|
WATER FOR INJECTION, STERILE INJECTION SOLUTION FOR SOLID FORM MIXTURES
|
Facility
|
IP
|
$18.11
|
|
|
Service Code
|
NDC 63323018507
|
| Hospital Charge Code |
301772
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$18.11 |
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: ASR ASR |
$17.57
|
| Rate for Payer: ASR Commercial |
$17.57
|
| Rate for Payer: BCBS Trust/PPO |
$14.76
|
| Rate for Payer: BCN Commercial |
$14.04
|
| Rate for Payer: Cash Price |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$17.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.49
|
| Rate for Payer: Healthscope Commercial |
$18.11
|
| Rate for Payer: Healthscope Whirlpool |
$17.57
|
| Rate for Payer: Mclaren Commercial |
$16.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.39
|
| Rate for Payer: Nomi Health Commercial |
$14.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.94
|
|
|
WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 00338001304
|
| Hospital Charge Code |
28400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$47.85 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: ASR ASR |
$46.41
|
| Rate for Payer: ASR Commercial |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$38.99
|
| Rate for Payer: BCN Commercial |
$37.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$44.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$47.85
|
| Rate for Payer: Healthscope Whirlpool |
$46.41
|
| Rate for Payer: Mclaren Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Nomi Health Commercial |
$39.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.11
|
|
|
WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 00338001304
|
| Hospital Charge Code |
28400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$47.85 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Medicare |
$23.93
|
| Rate for Payer: ASR ASR |
$46.41
|
| Rate for Payer: ASR Commercial |
$46.41
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: BCBS Trust/PPO |
$39.18
|
| Rate for Payer: BCN Commercial |
$37.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$44.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$47.85
|
| Rate for Payer: Healthscope Whirlpool |
$46.41
|
| Rate for Payer: Mclaren Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Nomi Health Commercial |
$39.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.93
|
| Rate for Payer: Priority Health Narrow Network |
$33.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.11
|
|
|
WHITE PETROLATUM 57.7 %-MINERAL OIL 31.9 % EYE OINTMENT
|
Facility
|
OP
|
$27.80
|
|
|
Service Code
|
NDC 63736014308
|
| Hospital Charge Code |
175688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$27.80 |
| Rate for Payer: Aetna Commercial |
$25.02
|
| Rate for Payer: Aetna Medicare |
$13.90
|
| Rate for Payer: ASR ASR |
$26.97
|
| Rate for Payer: ASR Commercial |
$26.97
|
| Rate for Payer: BCBS Complete |
$11.12
|
| Rate for Payer: BCBS Trust/PPO |
$22.77
|
| Rate for Payer: BCN Commercial |
$21.55
|
| Rate for Payer: Cash Price |
$22.24
|
| Rate for Payer: Cofinity Commercial |
$26.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.24
|
| Rate for Payer: Healthscope Commercial |
$27.80
|
| Rate for Payer: Healthscope Whirlpool |
$26.97
|
| Rate for Payer: Mclaren Commercial |
$25.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.63
|
| Rate for Payer: Nomi Health Commercial |
$22.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.36
|
| Rate for Payer: Priority Health Narrow Network |
$19.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.46
|
|
|
WHITE PETROLATUM 57.7 %-MINERAL OIL 31.9 % EYE OINTMENT
|
Facility
|
IP
|
$27.80
|
|
|
Service Code
|
NDC 63736014308
|
| Hospital Charge Code |
175688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$27.80 |
| Rate for Payer: Aetna Commercial |
$25.02
|
| Rate for Payer: ASR ASR |
$26.97
|
| Rate for Payer: ASR Commercial |
$26.97
|
| Rate for Payer: BCBS Trust/PPO |
$22.65
|
| Rate for Payer: BCN Commercial |
$21.55
|
| Rate for Payer: Cash Price |
$22.24
|
| Rate for Payer: Cofinity Commercial |
$26.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.24
|
| Rate for Payer: Healthscope Commercial |
$27.80
|
| Rate for Payer: Healthscope Whirlpool |
$26.97
|
| Rate for Payer: Mclaren Commercial |
$25.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.63
|
| Rate for Payer: Nomi Health Commercial |
$22.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.46
|
|
|
WHITE PETROLATUM-MINERAL OIL 56.8 %-42.5 % EYE OINTMENT
|
Facility
|
OP
|
$31.81
|
|
|
Service Code
|
NDC 00023031204
|
| Hospital Charge Code |
117955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna Commercial |
$28.63
|
| Rate for Payer: Aetna Medicare |
$15.90
|
| Rate for Payer: ASR ASR |
$30.86
|
| Rate for Payer: ASR Commercial |
$30.86
|
| Rate for Payer: BCBS Complete |
$12.72
|
| Rate for Payer: BCBS Trust/PPO |
$26.05
|
| Rate for Payer: BCN Commercial |
$24.66
|
| Rate for Payer: Cash Price |
$25.45
|
| Rate for Payer: Cofinity Commercial |
$29.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$31.81
|
| Rate for Payer: Healthscope Whirlpool |
$30.86
|
| Rate for Payer: Mclaren Commercial |
$28.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.04
|
| Rate for Payer: Nomi Health Commercial |
$26.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.87
|
| Rate for Payer: Priority Health Narrow Network |
$22.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.99
|
|
|
WHITE PETROLATUM-MINERAL OIL 56.8 %-42.5 % EYE OINTMENT
|
Facility
|
IP
|
$31.81
|
|
|
Service Code
|
NDC 00023031204
|
| Hospital Charge Code |
117955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna Commercial |
$28.63
|
| Rate for Payer: ASR ASR |
$30.86
|
| Rate for Payer: ASR Commercial |
$30.86
|
| Rate for Payer: BCBS Trust/PPO |
$25.92
|
| Rate for Payer: BCN Commercial |
$24.66
|
| Rate for Payer: Cash Price |
$25.45
|
| Rate for Payer: Cofinity Commercial |
$29.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$31.81
|
| Rate for Payer: Healthscope Whirlpool |
$30.86
|
| Rate for Payer: Mclaren Commercial |
$28.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.04
|
| Rate for Payer: Nomi Health Commercial |
$26.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.99
|
|
|
WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT
|
Facility
|
OP
|
$22.10
|
|
|
Service Code
|
NDC 00904648838
|
| Hospital Charge Code |
117765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Medicare |
$11.05
|
| Rate for Payer: ASR ASR |
$21.44
|
| Rate for Payer: ASR Commercial |
$21.44
|
| Rate for Payer: BCBS Complete |
$8.84
|
| Rate for Payer: BCBS Trust/PPO |
$18.10
|
| Rate for Payer: BCN Commercial |
$17.13
|
| Rate for Payer: Cash Price |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$20.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.68
|
| Rate for Payer: Healthscope Commercial |
$22.10
|
| Rate for Payer: Healthscope Whirlpool |
$21.44
|
| Rate for Payer: Mclaren Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.79
|
| Rate for Payer: Nomi Health Commercial |
$18.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.36
|
| Rate for Payer: Priority Health Narrow Network |
$15.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.45
|
|
|
WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT
|
Facility
|
IP
|
$22.10
|
|
|
Service Code
|
NDC 00904648838
|
| Hospital Charge Code |
117765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: ASR ASR |
$21.44
|
| Rate for Payer: ASR Commercial |
$21.44
|
| Rate for Payer: BCBS Trust/PPO |
$18.01
|
| Rate for Payer: BCN Commercial |
$17.13
|
| Rate for Payer: Cash Price |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$20.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.68
|
| Rate for Payer: Healthscope Commercial |
$22.10
|
| Rate for Payer: Healthscope Whirlpool |
$21.44
|
| Rate for Payer: Mclaren Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.79
|
| Rate for Payer: Nomi Health Commercial |
$18.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.45
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$493.06
|
|
|
Service Code
|
NDC 55111062660
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$320.49 |
| Max. Negotiated Rate |
$493.06 |
| Rate for Payer: Aetna Commercial |
$443.75
|
| Rate for Payer: ASR ASR |
$478.27
|
| Rate for Payer: ASR Commercial |
$478.27
|
| Rate for Payer: BCBS Trust/PPO |
$401.79
|
| Rate for Payer: BCN Commercial |
$382.27
|
| Rate for Payer: Cash Price |
$394.44
|
| Rate for Payer: Cofinity Commercial |
$463.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.45
|
| Rate for Payer: Healthscope Commercial |
$493.06
|
| Rate for Payer: Healthscope Whirlpool |
$478.27
|
| Rate for Payer: Mclaren Commercial |
$443.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.10
|
| Rate for Payer: Nomi Health Commercial |
$404.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$433.89
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$493.06
|
|
|
Service Code
|
NDC 55111062660
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.22 |
| Max. Negotiated Rate |
$493.06 |
| Rate for Payer: Aetna Commercial |
$443.75
|
| Rate for Payer: Aetna Medicare |
$246.53
|
| Rate for Payer: ASR ASR |
$478.27
|
| Rate for Payer: ASR Commercial |
$478.27
|
| Rate for Payer: BCBS Complete |
$197.22
|
| Rate for Payer: BCBS Trust/PPO |
$403.77
|
| Rate for Payer: BCN Commercial |
$382.27
|
| Rate for Payer: Cash Price |
$394.44
|
| Rate for Payer: Cofinity Commercial |
$463.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.45
|
| Rate for Payer: Healthscope Commercial |
$493.06
|
| Rate for Payer: Healthscope Whirlpool |
$478.27
|
| Rate for Payer: Mclaren Commercial |
$443.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.10
|
| Rate for Payer: Nomi Health Commercial |
$404.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$432.02
|
| Rate for Payer: Priority Health Narrow Network |
$345.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$433.89
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$9.88
|
|
|
Service Code
|
NDC 68084005911
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$9.88 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: ASR ASR |
$9.58
|
| Rate for Payer: ASR Commercial |
$9.58
|
| Rate for Payer: BCBS Trust/PPO |
$8.05
|
| Rate for Payer: BCN Commercial |
$7.66
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.90
|
| Rate for Payer: Healthscope Commercial |
$9.88
|
| Rate for Payer: Healthscope Whirlpool |
$9.58
|
| Rate for Payer: Mclaren Commercial |
$8.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.40
|
| Rate for Payer: Nomi Health Commercial |
$8.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.69
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$329.18
|
|
|
Service Code
|
NDC 31722000860
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna Commercial |
$296.26
|
| Rate for Payer: Aetna Medicare |
$164.59
|
| Rate for Payer: ASR ASR |
$319.30
|
| Rate for Payer: ASR Commercial |
$319.30
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS Trust/PPO |
$269.57
|
| Rate for Payer: BCN Commercial |
$255.21
|
| Rate for Payer: Cash Price |
$263.35
|
| Rate for Payer: Cofinity Commercial |
$309.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.34
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Healthscope Whirlpool |
$319.30
|
| Rate for Payer: Mclaren Commercial |
$296.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.80
|
| Rate for Payer: Nomi Health Commercial |
$269.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.43
|
| Rate for Payer: Priority Health Narrow Network |
$230.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.68
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$9.88
|
|
|
Service Code
|
NDC 68084005911
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$9.88 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Medicare |
$4.94
|
| Rate for Payer: ASR ASR |
$9.58
|
| Rate for Payer: ASR Commercial |
$9.58
|
| Rate for Payer: BCBS Complete |
$3.95
|
| Rate for Payer: BCBS Trust/PPO |
$8.09
|
| Rate for Payer: BCN Commercial |
$7.66
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.90
|
| Rate for Payer: Healthscope Commercial |
$9.88
|
| Rate for Payer: Healthscope Whirlpool |
$9.58
|
| Rate for Payer: Mclaren Commercial |
$8.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.40
|
| Rate for Payer: Nomi Health Commercial |
$8.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.66
|
| Rate for Payer: Priority Health Narrow Network |
$6.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.69
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$329.18
|
|
|
Service Code
|
NDC 31722000860
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.97 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna Commercial |
$296.26
|
| Rate for Payer: ASR ASR |
$319.30
|
| Rate for Payer: ASR Commercial |
$319.30
|
| Rate for Payer: BCBS Trust/PPO |
$268.25
|
| Rate for Payer: BCN Commercial |
$255.21
|
| Rate for Payer: Cash Price |
$263.35
|
| Rate for Payer: Cofinity Commercial |
$309.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.34
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Healthscope Whirlpool |
$319.30
|
| Rate for Payer: Mclaren Commercial |
$296.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.80
|
| Rate for Payer: Nomi Health Commercial |
$269.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.68
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$296.26
|
|
|
Service Code
|
NDC 68084005921
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.57 |
| Max. Negotiated Rate |
$296.26 |
| Rate for Payer: Aetna Commercial |
$266.63
|
| Rate for Payer: ASR ASR |
$287.37
|
| Rate for Payer: ASR Commercial |
$287.37
|
| Rate for Payer: BCBS Trust/PPO |
$241.42
|
| Rate for Payer: BCN Commercial |
$229.69
|
| Rate for Payer: Cash Price |
$237.01
|
| Rate for Payer: Cofinity Commercial |
$278.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.01
|
| Rate for Payer: Healthscope Commercial |
$296.26
|
| Rate for Payer: Healthscope Whirlpool |
$287.37
|
| Rate for Payer: Mclaren Commercial |
$266.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.82
|
| Rate for Payer: Nomi Health Commercial |
$242.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.71
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$296.26
|
|
|
Service Code
|
NDC 68084005921
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$296.26 |
| Rate for Payer: Aetna Commercial |
$266.63
|
| Rate for Payer: Aetna Medicare |
$148.13
|
| Rate for Payer: ASR ASR |
$287.37
|
| Rate for Payer: ASR Commercial |
$287.37
|
| Rate for Payer: BCBS Complete |
$118.50
|
| Rate for Payer: BCBS Trust/PPO |
$242.61
|
| Rate for Payer: BCN Commercial |
$229.69
|
| Rate for Payer: Cash Price |
$237.01
|
| Rate for Payer: Cofinity Commercial |
$278.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.01
|
| Rate for Payer: Healthscope Commercial |
$296.26
|
| Rate for Payer: Healthscope Whirlpool |
$287.37
|
| Rate for Payer: Mclaren Commercial |
$266.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.82
|
| Rate for Payer: Nomi Health Commercial |
$242.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.58
|
| Rate for Payer: Priority Health Narrow Network |
$207.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.71
|
|
|
ZIDOVUDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$126.65
|
|
|
Service Code
|
HCPCS J3485
|
| Hospital Charge Code |
11691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.32 |
| Max. Negotiated Rate |
$126.65 |
| Rate for Payer: Aetna Commercial |
$113.98
|
| Rate for Payer: ASR ASR |
$122.85
|
| Rate for Payer: ASR Commercial |
$122.85
|
| Rate for Payer: BCBS Trust/PPO |
$103.21
|
| Rate for Payer: BCN Commercial |
$98.19
|
| Rate for Payer: Cash Price |
$101.32
|
| Rate for Payer: Cofinity Commercial |
$119.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.32
|
| Rate for Payer: Healthscope Commercial |
$126.65
|
| Rate for Payer: Healthscope Whirlpool |
$122.85
|
| Rate for Payer: Mclaren Commercial |
$113.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.65
|
| Rate for Payer: Nomi Health Commercial |
$103.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.45
|
|
|
ZIDOVUDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$126.65
|
|
|
Service Code
|
HCPCS J3485
|
| Hospital Charge Code |
11691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.66 |
| Max. Negotiated Rate |
$126.65 |
| Rate for Payer: Aetna Commercial |
$113.98
|
| Rate for Payer: Aetna Medicare |
$63.33
|
| Rate for Payer: ASR ASR |
$122.85
|
| Rate for Payer: ASR Commercial |
$122.85
|
| Rate for Payer: BCBS Complete |
$50.66
|
| Rate for Payer: BCBS Trust/PPO |
$103.71
|
| Rate for Payer: BCN Commercial |
$98.19
|
| Rate for Payer: Cash Price |
$101.32
|
| Rate for Payer: Cofinity Commercial |
$119.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.32
|
| Rate for Payer: Healthscope Commercial |
$126.65
|
| Rate for Payer: Healthscope Whirlpool |
$122.85
|
| Rate for Payer: Mclaren Commercial |
$113.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.65
|
| Rate for Payer: Nomi Health Commercial |
$103.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.97
|
| Rate for Payer: Priority Health Narrow Network |
$88.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.45
|
|
|
ZINC OXIDE 17 %-WHITE PETROLATUM 57 % TOPICAL PASTE
|
Facility
|
IP
|
$23.73
|
|
|
Service Code
|
NDC 53329013744
|
| Hospital Charge Code |
172300
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$23.73 |
| Rate for Payer: Aetna Commercial |
$21.36
|
| Rate for Payer: ASR ASR |
$23.02
|
| Rate for Payer: ASR Commercial |
$23.02
|
| Rate for Payer: BCBS Trust/PPO |
$19.34
|
| Rate for Payer: BCN Commercial |
$18.40
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.98
|
| Rate for Payer: Healthscope Commercial |
$23.73
|
| Rate for Payer: Healthscope Whirlpool |
$23.02
|
| Rate for Payer: Mclaren Commercial |
$21.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.17
|
| Rate for Payer: Nomi Health Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.88
|
|
|
ZINC OXIDE 17 %-WHITE PETROLATUM 57 % TOPICAL PASTE
|
Facility
|
OP
|
$23.73
|
|
|
Service Code
|
NDC 53329013744
|
| Hospital Charge Code |
172300
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$23.73 |
| Rate for Payer: Aetna Commercial |
$21.36
|
| Rate for Payer: Aetna Medicare |
$11.87
|
| Rate for Payer: ASR ASR |
$23.02
|
| Rate for Payer: ASR Commercial |
$23.02
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS Trust/PPO |
$19.43
|
| Rate for Payer: BCN Commercial |
$18.40
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.98
|
| Rate for Payer: Healthscope Commercial |
$23.73
|
| Rate for Payer: Healthscope Whirlpool |
$23.02
|
| Rate for Payer: Mclaren Commercial |
$21.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.17
|
| Rate for Payer: Nomi Health Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.79
|
| Rate for Payer: Priority Health Narrow Network |
$16.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.88
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
|
IP
|
$39.19
|
|
|
Service Code
|
NDC 11701005033
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.47 |
| Max. Negotiated Rate |
$39.19 |
| Rate for Payer: Aetna Commercial |
$35.27
|
| Rate for Payer: ASR ASR |
$38.01
|
| Rate for Payer: ASR Commercial |
$38.01
|
| Rate for Payer: BCBS Trust/PPO |
$31.94
|
| Rate for Payer: BCN Commercial |
$30.38
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.35
|
| Rate for Payer: Healthscope Commercial |
$39.19
|
| Rate for Payer: Healthscope Whirlpool |
$38.01
|
| Rate for Payer: Mclaren Commercial |
$35.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.31
|
| Rate for Payer: Nomi Health Commercial |
$32.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.49
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
|
OP
|
$39.19
|
|
|
Service Code
|
NDC 11701005033
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$39.19 |
| Rate for Payer: Aetna Commercial |
$35.27
|
| Rate for Payer: Aetna Medicare |
$19.59
|
| Rate for Payer: ASR ASR |
$38.01
|
| Rate for Payer: ASR Commercial |
$38.01
|
| Rate for Payer: BCBS Complete |
$15.68
|
| Rate for Payer: BCBS Trust/PPO |
$32.09
|
| Rate for Payer: BCN Commercial |
$30.38
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.35
|
| Rate for Payer: Healthscope Commercial |
$39.19
|
| Rate for Payer: Healthscope Whirlpool |
$38.01
|
| Rate for Payer: Mclaren Commercial |
$35.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.31
|
| Rate for Payer: Nomi Health Commercial |
$32.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.34
|
| Rate for Payer: Priority Health Narrow Network |
$27.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.49
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 77333098325
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Aetna Commercial |
$1.51
|
| Rate for Payer: ASR ASR |
$1.63
|
| Rate for Payer: ASR Commercial |
$1.63
|
| Rate for Payer: BCBS Trust/PPO |
$1.37
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cofinity Commercial |
$1.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.34
|
| Rate for Payer: Healthscope Commercial |
$1.68
|
| Rate for Payer: Healthscope Whirlpool |
$1.63
|
| Rate for Payer: Mclaren Commercial |
$1.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.43
|
| Rate for Payer: Nomi Health Commercial |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.48
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
OP
|
$144.10
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$144.10 |
| Rate for Payer: Aetna Commercial |
$129.69
|
| Rate for Payer: Aetna Medicare |
$72.05
|
| Rate for Payer: ASR ASR |
$139.78
|
| Rate for Payer: ASR Commercial |
$139.78
|
| Rate for Payer: BCBS Complete |
$57.64
|
| Rate for Payer: BCBS Trust/PPO |
$118.00
|
| Rate for Payer: BCN Commercial |
$111.72
|
| Rate for Payer: Cash Price |
$115.28
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.28
|
| Rate for Payer: Healthscope Commercial |
$144.10
|
| Rate for Payer: Healthscope Whirlpool |
$139.78
|
| Rate for Payer: Mclaren Commercial |
$129.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.48
|
| Rate for Payer: Nomi Health Commercial |
$118.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.26
|
| Rate for Payer: Priority Health Narrow Network |
$101.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.81
|
|
