|
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
|
$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
|
|
|
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
|
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 SUBLINGUAL TABLET
|
Facility
|
IP
|
$132.46
|
|
|
Service Code
|
NDC 00071041813
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$132.46 |
| Rate for Payer: Aetna Commercial |
$119.21
|
| Rate for Payer: ASR ASR |
$128.49
|
| Rate for Payer: ASR Commercial |
$128.49
|
| Rate for Payer: BCBS Trust/PPO |
$107.94
|
| Rate for Payer: BCN Commercial |
$102.70
|
| Rate for Payer: Cash Price |
$105.97
|
| Rate for Payer: Cofinity Commercial |
$124.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.97
|
| Rate for Payer: Healthscope Commercial |
$132.46
|
| Rate for Payer: Healthscope Whirlpool |
$128.49
|
| Rate for Payer: Mclaren Commercial |
$119.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.59
|
| Rate for Payer: Nomi Health Commercial |
$108.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.56
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$132.46
|
|
|
Service Code
|
NDC 00071041813
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.98 |
| Max. Negotiated Rate |
$132.46 |
| Rate for Payer: Aetna Commercial |
$119.21
|
| Rate for Payer: Aetna Medicare |
$66.23
|
| Rate for Payer: ASR ASR |
$128.49
|
| Rate for Payer: ASR Commercial |
$128.49
|
| Rate for Payer: BCBS Complete |
$52.98
|
| Rate for Payer: BCBS Trust/PPO |
$108.47
|
| Rate for Payer: BCN Commercial |
$102.70
|
| Rate for Payer: Cash Price |
$105.97
|
| Rate for Payer: Cofinity Commercial |
$124.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.97
|
| Rate for Payer: Healthscope Commercial |
$132.46
|
| Rate for Payer: Healthscope Whirlpool |
$128.49
|
| Rate for Payer: Mclaren Commercial |
$119.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.59
|
| Rate for Payer: Nomi Health Commercial |
$108.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.06
|
| Rate for Payer: Priority Health Narrow Network |
$92.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.56
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$74.37
|
|
|
Service Code
|
NDC 43598043635
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.34 |
| Max. Negotiated Rate |
$74.37 |
| Rate for Payer: Aetna Commercial |
$66.93
|
| Rate for Payer: ASR ASR |
$72.14
|
| Rate for Payer: ASR Commercial |
$72.14
|
| Rate for Payer: BCBS Trust/PPO |
$60.60
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$69.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.50
|
| Rate for Payer: Healthscope Commercial |
$74.37
|
| Rate for Payer: Healthscope Whirlpool |
$72.14
|
| Rate for Payer: Mclaren Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.21
|
| Rate for Payer: Nomi Health Commercial |
$60.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.45
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$74.37
|
|
|
Service Code
|
NDC 43598043635
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$74.37 |
| Rate for Payer: Aetna Commercial |
$66.93
|
| Rate for Payer: Aetna Medicare |
$37.18
|
| Rate for Payer: ASR ASR |
$72.14
|
| Rate for Payer: ASR Commercial |
$72.14
|
| Rate for Payer: BCBS Complete |
$29.75
|
| Rate for Payer: BCBS Trust/PPO |
$60.90
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$69.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.50
|
| Rate for Payer: Healthscope Commercial |
$74.37
|
| Rate for Payer: Healthscope Whirlpool |
$72.14
|
| Rate for Payer: Mclaren Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.21
|
| Rate for Payer: Nomi Health Commercial |
$60.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.16
|
| Rate for Payer: Priority Health Narrow Network |
$52.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.45
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$74.37
|
|
|
Service Code
|
NDC 43598043611
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.34 |
| Max. Negotiated Rate |
$74.37 |
| Rate for Payer: Aetna Commercial |
$66.93
|
| Rate for Payer: ASR ASR |
$72.14
|
| Rate for Payer: ASR Commercial |
$72.14
|
| Rate for Payer: BCBS Trust/PPO |
$60.60
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$69.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.50
|
| Rate for Payer: Healthscope Commercial |
$74.37
|
| Rate for Payer: Healthscope Whirlpool |
$72.14
|
| Rate for Payer: Mclaren Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.21
|
| Rate for Payer: Nomi Health Commercial |
$60.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.45
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$74.37
|
|
|
Service Code
|
NDC 43598043611
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$74.37 |
| Rate for Payer: Aetna Commercial |
$66.93
|
| Rate for Payer: Aetna Medicare |
$37.18
|
| Rate for Payer: ASR ASR |
$72.14
|
| Rate for Payer: ASR Commercial |
$72.14
|
| Rate for Payer: BCBS Complete |
$29.75
|
| Rate for Payer: BCBS Trust/PPO |
$60.90
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$69.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.50
|
| Rate for Payer: Healthscope Commercial |
$74.37
|
| Rate for Payer: Healthscope Whirlpool |
$72.14
|
| Rate for Payer: Mclaren Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.21
|
| Rate for Payer: Nomi Health Commercial |
$60.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.16
|
| Rate for Payer: Priority Health Narrow Network |
$52.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.45
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$9.90
|
|
|
Service Code
|
NDC 70756001405
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: ASR ASR |
$9.60
|
| Rate for Payer: ASR Commercial |
$9.60
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$8.11
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Healthscope Whirlpool |
$9.60
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.42
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.67
|
| Rate for Payer: Priority Health Narrow Network |
$6.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$9.90
|
|
|
Service Code
|
NDC 70756001402
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: ASR ASR |
$9.60
|
| Rate for Payer: ASR Commercial |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$8.07
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Healthscope Whirlpool |
$9.60
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.42
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$9.90
|
|
|
Service Code
|
NDC 70756001405
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: ASR ASR |
$9.60
|
| Rate for Payer: ASR Commercial |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$8.07
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Healthscope Whirlpool |
$9.60
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.42
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$9.90
|
|
|
Service Code
|
NDC 70756001402
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: ASR ASR |
$9.60
|
| Rate for Payer: ASR Commercial |
$9.60
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$8.11
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Healthscope Whirlpool |
$9.60
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.42
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.67
|
| Rate for Payer: Priority Health Narrow Network |
$6.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$89.50
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
15859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.18 |
| Max. Negotiated Rate |
$89.50 |
| Rate for Payer: Aetna Commercial |
$80.55
|
| Rate for Payer: ASR ASR |
$86.82
|
| Rate for Payer: ASR Commercial |
$86.82
|
| Rate for Payer: BCBS Trust/PPO |
$72.93
|
| Rate for Payer: BCN Commercial |
$69.39
|
| Rate for Payer: Cash Price |
$71.60
|
| Rate for Payer: Cofinity Commercial |
$84.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.60
|
| Rate for Payer: Healthscope Commercial |
$89.50
|
| Rate for Payer: Healthscope Whirlpool |
$86.82
|
| Rate for Payer: Mclaren Commercial |
$80.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.08
|
| Rate for Payer: Nomi Health Commercial |
$73.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.76
|
|
|
NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
OP
|
$89.50
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
15859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$89.50 |
| Rate for Payer: Aetna Commercial |
$80.55
|
| Rate for Payer: Aetna Medicare |
$44.75
|
| Rate for Payer: ASR ASR |
$86.82
|
| Rate for Payer: ASR Commercial |
$86.82
|
| Rate for Payer: BCBS Complete |
$35.80
|
| Rate for Payer: BCBS Trust/PPO |
$73.29
|
| Rate for Payer: BCN Commercial |
$69.39
|
| Rate for Payer: Cash Price |
$71.60
|
| Rate for Payer: Cash Price |
$71.60
|
| Rate for Payer: Cofinity Commercial |
$84.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.60
|
| Rate for Payer: Healthscope Commercial |
$89.50
|
| Rate for Payer: Healthscope Whirlpool |
$86.82
|
| Rate for Payer: Mclaren Commercial |
$80.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.08
|
| Rate for Payer: Nomi Health Commercial |
$73.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.39
|
| Rate for Payer: Priority Health Narrow Network |
$1.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.76
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.07
|
|
|
Service Code
|
NDC 43066099701
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$15.07 |
| Rate for Payer: Aetna Commercial |
$13.56
|
| Rate for Payer: ASR ASR |
$14.62
|
| Rate for Payer: ASR Commercial |
$14.62
|
| Rate for Payer: BCBS Trust/PPO |
$12.28
|
| Rate for Payer: BCN Commercial |
$11.68
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$14.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.06
|
| Rate for Payer: Healthscope Commercial |
$15.07
|
| Rate for Payer: Healthscope Whirlpool |
$14.62
|
| Rate for Payer: Mclaren Commercial |
$13.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.81
|
| Rate for Payer: Nomi Health Commercial |
$12.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.26
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.58
|
|
|
Service Code
|
NDC 00703115303
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$74.58 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna Medicare |
$37.29
|
| Rate for Payer: ASR ASR |
$72.34
|
| Rate for Payer: ASR Commercial |
$72.34
|
| Rate for Payer: BCBS Complete |
$29.83
|
| Rate for Payer: BCBS Trust/PPO |
$61.07
|
| Rate for Payer: BCN Commercial |
$57.82
|
| Rate for Payer: Cash Price |
$59.67
|
| Rate for Payer: Cofinity Commercial |
$70.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.66
|
| Rate for Payer: Healthscope Commercial |
$74.58
|
| Rate for Payer: Healthscope Whirlpool |
$72.34
|
| Rate for Payer: Mclaren Commercial |
$67.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.39
|
| Rate for Payer: Nomi Health Commercial |
$61.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.35
|
| Rate for Payer: Priority Health Narrow Network |
$52.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.63
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$36.17
|
|
|
Service Code
|
NDC 47335061540
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.51 |
| Max. Negotiated Rate |
$36.17 |
| Rate for Payer: Aetna Commercial |
$32.55
|
| Rate for Payer: ASR ASR |
$35.08
|
| Rate for Payer: ASR Commercial |
$35.08
|
| Rate for Payer: BCBS Trust/PPO |
$29.47
|
| Rate for Payer: BCN Commercial |
$28.04
|
| Rate for Payer: Cash Price |
$28.94
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.94
|
| Rate for Payer: Healthscope Commercial |
$36.17
|
| Rate for Payer: Healthscope Whirlpool |
$35.08
|
| Rate for Payer: Mclaren Commercial |
$32.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.74
|
| Rate for Payer: Nomi Health Commercial |
$29.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.83
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.37
|
|
|
Service Code
|
NDC 67457085200
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$18.37 |
| Rate for Payer: Aetna Commercial |
$16.53
|
| Rate for Payer: Aetna Medicare |
$9.18
|
| Rate for Payer: ASR ASR |
$17.82
|
| Rate for Payer: ASR Commercial |
$17.82
|
| Rate for Payer: BCBS Complete |
$7.35
|
| Rate for Payer: BCBS Trust/PPO |
$15.04
|
| Rate for Payer: BCN Commercial |
$14.24
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cofinity Commercial |
$17.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.70
|
| Rate for Payer: Healthscope Commercial |
$18.37
|
| Rate for Payer: Healthscope Whirlpool |
$17.82
|
| Rate for Payer: Mclaren Commercial |
$16.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.61
|
| Rate for Payer: Nomi Health Commercial |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.10
|
| Rate for Payer: Priority Health Narrow Network |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.17
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.37
|
|
|
Service Code
|
NDC 67457085204
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$18.37 |
| Rate for Payer: Aetna Commercial |
$16.53
|
| Rate for Payer: Aetna Medicare |
$9.18
|
| Rate for Payer: ASR ASR |
$17.82
|
| Rate for Payer: ASR Commercial |
$17.82
|
| Rate for Payer: BCBS Complete |
$7.35
|
| Rate for Payer: BCBS Trust/PPO |
$15.04
|
| Rate for Payer: BCN Commercial |
$14.24
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cofinity Commercial |
$17.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.70
|
| Rate for Payer: Healthscope Commercial |
$18.37
|
| Rate for Payer: Healthscope Whirlpool |
$17.82
|
| Rate for Payer: Mclaren Commercial |
$16.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.61
|
| Rate for Payer: Nomi Health Commercial |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.10
|
| Rate for Payer: Priority Health Narrow Network |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.17
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.37
|
|
|
Service Code
|
NDC 67457085204
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$18.37 |
| Rate for Payer: Aetna Commercial |
$16.53
|
| Rate for Payer: ASR ASR |
$17.82
|
| Rate for Payer: ASR Commercial |
$17.82
|
| Rate for Payer: BCBS Trust/PPO |
$14.97
|
| Rate for Payer: BCN Commercial |
$14.24
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cofinity Commercial |
$17.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.70
|
| Rate for Payer: Healthscope Commercial |
$18.37
|
| Rate for Payer: Healthscope Whirlpool |
$17.82
|
| Rate for Payer: Mclaren Commercial |
$16.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.61
|
| Rate for Payer: Nomi Health Commercial |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.17
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.45
|
|
|
Service Code
|
NDC 00143931801
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$25.45 |
| Rate for Payer: Aetna Commercial |
$22.90
|
| Rate for Payer: Aetna Medicare |
$12.72
|
| Rate for Payer: ASR ASR |
$24.69
|
| Rate for Payer: ASR Commercial |
$24.69
|
| Rate for Payer: BCBS Complete |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$20.84
|
| Rate for Payer: BCN Commercial |
$19.73
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$23.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.36
|
| Rate for Payer: Healthscope Commercial |
$25.45
|
| Rate for Payer: Healthscope Whirlpool |
$24.69
|
| Rate for Payer: Mclaren Commercial |
$22.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.63
|
| Rate for Payer: Nomi Health Commercial |
$20.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.30
|
| Rate for Payer: Priority Health Narrow Network |
$17.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.40
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.58
|
|
|
Service Code
|
NDC 00703115301
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$74.58 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna Medicare |
$37.29
|
| Rate for Payer: ASR ASR |
$72.34
|
| Rate for Payer: ASR Commercial |
$72.34
|
| Rate for Payer: BCBS Complete |
$29.83
|
| Rate for Payer: BCBS Trust/PPO |
$61.07
|
| Rate for Payer: BCN Commercial |
$57.82
|
| Rate for Payer: Cash Price |
$59.67
|
| Rate for Payer: Cofinity Commercial |
$70.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.66
|
| Rate for Payer: Healthscope Commercial |
$74.58
|
| Rate for Payer: Healthscope Whirlpool |
$72.34
|
| Rate for Payer: Mclaren Commercial |
$67.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.39
|
| Rate for Payer: Nomi Health Commercial |
$61.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.35
|
| Rate for Payer: Priority Health Narrow Network |
$52.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.63
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.10
|
|
|
Service Code
|
NDC 51991098317
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$25.10 |
| Rate for Payer: Aetna Commercial |
$22.59
|
| Rate for Payer: Aetna Medicare |
$12.55
|
| Rate for Payer: ASR ASR |
$24.35
|
| Rate for Payer: ASR Commercial |
$24.35
|
| Rate for Payer: BCBS Complete |
$10.04
|
| Rate for Payer: BCBS Trust/PPO |
$20.55
|
| Rate for Payer: BCN Commercial |
$19.46
|
| Rate for Payer: Cash Price |
$20.08
|
| Rate for Payer: Cofinity Commercial |
$23.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.08
|
| Rate for Payer: Healthscope Commercial |
$25.10
|
| Rate for Payer: Healthscope Whirlpool |
$24.35
|
| Rate for Payer: Mclaren Commercial |
$22.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.34
|
| Rate for Payer: Nomi Health Commercial |
$20.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.99
|
| Rate for Payer: Priority Health Narrow Network |
$17.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.09
|
|
