|
FRAXEL FACE & NECK
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 00162
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Medicare |
$510.00
|
| Rate for Payer: BCBS Complete |
$408.00
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.00
|
|
|
FRAXEL FULL FACE
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 00152
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
|
|
FRAXEL HANDS
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 00154
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
|
|
FRAXEL LARGE SCAR
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 00161
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Medicare |
$408.00
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
|
|
FRAXEL MEDIUM SCAR
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
FRAXEL NECK
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00153
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
|
|
FRAXEL NECK & CHEST
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 00163
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$489.60 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: Aetna Medicare |
$612.00
|
| Rate for Payer: BCBS Complete |
$489.60
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$795.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$795.60
|
|
|
FRAXEL PARTIAL TREATMENT - BILATERAL EYES
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00157
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
FRAXEL PARTIAL TREATMENT - PERI-ORAL
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 00156
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Aetna Medicare |
$255.00
|
| Rate for Payer: BCBS Complete |
$204.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
|
|
FRAXEL PARTIAL TREATMENT - UPPER LIP
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00158
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
FRAXEL RESTORE
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00168
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
FRAXEL SMALL SCAR
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 00159
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
|
|
FRAXEL STRETCH MARKS - ENTIRE ABDOMEN
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 00165
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Medicare |
$408.00
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
|
|
FRAXEL STRETCH MARKS - PERI-UMBILICAL
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 00164
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
|
|
FRENOPLASTY (SURGICAL REVISION OF FRENUM, EG, WITH Z-PLASTY)
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 41520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,780.71
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS, AND/OR FEET; 20 SQ CM OR LESS
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 15240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$1,004.40
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS, EYELIDS, AND/OR LIPS; 20 SQ CM OR LESS
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 15260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$1,004.40
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$481.74
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
32767
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$433.57 |
| Rate for Payer: Aetna Commercial |
$409.48
|
| Rate for Payer: Aetna Commercial |
$3,607.68
|
| Rate for Payer: Aetna Commercial |
$688.96
|
| Rate for Payer: Aetna Commercial |
$676.38
|
| Rate for Payer: Aetna Commercial |
$676.61
|
| Rate for Payer: Aetna Commercial |
$316.84
|
| Rate for Payer: Aetna Commercial |
$787.16
|
| Rate for Payer: Aetna Commercial |
$358.61
|
| Rate for Payer: Aetna Commercial |
$612.74
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,758.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.41
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.73
|
| Rate for Payer: Cash Price |
$740.86
|
| Rate for Payer: Cash Price |
$337.51
|
| Rate for Payer: Cash Price |
$337.51
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cash Price |
$740.86
|
| Rate for Payer: Cash Price |
$648.43
|
| Rate for Payer: Cash Price |
$648.43
|
| Rate for Payer: Cash Price |
$636.81
|
| Rate for Payer: Cash Price |
$3,395.46
|
| Rate for Payer: Cash Price |
$636.81
|
| Rate for Payer: Cash Price |
$3,395.46
|
| Rate for Payer: Cash Price |
$636.59
|
| Rate for Payer: Cash Price |
$385.39
|
| Rate for Payer: Cash Price |
$636.59
|
| Rate for Payer: Cash Price |
$576.70
|
| Rate for Payer: Cash Price |
$385.39
|
| Rate for Payer: Cash Price |
$576.70
|
| Rate for Payer: Cofinity Commercial |
$796.42
|
| Rate for Payer: Cofinity Commercial |
$567.38
|
| Rate for Payer: Cofinity Commercial |
$337.22
|
| Rate for Payer: Cofinity Commercial |
$697.06
|
| Rate for Payer: Cofinity Commercial |
$684.34
|
| Rate for Payer: Cofinity Commercial |
$362.83
|
| Rate for Payer: Cofinity Commercial |
$320.56
|
| Rate for Payer: Cofinity Commercial |
$648.25
|
| Rate for Payer: Cofinity Commercial |
$260.93
|
| Rate for Payer: Cofinity Commercial |
$295.32
|
| Rate for Payer: Cofinity Commercial |
$557.02
|
| Rate for Payer: Cofinity Commercial |
$504.61
|
| Rate for Payer: Cofinity Commercial |
$619.95
|
| Rate for Payer: Cofinity Commercial |
$684.57
|
| Rate for Payer: Cofinity Commercial |
$2,971.03
|
| Rate for Payer: Cofinity Commercial |
$3,650.12
|
| Rate for Payer: Cofinity Commercial |
$557.21
|
| Rate for Payer: Cofinity Commercial |
$414.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$648.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$567.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,971.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$504.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$557.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$557.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,395.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Healthscope Commercial |
$3,819.90
|
| Rate for Payer: Healthscope Commercial |
$335.48
|
| Rate for Payer: Healthscope Commercial |
$833.46
|
| Rate for Payer: Healthscope Commercial |
$716.41
|
| Rate for Payer: Healthscope Commercial |
$379.70
|
| Rate for Payer: Healthscope Commercial |
$716.17
|
| Rate for Payer: Healthscope Commercial |
$433.57
|
| Rate for Payer: Healthscope Commercial |
$648.78
|
| Rate for Payer: Healthscope Commercial |
$729.49
|
| Rate for Payer: Mclaren Medicaid |
$3.61
|
| Rate for Payer: Mclaren Medicaid |
$3.61
|
| Rate for Payer: Mclaren Medicaid |
$3.61
|
| Rate for Payer: Mclaren Medicaid |
$3.61
|
| Rate for Payer: Mclaren Medicaid |
$3.61
|
| Rate for Payer: Mclaren Medicaid |
$3.61
|
| Rate for Payer: Mclaren Medicaid |
$3.61
|
| Rate for Payer: Mclaren Medicaid |
$3.61
|
| Rate for Payer: Mclaren Medicaid |
$3.61
|
| Rate for Payer: Mclaren Medicare |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$6.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: Meridian Medicaid |
$3.79
|
| Rate for Payer: Meridian Medicaid |
$3.79
|
| Rate for Payer: Meridian Medicaid |
$3.79
|
| Rate for Payer: Meridian Medicaid |
$3.79
|
| Rate for Payer: Meridian Medicaid |
$3.79
|
| Rate for Payer: Meridian Medicaid |
$3.79
|
| Rate for Payer: Meridian Medicaid |
$3.79
|
| Rate for Payer: Meridian Medicaid |
$3.79
|
| Rate for Payer: Meridian Medicaid |
$3.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,607.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$612.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$688.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.38
|
| Rate for Payer: PACE Medicare |
$6.39
|
| Rate for Payer: PACE Medicare |
$6.39
|
| Rate for Payer: PACE Medicare |
$6.39
|
| Rate for Payer: PACE Medicare |
$6.39
|
| Rate for Payer: PACE Medicare |
$6.39
|
| Rate for Payer: PACE Medicare |
$6.39
|
| Rate for Payer: PACE Medicare |
$6.39
|
| Rate for Payer: PACE Medicare |
$6.39
|
| Rate for Payer: PACE Medicare |
$6.39
|
| Rate for Payer: PACE SWMI |
$6.73
|
| Rate for Payer: PACE SWMI |
$6.73
|
| Rate for Payer: PACE SWMI |
$6.73
|
| Rate for Payer: PACE SWMI |
$6.73
|
| Rate for Payer: PACE SWMI |
$6.73
|
| Rate for Payer: PACE SWMI |
$6.73
|
| Rate for Payer: PACE SWMI |
$6.73
|
| Rate for Payer: PACE SWMI |
$6.73
|
| Rate for Payer: PACE SWMI |
$6.73
|
| Rate for Payer: PHP Commercial |
$688.96
|
| Rate for Payer: PHP Commercial |
$316.84
|
| Rate for Payer: PHP Commercial |
$3,607.68
|
| Rate for Payer: PHP Commercial |
$409.48
|
| Rate for Payer: PHP Commercial |
$676.61
|
| Rate for Payer: PHP Commercial |
$787.16
|
| Rate for Payer: PHP Commercial |
$676.38
|
| Rate for Payer: PHP Commercial |
$358.61
|
| Rate for Payer: PHP Commercial |
$612.74
|
| Rate for Payer: PHP Medicare Advantage |
$6.73
|
| Rate for Payer: PHP Medicare Advantage |
$6.73
|
| Rate for Payer: PHP Medicare Advantage |
$6.73
|
| Rate for Payer: PHP Medicare Advantage |
$6.73
|
| Rate for Payer: PHP Medicare Advantage |
$6.73
|
| Rate for Payer: PHP Medicare Advantage |
$6.73
|
| Rate for Payer: PHP Medicare Advantage |
$6.73
|
| Rate for Payer: PHP Medicare Advantage |
$6.73
|
| Rate for Payer: PHP Medicare Advantage |
$6.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$526.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,758.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.95
|
| Rate for Payer: Priority Health Medicare |
$6.73
|
| Rate for Payer: Priority Health Medicare |
$6.73
|
| Rate for Payer: Priority Health Medicare |
$6.73
|
| Rate for Payer: Priority Health Medicare |
$6.73
|
| Rate for Payer: Priority Health Medicare |
$6.73
|
| Rate for Payer: Priority Health Medicare |
$6.73
|
| Rate for Payer: Priority Health Medicare |
$6.73
|
| Rate for Payer: Priority Health Medicare |
$6.73
|
| Rate for Payer: Priority Health Medicare |
$6.73
|
| Rate for Payer: Priority Health SBD |
$234.83
|
| Rate for Payer: Priority Health SBD |
$501.32
|
| Rate for Payer: Priority Health SBD |
$265.79
|
| Rate for Payer: Priority Health SBD |
$501.49
|
| Rate for Payer: Priority Health SBD |
$583.42
|
| Rate for Payer: Priority Health SBD |
$454.15
|
| Rate for Payer: Priority Health SBD |
$2,673.93
|
| Rate for Payer: Priority Health SBD |
$303.50
|
| Rate for Payer: Priority Health SBD |
$510.64
|
| Rate for Payer: Railroad Medicare Medicare |
$6.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.73
|
| Rate for Payer: UHC Medicare Advantage |
$6.73
|
| Rate for Payer: UHC Medicare Advantage |
$6.73
|
| Rate for Payer: UHC Medicare Advantage |
$6.73
|
| Rate for Payer: UHC Medicare Advantage |
$6.73
|
| Rate for Payer: UHC Medicare Advantage |
$6.73
|
| Rate for Payer: UHC Medicare Advantage |
$6.73
|
| Rate for Payer: UHC Medicare Advantage |
$6.73
|
| Rate for Payer: UHC Medicare Advantage |
$6.73
|
| Rate for Payer: UHC Medicare Advantage |
$6.73
|
| Rate for Payer: UHCCP Medicaid |
$3.79
|
| Rate for Payer: UHCCP Medicaid |
$3.79
|
| Rate for Payer: UHCCP Medicaid |
$3.79
|
| Rate for Payer: UHCCP Medicaid |
$3.79
|
| Rate for Payer: UHCCP Medicaid |
$3.79
|
| Rate for Payer: UHCCP Medicaid |
$3.79
|
| Rate for Payer: UHCCP Medicaid |
$3.79
|
| Rate for Payer: UHCCP Medicaid |
$3.79
|
| Rate for Payer: UHCCP Medicaid |
$3.79
|
| Rate for Payer: VA VA |
$6.73
|
| Rate for Payer: VA VA |
$6.73
|
| Rate for Payer: VA VA |
$6.73
|
| Rate for Payer: VA VA |
$6.73
|
| Rate for Payer: VA VA |
$6.73
|
| Rate for Payer: VA VA |
$6.73
|
| Rate for Payer: VA VA |
$6.73
|
| Rate for Payer: VA VA |
$6.73
|
| Rate for Payer: VA VA |
$6.73
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$796.01
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
32767
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$501.49 |
| Max. Negotiated Rate |
$716.41 |
| Rate for Payer: Aetna Commercial |
$676.61
|
| Rate for Payer: Aetna Commercial |
$676.38
|
| Rate for Payer: Aetna Commercial |
$787.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.95
|
| Rate for Payer: Cash Price |
$636.59
|
| Rate for Payer: Cash Price |
$740.86
|
| Rate for Payer: Cash Price |
$636.81
|
| Rate for Payer: Cofinity Commercial |
$557.02
|
| Rate for Payer: Cofinity Commercial |
$684.34
|
| Rate for Payer: Cofinity Commercial |
$557.21
|
| Rate for Payer: Cofinity Commercial |
$684.57
|
| Rate for Payer: Cofinity Commercial |
$648.25
|
| Rate for Payer: Cofinity Commercial |
$796.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$557.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$648.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$557.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.86
|
| Rate for Payer: Healthscope Commercial |
$716.17
|
| Rate for Payer: Healthscope Commercial |
$716.41
|
| Rate for Payer: Healthscope Commercial |
$833.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.16
|
| Rate for Payer: PHP Commercial |
$676.61
|
| Rate for Payer: PHP Commercial |
$787.16
|
| Rate for Payer: PHP Commercial |
$676.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.23
|
| Rate for Payer: Priority Health SBD |
$583.42
|
| Rate for Payer: Priority Health SBD |
$501.49
|
| Rate for Payer: Priority Health SBD |
$501.32
|
|
|
FUROSEMIDE 10 MG/ML INJECTION (CODE)
|
Facility
|
OP
|
$11.70
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
163713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna Commercial |
$9.95
|
| Rate for Payer: Aetna Commercial |
$11.14
|
| Rate for Payer: Aetna Commercial |
$10.37
|
| Rate for Payer: Aetna Medicare |
$6.55
|
| Rate for Payer: Aetna Medicare |
$5.85
|
| Rate for Payer: Aetna Medicare |
$6.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.93
|
| Rate for Payer: BCBS Complete |
$4.88
|
| Rate for Payer: BCBS Complete |
$4.68
|
| Rate for Payer: BCBS Complete |
$5.24
|
| Rate for Payer: Cash Price |
$10.49
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Cofinity Commercial |
$9.18
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Cofinity Commercial |
$8.54
|
| Rate for Payer: Cofinity Commercial |
$10.49
|
| Rate for Payer: Cofinity Commercial |
$11.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$10.98
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$11.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.95
|
| Rate for Payer: PHP Commercial |
$10.37
|
| Rate for Payer: PHP Commercial |
$9.95
|
| Rate for Payer: PHP Commercial |
$11.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.93
|
| Rate for Payer: Priority Health SBD |
$8.26
|
| Rate for Payer: Priority Health SBD |
$7.69
|
| Rate for Payer: Priority Health SBD |
$7.37
|
|
|
FUROSEMIDE 10 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$11.70
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
163713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna Commercial |
$9.95
|
| Rate for Payer: Aetna Commercial |
$10.37
|
| Rate for Payer: Aetna Commercial |
$11.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.52
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Cash Price |
$10.49
|
| Rate for Payer: Cofinity Commercial |
$11.27
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Cofinity Commercial |
$9.18
|
| Rate for Payer: Cofinity Commercial |
$10.49
|
| Rate for Payer: Cofinity Commercial |
$8.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.49
|
| Rate for Payer: Healthscope Commercial |
$10.98
|
| Rate for Payer: Healthscope Commercial |
$11.80
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.14
|
| Rate for Payer: PHP Commercial |
$11.14
|
| Rate for Payer: PHP Commercial |
$9.95
|
| Rate for Payer: PHP Commercial |
$10.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.93
|
| Rate for Payer: Priority Health SBD |
$8.26
|
| Rate for Payer: Priority Health SBD |
$7.37
|
| Rate for Payer: Priority Health SBD |
$7.69
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$7.95
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
3291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Aetna Commercial |
$6.76
|
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Aetna Commercial |
$9.27
|
| Rate for Payer: Aetna Commercial |
$8.76
|
| Rate for Payer: Aetna Commercial |
$9.95
|
| Rate for Payer: Aetna Commercial |
$10.37
|
| Rate for Payer: Aetna Commercial |
$8.90
|
| Rate for Payer: Aetna Commercial |
$11.14
|
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$17.50
|
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: Aetna Commercial |
$10.35
|
| Rate for Payer: Aetna Commercial |
$18.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.52
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cash Price |
$10.49
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cash Price |
$8.38
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: Cash Price |
$6.52
|
| Rate for Payer: Cash Price |
$6.36
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cash Price |
$16.47
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cofinity Commercial |
$9.18
|
| Rate for Payer: Cofinity Commercial |
$8.53
|
| Rate for Payer: Cofinity Commercial |
$10.47
|
| Rate for Payer: Cofinity Commercial |
$19.21
|
| Rate for Payer: Cofinity Commercial |
$15.64
|
| Rate for Payer: Cofinity Commercial |
$11.27
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Cofinity Commercial |
$9.37
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$15.62
|
| Rate for Payer: Cofinity Commercial |
$7.63
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Commercial |
$7.33
|
| Rate for Payer: Cofinity Commercial |
$17.71
|
| Rate for Payer: Cofinity Commercial |
$14.41
|
| Rate for Payer: Cofinity Commercial |
$9.62
|
| Rate for Payer: Cofinity Commercial |
$8.86
|
| Rate for Payer: Cofinity Commercial |
$7.21
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$10.61
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$5.71
|
| Rate for Payer: Cofinity Commercial |
$8.54
|
| Rate for Payer: Cofinity Commercial |
$7.01
|
| Rate for Payer: Cofinity Commercial |
$10.49
|
| Rate for Payer: Cofinity Commercial |
$6.84
|
| Rate for Payer: Cofinity Commercial |
$5.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Healthscope Commercial |
$9.27
|
| Rate for Payer: Healthscope Commercial |
$10.98
|
| Rate for Payer: Healthscope Commercial |
$7.16
|
| Rate for Payer: Healthscope Commercial |
$18.53
|
| Rate for Payer: Healthscope Commercial |
$20.11
|
| Rate for Payer: Healthscope Commercial |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$20.08
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$11.80
|
| Rate for Payer: Healthscope Commercial |
$10.96
|
| Rate for Payer: Healthscope Commercial |
$9.81
|
| Rate for Payer: Healthscope Commercial |
$9.42
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.14
|
| Rate for Payer: PHP Commercial |
$11.14
|
| Rate for Payer: PHP Commercial |
$18.99
|
| Rate for Payer: PHP Commercial |
$9.27
|
| Rate for Payer: PHP Commercial |
$8.90
|
| Rate for Payer: PHP Commercial |
$10.37
|
| Rate for Payer: PHP Commercial |
$17.50
|
| Rate for Payer: PHP Commercial |
$6.76
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$9.95
|
| Rate for Payer: PHP Commercial |
$10.35
|
| Rate for Payer: PHP Commercial |
$6.93
|
| Rate for Payer: PHP Commercial |
$11.69
|
| Rate for Payer: PHP Commercial |
$8.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.38
|
| Rate for Payer: Priority Health SBD |
$8.26
|
| Rate for Payer: Priority Health SBD |
$5.01
|
| Rate for Payer: Priority Health SBD |
$6.60
|
| Rate for Payer: Priority Health SBD |
$7.67
|
| Rate for Payer: Priority Health SBD |
$8.66
|
| Rate for Payer: Priority Health SBD |
$5.13
|
| Rate for Payer: Priority Health SBD |
$14.06
|
| Rate for Payer: Priority Health SBD |
$12.97
|
| Rate for Payer: Priority Health SBD |
$7.37
|
| Rate for Payer: Priority Health SBD |
$14.07
|
| Rate for Payer: Priority Health SBD |
$6.87
|
| Rate for Payer: Priority Health SBD |
$6.49
|
| Rate for Payer: Priority Health SBD |
$7.69
|
| Rate for Payer: Priority Health SBD |
$9.54
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$7.95
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
3291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Aetna Commercial |
$6.76
|
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Aetna Commercial |
$9.95
|
| Rate for Payer: Aetna Commercial |
$8.90
|
| Rate for Payer: Aetna Commercial |
$8.76
|
| Rate for Payer: Aetna Commercial |
$10.35
|
| Rate for Payer: Aetna Commercial |
$9.27
|
| Rate for Payer: Aetna Commercial |
$10.37
|
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Aetna Commercial |
$11.14
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$17.50
|
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: Aetna Commercial |
$18.99
|
| Rate for Payer: Aetna Medicare |
$6.55
|
| Rate for Payer: Aetna Medicare |
$6.10
|
| Rate for Payer: Aetna Medicare |
$5.45
|
| Rate for Payer: Aetna Medicare |
$6.09
|
| Rate for Payer: Aetna Medicare |
$5.85
|
| Rate for Payer: Aetna Medicare |
$5.24
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna Medicare |
$4.08
|
| Rate for Payer: Aetna Medicare |
$3.98
|
| Rate for Payer: Aetna Medicare |
$11.17
|
| Rate for Payer: Aetna Medicare |
$11.15
|
| Rate for Payer: Aetna Medicare |
$10.29
|
| Rate for Payer: Aetna Medicare |
$7.58
|
| Rate for Payer: Aetna Medicare |
$6.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.17
|
| Rate for Payer: BCBS Complete |
$5.50
|
| Rate for Payer: BCBS Complete |
$3.18
|
| Rate for Payer: BCBS Complete |
$8.94
|
| Rate for Payer: BCBS Complete |
$4.88
|
| Rate for Payer: BCBS Complete |
$8.92
|
| Rate for Payer: BCBS Complete |
$8.24
|
| Rate for Payer: BCBS Complete |
$5.24
|
| Rate for Payer: BCBS Complete |
$6.06
|
| Rate for Payer: BCBS Complete |
$4.87
|
| Rate for Payer: BCBS Complete |
$4.12
|
| Rate for Payer: BCBS Complete |
$4.36
|
| Rate for Payer: BCBS Complete |
$4.68
|
| Rate for Payer: BCBS Complete |
$3.26
|
| Rate for Payer: BCBS Complete |
$4.19
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cash Price |
$8.38
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Cash Price |
$10.49
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$16.47
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cash Price |
$6.36
|
| Rate for Payer: Cash Price |
$6.52
|
| Rate for Payer: Cofinity Commercial |
$10.61
|
| Rate for Payer: Cofinity Commercial |
$8.54
|
| Rate for Payer: Cofinity Commercial |
$9.62
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Cofinity Commercial |
$15.64
|
| Rate for Payer: Cofinity Commercial |
$19.21
|
| Rate for Payer: Cofinity Commercial |
$8.53
|
| Rate for Payer: Cofinity Commercial |
$9.37
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$15.62
|
| Rate for Payer: Cofinity Commercial |
$7.63
|
| Rate for Payer: Cofinity Commercial |
$7.21
|
| Rate for Payer: Cofinity Commercial |
$8.86
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Commercial |
$7.33
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Cofinity Commercial |
$5.71
|
| Rate for Payer: Cofinity Commercial |
$7.01
|
| Rate for Payer: Cofinity Commercial |
$11.27
|
| Rate for Payer: Cofinity Commercial |
$9.18
|
| Rate for Payer: Cofinity Commercial |
$10.47
|
| Rate for Payer: Cofinity Commercial |
$17.71
|
| Rate for Payer: Cofinity Commercial |
$14.41
|
| Rate for Payer: Cofinity Commercial |
$5.57
|
| Rate for Payer: Cofinity Commercial |
$10.49
|
| Rate for Payer: Cofinity Commercial |
$6.84
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.76
|
| Rate for Payer: Healthscope Commercial |
$10.96
|
| Rate for Payer: Healthscope Commercial |
$9.42
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$9.81
|
| Rate for Payer: Healthscope Commercial |
$7.16
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$11.80
|
| Rate for Payer: Healthscope Commercial |
$20.08
|
| Rate for Payer: Healthscope Commercial |
$18.53
|
| Rate for Payer: Healthscope Commercial |
$9.27
|
| Rate for Payer: Healthscope Commercial |
$10.98
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Healthscope Commercial |
$20.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.35
|
| Rate for Payer: PHP Commercial |
$9.95
|
| Rate for Payer: PHP Commercial |
$10.37
|
| Rate for Payer: PHP Commercial |
$8.76
|
| Rate for Payer: PHP Commercial |
$8.90
|
| Rate for Payer: PHP Commercial |
$9.27
|
| Rate for Payer: PHP Commercial |
$11.14
|
| Rate for Payer: PHP Commercial |
$11.69
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$17.50
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: PHP Commercial |
$6.93
|
| Rate for Payer: PHP Commercial |
$18.99
|
| Rate for Payer: PHP Commercial |
$6.76
|
| Rate for Payer: PHP Commercial |
$10.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health SBD |
$14.07
|
| Rate for Payer: Priority Health SBD |
$12.97
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health SBD |
$8.66
|
| Rate for Payer: Priority Health SBD |
$8.26
|
| Rate for Payer: Priority Health SBD |
$5.01
|
| Rate for Payer: Priority Health SBD |
$7.69
|
| Rate for Payer: Priority Health SBD |
$5.13
|
| Rate for Payer: Priority Health SBD |
$6.49
|
| Rate for Payer: Priority Health SBD |
$6.60
|
| Rate for Payer: Priority Health SBD |
$7.37
|
| Rate for Payer: Priority Health SBD |
$6.87
|
| Rate for Payer: Priority Health SBD |
$7.67
|
| Rate for Payer: Priority Health SBD |
$14.06
|
|
|
FUROSEMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$126.90
|
|
|
Service Code
|
NDC 00054329446
|
| Hospital Charge Code |
3292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.95 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Cofinity Commercial |
$88.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.48
|
| Rate for Payer: Priority Health SBD |
$79.95
|
|
|
FUROSEMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$126.90
|
|
|
Service Code
|
NDC 00054329446
|
| Hospital Charge Code |
3292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.76 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna Medicare |
$63.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| Rate for Payer: BCBS Complete |
$50.76
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Cofinity Commercial |
$88.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.48
|
| Rate for Payer: Priority Health SBD |
$79.95
|
|
