|
PHENYLEPHRINE 0.5 % NASAL SPRAY
|
Facility
|
IP
|
$19.78
|
|
|
Service Code
|
NDC 00225080547
|
| Hospital Charge Code |
6244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$17.80 |
| Rate for Payer: Aetna Commercial |
$16.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.86
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Advantage |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$17.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$17.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.84
|
| Rate for Payer: PHP Commercial |
$16.81
|
| Rate for Payer: Priority Health SBD |
$12.46
|
|
|
PHENYLEPHRINE 0.5 % NASAL SPRAY
|
Facility
|
OP
|
$19.78
|
|
|
Service Code
|
NDC 00225080547
|
| Hospital Charge Code |
6244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$17.80 |
| Rate for Payer: Aetna Commercial |
$16.81
|
| Rate for Payer: Aetna Medicare |
$9.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.86
|
| Rate for Payer: BCBS Complete |
$7.91
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Advantage |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$17.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$17.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.84
|
| Rate for Payer: PHP Commercial |
$16.81
|
| Rate for Payer: Priority Health SBD |
$12.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.86
|
| Rate for Payer: UHC Core |
$10.31
|
| Rate for Payer: UHC Exchange |
$7.77
|
|
|
PHENYLEPHRINE 10 MG IN NS 200 ML
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 99000000209
|
| Hospital Charge Code |
155016
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.75
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Advantage |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health SBD |
$22.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.75
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: UHC Exchange |
$13.76
|
|
|
PHENYLEPHRINE 10 MG IN NS 200 ML
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 99000000209
|
| Hospital Charge Code |
155016
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.75
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Advantage |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health SBD |
$22.05
|
|
|
PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$11.65 |
| Rate for Payer: Aetna Commercial |
$11.01
|
| Rate for Payer: Aetna Commercial |
$9.79
|
| Rate for Payer: Aetna Commercial |
$123.87
|
| Rate for Payer: Aetna Commercial |
$12.60
|
| Rate for Payer: Aetna Commercial |
$11.98
|
| Rate for Payer: Aetna Commercial |
$13.07
|
| Rate for Payer: Aetna Commercial |
$10.92
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$14.24
|
| Rate for Payer: Aetna Commercial |
$158.13
|
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$9.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.35
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cash Price |
$148.83
|
| Rate for Payer: Cash Price |
$11.86
|
| Rate for Payer: Cash Price |
$10.28
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cash Price |
$9.25
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cofinity Advantage |
$8.06
|
| Rate for Payer: Cofinity Advantage |
$102.01
|
| Rate for Payer: Cofinity Advantage |
$8.09
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Advantage |
$130.23
|
| Rate for Payer: Cofinity Advantage |
$10.37
|
| Rate for Payer: Cofinity Advantage |
$14.54
|
| Rate for Payer: Cofinity Advantage |
$13.10
|
| Rate for Payer: Cofinity Advantage |
$11.72
|
| Rate for Payer: Cofinity Advantage |
$8.99
|
| Rate for Payer: Cofinity Advantage |
$9.06
|
| Rate for Payer: Cofinity Advantage |
$10.77
|
| Rate for Payer: Cofinity Advantage |
$9.87
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$12.13
|
| Rate for Payer: Cofinity Commercial |
$125.33
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$12.75
|
| Rate for Payer: Cofinity Commercial |
$13.23
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$159.99
|
| Rate for Payer: Cofinity Commercial |
$9.94
|
| Rate for Payer: Cofinity Commercial |
$9.91
|
| Rate for Payer: Cofinity Commercial |
$11.05
|
| Rate for Payer: Cofinity Commercial |
$11.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.62
|
| Rate for Payer: Healthscope Commercial |
$167.44
|
| Rate for Payer: Healthscope Commercial |
$131.16
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$18.69
|
| Rate for Payer: Healthscope Commercial |
$13.84
|
| Rate for Payer: Healthscope Commercial |
$12.69
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$11.56
|
| Rate for Payer: Healthscope Commercial |
$11.65
|
| Rate for Payer: Healthscope Commercial |
$15.07
|
| Rate for Payer: Healthscope Commercial |
$13.34
|
| Rate for Payer: Healthscope Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.67
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$12.60
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$13.07
|
| Rate for Payer: PHP Commercial |
$11.01
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: PHP Commercial |
$9.79
|
| Rate for Payer: PHP Commercial |
$10.92
|
| Rate for Payer: PHP Commercial |
$158.13
|
| Rate for Payer: PHP Commercial |
$9.83
|
| Rate for Payer: PHP Commercial |
$11.98
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: PHP Commercial |
$123.87
|
| Rate for Payer: Priority Health SBD |
$91.81
|
| Rate for Payer: Priority Health SBD |
$11.79
|
| Rate for Payer: Priority Health SBD |
$7.26
|
| Rate for Payer: Priority Health SBD |
$8.10
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: Priority Health SBD |
$8.16
|
| Rate for Payer: Priority Health SBD |
$9.69
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: Priority Health SBD |
$9.34
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: Priority Health SBD |
$8.88
|
| Rate for Payer: Priority Health SBD |
$117.21
|
| Rate for Payer: Priority Health SBD |
$7.28
|
|
|
PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$14.10
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$12.69 |
| Rate for Payer: Aetna Commercial |
$11.98
|
| Rate for Payer: Aetna Commercial |
$12.60
|
| Rate for Payer: Aetna Commercial |
$158.13
|
| Rate for Payer: Aetna Commercial |
$13.07
|
| Rate for Payer: Aetna Commercial |
$9.79
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$10.92
|
| Rate for Payer: Aetna Commercial |
$9.83
|
| Rate for Payer: Aetna Commercial |
$14.24
|
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Commercial |
$123.87
|
| Rate for Payer: Aetna Commercial |
$11.01
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Medicare |
$6.97
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: Aetna Medicare |
$72.86
|
| Rate for Payer: Aetna Medicare |
$7.05
|
| Rate for Payer: Aetna Medicare |
$7.41
|
| Rate for Payer: Aetna Medicare |
$5.78
|
| Rate for Payer: Aetna Medicare |
$93.02
|
| Rate for Payer: Aetna Medicare |
$7.69
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Aetna Medicare |
$8.38
|
| Rate for Payer: Aetna Medicare |
$6.42
|
| Rate for Payer: Aetna Medicare |
$10.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.42
|
| Rate for Payer: BCBS Complete |
$58.29
|
| Rate for Payer: BCBS Complete |
$4.62
|
| Rate for Payer: BCBS Complete |
$4.61
|
| Rate for Payer: BCBS Complete |
$5.14
|
| Rate for Payer: BCBS Complete |
$8.31
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS Complete |
$74.42
|
| Rate for Payer: BCBS Complete |
$6.70
|
| Rate for Payer: BCBS Complete |
$5.18
|
| Rate for Payer: BCBS Complete |
$6.15
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS Complete |
$5.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$148.83
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: Cash Price |
$10.28
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: Cash Price |
$9.25
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$10.28
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$9.25
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.86
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Cash Price |
$11.86
|
| Rate for Payer: Cash Price |
$148.83
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Advantage |
$130.23
|
| Rate for Payer: Cofinity Advantage |
$9.06
|
| Rate for Payer: Cofinity Advantage |
$8.09
|
| Rate for Payer: Cofinity Advantage |
$8.99
|
| Rate for Payer: Cofinity Advantage |
$9.87
|
| Rate for Payer: Cofinity Advantage |
$8.06
|
| Rate for Payer: Cofinity Advantage |
$11.72
|
| Rate for Payer: Cofinity Advantage |
$13.10
|
| Rate for Payer: Cofinity Advantage |
$10.37
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Advantage |
$102.01
|
| Rate for Payer: Cofinity Advantage |
$14.54
|
| Rate for Payer: Cofinity Advantage |
$10.77
|
| Rate for Payer: Cofinity Commercial |
$11.05
|
| Rate for Payer: Cofinity Commercial |
$9.94
|
| Rate for Payer: Cofinity Commercial |
$9.91
|
| Rate for Payer: Cofinity Commercial |
$11.14
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$12.13
|
| Rate for Payer: Cofinity Commercial |
$125.33
|
| Rate for Payer: Cofinity Commercial |
$12.75
|
| Rate for Payer: Cofinity Commercial |
$13.23
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$159.99
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.22
|
| Rate for Payer: Healthscope Commercial |
$167.44
|
| Rate for Payer: Healthscope Commercial |
$12.69
|
| Rate for Payer: Healthscope Commercial |
$18.69
|
| Rate for Payer: Healthscope Commercial |
$13.34
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$10.37
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$11.56
|
| Rate for Payer: Healthscope Commercial |
$131.16
|
| Rate for Payer: Healthscope Commercial |
$13.84
|
| Rate for Payer: Healthscope Commercial |
$11.65
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$15.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.64
|
| Rate for Payer: PHP Commercial |
$158.13
|
| Rate for Payer: PHP Commercial |
$123.87
|
| Rate for Payer: PHP Commercial |
$11.98
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$12.60
|
| Rate for Payer: PHP Commercial |
$11.01
|
| Rate for Payer: PHP Commercial |
$13.07
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: PHP Commercial |
$10.92
|
| Rate for Payer: PHP Commercial |
$9.79
|
| Rate for Payer: PHP Commercial |
$9.83
|
| Rate for Payer: Priority Health SBD |
$7.26
|
| Rate for Payer: Priority Health SBD |
$91.81
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: Priority Health SBD |
$9.34
|
| Rate for Payer: Priority Health SBD |
$8.16
|
| Rate for Payer: Priority Health SBD |
$9.69
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: Priority Health SBD |
$8.10
|
| Rate for Payer: Priority Health SBD |
$7.28
|
| Rate for Payer: Priority Health SBD |
$117.21
|
| Rate for Payer: Priority Health SBD |
$11.79
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: Priority Health SBD |
$8.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
OP
|
$23.86
|
|
|
Service Code
|
NDC 70092104646
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$21.47 |
| Rate for Payer: Aetna Commercial |
$20.28
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.51
|
| Rate for Payer: BCBS Complete |
$9.54
|
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: Cofinity Advantage |
$16.70
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.09
|
| Rate for Payer: Healthscope Commercial |
$21.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.89
|
| Rate for Payer: PHP Commercial |
$20.28
|
| Rate for Payer: Priority Health SBD |
$15.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.51
|
| Rate for Payer: UHC Core |
$12.43
|
| Rate for Payer: UHC Exchange |
$9.38
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 69374095710
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Advantage |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health SBD |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.76
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Exchange |
$1.67
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 69374095710
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Advantage |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health SBD |
$2.68
|
|
|
PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE
|
Facility
|
IP
|
$23.86
|
|
|
Service Code
|
NDC 70092104646
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$21.47 |
| Rate for Payer: Aetna Commercial |
$20.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.51
|
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: Cofinity Advantage |
$16.70
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.09
|
| Rate for Payer: Healthscope Commercial |
$21.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.89
|
| Rate for Payer: PHP Commercial |
$20.28
|
| Rate for Payer: Priority Health SBD |
$15.03
|
|
|
PHENYLEPHRINE 1 % NASAL SPRAY
|
Facility
|
OP
|
$19.51
|
|
|
Service Code
|
NDC 00024135202
|
| Hospital Charge Code |
109137
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna Medicare |
$9.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.68
|
| Rate for Payer: BCBS Complete |
$7.80
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cofinity Advantage |
$13.66
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$17.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.63
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: Priority Health SBD |
$12.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.68
|
| Rate for Payer: UHC Core |
$10.16
|
| Rate for Payer: UHC Exchange |
$7.67
|
|
|
PHENYLEPHRINE 1 % NASAL SPRAY
|
Facility
|
OP
|
$22.21
|
|
|
Service Code
|
NDC 00225081047
|
| Hospital Charge Code |
109137
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$19.99 |
| Rate for Payer: Aetna Commercial |
$18.88
|
| Rate for Payer: Aetna Medicare |
$11.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.44
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: Cofinity Advantage |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$19.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.77
|
| Rate for Payer: Healthscope Commercial |
$19.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.66
|
| Rate for Payer: PHP Commercial |
$18.88
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.44
|
| Rate for Payer: UHC Core |
$11.57
|
| Rate for Payer: UHC Exchange |
$8.73
|
|
|
PHENYLEPHRINE 1 % NASAL SPRAY
|
Facility
|
IP
|
$19.51
|
|
|
Service Code
|
NDC 00024135202
|
| Hospital Charge Code |
109137
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.68
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cofinity Advantage |
$13.66
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$17.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.63
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: Priority Health SBD |
$12.29
|
|
|
PHENYLEPHRINE 1 % NASAL SPRAY
|
Facility
|
IP
|
$22.21
|
|
|
Service Code
|
NDC 00225081047
|
| Hospital Charge Code |
109137
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$19.99 |
| Rate for Payer: Aetna Commercial |
$18.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.44
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: Cofinity Advantage |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$19.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.77
|
| Rate for Payer: Healthscope Commercial |
$19.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.66
|
| Rate for Payer: PHP Commercial |
$18.88
|
| Rate for Payer: Priority Health SBD |
$13.99
|
|
|
PHENYLEPHRINE 20 MG/250 ML (80 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$23.50
|
|
|
Service Code
|
HCPCS J7999
|
| Hospital Charge Code |
155583
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$11.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Advantage |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health SBD |
$14.80
|
|
|
PHENYLEPHRINE 20 MG/250 ML (80 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$23.50
|
|
|
Service Code
|
HCPCS J7999
|
| Hospital Charge Code |
155583
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Advantage |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health SBD |
$14.80
|
|
|
PHENYLEPHRINE 20MG/250ML NS (IV PREMIX)
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
NDC 09900000162
|
| Hospital Charge Code |
500533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Aetna Commercial |
$8.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.17
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Cofinity Advantage |
$6.65
|
| Rate for Payer: Cofinity Commercial |
$8.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.60
|
| Rate for Payer: Healthscope Commercial |
$8.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.12
|
| Rate for Payer: PHP Commercial |
$8.07
|
| Rate for Payer: Priority Health SBD |
$5.99
|
|
|
PHENYLEPHRINE 20MG/250ML NS (IV PREMIX)
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
NDC 09900000162
|
| Hospital Charge Code |
500533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Aetna Commercial |
$8.07
|
| Rate for Payer: Aetna Medicare |
$4.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.17
|
| Rate for Payer: BCBS Complete |
$3.80
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Cofinity Advantage |
$6.65
|
| Rate for Payer: Cofinity Commercial |
$8.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.60
|
| Rate for Payer: Healthscope Commercial |
$8.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.12
|
| Rate for Payer: PHP Commercial |
$8.07
|
| Rate for Payer: Priority Health SBD |
$5.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.17
|
| Rate for Payer: UHC Core |
$4.95
|
| Rate for Payer: UHC Exchange |
$3.73
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
IP
|
$99.40
|
|
|
Service Code
|
NDC 17478020102
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.62 |
| Max. Negotiated Rate |
$89.46 |
| Rate for Payer: Aetna Commercial |
$84.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.61
|
| Rate for Payer: Cash Price |
$79.52
|
| Rate for Payer: Cofinity Advantage |
$69.58
|
| Rate for Payer: Cofinity Commercial |
$85.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.52
|
| Rate for Payer: Healthscope Commercial |
$89.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.55
|
| Rate for Payer: PHP Commercial |
$84.49
|
| Rate for Payer: Priority Health SBD |
$62.62
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
OP
|
$99.40
|
|
|
Service Code
|
NDC 17478020102
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.06 |
| Max. Negotiated Rate |
$89.46 |
| Rate for Payer: Aetna Commercial |
$84.49
|
| Rate for Payer: Aetna Medicare |
$49.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.61
|
| Rate for Payer: BCBS Complete |
$39.76
|
| Rate for Payer: Cash Price |
$79.52
|
| Rate for Payer: Cofinity Advantage |
$69.58
|
| Rate for Payer: Cofinity Commercial |
$85.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.52
|
| Rate for Payer: Healthscope Commercial |
$89.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.55
|
| Rate for Payer: PHP Commercial |
$84.49
|
| Rate for Payer: Priority Health SBD |
$62.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.61
|
| Rate for Payer: UHC Core |
$51.79
|
| Rate for Payer: UHC Exchange |
$39.06
|
|
|
PHENYLEPHRINE IV INFUSION (INTRA-OP)
|
Facility
|
OP
|
$16.25
|
|
|
Service Code
|
NDC 09900000362
|
| Hospital Charge Code |
155179
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.81
|
| Rate for Payer: Aetna Medicare |
$8.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.56
|
| Rate for Payer: BCBS Complete |
$6.50
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cofinity Advantage |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.00
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.19
|
| Rate for Payer: PHP Commercial |
$13.81
|
| Rate for Payer: Priority Health SBD |
$10.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.56
|
| Rate for Payer: UHC Core |
$8.47
|
| Rate for Payer: UHC Exchange |
$6.39
|
|
|
PHENYLEPHRINE IV INFUSION (INTRA-OP)
|
Facility
|
IP
|
$16.25
|
|
|
Service Code
|
NDC 09900000362
|
| Hospital Charge Code |
155179
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.56
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cofinity Advantage |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.00
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.19
|
| Rate for Payer: PHP Commercial |
$13.81
|
| Rate for Payer: Priority Health SBD |
$10.24
|
|
|
PHENYTOIN 100 MG/4 ML ORAL SUSPENSION
|
Facility
|
IP
|
$22.38
|
|
|
Service Code
|
NDC 60687027563
|
| Hospital Charge Code |
118124
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$20.14 |
| Rate for Payer: Aetna Commercial |
$19.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cofinity Advantage |
$15.67
|
| Rate for Payer: Cofinity Commercial |
$19.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$20.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.79
|
| Rate for Payer: PHP Commercial |
$19.02
|
| Rate for Payer: Priority Health SBD |
$14.10
|
|
|
PHENYTOIN 100 MG/4 ML ORAL SUSPENSION
|
Facility
|
OP
|
$21.17
|
|
|
Service Code
|
NDC 66689003650
|
| Hospital Charge Code |
118124
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna Medicare |
$10.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.76
|
| Rate for Payer: BCBS Complete |
$8.47
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cofinity Advantage |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.88
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: Priority Health SBD |
$13.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.76
|
| Rate for Payer: UHC Core |
$11.03
|
| Rate for Payer: UHC Exchange |
$8.32
|
|
|
PHENYTOIN 100 MG/4 ML ORAL SUSPENSION
|
Facility
|
OP
|
$22.38
|
|
|
Service Code
|
NDC 60687027562
|
| Hospital Charge Code |
118124
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$20.14 |
| Rate for Payer: Aetna Commercial |
$19.02
|
| Rate for Payer: Aetna Medicare |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: BCBS Complete |
$8.95
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cofinity Advantage |
$15.67
|
| Rate for Payer: Cofinity Commercial |
$19.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$20.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.79
|
| Rate for Payer: PHP Commercial |
$19.02
|
| Rate for Payer: Priority Health SBD |
$14.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.55
|
| Rate for Payer: UHC Core |
$11.66
|
| Rate for Payer: UHC Exchange |
$8.80
|
|
