|
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
|
|
|
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
|
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 |
$185.54
|
| 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 |
$185.54
|
| 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
|
|
|
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 |
$185.54
|
| 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 |
$185.54
|
| 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
|
|
|
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
|
$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
|
$881.34
|
|
|
Service Code
|
NDC 68084044611
|
| 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
|
$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 |
$4.52
|
| 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
|
IP
|
$451.44
|
|
|
Service Code
|
NDC 50268062515
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.44 |
| Max. Negotiated Rate |
$451.44 |
| Rate for Payer: Aetna Commercial |
$406.30
|
| Rate for Payer: ASR ASR |
$437.90
|
| Rate for Payer: ASR Commercial |
$437.90
|
| Rate for Payer: BCBS Trust/PPO |
$367.88
|
| 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: UHC All Payor (Choice/PPO) + Core |
$397.27
|
|
|
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
|
$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
|
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
|
$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
|
|
|
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
|
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
|
|
|
NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$108.30
|
|
|
Service Code
|
NDC 49730011130
|
| Hospital Charge Code |
27472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna Commercial |
$97.47
|
| Rate for Payer: Aetna Medicare |
$54.15
|
| Rate for Payer: ASR ASR |
$105.05
|
| Rate for Payer: ASR Commercial |
$105.05
|
| Rate for Payer: BCBS Complete |
$43.32
|
| Rate for Payer: BCBS Trust/PPO |
$88.69
|
| Rate for Payer: BCN Commercial |
$83.96
|
| Rate for Payer: Cash Price |
$86.64
|
| Rate for Payer: Cofinity Commercial |
$101.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.64
|
| Rate for Payer: Healthscope Commercial |
$108.30
|
| Rate for Payer: Healthscope Whirlpool |
$105.05
|
| Rate for Payer: Mclaren Commercial |
$97.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.06
|
| Rate for Payer: Nomi Health Commercial |
$88.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.89
|
| Rate for Payer: Priority Health Narrow Network |
$75.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.30
|
|
|
NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$108.30
|
|
|
Service Code
|
NDC 49730011130
|
| Hospital Charge Code |
27472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna Commercial |
$97.47
|
| Rate for Payer: ASR ASR |
$105.05
|
| Rate for Payer: ASR Commercial |
$105.05
|
| Rate for Payer: BCBS Trust/PPO |
$88.25
|
| Rate for Payer: BCN Commercial |
$83.96
|
| Rate for Payer: Cash Price |
$86.64
|
| Rate for Payer: Cofinity Commercial |
$101.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.64
|
| Rate for Payer: Healthscope Commercial |
$108.30
|
| Rate for Payer: Healthscope Whirlpool |
$105.05
|
| Rate for Payer: Mclaren Commercial |
$97.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.06
|
| Rate for Payer: Nomi Health Commercial |
$88.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.30
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$109.44
|
|
|
Service Code
|
NDC 49730011230
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.78 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$98.50
|
| Rate for Payer: Aetna Medicare |
$54.72
|
| Rate for Payer: ASR ASR |
$106.16
|
| Rate for Payer: ASR Commercial |
$106.16
|
| Rate for Payer: BCBS Complete |
$43.78
|
| Rate for Payer: BCBS Trust/PPO |
$89.62
|
| Rate for Payer: BCN Commercial |
$84.85
|
| Rate for Payer: Cash Price |
$87.55
|
| Rate for Payer: Cofinity Commercial |
$102.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.55
|
| Rate for Payer: Healthscope Commercial |
$109.44
|
| Rate for Payer: Healthscope Whirlpool |
$106.16
|
| Rate for Payer: Mclaren Commercial |
$98.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.02
|
| Rate for Payer: Nomi Health Commercial |
$89.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.89
|
| Rate for Payer: Priority Health Narrow Network |
$76.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.31
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$3.67
|
|
|
Service Code
|
NDC 68382031001
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: ASR ASR |
$3.56
|
| Rate for Payer: ASR Commercial |
$3.56
|
| Rate for Payer: BCBS Complete |
$1.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.01
|
| Rate for Payer: BCN Commercial |
$2.85
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Healthscope Whirlpool |
$3.56
|
| Rate for Payer: Mclaren Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Nomi Health Commercial |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.22
|
| Rate for Payer: Priority Health Narrow Network |
$2.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.23
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$110.02
|
|
|
Service Code
|
NDC 68382031030
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.01 |
| Max. Negotiated Rate |
$110.02 |
| Rate for Payer: Aetna Commercial |
$99.02
|
| Rate for Payer: Aetna Medicare |
$55.01
|
| Rate for Payer: ASR ASR |
$106.72
|
| Rate for Payer: ASR Commercial |
$106.72
|
| Rate for Payer: BCBS Complete |
$44.01
|
| Rate for Payer: BCBS Trust/PPO |
$90.10
|
| Rate for Payer: BCN Commercial |
$85.30
|
| Rate for Payer: Cash Price |
$88.01
|
| Rate for Payer: Cofinity Commercial |
$103.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.02
|
| Rate for Payer: Healthscope Commercial |
$110.02
|
| Rate for Payer: Healthscope Whirlpool |
$106.72
|
| Rate for Payer: Mclaren Commercial |
$99.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.52
|
| Rate for Payer: Nomi Health Commercial |
$90.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.40
|
| Rate for Payer: Priority Health Narrow Network |
$77.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.82
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$109.44
|
|
|
Service Code
|
NDC 49730011230
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.14 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$98.50
|
| Rate for Payer: ASR ASR |
$106.16
|
| Rate for Payer: ASR Commercial |
$106.16
|
| Rate for Payer: BCBS Trust/PPO |
$89.18
|
| Rate for Payer: BCN Commercial |
$84.85
|
| Rate for Payer: Cash Price |
$87.55
|
| Rate for Payer: Cofinity Commercial |
$102.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.55
|
| Rate for Payer: Healthscope Commercial |
$109.44
|
| Rate for Payer: Healthscope Whirlpool |
$106.16
|
| Rate for Payer: Mclaren Commercial |
$98.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.02
|
| Rate for Payer: Nomi Health Commercial |
$89.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.31
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$3.33
|
|
|
Service Code
|
NDC 00378911216
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: ASR ASR |
$3.23
|
| Rate for Payer: ASR Commercial |
$3.23
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.58
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$3.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$3.33
|
| Rate for Payer: Healthscope Whirlpool |
$3.23
|
| Rate for Payer: Mclaren Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.83
|
| Rate for Payer: Nomi Health Commercial |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.93
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$99.94
|
|
|
Service Code
|
NDC 00378911293
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.96 |
| Max. Negotiated Rate |
$99.94 |
| Rate for Payer: Aetna Commercial |
$89.95
|
| Rate for Payer: ASR ASR |
$96.94
|
| Rate for Payer: ASR Commercial |
$96.94
|
| Rate for Payer: BCBS Trust/PPO |
$81.44
|
| Rate for Payer: BCN Commercial |
$77.48
|
| Rate for Payer: Cash Price |
$79.95
|
| Rate for Payer: Cofinity Commercial |
$93.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.95
|
| Rate for Payer: Healthscope Commercial |
$99.94
|
| Rate for Payer: Healthscope Whirlpool |
$96.94
|
| Rate for Payer: Mclaren Commercial |
$89.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.95
|
| Rate for Payer: Nomi Health Commercial |
$81.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.95
|
|
