|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$796.01
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
32767
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$716.41 |
| Rate for Payer: Aetna Commercial |
$676.61
|
| Rate for Payer: Aetna Commercial |
$409.48
|
| Rate for Payer: Aetna Commercial |
$787.16
|
| Rate for Payer: Aetna Commercial |
$3,607.68
|
| Rate for Payer: Aetna Commercial |
$688.96
|
| Rate for Payer: Aetna Commercial |
$612.74
|
| Rate for Payer: Aetna Commercial |
$532.49
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,758.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$407.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.56
|
| Rate for Payer: BCBS Complete |
$4.85
|
| Rate for Payer: BCBS Complete |
$4.85
|
| Rate for Payer: BCBS Complete |
$4.85
|
| Rate for Payer: BCBS Complete |
$4.85
|
| Rate for Payer: BCBS Complete |
$4.85
|
| Rate for Payer: BCBS Complete |
$4.85
|
| Rate for Payer: BCBS Complete |
$4.85
|
| Rate for Payer: BCBS MAPPO |
$8.44
|
| Rate for Payer: BCBS MAPPO |
$8.44
|
| Rate for Payer: BCBS MAPPO |
$8.44
|
| Rate for Payer: BCBS MAPPO |
$8.44
|
| Rate for Payer: BCBS MAPPO |
$8.44
|
| Rate for Payer: BCBS MAPPO |
$8.44
|
| Rate for Payer: BCBS MAPPO |
$8.44
|
| Rate for Payer: BCBS Trust/PPO |
$24.99
|
| Rate for Payer: BCBS Trust/PPO |
$24.99
|
| Rate for Payer: BCBS Trust/PPO |
$24.99
|
| Rate for Payer: BCBS Trust/PPO |
$24.99
|
| Rate for Payer: BCBS Trust/PPO |
$24.99
|
| Rate for Payer: BCBS Trust/PPO |
$24.99
|
| Rate for Payer: BCBS Trust/PPO |
$24.99
|
| Rate for Payer: BCN Medicare Advantage |
$8.44
|
| Rate for Payer: BCN Medicare Advantage |
$8.44
|
| Rate for Payer: BCN Medicare Advantage |
$8.44
|
| Rate for Payer: BCN Medicare Advantage |
$8.44
|
| Rate for Payer: BCN Medicare Advantage |
$8.44
|
| Rate for Payer: BCN Medicare Advantage |
$8.44
|
| Rate for Payer: BCN Medicare Advantage |
$8.44
|
| Rate for Payer: Cash Price |
$740.86
|
| Rate for Payer: Cash Price |
$3,395.46
|
| Rate for Payer: Cash Price |
$740.86
|
| Rate for Payer: Cash Price |
$576.70
|
| Rate for Payer: Cash Price |
$576.70
|
| Rate for Payer: Cash Price |
$636.81
|
| Rate for Payer: Cash Price |
$636.81
|
| Rate for Payer: Cash Price |
$385.39
|
| Rate for Payer: Cash Price |
$648.43
|
| Rate for Payer: Cash Price |
$648.43
|
| Rate for Payer: Cash Price |
$501.17
|
| Rate for Payer: Cash Price |
$3,395.46
|
| Rate for Payer: Cash Price |
$501.17
|
| Rate for Payer: Cash Price |
$385.39
|
| Rate for Payer: Cofinity Commercial |
$504.61
|
| Rate for Payer: Cofinity Commercial |
$3,650.12
|
| Rate for Payer: Cofinity Commercial |
$337.22
|
| Rate for Payer: Cofinity Commercial |
$414.30
|
| Rate for Payer: Cofinity Commercial |
$697.06
|
| Rate for Payer: Cofinity Commercial |
$567.38
|
| Rate for Payer: Cofinity Commercial |
$2,971.03
|
| Rate for Payer: Cofinity Commercial |
$796.42
|
| Rate for Payer: Cofinity Commercial |
$438.52
|
| Rate for Payer: Cofinity Commercial |
$538.76
|
| Rate for Payer: Cofinity Commercial |
$684.57
|
| Rate for Payer: Cofinity Commercial |
$557.21
|
| Rate for Payer: Cofinity Commercial |
$648.25
|
| Rate for Payer: Cofinity Commercial |
$619.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.44
|
| Rate for Payer: Healthscope Commercial |
$833.46
|
| Rate for Payer: Healthscope Commercial |
$3,819.90
|
| Rate for Payer: Healthscope Commercial |
$563.81
|
| Rate for Payer: Healthscope Commercial |
$716.41
|
| Rate for Payer: Healthscope Commercial |
$729.49
|
| Rate for Payer: Healthscope Commercial |
$433.57
|
| Rate for Payer: Healthscope Commercial |
$648.78
|
| Rate for Payer: Mclaren Medicaid |
$4.62
|
| Rate for Payer: Mclaren Medicaid |
$4.62
|
| Rate for Payer: Mclaren Medicaid |
$4.62
|
| Rate for Payer: Mclaren Medicaid |
$4.62
|
| Rate for Payer: Mclaren Medicaid |
$4.62
|
| Rate for Payer: Mclaren Medicaid |
$4.62
|
| Rate for Payer: Mclaren Medicaid |
$4.62
|
| Rate for Payer: Mclaren Medicare |
$8.44
|
| Rate for Payer: Mclaren Medicare |
$8.44
|
| Rate for Payer: Mclaren Medicare |
$8.44
|
| Rate for Payer: Mclaren Medicare |
$8.44
|
| Rate for Payer: Mclaren Medicare |
$8.44
|
| Rate for Payer: Mclaren Medicare |
$8.44
|
| Rate for Payer: Mclaren Medicare |
$8.44
|
| Rate for Payer: Meridian Medicaid |
$4.85
|
| Rate for Payer: Meridian Medicaid |
$4.85
|
| Rate for Payer: Meridian Medicaid |
$4.85
|
| Rate for Payer: Meridian Medicaid |
$4.85
|
| Rate for Payer: Meridian Medicaid |
$4.85
|
| Rate for Payer: Meridian Medicaid |
$4.85
|
| Rate for Payer: Meridian Medicaid |
$4.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$612.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$787.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,607.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$676.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$532.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$688.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$409.48
|
| Rate for Payer: PACE Medicare |
$8.02
|
| Rate for Payer: PACE Medicare |
$8.02
|
| Rate for Payer: PACE Medicare |
$8.02
|
| Rate for Payer: PACE Medicare |
$8.02
|
| Rate for Payer: PACE Medicare |
$8.02
|
| Rate for Payer: PACE Medicare |
$8.02
|
| Rate for Payer: PACE Medicare |
$8.02
|
| Rate for Payer: PACE SWMI |
$8.44
|
| Rate for Payer: PACE SWMI |
$8.44
|
| Rate for Payer: PACE SWMI |
$8.44
|
| Rate for Payer: PACE SWMI |
$8.44
|
| Rate for Payer: PACE SWMI |
$8.44
|
| Rate for Payer: PACE SWMI |
$8.44
|
| Rate for Payer: PACE SWMI |
$8.44
|
| Rate for Payer: PHP Commercial |
$3,607.68
|
| Rate for Payer: PHP Commercial |
$676.61
|
| Rate for Payer: PHP Commercial |
$787.16
|
| Rate for Payer: PHP Commercial |
$612.74
|
| Rate for Payer: PHP Commercial |
$532.49
|
| Rate for Payer: PHP Commercial |
$688.96
|
| Rate for Payer: PHP Commercial |
$409.48
|
| Rate for Payer: PHP Medicare Advantage |
$8.44
|
| Rate for Payer: PHP Medicare Advantage |
$8.44
|
| Rate for Payer: PHP Medicare Advantage |
$8.44
|
| Rate for Payer: PHP Medicare Advantage |
$8.44
|
| Rate for Payer: PHP Medicare Advantage |
$8.44
|
| Rate for Payer: PHP Medicare Advantage |
$8.44
|
| Rate for Payer: PHP Medicare Advantage |
$8.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,971.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.61
|
| Rate for Payer: Priority Health Medicare |
$8.44
|
| Rate for Payer: Priority Health Medicare |
$8.44
|
| Rate for Payer: Priority Health Medicare |
$8.44
|
| Rate for Payer: Priority Health Medicare |
$8.44
|
| Rate for Payer: Priority Health Medicare |
$8.44
|
| Rate for Payer: Priority Health Medicare |
$8.44
|
| Rate for Payer: Priority Health Medicare |
$8.44
|
| Rate for Payer: Priority Health SBD |
$454.15
|
| Rate for Payer: Priority Health SBD |
$394.67
|
| Rate for Payer: Priority Health SBD |
$303.50
|
| Rate for Payer: Priority Health SBD |
$501.49
|
| Rate for Payer: Priority Health SBD |
$583.42
|
| Rate for Payer: Priority Health SBD |
$510.64
|
| Rate for Payer: Priority Health SBD |
$2,673.93
|
| Rate for Payer: Railroad Medicare Medicare |
$8.44
|
| Rate for Payer: Railroad Medicare Medicare |
$8.44
|
| Rate for Payer: Railroad Medicare Medicare |
$8.44
|
| Rate for Payer: Railroad Medicare Medicare |
$8.44
|
| Rate for Payer: Railroad Medicare Medicare |
$8.44
|
| Rate for Payer: Railroad Medicare Medicare |
$8.44
|
| Rate for Payer: Railroad Medicare Medicare |
$8.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.44
|
| Rate for Payer: UHC Medicare Advantage |
$8.70
|
| Rate for Payer: UHC Medicare Advantage |
$8.70
|
| Rate for Payer: UHC Medicare Advantage |
$8.70
|
| Rate for Payer: UHC Medicare Advantage |
$8.70
|
| Rate for Payer: UHC Medicare Advantage |
$8.70
|
| Rate for Payer: UHC Medicare Advantage |
$8.70
|
| Rate for Payer: UHC Medicare Advantage |
$8.70
|
| Rate for Payer: VA VA |
$8.44
|
| Rate for Payer: VA VA |
$8.44
|
| Rate for Payer: VA VA |
$8.44
|
| Rate for Payer: VA VA |
$8.44
|
| Rate for Payer: VA VA |
$8.44
|
| Rate for Payer: VA VA |
$8.44
|
| Rate for Payer: VA VA |
$8.44
|
|
|
FUROSEMIDE 10 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$10.94
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
163713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$9.85 |
| Rate for Payer: Aetna Commercial |
$9.30
|
| Rate for Payer: Aetna Commercial |
$9.82
|
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.86
|
| Rate for Payer: Cash Price |
$9.24
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$7.66
|
| Rate for Payer: Cofinity Commercial |
$8.08
|
| Rate for Payer: Cofinity Commercial |
$14.36
|
| Rate for Payer: Cofinity Commercial |
$9.93
|
| Rate for Payer: Cofinity Commercial |
$11.69
|
| Rate for Payer: Cofinity Commercial |
$9.41
|
| Rate for Payer: Healthscope Commercial |
$9.85
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$15.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.20
|
| Rate for Payer: PHP Commercial |
$9.30
|
| Rate for Payer: PHP Commercial |
$14.20
|
| Rate for Payer: PHP Commercial |
$9.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health SBD |
$6.89
|
| Rate for Payer: Priority Health SBD |
$10.52
|
| Rate for Payer: Priority Health SBD |
$7.28
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$10.47
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
3291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$9.42 |
| Rate for Payer: Aetna Commercial |
$8.90
|
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Aetna Commercial |
$9.82
|
| Rate for Payer: Aetna Commercial |
$17.50
|
| Rate for Payer: Aetna Commercial |
$15.04
|
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Commercial |
$9.30
|
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$11.71
|
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.28
|
| Rate for Payer: Cash Price |
$9.24
|
| Rate for Payer: Cash Price |
$8.38
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cash Price |
$16.47
|
| Rate for Payer: Cofinity Commercial |
$11.69
|
| Rate for Payer: Cofinity Commercial |
$10.60
|
| Rate for Payer: Cofinity Commercial |
$9.93
|
| Rate for Payer: Cofinity Commercial |
$7.33
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Commercial |
$9.63
|
| Rate for Payer: Cofinity Commercial |
$9.41
|
| Rate for Payer: Cofinity Commercial |
$11.06
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$7.66
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$9.62
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$15.21
|
| Rate for Payer: Cofinity Commercial |
$8.08
|
| Rate for Payer: Cofinity Commercial |
$14.36
|
| Rate for Payer: Cofinity Commercial |
$17.71
|
| Rate for Payer: Cofinity Commercial |
$7.84
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$14.41
|
| Rate for Payer: Cofinity Commercial |
$11.85
|
| Rate for Payer: Cofinity Commercial |
$9.65
|
| Rate for Payer: Healthscope Commercial |
$9.85
|
| Rate for Payer: Healthscope Commercial |
$15.03
|
| Rate for Payer: Healthscope Commercial |
$10.08
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$18.53
|
| Rate for Payer: Healthscope Commercial |
$12.40
|
| Rate for Payer: Healthscope Commercial |
$13.64
|
| Rate for Payer: Healthscope Commercial |
$15.92
|
| Rate for Payer: Healthscope Commercial |
$9.42
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.20
|
| Rate for Payer: PHP Commercial |
$8.90
|
| Rate for Payer: PHP Commercial |
$9.82
|
| Rate for Payer: PHP Commercial |
$11.69
|
| Rate for Payer: PHP Commercial |
$9.30
|
| Rate for Payer: PHP Commercial |
$11.71
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: PHP Commercial |
$14.20
|
| Rate for Payer: PHP Commercial |
$15.04
|
| Rate for Payer: PHP Commercial |
$17.50
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.41
|
| Rate for Payer: Priority Health SBD |
$11.14
|
| Rate for Payer: Priority Health SBD |
$8.68
|
| Rate for Payer: Priority Health SBD |
$6.89
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health SBD |
$6.60
|
| Rate for Payer: Priority Health SBD |
$8.66
|
| Rate for Payer: Priority Health SBD |
$9.95
|
| Rate for Payer: Priority Health SBD |
$7.06
|
| Rate for Payer: Priority Health SBD |
$7.28
|
| Rate for Payer: Priority Health SBD |
$10.52
|
| Rate for Payer: Priority Health SBD |
$12.97
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$15.80
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
3291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.27
|
| Rate for Payer: BCBS Complete |
$6.32
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$11.06
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.43
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.06
|
| Rate for Payer: Priority Health SBD |
$9.95
|
|
|
FUROSEMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$124.08
|
|
|
Service Code
|
NDC 0054-3294-46
|
| Hospital Charge Code |
3292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.17 |
| Max. Negotiated Rate |
$111.67 |
| Rate for Payer: Aetna Commercial |
$105.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.65
|
| Rate for Payer: Cash Price |
$99.26
|
| Rate for Payer: Cofinity Commercial |
$106.71
|
| Rate for Payer: Cofinity Commercial |
$86.86
|
| Rate for Payer: Healthscope Commercial |
$111.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.47
|
| Rate for Payer: PHP Commercial |
$105.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.86
|
| Rate for Payer: Priority Health SBD |
$78.17
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$119.85
|
|
|
Service Code
|
NDC 0054-4297-25
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.51 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Cofinity Commercial |
$83.90
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.87
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.90
|
| Rate for Payer: Priority Health SBD |
$75.51
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 69315-116-01
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.82 |
| Max. Negotiated Rate |
$74.02 |
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.74
|
| Rate for Payer: Healthscope Commercial |
$74.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.91
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.58
|
| Rate for Payer: Priority Health SBD |
$51.82
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 51079-072-20
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.87 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.60
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Cofinity Commercial |
$95.41
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.86
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.41
|
| Rate for Payer: Priority Health SBD |
$85.87
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$1.37
|
|
|
Service Code
|
NDC 51079-072-01
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.89
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cofinity Commercial |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$0.96
|
| Rate for Payer: Healthscope Commercial |
$1.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.16
|
| Rate for Payer: PHP Commercial |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.96
|
| Rate for Payer: Priority Health SBD |
$0.86
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$368.95
|
|
|
Service Code
|
NDC 0054-8297-25
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.44 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.82
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Commercial |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$313.61
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.26
|
| Rate for Payer: Priority Health SBD |
$232.44
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
IP
|
$91.65
|
|
|
Service Code
|
NDC 69315-117-01
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.90
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.16
|
| Rate for Payer: Priority Health SBD |
$57.74
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 51079-073-20
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.27 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.84
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.64
|
| Rate for Payer: Priority Health SBD |
$93.27
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 43547-402-10
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.42 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.82
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.92
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.35
|
| Rate for Payer: Priority Health SBD |
$44.42
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
IP
|
$1.49
|
|
|
Service Code
|
NDC 51079-073-01
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.97
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.04
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.27
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.04
|
| Rate for Payer: Priority Health SBD |
$0.94
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
IP
|
$112.80
|
|
|
Service Code
|
NDC 0378-0216-01
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.06 |
| Max. Negotiated Rate |
$101.52 |
| Rate for Payer: Aetna Commercial |
$95.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.32
|
| Rate for Payer: Cash Price |
$90.24
|
| Rate for Payer: Cofinity Commercial |
$78.96
|
| Rate for Payer: Cofinity Commercial |
$97.01
|
| Rate for Payer: Healthscope Commercial |
$101.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.88
|
| Rate for Payer: PHP Commercial |
$95.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.96
|
| Rate for Payer: Priority Health SBD |
$71.06
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
NDC 67877-222-05
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.66 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.30
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.70
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.40
|
| Rate for Payer: Priority Health SBD |
$177.66
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$217.55
|
|
|
Service Code
|
NDC 60505-0112-0
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.06 |
| Max. Negotiated Rate |
$195.80 |
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.41
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Commercial |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Healthscope Commercial |
$195.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.92
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.28
|
| Rate for Payer: Priority Health SBD |
$137.06
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$183.30
|
|
|
Service Code
|
NDC 63739-591-10
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.14
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Commercial |
$128.31
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.80
|
| Rate for Payer: PHP Commercial |
$155.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.31
|
| Rate for Payer: Priority Health SBD |
$115.48
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 0904-6665-61
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.56 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna Commercial |
$147.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.04
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.82
|
| Rate for Payer: PHP Commercial |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.73
|
| Rate for Payer: Priority Health SBD |
$109.56
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$481.75
|
|
|
Service Code
|
NDC 67877-223-05
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.50 |
| Max. Negotiated Rate |
$433.58 |
| Rate for Payer: Aetna Commercial |
$409.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.14
|
| Rate for Payer: Cash Price |
$385.40
|
| Rate for Payer: Cofinity Commercial |
$337.22
|
| Rate for Payer: Cofinity Commercial |
$414.30
|
| Rate for Payer: Healthscope Commercial |
$433.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$409.49
|
| Rate for Payer: PHP Commercial |
$409.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.22
|
| Rate for Payer: Priority Health SBD |
$303.50
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$253.80
|
|
|
Service Code
|
NDC 68084-762-01
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.89 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.97
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$177.66
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.73
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.66
|
| Rate for Payer: Priority Health SBD |
$159.89
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 58657-621-01
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.27 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.84
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.64
|
| Rate for Payer: Priority Health SBD |
$93.27
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$249.10
|
|
|
Service Code
|
NDC 0904-6666-61
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.93 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.92
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Commercial |
$174.37
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.74
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.37
|
| Rate for Payer: Priority Health SBD |
$156.93
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$230.30
|
|
|
Service Code
|
NDC 63739-236-10
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.09 |
| Max. Negotiated Rate |
$207.27 |
| Rate for Payer: Aetna Commercial |
$195.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.70
|
| Rate for Payer: Cash Price |
$184.24
|
| Rate for Payer: Cofinity Commercial |
$161.21
|
| Rate for Payer: Cofinity Commercial |
$198.06
|
| Rate for Payer: Healthscope Commercial |
$207.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.76
|
| Rate for Payer: PHP Commercial |
$195.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.21
|
| Rate for Payer: Priority Health SBD |
$145.09
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 0904-6667-61
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.78 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.14
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.53
|
| Rate for Payer: Priority Health SBD |
$168.78
|
|
