|
COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL
|
Facility
|
OP
|
$164.60
|
|
|
Service Code
|
NDC 39328001416
|
| Hospital Charge Code |
176500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$164.60 |
| Rate for Payer: Aetna Commercial |
$148.14
|
| Rate for Payer: Aetna Medicare |
$82.30
|
| Rate for Payer: ASR ASR |
$159.66
|
| Rate for Payer: ASR Commercial |
$159.66
|
| Rate for Payer: BCBS Complete |
$65.84
|
| Rate for Payer: BCBS Trust/PPO |
$134.79
|
| Rate for Payer: BCN Commercial |
$127.61
|
| Rate for Payer: Cash Price |
$131.68
|
| Rate for Payer: Cofinity Commercial |
$154.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.68
|
| Rate for Payer: Healthscope Commercial |
$164.60
|
| Rate for Payer: Healthscope Whirlpool |
$159.66
|
| Rate for Payer: Mclaren Commercial |
$148.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.91
|
| Rate for Payer: Nomi Health Commercial |
$134.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.22
|
| Rate for Payer: Priority Health Narrow Network |
$115.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.85
|
|
|
COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL
|
Facility
|
IP
|
$164.60
|
|
|
Service Code
|
NDC 39328001416
|
| Hospital Charge Code |
176500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.99 |
| Max. Negotiated Rate |
$164.60 |
| Rate for Payer: Aetna Commercial |
$148.14
|
| Rate for Payer: ASR ASR |
$159.66
|
| Rate for Payer: ASR Commercial |
$159.66
|
| Rate for Payer: BCBS Trust/PPO |
$134.13
|
| Rate for Payer: BCN Commercial |
$127.61
|
| Rate for Payer: Cash Price |
$131.68
|
| Rate for Payer: Cofinity Commercial |
$154.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.68
|
| Rate for Payer: Healthscope Commercial |
$164.60
|
| Rate for Payer: Healthscope Whirlpool |
$159.66
|
| Rate for Payer: Mclaren Commercial |
$148.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.91
|
| Rate for Payer: Nomi Health Commercial |
$134.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.85
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
OP
|
$1,572.69
|
|
|
Service Code
|
NDC 00046087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$629.08 |
| Max. Negotiated Rate |
$1,572.69 |
| Rate for Payer: Aetna Commercial |
$1,415.42
|
| Rate for Payer: Aetna Medicare |
$786.34
|
| Rate for Payer: ASR ASR |
$1,525.51
|
| Rate for Payer: ASR Commercial |
$1,525.51
|
| Rate for Payer: BCBS Complete |
$629.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,287.88
|
| Rate for Payer: BCN Commercial |
$1,219.31
|
| Rate for Payer: Cash Price |
$1,258.15
|
| Rate for Payer: Cofinity Commercial |
$1,478.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,258.15
|
| Rate for Payer: Healthscope Commercial |
$1,572.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,525.51
|
| Rate for Payer: Mclaren Commercial |
$1,415.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,336.79
|
| Rate for Payer: Nomi Health Commercial |
$1,289.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,022.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,377.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,102.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,383.97
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
IP
|
$1,572.69
|
|
|
Service Code
|
NDC 00046087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,022.25 |
| Max. Negotiated Rate |
$1,572.69 |
| Rate for Payer: Aetna Commercial |
$1,415.42
|
| Rate for Payer: ASR ASR |
$1,525.51
|
| Rate for Payer: ASR Commercial |
$1,525.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,281.59
|
| Rate for Payer: BCN Commercial |
$1,219.31
|
| Rate for Payer: Cash Price |
$1,258.15
|
| Rate for Payer: Cofinity Commercial |
$1,478.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,258.15
|
| Rate for Payer: Healthscope Commercial |
$1,572.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,525.51
|
| Rate for Payer: Mclaren Commercial |
$1,415.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,336.79
|
| Rate for Payer: Nomi Health Commercial |
$1,289.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,022.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,383.97
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET
|
Facility
|
IP
|
$2,551.15
|
|
|
Service Code
|
NDC 00046110281
|
| Hospital Charge Code |
9974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,658.25 |
| Max. Negotiated Rate |
$2,551.15 |
| Rate for Payer: Aetna Commercial |
$2,296.04
|
| Rate for Payer: ASR ASR |
$2,474.62
|
| Rate for Payer: ASR Commercial |
$2,474.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,078.93
|
| Rate for Payer: BCN Commercial |
$1,977.91
|
| Rate for Payer: Cash Price |
$2,040.92
|
| Rate for Payer: Cofinity Commercial |
$2,398.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.92
|
| Rate for Payer: Healthscope Commercial |
$2,551.15
|
| Rate for Payer: Healthscope Whirlpool |
$2,474.62
|
| Rate for Payer: Mclaren Commercial |
$2,296.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.48
|
| Rate for Payer: Nomi Health Commercial |
$2,091.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,245.01
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET
|
Facility
|
OP
|
$2,551.15
|
|
|
Service Code
|
NDC 00046110281
|
| Hospital Charge Code |
9974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,020.46 |
| Max. Negotiated Rate |
$2,551.15 |
| Rate for Payer: Aetna Commercial |
$2,296.04
|
| Rate for Payer: Aetna Medicare |
$1,275.58
|
| Rate for Payer: ASR ASR |
$2,474.62
|
| Rate for Payer: ASR Commercial |
$2,474.62
|
| Rate for Payer: BCBS Complete |
$1,020.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,089.14
|
| Rate for Payer: BCN Commercial |
$1,977.91
|
| Rate for Payer: Cash Price |
$2,040.92
|
| Rate for Payer: Cofinity Commercial |
$2,398.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.92
|
| Rate for Payer: Healthscope Commercial |
$2,551.15
|
| Rate for Payer: Healthscope Whirlpool |
$2,474.62
|
| Rate for Payer: Mclaren Commercial |
$2,296.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.48
|
| Rate for Payer: Nomi Health Commercial |
$2,091.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,235.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,788.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,245.01
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$1,175.87
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$764.32 |
| Max. Negotiated Rate |
$1,175.87 |
| Rate for Payer: Aetna Commercial |
$1,058.28
|
| Rate for Payer: ASR ASR |
$1,140.59
|
| Rate for Payer: ASR Commercial |
$1,140.59
|
| Rate for Payer: BCBS Trust/PPO |
$958.22
|
| Rate for Payer: BCN Commercial |
$911.65
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cofinity Commercial |
$1,105.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.70
|
| Rate for Payer: Healthscope Commercial |
$1,175.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,140.59
|
| Rate for Payer: Mclaren Commercial |
$1,058.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.49
|
| Rate for Payer: Nomi Health Commercial |
$964.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,034.77
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$1,175.87
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$205.24 |
| Max. Negotiated Rate |
$1,175.87 |
| Rate for Payer: Aetna Commercial |
$1,058.28
|
| Rate for Payer: Aetna Medicare |
$382.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$478.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$478.64
|
| Rate for Payer: ASR ASR |
$1,140.59
|
| Rate for Payer: ASR Commercial |
$1,140.59
|
| Rate for Payer: BCBS Complete |
$215.50
|
| Rate for Payer: BCBS MAPPO |
$382.91
|
| Rate for Payer: BCBS Trust/PPO |
$962.92
|
| Rate for Payer: BCN Commercial |
$911.65
|
| Rate for Payer: BCN Medicare Advantage |
$382.91
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cofinity Commercial |
$1,105.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$382.91
|
| Rate for Payer: Healthscope Commercial |
$1,175.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,140.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$382.91
|
| Rate for Payer: Mclaren Commercial |
$1,058.28
|
| Rate for Payer: Mclaren Medicaid |
$205.24
|
| Rate for Payer: Mclaren Medicare |
$382.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$402.06
|
| Rate for Payer: Meridian Medicaid |
$215.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$440.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.49
|
| Rate for Payer: Nomi Health Commercial |
$964.21
|
| Rate for Payer: PACE Medicare |
$363.76
|
| Rate for Payer: PACE SWMI |
$382.91
|
| Rate for Payer: PHP Commercial |
$421.20
|
| Rate for Payer: PHP Medicaid |
$205.24
|
| Rate for Payer: PHP Medicare Advantage |
$382.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$397.34
|
| Rate for Payer: Priority Health Medicare |
$382.91
|
| Rate for Payer: Priority Health Narrow Network |
$317.87
|
| Rate for Payer: Railroad Medicare Medicare |
$382.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,034.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$382.91
|
| Rate for Payer: UHC Exchange |
$593.51
|
| Rate for Payer: UHC Medicare Advantage |
$382.91
|
| Rate for Payer: UHCCP DNSP |
$382.91
|
| Rate for Payer: UHCCP Medicaid |
$205.24
|
| Rate for Payer: VA VA |
$382.91
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$223.85
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.73 |
| Max. Negotiated Rate |
$223.85 |
| Rate for Payer: Aetna Commercial |
$201.46
|
| Rate for Payer: Aetna Commercial |
$74.49
|
| Rate for Payer: Aetna Commercial |
$261.98
|
| Rate for Payer: Aetna Medicare |
$41.38
|
| Rate for Payer: Aetna Medicare |
$111.92
|
| Rate for Payer: Aetna Medicare |
$145.54
|
| Rate for Payer: ASR ASR |
$282.36
|
| Rate for Payer: ASR ASR |
$217.13
|
| Rate for Payer: ASR ASR |
$80.29
|
| Rate for Payer: ASR Commercial |
$282.36
|
| Rate for Payer: ASR Commercial |
$217.13
|
| Rate for Payer: ASR Commercial |
$80.29
|
| Rate for Payer: BCBS Complete |
$89.54
|
| Rate for Payer: BCBS Complete |
$116.44
|
| Rate for Payer: BCBS Complete |
$33.11
|
| Rate for Payer: BCBS Trust/PPO |
$67.78
|
| Rate for Payer: BCBS Trust/PPO |
$183.31
|
| Rate for Payer: BCBS Trust/PPO |
$238.37
|
| Rate for Payer: BCN Commercial |
$225.68
|
| Rate for Payer: BCN Commercial |
$64.17
|
| Rate for Payer: BCN Commercial |
$173.55
|
| Rate for Payer: Cash Price |
$179.08
|
| Rate for Payer: Cash Price |
$179.08
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$77.80
|
| Rate for Payer: Cofinity Commercial |
$210.42
|
| Rate for Payer: Cofinity Commercial |
$273.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.87
|
| Rate for Payer: Healthscope Commercial |
$82.77
|
| Rate for Payer: Healthscope Commercial |
$291.09
|
| Rate for Payer: Healthscope Commercial |
$223.85
|
| Rate for Payer: Healthscope Whirlpool |
$80.29
|
| Rate for Payer: Healthscope Whirlpool |
$282.36
|
| Rate for Payer: Healthscope Whirlpool |
$217.13
|
| Rate for Payer: Mclaren Commercial |
$261.98
|
| Rate for Payer: Mclaren Commercial |
$74.49
|
| Rate for Payer: Mclaren Commercial |
$201.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.27
|
| Rate for Payer: Nomi Health Commercial |
$183.56
|
| Rate for Payer: Nomi Health Commercial |
$67.87
|
| Rate for Payer: Nomi Health Commercial |
$238.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.66
|
| Rate for Payer: Priority Health Narrow Network |
$27.73
|
| Rate for Payer: Priority Health Narrow Network |
$27.73
|
| Rate for Payer: Priority Health Narrow Network |
$27.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.84
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$291.09
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.21 |
| Max. Negotiated Rate |
$291.09 |
| Rate for Payer: Aetna Commercial |
$261.98
|
| Rate for Payer: Aetna Commercial |
$201.46
|
| Rate for Payer: Aetna Commercial |
$74.49
|
| Rate for Payer: ASR ASR |
$217.13
|
| Rate for Payer: ASR ASR |
$282.36
|
| Rate for Payer: ASR ASR |
$80.29
|
| Rate for Payer: ASR Commercial |
$282.36
|
| Rate for Payer: ASR Commercial |
$217.13
|
| Rate for Payer: ASR Commercial |
$80.29
|
| Rate for Payer: BCBS Trust/PPO |
$67.45
|
| Rate for Payer: BCBS Trust/PPO |
$182.42
|
| Rate for Payer: BCBS Trust/PPO |
$237.21
|
| Rate for Payer: BCN Commercial |
$173.55
|
| Rate for Payer: BCN Commercial |
$64.17
|
| Rate for Payer: BCN Commercial |
$225.68
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cash Price |
$179.08
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$77.80
|
| Rate for Payer: Cofinity Commercial |
$210.42
|
| Rate for Payer: Cofinity Commercial |
$273.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$223.85
|
| Rate for Payer: Healthscope Commercial |
$291.09
|
| Rate for Payer: Healthscope Commercial |
$82.77
|
| Rate for Payer: Healthscope Whirlpool |
$282.36
|
| Rate for Payer: Healthscope Whirlpool |
$217.13
|
| Rate for Payer: Healthscope Whirlpool |
$80.29
|
| Rate for Payer: Mclaren Commercial |
$261.98
|
| Rate for Payer: Mclaren Commercial |
$201.46
|
| Rate for Payer: Mclaren Commercial |
$74.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.27
|
| Rate for Payer: Nomi Health Commercial |
$238.69
|
| Rate for Payer: Nomi Health Commercial |
$183.56
|
| Rate for Payer: Nomi Health Commercial |
$67.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.99
|
|
|
CPT 0255T
|
Professional
|
Both
|
$455.00
|
|
|
Service Code
|
HCPCS 0255T
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$295.75 |
| Rate for Payer: Aetna Medicare |
$227.50
|
| Rate for Payer: BCBS Complete |
$182.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.75
|
|
|
CROMOLYN 4 % EYE DROPS
|
Facility
|
IP
|
$23.62
|
|
|
Service Code
|
NDC 61314023710
|
| Hospital Charge Code |
9691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$23.62 |
| Rate for Payer: Aetna Commercial |
$21.26
|
| Rate for Payer: ASR ASR |
$22.91
|
| Rate for Payer: ASR Commercial |
$22.91
|
| Rate for Payer: BCBS Trust/PPO |
$19.25
|
| Rate for Payer: BCN Commercial |
$18.31
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.90
|
| Rate for Payer: Healthscope Commercial |
$23.62
|
| Rate for Payer: Healthscope Whirlpool |
$22.91
|
| Rate for Payer: Mclaren Commercial |
$21.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.08
|
| Rate for Payer: Nomi Health Commercial |
$19.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.79
|
|
|
CROMOLYN 4 % EYE DROPS
|
Facility
|
OP
|
$23.62
|
|
|
Service Code
|
NDC 61314023710
|
| Hospital Charge Code |
9691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$23.62 |
| Rate for Payer: Aetna Commercial |
$21.26
|
| Rate for Payer: Aetna Medicare |
$11.81
|
| Rate for Payer: ASR ASR |
$22.91
|
| Rate for Payer: ASR Commercial |
$22.91
|
| Rate for Payer: BCBS Complete |
$9.45
|
| Rate for Payer: BCBS Trust/PPO |
$19.34
|
| Rate for Payer: BCN Commercial |
$18.31
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.90
|
| Rate for Payer: Healthscope Commercial |
$23.62
|
| Rate for Payer: Healthscope Whirlpool |
$22.91
|
| Rate for Payer: Mclaren Commercial |
$21.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.08
|
| Rate for Payer: Nomi Health Commercial |
$19.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.70
|
| Rate for Payer: Priority Health Narrow Network |
$16.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.79
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$177.53
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
108145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.01 |
| Max. Negotiated Rate |
$177.53 |
| Rate for Payer: Aetna Commercial |
$159.78
|
| Rate for Payer: Aetna Medicare |
$88.76
|
| Rate for Payer: ASR ASR |
$172.20
|
| Rate for Payer: ASR Commercial |
$172.20
|
| Rate for Payer: BCBS Complete |
$71.01
|
| Rate for Payer: BCBS Trust/PPO |
$145.38
|
| Rate for Payer: BCN Commercial |
$137.64
|
| Rate for Payer: Cash Price |
$142.02
|
| Rate for Payer: Cofinity Commercial |
$166.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.02
|
| Rate for Payer: Healthscope Commercial |
$177.53
|
| Rate for Payer: Healthscope Whirlpool |
$172.20
|
| Rate for Payer: Mclaren Commercial |
$159.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.90
|
| Rate for Payer: Nomi Health Commercial |
$145.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.55
|
| Rate for Payer: Priority Health Narrow Network |
$124.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$156.23
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$177.53
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
108145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.39 |
| Max. Negotiated Rate |
$177.53 |
| Rate for Payer: Aetna Commercial |
$159.78
|
| Rate for Payer: ASR ASR |
$172.20
|
| Rate for Payer: ASR Commercial |
$172.20
|
| Rate for Payer: BCBS Trust/PPO |
$144.67
|
| Rate for Payer: BCN Commercial |
$137.64
|
| Rate for Payer: Cash Price |
$142.02
|
| Rate for Payer: Cofinity Commercial |
$166.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.02
|
| Rate for Payer: Healthscope Commercial |
$177.53
|
| Rate for Payer: Healthscope Whirlpool |
$172.20
|
| Rate for Payer: Mclaren Commercial |
$159.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.90
|
| Rate for Payer: Nomi Health Commercial |
$145.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$156.23
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$22.55
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$22.55 |
| Rate for Payer: Aetna Commercial |
$20.30
|
| Rate for Payer: Aetna Commercial |
$11.77
|
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: Aetna Commercial |
$12.13
|
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Commercial |
$16.11
|
| Rate for Payer: Aetna Medicare |
$6.54
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: Aetna Medicare |
$6.74
|
| Rate for Payer: Aetna Medicare |
$8.76
|
| Rate for Payer: Aetna Medicare |
$8.72
|
| Rate for Payer: Aetna Medicare |
$11.28
|
| Rate for Payer: ASR ASR |
$12.69
|
| Rate for Payer: ASR ASR |
$17.00
|
| Rate for Payer: ASR ASR |
$16.91
|
| Rate for Payer: ASR ASR |
$21.87
|
| Rate for Payer: ASR ASR |
$17.36
|
| Rate for Payer: ASR ASR |
$13.08
|
| Rate for Payer: ASR Commercial |
$13.08
|
| Rate for Payer: ASR Commercial |
$16.91
|
| Rate for Payer: ASR Commercial |
$17.00
|
| Rate for Payer: ASR Commercial |
$17.36
|
| Rate for Payer: ASR Commercial |
$21.87
|
| Rate for Payer: ASR Commercial |
$12.69
|
| Rate for Payer: BCBS Complete |
$9.02
|
| Rate for Payer: BCBS Complete |
$5.23
|
| Rate for Payer: BCBS Complete |
$5.39
|
| Rate for Payer: BCBS Complete |
$7.01
|
| Rate for Payer: BCBS Complete |
$6.97
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Trust/PPO |
$10.71
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCBS Trust/PPO |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$14.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.47
|
| Rate for Payer: BCBS Trust/PPO |
$14.66
|
| Rate for Payer: BCN Commercial |
$13.88
|
| Rate for Payer: BCN Commercial |
$10.14
|
| Rate for Payer: BCN Commercial |
$10.45
|
| Rate for Payer: BCN Commercial |
$13.51
|
| Rate for Payer: BCN Commercial |
$13.59
|
| Rate for Payer: BCN Commercial |
$17.48
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cash Price |
$18.04
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$16.83
|
| Rate for Payer: Cofinity Commercial |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.04
|
| Rate for Payer: Healthscope Commercial |
$13.08
|
| Rate for Payer: Healthscope Commercial |
$22.55
|
| Rate for Payer: Healthscope Commercial |
$17.53
|
| Rate for Payer: Healthscope Commercial |
$13.48
|
| Rate for Payer: Healthscope Commercial |
$17.43
|
| Rate for Payer: Healthscope Commercial |
$17.90
|
| Rate for Payer: Healthscope Whirlpool |
$16.91
|
| Rate for Payer: Healthscope Whirlpool |
$12.69
|
| Rate for Payer: Healthscope Whirlpool |
$17.00
|
| Rate for Payer: Healthscope Whirlpool |
$17.36
|
| Rate for Payer: Healthscope Whirlpool |
$21.87
|
| Rate for Payer: Healthscope Whirlpool |
$13.08
|
| Rate for Payer: Mclaren Commercial |
$16.11
|
| Rate for Payer: Mclaren Commercial |
$15.78
|
| Rate for Payer: Mclaren Commercial |
$20.30
|
| Rate for Payer: Mclaren Commercial |
$11.77
|
| Rate for Payer: Mclaren Commercial |
$12.13
|
| Rate for Payer: Mclaren Commercial |
$15.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.90
|
| Rate for Payer: Nomi Health Commercial |
$11.05
|
| Rate for Payer: Nomi Health Commercial |
$14.29
|
| Rate for Payer: Nomi Health Commercial |
$18.49
|
| Rate for Payer: Nomi Health Commercial |
$14.68
|
| Rate for Payer: Nomi Health Commercial |
$14.37
|
| Rate for Payer: Nomi Health Commercial |
$10.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.69
|
| Rate for Payer: Priority Health Narrow Network |
$0.55
|
| Rate for Payer: Priority Health Narrow Network |
$0.55
|
| Rate for Payer: Priority Health Narrow Network |
$0.55
|
| Rate for Payer: Priority Health Narrow Network |
$0.55
|
| Rate for Payer: Priority Health Narrow Network |
$0.55
|
| Rate for Payer: Priority Health Narrow Network |
$0.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.43
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$17.53
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$17.53 |
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: Aetna Commercial |
$12.13
|
| Rate for Payer: Aetna Commercial |
$11.77
|
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Commercial |
$20.30
|
| Rate for Payer: Aetna Commercial |
$16.11
|
| Rate for Payer: ASR ASR |
$17.36
|
| Rate for Payer: ASR ASR |
$16.91
|
| Rate for Payer: ASR ASR |
$21.87
|
| Rate for Payer: ASR ASR |
$17.00
|
| Rate for Payer: ASR ASR |
$13.08
|
| Rate for Payer: ASR ASR |
$12.69
|
| Rate for Payer: ASR Commercial |
$21.87
|
| Rate for Payer: ASR Commercial |
$16.91
|
| Rate for Payer: ASR Commercial |
$17.36
|
| Rate for Payer: ASR Commercial |
$17.00
|
| Rate for Payer: ASR Commercial |
$13.08
|
| Rate for Payer: ASR Commercial |
$12.69
|
| Rate for Payer: BCBS Trust/PPO |
$10.98
|
| Rate for Payer: BCBS Trust/PPO |
$10.66
|
| Rate for Payer: BCBS Trust/PPO |
$14.59
|
| Rate for Payer: BCBS Trust/PPO |
$18.38
|
| Rate for Payer: BCBS Trust/PPO |
$14.29
|
| Rate for Payer: BCBS Trust/PPO |
$14.20
|
| Rate for Payer: BCN Commercial |
$13.59
|
| Rate for Payer: BCN Commercial |
$10.14
|
| Rate for Payer: BCN Commercial |
$10.45
|
| Rate for Payer: BCN Commercial |
$13.88
|
| Rate for Payer: BCN Commercial |
$13.51
|
| Rate for Payer: BCN Commercial |
$17.48
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cash Price |
$18.04
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cofinity Commercial |
$16.83
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$12.30
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.04
|
| Rate for Payer: Healthscope Commercial |
$13.08
|
| Rate for Payer: Healthscope Commercial |
$22.55
|
| Rate for Payer: Healthscope Commercial |
$17.43
|
| Rate for Payer: Healthscope Commercial |
$17.53
|
| Rate for Payer: Healthscope Commercial |
$13.48
|
| Rate for Payer: Healthscope Commercial |
$17.90
|
| Rate for Payer: Healthscope Whirlpool |
$17.00
|
| Rate for Payer: Healthscope Whirlpool |
$12.69
|
| Rate for Payer: Healthscope Whirlpool |
$13.08
|
| Rate for Payer: Healthscope Whirlpool |
$17.36
|
| Rate for Payer: Healthscope Whirlpool |
$16.91
|
| Rate for Payer: Healthscope Whirlpool |
$21.87
|
| Rate for Payer: Mclaren Commercial |
$15.69
|
| Rate for Payer: Mclaren Commercial |
$16.11
|
| Rate for Payer: Mclaren Commercial |
$15.78
|
| Rate for Payer: Mclaren Commercial |
$11.77
|
| Rate for Payer: Mclaren Commercial |
$20.30
|
| Rate for Payer: Mclaren Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.46
|
| Rate for Payer: Nomi Health Commercial |
$11.05
|
| Rate for Payer: Nomi Health Commercial |
$14.29
|
| Rate for Payer: Nomi Health Commercial |
$14.37
|
| Rate for Payer: Nomi Health Commercial |
$10.73
|
| Rate for Payer: Nomi Health Commercial |
$14.68
|
| Rate for Payer: Nomi Health Commercial |
$18.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.34
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
OP
|
$3.74
|
|
|
Service Code
|
NDC 50268085511
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna Medicare |
$1.87
|
| Rate for Payer: ASR ASR |
$3.63
|
| Rate for Payer: ASR Commercial |
$3.63
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$3.06
|
| Rate for Payer: BCN Commercial |
$2.90
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Healthscope Whirlpool |
$3.63
|
| Rate for Payer: Mclaren Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.28
|
| Rate for Payer: Priority Health Narrow Network |
$2.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.29
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
OP
|
$3.27
|
|
|
Service Code
|
NDC 77333093825
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$1.64
|
| Rate for Payer: ASR ASR |
$3.17
|
| Rate for Payer: ASR Commercial |
$3.17
|
| Rate for Payer: BCBS Complete |
$1.31
|
| Rate for Payer: BCBS Trust/PPO |
$2.68
|
| Rate for Payer: BCN Commercial |
$2.54
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$3.27
|
| Rate for Payer: Healthscope Whirlpool |
$3.17
|
| Rate for Payer: Mclaren Commercial |
$2.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.78
|
| Rate for Payer: Nomi Health Commercial |
$2.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.87
|
| Rate for Payer: Priority Health Narrow Network |
$2.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.88
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$186.82
|
|
|
Service Code
|
NDC 50268085515
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.43 |
| Max. Negotiated Rate |
$186.82 |
| Rate for Payer: Aetna Commercial |
$168.14
|
| Rate for Payer: ASR ASR |
$181.22
|
| Rate for Payer: ASR Commercial |
$181.22
|
| Rate for Payer: BCBS Trust/PPO |
$152.24
|
| Rate for Payer: BCN Commercial |
$144.84
|
| Rate for Payer: Cash Price |
$149.46
|
| Rate for Payer: Cofinity Commercial |
$175.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.46
|
| Rate for Payer: Healthscope Commercial |
$186.82
|
| Rate for Payer: Healthscope Whirlpool |
$181.22
|
| Rate for Payer: Mclaren Commercial |
$168.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.80
|
| Rate for Payer: Nomi Health Commercial |
$153.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.40
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
OP
|
$186.82
|
|
|
Service Code
|
NDC 50268085515
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.73 |
| Max. Negotiated Rate |
$186.82 |
| Rate for Payer: Aetna Commercial |
$168.14
|
| Rate for Payer: Aetna Medicare |
$93.41
|
| Rate for Payer: ASR ASR |
$181.22
|
| Rate for Payer: ASR Commercial |
$181.22
|
| Rate for Payer: BCBS Complete |
$74.73
|
| Rate for Payer: BCBS Trust/PPO |
$152.99
|
| Rate for Payer: BCN Commercial |
$144.84
|
| Rate for Payer: Cash Price |
$149.46
|
| Rate for Payer: Cofinity Commercial |
$175.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.46
|
| Rate for Payer: Healthscope Commercial |
$186.82
|
| Rate for Payer: Healthscope Whirlpool |
$181.22
|
| Rate for Payer: Mclaren Commercial |
$168.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.80
|
| Rate for Payer: Nomi Health Commercial |
$153.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.69
|
| Rate for Payer: Priority Health Narrow Network |
$130.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.40
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
OP
|
$326.65
|
|
|
Service Code
|
NDC 77333093810
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.66 |
| Max. Negotiated Rate |
$326.65 |
| Rate for Payer: Aetna Commercial |
$293.98
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: ASR ASR |
$316.85
|
| Rate for Payer: ASR Commercial |
$316.85
|
| Rate for Payer: BCBS Complete |
$130.66
|
| Rate for Payer: BCBS Trust/PPO |
$267.49
|
| Rate for Payer: BCN Commercial |
$253.25
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$307.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$326.65
|
| Rate for Payer: Healthscope Whirlpool |
$316.85
|
| Rate for Payer: Mclaren Commercial |
$293.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Nomi Health Commercial |
$267.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.21
|
| Rate for Payer: Priority Health Narrow Network |
$228.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.45
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$169.20
|
|
|
Service Code
|
NDC 20555000600
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.98 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$152.28
|
| Rate for Payer: ASR ASR |
$164.12
|
| Rate for Payer: ASR Commercial |
$164.12
|
| Rate for Payer: BCBS Trust/PPO |
$137.88
|
| Rate for Payer: BCN Commercial |
$131.18
|
| Rate for Payer: Cash Price |
$135.36
|
| Rate for Payer: Cofinity Commercial |
$159.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.36
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Healthscope Whirlpool |
$164.12
|
| Rate for Payer: Mclaren Commercial |
$152.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.82
|
| Rate for Payer: Nomi Health Commercial |
$138.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.90
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
OP
|
$169.20
|
|
|
Service Code
|
NDC 20555000600
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.68 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$152.28
|
| Rate for Payer: Aetna Medicare |
$84.60
|
| Rate for Payer: ASR ASR |
$164.12
|
| Rate for Payer: ASR Commercial |
$164.12
|
| Rate for Payer: BCBS Complete |
$67.68
|
| Rate for Payer: BCBS Trust/PPO |
$138.56
|
| Rate for Payer: BCN Commercial |
$131.18
|
| Rate for Payer: Cash Price |
$135.36
|
| Rate for Payer: Cofinity Commercial |
$159.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.36
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Healthscope Whirlpool |
$164.12
|
| Rate for Payer: Mclaren Commercial |
$152.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.82
|
| Rate for Payer: Nomi Health Commercial |
$138.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.25
|
| Rate for Payer: Priority Health Narrow Network |
$118.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.90
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$3.27
|
|
|
Service Code
|
NDC 77333093825
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: ASR ASR |
$3.17
|
| Rate for Payer: ASR Commercial |
$3.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.66
|
| Rate for Payer: BCN Commercial |
$2.54
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$3.27
|
| Rate for Payer: Healthscope Whirlpool |
$3.17
|
| Rate for Payer: Mclaren Commercial |
$2.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.78
|
| Rate for Payer: Nomi Health Commercial |
$2.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.88
|
|
