|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
IP
|
$58.59
|
|
|
Service Code
|
NDC 61314063006
|
| Hospital Charge Code |
10708
|
|
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-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
OP
|
$58.59
|
|
|
Service Code
|
NDC 61314063006
|
| Hospital Charge Code |
10708
|
|
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-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
OP
|
$45.71
|
|
|
Service Code
|
NDC 24208083060
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$45.71 |
| Rate for Payer: Aetna Commercial |
$41.14
|
| Rate for Payer: Aetna Medicare |
$22.86
|
| Rate for Payer: ASR ASR |
$44.34
|
| Rate for Payer: ASR Commercial |
$44.34
|
| Rate for Payer: BCBS Complete |
$18.28
|
| Rate for Payer: BCBS Trust/PPO |
$37.43
|
| Rate for Payer: BCN Commercial |
$35.44
|
| Rate for Payer: Cash Price |
$36.57
|
| Rate for Payer: Cofinity Commercial |
$42.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.57
|
| Rate for Payer: Healthscope Commercial |
$45.71
|
| Rate for Payer: Healthscope Whirlpool |
$44.34
|
| Rate for Payer: Mclaren Commercial |
$41.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.85
|
| Rate for Payer: Nomi Health Commercial |
$37.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.05
|
| Rate for Payer: Priority Health Narrow Network |
$32.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.22
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
IP
|
$45.71
|
|
|
Service Code
|
NDC 24208083060
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.71 |
| Max. Negotiated Rate |
$45.71 |
| Rate for Payer: Aetna Commercial |
$41.14
|
| Rate for Payer: ASR ASR |
$44.34
|
| Rate for Payer: ASR Commercial |
$44.34
|
| Rate for Payer: BCBS Trust/PPO |
$37.25
|
| Rate for Payer: BCN Commercial |
$35.44
|
| Rate for Payer: Cash Price |
$36.57
|
| Rate for Payer: Cofinity Commercial |
$42.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.57
|
| Rate for Payer: Healthscope Commercial |
$45.71
|
| Rate for Payer: Healthscope Whirlpool |
$44.34
|
| Rate for Payer: Mclaren Commercial |
$41.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.85
|
| Rate for Payer: Nomi Health Commercial |
$37.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.22
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
IP
|
$153.76
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.94 |
| Max. Negotiated Rate |
$153.76 |
| Rate for Payer: Aetna Commercial |
$138.38
|
| Rate for Payer: ASR ASR |
$149.15
|
| Rate for Payer: ASR Commercial |
$149.15
|
| Rate for Payer: BCBS Trust/PPO |
$125.30
|
| Rate for Payer: BCN Commercial |
$119.21
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cofinity Commercial |
$144.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.01
|
| Rate for Payer: Healthscope Commercial |
$153.76
|
| Rate for Payer: Healthscope Whirlpool |
$149.15
|
| Rate for Payer: Mclaren Commercial |
$138.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.70
|
| Rate for Payer: Nomi Health Commercial |
$126.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.31
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
OP
|
$153.76
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$153.76 |
| Rate for Payer: Aetna Commercial |
$138.38
|
| Rate for Payer: Aetna Medicare |
$76.88
|
| Rate for Payer: ASR ASR |
$149.15
|
| Rate for Payer: ASR Commercial |
$149.15
|
| Rate for Payer: BCBS Complete |
$61.50
|
| Rate for Payer: BCBS Trust/PPO |
$125.91
|
| Rate for Payer: BCN Commercial |
$119.21
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cofinity Commercial |
$144.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.01
|
| Rate for Payer: Healthscope Commercial |
$153.76
|
| Rate for Payer: Healthscope Whirlpool |
$149.15
|
| Rate for Payer: Mclaren Commercial |
$138.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.70
|
| Rate for Payer: Nomi Health Commercial |
$126.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.72
|
| Rate for Payer: Priority Health Narrow Network |
$107.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.31
|
|
|
NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48.19
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
12370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$48.19 |
| Rate for Payer: Aetna Commercial |
$43.37
|
| Rate for Payer: Aetna Commercial |
$117.86
|
| Rate for Payer: Aetna Commercial |
$46.58
|
| Rate for Payer: ASR ASR |
$127.03
|
| Rate for Payer: ASR ASR |
$46.74
|
| Rate for Payer: ASR ASR |
$50.20
|
| Rate for Payer: ASR Commercial |
$46.74
|
| Rate for Payer: ASR Commercial |
$127.03
|
| Rate for Payer: ASR Commercial |
$50.20
|
| Rate for Payer: BCBS Trust/PPO |
$42.17
|
| Rate for Payer: BCBS Trust/PPO |
$106.72
|
| Rate for Payer: BCBS Trust/PPO |
$39.27
|
| Rate for Payer: BCN Commercial |
$101.53
|
| Rate for Payer: BCN Commercial |
$40.12
|
| Rate for Payer: BCN Commercial |
$37.36
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cash Price |
$104.77
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cofinity Commercial |
$48.65
|
| Rate for Payer: Cofinity Commercial |
$123.10
|
| Rate for Payer: Cofinity Commercial |
$45.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.40
|
| Rate for Payer: Healthscope Commercial |
$130.96
|
| Rate for Payer: Healthscope Commercial |
$48.19
|
| Rate for Payer: Healthscope Commercial |
$51.75
|
| Rate for Payer: Healthscope Whirlpool |
$46.74
|
| Rate for Payer: Healthscope Whirlpool |
$127.03
|
| Rate for Payer: Healthscope Whirlpool |
$50.20
|
| Rate for Payer: Mclaren Commercial |
$43.37
|
| Rate for Payer: Mclaren Commercial |
$117.86
|
| Rate for Payer: Mclaren Commercial |
$46.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.32
|
| Rate for Payer: Nomi Health Commercial |
$39.52
|
| Rate for Payer: Nomi Health Commercial |
$107.39
|
| Rate for Payer: Nomi Health Commercial |
$42.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.24
|
|
|
NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$130.96
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
12370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.38 |
| Max. Negotiated Rate |
$130.96 |
| Rate for Payer: Aetna Commercial |
$117.86
|
| Rate for Payer: Aetna Commercial |
$43.37
|
| Rate for Payer: Aetna Commercial |
$46.58
|
| Rate for Payer: Aetna Medicare |
$24.09
|
| Rate for Payer: Aetna Medicare |
$25.88
|
| Rate for Payer: Aetna Medicare |
$65.48
|
| Rate for Payer: ASR ASR |
$46.74
|
| Rate for Payer: ASR ASR |
$127.03
|
| Rate for Payer: ASR ASR |
$50.20
|
| Rate for Payer: ASR Commercial |
$50.20
|
| Rate for Payer: ASR Commercial |
$46.74
|
| Rate for Payer: ASR Commercial |
$127.03
|
| Rate for Payer: BCBS Complete |
$52.38
|
| Rate for Payer: BCBS Complete |
$19.28
|
| Rate for Payer: BCBS Complete |
$20.70
|
| Rate for Payer: BCBS Trust/PPO |
$107.24
|
| Rate for Payer: BCBS Trust/PPO |
$39.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.38
|
| Rate for Payer: BCN Commercial |
$40.12
|
| Rate for Payer: BCN Commercial |
$101.53
|
| Rate for Payer: BCN Commercial |
$37.36
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cash Price |
$104.77
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cofinity Commercial |
$48.65
|
| Rate for Payer: Cofinity Commercial |
$123.10
|
| Rate for Payer: Cofinity Commercial |
$45.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.40
|
| Rate for Payer: Healthscope Commercial |
$130.96
|
| Rate for Payer: Healthscope Commercial |
$48.19
|
| Rate for Payer: Healthscope Commercial |
$51.75
|
| Rate for Payer: Healthscope Whirlpool |
$46.74
|
| Rate for Payer: Healthscope Whirlpool |
$127.03
|
| Rate for Payer: Healthscope Whirlpool |
$50.20
|
| Rate for Payer: Mclaren Commercial |
$117.86
|
| Rate for Payer: Mclaren Commercial |
$43.37
|
| Rate for Payer: Mclaren Commercial |
$46.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.99
|
| Rate for Payer: Nomi Health Commercial |
$107.39
|
| Rate for Payer: Nomi Health Commercial |
$39.52
|
| Rate for Payer: Nomi Health Commercial |
$42.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.34
|
| Rate for Payer: Priority Health Narrow Network |
$36.28
|
| Rate for Payer: Priority Health Narrow Network |
$91.80
|
| Rate for Payer: Priority Health Narrow Network |
$33.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.54
|
|
|
NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN
|
Facility
|
OP
|
$270.98
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
94576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.39 |
| Max. Negotiated Rate |
$270.98 |
| Rate for Payer: Aetna Commercial |
$243.88
|
| Rate for Payer: Aetna Commercial |
$283.97
|
| Rate for Payer: Aetna Medicare |
$135.49
|
| Rate for Payer: Aetna Medicare |
$157.76
|
| Rate for Payer: ASR ASR |
$262.85
|
| Rate for Payer: ASR ASR |
$306.05
|
| Rate for Payer: ASR Commercial |
$306.05
|
| Rate for Payer: ASR Commercial |
$262.85
|
| Rate for Payer: BCBS Complete |
$108.39
|
| Rate for Payer: BCBS Complete |
$126.21
|
| Rate for Payer: BCBS Trust/PPO |
$221.91
|
| Rate for Payer: BCBS Trust/PPO |
$258.38
|
| Rate for Payer: BCN Commercial |
$244.62
|
| Rate for Payer: BCN Commercial |
$210.09
|
| Rate for Payer: Cash Price |
$216.78
|
| Rate for Payer: Cash Price |
$252.42
|
| Rate for Payer: Cofinity Commercial |
$254.72
|
| Rate for Payer: Cofinity Commercial |
$296.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.42
|
| Rate for Payer: Healthscope Commercial |
$270.98
|
| Rate for Payer: Healthscope Commercial |
$315.52
|
| Rate for Payer: Healthscope Whirlpool |
$262.85
|
| Rate for Payer: Healthscope Whirlpool |
$306.05
|
| Rate for Payer: Mclaren Commercial |
$243.88
|
| Rate for Payer: Mclaren Commercial |
$283.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.33
|
| Rate for Payer: Nomi Health Commercial |
$222.20
|
| Rate for Payer: Nomi Health Commercial |
$258.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.46
|
| Rate for Payer: Priority Health Narrow Network |
$221.18
|
| Rate for Payer: Priority Health Narrow Network |
$189.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.46
|
|
|
NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN
|
Facility
|
IP
|
$315.52
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
94576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$205.09 |
| Max. Negotiated Rate |
$315.52 |
| Rate for Payer: Aetna Commercial |
$283.97
|
| Rate for Payer: Aetna Commercial |
$243.88
|
| Rate for Payer: ASR ASR |
$262.85
|
| Rate for Payer: ASR ASR |
$306.05
|
| Rate for Payer: ASR Commercial |
$262.85
|
| Rate for Payer: ASR Commercial |
$306.05
|
| Rate for Payer: BCBS Trust/PPO |
$220.82
|
| Rate for Payer: BCBS Trust/PPO |
$257.12
|
| Rate for Payer: BCN Commercial |
$244.62
|
| Rate for Payer: BCN Commercial |
$210.09
|
| Rate for Payer: Cash Price |
$252.42
|
| Rate for Payer: Cash Price |
$216.78
|
| Rate for Payer: Cofinity Commercial |
$254.72
|
| Rate for Payer: Cofinity Commercial |
$296.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.42
|
| Rate for Payer: Healthscope Commercial |
$270.98
|
| Rate for Payer: Healthscope Commercial |
$315.52
|
| Rate for Payer: Healthscope Whirlpool |
$306.05
|
| Rate for Payer: Healthscope Whirlpool |
$262.85
|
| Rate for Payer: Mclaren Commercial |
$243.88
|
| Rate for Payer: Mclaren Commercial |
$283.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.33
|
| Rate for Payer: Nomi Health Commercial |
$258.73
|
| Rate for Payer: Nomi Health Commercial |
$222.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.66
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$58.70
|
|
|
Service Code
|
NDC 00536589553
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$58.70 |
| Rate for Payer: Aetna Commercial |
$52.83
|
| Rate for Payer: ASR ASR |
$56.94
|
| Rate for Payer: ASR Commercial |
$56.94
|
| Rate for Payer: BCBS Trust/PPO |
$47.83
|
| Rate for Payer: BCN Commercial |
$45.51
|
| Rate for Payer: Cash Price |
$46.96
|
| Rate for Payer: Cofinity Commercial |
$55.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.96
|
| Rate for Payer: Healthscope Commercial |
$58.70
|
| Rate for Payer: Healthscope Whirlpool |
$56.94
|
| Rate for Payer: Mclaren Commercial |
$52.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.90
|
| Rate for Payer: Nomi Health Commercial |
$48.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.66
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$8.22
|
|
|
Service Code
|
NDC 43598044771
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: Aetna Commercial |
$7.40
|
| Rate for Payer: Aetna Medicare |
$4.11
|
| Rate for Payer: ASR ASR |
$7.97
|
| Rate for Payer: ASR Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$3.29
|
| Rate for Payer: BCBS Trust/PPO |
$6.73
|
| Rate for Payer: BCN Commercial |
$6.37
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Cofinity Commercial |
$7.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.58
|
| Rate for Payer: Healthscope Commercial |
$8.22
|
| Rate for Payer: Healthscope Whirlpool |
$7.97
|
| Rate for Payer: Mclaren Commercial |
$7.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.99
|
| Rate for Payer: Nomi Health Commercial |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.20
|
| Rate for Payer: Priority Health Narrow Network |
$5.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.23
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$62.30
|
|
|
Service Code
|
NDC 43598044770
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.49 |
| Max. Negotiated Rate |
$62.30 |
| Rate for Payer: Aetna Commercial |
$56.07
|
| Rate for Payer: ASR ASR |
$60.43
|
| Rate for Payer: ASR Commercial |
$60.43
|
| Rate for Payer: BCBS Trust/PPO |
$50.77
|
| Rate for Payer: BCN Commercial |
$48.30
|
| Rate for Payer: Cash Price |
$49.84
|
| Rate for Payer: Cofinity Commercial |
$58.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.84
|
| Rate for Payer: Healthscope Commercial |
$62.30
|
| Rate for Payer: Healthscope Whirlpool |
$60.43
|
| Rate for Payer: Mclaren Commercial |
$56.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.95
|
| Rate for Payer: Nomi Health Commercial |
$51.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.82
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$8.22
|
|
|
Service Code
|
NDC 43598044771
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: Aetna Commercial |
$7.40
|
| Rate for Payer: ASR ASR |
$7.97
|
| Rate for Payer: ASR Commercial |
$7.97
|
| Rate for Payer: BCBS Trust/PPO |
$6.70
|
| Rate for Payer: BCN Commercial |
$6.37
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Cofinity Commercial |
$7.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.58
|
| Rate for Payer: Healthscope Commercial |
$8.22
|
| Rate for Payer: Healthscope Whirlpool |
$7.97
|
| Rate for Payer: Mclaren Commercial |
$7.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.99
|
| Rate for Payer: Nomi Health Commercial |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.23
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$120.69
|
|
|
Service Code
|
NDC 60505708900
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$120.69 |
| Rate for Payer: Aetna Commercial |
$108.62
|
| Rate for Payer: Aetna Medicare |
$60.34
|
| Rate for Payer: ASR ASR |
$117.07
|
| Rate for Payer: ASR Commercial |
$117.07
|
| Rate for Payer: BCBS Complete |
$48.28
|
| Rate for Payer: BCBS Trust/PPO |
$98.83
|
| Rate for Payer: BCN Commercial |
$93.57
|
| Rate for Payer: Cash Price |
$96.55
|
| Rate for Payer: Cofinity Commercial |
$113.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.55
|
| Rate for Payer: Healthscope Commercial |
$120.69
|
| Rate for Payer: Healthscope Whirlpool |
$117.07
|
| Rate for Payer: Mclaren Commercial |
$108.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.59
|
| Rate for Payer: Nomi Health Commercial |
$98.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.75
|
| Rate for Payer: Priority Health Narrow Network |
$84.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.21
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$62.30
|
|
|
Service Code
|
NDC 43598044770
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$62.30 |
| Rate for Payer: Aetna Commercial |
$56.07
|
| Rate for Payer: Aetna Medicare |
$31.15
|
| Rate for Payer: ASR ASR |
$60.43
|
| Rate for Payer: ASR Commercial |
$60.43
|
| Rate for Payer: BCBS Complete |
$24.92
|
| Rate for Payer: BCBS Trust/PPO |
$51.02
|
| Rate for Payer: BCN Commercial |
$48.30
|
| Rate for Payer: Cash Price |
$49.84
|
| Rate for Payer: Cofinity Commercial |
$58.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.84
|
| Rate for Payer: Healthscope Commercial |
$62.30
|
| Rate for Payer: Healthscope Whirlpool |
$60.43
|
| Rate for Payer: Mclaren Commercial |
$56.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.95
|
| Rate for Payer: Nomi Health Commercial |
$51.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.59
|
| Rate for Payer: Priority Health Narrow Network |
$43.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.82
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$174.77
|
|
|
Service Code
|
NDC 00766143020
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.91 |
| Max. Negotiated Rate |
$174.77 |
| Rate for Payer: Aetna Commercial |
$157.29
|
| Rate for Payer: Aetna Medicare |
$87.39
|
| Rate for Payer: ASR ASR |
$169.53
|
| Rate for Payer: ASR Commercial |
$169.53
|
| Rate for Payer: BCBS Complete |
$69.91
|
| Rate for Payer: BCBS Trust/PPO |
$143.12
|
| Rate for Payer: BCN Commercial |
$135.50
|
| Rate for Payer: Cash Price |
$139.82
|
| Rate for Payer: Cofinity Commercial |
$164.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.82
|
| Rate for Payer: Healthscope Commercial |
$174.77
|
| Rate for Payer: Healthscope Whirlpool |
$169.53
|
| Rate for Payer: Mclaren Commercial |
$157.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.55
|
| Rate for Payer: Nomi Health Commercial |
$143.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.13
|
| Rate for Payer: Priority Health Narrow Network |
$122.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.80
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$106.98
|
|
|
Service Code
|
NDC 00536589588
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.79 |
| Max. Negotiated Rate |
$106.98 |
| Rate for Payer: Aetna Commercial |
$96.28
|
| Rate for Payer: Aetna Medicare |
$53.49
|
| Rate for Payer: ASR ASR |
$103.77
|
| Rate for Payer: ASR Commercial |
$103.77
|
| Rate for Payer: BCBS Complete |
$42.79
|
| Rate for Payer: BCBS Trust/PPO |
$87.61
|
| Rate for Payer: BCN Commercial |
$82.94
|
| Rate for Payer: Cash Price |
$85.59
|
| Rate for Payer: Cofinity Commercial |
$100.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.58
|
| Rate for Payer: Healthscope Commercial |
$106.98
|
| Rate for Payer: Healthscope Whirlpool |
$103.77
|
| Rate for Payer: Mclaren Commercial |
$96.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.93
|
| Rate for Payer: Nomi Health Commercial |
$87.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.74
|
| Rate for Payer: Priority Health Narrow Network |
$74.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.14
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$58.70
|
|
|
Service Code
|
NDC 00536589553
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$58.70 |
| Rate for Payer: Aetna Commercial |
$52.83
|
| Rate for Payer: Aetna Medicare |
$29.35
|
| Rate for Payer: ASR ASR |
$56.94
|
| Rate for Payer: ASR Commercial |
$56.94
|
| Rate for Payer: BCBS Complete |
$23.48
|
| Rate for Payer: BCBS Trust/PPO |
$48.07
|
| Rate for Payer: BCN Commercial |
$45.51
|
| Rate for Payer: Cash Price |
$46.96
|
| Rate for Payer: Cofinity Commercial |
$55.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.96
|
| Rate for Payer: Healthscope Commercial |
$58.70
|
| Rate for Payer: Healthscope Whirlpool |
$56.94
|
| Rate for Payer: Mclaren Commercial |
$52.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.90
|
| Rate for Payer: Nomi Health Commercial |
$48.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.43
|
| Rate for Payer: Priority Health Narrow Network |
$41.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.66
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$174.77
|
|
|
Service Code
|
NDC 00766143020
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$174.77 |
| Rate for Payer: Aetna Commercial |
$157.29
|
| Rate for Payer: ASR ASR |
$169.53
|
| Rate for Payer: ASR Commercial |
$169.53
|
| Rate for Payer: BCBS Trust/PPO |
$142.42
|
| Rate for Payer: BCN Commercial |
$135.50
|
| Rate for Payer: Cash Price |
$139.82
|
| Rate for Payer: Cofinity Commercial |
$164.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.82
|
| Rate for Payer: Healthscope Commercial |
$174.77
|
| Rate for Payer: Healthscope Whirlpool |
$169.53
|
| Rate for Payer: Mclaren Commercial |
$157.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.55
|
| Rate for Payer: Nomi Health Commercial |
$143.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.80
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$106.98
|
|
|
Service Code
|
NDC 00536589588
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.54 |
| Max. Negotiated Rate |
$106.98 |
| Rate for Payer: Aetna Commercial |
$96.28
|
| Rate for Payer: ASR ASR |
$103.77
|
| Rate for Payer: ASR Commercial |
$103.77
|
| Rate for Payer: BCBS Trust/PPO |
$87.18
|
| Rate for Payer: BCN Commercial |
$82.94
|
| Rate for Payer: Cash Price |
$85.59
|
| Rate for Payer: Cofinity Commercial |
$100.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.58
|
| Rate for Payer: Healthscope Commercial |
$106.98
|
| Rate for Payer: Healthscope Whirlpool |
$103.77
|
| Rate for Payer: Mclaren Commercial |
$96.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.93
|
| Rate for Payer: Nomi Health Commercial |
$87.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.14
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$8.62
|
|
|
Service Code
|
NDC 60505706200
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Aetna Commercial |
$7.76
|
| Rate for Payer: Aetna Medicare |
$4.31
|
| Rate for Payer: ASR ASR |
$8.36
|
| Rate for Payer: ASR Commercial |
$8.36
|
| Rate for Payer: BCBS Complete |
$3.45
|
| Rate for Payer: BCBS Trust/PPO |
$7.06
|
| Rate for Payer: BCN Commercial |
$6.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$8.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$8.62
|
| Rate for Payer: Healthscope Whirlpool |
$8.36
|
| Rate for Payer: Mclaren Commercial |
$7.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.33
|
| Rate for Payer: Nomi Health Commercial |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.55
|
| Rate for Payer: Priority Health Narrow Network |
$6.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.59
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$120.69
|
|
|
Service Code
|
NDC 60505708900
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.45 |
| Max. Negotiated Rate |
$120.69 |
| Rate for Payer: Aetna Commercial |
$108.62
|
| Rate for Payer: ASR ASR |
$117.07
|
| Rate for Payer: ASR Commercial |
$117.07
|
| Rate for Payer: BCBS Trust/PPO |
$98.35
|
| Rate for Payer: BCN Commercial |
$93.57
|
| Rate for Payer: Cash Price |
$96.55
|
| Rate for Payer: Cofinity Commercial |
$113.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.55
|
| Rate for Payer: Healthscope Commercial |
$120.69
|
| Rate for Payer: Healthscope Whirlpool |
$117.07
|
| Rate for Payer: Mclaren Commercial |
$108.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.59
|
| Rate for Payer: Nomi Health Commercial |
$98.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.21
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$8.62
|
|
|
Service Code
|
NDC 60505706200
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Aetna Commercial |
$7.76
|
| Rate for Payer: ASR ASR |
$8.36
|
| Rate for Payer: ASR Commercial |
$8.36
|
| Rate for Payer: BCBS Trust/PPO |
$7.02
|
| Rate for Payer: BCN Commercial |
$6.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$8.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$8.62
|
| Rate for Payer: Healthscope Whirlpool |
$8.36
|
| Rate for Payer: Mclaren Commercial |
$7.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.33
|
| Rate for Payer: Nomi Health Commercial |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.59
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$115.11
|
|
|
Service Code
|
NDC 00536110888
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.82 |
| Max. Negotiated Rate |
$115.11 |
| Rate for Payer: Aetna Commercial |
$103.60
|
| Rate for Payer: ASR ASR |
$111.66
|
| Rate for Payer: ASR Commercial |
$111.66
|
| Rate for Payer: BCBS Trust/PPO |
$93.80
|
| Rate for Payer: BCN Commercial |
$89.24
|
| Rate for Payer: Cash Price |
$92.09
|
| Rate for Payer: Cofinity Commercial |
$108.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.09
|
| Rate for Payer: Healthscope Commercial |
$115.11
|
| Rate for Payer: Healthscope Whirlpool |
$111.66
|
| Rate for Payer: Mclaren Commercial |
$103.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.84
|
| Rate for Payer: Nomi Health Commercial |
$94.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.30
|
|
