|
PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$11.52
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$10.37 |
| Rate for Payer: Aetna Commercial |
$9.79
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$14.24
|
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Commercial |
$158.13
|
| Rate for Payer: Aetna Commercial |
$12.32
|
| Rate for Payer: Aetna Commercial |
$14.10
|
| Rate for Payer: Aetna Commercial |
$13.76
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Commercial |
$10.69
|
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna Commercial |
$126.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cash Price |
$148.83
|
| Rate for Payer: Cash Price |
$11.60
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$119.37
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$10.06
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$14.27
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Cofinity Commercial |
$128.32
|
| Rate for Payer: Cofinity Commercial |
$7.55
|
| Rate for Payer: Cofinity Commercial |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$8.06
|
| Rate for Payer: Cofinity Commercial |
$9.91
|
| Rate for Payer: Cofinity Commercial |
$10.82
|
| Rate for Payer: Cofinity Commercial |
$8.81
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$9.80
|
| Rate for Payer: Cofinity Commercial |
$10.15
|
| Rate for Payer: Cofinity Commercial |
$12.47
|
| Rate for Payer: Cofinity Commercial |
$104.45
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$159.99
|
| Rate for Payer: Cofinity Commercial |
$130.23
|
| Rate for Payer: Cofinity Commercial |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$11.33
|
| Rate for Payer: Cofinity Commercial |
$13.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| 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 |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$167.44
|
| Rate for Payer: Healthscope Commercial |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$13.05
|
| Rate for Payer: Healthscope Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$10.37
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$14.93
|
| Rate for Payer: Healthscope Commercial |
$134.29
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$18.69
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.76
|
| Rate for Payer: PHP Commercial |
$126.83
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: PHP Commercial |
$10.69
|
| Rate for Payer: PHP Commercial |
$9.17
|
| Rate for Payer: PHP Commercial |
$9.79
|
| Rate for Payer: PHP Commercial |
$13.76
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: PHP Commercial |
$12.32
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Commercial |
$14.10
|
| Rate for Payer: PHP Commercial |
$158.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health SBD |
$11.79
|
| Rate for Payer: Priority Health SBD |
$10.45
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: Priority Health SBD |
$10.49
|
| Rate for Payer: Priority Health SBD |
$7.26
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: Priority Health SBD |
$7.93
|
| Rate for Payer: Priority Health SBD |
$10.20
|
| Rate for Payer: Priority Health SBD |
$8.82
|
| Rate for Payer: Priority Health SBD |
$9.14
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: Priority Health SBD |
$117.21
|
| Rate for Payer: Priority Health SBD |
$94.00
|
|
|
PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$10.79
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna Commercial |
$12.32
|
| Rate for Payer: Aetna Commercial |
$10.69
|
| Rate for Payer: Aetna Commercial |
$158.13
|
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Commercial |
$13.76
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Commercial |
$14.10
|
| Rate for Payer: Aetna Commercial |
$126.83
|
| Rate for Payer: Aetna Commercial |
$14.24
|
| Rate for Payer: Aetna Commercial |
$9.79
|
| Rate for Payer: Aetna Medicare |
$6.29
|
| Rate for Payer: Aetna Medicare |
$8.32
|
| Rate for Payer: Aetna Medicare |
$74.60
|
| Rate for Payer: Aetna Medicare |
$8.10
|
| Rate for Payer: Aetna Medicare |
$8.30
|
| Rate for Payer: Aetna Medicare |
$7.25
|
| Rate for Payer: Aetna Medicare |
$8.38
|
| Rate for Payer: Aetna Medicare |
$93.02
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: Aetna Medicare |
$10.38
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna Medicare |
$5.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.10
|
| 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) |
$10.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.49
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Complete |
$6.70
|
| Rate for Payer: BCBS Complete |
$74.42
|
| Rate for Payer: BCBS Complete |
$5.03
|
| Rate for Payer: BCBS Complete |
$6.64
|
| Rate for Payer: BCBS Complete |
$6.66
|
| Rate for Payer: BCBS Complete |
$5.80
|
| Rate for Payer: BCBS Complete |
$4.61
|
| Rate for Payer: BCBS Complete |
$59.68
|
| Rate for Payer: BCBS Complete |
$4.32
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: BCBS Complete |
$8.31
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$119.37
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$119.37
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$148.83
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$148.83
|
| Rate for Payer: Cash Price |
$10.06
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cash Price |
$11.60
|
| Rate for Payer: Cash Price |
$10.06
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$11.60
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cofinity Commercial |
$11.33
|
| Rate for Payer: Cofinity Commercial |
$7.55
|
| Rate for Payer: Cofinity Commercial |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$8.06
|
| Rate for Payer: Cofinity Commercial |
$9.91
|
| Rate for Payer: Cofinity Commercial |
$10.82
|
| Rate for Payer: Cofinity Commercial |
$8.81
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$9.80
|
| Rate for Payer: Cofinity Commercial |
$10.15
|
| Rate for Payer: Cofinity Commercial |
$12.47
|
| Rate for Payer: Cofinity Commercial |
$104.45
|
| Rate for Payer: Cofinity Commercial |
$128.32
|
| Rate for Payer: Cofinity Commercial |
$13.92
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Cofinity Commercial |
$14.27
|
| Rate for Payer: Cofinity Commercial |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$130.23
|
| Rate for Payer: Cofinity Commercial |
$159.99
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.62
|
| Rate for Payer: Healthscope Commercial |
$134.29
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$18.69
|
| Rate for Payer: Healthscope Commercial |
$14.93
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$10.37
|
| Rate for Payer: Healthscope Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$13.05
|
| Rate for Payer: Healthscope Commercial |
$167.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.79
|
| Rate for Payer: PHP Commercial |
$9.17
|
| Rate for Payer: PHP Commercial |
$14.10
|
| Rate for Payer: PHP Commercial |
$126.83
|
| Rate for Payer: PHP Commercial |
$12.32
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: PHP Commercial |
$10.69
|
| Rate for Payer: PHP Commercial |
$9.79
|
| Rate for Payer: PHP Commercial |
$158.13
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: PHP Commercial |
$13.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.18
|
| Rate for Payer: Priority Health SBD |
$8.82
|
| Rate for Payer: Priority Health SBD |
$9.14
|
| Rate for Payer: Priority Health SBD |
$10.20
|
| Rate for Payer: Priority Health SBD |
$7.26
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: Priority Health SBD |
$10.45
|
| Rate for Payer: Priority Health SBD |
$117.21
|
| Rate for Payer: Priority Health SBD |
$11.79
|
| Rate for Payer: Priority Health SBD |
$94.00
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: Priority Health SBD |
$7.93
|
| Rate for Payer: Priority Health SBD |
$10.49
|
|
|
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 |
$1.70 |
| Max. Negotiated Rate |
$3.82 |
| 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 Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| 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
|
$4.25
|
|
|
Service Code
|
NDC 69374095710
|
| Hospital Charge Code |
119800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$3.82 |
| 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 Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: Priority Health SBD |
$2.68
|
|
|
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 Commercial |
$13.66
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.66
|
| 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: PHP Commercial |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.68
|
| Rate for Payer: Priority Health SBD |
$12.29
|
|
|
PHENYLEPHRINE 1 % NASAL SPRAY
|
Facility
|
OP
|
$19.51
|
|
|
Service Code
|
NDC 00024135202
|
| Hospital Charge Code |
109137
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.80 |
| 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 Commercial |
$13.66
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.66
|
| 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: PHP Commercial |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.68
|
| 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 Commercial |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$19.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.55
|
| 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: PHP Commercial |
$18.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.44
|
| Rate for Payer: Priority Health SBD |
$13.99
|
|
|
PHENYLEPHRINE 1 % NASAL SPRAY
|
Facility
|
OP
|
$22.21
|
|
|
Service Code
|
NDC 00225081047
|
| Hospital Charge Code |
109137
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$19.99 |
| Rate for Payer: Aetna Commercial |
$18.88
|
| Rate for Payer: Aetna Medicare |
$11.10
|
| 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 Commercial |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$19.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.55
|
| 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: PHP Commercial |
$18.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.44
|
| Rate for Payer: Priority Health SBD |
$13.99
|
|
|
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 Commercial |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.45
|
| 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: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health SBD |
$14.80
|
|
|
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 Commercial |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.45
|
| 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: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health SBD |
$14.80
|
|
|
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 |
$3.80 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Aetna Commercial |
$8.08
|
| Rate for Payer: Aetna Medicare |
$4.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.18
|
| Rate for Payer: BCBS Complete |
$3.80
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Cofinity Commercial |
$6.65
|
| Rate for Payer: Cofinity Commercial |
$8.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.65
|
| 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 |
$8.08
|
| Rate for Payer: PHP Commercial |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.18
|
| Rate for Payer: Priority Health SBD |
$5.98
|
|
|
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 |
$5.98 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Aetna Commercial |
$8.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.18
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Cofinity Commercial |
$6.65
|
| Rate for Payer: Cofinity Commercial |
$8.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.65
|
| 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 |
$8.08
|
| Rate for Payer: PHP Commercial |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.18
|
| Rate for Payer: Priority Health SBD |
$5.98
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
OP
|
$99.40
|
|
|
Service Code
|
NDC 17478020102
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.76 |
| 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 Commercial |
$69.58
|
| Rate for Payer: Cofinity Commercial |
$85.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.58
|
| 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: PHP Commercial |
$84.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.61
|
| Rate for Payer: Priority Health SBD |
$62.62
|
|
|
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 Commercial |
$69.58
|
| Rate for Payer: Cofinity Commercial |
$85.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.58
|
| 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: PHP Commercial |
$84.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.61
|
| Rate for Payer: Priority Health SBD |
$62.62
|
|
|
PHENYLEPHRINE IV INFUSION (INTRA-OP)
|
Facility
|
OP
|
$16.25
|
|
|
Service Code
|
NDC 09900000362
|
| Hospital Charge Code |
155179
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.50 |
| 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 Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.38
|
| 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: PHP Commercial |
$13.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health SBD |
$10.24
|
|
|
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 Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.38
|
| 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: PHP Commercial |
$13.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health SBD |
$10.24
|
|
|
PHENYTOIN 100 MG/4 ML ORAL SUSPENSION
|
Facility
|
IP
|
$3.47
|
|
|
Service Code
|
NDC 09900000406
|
| Hospital Charge Code |
118124
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna Commercial |
$2.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.26
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.95
|
| Rate for Payer: PHP Commercial |
$2.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.26
|
| Rate for Payer: Priority Health SBD |
$2.19
|
|
|
PHENYTOIN 100 MG/4 ML ORAL SUSPENSION
|
Facility
|
OP
|
$3.47
|
|
|
Service Code
|
NDC 09900000406
|
| Hospital Charge Code |
118124
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna Commercial |
$2.95
|
| Rate for Payer: Aetna Medicare |
$1.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.26
|
| Rate for Payer: BCBS Complete |
$1.39
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.95
|
| Rate for Payer: PHP Commercial |
$2.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.26
|
| Rate for Payer: Priority Health SBD |
$2.19
|
|
|
PHENYTOIN 100 MG/4 ML ORAL SUSPENSION
|
Facility
|
OP
|
$19.30
|
|
|
Service Code
|
NDC 60687027566
|
| Hospital Charge Code |
118124
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$17.37 |
| Rate for Payer: Aetna Commercial |
$16.40
|
| Rate for Payer: Aetna Medicare |
$9.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.54
|
| Rate for Payer: BCBS Complete |
$7.72
|
| Rate for Payer: Cash Price |
$15.44
|
| Rate for Payer: Cofinity Commercial |
$13.51
|
| Rate for Payer: Cofinity Commercial |
$16.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.44
|
| Rate for Payer: Healthscope Commercial |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.40
|
| Rate for Payer: PHP Commercial |
$16.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.54
|
| Rate for Payer: Priority Health SBD |
$12.16
|
|
|
PHENYTOIN 100 MG/4 ML ORAL SUSPENSION
|
Facility
|
IP
|
$21.17
|
|
|
Service Code
|
NDC 66689003650
|
| Hospital Charge Code |
118124
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.76
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.76
|
| Rate for Payer: Priority Health SBD |
$13.34
|
|
|
PHENYTOIN 100 MG/4 ML ORAL SUSPENSION
|
Facility
|
IP
|
$19.30
|
|
|
Service Code
|
NDC 60687027566
|
| Hospital Charge Code |
118124
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$17.37 |
| Rate for Payer: Aetna Commercial |
$16.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.54
|
| Rate for Payer: Cash Price |
$15.44
|
| Rate for Payer: Cofinity Commercial |
$13.51
|
| Rate for Payer: Cofinity Commercial |
$16.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.44
|
| Rate for Payer: Healthscope Commercial |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.40
|
| Rate for Payer: PHP Commercial |
$16.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.54
|
| Rate for Payer: Priority Health SBD |
$12.16
|
|
|
PHENYTOIN 100 MG/4 ML ORAL SUSPENSION
|
Facility
|
IP
|
$19.30
|
|
|
Service Code
|
NDC 60687027562
|
| Hospital Charge Code |
118124
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$17.37 |
| Rate for Payer: Aetna Commercial |
$16.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.54
|
| Rate for Payer: Cash Price |
$15.44
|
| Rate for Payer: Cofinity Commercial |
$13.51
|
| Rate for Payer: Cofinity Commercial |
$16.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.44
|
| Rate for Payer: Healthscope Commercial |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.40
|
| Rate for Payer: PHP Commercial |
$16.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.54
|
| Rate for Payer: Priority Health SBD |
$12.16
|
|
|
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 |
$8.47 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna Medicare |
$10.58
|
| 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 Commercial |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.76
|
| Rate for Payer: Priority Health SBD |
$13.34
|
|
|
PHENYTOIN 100 MG/4 ML ORAL SUSPENSION
|
Facility
|
OP
|
$19.30
|
|
|
Service Code
|
NDC 60687027563
|
| Hospital Charge Code |
118124
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$17.37 |
| Rate for Payer: Aetna Commercial |
$16.40
|
| Rate for Payer: Aetna Medicare |
$9.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.54
|
| Rate for Payer: BCBS Complete |
$7.72
|
| Rate for Payer: Cash Price |
$15.44
|
| Rate for Payer: Cofinity Commercial |
$13.51
|
| Rate for Payer: Cofinity Commercial |
$16.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.44
|
| Rate for Payer: Healthscope Commercial |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.40
|
| Rate for Payer: PHP Commercial |
$16.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.54
|
| Rate for Payer: Priority Health SBD |
$12.16
|
|
|
PHENYTOIN 100 MG/4 ML ORAL SUSPENSION
|
Facility
|
IP
|
$19.30
|
|
|
Service Code
|
NDC 60687027563
|
| Hospital Charge Code |
118124
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$17.37 |
| Rate for Payer: Aetna Commercial |
$16.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.54
|
| Rate for Payer: Cash Price |
$15.44
|
| Rate for Payer: Cofinity Commercial |
$13.51
|
| Rate for Payer: Cofinity Commercial |
$16.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.44
|
| Rate for Payer: Healthscope Commercial |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.40
|
| Rate for Payer: PHP Commercial |
$16.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.54
|
| Rate for Payer: Priority Health SBD |
$12.16
|
|
