|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$330.24
|
|
|
Service Code
|
NDC 00904671839
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.10 |
| Max. Negotiated Rate |
$330.24 |
| Rate for Payer: Aetna Commercial |
$297.22
|
| Rate for Payer: Aetna Medicare |
$165.12
|
| Rate for Payer: ASR ASR |
$320.33
|
| Rate for Payer: ASR Commercial |
$320.33
|
| Rate for Payer: BCBS Complete |
$132.10
|
| Rate for Payer: BCBS Trust/PPO |
$270.43
|
| Rate for Payer: BCN Commercial |
$256.04
|
| Rate for Payer: Cash Price |
$264.19
|
| Rate for Payer: Cofinity Commercial |
$310.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.19
|
| Rate for Payer: Healthscope Commercial |
$330.24
|
| Rate for Payer: Healthscope Whirlpool |
$320.33
|
| Rate for Payer: Mclaren Commercial |
$297.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.70
|
| Rate for Payer: Nomi Health Commercial |
$270.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.36
|
| Rate for Payer: Priority Health Narrow Network |
$231.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$290.61
|
|
|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN
|
Facility
|
IP
|
$51.02
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
11931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.16 |
| Max. Negotiated Rate |
$51.02 |
| Rate for Payer: Aetna Commercial |
$45.92
|
| Rate for Payer: ASR ASR |
$49.49
|
| Rate for Payer: ASR Commercial |
$49.49
|
| Rate for Payer: BCBS Trust/PPO |
$41.58
|
| Rate for Payer: BCN Commercial |
$39.56
|
| Rate for Payer: Cash Price |
$40.82
|
| Rate for Payer: Cofinity Commercial |
$47.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.82
|
| Rate for Payer: Healthscope Commercial |
$51.02
|
| Rate for Payer: Healthscope Whirlpool |
$49.49
|
| Rate for Payer: Mclaren Commercial |
$45.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.37
|
| Rate for Payer: Nomi Health Commercial |
$41.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.90
|
|
|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN
|
Facility
|
OP
|
$51.02
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
11931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$51.02 |
| Rate for Payer: Aetna Commercial |
$45.92
|
| Rate for Payer: Aetna Medicare |
$25.51
|
| Rate for Payer: ASR ASR |
$49.49
|
| Rate for Payer: ASR Commercial |
$49.49
|
| Rate for Payer: BCBS Complete |
$20.41
|
| Rate for Payer: BCBS Trust/PPO |
$41.78
|
| Rate for Payer: BCN Commercial |
$39.56
|
| Rate for Payer: Cash Price |
$40.82
|
| Rate for Payer: Cash Price |
$40.82
|
| Rate for Payer: Cofinity Commercial |
$47.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.82
|
| Rate for Payer: Healthscope Commercial |
$51.02
|
| Rate for Payer: Healthscope Whirlpool |
$49.49
|
| Rate for Payer: Mclaren Commercial |
$45.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.37
|
| Rate for Payer: Nomi Health Commercial |
$41.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.87
|
| Rate for Payer: Priority Health Narrow Network |
$11.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.90
|
|
|
HAIR REMOVAL
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 00170
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
|
|
HALOPERIDOL 0.5 MG TABLET
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
NDC 51079073301
|
| Hospital Charge Code |
3578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: ASR ASR |
$2.81
|
| Rate for Payer: ASR Commercial |
$2.81
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Healthscope Commercial |
$2.90
|
| Rate for Payer: Healthscope Whirlpool |
$2.81
|
| Rate for Payer: Mclaren Commercial |
$2.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Nomi Health Commercial |
$2.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.55
|
|
|
HALOPERIDOL 0.5 MG TABLET
|
Facility
|
OP
|
$229.90
|
|
|
Service Code
|
NDC 00904738961
|
| Hospital Charge Code |
3578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Aetna Commercial |
$206.91
|
| Rate for Payer: Aetna Medicare |
$114.95
|
| Rate for Payer: ASR ASR |
$223.00
|
| Rate for Payer: ASR Commercial |
$223.00
|
| Rate for Payer: BCBS Complete |
$91.96
|
| Rate for Payer: BCBS Trust/PPO |
$188.27
|
| Rate for Payer: BCN Commercial |
$178.24
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$216.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$229.90
|
| Rate for Payer: Healthscope Whirlpool |
$223.00
|
| Rate for Payer: Mclaren Commercial |
$206.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.42
|
| Rate for Payer: Nomi Health Commercial |
$188.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.44
|
| Rate for Payer: Priority Health Narrow Network |
$161.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.31
|
|
|
HALOPERIDOL 0.5 MG TABLET
|
Facility
|
OP
|
$289.75
|
|
|
Service Code
|
NDC 51079073320
|
| Hospital Charge Code |
3578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.90 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Aetna Commercial |
$260.78
|
| Rate for Payer: Aetna Medicare |
$144.88
|
| Rate for Payer: ASR ASR |
$281.06
|
| Rate for Payer: ASR Commercial |
$281.06
|
| Rate for Payer: BCBS Complete |
$115.90
|
| Rate for Payer: BCBS Trust/PPO |
$237.28
|
| Rate for Payer: BCN Commercial |
$224.64
|
| Rate for Payer: Cash Price |
$231.80
|
| Rate for Payer: Cofinity Commercial |
$272.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.80
|
| Rate for Payer: Healthscope Commercial |
$289.75
|
| Rate for Payer: Healthscope Whirlpool |
$281.06
|
| Rate for Payer: Mclaren Commercial |
$260.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.29
|
| Rate for Payer: Nomi Health Commercial |
$237.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.88
|
| Rate for Payer: Priority Health Narrow Network |
$203.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.98
|
|
|
HALOPERIDOL 0.5 MG TABLET
|
Facility
|
IP
|
$289.75
|
|
|
Service Code
|
NDC 51079073320
|
| Hospital Charge Code |
3578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.34 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Aetna Commercial |
$260.78
|
| Rate for Payer: ASR ASR |
$281.06
|
| Rate for Payer: ASR Commercial |
$281.06
|
| Rate for Payer: BCBS Trust/PPO |
$236.12
|
| Rate for Payer: BCN Commercial |
$224.64
|
| Rate for Payer: Cash Price |
$231.80
|
| Rate for Payer: Cofinity Commercial |
$272.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.80
|
| Rate for Payer: Healthscope Commercial |
$289.75
|
| Rate for Payer: Healthscope Whirlpool |
$281.06
|
| Rate for Payer: Mclaren Commercial |
$260.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.29
|
| Rate for Payer: Nomi Health Commercial |
$237.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.98
|
|
|
HALOPERIDOL 0.5 MG TABLET
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
NDC 51079073301
|
| Hospital Charge Code |
3578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: Aetna Medicare |
$1.45
|
| Rate for Payer: ASR ASR |
$2.81
|
| Rate for Payer: ASR Commercial |
$2.81
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCN Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Healthscope Commercial |
$2.90
|
| Rate for Payer: Healthscope Whirlpool |
$2.81
|
| Rate for Payer: Mclaren Commercial |
$2.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Nomi Health Commercial |
$2.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.54
|
| Rate for Payer: Priority Health Narrow Network |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.55
|
|
|
HALOPERIDOL 0.5 MG TABLET
|
Facility
|
IP
|
$229.90
|
|
|
Service Code
|
NDC 00904738961
|
| Hospital Charge Code |
3578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.44 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Aetna Commercial |
$206.91
|
| Rate for Payer: ASR ASR |
$223.00
|
| Rate for Payer: ASR Commercial |
$223.00
|
| Rate for Payer: BCBS Trust/PPO |
$187.35
|
| Rate for Payer: BCN Commercial |
$178.24
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$216.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$229.90
|
| Rate for Payer: Healthscope Whirlpool |
$223.00
|
| Rate for Payer: Mclaren Commercial |
$206.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.42
|
| Rate for Payer: Nomi Health Commercial |
$188.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.31
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$2.74
|
|
|
Service Code
|
NDC 51079073601
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: ASR ASR |
$2.66
|
| Rate for Payer: ASR Commercial |
$2.66
|
| Rate for Payer: BCBS Trust/PPO |
$2.23
|
| Rate for Payer: BCN Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Healthscope Whirlpool |
$2.66
|
| Rate for Payer: Mclaren Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: Nomi Health Commercial |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.41
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$415.15
|
|
|
Service Code
|
NDC 00904678261
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.06 |
| Max. Negotiated Rate |
$415.15 |
| Rate for Payer: Aetna Commercial |
$373.64
|
| Rate for Payer: Aetna Medicare |
$207.58
|
| Rate for Payer: ASR ASR |
$402.70
|
| Rate for Payer: ASR Commercial |
$402.70
|
| Rate for Payer: BCBS Complete |
$166.06
|
| Rate for Payer: BCBS Trust/PPO |
$339.97
|
| Rate for Payer: BCN Commercial |
$321.87
|
| Rate for Payer: Cash Price |
$332.12
|
| Rate for Payer: Cofinity Commercial |
$390.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.12
|
| Rate for Payer: Healthscope Commercial |
$415.15
|
| Rate for Payer: Healthscope Whirlpool |
$402.70
|
| Rate for Payer: Mclaren Commercial |
$373.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.88
|
| Rate for Payer: Nomi Health Commercial |
$340.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$363.75
|
| Rate for Payer: Priority Health Narrow Network |
$291.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$365.33
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$425.60
|
|
|
Service Code
|
NDC 68382007901
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.64 |
| Max. Negotiated Rate |
$425.60 |
| Rate for Payer: Aetna Commercial |
$383.04
|
| Rate for Payer: ASR ASR |
$412.83
|
| Rate for Payer: ASR Commercial |
$412.83
|
| Rate for Payer: BCBS Trust/PPO |
$346.82
|
| Rate for Payer: BCN Commercial |
$329.97
|
| Rate for Payer: Cash Price |
$340.48
|
| Rate for Payer: Cofinity Commercial |
$400.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.48
|
| Rate for Payer: Healthscope Commercial |
$425.60
|
| Rate for Payer: Healthscope Whirlpool |
$412.83
|
| Rate for Payer: Mclaren Commercial |
$383.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.76
|
| Rate for Payer: Nomi Health Commercial |
$348.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$374.53
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$425.60
|
|
|
Service Code
|
NDC 68382007901
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.24 |
| Max. Negotiated Rate |
$425.60 |
| Rate for Payer: Aetna Commercial |
$383.04
|
| Rate for Payer: Aetna Medicare |
$212.80
|
| Rate for Payer: ASR ASR |
$412.83
|
| Rate for Payer: ASR Commercial |
$412.83
|
| Rate for Payer: BCBS Complete |
$170.24
|
| Rate for Payer: BCBS Trust/PPO |
$348.52
|
| Rate for Payer: BCN Commercial |
$329.97
|
| Rate for Payer: Cash Price |
$340.48
|
| Rate for Payer: Cofinity Commercial |
$400.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.48
|
| Rate for Payer: Healthscope Commercial |
$425.60
|
| Rate for Payer: Healthscope Whirlpool |
$412.83
|
| Rate for Payer: Mclaren Commercial |
$383.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.76
|
| Rate for Payer: Nomi Health Commercial |
$348.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$372.91
|
| Rate for Payer: Priority Health Narrow Network |
$298.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$374.53
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$415.15
|
|
|
Service Code
|
NDC 00904678261
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.85 |
| Max. Negotiated Rate |
$415.15 |
| Rate for Payer: Aetna Commercial |
$373.64
|
| Rate for Payer: ASR ASR |
$402.70
|
| Rate for Payer: ASR Commercial |
$402.70
|
| Rate for Payer: BCBS Trust/PPO |
$338.31
|
| Rate for Payer: BCN Commercial |
$321.87
|
| Rate for Payer: Cash Price |
$332.12
|
| Rate for Payer: Cofinity Commercial |
$390.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.12
|
| Rate for Payer: Healthscope Commercial |
$415.15
|
| Rate for Payer: Healthscope Whirlpool |
$402.70
|
| Rate for Payer: Mclaren Commercial |
$373.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.88
|
| Rate for Payer: Nomi Health Commercial |
$340.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$365.33
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$2.74
|
|
|
Service Code
|
NDC 51079073601
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: ASR ASR |
$2.66
|
| Rate for Payer: ASR Commercial |
$2.66
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Healthscope Whirlpool |
$2.66
|
| Rate for Payer: Mclaren Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: Nomi Health Commercial |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.40
|
| Rate for Payer: Priority Health Narrow Network |
$1.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.41
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$107.14
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.64 |
| Max. Negotiated Rate |
$107.14 |
| Rate for Payer: Aetna Commercial |
$96.43
|
| Rate for Payer: ASR ASR |
$103.93
|
| Rate for Payer: ASR Commercial |
$103.93
|
| Rate for Payer: BCBS Trust/PPO |
$87.31
|
| Rate for Payer: BCN Commercial |
$83.07
|
| Rate for Payer: Cash Price |
$85.71
|
| Rate for Payer: Cofinity Commercial |
$100.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.71
|
| Rate for Payer: Healthscope Commercial |
$107.14
|
| Rate for Payer: Healthscope Whirlpool |
$103.93
|
| Rate for Payer: Mclaren Commercial |
$96.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.07
|
| Rate for Payer: Nomi Health Commercial |
$87.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.28
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$107.14
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$107.14 |
| Rate for Payer: Aetna Commercial |
$96.43
|
| Rate for Payer: Aetna Medicare |
$53.57
|
| Rate for Payer: ASR ASR |
$103.93
|
| Rate for Payer: ASR Commercial |
$103.93
|
| Rate for Payer: BCBS Complete |
$42.86
|
| Rate for Payer: BCBS Trust/PPO |
$87.74
|
| Rate for Payer: BCN Commercial |
$83.07
|
| Rate for Payer: Cash Price |
$85.71
|
| Rate for Payer: Cash Price |
$85.71
|
| Rate for Payer: Cofinity Commercial |
$100.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.71
|
| Rate for Payer: Healthscope Commercial |
$107.14
|
| Rate for Payer: Healthscope Whirlpool |
$103.93
|
| Rate for Payer: Mclaren Commercial |
$96.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.07
|
| Rate for Payer: Nomi Health Commercial |
$87.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.79
|
| Rate for Payer: Priority Health Narrow Network |
$3.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.28
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$23.27
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
3584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$23.27 |
| Rate for Payer: Aetna Commercial |
$20.94
|
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: Aetna Commercial |
$10.67
|
| Rate for Payer: Aetna Medicare |
$8.60
|
| Rate for Payer: Aetna Medicare |
$5.33
|
| Rate for Payer: Aetna Medicare |
$5.93
|
| Rate for Payer: Aetna Medicare |
$11.64
|
| Rate for Payer: ASR ASR |
$10.34
|
| Rate for Payer: ASR ASR |
$11.50
|
| Rate for Payer: ASR ASR |
$16.68
|
| Rate for Payer: ASR ASR |
$22.57
|
| Rate for Payer: ASR Commercial |
$10.34
|
| Rate for Payer: ASR Commercial |
$16.68
|
| Rate for Payer: ASR Commercial |
$22.57
|
| Rate for Payer: ASR Commercial |
$11.50
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Complete |
$9.31
|
| Rate for Payer: BCBS Complete |
$4.26
|
| Rate for Payer: BCBS Complete |
$4.74
|
| Rate for Payer: BCBS Trust/PPO |
$19.06
|
| Rate for Payer: BCBS Trust/PPO |
$9.71
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| Rate for Payer: BCBS Trust/PPO |
$14.09
|
| Rate for Payer: BCN Commercial |
$8.26
|
| Rate for Payer: BCN Commercial |
$18.04
|
| Rate for Payer: BCN Commercial |
$9.20
|
| Rate for Payer: BCN Commercial |
$13.34
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cash Price |
$8.53
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cash Price |
$8.53
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cofinity Commercial |
$11.15
|
| Rate for Payer: Cofinity Commercial |
$10.02
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$21.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.53
|
| Rate for Payer: Healthscope Commercial |
$23.27
|
| Rate for Payer: Healthscope Commercial |
$11.86
|
| Rate for Payer: Healthscope Commercial |
$10.66
|
| Rate for Payer: Healthscope Commercial |
$17.20
|
| Rate for Payer: Healthscope Whirlpool |
$11.50
|
| Rate for Payer: Healthscope Whirlpool |
$10.34
|
| Rate for Payer: Healthscope Whirlpool |
$16.68
|
| Rate for Payer: Healthscope Whirlpool |
$22.57
|
| Rate for Payer: Mclaren Commercial |
$15.48
|
| Rate for Payer: Mclaren Commercial |
$20.94
|
| Rate for Payer: Mclaren Commercial |
$9.59
|
| Rate for Payer: Mclaren Commercial |
$10.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.78
|
| Rate for Payer: Nomi Health Commercial |
$9.73
|
| Rate for Payer: Nomi Health Commercial |
$14.10
|
| Rate for Payer: Nomi Health Commercial |
$19.08
|
| Rate for Payer: Nomi Health Commercial |
$8.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.81
|
| Rate for Payer: Priority Health Narrow Network |
$0.65
|
| Rate for Payer: Priority Health Narrow Network |
$0.65
|
| Rate for Payer: Priority Health Narrow Network |
$0.65
|
| Rate for Payer: Priority Health Narrow Network |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.44
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$17.20
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
3584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$17.20 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$10.67
|
| Rate for Payer: Aetna Commercial |
$20.94
|
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: ASR ASR |
$10.34
|
| Rate for Payer: ASR ASR |
$16.68
|
| Rate for Payer: ASR ASR |
$11.50
|
| Rate for Payer: ASR ASR |
$22.57
|
| Rate for Payer: ASR Commercial |
$16.68
|
| Rate for Payer: ASR Commercial |
$22.57
|
| Rate for Payer: ASR Commercial |
$11.50
|
| Rate for Payer: ASR Commercial |
$10.34
|
| Rate for Payer: BCBS Trust/PPO |
$18.96
|
| Rate for Payer: BCBS Trust/PPO |
$8.69
|
| Rate for Payer: BCBS Trust/PPO |
$9.66
|
| Rate for Payer: BCBS Trust/PPO |
$14.02
|
| Rate for Payer: BCN Commercial |
$18.04
|
| Rate for Payer: BCN Commercial |
$8.26
|
| Rate for Payer: BCN Commercial |
$13.34
|
| Rate for Payer: BCN Commercial |
$9.20
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cash Price |
$8.53
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$11.15
|
| Rate for Payer: Cofinity Commercial |
$21.87
|
| Rate for Payer: Cofinity Commercial |
$10.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.76
|
| Rate for Payer: Healthscope Commercial |
$11.86
|
| Rate for Payer: Healthscope Commercial |
$10.66
|
| Rate for Payer: Healthscope Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$23.27
|
| Rate for Payer: Healthscope Whirlpool |
$22.57
|
| Rate for Payer: Healthscope Whirlpool |
$11.50
|
| Rate for Payer: Healthscope Whirlpool |
$16.68
|
| Rate for Payer: Healthscope Whirlpool |
$10.34
|
| Rate for Payer: Mclaren Commercial |
$15.48
|
| Rate for Payer: Mclaren Commercial |
$20.94
|
| Rate for Payer: Mclaren Commercial |
$10.67
|
| Rate for Payer: Mclaren Commercial |
$9.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.06
|
| Rate for Payer: Nomi Health Commercial |
$8.74
|
| Rate for Payer: Nomi Health Commercial |
$19.08
|
| Rate for Payer: Nomi Health Commercial |
$14.10
|
| Rate for Payer: Nomi Health Commercial |
$9.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.38
|
|
|
HC 11 DEOXYCORTISOL
|
Facility
|
OP
|
$65.55
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
30100189
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.69 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$59.00
|
| Rate for Payer: Aetna Medicare |
$29.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.60
|
| Rate for Payer: ASR ASR |
$63.58
|
| Rate for Payer: ASR Commercial |
$63.58
|
| Rate for Payer: BCBS Complete |
$16.48
|
| Rate for Payer: BCBS MAPPO |
$29.28
|
| Rate for Payer: BCBS Trust/PPO |
$53.68
|
| Rate for Payer: BCN Commercial |
$50.82
|
| Rate for Payer: BCN Medicare Advantage |
$29.28
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$61.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.28
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Healthscope Whirlpool |
$63.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.28
|
| Rate for Payer: Mclaren Commercial |
$59.00
|
| Rate for Payer: Mclaren Medicaid |
$15.69
|
| Rate for Payer: Mclaren Medicare |
$29.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.74
|
| Rate for Payer: Meridian Medicaid |
$16.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.72
|
| Rate for Payer: Nomi Health Commercial |
$53.75
|
| Rate for Payer: PACE Medicare |
$27.82
|
| Rate for Payer: PACE SWMI |
$29.28
|
| Rate for Payer: PHP Commercial |
$32.21
|
| Rate for Payer: PHP Medicaid |
$15.69
|
| Rate for Payer: PHP Medicare Advantage |
$29.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.43
|
| Rate for Payer: Priority Health Medicare |
$29.28
|
| Rate for Payer: Priority Health Narrow Network |
$45.95
|
| Rate for Payer: Railroad Medicare Medicare |
$29.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.28
|
| Rate for Payer: UHC Exchange |
$45.38
|
| Rate for Payer: UHC Medicare Advantage |
$29.28
|
| Rate for Payer: UHCCP DNSP |
$29.28
|
| Rate for Payer: UHCCP Medicaid |
$15.69
|
| Rate for Payer: VA VA |
$29.28
|
|
|
HC 11 DEOXYCORTISOL
|
Facility
|
IP
|
$65.55
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
30100189
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$59.00
|
| Rate for Payer: ASR ASR |
$63.58
|
| Rate for Payer: ASR Commercial |
$63.58
|
| Rate for Payer: BCBS Trust/PPO |
$53.42
|
| Rate for Payer: BCN Commercial |
$50.82
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$61.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.44
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Healthscope Whirlpool |
$63.58
|
| Rate for Payer: Mclaren Commercial |
$59.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.72
|
| Rate for Payer: Nomi Health Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.68
|
|
|
HC 1/2 X 1/2 STERILE W/LL
|
Facility
|
IP
|
$6.89
|
|
| Hospital Charge Code |
27000680
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$6.89 |
| Rate for Payer: Aetna Commercial |
$6.20
|
| Rate for Payer: ASR ASR |
$6.68
|
| Rate for Payer: ASR Commercial |
$6.68
|
| Rate for Payer: BCBS Trust/PPO |
$5.61
|
| Rate for Payer: BCN Commercial |
$5.34
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cofinity Commercial |
$6.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.51
|
| Rate for Payer: Healthscope Commercial |
$6.89
|
| Rate for Payer: Healthscope Whirlpool |
$6.68
|
| Rate for Payer: Mclaren Commercial |
$6.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.86
|
| Rate for Payer: Nomi Health Commercial |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.06
|
|
|
HC 1/2 X 1/2 STERILE W/LL
|
Facility
|
OP
|
$6.89
|
|
| Hospital Charge Code |
27000680
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$6.89 |
| Rate for Payer: Aetna Commercial |
$6.20
|
| Rate for Payer: Aetna Medicare |
$3.44
|
| Rate for Payer: ASR ASR |
$6.68
|
| Rate for Payer: ASR Commercial |
$6.68
|
| Rate for Payer: BCBS Complete |
$2.76
|
| Rate for Payer: BCBS Trust/PPO |
$5.64
|
| Rate for Payer: BCN Commercial |
$5.34
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cofinity Commercial |
$6.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.51
|
| Rate for Payer: Healthscope Commercial |
$6.89
|
| Rate for Payer: Healthscope Whirlpool |
$6.68
|
| Rate for Payer: Mclaren Commercial |
$6.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.86
|
| Rate for Payer: Nomi Health Commercial |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.04
|
| Rate for Payer: Priority Health Narrow Network |
$4.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.06
|
|
|
HC 20CM TL CATHETER
|
Facility
|
IP
|
$278.41
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.97 |
| Max. Negotiated Rate |
$278.41 |
| Rate for Payer: Aetna Commercial |
$250.57
|
| Rate for Payer: ASR ASR |
$270.06
|
| Rate for Payer: ASR Commercial |
$270.06
|
| Rate for Payer: BCBS Trust/PPO |
$226.88
|
| Rate for Payer: BCN Commercial |
$215.85
|
| Rate for Payer: Cash Price |
$222.73
|
| Rate for Payer: Cofinity Commercial |
$261.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.73
|
| Rate for Payer: Healthscope Commercial |
$278.41
|
| Rate for Payer: Healthscope Whirlpool |
$270.06
|
| Rate for Payer: Mclaren Commercial |
$250.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.65
|
| Rate for Payer: Nomi Health Commercial |
$228.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.00
|
|
