|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$19.95
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$17.95 |
| Rate for Payer: Aetna Commercial |
$16.96
|
| Rate for Payer: Aetna Commercial |
$52.31
|
| Rate for Payer: Aetna Commercial |
$18.95
|
| Rate for Payer: Aetna Medicare |
$30.77
|
| Rate for Payer: Aetna Medicare |
$9.97
|
| Rate for Payer: Aetna Medicare |
$11.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.49
|
| Rate for Payer: BCBS Complete |
$8.92
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS Complete |
$24.62
|
| Rate for Payer: Cash Price |
$49.23
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cofinity Commercial |
$52.92
|
| Rate for Payer: Cofinity Commercial |
$17.16
|
| Rate for Payer: Cofinity Commercial |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Cofinity Commercial |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$43.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.96
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Healthscope Commercial |
$17.95
|
| Rate for Payer: Healthscope Commercial |
$55.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.96
|
| Rate for Payer: PHP Commercial |
$18.95
|
| Rate for Payer: PHP Commercial |
$16.96
|
| Rate for Payer: PHP Commercial |
$52.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.49
|
| Rate for Payer: Priority Health SBD |
$38.77
|
| Rate for Payer: Priority Health SBD |
$14.05
|
| Rate for Payer: Priority Health SBD |
$12.57
|
|
|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$22.30
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$20.07 |
| Rate for Payer: Aetna Commercial |
$18.95
|
| Rate for Payer: Aetna Commercial |
$16.96
|
| Rate for Payer: Aetna Commercial |
$52.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.49
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$49.23
|
| Rate for Payer: Cofinity Commercial |
$43.08
|
| Rate for Payer: Cofinity Commercial |
$52.92
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Cofinity Commercial |
$17.16
|
| Rate for Payer: Cofinity Commercial |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$15.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.23
|
| Rate for Payer: Healthscope Commercial |
$17.95
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Healthscope Commercial |
$55.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.31
|
| Rate for Payer: PHP Commercial |
$16.96
|
| Rate for Payer: PHP Commercial |
$18.95
|
| Rate for Payer: PHP Commercial |
$52.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.00
|
| Rate for Payer: Priority Health SBD |
$38.77
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: Priority Health SBD |
$14.05
|
|
|
NAFCILLIN 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$19.95
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$17.95 |
| Rate for Payer: Aetna Commercial |
$16.96
|
| Rate for Payer: Aetna Medicare |
$9.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cofinity Commercial |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$17.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.96
|
| Rate for Payer: Healthscope Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.96
|
| Rate for Payer: PHP Commercial |
$16.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: Priority Health SBD |
$12.57
|
|
|
NAFCILLIN 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$19.95
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$17.95 |
| Rate for Payer: Aetna Commercial |
$16.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cofinity Commercial |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$17.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.96
|
| Rate for Payer: Healthscope Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.96
|
| Rate for Payer: PHP Commercial |
$16.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: Priority Health SBD |
$12.57
|
|
|
NAFCILLIN 2 GRAM IVPB (INTRA-OP)
|
Facility
|
IP
|
$21.20
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna Commercial |
$18.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.78
|
| Rate for Payer: Cash Price |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$14.84
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$19.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.02
|
| Rate for Payer: PHP Commercial |
$18.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.78
|
| Rate for Payer: Priority Health SBD |
$13.36
|
|
|
NAFCILLIN 2 GRAM IVPB (INTRA-OP)
|
Facility
|
OP
|
$21.20
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna Commercial |
$18.02
|
| Rate for Payer: Aetna Medicare |
$10.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.78
|
| Rate for Payer: BCBS Complete |
$8.48
|
| Rate for Payer: Cash Price |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$14.84
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$19.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.02
|
| Rate for Payer: PHP Commercial |
$18.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.78
|
| Rate for Payer: Priority Health SBD |
$13.36
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$93.12
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.25 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Commercial |
$80.23
|
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Aetna Medicare |
$47.20
|
| Rate for Payer: Aetna Medicare |
$46.56
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: Aetna Medicare |
$10.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.35
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS Complete |
$37.76
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS Complete |
$37.25
|
| Rate for Payer: Cash Price |
$75.51
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$81.18
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$66.07
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Commercial |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$18.89
|
| Rate for Payer: Healthscope Commercial |
$84.95
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.84
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$80.23
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$17.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.35
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: Priority Health SBD |
$15.18
|
| Rate for Payer: Priority Health SBD |
$59.47
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$93.12
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.67 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Commercial |
$80.23
|
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.35
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$75.51
|
| Rate for Payer: Cofinity Commercial |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$81.18
|
| Rate for Payer: Cofinity Commercial |
$66.07
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$18.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.51
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Healthscope Commercial |
$18.89
|
| Rate for Payer: Healthscope Commercial |
$84.95
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.84
|
| Rate for Payer: PHP Commercial |
$17.84
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$80.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.35
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: Priority Health SBD |
$15.18
|
| Rate for Payer: Priority Health SBD |
$59.47
|
|
|
NAFCILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$93.12
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.67 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.53
|
| Rate for Payer: Priority Health SBD |
$58.67
|
|
|
NAFCILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$93.12
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.25 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Medicare |
$46.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: BCBS Complete |
$37.25
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.53
|
| Rate for Payer: Priority Health SBD |
$58.67
|
|
|
NALOXEGOL 12.5 MG TABLET
|
Facility
|
OP
|
$1,361.97
|
|
|
Service Code
|
NDC 57841130001
|
| Hospital Charge Code |
173967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$544.79 |
| Max. Negotiated Rate |
$1,225.77 |
| Rate for Payer: Aetna Commercial |
$1,157.67
|
| Rate for Payer: Aetna Medicare |
$680.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.28
|
| Rate for Payer: BCBS Complete |
$544.79
|
| Rate for Payer: Cash Price |
$1,089.58
|
| Rate for Payer: Cofinity Commercial |
$1,171.29
|
| Rate for Payer: Cofinity Commercial |
$953.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$953.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.58
|
| Rate for Payer: Healthscope Commercial |
$1,225.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.67
|
| Rate for Payer: PHP Commercial |
$1,157.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.28
|
| Rate for Payer: Priority Health SBD |
$858.04
|
|
|
NALOXEGOL 12.5 MG TABLET
|
Facility
|
IP
|
$1,361.97
|
|
|
Service Code
|
NDC 57841130001
|
| Hospital Charge Code |
173967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$858.04 |
| Max. Negotiated Rate |
$1,225.77 |
| Rate for Payer: Aetna Commercial |
$1,157.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.28
|
| Rate for Payer: Cash Price |
$1,089.58
|
| Rate for Payer: Cofinity Commercial |
$1,171.29
|
| Rate for Payer: Cofinity Commercial |
$953.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$953.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.58
|
| Rate for Payer: Healthscope Commercial |
$1,225.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.67
|
| Rate for Payer: PHP Commercial |
$1,157.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.28
|
| Rate for Payer: Priority Health SBD |
$858.04
|
|
|
NALOXEGOL 25 MG TABLET
|
Facility
|
IP
|
$1,361.97
|
|
|
Service Code
|
NDC 57841130101
|
| Hospital Charge Code |
173968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$858.04 |
| Max. Negotiated Rate |
$1,225.77 |
| Rate for Payer: Aetna Commercial |
$1,157.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.28
|
| Rate for Payer: Cash Price |
$1,089.58
|
| Rate for Payer: Cofinity Commercial |
$1,171.29
|
| Rate for Payer: Cofinity Commercial |
$953.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$953.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.58
|
| Rate for Payer: Healthscope Commercial |
$1,225.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.67
|
| Rate for Payer: PHP Commercial |
$1,157.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.28
|
| Rate for Payer: Priority Health SBD |
$858.04
|
|
|
NALOXEGOL 25 MG TABLET
|
Facility
|
OP
|
$4,404.11
|
|
|
Service Code
|
NDC 57841130103
|
| Hospital Charge Code |
173968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,761.64 |
| Max. Negotiated Rate |
$3,963.70 |
| Rate for Payer: Aetna Commercial |
$3,743.49
|
| Rate for Payer: Aetna Medicare |
$2,202.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,862.67
|
| Rate for Payer: BCBS Complete |
$1,761.64
|
| Rate for Payer: Cash Price |
$3,523.29
|
| Rate for Payer: Cofinity Commercial |
$3,082.88
|
| Rate for Payer: Cofinity Commercial |
$3,787.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,082.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,523.29
|
| Rate for Payer: Healthscope Commercial |
$3,963.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,743.49
|
| Rate for Payer: PHP Commercial |
$3,743.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,862.67
|
| Rate for Payer: Priority Health SBD |
$2,774.59
|
|
|
NALOXEGOL 25 MG TABLET
|
Facility
|
IP
|
$4,404.11
|
|
|
Service Code
|
NDC 57841130103
|
| Hospital Charge Code |
173968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,774.59 |
| Max. Negotiated Rate |
$3,963.70 |
| Rate for Payer: Aetna Commercial |
$3,743.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,862.67
|
| Rate for Payer: Cash Price |
$3,523.29
|
| Rate for Payer: Cofinity Commercial |
$3,082.88
|
| Rate for Payer: Cofinity Commercial |
$3,787.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,082.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,523.29
|
| Rate for Payer: Healthscope Commercial |
$3,963.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,743.49
|
| Rate for Payer: PHP Commercial |
$3,743.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,862.67
|
| Rate for Payer: Priority Health SBD |
$2,774.59
|
|
|
NALOXEGOL 25 MG TABLET
|
Facility
|
OP
|
$1,361.97
|
|
|
Service Code
|
NDC 57841130101
|
| Hospital Charge Code |
173968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$544.79 |
| Max. Negotiated Rate |
$1,225.77 |
| Rate for Payer: Aetna Commercial |
$1,157.67
|
| Rate for Payer: Aetna Medicare |
$680.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.28
|
| Rate for Payer: BCBS Complete |
$544.79
|
| Rate for Payer: Cash Price |
$1,089.58
|
| Rate for Payer: Cofinity Commercial |
$1,171.29
|
| Rate for Payer: Cofinity Commercial |
$953.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$953.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.58
|
| Rate for Payer: Healthscope Commercial |
$1,225.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.67
|
| Rate for Payer: PHP Commercial |
$1,157.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.28
|
| Rate for Payer: Priority Health SBD |
$858.04
|
|
|
NALOXONE 0.4 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$63.57
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
163714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.05 |
| Max. Negotiated Rate |
$57.21 |
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.32
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$44.50
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.02
|
| Rate for Payer: Priority Health SBD |
$40.05
|
| Rate for Payer: Priority Health SBD |
$12.62
|
|
|
NALOXONE 0.4 MG/ML INJECTION (CODE)
|
Facility
|
OP
|
$63.57
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
163714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.43 |
| Max. Negotiated Rate |
$57.21 |
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Medicare |
$10.02
|
| Rate for Payer: Aetna Medicare |
$31.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.32
|
| Rate for Payer: BCBS Complete |
$25.43
|
| Rate for Payer: BCBS Complete |
$8.01
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$44.50
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.32
|
| Rate for Payer: Priority Health SBD |
$40.05
|
| Rate for Payer: Priority Health SBD |
$12.62
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$20.03
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Commercial |
$16.63
|
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Medicare |
$31.79
|
| Rate for Payer: Aetna Medicare |
$10.02
|
| Rate for Payer: Aetna Medicare |
$9.78
|
| Rate for Payer: Aetna Medicare |
$9.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.32
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS Complete |
$25.43
|
| Rate for Payer: BCBS Complete |
$7.82
|
| Rate for Payer: BCBS Complete |
$8.01
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$15.65
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cofinity Commercial |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$44.50
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$12.92
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.65
|
| Rate for Payer: Healthscope Commercial |
$16.61
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: Healthscope Commercial |
$17.60
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.69
|
| Rate for Payer: PHP Commercial |
$16.63
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: PHP Commercial |
$15.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.32
|
| Rate for Payer: Priority Health SBD |
$11.63
|
| Rate for Payer: Priority Health SBD |
$12.62
|
| Rate for Payer: Priority Health SBD |
$12.32
|
| Rate for Payer: Priority Health SBD |
$40.05
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$20.03
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Commercial |
$16.63
|
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.32
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cash Price |
$15.65
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cofinity Commercial |
$12.92
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$44.50
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Cofinity Commercial |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$17.60
|
| Rate for Payer: Healthscope Commercial |
$16.61
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.69
|
| Rate for Payer: PHP Commercial |
$15.69
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: PHP Commercial |
$16.63
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.32
|
| Rate for Payer: Priority Health SBD |
$11.63
|
| Rate for Payer: Priority Health SBD |
$12.62
|
| Rate for Payer: Priority Health SBD |
$12.32
|
| Rate for Payer: Priority Health SBD |
$40.05
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$86.71
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.68 |
| Max. Negotiated Rate |
$78.04 |
| Rate for Payer: Aetna Commercial |
$73.70
|
| Rate for Payer: Aetna Commercial |
$59.72
|
| Rate for Payer: Aetna Medicare |
$35.13
|
| Rate for Payer: Aetna Medicare |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.36
|
| Rate for Payer: BCBS Complete |
$34.68
|
| Rate for Payer: BCBS Complete |
$28.10
|
| Rate for Payer: Cash Price |
$56.21
|
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Cofinity Commercial |
$49.18
|
| Rate for Payer: Cofinity Commercial |
$60.70
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$60.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.37
|
| Rate for Payer: Healthscope Commercial |
$63.23
|
| Rate for Payer: Healthscope Commercial |
$78.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.70
|
| Rate for Payer: PHP Commercial |
$73.70
|
| Rate for Payer: PHP Commercial |
$59.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.36
|
| Rate for Payer: Priority Health SBD |
$54.63
|
| Rate for Payer: Priority Health SBD |
$44.26
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$86.71
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.63 |
| Max. Negotiated Rate |
$78.04 |
| Rate for Payer: Aetna Commercial |
$73.70
|
| Rate for Payer: Aetna Commercial |
$59.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.36
|
| Rate for Payer: Cash Price |
$56.21
|
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Cofinity Commercial |
$49.18
|
| Rate for Payer: Cofinity Commercial |
$60.70
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$60.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.37
|
| Rate for Payer: Healthscope Commercial |
$63.23
|
| Rate for Payer: Healthscope Commercial |
$78.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.70
|
| Rate for Payer: PHP Commercial |
$59.72
|
| Rate for Payer: PHP Commercial |
$73.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.67
|
| Rate for Payer: Priority Health SBD |
$54.63
|
| Rate for Payer: Priority Health SBD |
$44.26
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
IP
|
$377.28
|
|
|
Service Code
|
NDC 51224020650
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.69 |
| Max. Negotiated Rate |
$339.55 |
| Rate for Payer: Aetna Commercial |
$320.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.23
|
| Rate for Payer: Cash Price |
$301.82
|
| Rate for Payer: Cofinity Commercial |
$264.10
|
| Rate for Payer: Cofinity Commercial |
$324.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$264.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.82
|
| Rate for Payer: Healthscope Commercial |
$339.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.69
|
| Rate for Payer: PHP Commercial |
$320.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.23
|
| Rate for Payer: Priority Health SBD |
$237.69
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
OP
|
$252.42
|
|
|
Service Code
|
NDC 68094085362
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.97 |
| Max. Negotiated Rate |
$227.18 |
| Rate for Payer: Aetna Commercial |
$214.56
|
| Rate for Payer: Aetna Medicare |
$126.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.07
|
| Rate for Payer: BCBS Complete |
$100.97
|
| Rate for Payer: Cash Price |
$201.94
|
| Rate for Payer: Cofinity Commercial |
$176.69
|
| Rate for Payer: Cofinity Commercial |
$217.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.94
|
| Rate for Payer: Healthscope Commercial |
$227.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.56
|
| Rate for Payer: PHP Commercial |
$214.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.07
|
| Rate for Payer: Priority Health SBD |
$159.02
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
IP
|
$252.42
|
|
|
Service Code
|
NDC 68094085362
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.02 |
| Max. Negotiated Rate |
$227.18 |
| Rate for Payer: Aetna Commercial |
$214.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.07
|
| Rate for Payer: Cash Price |
$201.94
|
| Rate for Payer: Cofinity Commercial |
$176.69
|
| Rate for Payer: Cofinity Commercial |
$217.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.94
|
| Rate for Payer: Healthscope Commercial |
$227.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.56
|
| Rate for Payer: PHP Commercial |
$214.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.07
|
| Rate for Payer: Priority Health SBD |
$159.02
|
|
