|
FRAXEL FACE & NECK
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 00162
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Medicare |
$510.00
|
| Rate for Payer: BCBS Complete |
$408.00
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.00
|
|
|
FRAXEL FULL FACE
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 00152
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
|
|
FRAXEL HANDS
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 00154
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
|
|
FRAXEL LARGE SCAR
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 00161
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Medicare |
$408.00
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
|
|
FRAXEL MEDIUM SCAR
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
FRAXEL NECK
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00153
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
|
|
FRAXEL NECK & CHEST
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 00163
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$489.60 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: Aetna Medicare |
$612.00
|
| Rate for Payer: BCBS Complete |
$489.60
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$795.60
|
|
|
FRAXEL PARTIAL TREATMENT - BILATERAL EYES
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00157
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
FRAXEL PARTIAL TREATMENT - PERI-ORAL
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 00156
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Aetna Medicare |
$255.00
|
| Rate for Payer: BCBS Complete |
$204.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
|
|
FRAXEL PARTIAL TREATMENT - UPPER LIP
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00158
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
FRAXEL RESTORE
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00168
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
FRAXEL SMALL SCAR
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 00159
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
|
|
FRAXEL STRETCH MARKS - ENTIRE ABDOMEN
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 00165
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Medicare |
$408.00
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
|
|
FRAXEL STRETCH MARKS - PERI-UMBILICAL
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 00164
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
|
|
FUROSEMIDE 10 MG/ML INJECTION (CODE)
|
Facility
|
OP
|
$7.95
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
163713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$7.95 |
| Rate for Payer: Aetna Commercial |
$7.16
|
| Rate for Payer: Aetna Commercial |
$10.98
|
| Rate for Payer: Aetna Commercial |
$11.80
|
| Rate for Payer: Aetna Commercial |
$20.11
|
| Rate for Payer: Aetna Commercial |
$20.07
|
| Rate for Payer: Aetna Commercial |
$9.81
|
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: Aetna Medicare |
$3.98
|
| Rate for Payer: Aetna Medicare |
$6.10
|
| Rate for Payer: Aetna Medicare |
$14.10
|
| Rate for Payer: Aetna Medicare |
$5.45
|
| Rate for Payer: Aetna Medicare |
$11.17
|
| Rate for Payer: Aetna Medicare |
$6.56
|
| Rate for Payer: Aetna Medicare |
$11.15
|
| Rate for Payer: ASR ASR |
$12.72
|
| Rate for Payer: ASR ASR |
$27.34
|
| Rate for Payer: ASR ASR |
$7.71
|
| Rate for Payer: ASR ASR |
$21.67
|
| Rate for Payer: ASR ASR |
$11.83
|
| Rate for Payer: ASR ASR |
$21.63
|
| Rate for Payer: ASR ASR |
$10.57
|
| Rate for Payer: ASR Commercial |
$12.72
|
| Rate for Payer: ASR Commercial |
$10.57
|
| Rate for Payer: ASR Commercial |
$21.67
|
| Rate for Payer: ASR Commercial |
$7.71
|
| Rate for Payer: ASR Commercial |
$27.34
|
| Rate for Payer: ASR Commercial |
$11.83
|
| Rate for Payer: ASR Commercial |
$21.63
|
| Rate for Payer: BCBS Complete |
$8.92
|
| Rate for Payer: BCBS Complete |
$4.36
|
| Rate for Payer: BCBS Complete |
$8.94
|
| Rate for Payer: BCBS Complete |
$5.24
|
| Rate for Payer: BCBS Complete |
$4.88
|
| Rate for Payer: BCBS Complete |
$3.18
|
| Rate for Payer: BCBS Complete |
$11.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.08
|
| Rate for Payer: BCBS Trust/PPO |
$18.26
|
| Rate for Payer: BCBS Trust/PPO |
$8.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.99
|
| Rate for Payer: BCBS Trust/PPO |
$10.74
|
| Rate for Payer: BCBS Trust/PPO |
$18.29
|
| Rate for Payer: BCBS Trust/PPO |
$6.51
|
| Rate for Payer: BCN Commercial |
$21.86
|
| Rate for Payer: BCN Commercial |
$17.32
|
| Rate for Payer: BCN Commercial |
$6.16
|
| Rate for Payer: BCN Commercial |
$17.29
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: BCN Commercial |
$8.45
|
| Rate for Payer: BCN Commercial |
$10.16
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Cash Price |
$10.49
|
| Rate for Payer: Cash Price |
$6.36
|
| Rate for Payer: Cofinity Commercial |
$7.47
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Cofinity Commercial |
$10.25
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$12.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.87
|
| Rate for Payer: Healthscope Commercial |
$10.90
|
| Rate for Payer: Healthscope Commercial |
$7.95
|
| Rate for Payer: Healthscope Commercial |
$28.19
|
| Rate for Payer: Healthscope Commercial |
$22.30
|
| Rate for Payer: Healthscope Commercial |
$12.20
|
| Rate for Payer: Healthscope Commercial |
$22.34
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Healthscope Whirlpool |
$12.72
|
| Rate for Payer: Healthscope Whirlpool |
$10.57
|
| Rate for Payer: Healthscope Whirlpool |
$21.63
|
| Rate for Payer: Healthscope Whirlpool |
$21.67
|
| Rate for Payer: Healthscope Whirlpool |
$27.34
|
| Rate for Payer: Healthscope Whirlpool |
$7.71
|
| Rate for Payer: Healthscope Whirlpool |
$11.83
|
| Rate for Payer: Mclaren Commercial |
$11.80
|
| Rate for Payer: Mclaren Commercial |
$20.11
|
| Rate for Payer: Mclaren Commercial |
$25.37
|
| Rate for Payer: Mclaren Commercial |
$7.16
|
| Rate for Payer: Mclaren Commercial |
$20.07
|
| Rate for Payer: Mclaren Commercial |
$9.81
|
| Rate for Payer: Mclaren Commercial |
$10.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.76
|
| Rate for Payer: Nomi Health Commercial |
$10.75
|
| Rate for Payer: Nomi Health Commercial |
$23.12
|
| Rate for Payer: Nomi Health Commercial |
$18.32
|
| Rate for Payer: Nomi Health Commercial |
$6.52
|
| Rate for Payer: Nomi Health Commercial |
$10.00
|
| Rate for Payer: Nomi Health Commercial |
$8.94
|
| Rate for Payer: Nomi Health Commercial |
$18.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.69
|
| Rate for Payer: Priority Health Narrow Network |
$8.55
|
| Rate for Payer: Priority Health Narrow Network |
$15.63
|
| Rate for Payer: Priority Health Narrow Network |
$9.19
|
| Rate for Payer: Priority Health Narrow Network |
$7.64
|
| Rate for Payer: Priority Health Narrow Network |
$19.76
|
| Rate for Payer: Priority Health Narrow Network |
$15.66
|
| Rate for Payer: Priority Health Narrow Network |
$5.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.59
|
|
|
FUROSEMIDE 10 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$12.20
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
163713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$12.20 |
| Rate for Payer: Aetna Commercial |
$10.98
|
| Rate for Payer: Aetna Commercial |
$20.07
|
| Rate for Payer: Aetna Commercial |
$11.80
|
| Rate for Payer: Aetna Commercial |
$20.11
|
| Rate for Payer: Aetna Commercial |
$7.16
|
| Rate for Payer: Aetna Commercial |
$9.81
|
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: ASR ASR |
$21.63
|
| Rate for Payer: ASR ASR |
$12.72
|
| Rate for Payer: ASR ASR |
$7.71
|
| Rate for Payer: ASR ASR |
$21.67
|
| Rate for Payer: ASR ASR |
$11.83
|
| Rate for Payer: ASR ASR |
$10.57
|
| Rate for Payer: ASR ASR |
$27.34
|
| Rate for Payer: ASR Commercial |
$7.71
|
| Rate for Payer: ASR Commercial |
$27.34
|
| Rate for Payer: ASR Commercial |
$12.72
|
| Rate for Payer: ASR Commercial |
$21.67
|
| Rate for Payer: ASR Commercial |
$21.63
|
| Rate for Payer: ASR Commercial |
$11.83
|
| Rate for Payer: ASR Commercial |
$10.57
|
| Rate for Payer: BCBS Trust/PPO |
$22.97
|
| Rate for Payer: BCBS Trust/PPO |
$18.20
|
| Rate for Payer: BCBS Trust/PPO |
$8.88
|
| Rate for Payer: BCBS Trust/PPO |
$9.94
|
| Rate for Payer: BCBS Trust/PPO |
$18.17
|
| Rate for Payer: BCBS Trust/PPO |
$10.68
|
| Rate for Payer: BCBS Trust/PPO |
$6.48
|
| Rate for Payer: BCN Commercial |
$10.16
|
| Rate for Payer: BCN Commercial |
$6.16
|
| Rate for Payer: BCN Commercial |
$17.32
|
| Rate for Payer: BCN Commercial |
$8.45
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: BCN Commercial |
$21.86
|
| Rate for Payer: BCN Commercial |
$17.29
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cash Price |
$10.49
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Cash Price |
$6.36
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$12.32
|
| Rate for Payer: Cofinity Commercial |
$10.25
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Cofinity Commercial |
$7.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.87
|
| Rate for Payer: Healthscope Commercial |
$22.34
|
| Rate for Payer: Healthscope Commercial |
$7.95
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Healthscope Commercial |
$22.30
|
| Rate for Payer: Healthscope Commercial |
$28.19
|
| Rate for Payer: Healthscope Commercial |
$12.20
|
| Rate for Payer: Healthscope Commercial |
$10.90
|
| Rate for Payer: Healthscope Whirlpool |
$27.34
|
| Rate for Payer: Healthscope Whirlpool |
$21.67
|
| Rate for Payer: Healthscope Whirlpool |
$21.63
|
| Rate for Payer: Healthscope Whirlpool |
$11.83
|
| Rate for Payer: Healthscope Whirlpool |
$12.72
|
| Rate for Payer: Healthscope Whirlpool |
$10.57
|
| Rate for Payer: Healthscope Whirlpool |
$7.71
|
| Rate for Payer: Mclaren Commercial |
$20.11
|
| Rate for Payer: Mclaren Commercial |
$7.16
|
| Rate for Payer: Mclaren Commercial |
$9.81
|
| Rate for Payer: Mclaren Commercial |
$25.37
|
| Rate for Payer: Mclaren Commercial |
$11.80
|
| Rate for Payer: Mclaren Commercial |
$10.98
|
| Rate for Payer: Mclaren Commercial |
$20.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.96
|
| Rate for Payer: Nomi Health Commercial |
$8.94
|
| Rate for Payer: Nomi Health Commercial |
$23.12
|
| Rate for Payer: Nomi Health Commercial |
$6.52
|
| Rate for Payer: Nomi Health Commercial |
$18.29
|
| Rate for Payer: Nomi Health Commercial |
$10.75
|
| Rate for Payer: Nomi Health Commercial |
$10.00
|
| Rate for Payer: Nomi Health Commercial |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.54
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$10.67
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
3291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Aetna Commercial |
$9.60
|
| Rate for Payer: Aetna Commercial |
$7.16
|
| Rate for Payer: Aetna Commercial |
$13.36
|
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: Aetna Commercial |
$12.64
|
| Rate for Payer: Aetna Commercial |
$14.04
|
| Rate for Payer: Aetna Commercial |
$15.51
|
| Rate for Payer: Aetna Commercial |
$12.47
|
| Rate for Payer: Aetna Commercial |
$17.96
|
| Rate for Payer: Aetna Commercial |
$10.98
|
| Rate for Payer: Aetna Commercial |
$20.07
|
| Rate for Payer: Aetna Commercial |
$20.11
|
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: Aetna Commercial |
$10.94
|
| Rate for Payer: Aetna Commercial |
$11.80
|
| Rate for Payer: Aetna Commercial |
$9.81
|
| Rate for Payer: ASR ASR |
$19.35
|
| Rate for Payer: ASR ASR |
$27.34
|
| Rate for Payer: ASR ASR |
$16.71
|
| Rate for Payer: ASR ASR |
$7.71
|
| Rate for Payer: ASR ASR |
$11.79
|
| Rate for Payer: ASR ASR |
$8.10
|
| Rate for Payer: ASR ASR |
$13.44
|
| Rate for Payer: ASR ASR |
$11.83
|
| Rate for Payer: ASR ASR |
$10.57
|
| Rate for Payer: ASR ASR |
$10.35
|
| Rate for Payer: ASR ASR |
$21.63
|
| Rate for Payer: ASR ASR |
$21.67
|
| Rate for Payer: ASR ASR |
$12.72
|
| Rate for Payer: ASR ASR |
$13.62
|
| Rate for Payer: ASR ASR |
$14.40
|
| Rate for Payer: ASR ASR |
$15.13
|
| Rate for Payer: ASR Commercial |
$11.83
|
| Rate for Payer: ASR Commercial |
$14.40
|
| Rate for Payer: ASR Commercial |
$11.79
|
| Rate for Payer: ASR Commercial |
$12.72
|
| Rate for Payer: ASR Commercial |
$10.57
|
| Rate for Payer: ASR Commercial |
$10.35
|
| Rate for Payer: ASR Commercial |
$8.10
|
| Rate for Payer: ASR Commercial |
$7.71
|
| Rate for Payer: ASR Commercial |
$27.34
|
| Rate for Payer: ASR Commercial |
$21.67
|
| Rate for Payer: ASR Commercial |
$21.63
|
| Rate for Payer: ASR Commercial |
$19.35
|
| Rate for Payer: ASR Commercial |
$16.71
|
| Rate for Payer: ASR Commercial |
$13.44
|
| Rate for Payer: ASR Commercial |
$15.13
|
| Rate for Payer: ASR Commercial |
$13.62
|
| Rate for Payer: BCBS Trust/PPO |
$10.68
|
| Rate for Payer: BCBS Trust/PPO |
$18.20
|
| Rate for Payer: BCBS Trust/PPO |
$12.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.17
|
| Rate for Payer: BCBS Trust/PPO |
$16.26
|
| Rate for Payer: BCBS Trust/PPO |
$14.04
|
| Rate for Payer: BCBS Trust/PPO |
$9.90
|
| Rate for Payer: BCBS Trust/PPO |
$11.44
|
| Rate for Payer: BCBS Trust/PPO |
$11.29
|
| Rate for Payer: BCBS Trust/PPO |
$9.94
|
| Rate for Payer: BCBS Trust/PPO |
$8.88
|
| Rate for Payer: BCBS Trust/PPO |
$8.69
|
| Rate for Payer: BCBS Trust/PPO |
$12.71
|
| Rate for Payer: BCBS Trust/PPO |
$6.48
|
| Rate for Payer: BCBS Trust/PPO |
$6.80
|
| Rate for Payer: BCBS Trust/PPO |
$22.97
|
| Rate for Payer: BCN Commercial |
$9.42
|
| Rate for Payer: BCN Commercial |
$13.36
|
| Rate for Payer: BCN Commercial |
$12.09
|
| Rate for Payer: BCN Commercial |
$8.45
|
| Rate for Payer: BCN Commercial |
$17.32
|
| Rate for Payer: BCN Commercial |
$10.16
|
| Rate for Payer: BCN Commercial |
$10.89
|
| Rate for Payer: BCN Commercial |
$6.47
|
| Rate for Payer: BCN Commercial |
$8.27
|
| Rate for Payer: BCN Commercial |
$6.16
|
| Rate for Payer: BCN Commercial |
$17.29
|
| Rate for Payer: BCN Commercial |
$21.86
|
| Rate for Payer: BCN Commercial |
$11.51
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: BCN Commercial |
$15.47
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$10.49
|
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$13.78
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cash Price |
$6.36
|
| Rate for Payer: Cash Price |
$11.09
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Cofinity Commercial |
$10.03
|
| Rate for Payer: Cofinity Commercial |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$10.25
|
| Rate for Payer: Cofinity Commercial |
$12.32
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$13.20
|
| Rate for Payer: Cofinity Commercial |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$18.75
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Cofinity Commercial |
$7.47
|
| Rate for Payer: Cofinity Commercial |
$7.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.48
|
| Rate for Payer: Healthscope Commercial |
$15.60
|
| Rate for Payer: Healthscope Commercial |
$22.34
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Healthscope Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$12.20
|
| Rate for Payer: Healthscope Commercial |
$14.85
|
| Rate for Payer: Healthscope Commercial |
$8.35
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Healthscope Commercial |
$7.95
|
| Rate for Payer: Healthscope Commercial |
$10.90
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Healthscope Commercial |
$10.67
|
| Rate for Payer: Healthscope Commercial |
$19.95
|
| Rate for Payer: Healthscope Commercial |
$14.04
|
| Rate for Payer: Healthscope Commercial |
$28.19
|
| Rate for Payer: Healthscope Commercial |
$22.30
|
| Rate for Payer: Healthscope Whirlpool |
$16.71
|
| Rate for Payer: Healthscope Whirlpool |
$13.62
|
| Rate for Payer: Healthscope Whirlpool |
$12.72
|
| Rate for Payer: Healthscope Whirlpool |
$21.67
|
| Rate for Payer: Healthscope Whirlpool |
$10.35
|
| Rate for Payer: Healthscope Whirlpool |
$8.10
|
| Rate for Payer: Healthscope Whirlpool |
$19.35
|
| Rate for Payer: Healthscope Whirlpool |
$15.13
|
| Rate for Payer: Healthscope Whirlpool |
$13.44
|
| Rate for Payer: Healthscope Whirlpool |
$11.79
|
| Rate for Payer: Healthscope Whirlpool |
$10.57
|
| Rate for Payer: Healthscope Whirlpool |
$11.83
|
| Rate for Payer: Healthscope Whirlpool |
$7.71
|
| Rate for Payer: Healthscope Whirlpool |
$27.34
|
| Rate for Payer: Healthscope Whirlpool |
$14.40
|
| Rate for Payer: Healthscope Whirlpool |
$21.63
|
| Rate for Payer: Mclaren Commercial |
$17.96
|
| Rate for Payer: Mclaren Commercial |
$15.51
|
| Rate for Payer: Mclaren Commercial |
$12.64
|
| Rate for Payer: Mclaren Commercial |
$10.98
|
| Rate for Payer: Mclaren Commercial |
$20.07
|
| Rate for Payer: Mclaren Commercial |
$9.81
|
| Rate for Payer: Mclaren Commercial |
$11.80
|
| Rate for Payer: Mclaren Commercial |
$14.04
|
| Rate for Payer: Mclaren Commercial |
$10.94
|
| Rate for Payer: Mclaren Commercial |
$13.36
|
| Rate for Payer: Mclaren Commercial |
$7.52
|
| Rate for Payer: Mclaren Commercial |
$7.16
|
| Rate for Payer: Mclaren Commercial |
$12.47
|
| Rate for Payer: Mclaren Commercial |
$20.11
|
| Rate for Payer: Mclaren Commercial |
$9.60
|
| Rate for Payer: Mclaren Commercial |
$25.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.93
|
| Rate for Payer: Nomi Health Commercial |
$9.96
|
| Rate for Payer: Nomi Health Commercial |
$11.37
|
| Rate for Payer: Nomi Health Commercial |
$12.79
|
| Rate for Payer: Nomi Health Commercial |
$6.85
|
| Rate for Payer: Nomi Health Commercial |
$16.36
|
| Rate for Payer: Nomi Health Commercial |
$6.52
|
| Rate for Payer: Nomi Health Commercial |
$12.18
|
| Rate for Payer: Nomi Health Commercial |
$10.75
|
| Rate for Payer: Nomi Health Commercial |
$18.32
|
| Rate for Payer: Nomi Health Commercial |
$8.75
|
| Rate for Payer: Nomi Health Commercial |
$14.13
|
| Rate for Payer: Nomi Health Commercial |
$18.29
|
| Rate for Payer: Nomi Health Commercial |
$11.51
|
| Rate for Payer: Nomi Health Commercial |
$8.94
|
| Rate for Payer: Nomi Health Commercial |
$10.00
|
| Rate for Payer: Nomi Health Commercial |
$23.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.20
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$10.67
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
3291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Aetna Commercial |
$9.60
|
| Rate for Payer: Aetna Commercial |
$10.94
|
| Rate for Payer: Aetna Commercial |
$9.81
|
| Rate for Payer: Aetna Commercial |
$10.98
|
| Rate for Payer: Aetna Commercial |
$11.80
|
| Rate for Payer: Aetna Commercial |
$12.47
|
| Rate for Payer: Aetna Commercial |
$12.64
|
| Rate for Payer: Aetna Commercial |
$13.36
|
| Rate for Payer: Aetna Commercial |
$14.04
|
| Rate for Payer: Aetna Commercial |
$15.51
|
| Rate for Payer: Aetna Commercial |
$17.96
|
| Rate for Payer: Aetna Commercial |
$20.07
|
| Rate for Payer: Aetna Commercial |
$20.11
|
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: Aetna Commercial |
$7.16
|
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: Aetna Medicare |
$3.98
|
| Rate for Payer: Aetna Medicare |
$6.56
|
| Rate for Payer: Aetna Medicare |
$11.17
|
| Rate for Payer: Aetna Medicare |
$9.98
|
| Rate for Payer: Aetna Medicare |
$7.42
|
| Rate for Payer: Aetna Medicare |
$7.02
|
| Rate for Payer: Aetna Medicare |
$8.62
|
| Rate for Payer: Aetna Medicare |
$4.18
|
| Rate for Payer: Aetna Medicare |
$6.93
|
| Rate for Payer: Aetna Medicare |
$11.15
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: Aetna Medicare |
$5.34
|
| Rate for Payer: Aetna Medicare |
$5.45
|
| Rate for Payer: Aetna Medicare |
$6.10
|
| Rate for Payer: Aetna Medicare |
$6.08
|
| Rate for Payer: Aetna Medicare |
$14.10
|
| Rate for Payer: ASR ASR |
$21.67
|
| Rate for Payer: ASR ASR |
$27.34
|
| Rate for Payer: ASR ASR |
$8.10
|
| Rate for Payer: ASR ASR |
$7.71
|
| Rate for Payer: ASR ASR |
$14.40
|
| Rate for Payer: ASR ASR |
$16.71
|
| Rate for Payer: ASR ASR |
$19.35
|
| Rate for Payer: ASR ASR |
$13.44
|
| Rate for Payer: ASR ASR |
$21.63
|
| Rate for Payer: ASR ASR |
$12.72
|
| Rate for Payer: ASR ASR |
$15.13
|
| Rate for Payer: ASR ASR |
$13.62
|
| Rate for Payer: ASR ASR |
$10.57
|
| Rate for Payer: ASR ASR |
$11.83
|
| Rate for Payer: ASR ASR |
$10.35
|
| Rate for Payer: ASR ASR |
$11.79
|
| Rate for Payer: ASR Commercial |
$15.13
|
| Rate for Payer: ASR Commercial |
$14.40
|
| Rate for Payer: ASR Commercial |
$10.35
|
| Rate for Payer: ASR Commercial |
$11.83
|
| Rate for Payer: ASR Commercial |
$11.79
|
| Rate for Payer: ASR Commercial |
$10.57
|
| Rate for Payer: ASR Commercial |
$8.10
|
| Rate for Payer: ASR Commercial |
$7.71
|
| Rate for Payer: ASR Commercial |
$27.34
|
| Rate for Payer: ASR Commercial |
$21.67
|
| Rate for Payer: ASR Commercial |
$12.72
|
| Rate for Payer: ASR Commercial |
$21.63
|
| Rate for Payer: ASR Commercial |
$13.44
|
| Rate for Payer: ASR Commercial |
$19.35
|
| Rate for Payer: ASR Commercial |
$16.71
|
| Rate for Payer: ASR Commercial |
$13.62
|
| Rate for Payer: BCBS Complete |
$6.24
|
| Rate for Payer: BCBS Complete |
$6.89
|
| Rate for Payer: BCBS Complete |
$8.94
|
| Rate for Payer: BCBS Complete |
$5.54
|
| Rate for Payer: BCBS Complete |
$3.34
|
| Rate for Payer: BCBS Complete |
$4.36
|
| Rate for Payer: BCBS Complete |
$3.18
|
| Rate for Payer: BCBS Complete |
$4.86
|
| Rate for Payer: BCBS Complete |
$4.88
|
| Rate for Payer: BCBS Complete |
$5.24
|
| Rate for Payer: BCBS Complete |
$11.28
|
| Rate for Payer: BCBS Complete |
$8.92
|
| Rate for Payer: BCBS Complete |
$5.62
|
| Rate for Payer: BCBS Complete |
$4.27
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS Trust/PPO |
$12.16
|
| Rate for Payer: BCBS Trust/PPO |
$10.74
|
| Rate for Payer: BCBS Trust/PPO |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$6.51
|
| Rate for Payer: BCBS Trust/PPO |
$11.35
|
| Rate for Payer: BCBS Trust/PPO |
$23.08
|
| Rate for Payer: BCBS Trust/PPO |
$14.11
|
| Rate for Payer: BCBS Trust/PPO |
$9.95
|
| Rate for Payer: BCBS Trust/PPO |
$12.77
|
| Rate for Payer: BCBS Trust/PPO |
$8.74
|
| Rate for Payer: BCBS Trust/PPO |
$9.99
|
| Rate for Payer: BCBS Trust/PPO |
$11.50
|
| Rate for Payer: BCBS Trust/PPO |
$18.26
|
| Rate for Payer: BCBS Trust/PPO |
$8.93
|
| Rate for Payer: BCBS Trust/PPO |
$18.29
|
| Rate for Payer: BCBS Trust/PPO |
$6.84
|
| Rate for Payer: BCN Commercial |
$10.89
|
| Rate for Payer: BCN Commercial |
$17.32
|
| Rate for Payer: BCN Commercial |
$6.47
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: BCN Commercial |
$10.16
|
| Rate for Payer: BCN Commercial |
$17.29
|
| Rate for Payer: BCN Commercial |
$15.47
|
| Rate for Payer: BCN Commercial |
$12.09
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: BCN Commercial |
$9.42
|
| Rate for Payer: BCN Commercial |
$8.27
|
| Rate for Payer: BCN Commercial |
$13.36
|
| Rate for Payer: BCN Commercial |
$8.45
|
| Rate for Payer: BCN Commercial |
$11.51
|
| Rate for Payer: BCN Commercial |
$6.16
|
| Rate for Payer: BCN Commercial |
$21.86
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cash Price |
$10.49
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cash Price |
$13.78
|
| Rate for Payer: Cash Price |
$6.36
|
| Rate for Payer: Cash Price |
$11.09
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cofinity Commercial |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$10.03
|
| Rate for Payer: Cofinity Commercial |
$10.25
|
| Rate for Payer: Cofinity Commercial |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$12.32
|
| Rate for Payer: Cofinity Commercial |
$7.85
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$13.20
|
| Rate for Payer: Cofinity Commercial |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$18.75
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Cofinity Commercial |
$7.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.23
|
| Rate for Payer: Healthscope Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$28.19
|
| Rate for Payer: Healthscope Commercial |
$12.20
|
| Rate for Payer: Healthscope Commercial |
$14.04
|
| Rate for Payer: Healthscope Commercial |
$15.60
|
| Rate for Payer: Healthscope Commercial |
$8.35
|
| Rate for Payer: Healthscope Commercial |
$10.90
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Healthscope Commercial |
$14.85
|
| Rate for Payer: Healthscope Commercial |
$10.67
|
| Rate for Payer: Healthscope Commercial |
$19.95
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Healthscope Commercial |
$22.30
|
| Rate for Payer: Healthscope Commercial |
$7.95
|
| Rate for Payer: Healthscope Commercial |
$22.34
|
| Rate for Payer: Healthscope Whirlpool |
$21.67
|
| Rate for Payer: Healthscope Whirlpool |
$15.13
|
| Rate for Payer: Healthscope Whirlpool |
$7.71
|
| Rate for Payer: Healthscope Whirlpool |
$14.40
|
| Rate for Payer: Healthscope Whirlpool |
$10.35
|
| Rate for Payer: Healthscope Whirlpool |
$13.62
|
| Rate for Payer: Healthscope Whirlpool |
$27.34
|
| Rate for Payer: Healthscope Whirlpool |
$16.71
|
| Rate for Payer: Healthscope Whirlpool |
$21.63
|
| Rate for Payer: Healthscope Whirlpool |
$19.35
|
| Rate for Payer: Healthscope Whirlpool |
$12.72
|
| Rate for Payer: Healthscope Whirlpool |
$11.83
|
| Rate for Payer: Healthscope Whirlpool |
$10.57
|
| Rate for Payer: Healthscope Whirlpool |
$11.79
|
| Rate for Payer: Healthscope Whirlpool |
$8.10
|
| Rate for Payer: Healthscope Whirlpool |
$13.44
|
| Rate for Payer: Mclaren Commercial |
$9.81
|
| Rate for Payer: Mclaren Commercial |
$25.37
|
| Rate for Payer: Mclaren Commercial |
$14.04
|
| Rate for Payer: Mclaren Commercial |
$11.80
|
| Rate for Payer: Mclaren Commercial |
$12.47
|
| Rate for Payer: Mclaren Commercial |
$20.07
|
| Rate for Payer: Mclaren Commercial |
$15.51
|
| Rate for Payer: Mclaren Commercial |
$20.11
|
| Rate for Payer: Mclaren Commercial |
$9.60
|
| Rate for Payer: Mclaren Commercial |
$7.52
|
| Rate for Payer: Mclaren Commercial |
$13.36
|
| Rate for Payer: Mclaren Commercial |
$12.64
|
| Rate for Payer: Mclaren Commercial |
$10.98
|
| Rate for Payer: Mclaren Commercial |
$17.96
|
| Rate for Payer: Mclaren Commercial |
$10.94
|
| Rate for Payer: Mclaren Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.26
|
| Rate for Payer: Nomi Health Commercial |
$18.32
|
| Rate for Payer: Nomi Health Commercial |
$10.75
|
| Rate for Payer: Nomi Health Commercial |
$6.85
|
| Rate for Payer: Nomi Health Commercial |
$11.51
|
| Rate for Payer: Nomi Health Commercial |
$6.52
|
| Rate for Payer: Nomi Health Commercial |
$11.37
|
| Rate for Payer: Nomi Health Commercial |
$12.79
|
| Rate for Payer: Nomi Health Commercial |
$12.18
|
| Rate for Payer: Nomi Health Commercial |
$23.12
|
| Rate for Payer: Nomi Health Commercial |
$16.36
|
| Rate for Payer: Nomi Health Commercial |
$9.96
|
| Rate for Payer: Nomi Health Commercial |
$8.75
|
| Rate for Payer: Nomi Health Commercial |
$8.94
|
| Rate for Payer: Nomi Health Commercial |
$10.00
|
| Rate for Payer: Nomi Health Commercial |
$14.13
|
| Rate for Payer: Nomi Health Commercial |
$18.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.67
|
| Rate for Payer: Priority Health Narrow Network |
$15.63
|
| Rate for Payer: Priority Health Narrow Network |
$5.57
|
| Rate for Payer: Priority Health Narrow Network |
$15.66
|
| Rate for Payer: Priority Health Narrow Network |
$13.98
|
| Rate for Payer: Priority Health Narrow Network |
$12.08
|
| Rate for Payer: Priority Health Narrow Network |
$8.55
|
| Rate for Payer: Priority Health Narrow Network |
$9.84
|
| Rate for Payer: Priority Health Narrow Network |
$7.64
|
| Rate for Payer: Priority Health Narrow Network |
$19.76
|
| Rate for Payer: Priority Health Narrow Network |
$10.94
|
| Rate for Payer: Priority Health Narrow Network |
$5.85
|
| Rate for Payer: Priority Health Narrow Network |
$8.52
|
| Rate for Payer: Priority Health Narrow Network |
$7.48
|
| Rate for Payer: Priority Health Narrow Network |
$9.72
|
| Rate for Payer: Priority Health Narrow Network |
$10.41
|
| Rate for Payer: Priority Health Narrow Network |
$9.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.07
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$1.41
|
|
|
Service Code
|
NDC 51079007201
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna Medicare |
$0.71
|
| Rate for Payer: ASR ASR |
$1.37
|
| Rate for Payer: ASR Commercial |
$1.37
|
| Rate for Payer: BCBS Complete |
$0.56
|
| Rate for Payer: BCBS Trust/PPO |
$1.15
|
| Rate for Payer: BCN Commercial |
$1.09
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Cofinity Commercial |
$1.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.13
|
| Rate for Payer: Healthscope Commercial |
$1.41
|
| Rate for Payer: Healthscope Whirlpool |
$1.37
|
| Rate for Payer: Mclaren Commercial |
$1.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.20
|
| Rate for Payer: Nomi Health Commercial |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.24
|
| Rate for Payer: Priority Health Narrow Network |
$0.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.24
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$129.25
|
|
|
Service Code
|
NDC 00904717761
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.01 |
| Max. Negotiated Rate |
$129.25 |
| Rate for Payer: Aetna Commercial |
$116.32
|
| Rate for Payer: ASR ASR |
$125.37
|
| Rate for Payer: ASR Commercial |
$125.37
|
| Rate for Payer: BCBS Trust/PPO |
$105.33
|
| Rate for Payer: BCN Commercial |
$100.21
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$121.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$129.25
|
| Rate for Payer: Healthscope Whirlpool |
$125.37
|
| Rate for Payer: Mclaren Commercial |
$116.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.86
|
| Rate for Payer: Nomi Health Commercial |
$105.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.74
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$1.41
|
|
|
Service Code
|
NDC 51079007201
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: ASR ASR |
$1.37
|
| Rate for Payer: ASR Commercial |
$1.37
|
| Rate for Payer: BCBS Trust/PPO |
$1.15
|
| Rate for Payer: BCN Commercial |
$1.09
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Cofinity Commercial |
$1.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.13
|
| Rate for Payer: Healthscope Commercial |
$1.41
|
| Rate for Payer: Healthscope Whirlpool |
$1.37
|
| Rate for Payer: Mclaren Commercial |
$1.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.20
|
| Rate for Payer: Nomi Health Commercial |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.24
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$129.25
|
|
|
Service Code
|
NDC 00904717761
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$129.25 |
| Rate for Payer: Aetna Commercial |
$116.32
|
| Rate for Payer: Aetna Medicare |
$64.62
|
| Rate for Payer: ASR ASR |
$125.37
|
| Rate for Payer: ASR Commercial |
$125.37
|
| Rate for Payer: BCBS Complete |
$51.70
|
| Rate for Payer: BCBS Trust/PPO |
$105.84
|
| Rate for Payer: BCN Commercial |
$100.21
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$121.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$129.25
|
| Rate for Payer: Healthscope Whirlpool |
$125.37
|
| Rate for Payer: Mclaren Commercial |
$116.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.86
|
| Rate for Payer: Nomi Health Commercial |
$105.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.25
|
| Rate for Payer: Priority Health Narrow Network |
$90.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.74
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
IP
|
$1.48
|
|
|
Service Code
|
NDC 51079007301
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.33
|
| Rate for Payer: ASR ASR |
$1.44
|
| Rate for Payer: ASR Commercial |
$1.44
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$1.48
|
| Rate for Payer: Healthscope Whirlpool |
$1.44
|
| Rate for Payer: Mclaren Commercial |
$1.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.26
|
| Rate for Payer: Nomi Health Commercial |
$1.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.30
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
OP
|
$1.48
|
|
|
Service Code
|
NDC 51079007301
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.33
|
| Rate for Payer: Aetna Medicare |
$0.74
|
| Rate for Payer: ASR ASR |
$1.44
|
| Rate for Payer: ASR Commercial |
$1.44
|
| Rate for Payer: BCBS Complete |
$0.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$1.48
|
| Rate for Payer: Healthscope Whirlpool |
$1.44
|
| Rate for Payer: Mclaren Commercial |
$1.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.26
|
| Rate for Payer: Nomi Health Commercial |
$1.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.30
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
IP
|
$72.85
|
|
|
Service Code
|
NDC 43547040210
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.35 |
| Max. Negotiated Rate |
$72.85 |
| Rate for Payer: Aetna Commercial |
$65.56
|
| Rate for Payer: ASR ASR |
$70.66
|
| Rate for Payer: ASR Commercial |
$70.66
|
| Rate for Payer: BCBS Trust/PPO |
$59.37
|
| Rate for Payer: BCN Commercial |
$56.48
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Commercial |
$68.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$72.85
|
| Rate for Payer: Healthscope Whirlpool |
$70.66
|
| Rate for Payer: Mclaren Commercial |
$65.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: Nomi Health Commercial |
$59.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.11
|
|
