|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$17.75
|
|
|
Service Code
|
NDC 67877025115
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$17.75 |
| Rate for Payer: Aetna Commercial |
$15.98
|
| Rate for Payer: ASR ASR |
$17.22
|
| Rate for Payer: BCBS Trust/PPO |
$14.58
|
| Rate for Payer: BCN Commercial |
$14.58
|
| Rate for Payer: Cash Price |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$16.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.20
|
| Rate for Payer: Healthscope Commercial |
$17.22
|
| Rate for Payer: Healthscope Whirlpool |
$17.75
|
| Rate for Payer: Mclaren Commercial |
$15.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.09
|
| Rate for Payer: Nomi Health Commercial |
$14.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.62
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$10.26
|
|
|
Service Code
|
NDC 21922006204
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Aetna Commercial |
$9.23
|
| Rate for Payer: Aetna Medicare |
$3.80
|
| Rate for Payer: ASR ASR |
$9.95
|
| Rate for Payer: BCBS Complete |
$4.10
|
| Rate for Payer: BCBS Trust/PPO |
$8.46
|
| Rate for Payer: BCN Commercial |
$8.46
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$9.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$9.95
|
| Rate for Payer: Healthscope Whirlpool |
$10.26
|
| Rate for Payer: Mclaren Commercial |
$9.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: Nomi Health Commercial |
$8.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.99
|
| Rate for Payer: Priority Health Narrow Network |
$7.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.03
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$10.26
|
|
|
Service Code
|
NDC 21922006204
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Aetna Commercial |
$9.23
|
| Rate for Payer: ASR ASR |
$9.95
|
| Rate for Payer: BCBS Trust/PPO |
$8.43
|
| Rate for Payer: BCN Commercial |
$8.43
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$9.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$9.95
|
| Rate for Payer: Healthscope Whirlpool |
$10.26
|
| Rate for Payer: Mclaren Commercial |
$9.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: Nomi Health Commercial |
$8.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.03
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$38.72
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
8120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.04 |
| Max. Negotiated Rate |
$38.72 |
| Rate for Payer: Aetna Commercial |
$34.84
|
| Rate for Payer: Aetna Commercial |
$23.28
|
| Rate for Payer: Aetna Commercial |
$264.29
|
| Rate for Payer: Aetna Commercial |
$176.94
|
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: ASR ASR |
$25.09
|
| Rate for Payer: ASR ASR |
$15.94
|
| Rate for Payer: ASR ASR |
$37.55
|
| Rate for Payer: ASR ASR |
$190.70
|
| Rate for Payer: ASR ASR |
$284.85
|
| Rate for Payer: BCBS Trust/PPO |
$31.79
|
| Rate for Payer: BCBS Trust/PPO |
$161.45
|
| Rate for Payer: BCBS Trust/PPO |
$13.49
|
| Rate for Payer: BCBS Trust/PPO |
$241.15
|
| Rate for Payer: BCBS Trust/PPO |
$21.24
|
| Rate for Payer: BCN Commercial |
$21.24
|
| Rate for Payer: BCN Commercial |
$161.45
|
| Rate for Payer: BCN Commercial |
$241.15
|
| Rate for Payer: BCN Commercial |
$31.79
|
| Rate for Payer: BCN Commercial |
$13.49
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Cash Price |
$20.69
|
| Rate for Payer: Cash Price |
$234.92
|
| Rate for Payer: Cash Price |
$157.28
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$276.04
|
| Rate for Payer: Cofinity Commercial |
$15.44
|
| Rate for Payer: Cofinity Commercial |
$24.32
|
| Rate for Payer: Cofinity Commercial |
$36.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.97
|
| Rate for Payer: Healthscope Commercial |
$25.09
|
| Rate for Payer: Healthscope Commercial |
$190.70
|
| Rate for Payer: Healthscope Commercial |
$284.85
|
| Rate for Payer: Healthscope Commercial |
$15.94
|
| Rate for Payer: Healthscope Commercial |
$37.55
|
| Rate for Payer: Healthscope Whirlpool |
$293.66
|
| Rate for Payer: Healthscope Whirlpool |
$38.72
|
| Rate for Payer: Healthscope Whirlpool |
$16.43
|
| Rate for Payer: Healthscope Whirlpool |
$196.60
|
| Rate for Payer: Healthscope Whirlpool |
$25.87
|
| Rate for Payer: Mclaren Commercial |
$176.94
|
| Rate for Payer: Mclaren Commercial |
$264.29
|
| Rate for Payer: Mclaren Commercial |
$14.79
|
| Rate for Payer: Mclaren Commercial |
$34.84
|
| Rate for Payer: Mclaren Commercial |
$23.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.91
|
| Rate for Payer: Nomi Health Commercial |
$240.80
|
| Rate for Payer: Nomi Health Commercial |
$21.21
|
| Rate for Payer: Nomi Health Commercial |
$161.21
|
| Rate for Payer: Nomi Health Commercial |
$13.47
|
| Rate for Payer: Nomi Health Commercial |
$31.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.46
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$25.87
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
8120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$25.87 |
| Rate for Payer: Aetna Commercial |
$23.28
|
| Rate for Payer: Aetna Commercial |
$34.84
|
| Rate for Payer: Aetna Commercial |
$176.94
|
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: Aetna Commercial |
$264.29
|
| Rate for Payer: Aetna Medicare |
$14.32
|
| Rate for Payer: Aetna Medicare |
$6.08
|
| Rate for Payer: Aetna Medicare |
$108.65
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Aetna Medicare |
$72.74
|
| Rate for Payer: ASR ASR |
$25.09
|
| Rate for Payer: ASR ASR |
$37.55
|
| Rate for Payer: ASR ASR |
$284.85
|
| Rate for Payer: ASR ASR |
$190.70
|
| Rate for Payer: ASR ASR |
$15.94
|
| Rate for Payer: BCBS Complete |
$117.46
|
| Rate for Payer: BCBS Complete |
$6.57
|
| Rate for Payer: BCBS Complete |
$15.49
|
| Rate for Payer: BCBS Complete |
$10.35
|
| Rate for Payer: BCBS Complete |
$78.64
|
| Rate for Payer: BCBS Trust/PPO |
$13.54
|
| Rate for Payer: BCBS Trust/PPO |
$162.10
|
| Rate for Payer: BCBS Trust/PPO |
$242.12
|
| Rate for Payer: BCBS Trust/PPO |
$31.92
|
| Rate for Payer: BCBS Trust/PPO |
$21.33
|
| Rate for Payer: BCN Commercial |
$242.12
|
| Rate for Payer: BCN Commercial |
$162.10
|
| Rate for Payer: BCN Commercial |
$13.54
|
| Rate for Payer: BCN Commercial |
$31.92
|
| Rate for Payer: BCN Commercial |
$21.33
|
| Rate for Payer: Cash Price |
$234.92
|
| Rate for Payer: Cash Price |
$20.69
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Cash Price |
$157.28
|
| Rate for Payer: Cash Price |
$157.28
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Cash Price |
$20.69
|
| Rate for Payer: Cash Price |
$234.92
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$15.44
|
| Rate for Payer: Cofinity Commercial |
$36.39
|
| Rate for Payer: Cofinity Commercial |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$24.32
|
| Rate for Payer: Cofinity Commercial |
$276.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.28
|
| Rate for Payer: Healthscope Commercial |
$15.94
|
| Rate for Payer: Healthscope Commercial |
$190.70
|
| Rate for Payer: Healthscope Commercial |
$37.55
|
| Rate for Payer: Healthscope Commercial |
$25.09
|
| Rate for Payer: Healthscope Commercial |
$284.85
|
| Rate for Payer: Healthscope Whirlpool |
$25.87
|
| Rate for Payer: Healthscope Whirlpool |
$16.43
|
| Rate for Payer: Healthscope Whirlpool |
$196.60
|
| Rate for Payer: Healthscope Whirlpool |
$38.72
|
| Rate for Payer: Healthscope Whirlpool |
$293.66
|
| Rate for Payer: Mclaren Commercial |
$176.94
|
| Rate for Payer: Mclaren Commercial |
$14.79
|
| Rate for Payer: Mclaren Commercial |
$34.84
|
| Rate for Payer: Mclaren Commercial |
$264.29
|
| Rate for Payer: Mclaren Commercial |
$23.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.99
|
| Rate for Payer: Nomi Health Commercial |
$161.21
|
| Rate for Payer: Nomi Health Commercial |
$13.47
|
| Rate for Payer: Nomi Health Commercial |
$31.75
|
| Rate for Payer: Nomi Health Commercial |
$240.80
|
| Rate for Payer: Nomi Health Commercial |
$21.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.77
|
| Rate for Payer: Priority Health Narrow Network |
$0.62
|
| Rate for Payer: Priority Health Narrow Network |
$0.62
|
| Rate for Payer: Priority Health Narrow Network |
$0.62
|
| Rate for Payer: Priority Health Narrow Network |
$0.62
|
| Rate for Payer: Priority Health Narrow Network |
$0.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.76
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$121.82
|
|
|
Service Code
|
NDC 68084075025
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.07 |
| Max. Negotiated Rate |
$121.82 |
| Rate for Payer: Aetna Commercial |
$109.64
|
| Rate for Payer: Aetna Medicare |
$45.07
|
| Rate for Payer: ASR ASR |
$118.17
|
| Rate for Payer: BCBS Complete |
$48.73
|
| Rate for Payer: BCBS Trust/PPO |
$100.44
|
| Rate for Payer: BCN Commercial |
$100.44
|
| Rate for Payer: Cash Price |
$97.46
|
| Rate for Payer: Cofinity Commercial |
$114.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.46
|
| Rate for Payer: Healthscope Commercial |
$118.17
|
| Rate for Payer: Healthscope Whirlpool |
$121.82
|
| Rate for Payer: Mclaren Commercial |
$109.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.55
|
| Rate for Payer: Nomi Health Commercial |
$99.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$106.74
|
| Rate for Payer: Priority Health Narrow Network |
$85.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.21
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$4.06
|
|
|
Service Code
|
NDC 68084075095
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: ASR ASR |
$3.94
|
| Rate for Payer: BCBS Complete |
$1.62
|
| Rate for Payer: BCBS Trust/PPO |
$3.35
|
| Rate for Payer: BCN Commercial |
$3.35
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.25
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Healthscope Whirlpool |
$4.06
|
| Rate for Payer: Mclaren Commercial |
$3.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.45
|
| Rate for Payer: Nomi Health Commercial |
$3.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.56
|
| Rate for Payer: Priority Health Narrow Network |
$2.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.57
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$4.06
|
|
|
Service Code
|
NDC 68084075095
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: ASR ASR |
$3.94
|
| Rate for Payer: BCBS Trust/PPO |
$3.33
|
| Rate for Payer: BCN Commercial |
$3.33
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.25
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Healthscope Whirlpool |
$4.06
|
| Rate for Payer: Mclaren Commercial |
$3.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.45
|
| Rate for Payer: Nomi Health Commercial |
$3.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.57
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$121.82
|
|
|
Service Code
|
NDC 68084075025
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.37 |
| Max. Negotiated Rate |
$121.82 |
| Rate for Payer: Aetna Commercial |
$109.64
|
| Rate for Payer: ASR ASR |
$118.17
|
| Rate for Payer: BCBS Trust/PPO |
$100.04
|
| Rate for Payer: BCN Commercial |
$100.04
|
| Rate for Payer: Cash Price |
$97.46
|
| Rate for Payer: Cofinity Commercial |
$114.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.46
|
| Rate for Payer: Healthscope Commercial |
$118.17
|
| Rate for Payer: Healthscope Whirlpool |
$121.82
|
| Rate for Payer: Mclaren Commercial |
$109.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.55
|
| Rate for Payer: Nomi Health Commercial |
$99.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.21
|
|
|
TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET
|
Facility
|
OP
|
$248.90
|
|
|
Service Code
|
NDC 60505265701
|
| Hospital Charge Code |
8134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.09 |
| Max. Negotiated Rate |
$248.90 |
| Rate for Payer: Aetna Commercial |
$224.01
|
| Rate for Payer: Aetna Medicare |
$92.09
|
| Rate for Payer: ASR ASR |
$241.43
|
| Rate for Payer: BCBS Complete |
$99.56
|
| Rate for Payer: BCBS Trust/PPO |
$205.22
|
| Rate for Payer: BCN Commercial |
$205.22
|
| Rate for Payer: Cash Price |
$199.12
|
| Rate for Payer: Cofinity Commercial |
$233.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.12
|
| Rate for Payer: Healthscope Commercial |
$241.43
|
| Rate for Payer: Healthscope Whirlpool |
$248.90
|
| Rate for Payer: Mclaren Commercial |
$224.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.56
|
| Rate for Payer: Nomi Health Commercial |
$204.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$218.09
|
| Rate for Payer: Priority Health Narrow Network |
$174.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.03
|
|
|
TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET
|
Facility
|
OP
|
$190.35
|
|
|
Service Code
|
NDC 72888009501
|
| Hospital Charge Code |
8134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.43 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$171.31
|
| Rate for Payer: Aetna Medicare |
$70.43
|
| Rate for Payer: ASR ASR |
$184.64
|
| Rate for Payer: BCBS Complete |
$76.14
|
| Rate for Payer: BCBS Trust/PPO |
$156.94
|
| Rate for Payer: BCN Commercial |
$156.94
|
| 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 |
$184.64
|
| Rate for Payer: Healthscope Whirlpool |
$190.35
|
| Rate for Payer: Mclaren Commercial |
$171.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.76
|
| Rate for Payer: Priority Health Cigna 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
|
|
|
TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET
|
Facility
|
IP
|
$190.35
|
|
|
Service Code
|
NDC 72888009501
|
| Hospital Charge Code |
8134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.76 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$171.31
|
| Rate for Payer: ASR ASR |
$184.64
|
| Rate for Payer: BCBS Trust/PPO |
$156.32
|
| Rate for Payer: BCN Commercial |
$156.32
|
| 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 |
$184.64
|
| Rate for Payer: Healthscope Whirlpool |
$190.35
|
| Rate for Payer: Mclaren Commercial |
$171.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.51
|
|
|
TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET
|
Facility
|
IP
|
$248.90
|
|
|
Service Code
|
NDC 60505265701
|
| Hospital Charge Code |
8134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.68 |
| Max. Negotiated Rate |
$248.90 |
| Rate for Payer: Aetna Commercial |
$224.01
|
| Rate for Payer: ASR ASR |
$241.43
|
| Rate for Payer: BCBS Trust/PPO |
$204.40
|
| Rate for Payer: BCN Commercial |
$204.40
|
| Rate for Payer: Cash Price |
$199.12
|
| Rate for Payer: Cofinity Commercial |
$233.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.12
|
| Rate for Payer: Healthscope Commercial |
$241.43
|
| Rate for Payer: Healthscope Whirlpool |
$248.90
|
| Rate for Payer: Mclaren Commercial |
$224.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.56
|
| Rate for Payer: Nomi Health Commercial |
$204.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.03
|
|
|
TRICLOSAN TOPICAL BAR
|
Facility
|
IP
|
$11.64
|
|
|
Service Code
|
NDC 9900000607
|
| Hospital Charge Code |
169208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Aetna Commercial |
$10.48
|
| Rate for Payer: ASR ASR |
$11.29
|
| Rate for Payer: BCBS Trust/PPO |
$9.56
|
| Rate for Payer: BCN Commercial |
$9.56
|
| Rate for Payer: Cash Price |
$9.31
|
| Rate for Payer: Cofinity Commercial |
$10.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.31
|
| Rate for Payer: Healthscope Commercial |
$11.29
|
| Rate for Payer: Healthscope Whirlpool |
$11.64
|
| Rate for Payer: Mclaren Commercial |
$10.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.89
|
| Rate for Payer: Nomi Health Commercial |
$9.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.24
|
|
|
TRICLOSAN TOPICAL BAR
|
Facility
|
IP
|
$9.09
|
|
|
Service Code
|
NDC 72140085700
|
| Hospital Charge Code |
169208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$9.09 |
| Rate for Payer: Aetna Commercial |
$8.18
|
| Rate for Payer: ASR ASR |
$8.82
|
| Rate for Payer: BCBS Trust/PPO |
$7.46
|
| Rate for Payer: BCN Commercial |
$7.46
|
| Rate for Payer: Cash Price |
$7.27
|
| Rate for Payer: Cofinity Commercial |
$8.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.27
|
| Rate for Payer: Healthscope Commercial |
$8.82
|
| Rate for Payer: Healthscope Whirlpool |
$9.09
|
| Rate for Payer: Mclaren Commercial |
$8.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.73
|
| Rate for Payer: Nomi Health Commercial |
$7.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.00
|
|
|
TRICLOSAN TOPICAL BAR
|
Facility
|
OP
|
$9.09
|
|
|
Service Code
|
NDC 72140085700
|
| Hospital Charge Code |
169208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$9.09 |
| Rate for Payer: Aetna Commercial |
$8.18
|
| Rate for Payer: Aetna Medicare |
$3.36
|
| Rate for Payer: ASR ASR |
$8.82
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS Trust/PPO |
$7.49
|
| Rate for Payer: BCN Commercial |
$7.49
|
| Rate for Payer: Cash Price |
$7.27
|
| Rate for Payer: Cofinity Commercial |
$8.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.27
|
| Rate for Payer: Healthscope Commercial |
$8.82
|
| Rate for Payer: Healthscope Whirlpool |
$9.09
|
| Rate for Payer: Mclaren Commercial |
$8.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.73
|
| Rate for Payer: Nomi Health Commercial |
$7.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.96
|
| Rate for Payer: Priority Health Narrow Network |
$6.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.00
|
|
|
TRICLOSAN TOPICAL BAR
|
Facility
|
OP
|
$11.64
|
|
|
Service Code
|
NDC 9900000607
|
| Hospital Charge Code |
169208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Aetna Commercial |
$10.48
|
| Rate for Payer: Aetna Medicare |
$4.31
|
| Rate for Payer: ASR ASR |
$11.29
|
| Rate for Payer: BCBS Complete |
$4.66
|
| Rate for Payer: BCBS Trust/PPO |
$9.60
|
| Rate for Payer: BCN Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$9.31
|
| Rate for Payer: Cofinity Commercial |
$10.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.31
|
| Rate for Payer: Healthscope Commercial |
$11.29
|
| Rate for Payer: Healthscope Whirlpool |
$11.64
|
| Rate for Payer: Mclaren Commercial |
$10.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.89
|
| Rate for Payer: Nomi Health Commercial |
$9.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.20
|
| Rate for Payer: Priority Health Narrow Network |
$8.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.24
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
OP
|
$23.13
|
|
|
Service Code
|
NDC 24208058559
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$23.13 |
| Rate for Payer: Aetna Commercial |
$20.82
|
| Rate for Payer: Aetna Medicare |
$8.56
|
| Rate for Payer: ASR ASR |
$22.44
|
| Rate for Payer: BCBS Complete |
$9.25
|
| Rate for Payer: BCBS Trust/PPO |
$19.07
|
| Rate for Payer: BCN Commercial |
$19.07
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cofinity Commercial |
$21.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.50
|
| Rate for Payer: Healthscope Commercial |
$22.44
|
| Rate for Payer: Healthscope Whirlpool |
$23.13
|
| Rate for Payer: Mclaren Commercial |
$20.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.66
|
| Rate for Payer: Nomi Health Commercial |
$18.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.27
|
| Rate for Payer: Priority Health Narrow Network |
$16.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.35
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
OP
|
$97.65
|
|
|
Service Code
|
NDC 24208058564
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna Medicare |
$36.13
|
| Rate for Payer: ASR ASR |
$94.72
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS Trust/PPO |
$80.51
|
| Rate for Payer: BCN Commercial |
$80.51
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$91.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$94.72
|
| Rate for Payer: Healthscope Whirlpool |
$97.65
|
| Rate for Payer: Mclaren Commercial |
$87.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Nomi Health Commercial |
$80.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$85.56
|
| Rate for Payer: Priority Health Narrow Network |
$68.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.93
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
OP
|
$33.71
|
|
|
Service Code
|
NDC 61314035501
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$30.33
|
| Rate for Payer: Aetna Medicare |
$12.47
|
| Rate for Payer: ASR ASR |
$32.69
|
| Rate for Payer: BCBS Complete |
$13.48
|
| Rate for Payer: BCBS Trust/PPO |
$27.79
|
| Rate for Payer: BCN Commercial |
$27.79
|
| Rate for Payer: Cash Price |
$26.96
|
| Rate for Payer: Cofinity Commercial |
$31.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.96
|
| Rate for Payer: Healthscope Commercial |
$32.69
|
| Rate for Payer: Healthscope Whirlpool |
$33.70
|
| Rate for Payer: Mclaren Commercial |
$30.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.65
|
| Rate for Payer: Nomi Health Commercial |
$27.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29.53
|
| Rate for Payer: Priority Health Narrow Network |
$23.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.66
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
OP
|
$26.20
|
|
|
Service Code
|
NDC 17478010212
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$26.20 |
| Rate for Payer: Aetna Commercial |
$23.58
|
| Rate for Payer: Aetna Medicare |
$9.69
|
| Rate for Payer: ASR ASR |
$25.41
|
| Rate for Payer: BCBS Complete |
$10.48
|
| Rate for Payer: BCBS Trust/PPO |
$21.60
|
| Rate for Payer: BCN Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$24.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.96
|
| Rate for Payer: Healthscope Commercial |
$25.41
|
| Rate for Payer: Healthscope Whirlpool |
$26.20
|
| Rate for Payer: Mclaren Commercial |
$23.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.27
|
| Rate for Payer: Nomi Health Commercial |
$21.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.95
|
| Rate for Payer: Priority Health Narrow Network |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.05
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
OP
|
$346.19
|
|
|
Service Code
|
NDC 998035515
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.09 |
| Max. Negotiated Rate |
$346.19 |
| Rate for Payer: Aetna Commercial |
$311.57
|
| Rate for Payer: Aetna Medicare |
$128.09
|
| Rate for Payer: ASR ASR |
$335.80
|
| Rate for Payer: BCBS Complete |
$138.47
|
| Rate for Payer: BCBS Trust/PPO |
$285.43
|
| Rate for Payer: BCN Commercial |
$285.43
|
| Rate for Payer: Cash Price |
$276.95
|
| Rate for Payer: Cofinity Commercial |
$325.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.95
|
| Rate for Payer: Healthscope Commercial |
$335.80
|
| Rate for Payer: Healthscope Whirlpool |
$346.19
|
| Rate for Payer: Mclaren Commercial |
$311.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.26
|
| Rate for Payer: Nomi Health Commercial |
$283.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$303.33
|
| Rate for Payer: Priority Health Narrow Network |
$242.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.64
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
IP
|
$346.19
|
|
|
Service Code
|
NDC 998035515
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.64 |
| Max. Negotiated Rate |
$346.19 |
| Rate for Payer: Aetna Commercial |
$311.57
|
| Rate for Payer: ASR ASR |
$335.80
|
| Rate for Payer: BCBS Trust/PPO |
$284.29
|
| Rate for Payer: BCN Commercial |
$284.29
|
| Rate for Payer: Cash Price |
$276.95
|
| Rate for Payer: Cofinity Commercial |
$325.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.95
|
| Rate for Payer: Healthscope Commercial |
$335.80
|
| Rate for Payer: Healthscope Whirlpool |
$346.19
|
| Rate for Payer: Mclaren Commercial |
$311.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.26
|
| Rate for Payer: Nomi Health Commercial |
$283.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.64
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
IP
|
$33.71
|
|
|
Service Code
|
NDC 61314035501
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$30.33
|
| Rate for Payer: ASR ASR |
$32.69
|
| Rate for Payer: BCBS Trust/PPO |
$27.68
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: Cash Price |
$26.96
|
| Rate for Payer: Cofinity Commercial |
$31.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.96
|
| Rate for Payer: Healthscope Commercial |
$32.69
|
| Rate for Payer: Healthscope Whirlpool |
$33.70
|
| Rate for Payer: Mclaren Commercial |
$30.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.65
|
| Rate for Payer: Nomi Health Commercial |
$27.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.66
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
IP
|
$23.13
|
|
|
Service Code
|
NDC 24208058559
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$23.13 |
| Rate for Payer: Aetna Commercial |
$20.82
|
| Rate for Payer: ASR ASR |
$22.44
|
| Rate for Payer: BCBS Trust/PPO |
$18.99
|
| Rate for Payer: BCN Commercial |
$18.99
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cofinity Commercial |
$21.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.50
|
| Rate for Payer: Healthscope Commercial |
$22.44
|
| Rate for Payer: Healthscope Whirlpool |
$23.13
|
| Rate for Payer: Mclaren Commercial |
$20.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.66
|
| Rate for Payer: Nomi Health Commercial |
$18.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.35
|
|
