|
LACTATED RINGERS EYE BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
300324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health SBD |
$44.05
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.05 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health SBD |
$44.05
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$87.40
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.96 |
| Max. Negotiated Rate |
$78.66 |
| Rate for Payer: Aetna Commercial |
$74.29
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna Medicare |
$43.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.81
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Complete |
$34.96
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$69.92
|
| Rate for Payer: Cofinity Commercial |
$61.18
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$75.16
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.92
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$78.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$74.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.81
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: Priority Health SBD |
$55.06
|
|
|
LACTATED RINGERS IV BOLUS
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
400296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.33 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: Priority Health SBD |
$42.33
|
|
|
LACTATED RINGERS IV BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
400296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$44.05
|
|
|
LACTATED RINGERS IV -DKA
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
301462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.33 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: Priority Health SBD |
$42.33
|
|
|
LACTATED RINGERS IV -DKA
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
301462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$44.05
|
|
|
LACTATED RINGERS IV INFUSION/BOLUS (CODE)
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
163717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.05 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: Priority Health SBD |
$42.33
|
|
|
LACTATED RINGERS IV INFUSION/BOLUS (CODE)
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
163717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: Priority Health SBD |
$42.33
|
|
|
LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE
|
Facility
|
IP
|
$390.24
|
|
|
Service Code
|
NDC 49100040007
|
| Hospital Charge Code |
27974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.85 |
| Max. Negotiated Rate |
$351.22 |
| Rate for Payer: Aetna Commercial |
$331.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.66
|
| Rate for Payer: Cash Price |
$312.19
|
| Rate for Payer: Cofinity Commercial |
$273.17
|
| Rate for Payer: Cofinity Commercial |
$335.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$273.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.19
|
| Rate for Payer: Healthscope Commercial |
$351.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.70
|
| Rate for Payer: PHP Commercial |
$331.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.66
|
| Rate for Payer: Priority Health SBD |
$245.85
|
|
|
LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE
|
Facility
|
OP
|
$390.24
|
|
|
Service Code
|
NDC 49100040007
|
| Hospital Charge Code |
27974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.10 |
| Max. Negotiated Rate |
$351.22 |
| Rate for Payer: Aetna Commercial |
$331.70
|
| Rate for Payer: Aetna Medicare |
$195.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.66
|
| Rate for Payer: BCBS Complete |
$156.10
|
| Rate for Payer: Cash Price |
$312.19
|
| Rate for Payer: Cofinity Commercial |
$273.17
|
| Rate for Payer: Cofinity Commercial |
$335.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$273.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.19
|
| Rate for Payer: Healthscope Commercial |
$351.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.70
|
| Rate for Payer: PHP Commercial |
$331.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.66
|
| Rate for Payer: Priority Health SBD |
$245.85
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$6.63
|
|
|
Service Code
|
NDC 81033024130
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Aetna Commercial |
$5.64
|
| Rate for Payer: Aetna Medicare |
$3.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.31
|
| Rate for Payer: BCBS Complete |
$2.65
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cofinity Commercial |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$5.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$5.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.64
|
| Rate for Payer: PHP Commercial |
$5.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.31
|
| Rate for Payer: Priority Health SBD |
$4.18
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$6.63
|
|
|
Service Code
|
NDC 81033024151
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Aetna Commercial |
$5.64
|
| Rate for Payer: Aetna Medicare |
$3.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.31
|
| Rate for Payer: BCBS Complete |
$2.65
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cofinity Commercial |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$5.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$5.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.64
|
| Rate for Payer: PHP Commercial |
$5.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.31
|
| Rate for Payer: Priority Health SBD |
$4.18
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$38.51
|
|
|
Service Code
|
NDC 50383077932
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.26 |
| Max. Negotiated Rate |
$34.66 |
| Rate for Payer: Aetna Commercial |
$32.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.03
|
| Rate for Payer: Cash Price |
$30.81
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Cofinity Commercial |
$33.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.81
|
| Rate for Payer: Healthscope Commercial |
$34.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.73
|
| Rate for Payer: PHP Commercial |
$32.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.03
|
| Rate for Payer: Priority Health SBD |
$24.26
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$6.63
|
|
|
Service Code
|
NDC 81033024151
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Aetna Commercial |
$5.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.31
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cofinity Commercial |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$5.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$5.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.64
|
| Rate for Payer: PHP Commercial |
$5.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.31
|
| Rate for Payer: Priority Health SBD |
$4.18
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$43.76
|
|
|
Service Code
|
NDC 00121087316
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.57 |
| Max. Negotiated Rate |
$39.38 |
| Rate for Payer: Aetna Commercial |
$37.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.44
|
| Rate for Payer: Cash Price |
$35.01
|
| Rate for Payer: Cofinity Commercial |
$30.63
|
| Rate for Payer: Cofinity Commercial |
$37.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.01
|
| Rate for Payer: Healthscope Commercial |
$39.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.20
|
| Rate for Payer: PHP Commercial |
$37.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.44
|
| Rate for Payer: Priority Health SBD |
$27.57
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$38.51
|
|
|
Service Code
|
NDC 50383077932
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$34.66 |
| Rate for Payer: Aetna Commercial |
$32.73
|
| Rate for Payer: Aetna Medicare |
$19.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.03
|
| Rate for Payer: BCBS Complete |
$15.40
|
| Rate for Payer: Cash Price |
$30.81
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Cofinity Commercial |
$33.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.81
|
| Rate for Payer: Healthscope Commercial |
$34.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.73
|
| Rate for Payer: PHP Commercial |
$32.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.03
|
| Rate for Payer: Priority Health SBD |
$24.26
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$6.63
|
|
|
Service Code
|
NDC 81033024130
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Aetna Commercial |
$5.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.31
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cofinity Commercial |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$5.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$5.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.64
|
| Rate for Payer: PHP Commercial |
$5.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.31
|
| Rate for Payer: Priority Health SBD |
$4.18
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$43.76
|
|
|
Service Code
|
NDC 00121087316
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$39.38 |
| Rate for Payer: Aetna Commercial |
$37.20
|
| Rate for Payer: Aetna Medicare |
$21.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.44
|
| Rate for Payer: BCBS Complete |
$17.50
|
| Rate for Payer: Cash Price |
$35.01
|
| Rate for Payer: Cofinity Commercial |
$30.63
|
| Rate for Payer: Cofinity Commercial |
$37.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.01
|
| Rate for Payer: Healthscope Commercial |
$39.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.20
|
| Rate for Payer: PHP Commercial |
$37.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.44
|
| Rate for Payer: Priority Health SBD |
$27.57
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$3.42
|
|
|
Service Code
|
NDC 50383077931
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.91
|
| Rate for Payer: PHP Commercial |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.22
|
| Rate for Payer: Priority Health SBD |
$2.15
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$7.20
|
|
|
Service Code
|
NDC 00121115440
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Aetna Commercial |
$6.12
|
| Rate for Payer: Aetna Medicare |
$3.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.68
|
| Rate for Payer: BCBS Complete |
$2.88
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cofinity Commercial |
$5.04
|
| Rate for Payer: Cofinity Commercial |
$6.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.76
|
| Rate for Payer: Healthscope Commercial |
$6.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.12
|
| Rate for Payer: PHP Commercial |
$6.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.68
|
| Rate for Payer: Priority Health SBD |
$4.54
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$3.42
|
|
|
Service Code
|
NDC 50383077930
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.91
|
| Rate for Payer: PHP Commercial |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.22
|
| Rate for Payer: Priority Health SBD |
$2.15
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$6.63
|
|
|
Service Code
|
NDC 00121115430
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Aetna Commercial |
$5.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.31
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cofinity Commercial |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$5.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$5.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.64
|
| Rate for Payer: PHP Commercial |
$5.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.31
|
| Rate for Payer: Priority Health SBD |
$4.18
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$3.42
|
|
|
Service Code
|
NDC 50383077930
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: Aetna Medicare |
$1.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.91
|
| Rate for Payer: PHP Commercial |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.22
|
| Rate for Payer: Priority Health SBD |
$2.15
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$3.42
|
|
|
Service Code
|
NDC 50383077931
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: Aetna Medicare |
$1.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.91
|
| Rate for Payer: PHP Commercial |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.22
|
| Rate for Payer: Priority Health SBD |
$2.15
|
|
