|
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 |
$89.54 |
| Max. Negotiated Rate |
$223.85 |
| Rate for Payer: Aetna Commercial |
$201.47
|
| Rate for Payer: Aetna Commercial |
$261.98
|
| Rate for Payer: Aetna Commercial |
$74.49
|
| Rate for Payer: Aetna Medicare |
$145.54
|
| Rate for Payer: Aetna Medicare |
$41.38
|
| Rate for Payer: Aetna Medicare |
$111.92
|
| 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 |
$80.29
|
| Rate for Payer: ASR Commercial |
$282.36
|
| Rate for Payer: ASR Commercial |
$217.13
|
| 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 |
$183.31
|
| Rate for Payer: BCBS Trust/PPO |
$238.37
|
| Rate for Payer: BCBS Trust/PPO |
$67.78
|
| Rate for Payer: BCN Commercial |
$64.17
|
| Rate for Payer: BCN Commercial |
$173.55
|
| 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 |
$201.47
|
| Rate for Payer: Mclaren Commercial |
$261.98
|
| Rate for Payer: Mclaren Commercial |
$74.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Nomi Health Commercial |
$183.56
|
| Rate for Payer: Nomi Health Commercial |
$238.69
|
| Rate for Payer: Nomi Health Commercial |
$67.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.52
|
| Rate for Payer: Priority Health Narrow Network |
$58.02
|
| Rate for Payer: Priority Health Narrow Network |
$156.92
|
| Rate for Payer: Priority Health Narrow Network |
$204.05
|
| 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
|
|
|
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 |
$88.77
|
| 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
|
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 |
$15.21
|
| 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 |
$11.63
|
| 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/ML INJECTION SOLUTION
|
Facility
|
OP
|
$17.53
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.01 |
| 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 |
$16.11
|
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Commercial |
$20.30
|
| Rate for Payer: Aetna Medicare |
$11.28
|
| Rate for Payer: Aetna Medicare |
$8.77
|
| Rate for Payer: Aetna Medicare |
$6.74
|
| Rate for Payer: Aetna Medicare |
$6.54
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: Aetna Medicare |
$8.71
|
| Rate for Payer: ASR ASR |
$16.91
|
| Rate for Payer: ASR ASR |
$12.69
|
| Rate for Payer: ASR ASR |
$17.36
|
| 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 Commercial |
$17.36
|
| 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 |
$12.69
|
| Rate for Payer: ASR Commercial |
$21.87
|
| Rate for Payer: BCBS Complete |
$9.02
|
| Rate for Payer: BCBS Complete |
$5.23
|
| Rate for Payer: BCBS Complete |
$7.01
|
| Rate for Payer: BCBS Complete |
$6.97
|
| Rate for Payer: BCBS Complete |
$5.39
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCBS Trust/PPO |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$18.47
|
| Rate for Payer: BCBS Trust/PPO |
$14.27
|
| Rate for Payer: BCBS Trust/PPO |
$14.66
|
| Rate for Payer: BCBS Trust/PPO |
$10.71
|
| Rate for Payer: BCN Commercial |
$13.59
|
| Rate for Payer: BCN Commercial |
$10.45
|
| Rate for Payer: BCN Commercial |
$10.14
|
| Rate for Payer: BCN Commercial |
$13.51
|
| Rate for Payer: BCN Commercial |
$17.48
|
| Rate for Payer: BCN Commercial |
$13.88
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$16.83
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$12.30
|
| 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 |
$10.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
| 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 |
$13.48
|
| Rate for Payer: Healthscope Commercial |
$17.43
|
| Rate for Payer: Healthscope Commercial |
$13.08
|
| Rate for Payer: Healthscope Commercial |
$17.53
|
| Rate for Payer: Healthscope Commercial |
$22.55
|
| Rate for Payer: Healthscope Commercial |
$17.90
|
| Rate for Payer: Healthscope Whirlpool |
$17.00
|
| Rate for Payer: Healthscope Whirlpool |
$16.91
|
| Rate for Payer: Healthscope Whirlpool |
$13.08
|
| Rate for Payer: Healthscope Whirlpool |
$12.69
|
| Rate for Payer: Healthscope Whirlpool |
$21.87
|
| Rate for Payer: Healthscope Whirlpool |
$17.36
|
| Rate for Payer: Mclaren Commercial |
$12.13
|
| Rate for Payer: Mclaren Commercial |
$20.30
|
| 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 |
$15.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.46
|
| 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 |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.82
|
| Rate for Payer: Nomi Health Commercial |
$10.73
|
| Rate for Payer: Nomi Health Commercial |
$14.37
|
| Rate for Payer: Nomi Health Commercial |
$14.29
|
| Rate for Payer: Nomi Health Commercial |
$11.05
|
| Rate for Payer: Nomi Health Commercial |
$14.68
|
| Rate for Payer: Nomi Health Commercial |
$18.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.76
|
| Rate for Payer: Priority Health Narrow Network |
$15.81
|
| Rate for Payer: Priority Health Narrow Network |
$9.17
|
| Rate for Payer: Priority Health Narrow Network |
$9.45
|
| Rate for Payer: Priority Health Narrow Network |
$12.22
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.75
|
| 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 |
$11.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.86
|
|
|
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
|
$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
|
$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
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 50268085511
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: ASR ASR |
$3.63
|
| Rate for Payer: ASR Commercial |
$3.63
|
| Rate for Payer: BCBS Trust/PPO |
$3.05
|
| 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: UHC All Payor (Choice/PPO) + Core |
$3.29
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 77333093810
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.32 |
| Max. Negotiated Rate |
$326.65 |
| Rate for Payer: Aetna Commercial |
$293.99
|
| Rate for Payer: ASR ASR |
$316.85
|
| Rate for Payer: ASR Commercial |
$316.85
|
| Rate for Payer: BCBS Trust/PPO |
$266.19
|
| 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 |
$293.99
|
| 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: UHC All Payor (Choice/PPO) + Core |
$287.45
|
|
|
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 |
$293.99
|
| 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 |
$293.99
|
| 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
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$99.36
|
|
|
Service Code
|
NDC 00065039602
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$99.36 |
| Rate for Payer: Aetna Commercial |
$89.42
|
| Rate for Payer: ASR ASR |
$96.38
|
| Rate for Payer: ASR Commercial |
$96.38
|
| Rate for Payer: BCBS Trust/PPO |
$80.97
|
| Rate for Payer: BCN Commercial |
$77.03
|
| Rate for Payer: Cash Price |
$79.49
|
| Rate for Payer: Cofinity Commercial |
$93.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.49
|
| Rate for Payer: Healthscope Commercial |
$99.36
|
| Rate for Payer: Healthscope Whirlpool |
$96.38
|
| Rate for Payer: Mclaren Commercial |
$89.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.46
|
| Rate for Payer: Nomi Health Commercial |
$81.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.44
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$18.86
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: ASR ASR |
$18.29
|
| Rate for Payer: ASR Commercial |
$18.29
|
| Rate for Payer: BCBS Trust/PPO |
$15.37
|
| Rate for Payer: BCN Commercial |
$14.62
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$17.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.09
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Healthscope Whirlpool |
$18.29
|
| Rate for Payer: Mclaren Commercial |
$16.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.03
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.60
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$40.25
|
|
|
Service Code
|
NDC 24208073501
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.16 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna Commercial |
$36.23
|
| Rate for Payer: ASR ASR |
$39.04
|
| Rate for Payer: ASR Commercial |
$39.04
|
| Rate for Payer: BCBS Trust/PPO |
$32.80
|
| Rate for Payer: BCN Commercial |
$31.21
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Healthscope Commercial |
$40.25
|
| Rate for Payer: Healthscope Whirlpool |
$39.04
|
| Rate for Payer: Mclaren Commercial |
$36.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Nomi Health Commercial |
$33.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.42
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$40.25
|
|
|
Service Code
|
NDC 24208073501
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna Commercial |
$36.23
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: ASR ASR |
$39.04
|
| Rate for Payer: ASR Commercial |
$39.04
|
| Rate for Payer: BCBS Complete |
$16.10
|
| Rate for Payer: BCBS Trust/PPO |
$32.96
|
| Rate for Payer: BCN Commercial |
$31.21
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Healthscope Commercial |
$40.25
|
| Rate for Payer: Healthscope Whirlpool |
$39.04
|
| Rate for Payer: Mclaren Commercial |
$36.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Nomi Health Commercial |
$33.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.27
|
| Rate for Payer: Priority Health Narrow Network |
$28.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.42
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$99.36
|
|
|
Service Code
|
NDC 00065039602
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.74 |
| Max. Negotiated Rate |
$99.36 |
| Rate for Payer: Aetna Commercial |
$89.42
|
| Rate for Payer: Aetna Medicare |
$49.68
|
| Rate for Payer: ASR ASR |
$96.38
|
| Rate for Payer: ASR Commercial |
$96.38
|
| Rate for Payer: BCBS Complete |
$39.74
|
| Rate for Payer: BCBS Trust/PPO |
$81.37
|
| Rate for Payer: BCN Commercial |
$77.03
|
| Rate for Payer: Cash Price |
$79.49
|
| Rate for Payer: Cofinity Commercial |
$93.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.49
|
| Rate for Payer: Healthscope Commercial |
$99.36
|
| Rate for Payer: Healthscope Whirlpool |
$96.38
|
| Rate for Payer: Mclaren Commercial |
$89.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.46
|
| Rate for Payer: Nomi Health Commercial |
$81.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.06
|
| Rate for Payer: Priority Health Narrow Network |
$69.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.44
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$15.21
|
|
|
Service Code
|
NDC 61314039601
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$15.21 |
| Rate for Payer: Aetna Commercial |
$13.69
|
| Rate for Payer: ASR ASR |
$14.75
|
| Rate for Payer: ASR Commercial |
$14.75
|
| Rate for Payer: BCBS Trust/PPO |
$12.39
|
| Rate for Payer: BCN Commercial |
$11.79
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$14.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.17
|
| Rate for Payer: Healthscope Commercial |
$15.21
|
| Rate for Payer: Healthscope Whirlpool |
$14.75
|
| Rate for Payer: Mclaren Commercial |
$13.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.93
|
| Rate for Payer: Nomi Health Commercial |
$12.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.38
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$18.86
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna Medicare |
$9.43
|
| Rate for Payer: ASR ASR |
$18.29
|
| Rate for Payer: ASR Commercial |
$18.29
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: BCBS Trust/PPO |
$15.44
|
| Rate for Payer: BCN Commercial |
$14.62
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$17.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.09
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Healthscope Whirlpool |
$18.29
|
| Rate for Payer: Mclaren Commercial |
$16.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.03
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.53
|
| Rate for Payer: Priority Health Narrow Network |
$13.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.60
|
|
