|
BENZOCAINE 20 % TOPICAL AEROSOL
|
Facility
|
OP
|
$59.51
|
|
|
Service Code
|
NDC 63736037882
|
| Hospital Charge Code |
108881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$53.56 |
| Rate for Payer: Aetna Commercial |
$50.58
|
| Rate for Payer: Aetna Medicare |
$29.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.68
|
| Rate for Payer: BCBS Complete |
$23.80
|
| Rate for Payer: Cash Price |
$47.61
|
| Rate for Payer: Cofinity Commercial |
$41.66
|
| Rate for Payer: Cofinity Commercial |
$51.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.61
|
| Rate for Payer: Healthscope Commercial |
$53.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.58
|
| Rate for Payer: PHP Commercial |
$50.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.68
|
| Rate for Payer: Priority Health SBD |
$37.49
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$312.55
|
|
|
Service Code
|
NDC 68382024701
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.02 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: Aetna Medicare |
$156.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: BCBS Complete |
$125.02
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: PHP Commercial |
$265.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.16
|
| Rate for Payer: Priority Health SBD |
$196.91
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$312.55
|
|
|
Service Code
|
NDC 68382024701
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.91 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: PHP Commercial |
$265.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.16
|
| Rate for Payer: Priority Health SBD |
$196.91
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$302.10
|
|
|
Service Code
|
NDC 00904656461
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.32 |
| Max. Negotiated Rate |
$271.89 |
| Rate for Payer: Aetna Commercial |
$256.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.36
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$211.47
|
| Rate for Payer: Cofinity Commercial |
$259.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Healthscope Commercial |
$271.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.78
|
| Rate for Payer: PHP Commercial |
$256.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.36
|
| Rate for Payer: Priority Health SBD |
$190.32
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$302.10
|
|
|
Service Code
|
NDC 00904656461
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.84 |
| Max. Negotiated Rate |
$271.89 |
| Rate for Payer: Aetna Commercial |
$256.78
|
| Rate for Payer: Aetna Medicare |
$151.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.36
|
| Rate for Payer: BCBS Complete |
$120.84
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$211.47
|
| Rate for Payer: Cofinity Commercial |
$259.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Healthscope Commercial |
$271.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.78
|
| Rate for Payer: PHP Commercial |
$256.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.36
|
| Rate for Payer: Priority Health SBD |
$190.32
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
NDC 42806071401
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.88 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$136.54
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.78
|
| Rate for Payer: Priority Health SBD |
$122.88
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$195.05
|
|
|
Service Code
|
NDC 42806071401
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.02 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$97.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: BCBS Complete |
$78.02
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$136.54
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.78
|
| Rate for Payer: Priority Health SBD |
$122.88
|
|
|
BENZTROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$81.90
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
9259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$73.71 |
| Rate for Payer: Aetna Commercial |
$69.62
|
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.24
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cofinity Commercial |
$72.43
|
| Rate for Payer: Cofinity Commercial |
$57.33
|
| Rate for Payer: Cofinity Commercial |
$70.98
|
| Rate for Payer: Cofinity Commercial |
$70.43
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.52
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Healthscope Commercial |
$73.71
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.62
|
| Rate for Payer: PHP Commercial |
$69.62
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.24
|
| Rate for Payer: Priority Health SBD |
$63.88
|
| Rate for Payer: Priority Health SBD |
$65.19
|
| Rate for Payer: Priority Health SBD |
$51.60
|
|
|
BENZTROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$81.90
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
9259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$73.71 |
| Rate for Payer: Aetna Commercial |
$69.62
|
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: Aetna Medicare |
$50.70
|
| Rate for Payer: Aetna Medicare |
$51.74
|
| Rate for Payer: Aetna Medicare |
$40.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.24
|
| Rate for Payer: BCBS Complete |
$41.39
|
| Rate for Payer: BCBS Complete |
$40.56
|
| Rate for Payer: BCBS Complete |
$32.76
|
| Rate for Payer: BCBS Trust/PPO |
$46.77
|
| Rate for Payer: BCBS Trust/PPO |
$46.77
|
| Rate for Payer: BCBS Trust/PPO |
$46.77
|
| Rate for Payer: BCN Commercial |
$46.77
|
| Rate for Payer: BCN Commercial |
$46.77
|
| Rate for Payer: BCN Commercial |
$46.77
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Cofinity Commercial |
$72.43
|
| Rate for Payer: Cofinity Commercial |
$70.98
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Cofinity Commercial |
$57.33
|
| Rate for Payer: Cofinity Commercial |
$70.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.52
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Healthscope Commercial |
$73.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.62
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: PHP Commercial |
$69.62
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.91
|
| Rate for Payer: Priority Health SBD |
$63.88
|
| Rate for Payer: Priority Health SBD |
$51.60
|
| Rate for Payer: Priority Health SBD |
$65.19
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$166.85
|
|
|
Service Code
|
NDC 69315013701
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.12 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.45
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$143.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$150.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.45
|
| Rate for Payer: Priority Health SBD |
$105.12
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$350.15
|
|
|
Service Code
|
NDC 00603243821
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.59 |
| Max. Negotiated Rate |
$315.14 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.60
|
| Rate for Payer: Priority Health SBD |
$220.59
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
NDC 68084038801
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.80 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Medicare |
$218.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.05
|
| Rate for Payer: BCBS Complete |
$174.80
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cofinity Commercial |
$305.90
|
| Rate for Payer: Cofinity Commercial |
$375.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.60
|
| Rate for Payer: Healthscope Commercial |
$393.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.45
|
| Rate for Payer: PHP Commercial |
$371.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.05
|
| Rate for Payer: Priority Health SBD |
$275.31
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$433.20
|
|
|
Service Code
|
NDC 60687036801
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.92 |
| Max. Negotiated Rate |
$389.88 |
| Rate for Payer: Aetna Commercial |
$368.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.58
|
| Rate for Payer: Cash Price |
$346.56
|
| Rate for Payer: Cofinity Commercial |
$303.24
|
| Rate for Payer: Cofinity Commercial |
$372.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$303.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.56
|
| Rate for Payer: Healthscope Commercial |
$389.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.22
|
| Rate for Payer: PHP Commercial |
$368.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.58
|
| Rate for Payer: Priority Health SBD |
$272.92
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$4.37
|
|
|
Service Code
|
NDC 68084038811
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna Medicare |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.84
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: Priority Health SBD |
$2.75
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$4.34
|
|
|
Service Code
|
NDC 60687036811
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$3.91 |
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.82
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$3.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.47
|
| Rate for Payer: Healthscope Commercial |
$3.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.69
|
| Rate for Payer: PHP Commercial |
$3.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.82
|
| Rate for Payer: Priority Health SBD |
$2.73
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$287.85
|
|
|
Service Code
|
NDC 00904679061
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.14 |
| Max. Negotiated Rate |
$259.06 |
| Rate for Payer: Aetna Commercial |
$244.67
|
| Rate for Payer: Aetna Medicare |
$143.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.10
|
| Rate for Payer: BCBS Complete |
$115.14
|
| Rate for Payer: Cash Price |
$230.28
|
| Rate for Payer: Cofinity Commercial |
$201.50
|
| Rate for Payer: Cofinity Commercial |
$247.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.28
|
| Rate for Payer: Healthscope Commercial |
$259.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.67
|
| Rate for Payer: PHP Commercial |
$244.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.10
|
| Rate for Payer: Priority Health SBD |
$181.35
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$433.20
|
|
|
Service Code
|
NDC 60687036801
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.28 |
| Max. Negotiated Rate |
$389.88 |
| Rate for Payer: Aetna Commercial |
$368.22
|
| Rate for Payer: Aetna Medicare |
$216.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.58
|
| Rate for Payer: BCBS Complete |
$173.28
|
| Rate for Payer: Cash Price |
$346.56
|
| Rate for Payer: Cofinity Commercial |
$303.24
|
| Rate for Payer: Cofinity Commercial |
$372.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$303.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.56
|
| Rate for Payer: Healthscope Commercial |
$389.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.22
|
| Rate for Payer: PHP Commercial |
$368.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.58
|
| Rate for Payer: Priority Health SBD |
$272.92
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$287.85
|
|
|
Service Code
|
NDC 00904679061
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.35 |
| Max. Negotiated Rate |
$259.06 |
| Rate for Payer: Aetna Commercial |
$244.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.10
|
| Rate for Payer: Cash Price |
$230.28
|
| Rate for Payer: Cofinity Commercial |
$201.50
|
| Rate for Payer: Cofinity Commercial |
$247.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.28
|
| Rate for Payer: Healthscope Commercial |
$259.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.67
|
| Rate for Payer: PHP Commercial |
$244.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.10
|
| Rate for Payer: Priority Health SBD |
$181.35
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
NDC 68084038811
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.84
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: Priority Health SBD |
$2.75
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$166.85
|
|
|
Service Code
|
NDC 69315013701
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna Medicare |
$83.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.45
|
| Rate for Payer: BCBS Complete |
$66.74
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$143.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$150.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.45
|
| Rate for Payer: Priority Health SBD |
$105.12
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
NDC 68084038801
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.31 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.05
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cofinity Commercial |
$305.90
|
| Rate for Payer: Cofinity Commercial |
$375.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.60
|
| Rate for Payer: Healthscope Commercial |
$393.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.45
|
| Rate for Payer: PHP Commercial |
$371.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.05
|
| Rate for Payer: Priority Health SBD |
$275.31
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$350.15
|
|
|
Service Code
|
NDC 00603243821
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.06 |
| Max. Negotiated Rate |
$315.14 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna Medicare |
$175.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: BCBS Complete |
$140.06
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.60
|
| Rate for Payer: Priority Health SBD |
$220.59
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$4.34
|
|
|
Service Code
|
NDC 60687036811
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.91 |
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.82
|
| Rate for Payer: BCBS Complete |
$1.74
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$3.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.47
|
| Rate for Payer: Healthscope Commercial |
$3.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.69
|
| Rate for Payer: PHP Commercial |
$3.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.82
|
| Rate for Payer: Priority Health SBD |
$2.73
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$189.22
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$170.30 |
| Rate for Payer: Aetna Commercial |
$160.84
|
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna Commercial |
$132.20
|
| Rate for Payer: Aetna Commercial |
$131.94
|
| Rate for Payer: Aetna Medicare |
$77.76
|
| Rate for Payer: Aetna Medicare |
$76.76
|
| Rate for Payer: Aetna Medicare |
$94.61
|
| Rate for Payer: Aetna Medicare |
$77.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.89
|
| Rate for Payer: BCBS Complete |
$62.21
|
| Rate for Payer: BCBS Complete |
$75.69
|
| Rate for Payer: BCBS Complete |
$62.09
|
| Rate for Payer: BCBS Complete |
$61.41
|
| Rate for Payer: BCBS Trust/PPO |
$20.88
|
| Rate for Payer: BCBS Trust/PPO |
$20.88
|
| Rate for Payer: BCBS Trust/PPO |
$20.88
|
| Rate for Payer: BCBS Trust/PPO |
$20.88
|
| Rate for Payer: BCN Commercial |
$20.88
|
| Rate for Payer: BCN Commercial |
$20.88
|
| Rate for Payer: BCN Commercial |
$20.88
|
| Rate for Payer: BCN Commercial |
$20.88
|
| Rate for Payer: Cash Price |
$124.18
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cash Price |
$124.18
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cash Price |
$151.38
|
| Rate for Payer: Cash Price |
$151.38
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cofinity Commercial |
$108.65
|
| Rate for Payer: Cofinity Commercial |
$107.47
|
| Rate for Payer: Cofinity Commercial |
$132.04
|
| Rate for Payer: Cofinity Commercial |
$133.49
|
| Rate for Payer: Cofinity Commercial |
$108.87
|
| Rate for Payer: Cofinity Commercial |
$133.76
|
| Rate for Payer: Cofinity Commercial |
$132.45
|
| Rate for Payer: Cofinity Commercial |
$162.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.18
|
| Rate for Payer: Healthscope Commercial |
$139.70
|
| Rate for Payer: Healthscope Commercial |
$170.30
|
| Rate for Payer: Healthscope Commercial |
$139.98
|
| Rate for Payer: Healthscope Commercial |
$138.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.84
|
| Rate for Payer: PHP Commercial |
$160.84
|
| Rate for Payer: PHP Commercial |
$131.94
|
| Rate for Payer: PHP Commercial |
$132.20
|
| Rate for Payer: PHP Commercial |
$130.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.89
|
| Rate for Payer: Priority Health SBD |
$119.21
|
| Rate for Payer: Priority Health SBD |
$97.79
|
| Rate for Payer: Priority Health SBD |
$96.72
|
| Rate for Payer: Priority Health SBD |
$97.98
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$155.53
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.98 |
| Max. Negotiated Rate |
$139.98 |
| Rate for Payer: Aetna Commercial |
$132.20
|
| Rate for Payer: Aetna Commercial |
$131.94
|
| Rate for Payer: Aetna Commercial |
$160.84
|
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.99
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cash Price |
$124.18
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cash Price |
$151.38
|
| Rate for Payer: Cofinity Commercial |
$107.47
|
| Rate for Payer: Cofinity Commercial |
$162.73
|
| Rate for Payer: Cofinity Commercial |
$132.45
|
| Rate for Payer: Cofinity Commercial |
$108.65
|
| Rate for Payer: Cofinity Commercial |
$133.49
|
| Rate for Payer: Cofinity Commercial |
$133.76
|
| Rate for Payer: Cofinity Commercial |
$108.87
|
| Rate for Payer: Cofinity Commercial |
$132.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.38
|
| Rate for Payer: Healthscope Commercial |
$139.70
|
| Rate for Payer: Healthscope Commercial |
$138.18
|
| Rate for Payer: Healthscope Commercial |
$170.30
|
| Rate for Payer: Healthscope Commercial |
$139.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.50
|
| Rate for Payer: PHP Commercial |
$130.50
|
| Rate for Payer: PHP Commercial |
$132.20
|
| Rate for Payer: PHP Commercial |
$131.94
|
| Rate for Payer: PHP Commercial |
$160.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.99
|
| Rate for Payer: Priority Health SBD |
$96.72
|
| Rate for Payer: Priority Health SBD |
$97.98
|
| Rate for Payer: Priority Health SBD |
$97.79
|
| Rate for Payer: Priority Health SBD |
$119.21
|
|
