|
AMINO ACIDS 4.25 % WITH LYTES AND CALCIUM IN D10W INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$137.95
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
27951
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.18 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Aetna Commercial |
$117.26
|
| Rate for Payer: Aetna Medicare |
$68.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.67
|
| Rate for Payer: BCBS Complete |
$55.18
|
| Rate for Payer: Cash Price |
$110.36
|
| Rate for Payer: Cofinity Commercial |
$118.64
|
| Rate for Payer: Cofinity Commercial |
$96.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.36
|
| Rate for Payer: Healthscope Commercial |
$124.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.26
|
| Rate for Payer: PHP Commercial |
$117.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.67
|
| Rate for Payer: Priority Health SBD |
$86.91
|
|
|
AMINO ACIDS 4.25 % WITH LYTES AND CALCIUM IN D10W INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$137.95
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
27951
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.91 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Aetna Commercial |
$117.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.67
|
| Rate for Payer: Cash Price |
$110.36
|
| Rate for Payer: Cofinity Commercial |
$118.64
|
| Rate for Payer: Cofinity Commercial |
$96.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.36
|
| Rate for Payer: Healthscope Commercial |
$124.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.26
|
| Rate for Payer: PHP Commercial |
$117.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.67
|
| Rate for Payer: Priority Health SBD |
$86.91
|
|
|
AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$173.55
|
|
|
Service Code
|
NDC 00338020201
|
| Hospital Charge Code |
195267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$156.20 |
| Rate for Payer: Aetna Commercial |
$147.52
|
| Rate for Payer: Aetna Medicare |
$86.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.81
|
| Rate for Payer: BCBS Complete |
$69.42
|
| Rate for Payer: Cash Price |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$121.48
|
| Rate for Payer: Cofinity Commercial |
$149.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.84
|
| Rate for Payer: Healthscope Commercial |
$156.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.52
|
| Rate for Payer: PHP Commercial |
$147.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.81
|
| Rate for Payer: Priority Health SBD |
$109.34
|
|
|
AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$173.55
|
|
|
Service Code
|
NDC 00338020206
|
| Hospital Charge Code |
195267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$156.20 |
| Rate for Payer: Aetna Commercial |
$147.52
|
| Rate for Payer: Aetna Medicare |
$86.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.81
|
| Rate for Payer: BCBS Complete |
$69.42
|
| Rate for Payer: Cash Price |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$121.48
|
| Rate for Payer: Cofinity Commercial |
$149.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.84
|
| Rate for Payer: Healthscope Commercial |
$156.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.52
|
| Rate for Payer: PHP Commercial |
$147.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.81
|
| Rate for Payer: Priority Health SBD |
$109.34
|
|
|
AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$173.55
|
|
|
Service Code
|
NDC 00338020206
|
| Hospital Charge Code |
195267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$109.34 |
| Max. Negotiated Rate |
$156.20 |
| Rate for Payer: Aetna Commercial |
$147.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.81
|
| Rate for Payer: Cash Price |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$121.48
|
| Rate for Payer: Cofinity Commercial |
$149.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.84
|
| Rate for Payer: Healthscope Commercial |
$156.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.52
|
| Rate for Payer: PHP Commercial |
$147.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.81
|
| Rate for Payer: Priority Health SBD |
$109.34
|
|
|
AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$173.55
|
|
|
Service Code
|
NDC 00338020201
|
| Hospital Charge Code |
195267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$109.34 |
| Max. Negotiated Rate |
$156.20 |
| Rate for Payer: Aetna Commercial |
$147.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.81
|
| Rate for Payer: Cash Price |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$121.48
|
| Rate for Payer: Cofinity Commercial |
$149.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.84
|
| Rate for Payer: Healthscope Commercial |
$156.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.52
|
| Rate for Payer: PHP Commercial |
$147.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.81
|
| Rate for Payer: Priority Health SBD |
$109.34
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$165.30
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.30 |
| Max. Negotiated Rate |
$148.77 |
| Rate for Payer: Aetna Commercial |
$140.50
|
| Rate for Payer: Aetna Medicare |
$82.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.44
|
| Rate for Payer: BCBS Complete |
$66.12
|
| Rate for Payer: BCBS Trust/PPO |
$18.30
|
| Rate for Payer: BCN Commercial |
$18.30
|
| Rate for Payer: Cash Price |
$132.24
|
| Rate for Payer: Cash Price |
$132.24
|
| Rate for Payer: Cofinity Commercial |
$115.71
|
| Rate for Payer: Cofinity Commercial |
$142.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.24
|
| Rate for Payer: Healthscope Commercial |
$148.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.50
|
| Rate for Payer: PHP Commercial |
$140.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.44
|
| Rate for Payer: Priority Health SBD |
$104.14
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$165.30
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.14 |
| Max. Negotiated Rate |
$148.77 |
| Rate for Payer: Aetna Commercial |
$140.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.44
|
| Rate for Payer: Cash Price |
$132.24
|
| Rate for Payer: Cofinity Commercial |
$115.71
|
| Rate for Payer: Cofinity Commercial |
$142.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.24
|
| Rate for Payer: Healthscope Commercial |
$148.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.50
|
| Rate for Payer: PHP Commercial |
$140.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.44
|
| Rate for Payer: Priority Health SBD |
$104.14
|
|
|
AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$32.76
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
113386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$29.48 |
| Rate for Payer: Aetna Commercial |
$27.85
|
| Rate for Payer: Aetna Medicare |
$16.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.29
|
| Rate for Payer: BCBS Complete |
$13.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.30
|
| Rate for Payer: BCN Commercial |
$18.30
|
| Rate for Payer: Cash Price |
$26.21
|
| Rate for Payer: Cash Price |
$26.21
|
| Rate for Payer: Cofinity Commercial |
$22.93
|
| Rate for Payer: Cofinity Commercial |
$28.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.21
|
| Rate for Payer: Healthscope Commercial |
$29.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.85
|
| Rate for Payer: PHP Commercial |
$27.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.29
|
| Rate for Payer: Priority Health SBD |
$20.64
|
|
|
AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$32.76
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
113386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$29.48 |
| Rate for Payer: Aetna Commercial |
$27.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.29
|
| Rate for Payer: Cash Price |
$26.21
|
| Rate for Payer: Cofinity Commercial |
$22.93
|
| Rate for Payer: Cofinity Commercial |
$28.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.21
|
| Rate for Payer: Healthscope Commercial |
$29.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.85
|
| Rate for Payer: PHP Commercial |
$27.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.29
|
| Rate for Payer: Priority Health SBD |
$20.64
|
|
|
AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV
|
Facility
|
IP
|
$93.90
|
|
|
Service Code
|
HCPCS J0283
|
| Hospital Charge Code |
152869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$84.51 |
| Rate for Payer: Aetna Commercial |
$79.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.04
|
| Rate for Payer: Cash Price |
$75.12
|
| Rate for Payer: Cofinity Commercial |
$65.73
|
| Rate for Payer: Cofinity Commercial |
$80.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.12
|
| Rate for Payer: Healthscope Commercial |
$84.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.82
|
| Rate for Payer: PHP Commercial |
$79.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.04
|
| Rate for Payer: Priority Health SBD |
$59.16
|
|
|
AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV
|
Facility
|
OP
|
$93.90
|
|
|
Service Code
|
HCPCS J0283
|
| Hospital Charge Code |
152869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$84.51 |
| Rate for Payer: Aetna Commercial |
$79.82
|
| Rate for Payer: Aetna Medicare |
$46.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.04
|
| Rate for Payer: BCBS Complete |
$37.56
|
| Rate for Payer: BCBS Trust/PPO |
$7.18
|
| Rate for Payer: BCN Commercial |
$7.18
|
| Rate for Payer: Cash Price |
$75.12
|
| Rate for Payer: Cash Price |
$75.12
|
| Rate for Payer: Cofinity Commercial |
$80.75
|
| Rate for Payer: Cofinity Commercial |
$65.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.12
|
| Rate for Payer: Healthscope Commercial |
$84.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.82
|
| Rate for Payer: PHP Commercial |
$79.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.52
|
| Rate for Payer: Priority Health Narrow Network |
$2.02
|
| Rate for Payer: Priority Health SBD |
$59.16
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$124.08
|
|
|
Service Code
|
NDC 72888003960
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$111.67 |
| Rate for Payer: Aetna Commercial |
$105.47
|
| Rate for Payer: Aetna Medicare |
$62.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.65
|
| Rate for Payer: BCBS Complete |
$49.63
|
| Rate for Payer: Cash Price |
$99.26
|
| Rate for Payer: Cofinity Commercial |
$106.71
|
| Rate for Payer: Cofinity Commercial |
$86.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.26
|
| Rate for Payer: Healthscope Commercial |
$111.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.47
|
| Rate for Payer: PHP Commercial |
$105.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.65
|
| Rate for Payer: Priority Health SBD |
$78.17
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$124.08
|
|
|
Service Code
|
NDC 72888003960
|
| Hospital Charge Code |
9066
|
|
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: Cofinity Medicare Advantage |
$86.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.26
|
| Rate for Payer: Healthscope Commercial |
$111.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.47
|
| Rate for Payer: PHP Commercial |
$105.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.65
|
| Rate for Payer: Priority Health SBD |
$78.17
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$260.30
|
|
|
Service Code
|
NDC 60687043701
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.12 |
| Max. Negotiated Rate |
$234.27 |
| Rate for Payer: Aetna Commercial |
$221.26
|
| Rate for Payer: Aetna Medicare |
$130.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.20
|
| Rate for Payer: BCBS Complete |
$104.12
|
| Rate for Payer: Cash Price |
$208.24
|
| Rate for Payer: Cofinity Commercial |
$182.21
|
| Rate for Payer: Cofinity Commercial |
$223.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.24
|
| Rate for Payer: Healthscope Commercial |
$234.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.26
|
| Rate for Payer: PHP Commercial |
$221.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.20
|
| Rate for Payer: Priority Health SBD |
$163.99
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$2.61
|
|
|
Service Code
|
NDC 60687043711
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.70
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$1.83
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.09
|
| Rate for Payer: Healthscope Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.22
|
| Rate for Payer: PHP Commercial |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| Rate for Payer: Priority Health SBD |
$1.64
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$260.30
|
|
|
Service Code
|
NDC 60687043701
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.99 |
| Max. Negotiated Rate |
$234.27 |
| Rate for Payer: Aetna Commercial |
$221.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.20
|
| Rate for Payer: Cash Price |
$208.24
|
| Rate for Payer: Cofinity Commercial |
$182.21
|
| Rate for Payer: Cofinity Commercial |
$223.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.24
|
| Rate for Payer: Healthscope Commercial |
$234.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.26
|
| Rate for Payer: PHP Commercial |
$221.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.20
|
| Rate for Payer: Priority Health SBD |
$163.99
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$460.60
|
|
|
Service Code
|
NDC 00904699361
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.24 |
| Max. Negotiated Rate |
$414.54 |
| Rate for Payer: Aetna Commercial |
$391.51
|
| Rate for Payer: Aetna Medicare |
$230.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.39
|
| Rate for Payer: BCBS Complete |
$184.24
|
| Rate for Payer: Cash Price |
$368.48
|
| Rate for Payer: Cofinity Commercial |
$322.42
|
| Rate for Payer: Cofinity Commercial |
$396.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$322.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.48
|
| Rate for Payer: Healthscope Commercial |
$414.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.51
|
| Rate for Payer: PHP Commercial |
$391.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.39
|
| Rate for Payer: Priority Health SBD |
$290.18
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$2.61
|
|
|
Service Code
|
NDC 60687043711
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.70
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$1.83
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.09
|
| Rate for Payer: Healthscope Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.22
|
| Rate for Payer: PHP Commercial |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| Rate for Payer: Priority Health SBD |
$1.64
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$460.60
|
|
|
Service Code
|
NDC 00904699361
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$290.18 |
| Max. Negotiated Rate |
$414.54 |
| Rate for Payer: Aetna Commercial |
$391.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.39
|
| Rate for Payer: Cash Price |
$368.48
|
| Rate for Payer: Cofinity Commercial |
$322.42
|
| Rate for Payer: Cofinity Commercial |
$396.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$322.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.48
|
| Rate for Payer: Healthscope Commercial |
$414.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.51
|
| Rate for Payer: PHP Commercial |
$391.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.39
|
| Rate for Payer: Priority Health SBD |
$290.18
|
|
|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.72
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
9065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.09 |
| Max. Negotiated Rate |
$25.85 |
| Rate for Payer: Aetna Commercial |
$24.41
|
| Rate for Payer: Aetna Commercial |
$22.01
|
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna Commercial |
$23.52
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna Commercial |
$47.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.99
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cofinity Commercial |
$39.02
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$11.13
|
| Rate for Payer: Cofinity Commercial |
$13.67
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Commercial |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$23.08
|
| Rate for Payer: Cofinity Commercial |
$19.37
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.98
|
| Rate for Payer: Healthscope Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$24.90
|
| Rate for Payer: Healthscope Commercial |
$23.72
|
| Rate for Payer: Healthscope Commercial |
$24.16
|
| Rate for Payer: Healthscope Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$25.85
|
| Rate for Payer: Healthscope Commercial |
$50.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.39
|
| Rate for Payer: PHP Commercial |
$24.41
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: PHP Commercial |
$23.52
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: PHP Commercial |
$22.01
|
| Rate for Payer: PHP Commercial |
$47.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.83
|
| Rate for Payer: Priority Health SBD |
$17.43
|
| Rate for Payer: Priority Health SBD |
$16.31
|
| Rate for Payer: Priority Health SBD |
$35.12
|
| Rate for Payer: Priority Health SBD |
$10.02
|
| Rate for Payer: Priority Health SBD |
$16.61
|
| Rate for Payer: Priority Health SBD |
$16.91
|
| Rate for Payer: Priority Health SBD |
$18.09
|
|
|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.84
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
9065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$24.16 |
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna Commercial |
$47.39
|
| Rate for Payer: Aetna Commercial |
$22.01
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Commercial |
$24.41
|
| Rate for Payer: Aetna Commercial |
$23.52
|
| Rate for Payer: Aetna Medicare |
$13.84
|
| Rate for Payer: Aetna Medicare |
$13.18
|
| Rate for Payer: Aetna Medicare |
$7.95
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: Aetna Medicare |
$12.94
|
| Rate for Payer: Aetna Medicare |
$27.88
|
| Rate for Payer: Aetna Medicare |
$14.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.24
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS Complete |
$6.36
|
| Rate for Payer: BCBS Complete |
$11.07
|
| Rate for Payer: BCBS Complete |
$11.49
|
| Rate for Payer: BCBS Complete |
$22.30
|
| Rate for Payer: BCBS Complete |
$10.54
|
| Rate for Payer: BCBS Complete |
$10.74
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cofinity Commercial |
$23.08
|
| Rate for Payer: Cofinity Commercial |
$11.13
|
| Rate for Payer: Cofinity Commercial |
$13.67
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Commercial |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Cofinity Commercial |
$39.02
|
| Rate for Payer: Cofinity Commercial |
$19.37
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.71
|
| Rate for Payer: Healthscope Commercial |
$24.90
|
| Rate for Payer: Healthscope Commercial |
$23.72
|
| Rate for Payer: Healthscope Commercial |
$24.16
|
| Rate for Payer: Healthscope Commercial |
$50.18
|
| Rate for Payer: Healthscope Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$25.85
|
| Rate for Payer: Healthscope Commercial |
$14.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: PHP Commercial |
$22.01
|
| Rate for Payer: PHP Commercial |
$24.41
|
| Rate for Payer: PHP Commercial |
$47.39
|
| Rate for Payer: PHP Commercial |
$23.52
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.34
|
| Rate for Payer: Priority Health SBD |
$17.43
|
| Rate for Payer: Priority Health SBD |
$18.09
|
| Rate for Payer: Priority Health SBD |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.61
|
| Rate for Payer: Priority Health SBD |
$10.02
|
| Rate for Payer: Priority Health SBD |
$16.31
|
| Rate for Payer: Priority Health SBD |
$35.12
|
|
|
AMIODARONE 50 MG/ML IV (CODE)
|
Facility
|
OP
|
$25.89
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
163703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$23.30 |
| Rate for Payer: Aetna Commercial |
$22.01
|
| Rate for Payer: Aetna Medicare |
$12.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.83
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.71
|
| Rate for Payer: Healthscope Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.01
|
| Rate for Payer: PHP Commercial |
$22.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.83
|
| Rate for Payer: Priority Health SBD |
$16.31
|
|
|
AMIODARONE 50 MG/ML IV (CODE)
|
Facility
|
IP
|
$25.89
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
163703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$23.30 |
| Rate for Payer: Aetna Commercial |
$22.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.83
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.71
|
| Rate for Payer: Healthscope Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.01
|
| Rate for Payer: PHP Commercial |
$22.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.83
|
| Rate for Payer: Priority Health SBD |
$16.31
|
|
|
AMITRIPTYLINE 100 MG TABLET
|
Facility
|
OP
|
$3.66
|
|
|
Service Code
|
NDC 51079056301
|
| Hospital Charge Code |
433
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna Commercial |
$3.11
|
| Rate for Payer: Aetna Medicare |
$1.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.38
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$2.56
|
| Rate for Payer: Cofinity Commercial |
$3.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$3.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.11
|
| Rate for Payer: PHP Commercial |
$3.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.38
|
| Rate for Payer: Priority Health SBD |
$2.31
|
|
