|
IPL CHEST FIRST
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00128
|
|
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
|
|
|
IPL CHEST SECOND
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 00129
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
|
|
IPL FACE FIRST
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 00130
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Aetna Medicare |
$115.00
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
|
|
IPL FACE, NECK, CHEST FIRST
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00132
|
|
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
|
|
|
IPL FACE, NECK, CHEST SECOND
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 00133
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
|
|
IPL FACE & NECK FIRST
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00134
|
|
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
|
|
|
IPL FACE & NECK SECOND
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 00135
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Aetna Medicare |
$89.50
|
| Rate for Payer: BCBS Complete |
$71.60
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.35
|
|
|
IPL FACE SECOND
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 00131
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
|
|
IPL HANDS & ARMS FIRST
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 00136
|
|
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
|
|
|
IPL HANDS & ARMS SECOND
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 00137
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Aetna Medicare |
$115.00
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
|
|
IPL NECK
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 00138
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
|
|
IPL NOSE & CHEEKS FIRST
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00127
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN
|
Facility
|
OP
|
$2.66
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
30510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: Aetna Commercial |
$3.78
|
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Aetna Medicare |
$1.46
|
| Rate for Payer: Aetna Medicare |
$1.45
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna Medicare |
$1.47
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna Medicare |
$2.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: BCBS Complete |
$1.77
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Cofinity Commercial |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$3.83
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Healthscope Commercial |
$2.65
|
| Rate for Payer: Healthscope Commercial |
$3.98
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.47
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.50
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: PHP Commercial |
$3.76
|
| Rate for Payer: PHP Commercial |
$3.78
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: PHP Commercial |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.91
|
| Rate for Payer: Priority Health SBD |
$2.78
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: Priority Health SBD |
$2.80
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: Priority Health SBD |
$1.85
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN
|
Facility
|
IP
|
$2.94
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
30510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.65
|
| Rate for Payer: Healthscope Commercial |
$3.98
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: PHP Commercial |
$3.76
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: PHP Commercial |
$2.47
|
| Rate for Payer: PHP Commercial |
$2.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.89
|
| Rate for Payer: Priority Health SBD |
$2.78
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: Priority Health SBD |
$1.85
|
| Rate for Payer: Priority Health SBD |
$1.83
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION
|
Facility
|
IP
|
$3.53
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
12580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Commercial |
$4.65
|
| Rate for Payer: Aetna Commercial |
$4.30
|
| Rate for Payer: Aetna Commercial |
$5.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.56
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$4.35
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Cofinity Commercial |
$4.70
|
| Rate for Payer: Cofinity Commercial |
$3.83
|
| Rate for Payer: Cofinity Commercial |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$5.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$5.40
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Healthscope Commercial |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$4.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.10
|
| Rate for Payer: PHP Commercial |
$4.65
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$4.30
|
| Rate for Payer: PHP Commercial |
$5.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: Priority Health SBD |
$3.78
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: Priority Health SBD |
$3.19
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: Priority Health SBD |
$3.45
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION
|
Facility
|
OP
|
$5.47
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
12580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$4.65
|
| Rate for Payer: Aetna Commercial |
$4.30
|
| Rate for Payer: Aetna Commercial |
$5.10
|
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$2.53
|
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: Aetna Medicare |
$2.73
|
| Rate for Payer: Aetna Medicare |
$2.29
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS Complete |
$2.19
|
| Rate for Payer: BCBS Complete |
$2.02
|
| Rate for Payer: BCBS Complete |
$1.41
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cofinity Commercial |
$4.70
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Cofinity Commercial |
$4.35
|
| Rate for Payer: Cofinity Commercial |
$3.83
|
| Rate for Payer: Cofinity Commercial |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$5.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$4.92
|
| Rate for Payer: Healthscope Commercial |
$5.40
|
| Rate for Payer: Healthscope Commercial |
$4.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.10
|
| Rate for Payer: PHP Commercial |
$4.65
|
| Rate for Payer: PHP Commercial |
$4.30
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: PHP Commercial |
$5.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.29
|
| Rate for Payer: Priority Health SBD |
$3.78
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: Priority Health SBD |
$3.45
|
| Rate for Payer: Priority Health SBD |
$3.19
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY
|
Facility
|
IP
|
$43.21
|
|
|
Service Code
|
NDC 69238201702
|
| Hospital Charge Code |
16071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$38.89 |
| Rate for Payer: Aetna Commercial |
$36.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.09
|
| Rate for Payer: Cash Price |
$34.57
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Commercial |
$37.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.57
|
| Rate for Payer: Healthscope Commercial |
$38.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.73
|
| Rate for Payer: PHP Commercial |
$36.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.09
|
| Rate for Payer: Priority Health SBD |
$27.22
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY
|
Facility
|
OP
|
$125.95
|
|
|
Service Code
|
NDC 00054004641
|
| Hospital Charge Code |
16071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.38 |
| Max. Negotiated Rate |
$113.36 |
| Rate for Payer: Aetna Commercial |
$107.06
|
| Rate for Payer: Aetna Medicare |
$62.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.87
|
| Rate for Payer: BCBS Complete |
$50.38
|
| Rate for Payer: Cash Price |
$100.76
|
| Rate for Payer: Cofinity Commercial |
$108.32
|
| Rate for Payer: Cofinity Commercial |
$88.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.76
|
| Rate for Payer: Healthscope Commercial |
$113.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.06
|
| Rate for Payer: PHP Commercial |
$107.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.87
|
| Rate for Payer: Priority Health SBD |
$79.35
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY
|
Facility
|
IP
|
$125.95
|
|
|
Service Code
|
NDC 00054004641
|
| Hospital Charge Code |
16071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.35 |
| Max. Negotiated Rate |
$113.36 |
| Rate for Payer: Aetna Commercial |
$107.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.87
|
| Rate for Payer: Cash Price |
$100.76
|
| Rate for Payer: Cofinity Commercial |
$108.32
|
| Rate for Payer: Cofinity Commercial |
$88.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.76
|
| Rate for Payer: Healthscope Commercial |
$113.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.06
|
| Rate for Payer: PHP Commercial |
$107.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.87
|
| Rate for Payer: Priority Health SBD |
$79.35
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY
|
Facility
|
OP
|
$43.21
|
|
|
Service Code
|
NDC 69238201702
|
| Hospital Charge Code |
16071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$38.89 |
| Rate for Payer: Aetna Commercial |
$36.73
|
| Rate for Payer: Aetna Medicare |
$21.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.09
|
| Rate for Payer: BCBS Complete |
$17.28
|
| Rate for Payer: Cash Price |
$34.57
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Commercial |
$37.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.57
|
| Rate for Payer: Healthscope Commercial |
$38.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.73
|
| Rate for Payer: PHP Commercial |
$36.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.09
|
| Rate for Payer: Priority Health SBD |
$27.22
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$112.14
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
17450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.65 |
| Max. Negotiated Rate |
$100.93 |
| Rate for Payer: Aetna Commercial |
$95.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.89
|
| Rate for Payer: Cash Price |
$89.71
|
| Rate for Payer: Cofinity Commercial |
$78.50
|
| Rate for Payer: Cofinity Commercial |
$96.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.71
|
| Rate for Payer: Healthscope Commercial |
$100.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.32
|
| Rate for Payer: PHP Commercial |
$95.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.89
|
| Rate for Payer: Priority Health SBD |
$70.65
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$112.14
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
17450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.86 |
| Max. Negotiated Rate |
$100.93 |
| Rate for Payer: Aetna Commercial |
$95.32
|
| Rate for Payer: Aetna Commercial |
$215.90
|
| Rate for Payer: Aetna Commercial |
$167.56
|
| Rate for Payer: Aetna Commercial |
$226.87
|
| Rate for Payer: Aetna Medicare |
$127.00
|
| Rate for Payer: Aetna Medicare |
$56.07
|
| Rate for Payer: Aetna Medicare |
$133.46
|
| Rate for Payer: Aetna Medicare |
$98.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.49
|
| Rate for Payer: BCBS Complete |
$106.76
|
| Rate for Payer: BCBS Complete |
$44.86
|
| Rate for Payer: BCBS Complete |
$101.60
|
| Rate for Payer: BCBS Complete |
$78.85
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cash Price |
$213.53
|
| Rate for Payer: Cash Price |
$89.71
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$169.53
|
| Rate for Payer: Cofinity Commercial |
$78.50
|
| Rate for Payer: Cofinity Commercial |
$96.44
|
| Rate for Payer: Cofinity Commercial |
$137.99
|
| Rate for Payer: Cofinity Commercial |
$177.80
|
| Rate for Payer: Cofinity Commercial |
$218.44
|
| Rate for Payer: Cofinity Commercial |
$186.84
|
| Rate for Payer: Cofinity Commercial |
$229.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.53
|
| Rate for Payer: Healthscope Commercial |
$228.60
|
| Rate for Payer: Healthscope Commercial |
$240.22
|
| Rate for Payer: Healthscope Commercial |
$177.42
|
| Rate for Payer: Healthscope Commercial |
$100.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.90
|
| Rate for Payer: PHP Commercial |
$215.90
|
| Rate for Payer: PHP Commercial |
$95.32
|
| Rate for Payer: PHP Commercial |
$167.56
|
| Rate for Payer: PHP Commercial |
$226.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.10
|
| Rate for Payer: Priority Health SBD |
$160.02
|
| Rate for Payer: Priority Health SBD |
$168.15
|
| Rate for Payer: Priority Health SBD |
$70.65
|
| Rate for Payer: Priority Health SBD |
$124.19
|
|
|
IRINOTECAN 300 MG/15 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$995.26
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
120104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$627.01 |
| Max. Negotiated Rate |
$895.73 |
| Rate for Payer: Aetna Commercial |
$845.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.92
|
| Rate for Payer: Cash Price |
$796.21
|
| Rate for Payer: Cofinity Commercial |
$696.68
|
| Rate for Payer: Cofinity Commercial |
$855.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$696.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$796.21
|
| Rate for Payer: Healthscope Commercial |
$895.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.97
|
| Rate for Payer: PHP Commercial |
$845.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.92
|
| Rate for Payer: Priority Health SBD |
$627.01
|
|
|
IRINOTECAN 300 MG/15 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$995.26
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
120104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$398.10 |
| Max. Negotiated Rate |
$895.73 |
| Rate for Payer: Aetna Commercial |
$845.97
|
| Rate for Payer: Aetna Medicare |
$497.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.92
|
| Rate for Payer: BCBS Complete |
$398.10
|
| Rate for Payer: Cash Price |
$796.21
|
| Rate for Payer: Cofinity Commercial |
$696.68
|
| Rate for Payer: Cofinity Commercial |
$855.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$696.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$796.21
|
| Rate for Payer: Healthscope Commercial |
$895.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.97
|
| Rate for Payer: PHP Commercial |
$845.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.92
|
| Rate for Payer: Priority Health SBD |
$627.01
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS
|
Facility
|
IP
|
$13,047.94
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
176129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,220.20 |
| Max. Negotiated Rate |
$11,743.15 |
| Rate for Payer: Aetna Commercial |
$11,090.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,481.16
|
| Rate for Payer: Cash Price |
$10,438.35
|
| Rate for Payer: Cofinity Commercial |
$11,221.23
|
| Rate for Payer: Cofinity Commercial |
$9,133.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,133.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,438.35
|
| Rate for Payer: Healthscope Commercial |
$11,743.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,090.75
|
| Rate for Payer: PHP Commercial |
$11,090.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,481.16
|
| Rate for Payer: Priority Health SBD |
$8,220.20
|
|
