|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
OP
|
$3.13
|
|
|
Service Code
|
NDC 51079087001
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna Medicare |
$1.56
|
| Rate for Payer: ASR ASR |
$3.04
|
| Rate for Payer: ASR Commercial |
$3.04
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: BCBS Trust/PPO |
$2.56
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$3.13
|
| Rate for Payer: Healthscope Whirlpool |
$3.04
|
| Rate for Payer: Mclaren Commercial |
$2.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.66
|
| Rate for Payer: Nomi Health Commercial |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.74
|
| Rate for Payer: Priority Health Narrow Network |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.75
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
OP
|
$320.15
|
|
|
Service Code
|
NDC 00904385461
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.06 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna Commercial |
$288.14
|
| Rate for Payer: Aetna Medicare |
$160.08
|
| Rate for Payer: ASR ASR |
$310.55
|
| Rate for Payer: ASR Commercial |
$310.55
|
| Rate for Payer: BCBS Complete |
$128.06
|
| Rate for Payer: BCBS Trust/PPO |
$262.17
|
| Rate for Payer: BCN Commercial |
$248.21
|
| Rate for Payer: Cash Price |
$256.12
|
| Rate for Payer: Cofinity Commercial |
$300.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.12
|
| Rate for Payer: Healthscope Commercial |
$320.15
|
| Rate for Payer: Healthscope Whirlpool |
$310.55
|
| Rate for Payer: Mclaren Commercial |
$288.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.13
|
| Rate for Payer: Nomi Health Commercial |
$262.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.52
|
| Rate for Payer: Priority Health Narrow Network |
$224.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$281.73
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 75834022101
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.85 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: ASR ASR |
$319.13
|
| Rate for Payer: ASR Commercial |
$319.13
|
| Rate for Payer: BCBS Trust/PPO |
$268.10
|
| Rate for Payer: BCN Commercial |
$255.07
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$309.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$329.00
|
| Rate for Payer: Healthscope Whirlpool |
$319.13
|
| Rate for Payer: Mclaren Commercial |
$296.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.52
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$249.12
|
|
|
Service Code
|
NDC 00904617261
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.93 |
| Max. Negotiated Rate |
$249.12 |
| Rate for Payer: Aetna Commercial |
$224.21
|
| Rate for Payer: ASR ASR |
$241.65
|
| Rate for Payer: ASR Commercial |
$241.65
|
| Rate for Payer: BCBS Trust/PPO |
$203.01
|
| Rate for Payer: BCN Commercial |
$193.14
|
| Rate for Payer: Cash Price |
$199.30
|
| Rate for Payer: Cofinity Commercial |
$234.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.30
|
| Rate for Payer: Healthscope Commercial |
$249.12
|
| Rate for Payer: Healthscope Whirlpool |
$241.65
|
| Rate for Payer: Mclaren Commercial |
$224.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.75
|
| Rate for Payer: Nomi Health Commercial |
$204.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.23
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
OP
|
$249.12
|
|
|
Service Code
|
NDC 00904617261
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.65 |
| Max. Negotiated Rate |
$249.12 |
| Rate for Payer: Aetna Commercial |
$224.21
|
| Rate for Payer: Aetna Medicare |
$124.56
|
| Rate for Payer: ASR ASR |
$241.65
|
| Rate for Payer: ASR Commercial |
$241.65
|
| Rate for Payer: BCBS Complete |
$99.65
|
| Rate for Payer: BCBS Trust/PPO |
$204.00
|
| Rate for Payer: BCN Commercial |
$193.14
|
| Rate for Payer: Cash Price |
$199.30
|
| Rate for Payer: Cofinity Commercial |
$234.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.30
|
| Rate for Payer: Healthscope Commercial |
$249.12
|
| Rate for Payer: Healthscope Whirlpool |
$241.65
|
| Rate for Payer: Mclaren Commercial |
$224.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.75
|
| Rate for Payer: Nomi Health Commercial |
$204.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.28
|
| Rate for Payer: Priority Health Narrow Network |
$174.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.23
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
NDC 75834022101
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.60 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: Aetna Medicare |
$164.50
|
| Rate for Payer: ASR ASR |
$319.13
|
| Rate for Payer: ASR Commercial |
$319.13
|
| Rate for Payer: BCBS Complete |
$131.60
|
| Rate for Payer: BCBS Trust/PPO |
$269.42
|
| Rate for Payer: BCN Commercial |
$255.07
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$309.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$329.00
|
| Rate for Payer: Healthscope Whirlpool |
$319.13
|
| Rate for Payer: Mclaren Commercial |
$296.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.27
|
| Rate for Payer: Priority Health Narrow Network |
$230.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.52
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$347.10
|
|
|
Service Code
|
NDC 60687058321
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.84 |
| Max. Negotiated Rate |
$347.10 |
| Rate for Payer: Aetna Commercial |
$312.39
|
| Rate for Payer: Aetna Medicare |
$173.55
|
| Rate for Payer: ASR ASR |
$336.69
|
| Rate for Payer: ASR Commercial |
$336.69
|
| Rate for Payer: BCBS Complete |
$138.84
|
| Rate for Payer: BCBS Trust/PPO |
$284.24
|
| Rate for Payer: BCN Commercial |
$269.11
|
| Rate for Payer: Cash Price |
$277.68
|
| Rate for Payer: Cofinity Commercial |
$326.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.68
|
| Rate for Payer: Healthscope Commercial |
$347.10
|
| Rate for Payer: Healthscope Whirlpool |
$336.69
|
| Rate for Payer: Mclaren Commercial |
$312.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.04
|
| Rate for Payer: Nomi Health Commercial |
$284.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.13
|
| Rate for Payer: Priority Health Narrow Network |
$243.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.45
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$347.10
|
|
|
Service Code
|
NDC 60687058321
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.62 |
| Max. Negotiated Rate |
$347.10 |
| Rate for Payer: Aetna Commercial |
$312.39
|
| Rate for Payer: ASR ASR |
$336.69
|
| Rate for Payer: ASR Commercial |
$336.69
|
| Rate for Payer: BCBS Trust/PPO |
$282.85
|
| Rate for Payer: BCN Commercial |
$269.11
|
| Rate for Payer: Cash Price |
$277.68
|
| Rate for Payer: Cofinity Commercial |
$326.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.68
|
| Rate for Payer: Healthscope Commercial |
$347.10
|
| Rate for Payer: Healthscope Whirlpool |
$336.69
|
| Rate for Payer: Mclaren Commercial |
$312.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.04
|
| Rate for Payer: Nomi Health Commercial |
$284.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.45
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$11.57
|
|
|
Service Code
|
NDC 60687058311
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$11.57 |
| Rate for Payer: Aetna Commercial |
$10.41
|
| Rate for Payer: ASR ASR |
$11.22
|
| Rate for Payer: ASR Commercial |
$11.22
|
| Rate for Payer: BCBS Trust/PPO |
$9.43
|
| Rate for Payer: BCN Commercial |
$8.97
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$10.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.26
|
| Rate for Payer: Healthscope Commercial |
$11.57
|
| Rate for Payer: Healthscope Whirlpool |
$11.22
|
| Rate for Payer: Mclaren Commercial |
$10.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.83
|
| Rate for Payer: Nomi Health Commercial |
$9.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.18
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$11.57
|
|
|
Service Code
|
NDC 60687058311
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$11.57 |
| Rate for Payer: Aetna Commercial |
$10.41
|
| Rate for Payer: Aetna Medicare |
$5.78
|
| Rate for Payer: ASR ASR |
$11.22
|
| Rate for Payer: ASR Commercial |
$11.22
|
| Rate for Payer: BCBS Complete |
$4.63
|
| Rate for Payer: BCBS Trust/PPO |
$9.47
|
| Rate for Payer: BCN Commercial |
$8.97
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$10.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.26
|
| Rate for Payer: Healthscope Commercial |
$11.57
|
| Rate for Payer: Healthscope Whirlpool |
$11.22
|
| Rate for Payer: Mclaren Commercial |
$10.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.83
|
| Rate for Payer: Nomi Health Commercial |
$9.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.14
|
| Rate for Payer: Priority Health Narrow Network |
$8.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.18
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$10.33
|
|
|
Service Code
|
NDC 23558076501
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$10.33 |
| Rate for Payer: Aetna Commercial |
$9.30
|
| Rate for Payer: ASR ASR |
$10.02
|
| Rate for Payer: ASR Commercial |
$10.02
|
| Rate for Payer: BCBS Trust/PPO |
$8.42
|
| Rate for Payer: BCN Commercial |
$8.01
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$10.33
|
| Rate for Payer: Healthscope Whirlpool |
$10.02
|
| Rate for Payer: Mclaren Commercial |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.78
|
| Rate for Payer: Nomi Health Commercial |
$8.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.09
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$22.36
|
|
|
Service Code
|
NDC 42037010478
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna Commercial |
$20.12
|
| Rate for Payer: Aetna Medicare |
$11.18
|
| Rate for Payer: ASR ASR |
$21.69
|
| Rate for Payer: ASR Commercial |
$21.69
|
| Rate for Payer: BCBS Complete |
$8.94
|
| Rate for Payer: BCBS Trust/PPO |
$18.31
|
| Rate for Payer: BCN Commercial |
$17.34
|
| Rate for Payer: Cash Price |
$17.89
|
| Rate for Payer: Cofinity Commercial |
$21.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.89
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Healthscope Whirlpool |
$21.69
|
| Rate for Payer: Mclaren Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.01
|
| Rate for Payer: Nomi Health Commercial |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.59
|
| Rate for Payer: Priority Health Narrow Network |
$15.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.68
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$9.45
|
|
|
Service Code
|
NDC 00904662735
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna Commercial |
$8.50
|
| 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 |
$8.50
|
| 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
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$22.75
|
|
|
Service Code
|
NDC 78112073623
|
| Hospital Charge Code |
1359
|
|
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 |
$21.38
|
| 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
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$9.45
|
|
|
Service Code
|
NDC 00904662735
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna Commercial |
$8.50
|
| 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 |
$8.50
|
| 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
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$10.12
|
|
|
Service Code
|
NDC 70000049001
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: Aetna Medicare |
$5.06
|
| Rate for Payer: ASR ASR |
$9.82
|
| Rate for Payer: ASR Commercial |
$9.82
|
| Rate for Payer: BCBS Complete |
$4.05
|
| Rate for Payer: BCBS Trust/PPO |
$8.29
|
| Rate for Payer: BCN Commercial |
$7.85
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cofinity Commercial |
$9.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$10.12
|
| Rate for Payer: Healthscope Whirlpool |
$9.82
|
| Rate for Payer: Mclaren Commercial |
$9.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.60
|
| Rate for Payer: Nomi Health Commercial |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.87
|
| Rate for Payer: Priority Health Narrow Network |
$7.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.91
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$10.12
|
|
|
Service Code
|
NDC 70000049001
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: ASR ASR |
$9.82
|
| Rate for Payer: ASR Commercial |
$9.82
|
| Rate for Payer: BCBS Trust/PPO |
$8.25
|
| Rate for Payer: BCN Commercial |
$7.85
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cofinity Commercial |
$9.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$10.12
|
| Rate for Payer: Healthscope Whirlpool |
$9.82
|
| Rate for Payer: Mclaren Commercial |
$9.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.60
|
| Rate for Payer: Nomi Health Commercial |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.91
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$10.33
|
|
|
Service Code
|
NDC 23558076501
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$10.33 |
| Rate for Payer: Aetna Commercial |
$9.30
|
| Rate for Payer: Aetna Medicare |
$5.16
|
| Rate for Payer: ASR ASR |
$10.02
|
| Rate for Payer: ASR Commercial |
$10.02
|
| Rate for Payer: BCBS Complete |
$4.13
|
| Rate for Payer: BCBS Trust/PPO |
$8.46
|
| Rate for Payer: BCN Commercial |
$8.01
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$10.33
|
| Rate for Payer: Healthscope Whirlpool |
$10.02
|
| Rate for Payer: Mclaren Commercial |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.78
|
| Rate for Payer: Nomi Health Commercial |
$8.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.05
|
| Rate for Payer: Priority Health Narrow Network |
$7.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.09
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$22.36
|
|
|
Service Code
|
NDC 42037010478
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna Commercial |
$20.12
|
| Rate for Payer: ASR ASR |
$21.69
|
| Rate for Payer: ASR Commercial |
$21.69
|
| Rate for Payer: BCBS Trust/PPO |
$18.22
|
| Rate for Payer: BCN Commercial |
$17.34
|
| Rate for Payer: Cash Price |
$17.89
|
| Rate for Payer: Cofinity Commercial |
$21.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.89
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Healthscope Whirlpool |
$21.69
|
| Rate for Payer: Mclaren Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.01
|
| Rate for Payer: Nomi Health Commercial |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.68
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$22.75
|
|
|
Service Code
|
NDC 78112073623
|
| Hospital Charge Code |
1359
|
|
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 |
$21.38
|
| 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
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$190.35
|
|
|
Service Code
|
NDC 00228253910
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.14 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$171.32
|
| Rate for Payer: Aetna Medicare |
$95.18
|
| Rate for Payer: ASR ASR |
$184.64
|
| Rate for Payer: ASR Commercial |
$184.64
|
| Rate for Payer: BCBS Complete |
$76.14
|
| Rate for Payer: BCBS Trust/PPO |
$155.88
|
| Rate for Payer: BCN Commercial |
$147.58
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$178.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Healthscope Whirlpool |
$184.64
|
| Rate for Payer: Mclaren Commercial |
$171.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.78
|
| Rate for Payer: Priority Health Narrow Network |
$133.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.51
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 00904623761
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.85 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: ASR ASR |
$319.13
|
| Rate for Payer: ASR Commercial |
$319.13
|
| Rate for Payer: BCBS Trust/PPO |
$268.10
|
| Rate for Payer: BCN Commercial |
$255.07
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$309.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$329.00
|
| Rate for Payer: Healthscope Whirlpool |
$319.13
|
| Rate for Payer: Mclaren Commercial |
$296.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.52
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
NDC 00904623761
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.60 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: Aetna Medicare |
$164.50
|
| Rate for Payer: ASR ASR |
$319.13
|
| Rate for Payer: ASR Commercial |
$319.13
|
| Rate for Payer: BCBS Complete |
$131.60
|
| Rate for Payer: BCBS Trust/PPO |
$269.42
|
| Rate for Payer: BCN Commercial |
$255.07
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$309.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$329.00
|
| Rate for Payer: Healthscope Whirlpool |
$319.13
|
| Rate for Payer: Mclaren Commercial |
$296.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.27
|
| Rate for Payer: Priority Health Narrow Network |
$230.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.52
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$359.55
|
|
|
Service Code
|
NDC 00904725761
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.82 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: Aetna Medicare |
$179.78
|
| Rate for Payer: ASR ASR |
$348.76
|
| Rate for Payer: ASR Commercial |
$348.76
|
| Rate for Payer: BCBS Complete |
$143.82
|
| Rate for Payer: BCBS Trust/PPO |
$294.44
|
| Rate for Payer: BCN Commercial |
$278.76
|
| Rate for Payer: Cash Price |
$287.64
|
| Rate for Payer: Cofinity Commercial |
$337.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.64
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: Healthscope Whirlpool |
$348.76
|
| Rate for Payer: Mclaren Commercial |
$323.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.62
|
| Rate for Payer: Nomi Health Commercial |
$294.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$315.04
|
| Rate for Payer: Priority Health Narrow Network |
$252.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.40
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$202.35
|
|
|
Service Code
|
NDC 68084009301
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.53 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Aetna Commercial |
$182.12
|
| Rate for Payer: ASR ASR |
$196.28
|
| Rate for Payer: ASR Commercial |
$196.28
|
| Rate for Payer: BCBS Trust/PPO |
$164.90
|
| Rate for Payer: BCN Commercial |
$156.88
|
| Rate for Payer: Cash Price |
$161.88
|
| Rate for Payer: Cofinity Commercial |
$190.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.88
|
| Rate for Payer: Healthscope Commercial |
$202.35
|
| Rate for Payer: Healthscope Whirlpool |
$196.28
|
| Rate for Payer: Mclaren Commercial |
$182.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.00
|
| Rate for Payer: Nomi Health Commercial |
$165.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.07
|
|
