|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$25.03
|
|
|
Service Code
|
NDC 63739005269
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Aetna Commercial |
$21.28
|
| Rate for Payer: Aetna Medicare |
$12.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.27
|
| Rate for Payer: BCBS Complete |
$10.01
|
| Rate for Payer: Cash Price |
$20.02
|
| Rate for Payer: Cofinity Advantage |
$17.52
|
| Rate for Payer: Cofinity Commercial |
$21.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$22.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.77
|
| Rate for Payer: PHP Commercial |
$21.28
|
| Rate for Payer: Priority Health SBD |
$15.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.27
|
| Rate for Payer: UHC Core |
$13.04
|
| Rate for Payer: UHC Exchange |
$9.84
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$25.74
|
|
|
Service Code
|
NDC 69339013817
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$23.17 |
| Rate for Payer: Aetna Commercial |
$21.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.73
|
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Cofinity Advantage |
$18.02
|
| Rate for Payer: Cofinity Commercial |
$22.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.59
|
| Rate for Payer: Healthscope Commercial |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.30
|
| Rate for Payer: PHP Commercial |
$21.88
|
| Rate for Payer: Priority Health SBD |
$16.22
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$3.88
|
|
|
Service Code
|
NDC 09900000023
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Advantage |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.91
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: Priority Health SBD |
$2.44
|
|
|
CHLOROPROCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$82.86
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
150549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$74.57 |
| Rate for Payer: Aetna Commercial |
$70.43
|
| Rate for Payer: Aetna Commercial |
$66.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.86
|
| Rate for Payer: Cash Price |
$62.23
|
| Rate for Payer: Cash Price |
$66.29
|
| Rate for Payer: Cofinity Advantage |
$58.00
|
| Rate for Payer: Cofinity Advantage |
$54.45
|
| Rate for Payer: Cofinity Commercial |
$66.90
|
| Rate for Payer: Cofinity Commercial |
$71.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.29
|
| Rate for Payer: Healthscope Commercial |
$70.01
|
| Rate for Payer: Healthscope Commercial |
$74.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.34
|
| Rate for Payer: PHP Commercial |
$66.12
|
| Rate for Payer: PHP Commercial |
$70.43
|
| Rate for Payer: Priority Health SBD |
$49.01
|
| Rate for Payer: Priority Health SBD |
$52.20
|
|
|
CHLOROPROCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$82.86
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
150549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$74.57 |
| Rate for Payer: Aetna Commercial |
$70.43
|
| Rate for Payer: Aetna Commercial |
$66.12
|
| Rate for Payer: Aetna Medicare |
$41.43
|
| Rate for Payer: Aetna Medicare |
$38.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.86
|
| Rate for Payer: BCBS Complete |
$31.12
|
| Rate for Payer: BCBS Complete |
$33.14
|
| Rate for Payer: Cash Price |
$62.23
|
| Rate for Payer: Cash Price |
$62.23
|
| Rate for Payer: Cash Price |
$66.29
|
| Rate for Payer: Cash Price |
$66.29
|
| Rate for Payer: Cofinity Advantage |
$54.45
|
| Rate for Payer: Cofinity Advantage |
$58.00
|
| Rate for Payer: Cofinity Commercial |
$66.90
|
| Rate for Payer: Cofinity Commercial |
$71.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.29
|
| Rate for Payer: Healthscope Commercial |
$70.01
|
| Rate for Payer: Healthscope Commercial |
$74.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.15
|
| Rate for Payer: PHP Commercial |
$70.43
|
| Rate for Payer: PHP Commercial |
$66.12
|
| Rate for Payer: Priority Health SBD |
$52.20
|
| Rate for Payer: Priority Health SBD |
$49.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
|
|
CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION
|
Facility
|
IP
|
$87.05
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
1635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$78.34 |
| Rate for Payer: Aetna Commercial |
$73.99
|
| Rate for Payer: Aetna Commercial |
$69.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.58
|
| Rate for Payer: Cash Price |
$65.37
|
| Rate for Payer: Cash Price |
$69.64
|
| Rate for Payer: Cofinity Advantage |
$60.94
|
| Rate for Payer: Cofinity Advantage |
$57.20
|
| Rate for Payer: Cofinity Commercial |
$70.27
|
| Rate for Payer: Cofinity Commercial |
$74.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.64
|
| Rate for Payer: Healthscope Commercial |
$73.54
|
| Rate for Payer: Healthscope Commercial |
$78.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.28
|
| Rate for Payer: PHP Commercial |
$69.45
|
| Rate for Payer: PHP Commercial |
$73.99
|
| Rate for Payer: Priority Health SBD |
$51.48
|
| Rate for Payer: Priority Health SBD |
$54.84
|
|
|
CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION
|
Facility
|
OP
|
$87.05
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
1635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$78.34 |
| Rate for Payer: Aetna Commercial |
$73.99
|
| Rate for Payer: Aetna Commercial |
$69.45
|
| Rate for Payer: Aetna Medicare |
$43.52
|
| Rate for Payer: Aetna Medicare |
$40.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.58
|
| Rate for Payer: BCBS Complete |
$32.68
|
| Rate for Payer: BCBS Complete |
$34.82
|
| Rate for Payer: Cash Price |
$65.37
|
| Rate for Payer: Cash Price |
$65.37
|
| Rate for Payer: Cash Price |
$69.64
|
| Rate for Payer: Cash Price |
$69.64
|
| Rate for Payer: Cofinity Advantage |
$57.20
|
| Rate for Payer: Cofinity Advantage |
$60.94
|
| Rate for Payer: Cofinity Commercial |
$70.27
|
| Rate for Payer: Cofinity Commercial |
$74.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.64
|
| Rate for Payer: Healthscope Commercial |
$73.54
|
| Rate for Payer: Healthscope Commercial |
$78.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.29
|
| Rate for Payer: PHP Commercial |
$73.99
|
| Rate for Payer: PHP Commercial |
$69.45
|
| Rate for Payer: Priority Health SBD |
$54.84
|
| Rate for Payer: Priority Health SBD |
$51.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$175.91
|
|
|
Service Code
|
HCPCS J1205
|
| Hospital Charge Code |
9526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.82 |
| Max. Negotiated Rate |
$158.32 |
| Rate for Payer: Aetna Commercial |
$149.52
|
| Rate for Payer: Aetna Commercial |
$111.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.34
|
| Rate for Payer: Cash Price |
$104.66
|
| Rate for Payer: Cash Price |
$140.73
|
| Rate for Payer: Cofinity Advantage |
$123.14
|
| Rate for Payer: Cofinity Advantage |
$91.58
|
| Rate for Payer: Cofinity Commercial |
$112.51
|
| Rate for Payer: Cofinity Commercial |
$151.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.73
|
| Rate for Payer: Healthscope Commercial |
$117.75
|
| Rate for Payer: Healthscope Commercial |
$158.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.12
|
| Rate for Payer: PHP Commercial |
$111.21
|
| Rate for Payer: PHP Commercial |
$149.52
|
| Rate for Payer: Priority Health SBD |
$82.42
|
| Rate for Payer: Priority Health SBD |
$110.82
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$175.91
|
|
|
Service Code
|
HCPCS J1205
|
| Hospital Charge Code |
9526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.36 |
| Max. Negotiated Rate |
$158.32 |
| Rate for Payer: Aetna Commercial |
$149.52
|
| Rate for Payer: Aetna Commercial |
$111.21
|
| Rate for Payer: Aetna Medicare |
$65.42
|
| Rate for Payer: Aetna Medicare |
$87.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.04
|
| Rate for Payer: BCBS Complete |
$52.33
|
| Rate for Payer: BCBS Complete |
$70.36
|
| Rate for Payer: BCBS Trust/PPO |
$145.82
|
| Rate for Payer: BCBS Trust/PPO |
$145.82
|
| Rate for Payer: BCN Commercial |
$145.82
|
| Rate for Payer: BCN Commercial |
$145.82
|
| Rate for Payer: Cash Price |
$140.73
|
| Rate for Payer: Cash Price |
$104.66
|
| Rate for Payer: Cash Price |
$140.73
|
| Rate for Payer: Cash Price |
$104.66
|
| Rate for Payer: Cofinity Advantage |
$123.14
|
| Rate for Payer: Cofinity Advantage |
$91.58
|
| Rate for Payer: Cofinity Commercial |
$151.28
|
| Rate for Payer: Cofinity Commercial |
$112.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.73
|
| Rate for Payer: Healthscope Commercial |
$117.75
|
| Rate for Payer: Healthscope Commercial |
$158.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.12
|
| Rate for Payer: PHP Commercial |
$149.52
|
| Rate for Payer: PHP Commercial |
$111.21
|
| Rate for Payer: Priority Health SBD |
$110.82
|
| Rate for Payer: Priority Health SBD |
$82.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.91
|
| Rate for Payer: UHC Core |
$95.91
|
| Rate for Payer: UHC Core |
$95.91
|
| Rate for Payer: UHC Exchange |
$95.91
|
| Rate for Payer: UHC Exchange |
$95.91
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG SOLUTION FOR SOLID FORM MIXTURE CUSTOM
|
Facility
|
OP
|
$212.90
|
|
|
Service Code
|
HCPCS J1205
|
| Hospital Charge Code |
301757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.16 |
| Max. Negotiated Rate |
$191.61 |
| Rate for Payer: Aetna Commercial |
$180.97
|
| Rate for Payer: Aetna Medicare |
$106.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.38
|
| Rate for Payer: BCBS Complete |
$85.16
|
| Rate for Payer: BCBS Trust/PPO |
$145.82
|
| Rate for Payer: BCN Commercial |
$145.82
|
| Rate for Payer: Cash Price |
$170.32
|
| Rate for Payer: Cash Price |
$170.32
|
| Rate for Payer: Cofinity Advantage |
$149.03
|
| Rate for Payer: Cofinity Commercial |
$183.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.32
|
| Rate for Payer: Healthscope Commercial |
$191.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$170.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.68
|
| Rate for Payer: PHP Commercial |
$180.97
|
| Rate for Payer: Priority Health SBD |
$134.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.91
|
| Rate for Payer: UHC Core |
$95.91
|
| Rate for Payer: UHC Exchange |
$95.91
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG SOLUTION FOR SOLID FORM MIXTURE CUSTOM
|
Facility
|
IP
|
$212.90
|
|
|
Service Code
|
HCPCS J1205
|
| Hospital Charge Code |
301757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.13 |
| Max. Negotiated Rate |
$191.61 |
| Rate for Payer: Aetna Commercial |
$180.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.38
|
| Rate for Payer: Cash Price |
$170.32
|
| Rate for Payer: Cofinity Advantage |
$149.03
|
| Rate for Payer: Cofinity Commercial |
$183.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.32
|
| Rate for Payer: Healthscope Commercial |
$191.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.68
|
| Rate for Payer: PHP Commercial |
$180.97
|
| Rate for Payer: Priority Health SBD |
$134.13
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
OP
|
$12.19
|
|
|
Service Code
|
NDC 51079051801
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$10.97 |
| Rate for Payer: Aetna Commercial |
$10.36
|
| Rate for Payer: Aetna Medicare |
$6.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.92
|
| Rate for Payer: BCBS Complete |
$4.88
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Cofinity Advantage |
$8.53
|
| Rate for Payer: Cofinity Commercial |
$10.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.75
|
| Rate for Payer: Healthscope Commercial |
$10.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.14
|
| Rate for Payer: PHP Commercial |
$10.36
|
| Rate for Payer: Priority Health SBD |
$7.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.92
|
| Rate for Payer: UHC Core |
$6.35
|
| Rate for Payer: UHC Exchange |
$4.79
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
IP
|
$374.40
|
|
|
Service Code
|
NDC 50268016215
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.87 |
| Max. Negotiated Rate |
$336.96 |
| Rate for Payer: Aetna Commercial |
$318.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.36
|
| Rate for Payer: Cash Price |
$299.52
|
| Rate for Payer: Cofinity Advantage |
$262.08
|
| Rate for Payer: Cofinity Commercial |
$321.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.52
|
| Rate for Payer: Healthscope Commercial |
$336.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.80
|
| Rate for Payer: PHP Commercial |
$318.24
|
| Rate for Payer: Priority Health SBD |
$235.87
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
IP
|
$1,218.78
|
|
|
Service Code
|
NDC 51079051820
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$767.83 |
| Max. Negotiated Rate |
$1,096.90 |
| Rate for Payer: Aetna Commercial |
$1,035.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$792.21
|
| Rate for Payer: Cash Price |
$975.02
|
| Rate for Payer: Cofinity Advantage |
$853.15
|
| Rate for Payer: Cofinity Commercial |
$1,048.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$975.02
|
| Rate for Payer: Healthscope Commercial |
$1,096.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,035.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$914.09
|
| Rate for Payer: PHP Commercial |
$1,035.96
|
| Rate for Payer: Priority Health SBD |
$767.83
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
IP
|
$12.19
|
|
|
Service Code
|
NDC 51079051801
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$10.97 |
| Rate for Payer: Aetna Commercial |
$10.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.92
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Cofinity Advantage |
$8.53
|
| Rate for Payer: Cofinity Commercial |
$10.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.75
|
| Rate for Payer: Healthscope Commercial |
$10.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.14
|
| Rate for Payer: PHP Commercial |
$10.36
|
| Rate for Payer: Priority Health SBD |
$7.68
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
IP
|
$7.49
|
|
|
Service Code
|
NDC 50268016211
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$6.74 |
| Rate for Payer: Aetna Commercial |
$6.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.87
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cofinity Advantage |
$5.24
|
| Rate for Payer: Cofinity Commercial |
$6.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.99
|
| Rate for Payer: Healthscope Commercial |
$6.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.62
|
| Rate for Payer: PHP Commercial |
$6.37
|
| Rate for Payer: Priority Health SBD |
$4.72
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
IP
|
$912.79
|
|
|
Service Code
|
NDC 00832030000
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$575.06 |
| Max. Negotiated Rate |
$821.51 |
| Rate for Payer: Aetna Commercial |
$775.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.31
|
| Rate for Payer: Cash Price |
$730.23
|
| Rate for Payer: Cofinity Advantage |
$638.95
|
| Rate for Payer: Cofinity Commercial |
$785.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.23
|
| Rate for Payer: Healthscope Commercial |
$821.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$775.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$684.59
|
| Rate for Payer: PHP Commercial |
$775.87
|
| Rate for Payer: Priority Health SBD |
$575.06
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
OP
|
$1,218.78
|
|
|
Service Code
|
NDC 51079051820
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$478.98 |
| Max. Negotiated Rate |
$1,096.90 |
| Rate for Payer: Aetna Commercial |
$1,035.96
|
| Rate for Payer: Aetna Medicare |
$609.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$792.21
|
| Rate for Payer: BCBS Complete |
$487.51
|
| Rate for Payer: Cash Price |
$975.02
|
| Rate for Payer: Cofinity Advantage |
$853.15
|
| Rate for Payer: Cofinity Commercial |
$1,048.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$975.02
|
| Rate for Payer: Healthscope Commercial |
$1,096.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$975.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,035.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$914.09
|
| Rate for Payer: PHP Commercial |
$1,035.96
|
| Rate for Payer: Priority Health SBD |
$767.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$792.21
|
| Rate for Payer: UHC Core |
$634.98
|
| Rate for Payer: UHC Exchange |
$478.98
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
OP
|
$7.49
|
|
|
Service Code
|
NDC 50268016211
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$6.74 |
| Rate for Payer: Aetna Commercial |
$6.37
|
| Rate for Payer: Aetna Medicare |
$3.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.87
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cofinity Advantage |
$5.24
|
| Rate for Payer: Cofinity Commercial |
$6.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.99
|
| Rate for Payer: Healthscope Commercial |
$6.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.62
|
| Rate for Payer: PHP Commercial |
$6.37
|
| Rate for Payer: Priority Health SBD |
$4.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.87
|
| Rate for Payer: UHC Core |
$3.90
|
| Rate for Payer: UHC Exchange |
$2.94
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
OP
|
$374.40
|
|
|
Service Code
|
NDC 50268016215
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.14 |
| Max. Negotiated Rate |
$336.96 |
| Rate for Payer: Aetna Commercial |
$318.24
|
| Rate for Payer: Aetna Medicare |
$187.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.36
|
| Rate for Payer: BCBS Complete |
$149.76
|
| Rate for Payer: Cash Price |
$299.52
|
| Rate for Payer: Cofinity Advantage |
$262.08
|
| Rate for Payer: Cofinity Commercial |
$321.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.52
|
| Rate for Payer: Healthscope Commercial |
$336.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.80
|
| Rate for Payer: PHP Commercial |
$318.24
|
| Rate for Payer: Priority Health SBD |
$235.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.36
|
| Rate for Payer: UHC Core |
$195.06
|
| Rate for Payer: UHC Exchange |
$147.14
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
OP
|
$912.79
|
|
|
Service Code
|
NDC 00832030000
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$358.73 |
| Max. Negotiated Rate |
$821.51 |
| Rate for Payer: Aetna Commercial |
$775.87
|
| Rate for Payer: Aetna Medicare |
$456.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.31
|
| Rate for Payer: BCBS Complete |
$365.12
|
| Rate for Payer: Cash Price |
$730.23
|
| Rate for Payer: Cofinity Advantage |
$638.95
|
| Rate for Payer: Cofinity Commercial |
$785.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.23
|
| Rate for Payer: Healthscope Commercial |
$821.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$730.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$775.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$684.59
|
| Rate for Payer: PHP Commercial |
$775.87
|
| Rate for Payer: Priority Health SBD |
$575.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$593.31
|
| Rate for Payer: UHC Core |
$475.56
|
| Rate for Payer: UHC Exchange |
$358.73
|
|
|
CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$94.04
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
1649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.93
|
| Rate for Payer: Aetna Commercial |
$69.37
|
| Rate for Payer: Aetna Commercial |
$41.77
|
| Rate for Payer: Aetna Commercial |
$50.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cash Price |
$47.36
|
| Rate for Payer: Cash Price |
$65.29
|
| Rate for Payer: Cash Price |
$75.23
|
| Rate for Payer: Cofinity Advantage |
$41.44
|
| Rate for Payer: Cofinity Advantage |
$57.13
|
| Rate for Payer: Cofinity Advantage |
$65.83
|
| Rate for Payer: Cofinity Advantage |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$50.91
|
| Rate for Payer: Cofinity Commercial |
$80.87
|
| Rate for Payer: Cofinity Commercial |
$42.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.23
|
| Rate for Payer: Healthscope Commercial |
$44.23
|
| Rate for Payer: Healthscope Commercial |
$73.45
|
| Rate for Payer: Healthscope Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.53
|
| Rate for Payer: PHP Commercial |
$50.32
|
| Rate for Payer: PHP Commercial |
$41.77
|
| Rate for Payer: PHP Commercial |
$79.93
|
| Rate for Payer: PHP Commercial |
$69.37
|
| Rate for Payer: Priority Health SBD |
$51.41
|
| Rate for Payer: Priority Health SBD |
$37.30
|
| Rate for Payer: Priority Health SBD |
$59.25
|
| Rate for Payer: Priority Health SBD |
$30.96
|
|
|
CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$59.20
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
1649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$59.61 |
| Rate for Payer: Aetna Commercial |
$50.32
|
| Rate for Payer: Aetna Commercial |
$79.93
|
| Rate for Payer: Aetna Commercial |
$69.37
|
| Rate for Payer: Aetna Commercial |
$41.77
|
| Rate for Payer: Aetna Medicare |
$29.60
|
| Rate for Payer: Aetna Medicare |
$47.02
|
| Rate for Payer: Aetna Medicare |
$40.80
|
| Rate for Payer: Aetna Medicare |
$24.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.48
|
| Rate for Payer: BCBS Complete |
$37.62
|
| Rate for Payer: BCBS Complete |
$23.68
|
| Rate for Payer: BCBS Complete |
$19.66
|
| Rate for Payer: BCBS Complete |
$32.64
|
| Rate for Payer: BCBS Trust/PPO |
$59.61
|
| Rate for Payer: BCBS Trust/PPO |
$59.61
|
| Rate for Payer: BCBS Trust/PPO |
$59.61
|
| Rate for Payer: BCBS Trust/PPO |
$59.61
|
| Rate for Payer: BCN Commercial |
$59.61
|
| Rate for Payer: BCN Commercial |
$59.61
|
| Rate for Payer: BCN Commercial |
$59.61
|
| Rate for Payer: BCN Commercial |
$59.61
|
| Rate for Payer: Cash Price |
$47.36
|
| Rate for Payer: Cash Price |
$65.29
|
| Rate for Payer: Cash Price |
$75.23
|
| Rate for Payer: Cash Price |
$65.29
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cash Price |
$75.23
|
| Rate for Payer: Cash Price |
$47.36
|
| Rate for Payer: Cofinity Advantage |
$65.83
|
| Rate for Payer: Cofinity Advantage |
$34.40
|
| Rate for Payer: Cofinity Advantage |
$57.13
|
| Rate for Payer: Cofinity Advantage |
$41.44
|
| Rate for Payer: Cofinity Commercial |
$42.26
|
| Rate for Payer: Cofinity Commercial |
$80.87
|
| Rate for Payer: Cofinity Commercial |
$50.91
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.36
|
| Rate for Payer: Healthscope Commercial |
$73.45
|
| Rate for Payer: Healthscope Commercial |
$44.23
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Healthscope Commercial |
$53.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.53
|
| Rate for Payer: PHP Commercial |
$69.37
|
| Rate for Payer: PHP Commercial |
$50.32
|
| Rate for Payer: PHP Commercial |
$79.93
|
| Rate for Payer: PHP Commercial |
$41.77
|
| Rate for Payer: Priority Health SBD |
$30.96
|
| Rate for Payer: Priority Health SBD |
$51.41
|
| Rate for Payer: Priority Health SBD |
$59.25
|
| Rate for Payer: Priority Health SBD |
$37.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.22
|
| Rate for Payer: UHC Core |
$39.22
|
| Rate for Payer: UHC Core |
$39.22
|
| Rate for Payer: UHC Core |
$39.22
|
| Rate for Payer: UHC Core |
$39.22
|
| Rate for Payer: UHC Exchange |
$39.22
|
| Rate for Payer: UHC Exchange |
$39.22
|
| Rate for Payer: UHC Exchange |
$39.22
|
| Rate for Payer: UHC Exchange |
$39.22
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$1,276.87
|
|
|
Service Code
|
NDC 00904713061
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$501.81 |
| Max. Negotiated Rate |
$1,149.18 |
| Rate for Payer: Aetna Commercial |
$1,085.34
|
| Rate for Payer: Aetna Medicare |
$638.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$829.97
|
| Rate for Payer: BCBS Complete |
$510.75
|
| Rate for Payer: Cash Price |
$1,021.50
|
| Rate for Payer: Cofinity Advantage |
$893.81
|
| Rate for Payer: Cofinity Commercial |
$1,098.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.50
|
| Rate for Payer: Healthscope Commercial |
$1,149.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,021.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$957.65
|
| Rate for Payer: PHP Commercial |
$1,085.34
|
| Rate for Payer: Priority Health SBD |
$804.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$829.97
|
| Rate for Payer: UHC Core |
$665.25
|
| Rate for Payer: UHC Exchange |
$501.81
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$1,276.87
|
|
|
Service Code
|
NDC 00904713061
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$804.43 |
| Max. Negotiated Rate |
$1,149.18 |
| Rate for Payer: Aetna Commercial |
$1,085.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$829.97
|
| Rate for Payer: Cash Price |
$1,021.50
|
| Rate for Payer: Cofinity Advantage |
$893.81
|
| Rate for Payer: Cofinity Commercial |
$1,098.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.50
|
| Rate for Payer: Healthscope Commercial |
$1,149.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$957.65
|
| Rate for Payer: PHP Commercial |
$1,085.34
|
| Rate for Payer: Priority Health SBD |
$804.43
|
|
