|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 00904727641
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$4.13
|
| Rate for Payer: ASR ASR |
$4.45
|
| Rate for Payer: ASR Commercial |
$4.45
|
| Rate for Payer: BCBS Trust/PPO |
$3.74
|
| Rate for Payer: BCN Commercial |
$3.56
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Healthscope Whirlpool |
$4.45
|
| Rate for Payer: Mclaren Commercial |
$4.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.04
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 00904727670
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$4.13
|
| Rate for Payer: ASR ASR |
$4.45
|
| Rate for Payer: ASR Commercial |
$4.45
|
| Rate for Payer: BCBS Trust/PPO |
$3.74
|
| Rate for Payer: BCN Commercial |
$3.56
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Healthscope Whirlpool |
$4.45
|
| Rate for Payer: Mclaren Commercial |
$4.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.04
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$9.90
|
|
|
Service Code
|
NDC 68094059959
|
| Hospital Charge Code |
5751
|
|
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 |
$8.41
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.43
|
| 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
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$6.48
|
|
|
Service Code
|
NDC 00121086805
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Aetna Commercial |
$5.83
|
| Rate for Payer: ASR ASR |
$6.29
|
| Rate for Payer: ASR Commercial |
$6.29
|
| Rate for Payer: BCBS Trust/PPO |
$5.28
|
| Rate for Payer: BCN Commercial |
$5.02
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cofinity Commercial |
$6.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$6.48
|
| Rate for Payer: Healthscope Whirlpool |
$6.29
|
| Rate for Payer: Mclaren Commercial |
$5.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.51
|
| Rate for Payer: Nomi Health Commercial |
$5.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.70
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$9.90
|
|
|
Service Code
|
NDC 68094059959
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.43 |
| 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 |
$8.41
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 00904727670
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$4.13
|
| Rate for Payer: Aetna Medicare |
$2.29
|
| Rate for Payer: ASR ASR |
$4.45
|
| Rate for Payer: ASR Commercial |
$4.45
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$3.76
|
| Rate for Payer: BCN Commercial |
$3.56
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Healthscope Whirlpool |
$4.45
|
| Rate for Payer: Mclaren Commercial |
$4.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.02
|
| Rate for Payer: Priority Health Narrow Network |
$3.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.04
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 00904727641
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$4.13
|
| Rate for Payer: Aetna Medicare |
$2.29
|
| Rate for Payer: ASR ASR |
$4.45
|
| Rate for Payer: ASR Commercial |
$4.45
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$3.76
|
| Rate for Payer: BCN Commercial |
$3.56
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Healthscope Whirlpool |
$4.45
|
| Rate for Payer: Mclaren Commercial |
$4.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.02
|
| Rate for Payer: Priority Health Narrow Network |
$3.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.04
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$5.49
|
|
|
Service Code
|
NDC 66689003701
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$5.49 |
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Aetna Medicare |
$2.75
|
| Rate for Payer: ASR ASR |
$5.33
|
| Rate for Payer: ASR Commercial |
$5.33
|
| Rate for Payer: BCBS Complete |
$2.20
|
| Rate for Payer: BCBS Trust/PPO |
$4.50
|
| Rate for Payer: BCN Commercial |
$4.26
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cofinity Commercial |
$5.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.39
|
| Rate for Payer: Healthscope Commercial |
$5.49
|
| Rate for Payer: Healthscope Whirlpool |
$5.33
|
| Rate for Payer: Mclaren Commercial |
$4.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.67
|
| Rate for Payer: Nomi Health Commercial |
$4.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.81
|
| Rate for Payer: Priority Health Narrow Network |
$3.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.83
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$95.76
|
|
|
Service Code
|
NDC 68462031435
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.30 |
| Max. Negotiated Rate |
$95.76 |
| Rate for Payer: Aetna Commercial |
$86.18
|
| Rate for Payer: Aetna Medicare |
$47.88
|
| Rate for Payer: ASR ASR |
$92.89
|
| Rate for Payer: ASR Commercial |
$92.89
|
| Rate for Payer: BCBS Complete |
$38.30
|
| Rate for Payer: BCBS Trust/PPO |
$78.42
|
| Rate for Payer: BCN Commercial |
$74.24
|
| Rate for Payer: Cash Price |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$90.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.61
|
| Rate for Payer: Healthscope Commercial |
$95.76
|
| Rate for Payer: Healthscope Whirlpool |
$92.89
|
| Rate for Payer: Mclaren Commercial |
$86.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: Nomi Health Commercial |
$78.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.90
|
| Rate for Payer: Priority Health Narrow Network |
$67.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.27
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$95.76
|
|
|
Service Code
|
NDC 51672126302
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$95.76 |
| Rate for Payer: Aetna Commercial |
$86.18
|
| Rate for Payer: ASR ASR |
$92.89
|
| Rate for Payer: ASR Commercial |
$92.89
|
| Rate for Payer: BCBS Trust/PPO |
$78.03
|
| Rate for Payer: BCN Commercial |
$74.24
|
| Rate for Payer: Cash Price |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$90.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.61
|
| Rate for Payer: Healthscope Commercial |
$95.76
|
| Rate for Payer: Healthscope Whirlpool |
$92.89
|
| Rate for Payer: Mclaren Commercial |
$86.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: Nomi Health Commercial |
$78.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.27
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$95.76
|
|
|
Service Code
|
NDC 68462031435
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$95.76 |
| Rate for Payer: Aetna Commercial |
$86.18
|
| Rate for Payer: ASR ASR |
$92.89
|
| Rate for Payer: ASR Commercial |
$92.89
|
| Rate for Payer: BCBS Trust/PPO |
$78.03
|
| Rate for Payer: BCN Commercial |
$74.24
|
| Rate for Payer: Cash Price |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$90.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.61
|
| Rate for Payer: Healthscope Commercial |
$95.76
|
| Rate for Payer: Healthscope Whirlpool |
$92.89
|
| Rate for Payer: Mclaren Commercial |
$86.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: Nomi Health Commercial |
$78.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.27
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$95.76
|
|
|
Service Code
|
NDC 51672126302
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.30 |
| Max. Negotiated Rate |
$95.76 |
| Rate for Payer: Aetna Commercial |
$86.18
|
| Rate for Payer: Aetna Medicare |
$47.88
|
| Rate for Payer: ASR ASR |
$92.89
|
| Rate for Payer: ASR Commercial |
$92.89
|
| Rate for Payer: BCBS Complete |
$38.30
|
| Rate for Payer: BCBS Trust/PPO |
$78.42
|
| Rate for Payer: BCN Commercial |
$74.24
|
| Rate for Payer: Cash Price |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$90.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.61
|
| Rate for Payer: Healthscope Commercial |
$95.76
|
| Rate for Payer: Healthscope Whirlpool |
$92.89
|
| Rate for Payer: Mclaren Commercial |
$86.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: Nomi Health Commercial |
$78.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.90
|
| Rate for Payer: Priority Health Narrow Network |
$67.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.27
|
|
|
OB/GYN SPEC KZOO ONLY - NITROUS OXIDE ADMIN
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 00563
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$17.89
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Aetna Commercial |
$16.10
|
| Rate for Payer: Aetna Commercial |
$20.03
|
| Rate for Payer: Aetna Commercial |
$46.40
|
| Rate for Payer: Aetna Commercial |
$18.25
|
| Rate for Payer: Aetna Commercial |
$15.54
|
| Rate for Payer: ASR ASR |
$50.00
|
| Rate for Payer: ASR ASR |
$21.59
|
| Rate for Payer: ASR ASR |
$19.67
|
| Rate for Payer: ASR ASR |
$17.35
|
| Rate for Payer: ASR ASR |
$16.75
|
| Rate for Payer: ASR Commercial |
$19.67
|
| Rate for Payer: ASR Commercial |
$50.00
|
| Rate for Payer: ASR Commercial |
$21.59
|
| Rate for Payer: ASR Commercial |
$17.35
|
| Rate for Payer: ASR Commercial |
$16.75
|
| Rate for Payer: BCBS Trust/PPO |
$42.01
|
| Rate for Payer: BCBS Trust/PPO |
$14.07
|
| Rate for Payer: BCBS Trust/PPO |
$14.58
|
| Rate for Payer: BCBS Trust/PPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$16.53
|
| Rate for Payer: BCN Commercial |
$13.87
|
| Rate for Payer: BCN Commercial |
$39.97
|
| Rate for Payer: BCN Commercial |
$13.39
|
| Rate for Payer: BCN Commercial |
$15.72
|
| Rate for Payer: BCN Commercial |
$17.26
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cash Price |
$41.24
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: Cofinity Commercial |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$19.06
|
| Rate for Payer: Cofinity Commercial |
$16.23
|
| Rate for Payer: Cofinity Commercial |
$20.92
|
| Rate for Payer: Cofinity Commercial |
$48.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$20.28
|
| Rate for Payer: Healthscope Commercial |
$22.26
|
| Rate for Payer: Healthscope Commercial |
$17.89
|
| Rate for Payer: Healthscope Commercial |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$51.55
|
| Rate for Payer: Healthscope Whirlpool |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$16.75
|
| Rate for Payer: Healthscope Whirlpool |
$19.67
|
| Rate for Payer: Healthscope Whirlpool |
$17.35
|
| Rate for Payer: Healthscope Whirlpool |
$21.59
|
| Rate for Payer: Mclaren Commercial |
$16.10
|
| Rate for Payer: Mclaren Commercial |
$18.25
|
| Rate for Payer: Mclaren Commercial |
$15.54
|
| Rate for Payer: Mclaren Commercial |
$20.03
|
| Rate for Payer: Mclaren Commercial |
$46.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.24
|
| Rate for Payer: Nomi Health Commercial |
$16.63
|
| Rate for Payer: Nomi Health Commercial |
$14.16
|
| Rate for Payer: Nomi Health Commercial |
$14.67
|
| Rate for Payer: Nomi Health Commercial |
$42.27
|
| Rate for Payer: Nomi Health Commercial |
$18.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.59
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$17.27
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$17.27 |
| Rate for Payer: Aetna Commercial |
$15.54
|
| Rate for Payer: Aetna Commercial |
$20.03
|
| Rate for Payer: Aetna Commercial |
$46.40
|
| Rate for Payer: Aetna Commercial |
$16.10
|
| Rate for Payer: Aetna Commercial |
$18.25
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: Aetna Medicare |
$10.14
|
| Rate for Payer: Aetna Medicare |
$8.63
|
| Rate for Payer: Aetna Medicare |
$25.77
|
| Rate for Payer: Aetna Medicare |
$11.13
|
| Rate for Payer: ASR ASR |
$50.00
|
| Rate for Payer: ASR ASR |
$19.67
|
| Rate for Payer: ASR ASR |
$16.75
|
| Rate for Payer: ASR ASR |
$21.59
|
| Rate for Payer: ASR ASR |
$17.35
|
| Rate for Payer: ASR Commercial |
$50.00
|
| Rate for Payer: ASR Commercial |
$17.35
|
| Rate for Payer: ASR Commercial |
$19.67
|
| Rate for Payer: ASR Commercial |
$21.59
|
| Rate for Payer: ASR Commercial |
$16.75
|
| Rate for Payer: BCBS Complete |
$20.62
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Complete |
$8.11
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS Complete |
$6.91
|
| Rate for Payer: BCBS Trust/PPO |
$18.23
|
| Rate for Payer: BCBS Trust/PPO |
$14.14
|
| Rate for Payer: BCBS Trust/PPO |
$14.65
|
| Rate for Payer: BCBS Trust/PPO |
$16.61
|
| Rate for Payer: BCBS Trust/PPO |
$42.21
|
| Rate for Payer: BCN Commercial |
$39.97
|
| Rate for Payer: BCN Commercial |
$17.26
|
| Rate for Payer: BCN Commercial |
$13.87
|
| Rate for Payer: BCN Commercial |
$13.39
|
| Rate for Payer: BCN Commercial |
$15.72
|
| Rate for Payer: Cash Price |
$41.24
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: Cofinity Commercial |
$48.46
|
| Rate for Payer: Cofinity Commercial |
$20.92
|
| Rate for Payer: Cofinity Commercial |
$19.06
|
| Rate for Payer: Cofinity Commercial |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$16.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Healthscope Commercial |
$20.28
|
| Rate for Payer: Healthscope Commercial |
$22.26
|
| Rate for Payer: Healthscope Commercial |
$51.55
|
| Rate for Payer: Healthscope Commercial |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$17.89
|
| Rate for Payer: Healthscope Whirlpool |
$21.59
|
| Rate for Payer: Healthscope Whirlpool |
$19.67
|
| Rate for Payer: Healthscope Whirlpool |
$17.35
|
| Rate for Payer: Healthscope Whirlpool |
$16.75
|
| Rate for Payer: Healthscope Whirlpool |
$50.00
|
| Rate for Payer: Mclaren Commercial |
$46.40
|
| Rate for Payer: Mclaren Commercial |
$18.25
|
| Rate for Payer: Mclaren Commercial |
$16.10
|
| Rate for Payer: Mclaren Commercial |
$20.03
|
| Rate for Payer: Mclaren Commercial |
$15.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.82
|
| Rate for Payer: Nomi Health Commercial |
$18.25
|
| Rate for Payer: Nomi Health Commercial |
$16.63
|
| Rate for Payer: Nomi Health Commercial |
$14.16
|
| Rate for Payer: Nomi Health Commercial |
$14.67
|
| Rate for Payer: Nomi Health Commercial |
$42.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.17
|
| Rate for Payer: Priority Health Narrow Network |
$36.14
|
| Rate for Payer: Priority Health Narrow Network |
$15.60
|
| Rate for Payer: Priority Health Narrow Network |
$12.54
|
| Rate for Payer: Priority Health Narrow Network |
$12.11
|
| Rate for Payer: Priority Health Narrow Network |
$14.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.85
|
|
|
OFLOXACIN 0.3 % EAR DROPS
|
Facility
|
IP
|
$58.24
|
|
|
Service Code
|
NDC 60505036301
|
| Hospital Charge Code |
22257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.86 |
| Max. Negotiated Rate |
$58.24 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: ASR ASR |
$56.49
|
| Rate for Payer: ASR Commercial |
$56.49
|
| Rate for Payer: BCBS Trust/PPO |
$47.46
|
| Rate for Payer: BCN Commercial |
$45.15
|
| Rate for Payer: Cash Price |
$46.59
|
| Rate for Payer: Cofinity Commercial |
$54.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.59
|
| Rate for Payer: Healthscope Commercial |
$58.24
|
| Rate for Payer: Healthscope Whirlpool |
$56.49
|
| Rate for Payer: Mclaren Commercial |
$52.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$47.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.25
|
|
|
OFLOXACIN 0.3 % EAR DROPS
|
Facility
|
IP
|
$427.49
|
|
|
Service Code
|
NDC 24208041005
|
| Hospital Charge Code |
22257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.87 |
| Max. Negotiated Rate |
$427.49 |
| Rate for Payer: Aetna Commercial |
$384.74
|
| Rate for Payer: ASR ASR |
$414.67
|
| Rate for Payer: ASR Commercial |
$414.67
|
| Rate for Payer: BCBS Trust/PPO |
$348.36
|
| Rate for Payer: BCN Commercial |
$331.43
|
| Rate for Payer: Cash Price |
$341.99
|
| Rate for Payer: Cofinity Commercial |
$401.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.99
|
| Rate for Payer: Healthscope Commercial |
$427.49
|
| Rate for Payer: Healthscope Whirlpool |
$414.67
|
| Rate for Payer: Mclaren Commercial |
$384.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.37
|
| Rate for Payer: Nomi Health Commercial |
$350.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.19
|
|
|
OFLOXACIN 0.3 % EAR DROPS
|
Facility
|
OP
|
$58.24
|
|
|
Service Code
|
NDC 60505036301
|
| Hospital Charge Code |
22257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$58.24 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Medicare |
$29.12
|
| Rate for Payer: ASR ASR |
$56.49
|
| Rate for Payer: ASR Commercial |
$56.49
|
| Rate for Payer: BCBS Complete |
$23.30
|
| Rate for Payer: BCBS Trust/PPO |
$47.69
|
| Rate for Payer: BCN Commercial |
$45.15
|
| Rate for Payer: Cash Price |
$46.59
|
| Rate for Payer: Cofinity Commercial |
$54.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.59
|
| Rate for Payer: Healthscope Commercial |
$58.24
|
| Rate for Payer: Healthscope Whirlpool |
$56.49
|
| Rate for Payer: Mclaren Commercial |
$52.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$47.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.03
|
| Rate for Payer: Priority Health Narrow Network |
$40.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.25
|
|
|
OFLOXACIN 0.3 % EAR DROPS
|
Facility
|
OP
|
$427.49
|
|
|
Service Code
|
NDC 24208041005
|
| Hospital Charge Code |
22257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$427.49 |
| Rate for Payer: Aetna Commercial |
$384.74
|
| Rate for Payer: Aetna Medicare |
$213.75
|
| Rate for Payer: ASR ASR |
$414.67
|
| Rate for Payer: ASR Commercial |
$414.67
|
| Rate for Payer: BCBS Complete |
$171.00
|
| Rate for Payer: BCBS Trust/PPO |
$350.07
|
| Rate for Payer: BCN Commercial |
$331.43
|
| Rate for Payer: Cash Price |
$341.99
|
| Rate for Payer: Cofinity Commercial |
$401.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.99
|
| Rate for Payer: Healthscope Commercial |
$427.49
|
| Rate for Payer: Healthscope Whirlpool |
$414.67
|
| Rate for Payer: Mclaren Commercial |
$384.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.37
|
| Rate for Payer: Nomi Health Commercial |
$350.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$374.57
|
| Rate for Payer: Priority Health Narrow Network |
$299.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.19
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$48.83
|
|
|
Service Code
|
NDC 70756060730
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna Commercial |
$43.95
|
| Rate for Payer: ASR ASR |
$47.37
|
| Rate for Payer: ASR Commercial |
$47.37
|
| Rate for Payer: BCBS Trust/PPO |
$39.79
|
| Rate for Payer: BCN Commercial |
$37.86
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$45.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$48.83
|
| Rate for Payer: Healthscope Whirlpool |
$47.37
|
| Rate for Payer: Mclaren Commercial |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.51
|
| Rate for Payer: Nomi Health Commercial |
$40.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.97
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$25.34
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$25.34 |
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna Medicare |
$12.67
|
| Rate for Payer: ASR ASR |
$24.58
|
| Rate for Payer: ASR Commercial |
$24.58
|
| Rate for Payer: BCBS Complete |
$10.14
|
| Rate for Payer: BCBS Trust/PPO |
$20.75
|
| Rate for Payer: BCN Commercial |
$19.65
|
| Rate for Payer: Cash Price |
$20.27
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.27
|
| Rate for Payer: Healthscope Commercial |
$25.34
|
| Rate for Payer: Healthscope Whirlpool |
$24.58
|
| Rate for Payer: Mclaren Commercial |
$22.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.54
|
| Rate for Payer: Nomi Health Commercial |
$20.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.20
|
| Rate for Payer: Priority Health Narrow Network |
$17.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.30
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$45.29
|
|
|
Service Code
|
NDC 64980051501
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.44 |
| Max. Negotiated Rate |
$45.29 |
| Rate for Payer: Aetna Commercial |
$40.76
|
| Rate for Payer: ASR ASR |
$43.93
|
| Rate for Payer: ASR Commercial |
$43.93
|
| Rate for Payer: BCBS Trust/PPO |
$36.91
|
| Rate for Payer: BCN Commercial |
$35.11
|
| Rate for Payer: Cash Price |
$36.23
|
| Rate for Payer: Cofinity Commercial |
$42.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.23
|
| Rate for Payer: Healthscope Commercial |
$45.29
|
| Rate for Payer: Healthscope Whirlpool |
$43.93
|
| Rate for Payer: Mclaren Commercial |
$40.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.50
|
| Rate for Payer: Nomi Health Commercial |
$37.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.86
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$66.53
|
|
|
Service Code
|
NDC 24208043405
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.24 |
| Max. Negotiated Rate |
$66.53 |
| Rate for Payer: Aetna Commercial |
$59.88
|
| Rate for Payer: ASR ASR |
$64.53
|
| Rate for Payer: ASR Commercial |
$64.53
|
| Rate for Payer: BCBS Trust/PPO |
$54.22
|
| Rate for Payer: BCN Commercial |
$51.58
|
| Rate for Payer: Cash Price |
$53.23
|
| Rate for Payer: Cofinity Commercial |
$62.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.22
|
| Rate for Payer: Healthscope Commercial |
$66.53
|
| Rate for Payer: Healthscope Whirlpool |
$64.53
|
| Rate for Payer: Mclaren Commercial |
$59.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.55
|
| Rate for Payer: Nomi Health Commercial |
$54.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.55
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$25.34
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$25.34 |
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: ASR ASR |
$24.58
|
| Rate for Payer: ASR Commercial |
$24.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.65
|
| Rate for Payer: BCN Commercial |
$19.65
|
| Rate for Payer: Cash Price |
$20.27
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.27
|
| Rate for Payer: Healthscope Commercial |
$25.34
|
| Rate for Payer: Healthscope Whirlpool |
$24.58
|
| Rate for Payer: Mclaren Commercial |
$22.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.54
|
| Rate for Payer: Nomi Health Commercial |
$20.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.30
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$403.83
|
|
|
Service Code
|
NDC 11980077905
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.53 |
| Max. Negotiated Rate |
$403.83 |
| Rate for Payer: Aetna Commercial |
$363.45
|
| Rate for Payer: Aetna Medicare |
$201.91
|
| Rate for Payer: ASR ASR |
$391.72
|
| Rate for Payer: ASR Commercial |
$391.72
|
| Rate for Payer: BCBS Complete |
$161.53
|
| Rate for Payer: BCBS Trust/PPO |
$330.70
|
| Rate for Payer: BCN Commercial |
$313.09
|
| Rate for Payer: Cash Price |
$323.06
|
| Rate for Payer: Cofinity Commercial |
$379.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.06
|
| Rate for Payer: Healthscope Commercial |
$403.83
|
| Rate for Payer: Healthscope Whirlpool |
$391.72
|
| Rate for Payer: Mclaren Commercial |
$363.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.26
|
| Rate for Payer: Nomi Health Commercial |
$331.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.84
|
| Rate for Payer: Priority Health Narrow Network |
$283.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.37
|
|
