|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 51079010301
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: Aetna Medicare |
$1.94
|
| Rate for Payer: ASR ASR |
$3.76
|
| Rate for Payer: ASR Commercial |
$3.76
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: BCBS Trust/PPO |
$3.18
|
| Rate for Payer: BCN Commercial |
$3.01
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.88
|
| Rate for Payer: Healthscope Whirlpool |
$3.76
|
| Rate for Payer: Mclaren Commercial |
$3.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Nomi Health Commercial |
$3.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.40
|
| Rate for Payer: Priority Health Narrow Network |
$2.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.41
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
NDC 63739054410
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.30 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: ASR ASR |
$273.54
|
| Rate for Payer: ASR Commercial |
$273.54
|
| Rate for Payer: BCBS Trust/PPO |
$229.80
|
| Rate for Payer: BCN Commercial |
$218.63
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$265.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$282.00
|
| Rate for Payer: Healthscope Whirlpool |
$273.54
|
| Rate for Payer: Mclaren Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Nomi Health Commercial |
$231.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.16
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$253.80
|
|
|
Service Code
|
NDC 00904692761
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.97 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$228.42
|
| Rate for Payer: ASR ASR |
$246.19
|
| Rate for Payer: ASR Commercial |
$246.19
|
| Rate for Payer: BCBS Trust/PPO |
$206.82
|
| Rate for Payer: BCN Commercial |
$196.77
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$238.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Healthscope Whirlpool |
$246.19
|
| Rate for Payer: Mclaren Commercial |
$228.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Nomi Health Commercial |
$208.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.34
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$253.80
|
|
|
Service Code
|
NDC 00904692761
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.52 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$228.42
|
| Rate for Payer: Aetna Medicare |
$126.90
|
| Rate for Payer: ASR ASR |
$246.19
|
| Rate for Payer: ASR Commercial |
$246.19
|
| Rate for Payer: BCBS Complete |
$101.52
|
| Rate for Payer: BCBS Trust/PPO |
$207.84
|
| Rate for Payer: BCN Commercial |
$196.77
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$238.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Healthscope Whirlpool |
$246.19
|
| Rate for Payer: Mclaren Commercial |
$228.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Nomi Health Commercial |
$208.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.38
|
| Rate for Payer: Priority Health Narrow Network |
$177.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.34
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
NDC 63739054410
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: Aetna Medicare |
$141.00
|
| Rate for Payer: ASR ASR |
$273.54
|
| Rate for Payer: ASR Commercial |
$273.54
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: BCBS Trust/PPO |
$230.93
|
| Rate for Payer: BCN Commercial |
$218.63
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$265.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$282.00
|
| Rate for Payer: Healthscope Whirlpool |
$273.54
|
| Rate for Payer: Mclaren Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Nomi Health Commercial |
$231.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.09
|
| Rate for Payer: Priority Health Narrow Network |
$197.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.16
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$79.34
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
163722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.57 |
| Max. Negotiated Rate |
$79.34 |
| Rate for Payer: Aetna Commercial |
$71.41
|
| Rate for Payer: ASR ASR |
$76.96
|
| Rate for Payer: ASR Commercial |
$76.96
|
| Rate for Payer: BCBS Trust/PPO |
$64.65
|
| Rate for Payer: BCN Commercial |
$61.51
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cofinity Commercial |
$74.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.47
|
| Rate for Payer: Healthscope Commercial |
$79.34
|
| Rate for Payer: Healthscope Whirlpool |
$76.96
|
| Rate for Payer: Mclaren Commercial |
$71.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.44
|
| Rate for Payer: Nomi Health Commercial |
$65.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.82
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION (CODE)
|
Facility
|
OP
|
$79.34
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
163722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$79.34 |
| Rate for Payer: Aetna Commercial |
$71.41
|
| Rate for Payer: Aetna Medicare |
$39.67
|
| Rate for Payer: ASR ASR |
$76.96
|
| Rate for Payer: ASR Commercial |
$76.96
|
| Rate for Payer: BCBS Complete |
$31.74
|
| Rate for Payer: BCBS Trust/PPO |
$64.97
|
| Rate for Payer: BCN Commercial |
$61.51
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cofinity Commercial |
$74.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.47
|
| Rate for Payer: Healthscope Commercial |
$79.34
|
| Rate for Payer: Healthscope Whirlpool |
$76.96
|
| Rate for Payer: Mclaren Commercial |
$71.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.44
|
| Rate for Payer: Nomi Health Commercial |
$65.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Narrow Network |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.82
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.79
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
7536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna Commercial |
$22.31
|
| Rate for Payer: Aetna Commercial |
$18.26
|
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Commercial |
$71.41
|
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: ASR ASR |
$26.63
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: ASR ASR |
$76.96
|
| Rate for Payer: ASR ASR |
$24.05
|
| Rate for Payer: ASR ASR |
$19.68
|
| Rate for Payer: ASR ASR |
$18.26
|
| Rate for Payer: ASR Commercial |
$76.96
|
| Rate for Payer: ASR Commercial |
$20.07
|
| Rate for Payer: ASR Commercial |
$26.63
|
| Rate for Payer: ASR Commercial |
$24.05
|
| Rate for Payer: ASR Commercial |
$19.68
|
| Rate for Payer: ASR Commercial |
$18.26
|
| Rate for Payer: BCBS Trust/PPO |
$16.53
|
| Rate for Payer: BCBS Trust/PPO |
$15.34
|
| Rate for Payer: BCBS Trust/PPO |
$22.37
|
| Rate for Payer: BCBS Trust/PPO |
$64.65
|
| Rate for Payer: BCBS Trust/PPO |
$20.20
|
| Rate for Payer: BCBS Trust/PPO |
$16.86
|
| Rate for Payer: BCN Commercial |
$19.22
|
| Rate for Payer: BCN Commercial |
$14.59
|
| Rate for Payer: BCN Commercial |
$15.73
|
| Rate for Payer: BCN Commercial |
$21.28
|
| Rate for Payer: BCN Commercial |
$16.04
|
| Rate for Payer: BCN Commercial |
$61.51
|
| Rate for Payer: Cash Price |
$16.23
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$15.06
|
| Rate for Payer: Cash Price |
$21.96
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$17.69
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$19.07
|
| Rate for Payer: Cofinity Commercial |
$74.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.47
|
| Rate for Payer: Healthscope Commercial |
$18.82
|
| Rate for Payer: Healthscope Commercial |
$79.34
|
| Rate for Payer: Healthscope Commercial |
$20.69
|
| Rate for Payer: Healthscope Commercial |
$24.79
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Healthscope Commercial |
$27.45
|
| Rate for Payer: Healthscope Whirlpool |
$24.05
|
| Rate for Payer: Healthscope Whirlpool |
$18.26
|
| Rate for Payer: Healthscope Whirlpool |
$19.68
|
| Rate for Payer: Healthscope Whirlpool |
$26.63
|
| Rate for Payer: Healthscope Whirlpool |
$20.07
|
| Rate for Payer: Healthscope Whirlpool |
$76.96
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$24.70
|
| Rate for Payer: Mclaren Commercial |
$22.31
|
| Rate for Payer: Mclaren Commercial |
$16.94
|
| Rate for Payer: Mclaren Commercial |
$71.41
|
| Rate for Payer: Mclaren Commercial |
$18.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.25
|
| Rate for Payer: Nomi Health Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$20.33
|
| Rate for Payer: Nomi Health Commercial |
$15.43
|
| Rate for Payer: Nomi Health Commercial |
$22.51
|
| Rate for Payer: Nomi Health Commercial |
$65.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$79.34
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
7536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$79.34 |
| Rate for Payer: Aetna Commercial |
$71.41
|
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Aetna Commercial |
$22.31
|
| Rate for Payer: Aetna Commercial |
$18.26
|
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Medicare |
$9.41
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna Medicare |
$10.14
|
| Rate for Payer: Aetna Medicare |
$12.40
|
| Rate for Payer: Aetna Medicare |
$10.34
|
| Rate for Payer: Aetna Medicare |
$39.67
|
| Rate for Payer: ASR ASR |
$18.26
|
| Rate for Payer: ASR ASR |
$24.05
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: ASR ASR |
$76.96
|
| Rate for Payer: ASR ASR |
$26.63
|
| Rate for Payer: ASR ASR |
$19.68
|
| Rate for Payer: ASR Commercial |
$19.68
|
| Rate for Payer: ASR Commercial |
$20.07
|
| Rate for Payer: ASR Commercial |
$24.05
|
| Rate for Payer: ASR Commercial |
$26.63
|
| Rate for Payer: ASR Commercial |
$76.96
|
| Rate for Payer: ASR Commercial |
$18.26
|
| Rate for Payer: BCBS Complete |
$31.74
|
| Rate for Payer: BCBS Complete |
$7.53
|
| Rate for Payer: BCBS Complete |
$8.12
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Complete |
$10.98
|
| Rate for Payer: BCBS Trust/PPO |
$15.41
|
| Rate for Payer: BCBS Trust/PPO |
$16.62
|
| Rate for Payer: BCBS Trust/PPO |
$20.30
|
| Rate for Payer: BCBS Trust/PPO |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$64.97
|
| Rate for Payer: BCBS Trust/PPO |
$22.48
|
| Rate for Payer: BCN Commercial |
$21.28
|
| Rate for Payer: BCN Commercial |
$14.59
|
| Rate for Payer: BCN Commercial |
$15.73
|
| Rate for Payer: BCN Commercial |
$16.04
|
| Rate for Payer: BCN Commercial |
$19.22
|
| Rate for Payer: BCN Commercial |
$61.51
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$21.96
|
| Rate for Payer: Cash Price |
$21.96
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$15.06
|
| Rate for Payer: Cash Price |
$16.23
|
| Rate for Payer: Cash Price |
$16.23
|
| Rate for Payer: Cash Price |
$15.06
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$74.58
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$19.07
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$17.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.47
|
| Rate for Payer: Healthscope Commercial |
$18.82
|
| Rate for Payer: Healthscope Commercial |
$79.34
|
| Rate for Payer: Healthscope Commercial |
$24.79
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Healthscope Commercial |
$20.69
|
| Rate for Payer: Healthscope Commercial |
$27.45
|
| Rate for Payer: Healthscope Whirlpool |
$20.07
|
| Rate for Payer: Healthscope Whirlpool |
$18.26
|
| Rate for Payer: Healthscope Whirlpool |
$24.05
|
| Rate for Payer: Healthscope Whirlpool |
$26.63
|
| Rate for Payer: Healthscope Whirlpool |
$76.96
|
| Rate for Payer: Healthscope Whirlpool |
$19.68
|
| Rate for Payer: Mclaren Commercial |
$24.70
|
| Rate for Payer: Mclaren Commercial |
$22.31
|
| Rate for Payer: Mclaren Commercial |
$71.41
|
| Rate for Payer: Mclaren Commercial |
$16.94
|
| Rate for Payer: Mclaren Commercial |
$18.26
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.07
|
| Rate for Payer: Nomi Health Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$65.06
|
| Rate for Payer: Nomi Health Commercial |
$22.51
|
| Rate for Payer: Nomi Health Commercial |
$20.33
|
| Rate for Payer: Nomi Health Commercial |
$15.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Narrow Network |
$0.67
|
| Rate for Payer: Priority Health Narrow Network |
$0.67
|
| Rate for Payer: Priority Health Narrow Network |
$0.67
|
| Rate for Payer: Priority Health Narrow Network |
$0.67
|
| Rate for Payer: Priority Health Narrow Network |
$0.67
|
| Rate for Payer: Priority Health Narrow Network |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.82
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
OP
|
$314.45
|
|
|
Service Code
|
NDC 51079075320
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.78 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Aetna Commercial |
$283.00
|
| Rate for Payer: Aetna Medicare |
$157.22
|
| Rate for Payer: ASR ASR |
$305.02
|
| Rate for Payer: ASR Commercial |
$305.02
|
| Rate for Payer: BCBS Complete |
$125.78
|
| Rate for Payer: BCBS Trust/PPO |
$257.50
|
| Rate for Payer: BCN Commercial |
$243.79
|
| Rate for Payer: Cash Price |
$251.56
|
| Rate for Payer: Cofinity Commercial |
$295.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.56
|
| Rate for Payer: Healthscope Commercial |
$314.45
|
| Rate for Payer: Healthscope Whirlpool |
$305.02
|
| Rate for Payer: Mclaren Commercial |
$283.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.28
|
| Rate for Payer: Nomi Health Commercial |
$257.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$275.52
|
| Rate for Payer: Priority Health Narrow Network |
$220.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$276.72
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
IP
|
$234.65
|
|
|
Service Code
|
NDC 00093221001
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.52 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Aetna Commercial |
$211.18
|
| Rate for Payer: ASR ASR |
$227.61
|
| Rate for Payer: ASR Commercial |
$227.61
|
| Rate for Payer: BCBS Trust/PPO |
$191.22
|
| Rate for Payer: BCN Commercial |
$181.92
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Commercial |
$220.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$234.65
|
| Rate for Payer: Healthscope Whirlpool |
$227.61
|
| Rate for Payer: Mclaren Commercial |
$211.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$192.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.49
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
OP
|
$234.65
|
|
|
Service Code
|
NDC 00093221001
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.86 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Aetna Commercial |
$211.18
|
| Rate for Payer: Aetna Medicare |
$117.32
|
| Rate for Payer: ASR ASR |
$227.61
|
| Rate for Payer: ASR Commercial |
$227.61
|
| Rate for Payer: BCBS Complete |
$93.86
|
| Rate for Payer: BCBS Trust/PPO |
$192.15
|
| Rate for Payer: BCN Commercial |
$181.92
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Commercial |
$220.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$234.65
|
| Rate for Payer: Healthscope Whirlpool |
$227.61
|
| Rate for Payer: Mclaren Commercial |
$211.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$192.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.60
|
| Rate for Payer: Priority Health Narrow Network |
$164.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.49
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
IP
|
$3.14
|
|
|
Service Code
|
NDC 51079075301
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Aetna Commercial |
$2.83
|
| Rate for Payer: ASR ASR |
$3.05
|
| Rate for Payer: ASR Commercial |
$3.05
|
| Rate for Payer: BCBS Trust/PPO |
$2.56
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.51
|
| Rate for Payer: Healthscope Commercial |
$3.14
|
| Rate for Payer: Healthscope Whirlpool |
$3.05
|
| Rate for Payer: Mclaren Commercial |
$2.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.67
|
| Rate for Payer: Nomi Health Commercial |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.76
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
OP
|
$3.14
|
|
|
Service Code
|
NDC 51079075301
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Aetna Commercial |
$2.83
|
| Rate for Payer: Aetna Medicare |
$1.57
|
| Rate for Payer: ASR ASR |
$3.05
|
| Rate for Payer: ASR Commercial |
$3.05
|
| Rate for Payer: BCBS Complete |
$1.26
|
| Rate for Payer: BCBS Trust/PPO |
$2.57
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.51
|
| Rate for Payer: Healthscope Commercial |
$3.14
|
| Rate for Payer: Healthscope Whirlpool |
$3.05
|
| Rate for Payer: Mclaren Commercial |
$2.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.67
|
| Rate for Payer: Nomi Health Commercial |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.75
|
| Rate for Payer: Priority Health Narrow Network |
$2.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.76
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
OP
|
$285.95
|
|
|
Service Code
|
NDC 60687069501
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.38 |
| Max. Negotiated Rate |
$285.95 |
| Rate for Payer: Aetna Commercial |
$257.36
|
| Rate for Payer: Aetna Medicare |
$142.98
|
| Rate for Payer: ASR ASR |
$277.37
|
| Rate for Payer: ASR Commercial |
$277.37
|
| Rate for Payer: BCBS Complete |
$114.38
|
| Rate for Payer: BCBS Trust/PPO |
$234.16
|
| Rate for Payer: BCN Commercial |
$221.70
|
| Rate for Payer: Cash Price |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.76
|
| Rate for Payer: Healthscope Commercial |
$285.95
|
| Rate for Payer: Healthscope Whirlpool |
$277.37
|
| Rate for Payer: Mclaren Commercial |
$257.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.06
|
| Rate for Payer: Nomi Health Commercial |
$234.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$250.55
|
| Rate for Payer: Priority Health Narrow Network |
$200.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.64
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
IP
|
$314.45
|
|
|
Service Code
|
NDC 51079075320
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.39 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Aetna Commercial |
$283.00
|
| Rate for Payer: ASR ASR |
$305.02
|
| Rate for Payer: ASR Commercial |
$305.02
|
| Rate for Payer: BCBS Trust/PPO |
$256.25
|
| Rate for Payer: BCN Commercial |
$243.79
|
| Rate for Payer: Cash Price |
$251.56
|
| Rate for Payer: Cofinity Commercial |
$295.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.56
|
| Rate for Payer: Healthscope Commercial |
$314.45
|
| Rate for Payer: Healthscope Whirlpool |
$305.02
|
| Rate for Payer: Mclaren Commercial |
$283.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.28
|
| Rate for Payer: Nomi Health Commercial |
$257.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$276.72
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
IP
|
$285.95
|
|
|
Service Code
|
NDC 60687069501
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.87 |
| Max. Negotiated Rate |
$285.95 |
| Rate for Payer: Aetna Commercial |
$257.36
|
| Rate for Payer: ASR ASR |
$277.37
|
| Rate for Payer: ASR Commercial |
$277.37
|
| Rate for Payer: BCBS Trust/PPO |
$233.02
|
| Rate for Payer: BCN Commercial |
$221.70
|
| Rate for Payer: Cash Price |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.76
|
| Rate for Payer: Healthscope Commercial |
$285.95
|
| Rate for Payer: Healthscope Whirlpool |
$277.37
|
| Rate for Payer: Mclaren Commercial |
$257.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.06
|
| Rate for Payer: Nomi Health Commercial |
$234.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.64
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 60687069511
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: ASR ASR |
$2.77
|
| Rate for Payer: ASR Commercial |
$2.77
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$2.86
|
| Rate for Payer: Healthscope Whirlpool |
$2.77
|
| Rate for Payer: Mclaren Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.43
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.52
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
OP
|
$2.86
|
|
|
Service Code
|
NDC 60687069511
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna Medicare |
$1.43
|
| Rate for Payer: ASR ASR |
$2.77
|
| Rate for Payer: ASR Commercial |
$2.77
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.34
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$2.86
|
| Rate for Payer: Healthscope Whirlpool |
$2.77
|
| Rate for Payer: Mclaren Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.43
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.51
|
| Rate for Payer: Priority Health Narrow Network |
$2.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.52
|
|
|
SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$449.45
|
|
|
Service Code
|
NDC 00006542302
|
| Hospital Charge Code |
177099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$292.14 |
| Max. Negotiated Rate |
$449.45 |
| Rate for Payer: Aetna Commercial |
$404.50
|
| Rate for Payer: ASR ASR |
$435.97
|
| Rate for Payer: ASR Commercial |
$435.97
|
| Rate for Payer: BCBS Trust/PPO |
$366.26
|
| Rate for Payer: BCN Commercial |
$348.46
|
| Rate for Payer: Cash Price |
$359.56
|
| Rate for Payer: Cofinity Commercial |
$422.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.56
|
| Rate for Payer: Healthscope Commercial |
$449.45
|
| Rate for Payer: Healthscope Whirlpool |
$435.97
|
| Rate for Payer: Mclaren Commercial |
$404.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.03
|
| Rate for Payer: Nomi Health Commercial |
$368.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.52
|
|
|
SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$449.45
|
|
|
Service Code
|
NDC 00006542312
|
| Hospital Charge Code |
177099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$292.14 |
| Max. Negotiated Rate |
$449.45 |
| Rate for Payer: Aetna Commercial |
$404.50
|
| Rate for Payer: ASR ASR |
$435.97
|
| Rate for Payer: ASR Commercial |
$435.97
|
| Rate for Payer: BCBS Trust/PPO |
$366.26
|
| Rate for Payer: BCN Commercial |
$348.46
|
| Rate for Payer: Cash Price |
$359.56
|
| Rate for Payer: Cofinity Commercial |
$422.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.56
|
| Rate for Payer: Healthscope Commercial |
$449.45
|
| Rate for Payer: Healthscope Whirlpool |
$435.97
|
| Rate for Payer: Mclaren Commercial |
$404.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.03
|
| Rate for Payer: Nomi Health Commercial |
$368.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.52
|
|
|
SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$449.45
|
|
|
Service Code
|
NDC 00006542312
|
| Hospital Charge Code |
177099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$179.78 |
| Max. Negotiated Rate |
$449.45 |
| Rate for Payer: Aetna Commercial |
$404.50
|
| Rate for Payer: Aetna Medicare |
$224.72
|
| Rate for Payer: ASR ASR |
$435.97
|
| Rate for Payer: ASR Commercial |
$435.97
|
| Rate for Payer: BCBS Complete |
$179.78
|
| Rate for Payer: BCBS Trust/PPO |
$368.05
|
| Rate for Payer: BCN Commercial |
$348.46
|
| Rate for Payer: Cash Price |
$359.56
|
| Rate for Payer: Cofinity Commercial |
$422.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.56
|
| Rate for Payer: Healthscope Commercial |
$449.45
|
| Rate for Payer: Healthscope Whirlpool |
$435.97
|
| Rate for Payer: Mclaren Commercial |
$404.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.03
|
| Rate for Payer: Nomi Health Commercial |
$368.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$393.81
|
| Rate for Payer: Priority Health Narrow Network |
$315.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.52
|
|
|
SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$449.45
|
|
|
Service Code
|
NDC 00006542302
|
| Hospital Charge Code |
177099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$179.78 |
| Max. Negotiated Rate |
$449.45 |
| Rate for Payer: Aetna Commercial |
$404.50
|
| Rate for Payer: Aetna Medicare |
$224.72
|
| Rate for Payer: ASR ASR |
$435.97
|
| Rate for Payer: ASR Commercial |
$435.97
|
| Rate for Payer: BCBS Complete |
$179.78
|
| Rate for Payer: BCBS Trust/PPO |
$368.05
|
| Rate for Payer: BCN Commercial |
$348.46
|
| Rate for Payer: Cash Price |
$359.56
|
| Rate for Payer: Cofinity Commercial |
$422.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.56
|
| Rate for Payer: Healthscope Commercial |
$449.45
|
| Rate for Payer: Healthscope Whirlpool |
$435.97
|
| Rate for Payer: Mclaren Commercial |
$404.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.03
|
| Rate for Payer: Nomi Health Commercial |
$368.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$393.81
|
| Rate for Payer: Priority Health Narrow Network |
$315.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.52
|
|
|
SULFACETAMIDE-PREDNISOLONE 10 %-0.23 % (0.25 %) EYE DROPS
|
Facility
|
OP
|
$48.79
|
|
|
Service Code
|
NDC 24208031705
|
| Hospital Charge Code |
70392
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$48.79 |
| Rate for Payer: Aetna Commercial |
$43.91
|
| Rate for Payer: Aetna Medicare |
$24.40
|
| Rate for Payer: ASR ASR |
$47.33
|
| Rate for Payer: ASR Commercial |
$47.33
|
| Rate for Payer: BCBS Complete |
$19.52
|
| Rate for Payer: BCBS Trust/PPO |
$39.95
|
| Rate for Payer: BCN Commercial |
$37.83
|
| Rate for Payer: Cash Price |
$39.03
|
| Rate for Payer: Cofinity Commercial |
$45.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.03
|
| Rate for Payer: Healthscope Commercial |
$48.79
|
| Rate for Payer: Healthscope Whirlpool |
$47.33
|
| Rate for Payer: Mclaren Commercial |
$43.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.47
|
| Rate for Payer: Nomi Health Commercial |
$40.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.75
|
| Rate for Payer: Priority Health Narrow Network |
$34.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.94
|
|
|
SULFACETAMIDE-PREDNISOLONE 10 %-0.23 % (0.25 %) EYE DROPS
|
Facility
|
IP
|
$48.79
|
|
|
Service Code
|
NDC 24208031705
|
| Hospital Charge Code |
70392
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.71 |
| Max. Negotiated Rate |
$48.79 |
| Rate for Payer: Aetna Commercial |
$43.91
|
| Rate for Payer: ASR ASR |
$47.33
|
| Rate for Payer: ASR Commercial |
$47.33
|
| Rate for Payer: BCBS Trust/PPO |
$39.76
|
| Rate for Payer: BCN Commercial |
$37.83
|
| Rate for Payer: Cash Price |
$39.03
|
| Rate for Payer: Cofinity Commercial |
$45.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.03
|
| Rate for Payer: Healthscope Commercial |
$48.79
|
| Rate for Payer: Healthscope Whirlpool |
$47.33
|
| Rate for Payer: Mclaren Commercial |
$43.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.47
|
| Rate for Payer: Nomi Health Commercial |
$40.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.94
|
|
