|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$95.09
|
|
|
Service Code
|
NDC 00536589688
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.04 |
| Max. Negotiated Rate |
$95.09 |
| Rate for Payer: Aetna Commercial |
$85.58
|
| Rate for Payer: Aetna Medicare |
$47.55
|
| Rate for Payer: ASR ASR |
$92.24
|
| Rate for Payer: ASR Commercial |
$92.24
|
| Rate for Payer: BCBS Complete |
$38.04
|
| Rate for Payer: BCBS Trust/PPO |
$77.87
|
| Rate for Payer: BCN Commercial |
$73.72
|
| Rate for Payer: Cash Price |
$76.07
|
| Rate for Payer: Cofinity Commercial |
$89.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.07
|
| Rate for Payer: Healthscope Commercial |
$95.09
|
| Rate for Payer: Healthscope Whirlpool |
$92.24
|
| Rate for Payer: Mclaren Commercial |
$85.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.83
|
| Rate for Payer: Nomi Health Commercial |
$77.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.32
|
| Rate for Payer: Priority Health Narrow Network |
$66.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.68
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$95.09
|
|
|
Service Code
|
NDC 00536589688
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.81 |
| Max. Negotiated Rate |
$95.09 |
| Rate for Payer: Aetna Commercial |
$85.58
|
| Rate for Payer: ASR ASR |
$92.24
|
| Rate for Payer: ASR Commercial |
$92.24
|
| Rate for Payer: BCBS Trust/PPO |
$77.49
|
| Rate for Payer: BCN Commercial |
$73.72
|
| Rate for Payer: Cash Price |
$76.07
|
| Rate for Payer: Cofinity Commercial |
$89.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.07
|
| Rate for Payer: Healthscope Commercial |
$95.09
|
| Rate for Payer: Healthscope Whirlpool |
$92.24
|
| Rate for Payer: Mclaren Commercial |
$85.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.83
|
| Rate for Payer: Nomi Health Commercial |
$77.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.68
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$115.11
|
|
|
Service Code
|
NDC 00536110888
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.04 |
| Max. Negotiated Rate |
$115.11 |
| Rate for Payer: Aetna Commercial |
$103.60
|
| Rate for Payer: Aetna Medicare |
$57.55
|
| Rate for Payer: ASR ASR |
$111.66
|
| Rate for Payer: ASR Commercial |
$111.66
|
| Rate for Payer: BCBS Complete |
$46.04
|
| Rate for Payer: BCBS Trust/PPO |
$94.26
|
| 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: Priority Health HMO/PPO/Tiered Network |
$100.86
|
| Rate for Payer: Priority Health Narrow Network |
$80.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.30
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$289.33
|
|
|
Service Code
|
NDC 45802008902
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.06 |
| Max. Negotiated Rate |
$289.33 |
| Rate for Payer: Aetna Commercial |
$260.40
|
| Rate for Payer: ASR ASR |
$280.65
|
| Rate for Payer: ASR Commercial |
$280.65
|
| Rate for Payer: BCBS Trust/PPO |
$235.78
|
| Rate for Payer: BCN Commercial |
$224.32
|
| Rate for Payer: Cash Price |
$231.47
|
| Rate for Payer: Cofinity Commercial |
$271.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.46
|
| Rate for Payer: Healthscope Commercial |
$289.33
|
| Rate for Payer: Healthscope Whirlpool |
$280.65
|
| Rate for Payer: Mclaren Commercial |
$260.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.93
|
| Rate for Payer: Nomi Health Commercial |
$237.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.61
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$263.17
|
|
|
Service Code
|
NDC 00536123981
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.27 |
| Max. Negotiated Rate |
$263.17 |
| Rate for Payer: Aetna Commercial |
$236.85
|
| Rate for Payer: Aetna Medicare |
$131.59
|
| Rate for Payer: ASR ASR |
$255.27
|
| Rate for Payer: ASR Commercial |
$255.27
|
| Rate for Payer: BCBS Complete |
$105.27
|
| Rate for Payer: BCBS Trust/PPO |
$215.51
|
| Rate for Payer: BCN Commercial |
$204.04
|
| Rate for Payer: Cash Price |
$210.54
|
| Rate for Payer: Cofinity Commercial |
$247.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.54
|
| Rate for Payer: Healthscope Commercial |
$263.17
|
| Rate for Payer: Healthscope Whirlpool |
$255.27
|
| Rate for Payer: Mclaren Commercial |
$236.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.69
|
| Rate for Payer: Nomi Health Commercial |
$215.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.59
|
| Rate for Payer: Priority Health Narrow Network |
$184.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.59
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$289.33
|
|
|
Service Code
|
NDC 45802008902
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.73 |
| Max. Negotiated Rate |
$289.33 |
| Rate for Payer: Aetna Commercial |
$260.40
|
| Rate for Payer: Aetna Medicare |
$144.66
|
| Rate for Payer: ASR ASR |
$280.65
|
| Rate for Payer: ASR Commercial |
$280.65
|
| Rate for Payer: BCBS Complete |
$115.73
|
| Rate for Payer: BCBS Trust/PPO |
$236.93
|
| Rate for Payer: BCN Commercial |
$224.32
|
| Rate for Payer: Cash Price |
$231.47
|
| Rate for Payer: Cofinity Commercial |
$271.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.46
|
| Rate for Payer: Healthscope Commercial |
$289.33
|
| Rate for Payer: Healthscope Whirlpool |
$280.65
|
| Rate for Payer: Mclaren Commercial |
$260.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.93
|
| Rate for Payer: Nomi Health Commercial |
$237.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.51
|
| Rate for Payer: Priority Health Narrow Network |
$202.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.61
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$60.19
|
|
|
Service Code
|
NDC 07667088057
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$60.19 |
| Rate for Payer: Aetna Commercial |
$54.17
|
| Rate for Payer: Aetna Medicare |
$30.09
|
| Rate for Payer: ASR ASR |
$58.38
|
| Rate for Payer: ASR Commercial |
$58.38
|
| Rate for Payer: BCBS Complete |
$24.08
|
| Rate for Payer: BCBS Trust/PPO |
$49.29
|
| Rate for Payer: BCN Commercial |
$46.67
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cofinity Commercial |
$56.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.15
|
| Rate for Payer: Healthscope Commercial |
$60.19
|
| Rate for Payer: Healthscope Whirlpool |
$58.38
|
| Rate for Payer: Mclaren Commercial |
$54.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.16
|
| Rate for Payer: Nomi Health Commercial |
$49.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.74
|
| Rate for Payer: Priority Health Narrow Network |
$42.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.97
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$96.44
|
|
|
Service Code
|
NDC 45802008901
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.69 |
| Max. Negotiated Rate |
$96.44 |
| Rate for Payer: Aetna Commercial |
$86.80
|
| Rate for Payer: ASR ASR |
$93.55
|
| Rate for Payer: ASR Commercial |
$93.55
|
| Rate for Payer: BCBS Trust/PPO |
$78.59
|
| Rate for Payer: BCN Commercial |
$74.77
|
| Rate for Payer: Cash Price |
$77.16
|
| Rate for Payer: Cofinity Commercial |
$90.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.15
|
| Rate for Payer: Healthscope Commercial |
$96.44
|
| Rate for Payer: Healthscope Whirlpool |
$93.55
|
| Rate for Payer: Mclaren Commercial |
$86.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.97
|
| Rate for Payer: Nomi Health Commercial |
$79.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.87
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$96.44
|
|
|
Service Code
|
NDC 45802008901
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.58 |
| Max. Negotiated Rate |
$96.44 |
| Rate for Payer: Aetna Commercial |
$86.80
|
| Rate for Payer: Aetna Medicare |
$48.22
|
| Rate for Payer: ASR ASR |
$93.55
|
| Rate for Payer: ASR Commercial |
$93.55
|
| Rate for Payer: BCBS Complete |
$38.58
|
| Rate for Payer: BCBS Trust/PPO |
$78.97
|
| Rate for Payer: BCN Commercial |
$74.77
|
| Rate for Payer: Cash Price |
$77.16
|
| Rate for Payer: Cofinity Commercial |
$90.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.15
|
| Rate for Payer: Healthscope Commercial |
$96.44
|
| Rate for Payer: Healthscope Whirlpool |
$93.55
|
| Rate for Payer: Mclaren Commercial |
$86.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.97
|
| Rate for Payer: Nomi Health Commercial |
$79.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.50
|
| Rate for Payer: Priority Health Narrow Network |
$67.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.87
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$60.19
|
|
|
Service Code
|
NDC 07667088057
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.12 |
| Max. Negotiated Rate |
$60.19 |
| Rate for Payer: Aetna Commercial |
$54.17
|
| Rate for Payer: ASR ASR |
$58.38
|
| Rate for Payer: ASR Commercial |
$58.38
|
| Rate for Payer: BCBS Trust/PPO |
$49.05
|
| Rate for Payer: BCN Commercial |
$46.67
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cofinity Commercial |
$56.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.15
|
| Rate for Payer: Healthscope Commercial |
$60.19
|
| Rate for Payer: Healthscope Whirlpool |
$58.38
|
| Rate for Payer: Mclaren Commercial |
$54.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.16
|
| Rate for Payer: Nomi Health Commercial |
$49.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.97
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$263.17
|
|
|
Service Code
|
NDC 00536123981
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.06 |
| Max. Negotiated Rate |
$263.17 |
| Rate for Payer: Aetna Commercial |
$236.85
|
| Rate for Payer: ASR ASR |
$255.27
|
| Rate for Payer: ASR Commercial |
$255.27
|
| Rate for Payer: BCBS Trust/PPO |
$214.46
|
| Rate for Payer: BCN Commercial |
$204.04
|
| Rate for Payer: Cash Price |
$210.54
|
| Rate for Payer: Cofinity Commercial |
$247.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.54
|
| Rate for Payer: Healthscope Commercial |
$263.17
|
| Rate for Payer: Healthscope Whirlpool |
$255.27
|
| Rate for Payer: Mclaren Commercial |
$236.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.69
|
| Rate for Payer: Nomi Health Commercial |
$215.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.59
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$326.80
|
|
|
Service Code
|
NDC 23155019401
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.42 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna Commercial |
$294.12
|
| Rate for Payer: ASR ASR |
$317.00
|
| Rate for Payer: ASR Commercial |
$317.00
|
| Rate for Payer: BCBS Trust/PPO |
$266.31
|
| Rate for Payer: BCN Commercial |
$253.37
|
| Rate for Payer: Cash Price |
$261.44
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.44
|
| Rate for Payer: Healthscope Commercial |
$326.80
|
| Rate for Payer: Healthscope Whirlpool |
$317.00
|
| Rate for Payer: Mclaren Commercial |
$294.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.78
|
| Rate for Payer: Nomi Health Commercial |
$267.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.58
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
OP
|
$326.80
|
|
|
Service Code
|
NDC 23155019401
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.72 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna Commercial |
$294.12
|
| Rate for Payer: Aetna Medicare |
$163.40
|
| Rate for Payer: ASR ASR |
$317.00
|
| Rate for Payer: ASR Commercial |
$317.00
|
| Rate for Payer: BCBS Complete |
$130.72
|
| Rate for Payer: BCBS Trust/PPO |
$267.62
|
| Rate for Payer: BCN Commercial |
$253.37
|
| Rate for Payer: Cash Price |
$261.44
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.44
|
| Rate for Payer: Healthscope Commercial |
$326.80
|
| Rate for Payer: Healthscope Whirlpool |
$317.00
|
| Rate for Payer: Mclaren Commercial |
$294.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.78
|
| Rate for Payer: Nomi Health Commercial |
$267.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.34
|
| Rate for Payer: Priority Health Narrow Network |
$229.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.58
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$206.15
|
|
|
Service Code
|
NDC 59651029701
|
| Hospital Charge Code |
37662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.46 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Aetna Commercial |
$185.53
|
| Rate for Payer: Aetna Medicare |
$103.08
|
| Rate for Payer: ASR ASR |
$199.97
|
| Rate for Payer: ASR Commercial |
$199.97
|
| Rate for Payer: BCBS Complete |
$82.46
|
| Rate for Payer: BCBS Trust/PPO |
$168.82
|
| Rate for Payer: BCN Commercial |
$159.83
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Cofinity Commercial |
$193.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.92
|
| Rate for Payer: Healthscope Commercial |
$206.15
|
| Rate for Payer: Healthscope Whirlpool |
$199.97
|
| Rate for Payer: Mclaren Commercial |
$185.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.23
|
| Rate for Payer: Nomi Health Commercial |
$169.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.63
|
| Rate for Payer: Priority Health Narrow Network |
$144.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.41
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$206.15
|
|
|
Service Code
|
NDC 59651029701
|
| Hospital Charge Code |
37662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Aetna Commercial |
$185.53
|
| Rate for Payer: ASR ASR |
$199.97
|
| Rate for Payer: ASR Commercial |
$199.97
|
| Rate for Payer: BCBS Trust/PPO |
$167.99
|
| Rate for Payer: BCN Commercial |
$159.83
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Cofinity Commercial |
$193.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.92
|
| Rate for Payer: Healthscope Commercial |
$206.15
|
| Rate for Payer: Healthscope Whirlpool |
$199.97
|
| Rate for Payer: Mclaren Commercial |
$185.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.23
|
| Rate for Payer: Nomi Health Commercial |
$169.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.41
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$282.24
|
|
|
Service Code
|
NDC 47781030301
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.46 |
| Max. Negotiated Rate |
$282.24 |
| Rate for Payer: Aetna Commercial |
$254.02
|
| Rate for Payer: ASR ASR |
$273.77
|
| Rate for Payer: ASR Commercial |
$273.77
|
| Rate for Payer: BCBS Trust/PPO |
$230.00
|
| Rate for Payer: BCN Commercial |
$218.82
|
| Rate for Payer: Cash Price |
$225.79
|
| Rate for Payer: Cofinity Commercial |
$265.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.79
|
| Rate for Payer: Healthscope Commercial |
$282.24
|
| Rate for Payer: Healthscope Whirlpool |
$273.77
|
| Rate for Payer: Mclaren Commercial |
$254.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.90
|
| Rate for Payer: Nomi Health Commercial |
$231.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.37
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$881.34
|
|
|
Service Code
|
NDC 68084044601
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$572.87 |
| Max. Negotiated Rate |
$881.34 |
| Rate for Payer: Aetna Commercial |
$793.21
|
| Rate for Payer: ASR ASR |
$854.90
|
| Rate for Payer: ASR Commercial |
$854.90
|
| Rate for Payer: BCBS Trust/PPO |
$718.20
|
| Rate for Payer: BCN Commercial |
$683.30
|
| Rate for Payer: Cash Price |
$705.07
|
| Rate for Payer: Cofinity Commercial |
$828.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.07
|
| Rate for Payer: Healthscope Commercial |
$881.34
|
| Rate for Payer: Healthscope Whirlpool |
$854.90
|
| Rate for Payer: Mclaren Commercial |
$793.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.14
|
| Rate for Payer: Nomi Health Commercial |
$722.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$572.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$775.58
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$11.12
|
|
|
Service Code
|
NDC 51079034801
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$11.12 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Aetna Medicare |
$5.56
|
| Rate for Payer: ASR ASR |
$10.79
|
| Rate for Payer: ASR Commercial |
$10.79
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: BCBS Trust/PPO |
$9.11
|
| Rate for Payer: BCN Commercial |
$8.62
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$10.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$11.12
|
| Rate for Payer: Healthscope Whirlpool |
$10.79
|
| Rate for Payer: Mclaren Commercial |
$10.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: Nomi Health Commercial |
$9.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.74
|
| Rate for Payer: Priority Health Narrow Network |
$7.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.79
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$11.12
|
|
|
Service Code
|
NDC 51079034801
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$11.12 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: ASR ASR |
$10.79
|
| Rate for Payer: ASR Commercial |
$10.79
|
| Rate for Payer: BCBS Trust/PPO |
$9.06
|
| Rate for Payer: BCN Commercial |
$8.62
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$10.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$11.12
|
| Rate for Payer: Healthscope Whirlpool |
$10.79
|
| Rate for Payer: Mclaren Commercial |
$10.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: Nomi Health Commercial |
$9.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.79
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$451.44
|
|
|
Service Code
|
NDC 50268062515
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.58 |
| Max. Negotiated Rate |
$451.44 |
| Rate for Payer: Aetna Commercial |
$406.30
|
| Rate for Payer: Aetna Medicare |
$225.72
|
| Rate for Payer: ASR ASR |
$437.90
|
| Rate for Payer: ASR Commercial |
$437.90
|
| Rate for Payer: BCBS Complete |
$180.58
|
| Rate for Payer: BCBS Trust/PPO |
$369.68
|
| Rate for Payer: BCN Commercial |
$350.00
|
| Rate for Payer: Cash Price |
$361.15
|
| Rate for Payer: Cofinity Commercial |
$424.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.15
|
| Rate for Payer: Healthscope Commercial |
$451.44
|
| Rate for Payer: Healthscope Whirlpool |
$437.90
|
| Rate for Payer: Mclaren Commercial |
$406.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.72
|
| Rate for Payer: Nomi Health Commercial |
$370.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$395.55
|
| Rate for Payer: Priority Health Narrow Network |
$316.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.27
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$9.03
|
|
|
Service Code
|
NDC 50268062511
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$9.03 |
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: Aetna Medicare |
$4.51
|
| Rate for Payer: ASR ASR |
$8.76
|
| Rate for Payer: ASR Commercial |
$8.76
|
| Rate for Payer: BCBS Complete |
$3.61
|
| Rate for Payer: BCBS Trust/PPO |
$7.39
|
| Rate for Payer: BCN Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cofinity Commercial |
$8.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.22
|
| Rate for Payer: Healthscope Commercial |
$9.03
|
| Rate for Payer: Healthscope Whirlpool |
$8.76
|
| Rate for Payer: Mclaren Commercial |
$8.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.68
|
| Rate for Payer: Nomi Health Commercial |
$7.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.91
|
| Rate for Payer: Priority Health Narrow Network |
$6.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.95
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$881.34
|
|
|
Service Code
|
NDC 68084044611
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$352.54 |
| Max. Negotiated Rate |
$881.34 |
| Rate for Payer: Aetna Commercial |
$793.21
|
| Rate for Payer: Aetna Medicare |
$440.67
|
| Rate for Payer: ASR ASR |
$854.90
|
| Rate for Payer: ASR Commercial |
$854.90
|
| Rate for Payer: BCBS Complete |
$352.54
|
| Rate for Payer: BCBS Trust/PPO |
$721.73
|
| Rate for Payer: BCN Commercial |
$683.30
|
| Rate for Payer: Cash Price |
$705.07
|
| Rate for Payer: Cofinity Commercial |
$828.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.07
|
| Rate for Payer: Healthscope Commercial |
$881.34
|
| Rate for Payer: Healthscope Whirlpool |
$854.90
|
| Rate for Payer: Mclaren Commercial |
$793.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.14
|
| Rate for Payer: Nomi Health Commercial |
$722.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$572.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$772.23
|
| Rate for Payer: Priority Health Narrow Network |
$617.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$775.58
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$282.24
|
|
|
Service Code
|
NDC 47781030301
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.90 |
| Max. Negotiated Rate |
$282.24 |
| Rate for Payer: Aetna Commercial |
$254.02
|
| Rate for Payer: Aetna Medicare |
$141.12
|
| Rate for Payer: ASR ASR |
$273.77
|
| Rate for Payer: ASR Commercial |
$273.77
|
| Rate for Payer: BCBS Complete |
$112.90
|
| Rate for Payer: BCBS Trust/PPO |
$231.13
|
| Rate for Payer: BCN Commercial |
$218.82
|
| Rate for Payer: Cash Price |
$225.79
|
| Rate for Payer: Cofinity Commercial |
$265.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.79
|
| Rate for Payer: Healthscope Commercial |
$282.24
|
| Rate for Payer: Healthscope Whirlpool |
$273.77
|
| Rate for Payer: Mclaren Commercial |
$254.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.90
|
| Rate for Payer: Nomi Health Commercial |
$231.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.30
|
| Rate for Payer: Priority Health Narrow Network |
$197.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.37
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$9.03
|
|
|
Service Code
|
NDC 50268062511
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$9.03 |
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: ASR ASR |
$8.76
|
| Rate for Payer: ASR Commercial |
$8.76
|
| Rate for Payer: BCBS Trust/PPO |
$7.36
|
| Rate for Payer: BCN Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cofinity Commercial |
$8.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.22
|
| Rate for Payer: Healthscope Commercial |
$9.03
|
| Rate for Payer: Healthscope Whirlpool |
$8.76
|
| Rate for Payer: Mclaren Commercial |
$8.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.68
|
| Rate for Payer: Nomi Health Commercial |
$7.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.95
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$881.34
|
|
|
Service Code
|
NDC 68084044601
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$352.54 |
| Max. Negotiated Rate |
$881.34 |
| Rate for Payer: Aetna Commercial |
$793.21
|
| Rate for Payer: Aetna Medicare |
$440.67
|
| Rate for Payer: ASR ASR |
$854.90
|
| Rate for Payer: ASR Commercial |
$854.90
|
| Rate for Payer: BCBS Complete |
$352.54
|
| Rate for Payer: BCBS Trust/PPO |
$721.73
|
| Rate for Payer: BCN Commercial |
$683.30
|
| Rate for Payer: Cash Price |
$705.07
|
| Rate for Payer: Cofinity Commercial |
$828.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.07
|
| Rate for Payer: Healthscope Commercial |
$881.34
|
| Rate for Payer: Healthscope Whirlpool |
$854.90
|
| Rate for Payer: Mclaren Commercial |
$793.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.14
|
| Rate for Payer: Nomi Health Commercial |
$722.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$572.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$772.23
|
| Rate for Payer: Priority Health Narrow Network |
$617.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$775.58
|
|
