|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.06
|
|
|
Service Code
|
NDC 81033010251
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$7.06 |
| Rate for Payer: Aetna Commercial |
$6.35
|
| Rate for Payer: ASR ASR |
$6.85
|
| Rate for Payer: ASR Commercial |
$6.85
|
| Rate for Payer: BCBS Trust/PPO |
$5.75
|
| Rate for Payer: BCN Commercial |
$5.47
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.65
|
| Rate for Payer: Healthscope Commercial |
$7.06
|
| Rate for Payer: Healthscope Whirlpool |
$6.85
|
| Rate for Payer: Mclaren Commercial |
$6.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Nomi Health Commercial |
$5.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.21
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.78
|
|
|
Service Code
|
NDC 00121174405
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.00
|
| Rate for Payer: Aetna Medicare |
$3.89
|
| Rate for Payer: ASR ASR |
$7.55
|
| Rate for Payer: ASR Commercial |
$7.55
|
| Rate for Payer: BCBS Complete |
$3.11
|
| Rate for Payer: BCBS Trust/PPO |
$6.37
|
| Rate for Payer: BCN Commercial |
$6.03
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Healthscope Whirlpool |
$7.55
|
| Rate for Payer: Mclaren Commercial |
$7.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.61
|
| Rate for Payer: Nomi Health Commercial |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.82
|
| Rate for Payer: Priority Health Narrow Network |
$5.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.85
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.78
|
|
|
Service Code
|
NDC 00121174405
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.00
|
| Rate for Payer: ASR ASR |
$7.55
|
| Rate for Payer: ASR Commercial |
$7.55
|
| Rate for Payer: BCBS Trust/PPO |
$6.34
|
| Rate for Payer: BCN Commercial |
$6.03
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Healthscope Whirlpool |
$7.55
|
| Rate for Payer: Mclaren Commercial |
$7.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.61
|
| Rate for Payer: Nomi Health Commercial |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.85
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
NDC 50383006305
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna Commercial |
$2.39
|
| Rate for Payer: ASR ASR |
$2.58
|
| Rate for Payer: ASR Commercial |
$2.58
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.06
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.66
|
| Rate for Payer: Healthscope Whirlpool |
$2.58
|
| Rate for Payer: Mclaren Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Nomi Health Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.34
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.06
|
|
|
Service Code
|
NDC 81033010205
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$7.06 |
| Rate for Payer: Aetna Commercial |
$6.35
|
| Rate for Payer: ASR ASR |
$6.85
|
| Rate for Payer: ASR Commercial |
$6.85
|
| Rate for Payer: BCBS Trust/PPO |
$5.75
|
| Rate for Payer: BCN Commercial |
$5.47
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.65
|
| Rate for Payer: Healthscope Commercial |
$7.06
|
| Rate for Payer: Healthscope Whirlpool |
$6.85
|
| Rate for Payer: Mclaren Commercial |
$6.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Nomi Health Commercial |
$5.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.21
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.06
|
|
|
Service Code
|
NDC 81033010205
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$7.06 |
| Rate for Payer: Aetna Commercial |
$6.35
|
| Rate for Payer: Aetna Medicare |
$3.53
|
| Rate for Payer: ASR ASR |
$6.85
|
| Rate for Payer: ASR Commercial |
$6.85
|
| Rate for Payer: BCBS Complete |
$2.82
|
| Rate for Payer: BCBS Trust/PPO |
$5.78
|
| Rate for Payer: BCN Commercial |
$5.47
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.65
|
| Rate for Payer: Healthscope Commercial |
$7.06
|
| Rate for Payer: Healthscope Whirlpool |
$6.85
|
| Rate for Payer: Mclaren Commercial |
$6.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Nomi Health Commercial |
$5.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.19
|
| Rate for Payer: Priority Health Narrow Network |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.21
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$330.24
|
|
|
Service Code
|
NDC 00904671839
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.66 |
| Max. Negotiated Rate |
$330.24 |
| Rate for Payer: Aetna Commercial |
$297.22
|
| Rate for Payer: ASR ASR |
$320.33
|
| Rate for Payer: ASR Commercial |
$320.33
|
| Rate for Payer: BCBS Trust/PPO |
$269.11
|
| 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: UHC All Payor (Choice/PPO) + Core |
$290.61
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$269.80
|
|
|
Service Code
|
NDC 63824000815
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.92 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Aetna Commercial |
$242.82
|
| Rate for Payer: Aetna Medicare |
$134.90
|
| Rate for Payer: ASR ASR |
$261.71
|
| Rate for Payer: ASR Commercial |
$261.71
|
| Rate for Payer: BCBS Complete |
$107.92
|
| Rate for Payer: BCBS Trust/PPO |
$220.94
|
| Rate for Payer: BCN Commercial |
$209.18
|
| Rate for Payer: Cash Price |
$215.84
|
| Rate for Payer: Cofinity Commercial |
$253.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.84
|
| Rate for Payer: Healthscope Commercial |
$269.80
|
| Rate for Payer: Healthscope Whirlpool |
$261.71
|
| Rate for Payer: Mclaren Commercial |
$242.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.33
|
| Rate for Payer: Nomi Health Commercial |
$221.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.40
|
| Rate for Payer: Priority Health Narrow Network |
$189.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.42
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$3.63
|
|
|
Service Code
|
NDC 68084057211
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Aetna Medicare |
$1.81
|
| Rate for Payer: ASR ASR |
$3.52
|
| Rate for Payer: ASR Commercial |
$3.52
|
| Rate for Payer: BCBS Complete |
$1.45
|
| Rate for Payer: BCBS Trust/PPO |
$2.97
|
| Rate for Payer: BCN Commercial |
$2.81
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.63
|
| Rate for Payer: Healthscope Whirlpool |
$3.52
|
| Rate for Payer: Mclaren Commercial |
$3.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Nomi Health Commercial |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.18
|
| Rate for Payer: Priority Health Narrow Network |
$2.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.19
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$63.65
|
|
|
Service Code
|
NDC 63824000832
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.46 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna Commercial |
$57.28
|
| Rate for Payer: Aetna Medicare |
$31.82
|
| Rate for Payer: ASR ASR |
$61.74
|
| Rate for Payer: ASR Commercial |
$61.74
|
| Rate for Payer: BCBS Complete |
$25.46
|
| Rate for Payer: BCBS Trust/PPO |
$52.12
|
| Rate for Payer: BCN Commercial |
$49.35
|
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Cofinity Commercial |
$59.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.92
|
| Rate for Payer: Healthscope Commercial |
$63.65
|
| Rate for Payer: Healthscope Whirlpool |
$61.74
|
| Rate for Payer: Mclaren Commercial |
$57.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.10
|
| Rate for Payer: Nomi Health Commercial |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.77
|
| Rate for Payer: Priority Health Narrow Network |
$44.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.01
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$363.36
|
|
|
Service Code
|
NDC 68084057201
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.18 |
| Max. Negotiated Rate |
$363.36 |
| Rate for Payer: Aetna Commercial |
$327.02
|
| Rate for Payer: ASR ASR |
$352.46
|
| Rate for Payer: ASR Commercial |
$352.46
|
| Rate for Payer: BCBS Trust/PPO |
$296.10
|
| Rate for Payer: BCN Commercial |
$281.71
|
| Rate for Payer: Cash Price |
$290.69
|
| Rate for Payer: Cofinity Commercial |
$341.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.69
|
| Rate for Payer: Healthscope Commercial |
$363.36
|
| Rate for Payer: Healthscope Whirlpool |
$352.46
|
| Rate for Payer: Mclaren Commercial |
$327.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.86
|
| Rate for Payer: Nomi Health Commercial |
$297.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.76
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$3.63
|
|
|
Service Code
|
NDC 68084057211
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: ASR ASR |
$3.52
|
| Rate for Payer: ASR Commercial |
$3.52
|
| Rate for Payer: BCBS Trust/PPO |
$2.96
|
| Rate for Payer: BCN Commercial |
$2.81
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.63
|
| Rate for Payer: Healthscope Whirlpool |
$3.52
|
| Rate for Payer: Mclaren Commercial |
$3.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Nomi Health Commercial |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.19
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$363.36
|
|
|
Service Code
|
NDC 68084057201
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.34 |
| Max. Negotiated Rate |
$363.36 |
| Rate for Payer: Aetna Commercial |
$327.02
|
| Rate for Payer: Aetna Medicare |
$181.68
|
| Rate for Payer: ASR ASR |
$352.46
|
| Rate for Payer: ASR Commercial |
$352.46
|
| Rate for Payer: BCBS Complete |
$145.34
|
| Rate for Payer: BCBS Trust/PPO |
$297.56
|
| Rate for Payer: BCN Commercial |
$281.71
|
| Rate for Payer: Cash Price |
$290.69
|
| Rate for Payer: Cofinity Commercial |
$341.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.69
|
| Rate for Payer: Healthscope Commercial |
$363.36
|
| Rate for Payer: Healthscope Whirlpool |
$352.46
|
| Rate for Payer: Mclaren Commercial |
$327.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.86
|
| Rate for Payer: Nomi Health Commercial |
$297.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.38
|
| Rate for Payer: Priority Health Narrow Network |
$254.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.76
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$63.65
|
|
|
Service Code
|
NDC 63824000832
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.37 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna Commercial |
$57.28
|
| Rate for Payer: ASR ASR |
$61.74
|
| Rate for Payer: ASR Commercial |
$61.74
|
| Rate for Payer: BCBS Trust/PPO |
$51.87
|
| Rate for Payer: BCN Commercial |
$49.35
|
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Cofinity Commercial |
$59.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.92
|
| Rate for Payer: Healthscope Commercial |
$63.65
|
| Rate for Payer: Healthscope Whirlpool |
$61.74
|
| Rate for Payer: Mclaren Commercial |
$57.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.10
|
| Rate for Payer: Nomi Health Commercial |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.01
|
|
|
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
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$269.80
|
|
|
Service Code
|
NDC 63824000815
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.37 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Aetna Commercial |
$242.82
|
| Rate for Payer: ASR ASR |
$261.71
|
| Rate for Payer: ASR Commercial |
$261.71
|
| Rate for Payer: BCBS Trust/PPO |
$219.86
|
| Rate for Payer: BCN Commercial |
$209.18
|
| Rate for Payer: Cash Price |
$215.84
|
| Rate for Payer: Cofinity Commercial |
$253.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.84
|
| Rate for Payer: Healthscope Commercial |
$269.80
|
| Rate for Payer: Healthscope Whirlpool |
$261.71
|
| Rate for Payer: Mclaren Commercial |
$242.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.33
|
| Rate for Payer: Nomi Health Commercial |
$221.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.42
|
|
|
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 |
$20.41 |
| 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: 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 |
$44.70
|
| Rate for Payer: Priority Health Narrow Network |
$35.77
|
| 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
|
$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 |
$260.77
|
| 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 |
$272.37
|
| 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 |
$260.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.29
|
| Rate for Payer: Nomi Health Commercial |
$237.59
|
| 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
|
IP
|
$2.90
|
|
|
Service Code
|
NDC 51079073301
|
| Hospital Charge Code |
3578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.89 |
| 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 |
$1.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.55
|
|
|
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 |
$1.89
|
| 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
|
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 |
$195.41
|
| 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
|
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 |
$195.41
|
| 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 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 |
$260.77
|
| 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 |
$272.37
|
| 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 |
$260.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.29
|
| Rate for Payer: Nomi Health Commercial |
$237.59
|
| 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
|
|
