|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
NDC 68084035501
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$414.05 |
| Max. Negotiated Rate |
$637.00 |
| Rate for Payer: Aetna Commercial |
$573.30
|
| Rate for Payer: ASR ASR |
$617.89
|
| Rate for Payer: ASR Commercial |
$617.89
|
| Rate for Payer: BCBS Trust/PPO |
$519.09
|
| Rate for Payer: BCN Commercial |
$493.87
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Cofinity Commercial |
$598.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.60
|
| Rate for Payer: Healthscope Commercial |
$637.00
|
| Rate for Payer: Healthscope Whirlpool |
$617.89
|
| Rate for Payer: Mclaren Commercial |
$573.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.45
|
| Rate for Payer: Nomi Health Commercial |
$522.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$560.56
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
NDC 68084035511
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$414.05 |
| Max. Negotiated Rate |
$637.00 |
| Rate for Payer: Aetna Commercial |
$573.30
|
| Rate for Payer: ASR ASR |
$617.89
|
| Rate for Payer: ASR Commercial |
$617.89
|
| Rate for Payer: BCBS Trust/PPO |
$519.09
|
| Rate for Payer: BCN Commercial |
$493.87
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Cofinity Commercial |
$598.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.60
|
| Rate for Payer: Healthscope Commercial |
$637.00
|
| Rate for Payer: Healthscope Whirlpool |
$617.89
|
| Rate for Payer: Mclaren Commercial |
$573.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.45
|
| Rate for Payer: Nomi Health Commercial |
$522.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$560.56
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$6.53
|
|
|
Service Code
|
NDC 00406051223
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$6.53 |
| Rate for Payer: Aetna Commercial |
$5.88
|
| Rate for Payer: ASR ASR |
$6.33
|
| Rate for Payer: ASR Commercial |
$6.33
|
| Rate for Payer: BCBS Trust/PPO |
$5.32
|
| Rate for Payer: BCN Commercial |
$5.06
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cofinity Commercial |
$6.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$6.53
|
| Rate for Payer: Healthscope Whirlpool |
$6.33
|
| Rate for Payer: Mclaren Commercial |
$5.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.55
|
| Rate for Payer: Nomi Health Commercial |
$5.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.75
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$6.53
|
|
|
Service Code
|
NDC 00406051223
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$6.53 |
| Rate for Payer: Aetna Commercial |
$5.88
|
| Rate for Payer: Aetna Medicare |
$3.27
|
| Rate for Payer: ASR ASR |
$6.33
|
| Rate for Payer: ASR Commercial |
$6.33
|
| Rate for Payer: BCBS Complete |
$2.61
|
| Rate for Payer: BCBS Trust/PPO |
$5.35
|
| Rate for Payer: BCN Commercial |
$5.06
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cofinity Commercial |
$6.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$6.53
|
| Rate for Payer: Healthscope Whirlpool |
$6.33
|
| Rate for Payer: Mclaren Commercial |
$5.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.55
|
| Rate for Payer: Nomi Health Commercial |
$5.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.72
|
| Rate for Payer: Priority Health Narrow Network |
$4.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.75
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$4.13
|
|
|
Service Code
|
NDC 09900000890
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: ASR ASR |
$4.01
|
| Rate for Payer: ASR Commercial |
$4.01
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.20
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Healthscope Whirlpool |
$4.01
|
| Rate for Payer: Mclaren Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.51
|
| Rate for Payer: Nomi Health Commercial |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.63
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$421.98
|
|
|
Service Code
|
NDC 59011041020
|
| Hospital Charge Code |
173651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.79 |
| Max. Negotiated Rate |
$421.98 |
| Rate for Payer: Aetna Commercial |
$379.78
|
| Rate for Payer: Aetna Medicare |
$210.99
|
| Rate for Payer: ASR ASR |
$409.32
|
| Rate for Payer: ASR Commercial |
$409.32
|
| Rate for Payer: BCBS Complete |
$168.79
|
| Rate for Payer: BCBS Trust/PPO |
$345.56
|
| Rate for Payer: BCN Commercial |
$327.16
|
| Rate for Payer: Cash Price |
$337.58
|
| Rate for Payer: Cofinity Commercial |
$396.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.58
|
| Rate for Payer: Healthscope Commercial |
$421.98
|
| Rate for Payer: Healthscope Whirlpool |
$409.32
|
| Rate for Payer: Mclaren Commercial |
$379.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.68
|
| Rate for Payer: Nomi Health Commercial |
$346.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.74
|
| Rate for Payer: Priority Health Narrow Network |
$295.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.34
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$421.98
|
|
|
Service Code
|
NDC 59011041020
|
| Hospital Charge Code |
173651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$274.29 |
| Max. Negotiated Rate |
$421.98 |
| Rate for Payer: Aetna Commercial |
$379.78
|
| Rate for Payer: ASR ASR |
$409.32
|
| Rate for Payer: ASR Commercial |
$409.32
|
| Rate for Payer: BCBS Trust/PPO |
$343.87
|
| Rate for Payer: BCN Commercial |
$327.16
|
| Rate for Payer: Cash Price |
$337.58
|
| Rate for Payer: Cofinity Commercial |
$396.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.58
|
| Rate for Payer: Healthscope Commercial |
$421.98
|
| Rate for Payer: Healthscope Whirlpool |
$409.32
|
| Rate for Payer: Mclaren Commercial |
$379.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.68
|
| Rate for Payer: Nomi Health Commercial |
$346.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.34
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$665.15
|
|
|
Service Code
|
NDC 59011042020
|
| Hospital Charge Code |
173653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.06 |
| Max. Negotiated Rate |
$665.15 |
| Rate for Payer: Aetna Commercial |
$598.63
|
| Rate for Payer: Aetna Medicare |
$332.57
|
| Rate for Payer: ASR ASR |
$645.20
|
| Rate for Payer: ASR Commercial |
$645.20
|
| Rate for Payer: BCBS Complete |
$266.06
|
| Rate for Payer: BCBS Trust/PPO |
$544.69
|
| Rate for Payer: BCN Commercial |
$515.69
|
| Rate for Payer: Cash Price |
$532.12
|
| Rate for Payer: Cofinity Commercial |
$625.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.12
|
| Rate for Payer: Healthscope Commercial |
$665.15
|
| Rate for Payer: Healthscope Whirlpool |
$645.20
|
| Rate for Payer: Mclaren Commercial |
$598.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$565.38
|
| Rate for Payer: Nomi Health Commercial |
$545.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$582.80
|
| Rate for Payer: Priority Health Narrow Network |
$466.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$585.33
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$665.15
|
|
|
Service Code
|
NDC 59011042020
|
| Hospital Charge Code |
173653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$432.35 |
| Max. Negotiated Rate |
$665.15 |
| Rate for Payer: Aetna Commercial |
$598.63
|
| Rate for Payer: ASR ASR |
$645.20
|
| Rate for Payer: ASR Commercial |
$645.20
|
| Rate for Payer: BCBS Trust/PPO |
$542.03
|
| Rate for Payer: BCN Commercial |
$515.69
|
| Rate for Payer: Cash Price |
$532.12
|
| Rate for Payer: Cofinity Commercial |
$625.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.12
|
| Rate for Payer: Healthscope Commercial |
$665.15
|
| Rate for Payer: Healthscope Whirlpool |
$645.20
|
| Rate for Payer: Mclaren Commercial |
$598.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$565.38
|
| Rate for Payer: Nomi Health Commercial |
$545.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$585.33
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$24.84
|
|
|
Service Code
|
NDC 23900001252
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna Commercial |
$22.36
|
| Rate for Payer: Aetna Medicare |
$12.42
|
| Rate for Payer: ASR ASR |
$24.09
|
| Rate for Payer: ASR Commercial |
$24.09
|
| Rate for Payer: BCBS Complete |
$9.94
|
| Rate for Payer: BCBS Trust/PPO |
$20.34
|
| Rate for Payer: BCN Commercial |
$19.26
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$23.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$24.84
|
| Rate for Payer: Healthscope Whirlpool |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: Nomi Health Commercial |
$20.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.76
|
| Rate for Payer: Priority Health Narrow Network |
$17.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.86
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$22.75
|
|
|
Service Code
|
NDC 50024043100
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.79 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: ASR ASR |
$22.07
|
| Rate for Payer: ASR Commercial |
$22.07
|
| Rate for Payer: BCBS Trust/PPO |
$18.54
|
| Rate for Payer: BCN Commercial |
$17.64
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$21.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.20
|
| Rate for Payer: Healthscope Commercial |
$22.75
|
| Rate for Payer: Healthscope Whirlpool |
$22.07
|
| Rate for Payer: Mclaren Commercial |
$20.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.34
|
| Rate for Payer: Nomi Health Commercial |
$18.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.02
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$27.14
|
|
|
Service Code
|
NDC 41100081123
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$27.14 |
| Rate for Payer: Aetna Commercial |
$24.43
|
| Rate for Payer: Aetna Medicare |
$13.57
|
| Rate for Payer: ASR ASR |
$26.33
|
| Rate for Payer: ASR Commercial |
$26.33
|
| Rate for Payer: BCBS Complete |
$10.86
|
| Rate for Payer: BCBS Trust/PPO |
$22.22
|
| Rate for Payer: BCN Commercial |
$21.04
|
| Rate for Payer: Cash Price |
$21.71
|
| Rate for Payer: Cofinity Commercial |
$25.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.71
|
| Rate for Payer: Healthscope Commercial |
$27.14
|
| Rate for Payer: Healthscope Whirlpool |
$26.33
|
| Rate for Payer: Mclaren Commercial |
$24.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.07
|
| Rate for Payer: Nomi Health Commercial |
$22.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.78
|
| Rate for Payer: Priority Health Narrow Network |
$19.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.88
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$10.53
|
|
|
Service Code
|
NDC 00904700635
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna Commercial |
$9.48
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: ASR ASR |
$10.21
|
| Rate for Payer: ASR Commercial |
$10.21
|
| Rate for Payer: BCBS Complete |
$4.21
|
| Rate for Payer: BCBS Trust/PPO |
$8.62
|
| Rate for Payer: BCN Commercial |
$8.16
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Healthscope Whirlpool |
$10.21
|
| Rate for Payer: Mclaren Commercial |
$9.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.95
|
| Rate for Payer: Nomi Health Commercial |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.23
|
| Rate for Payer: Priority Health Narrow Network |
$7.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.27
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$27.14
|
|
|
Service Code
|
NDC 41100081123
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$27.14 |
| Rate for Payer: Aetna Commercial |
$24.43
|
| Rate for Payer: ASR ASR |
$26.33
|
| Rate for Payer: ASR Commercial |
$26.33
|
| Rate for Payer: BCBS Trust/PPO |
$22.12
|
| Rate for Payer: BCN Commercial |
$21.04
|
| Rate for Payer: Cash Price |
$21.71
|
| Rate for Payer: Cofinity Commercial |
$25.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.71
|
| Rate for Payer: Healthscope Commercial |
$27.14
|
| Rate for Payer: Healthscope Whirlpool |
$26.33
|
| Rate for Payer: Mclaren Commercial |
$24.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.07
|
| Rate for Payer: Nomi Health Commercial |
$22.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.88
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$28.30
|
|
|
Service Code
|
NDC 41100081127
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.32 |
| Max. Negotiated Rate |
$28.30 |
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: Aetna Medicare |
$14.15
|
| Rate for Payer: ASR ASR |
$27.45
|
| Rate for Payer: ASR Commercial |
$27.45
|
| Rate for Payer: BCBS Complete |
$11.32
|
| Rate for Payer: BCBS Trust/PPO |
$23.17
|
| Rate for Payer: BCN Commercial |
$21.94
|
| Rate for Payer: Cash Price |
$22.64
|
| Rate for Payer: Cofinity Commercial |
$26.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.64
|
| Rate for Payer: Healthscope Commercial |
$28.30
|
| Rate for Payer: Healthscope Whirlpool |
$27.45
|
| Rate for Payer: Mclaren Commercial |
$25.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.05
|
| Rate for Payer: Nomi Health Commercial |
$23.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.80
|
| Rate for Payer: Priority Health Narrow Network |
$19.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.90
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$28.30
|
|
|
Service Code
|
NDC 41100081127
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$28.30 |
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: ASR ASR |
$27.45
|
| Rate for Payer: ASR Commercial |
$27.45
|
| Rate for Payer: BCBS Trust/PPO |
$23.06
|
| Rate for Payer: BCN Commercial |
$21.94
|
| Rate for Payer: Cash Price |
$22.64
|
| Rate for Payer: Cofinity Commercial |
$26.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.64
|
| Rate for Payer: Healthscope Commercial |
$28.30
|
| Rate for Payer: Healthscope Whirlpool |
$27.45
|
| Rate for Payer: Mclaren Commercial |
$25.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.05
|
| Rate for Payer: Nomi Health Commercial |
$23.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.90
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$11.34
|
|
|
Service Code
|
NDC 00904743535
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$11.34 |
| Rate for Payer: Aetna Commercial |
$10.21
|
| Rate for Payer: ASR ASR |
$11.00
|
| Rate for Payer: ASR Commercial |
$11.00
|
| Rate for Payer: BCBS Trust/PPO |
$9.24
|
| Rate for Payer: BCN Commercial |
$8.79
|
| Rate for Payer: Cash Price |
$9.07
|
| Rate for Payer: Cofinity Commercial |
$10.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.07
|
| Rate for Payer: Healthscope Commercial |
$11.34
|
| Rate for Payer: Healthscope Whirlpool |
$11.00
|
| Rate for Payer: Mclaren Commercial |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.64
|
| Rate for Payer: Nomi Health Commercial |
$9.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.98
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$9.45
|
|
|
Service Code
|
NDC 00904676130
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna Commercial |
$8.51
|
| Rate for Payer: Aetna Medicare |
$4.72
|
| Rate for Payer: ASR ASR |
$9.17
|
| Rate for Payer: ASR Commercial |
$9.17
|
| Rate for Payer: BCBS Complete |
$3.78
|
| Rate for Payer: BCBS Trust/PPO |
$7.74
|
| Rate for Payer: BCN Commercial |
$7.33
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$9.45
|
| Rate for Payer: Healthscope Whirlpool |
$9.17
|
| Rate for Payer: Mclaren Commercial |
$8.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: Nomi Health Commercial |
$7.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.28
|
| Rate for Payer: Priority Health Narrow Network |
$6.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.32
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$22.75
|
|
|
Service Code
|
NDC 50024043100
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Medicare |
$11.38
|
| Rate for Payer: ASR ASR |
$22.07
|
| Rate for Payer: ASR Commercial |
$22.07
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.63
|
| Rate for Payer: BCN Commercial |
$17.64
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$21.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.20
|
| Rate for Payer: Healthscope Commercial |
$22.75
|
| Rate for Payer: Healthscope Whirlpool |
$22.07
|
| Rate for Payer: Mclaren Commercial |
$20.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.34
|
| Rate for Payer: Nomi Health Commercial |
$18.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.93
|
| Rate for Payer: Priority Health Narrow Network |
$15.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.02
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 23900001252
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna Commercial |
$22.36
|
| Rate for Payer: ASR ASR |
$24.09
|
| Rate for Payer: ASR Commercial |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$20.24
|
| Rate for Payer: BCN Commercial |
$19.26
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$23.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$24.84
|
| Rate for Payer: Healthscope Whirlpool |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: Nomi Health Commercial |
$20.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.86
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$10.53
|
|
|
Service Code
|
NDC 00904700635
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna Commercial |
$9.48
|
| Rate for Payer: ASR ASR |
$10.21
|
| Rate for Payer: ASR Commercial |
$10.21
|
| Rate for Payer: BCBS Trust/PPO |
$8.58
|
| Rate for Payer: BCN Commercial |
$8.16
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Healthscope Whirlpool |
$10.21
|
| Rate for Payer: Mclaren Commercial |
$9.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.95
|
| Rate for Payer: Nomi Health Commercial |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.27
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$11.34
|
|
|
Service Code
|
NDC 00904743535
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$11.34 |
| Rate for Payer: Aetna Commercial |
$10.21
|
| Rate for Payer: Aetna Medicare |
$5.67
|
| Rate for Payer: ASR ASR |
$11.00
|
| Rate for Payer: ASR Commercial |
$11.00
|
| Rate for Payer: BCBS Complete |
$4.54
|
| Rate for Payer: BCBS Trust/PPO |
$9.29
|
| Rate for Payer: BCN Commercial |
$8.79
|
| Rate for Payer: Cash Price |
$9.07
|
| Rate for Payer: Cofinity Commercial |
$10.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.07
|
| Rate for Payer: Healthscope Commercial |
$11.34
|
| Rate for Payer: Healthscope Whirlpool |
$11.00
|
| Rate for Payer: Mclaren Commercial |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.64
|
| Rate for Payer: Nomi Health Commercial |
$9.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.94
|
| Rate for Payer: Priority Health Narrow Network |
$7.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.98
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$9.45
|
|
|
Service Code
|
NDC 00904676130
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna Commercial |
$8.51
|
| Rate for Payer: ASR ASR |
$9.17
|
| Rate for Payer: ASR Commercial |
$9.17
|
| Rate for Payer: BCBS Trust/PPO |
$7.70
|
| Rate for Payer: BCN Commercial |
$7.33
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$9.45
|
| Rate for Payer: Healthscope Whirlpool |
$9.17
|
| Rate for Payer: Mclaren Commercial |
$8.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: Nomi Health Commercial |
$7.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.32
|
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$13.22
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
5944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$13.22 |
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna Commercial |
$22.30
|
| Rate for Payer: Aetna Medicare |
$6.61
|
| Rate for Payer: Aetna Medicare |
$12.39
|
| Rate for Payer: ASR ASR |
$12.82
|
| Rate for Payer: ASR ASR |
$24.04
|
| Rate for Payer: ASR Commercial |
$24.04
|
| Rate for Payer: ASR Commercial |
$12.82
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: BCBS Complete |
$9.91
|
| Rate for Payer: BCBS Trust/PPO |
$10.83
|
| Rate for Payer: BCBS Trust/PPO |
$20.29
|
| Rate for Payer: BCN Commercial |
$19.21
|
| Rate for Payer: BCN Commercial |
$10.25
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cofinity Commercial |
$12.43
|
| Rate for Payer: Cofinity Commercial |
$23.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Healthscope Commercial |
$13.22
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Whirlpool |
$12.82
|
| Rate for Payer: Healthscope Whirlpool |
$24.04
|
| Rate for Payer: Mclaren Commercial |
$11.90
|
| Rate for Payer: Mclaren Commercial |
$22.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.24
|
| Rate for Payer: Nomi Health Commercial |
$10.84
|
| Rate for Payer: Nomi Health Commercial |
$20.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.71
|
| Rate for Payer: Priority Health Narrow Network |
$17.37
|
| Rate for Payer: Priority Health Narrow Network |
$9.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.63
|
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.78
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
5944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna Commercial |
$22.30
|
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: ASR ASR |
$12.82
|
| Rate for Payer: ASR ASR |
$24.04
|
| Rate for Payer: ASR Commercial |
$12.82
|
| Rate for Payer: ASR Commercial |
$24.04
|
| Rate for Payer: BCBS Trust/PPO |
$10.77
|
| Rate for Payer: BCBS Trust/PPO |
$20.19
|
| Rate for Payer: BCN Commercial |
$19.21
|
| Rate for Payer: BCN Commercial |
$10.25
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$12.43
|
| Rate for Payer: Cofinity Commercial |
$23.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Healthscope Commercial |
$13.22
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Whirlpool |
$24.04
|
| Rate for Payer: Healthscope Whirlpool |
$12.82
|
| Rate for Payer: Mclaren Commercial |
$11.90
|
| Rate for Payer: Mclaren Commercial |
$22.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.24
|
| Rate for Payer: Nomi Health Commercial |
$20.32
|
| Rate for Payer: Nomi Health Commercial |
$10.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.81
|
|
