate for Payer: BCN Commercial |
$67.38
|
| Rate for Payer: BCN Commercial |
$36.53
|
| Rate for Payer: Cash Price |
$37.69
|
| Rate for Payer: Cash Price |
$37.69
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Cofinity Commercial |
$44.29
|
| Rate for Payer: Cofinity Commercial |
$52.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.46
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: Healthscope Commercial |
$55.58
|
| Rate for Payer: Healthscope Commercial |
$47.12
|
| Rate for Payer: Healthscope Whirlpool |
$84.30
|
| Rate for Payer: Healthscope Whirlpool |
$53.91
|
| Rate for Payer: Healthscope Whirlpool |
$45.71
|
| Rate for Payer: Mclaren Commercial |
$50.02
|
| Rate for Payer: Mclaren Commercial |
$78.22
|
| Rate for Payer: Mclaren Commercial |
$42.41
|
| 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 |
$38.64
|
| Rate for Payer: Nomi Health Commercial |
$71.27
|
| Rate for Payer: Nomi Health Commercial |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.56
|
| Rate for Payer: Priority Health Narrow Network |
$7.65
|
| Rate for Payer: Priority Health Narrow Network |
$7.65
|
| Rate for Payer: Priority Health Narrow Network |
$7.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.48
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$55.58
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$55.58 |
| Rate for Payer: Aetna Commercial |
$50.02
|
| Rate for Payer: Aetna Commercial |
$42.41
|
| Rate for Payer: Aetna Commercial |
$78.22
|
| Rate for Payer: ASR ASR |
$45.71
|
| Rate for Payer: ASR ASR |
$53.91
|
| Rate for Payer: ASR ASR |
$84.30
|
| Rate for Payer: ASR Commercial |
$53.91
|
| Rate for Payer: ASR Commercial |
$45.71
|
| Rate for Payer: ASR Commercial |
$84.30
|
| Rate for Payer: BCBS Trust/PPO |
$70.82
|
| Rate for Payer: BCBS Trust/PPO |
$38.40
|
| Rate for Payer: BCBS Trust/PPO |
$45.29
|
| Rate for Payer: BCN Commercial |
$36.53
|
| Rate for Payer: BCN Commercial |
$67.38
|
| Rate for Payer: BCN Commercial |
$43.09
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cash Price |
$37.69
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Cofinity Commercial |
$44.29
|
| 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 |
$37.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Healthscope Commercial |
$47.12
|
| Rate for Payer: Healthscope Commercial |
$55.58
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: Healthscope Whirlpool |
$53.91
|
| Rate for Payer: Healthscope Whirlpool |
$45.71
|
| Rate for Payer: Healthscope Whirlpool |
$84.30
|
| Rate for Payer: Mclaren Commercial |
$50.02
|
| Rate for Payer: Mclaren Commercial |
$42.41
|
| Rate for Payer: Mclaren Commercial |
$78.22
|
| 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 |
$38.64
|
| Rate for Payer: Nomi Health Commercial |
$71.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.47
|
|
|
NALTREXONE ER 380 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
OP
|
$5,030.46
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
76527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$5,030.46 |
| Rate for Payer: Aetna Commercial |
$4,527.41
|
| Rate for Payer: Aetna Medicare |
$4.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.15
|
| Rate for Payer: ASR ASR |
$4,879.55
|
| Rate for Payer: ASR Commercial |
$4,879.55
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: BCBS MAPPO |
$4.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,119.44
|
| Rate for Payer: BCN Commercial |
$3,900.12
|
| Rate for Payer: BCN Medicare Advantage |
$4.12
|
| Rate for Payer: Cash Price |
$4,024.37
|
| Rate for Payer: Cash Price |
$4,024.37
|
| Rate for Payer: Cofinity Commercial |
$4,728.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,024.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.12
|
| Rate for Payer: Healthscope Commercial |
$5,030.46
|
| Rate for Payer: Healthscope Whirlpool |
$4,879.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.12
|
| Rate for Payer: Mclaren Commercial |
$4,527.41
|
| Rate for Payer: Mclaren Medicaid |
$2.21
|
| Rate for Payer: Mclaren Medicare |
$4.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.33
|
| Rate for Payer: Meridian Medicaid |
$2.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,275.89
|
| Rate for Payer: Nomi Health Commercial |
$4,124.98
|
| Rate for Payer: PACE Medicare |
$3.91
|
| Rate for Payer: PACE SWMI |
$4.12
|
| Rate for Payer: PHP Commercial |
$4.53
|
| Rate for Payer: PHP Medicaid |
$2.21
|
| Rate for Payer: PHP Medicare Advantage |
$4.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,269.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.28
|
| Rate for Payer: Priority Health Medicare |
$4.12
|
| Rate for Payer: Priority Health Narrow Network |
$3.42
|
| Rate for Payer: Railroad Medicare Medicare |
$4.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,426.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.12
|
| Rate for Payer: UHC Exchange |
$6.39
|
| Rate for Payer: UHC Medicare Advantage |
$4.12
|
| Rate for Payer: UHCCP DNSP |
$4.12
|
| Rate for Payer: UHCCP Medicaid |
$2.21
|
| Rate for Payer: VA VA |
$4.12
|
|
|
NALTREXONE ER 380 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
IP
|
$5,030.46
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
76527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,269.80 |
| Max. Negotiated Rate |
$5,030.46 |
| Rate for Payer: Aetna Commercial |
$4,527.41
|
| Rate for Payer: ASR ASR |
$4,879.55
|
| Rate for Payer: ASR Commercial |
$4,879.55
|
| Rate for Payer: BCBS Trust/PPO |
$4,099.32
|
| Rate for Payer: BCN Commercial |
$3,900.12
|
| Rate for Payer: Cash Price |
$4,024.37
|
| Rate for Payer: Cofinity Commercial |
$4,728.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,024.37
|
| Rate for Payer: Healthscope Commercial |
$5,030.46
|
| Rate for Payer: Healthscope Whirlpool |
$4,879.55
|
| Rate for Payer: Mclaren Commercial |
$4,527.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,275.89
|
| Rate for Payer: Nomi Health Commercial |
$4,124.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,269.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,426.80
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$212.68
|
|
|
Service Code
|
NDC 50268059415
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.07 |
| Max. Negotiated Rate |
$212.68 |
| Rate for Payer: Aetna Commercial |
$191.41
|
| Rate for Payer: Aetna Medicare |
$106.34
|
| Rate for Payer: ASR ASR |
$206.30
|
| Rate for Payer: ASR Commercial |
$206.30
|
| Rate for Payer: BCBS Complete |
$85.07
|
| Rate for Payer: BCBS Trust/PPO |
$174.16
|
| Rate for Payer: BCN Commercial |
$164.89
|
| Rate for Payer: Cash Price |
$170.14
|
| Rate for Payer: Cofinity Commercial |
$199.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.14
|
| Rate for Payer: Healthscope Commercial |
$212.68
|
| Rate for Payer: Healthscope Whirlpool |
$206.30
|
| Rate for Payer: Mclaren Commercial |
$191.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.78
|
| Rate for Payer: Nomi Health Commercial |
$174.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.35
|
| Rate for Payer: Priority Health Narrow Network |
$149.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.16
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$212.68
|
|
|
Service Code
|
NDC 50268059415
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$212.68 |
| Rate for Payer: Aetna Commercial |
$191.41
|
| Rate for Payer: ASR ASR |
$206.30
|
| Rate for Payer: ASR Commercial |
$206.30
|
| Rate for Payer: BCBS Trust/PPO |
$173.31
|
| Rate for Payer: BCN Commercial |
$164.89
|
| Rate for Payer: Cash Price |
$170.14
|
| Rate for Payer: Cofinity Commercial |
$199.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.14
|
| Rate for Payer: Healthscope Commercial |
$212.68
|
| Rate for Payer: Healthscope Whirlpool |
$206.30
|
| Rate for Payer: Mclaren Commercial |
$191.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.78
|
| Rate for Payer: Nomi Health Commercial |
$174.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.16
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 50268059411
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: ASR ASR |
$4.12
|
| Rate for Payer: ASR Commercial |
$4.12
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: BCBS Trust/PPO |
$3.48
|
| Rate for Payer: BCN Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$4.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$4.25
|
| Rate for Payer: Healthscope Whirlpool |
$4.12
|
| Rate for Payer: Mclaren Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.72
|
| Rate for Payer: Priority Health Narrow Network |
$2.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.74
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 50268059411
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: ASR ASR |
$4.12
|
| Rate for Payer: ASR Commercial |
$4.12
|
| Rate for Payer: BCBS Trust/PPO |
$3.46
|
| Rate for Payer: BCN Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$4.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$4.25
|
| Rate for Payer: Healthscope Whirlpool |
$4.12
|
| Rate for Payer: Mclaren Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.74
|
|
|
NASAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
OP
|
$3.19
|
|
|
Service Code
|
NDC 09900000401
|
| Hospital Charge Code |
169209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: ASR ASR |
$3.09
|
| Rate for Payer: ASR Commercial |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.61
|
| Rate for Payer: BCN Commercial |
$2.47
|
| 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 |
$3.19
|
| Rate for Payer: Healthscope Whirlpool |
$3.09
|
| 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: Priority Health Cigna Priority Health |
$2.07
|
| Rate for Payer: 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
|
|
|
NASAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
IP
|
$3.19
|
|
|
Service Code
|
NDC 09900000401
|
| Hospital Charge Code |
169209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: ASR ASR |
$3.09
|
| Rate for Payer: ASR Commercial |
$3.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.60
|
| Rate for Payer: BCN Commercial |
$2.47
|
| 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 |
$3.19
|
| Rate for Payer: Healthscope Whirlpool |
$3.09
|
| 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: Priority Health Cigna Priority Health |
$2.07
|
| 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
|
$166.15
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.46 |
| Max. Negotiated Rate |
$166.15 |
| Rate for Payer: Aetna Commercial |
$149.54
|
| Rate for Payer: Aetna Medicare |
$83.08
|
| Rate for Payer: ASR ASR |
$161.17
|
| Rate for Payer: ASR Commercial |
$161.17
|
| Rate for Payer: BCBS Complete |
$66.46
|
| Rate for Payer: BCBS Trust/PPO |
$136.06
|
| Rate for Payer: BCN Commercial |
$128.82
|
| Rate for Payer: Cash Price |
$132.92
|
| Rate for Payer: Cofinity Commercial |
$156.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.92
|
| Rate for Payer: Healthscope Commercial |
$166.15
|
| Rate for Payer: Healthscope Whirlpool |
$161.17
|
| Rate for Payer: Mclaren Commercial |
$149.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.23
|
| Rate for Payer: Nomi Health Commercial |
$136.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.58
|
| Rate for Payer: Priority Health Narrow Network |
$116.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.21
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS
|
Facility
|
IP
|
$166.15
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$166.15 |
| Rate for Payer: Aetna Commercial |
$149.54
|
| Rate for Payer: ASR ASR |
$161.17
|
| Rate for Payer: ASR Commercial |
$161.17
|
| Rate for Payer: BCBS Trust/PPO |
$135.40
|
| Rate for Payer: BCN Commercial |
$128.82
|
| Rate for Payer: Cash Price |
$132.92
|
| Rate for Payer: Cofinity Commercial |
$156.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.92
|
| Rate for Payer: Healthscope Commercial |
$166.15
|
| Rate for Payer: Healthscope Whirlpool |
$161.17
|
| Rate for Payer: Mclaren Commercial |
$149.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.23
|
| Rate for Payer: Nomi Health Commercial |
$136.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.21
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$46.72
|
|
|
Service Code
|
NDC 24208079535
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.37 |
| Max. Negotiated Rate |
$46.72 |
| Rate for Payer: Aetna Commercial |
$42.05
|
| Rate for Payer: ASR ASR |
$45.32
|
| Rate for Payer: ASR Commercial |
$45.32
|
| Rate for Payer: BCBS Trust/PPO |
$38.07
|
| Rate for Payer: BCN Commercial |
$36.22
|
| Rate for Payer: Cash Price |
$37.38
|
| Rate for Payer: Cofinity Commercial |
$43.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.38
|
| Rate for Payer: Healthscope Commercial |
$46.72
|
| Rate for Payer: Healthscope Whirlpool |
$45.32
|
| Rate for Payer: Mclaren Commercial |
$42.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.71
|
| Rate for Payer: Nomi Health Commercial |
$38.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.11
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
OP
|
$58.59
|
|
|
Service Code
|
NDC 61314063136
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.44 |
| Max. Negotiated Rate |
$58.59 |
| Rate for Payer: Aetna Commercial |
$52.73
|
| Rate for Payer: Aetna Medicare |
$29.30
|
| Rate for Payer: ASR ASR |
$56.83
|
| Rate for Payer: ASR Commercial |
$56.83
|
| Rate for Payer: BCBS Complete |
$23.44
|
| Rate for Payer: BCBS Trust/PPO |
$47.98
|
| Rate for Payer: BCN Commercial |
$45.42
|
| Rate for Payer: Cash Price |
$46.87
|
| Rate for Payer: Cofinity Commercial |
$55.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.87
|
| Rate for Payer: Healthscope Commercial |
$58.59
|
| Rate for Payer: Healthscope Whirlpool |
$56.83
|
| Rate for Payer: Mclaren Commercial |
$52.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.80
|
| Rate for Payer: Nomi Health Commercial |
$48.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.34
|
| Rate for Payer: Priority Health Narrow Network |
$41.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.56
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$58.59
|
|
|
Service Code
|
NDC 61314063136
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.08 |
| Max. Negotiated Rate |
$58.59 |
| Rate for Payer: Aetna Commercial |
$52.73
|
| Rate for Payer: ASR ASR |
$56.83
|
| Rate for Payer: ASR Commercial |
$56.83
|
| Rate for Payer: BCBS Trust/PPO |
$47.74
|
| Rate for Payer: BCN Commercial |
$45.42
|
| Rate for Payer: Cash Price |
$46.87
|
| Rate for Payer: Cofinity Commercial |
$55.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.87
|
| Rate for Payer: Healthscope Commercial |
$58.59
|
| Rate for Payer: Healthscope Whirlpool |
$56.83
|
| Rate for Payer: Mclaren Commercial |
$52.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.80
|
| Rate for Payer: Nomi Health Commercial |
$48.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.56
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$41.33
|
|
|
Service Code
|
NDC 00574416035
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.86 |
| Max. Negotiated Rate |
$41.33 |
| Rate for Payer: Aetna Commercial |
$37.20
|
| Rate for Payer: ASR ASR |
$40.09
|
| Rate for Payer: ASR Commercial |
$40.09
|
| Rate for Payer: BCBS Trust/PPO |
$33.68
|
| Rate for Payer: BCN Commercial |
$32.04
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cofinity Commercial |
$38.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.06
|
| Rate for Payer: Healthscope Commercial |
$41.33
|
| Rate for Payer: Healthscope Whirlpool |
$40.09
|
| Rate for Payer: Mclaren Commercial |
$37.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.13
|
| Rate for Payer: Nomi Health Commercial |
$33.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.37
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
OP
|
$41.33
|
|
|
Service Code
|
NDC 00574416035
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$41.33 |
| Rate for Payer: Aetna Commercial |
$37.20
|
| Rate for Payer: Aetna Medicare |
$20.66
|
| Rate for Payer: ASR ASR |
$40.09
|
| Rate for Payer: ASR Commercial |
$40.09
|
| Rate for Payer: BCBS Complete |
$16.53
|
| Rate for Payer: BCBS Trust/PPO |
$33.85
|
| Rate for Payer: BCN Commercial |
$32.04
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cofinity Commercial |
$38.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.06
|
| Rate for Payer: Healthscope Commercial |
$41.33
|
| Rate for Payer: Healthscope Whirlpool |
$40.09
|
| Rate for Payer: Mclaren Commercial |
$37.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.13
|
| Rate for Payer: Nomi Health Commercial |
$33.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.21
|
| Rate for Payer: Priority Health Narrow Network |
$28.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.37
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
OP
|
$46.72
|
|
|
Service Code
|
NDC 24208079535
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.69 |
| Max. Negotiated Rate |
$46.72 |
| Rate for Payer: Aetna Commercial |
$42.05
|
| Rate for Payer: Aetna Medicare |
$23.36
|
| Rate for Payer: ASR ASR |
$45.32
|
| Rate for Payer: ASR Commercial |
$45.32
|
| Rate for Payer: BCBS Complete |
$18.69
|
| Rate for Payer: BCBS Trust/PPO |
$38.26
|
| Rate for Payer: BCN Commercial |
$36.22
|
| Rate for Payer: Cash Price |
$37.38
|
| Rate for Payer: Cofinity Commercial |
$43.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.38
|
| Rate for Payer: Healthscope Commercial |
$46.72
|
| Rate for Payer: Healthscope Whirlpool |
$45.32
|
| Rate for Payer: Mclaren Commercial |
$42.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.71
|
| Rate for Payer: Nomi Health Commercial |
$38.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.94
|
| Rate for Payer: Priority Health Narrow Network |
$32.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.11
|
|
|
NEOMYCIN-BACITRACIN-POLY-HC 3.5 MG-400-10,000 UNIT/G-1 % EYE OINTMENT
|
Facility
|
IP
|
$85.64
|
|
|
Service Code
|
NDC 24208078555
|
| Hospital Charge Code |
849
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$85.64 |
| Rate for Payer: Aetna Commercial |
$77.08
|
| Rate for Payer: ASR ASR |
$83.07
|
| Rate for Payer: ASR Commercial |
$83.07
|
| Rate for Payer: BCBS Trust/PPO |
$69.79
|
| Rate for Payer: BCN Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$68.51
|
| Rate for Payer: Cofinity Commercial |
$80.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.51
|
| Rate for Payer: Healthscope Commercial |
$85.64
|
| Rate for Payer: Healthscope Whirlpool |
$83.07
|
| Rate for Payer: Mclaren Commercial |
$77.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.79
|
| Rate for Payer: Nomi Health Commercial |
$70.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.36
|
|
