|
ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.64
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
23128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$22.64 |
| Rate for Payer: Aetna Commercial |
$20.38
|
| Rate for Payer: Aetna Commercial |
$18.12
|
| Rate for Payer: Aetna Commercial |
$24.35
|
| Rate for Payer: Aetna Commercial |
$15.45
|
| Rate for Payer: ASR ASR |
$16.65
|
| Rate for Payer: ASR ASR |
$21.96
|
| Rate for Payer: ASR ASR |
$19.53
|
| Rate for Payer: ASR ASR |
$26.25
|
| Rate for Payer: ASR Commercial |
$21.96
|
| Rate for Payer: ASR Commercial |
$26.25
|
| Rate for Payer: ASR Commercial |
$19.53
|
| Rate for Payer: ASR Commercial |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$22.05
|
| Rate for Payer: BCBS Trust/PPO |
$13.99
|
| Rate for Payer: BCBS Trust/PPO |
$16.40
|
| Rate for Payer: BCBS Trust/PPO |
$18.45
|
| Rate for Payer: BCN Commercial |
$20.98
|
| Rate for Payer: BCN Commercial |
$13.31
|
| Rate for Payer: BCN Commercial |
$17.55
|
| Rate for Payer: BCN Commercial |
$15.61
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$13.73
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$21.28
|
| Rate for Payer: Cofinity Commercial |
$18.92
|
| Rate for Payer: Cofinity Commercial |
$25.44
|
| Rate for Payer: Cofinity Commercial |
$16.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.11
|
| Rate for Payer: Healthscope Commercial |
$20.13
|
| Rate for Payer: Healthscope Commercial |
$17.17
|
| Rate for Payer: Healthscope Commercial |
$22.64
|
| Rate for Payer: Healthscope Commercial |
$27.06
|
| Rate for Payer: Healthscope Whirlpool |
$26.25
|
| Rate for Payer: Healthscope Whirlpool |
$19.53
|
| Rate for Payer: Healthscope Whirlpool |
$21.96
|
| Rate for Payer: Healthscope Whirlpool |
$16.65
|
| Rate for Payer: Mclaren Commercial |
$20.38
|
| Rate for Payer: Mclaren Commercial |
$24.35
|
| Rate for Payer: Mclaren Commercial |
$18.12
|
| Rate for Payer: Mclaren Commercial |
$15.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.59
|
| Rate for Payer: Nomi Health Commercial |
$14.08
|
| Rate for Payer: Nomi Health Commercial |
$22.19
|
| Rate for Payer: Nomi Health Commercial |
$18.56
|
| Rate for Payer: Nomi Health Commercial |
$16.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.11
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.74
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
8975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.08 |
| Max. Negotiated Rate |
$24.74 |
| Rate for Payer: Aetna Commercial |
$22.27
|
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna Commercial |
$22.76
|
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: ASR ASR |
$16.74
|
| Rate for Payer: ASR ASR |
$24.00
|
| Rate for Payer: ASR ASR |
$17.50
|
| Rate for Payer: ASR ASR |
$24.53
|
| Rate for Payer: ASR Commercial |
$24.00
|
| Rate for Payer: ASR Commercial |
$24.53
|
| Rate for Payer: ASR Commercial |
$17.50
|
| Rate for Payer: ASR Commercial |
$16.74
|
| Rate for Payer: BCBS Trust/PPO |
$20.61
|
| Rate for Payer: BCBS Trust/PPO |
$14.07
|
| Rate for Payer: BCBS Trust/PPO |
$14.70
|
| Rate for Payer: BCBS Trust/PPO |
$20.16
|
| Rate for Payer: BCN Commercial |
$19.61
|
| Rate for Payer: BCN Commercial |
$13.38
|
| Rate for Payer: BCN Commercial |
$19.18
|
| Rate for Payer: BCN Commercial |
$13.99
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Cash Price |
$20.23
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.79
|
| Rate for Payer: Healthscope Commercial |
$18.04
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Healthscope Commercial |
$24.74
|
| Rate for Payer: Healthscope Commercial |
$25.29
|
| Rate for Payer: Healthscope Whirlpool |
$24.53
|
| Rate for Payer: Healthscope Whirlpool |
$17.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.00
|
| Rate for Payer: Healthscope Whirlpool |
$16.74
|
| Rate for Payer: Mclaren Commercial |
$22.27
|
| Rate for Payer: Mclaren Commercial |
$22.76
|
| Rate for Payer: Mclaren Commercial |
$16.24
|
| Rate for Payer: Mclaren Commercial |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.67
|
| Rate for Payer: Nomi Health Commercial |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$20.74
|
| Rate for Payer: Nomi Health Commercial |
$20.29
|
| Rate for Payer: Nomi Health Commercial |
$14.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.19
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.29
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
8975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$25.29 |
| Rate for Payer: Aetna Commercial |
$22.76
|
| Rate for Payer: Aetna Commercial |
$22.27
|
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna Medicare |
$12.37
|
| Rate for Payer: Aetna Medicare |
$8.63
|
| Rate for Payer: Aetna Medicare |
$9.02
|
| Rate for Payer: Aetna Medicare |
$12.64
|
| Rate for Payer: ASR ASR |
$16.74
|
| Rate for Payer: ASR ASR |
$17.50
|
| Rate for Payer: ASR ASR |
$24.00
|
| Rate for Payer: ASR ASR |
$24.53
|
| Rate for Payer: ASR Commercial |
$16.74
|
| Rate for Payer: ASR Commercial |
$24.00
|
| Rate for Payer: ASR Commercial |
$24.53
|
| Rate for Payer: ASR Commercial |
$17.50
|
| Rate for Payer: BCBS Complete |
$9.90
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: BCBS Complete |
$6.90
|
| Rate for Payer: BCBS Complete |
$7.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.71
|
| Rate for Payer: BCBS Trust/PPO |
$14.77
|
| Rate for Payer: BCBS Trust/PPO |
$14.13
|
| Rate for Payer: BCBS Trust/PPO |
$20.26
|
| Rate for Payer: BCN Commercial |
$13.38
|
| Rate for Payer: BCN Commercial |
$19.61
|
| Rate for Payer: BCN Commercial |
$13.99
|
| Rate for Payer: BCN Commercial |
$19.18
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Cash Price |
$20.23
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Cash Price |
$20.23
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Cofinity Commercial |
$23.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.81
|
| Rate for Payer: Healthscope Commercial |
$25.29
|
| Rate for Payer: Healthscope Commercial |
$18.04
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Healthscope Commercial |
$24.74
|
| Rate for Payer: Healthscope Whirlpool |
$17.50
|
| Rate for Payer: Healthscope Whirlpool |
$16.74
|
| Rate for Payer: Healthscope Whirlpool |
$24.00
|
| Rate for Payer: Healthscope Whirlpool |
$24.53
|
| Rate for Payer: Mclaren Commercial |
$22.27
|
| Rate for Payer: Mclaren Commercial |
$22.76
|
| Rate for Payer: Mclaren Commercial |
$15.53
|
| Rate for Payer: Mclaren Commercial |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Nomi Health Commercial |
$14.79
|
| Rate for Payer: Nomi Health Commercial |
$20.29
|
| Rate for Payer: Nomi Health Commercial |
$20.74
|
| Rate for Payer: Nomi Health Commercial |
$14.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.40
|
| Rate for Payer: Priority Health Narrow Network |
$0.32
|
| Rate for Payer: Priority Health Narrow Network |
$0.32
|
| Rate for Payer: Priority Health Narrow Network |
$0.32
|
| Rate for Payer: Priority Health Narrow Network |
$0.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.88
|
|
|
ADENOSINE 3 MG/ML IV (CODE)
|
Facility
|
IP
|
$22.75
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
163702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.79 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: ASR ASR |
$22.07
|
| Rate for Payer: ASR ASR |
$17.50
|
| Rate for Payer: ASR Commercial |
$17.50
|
| Rate for Payer: ASR Commercial |
$22.07
|
| Rate for Payer: BCBS Trust/PPO |
$14.70
|
| Rate for Payer: BCBS Trust/PPO |
$18.54
|
| Rate for Payer: BCN Commercial |
$17.64
|
| Rate for Payer: BCN Commercial |
$13.99
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.20
|
| Rate for Payer: Healthscope Commercial |
$18.04
|
| Rate for Payer: Healthscope Commercial |
$22.75
|
| Rate for Payer: Healthscope Whirlpool |
$17.50
|
| Rate for Payer: Healthscope Whirlpool |
$22.07
|
| Rate for Payer: Mclaren Commercial |
$16.24
|
| Rate for Payer: Mclaren Commercial |
$20.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.34
|
| Rate for Payer: Nomi Health Commercial |
$14.79
|
| Rate for Payer: Nomi Health Commercial |
$18.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.02
|
|
|
ADENOSINE 3 MG/ML IV (CODE)
|
Facility
|
OP
|
$22.75
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
163702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna Medicare |
$9.02
|
| Rate for Payer: Aetna Medicare |
$11.38
|
| Rate for Payer: ASR ASR |
$22.07
|
| Rate for Payer: ASR ASR |
$17.50
|
| Rate for Payer: ASR Commercial |
$17.50
|
| Rate for Payer: ASR Commercial |
$22.07
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: BCBS Complete |
$7.22
|
| Rate for Payer: BCBS Trust/PPO |
$18.63
|
| Rate for Payer: BCBS Trust/PPO |
$14.77
|
| Rate for Payer: BCN Commercial |
$13.99
|
| Rate for Payer: BCN Commercial |
$17.64
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.43
|
| Rate for Payer: Healthscope Commercial |
$22.75
|
| Rate for Payer: Healthscope Commercial |
$18.04
|
| Rate for Payer: Healthscope Whirlpool |
$22.07
|
| Rate for Payer: Healthscope Whirlpool |
$17.50
|
| Rate for Payer: Mclaren Commercial |
$16.24
|
| Rate for Payer: Mclaren Commercial |
$20.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.33
|
| Rate for Payer: Nomi Health Commercial |
$18.66
|
| Rate for Payer: Nomi Health Commercial |
$14.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.40
|
| Rate for Payer: Priority Health Narrow Network |
$0.32
|
| Rate for Payer: Priority Health Narrow Network |
$0.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.02
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$270.15
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
8981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.60 |
| Max. Negotiated Rate |
$270.15 |
| Rate for Payer: Aetna Commercial |
$243.14
|
| Rate for Payer: Aetna Commercial |
$217.58
|
| Rate for Payer: Aetna Commercial |
$255.60
|
| Rate for Payer: Aetna Commercial |
$211.82
|
| Rate for Payer: ASR ASR |
$228.30
|
| Rate for Payer: ASR ASR |
$262.05
|
| Rate for Payer: ASR ASR |
$234.51
|
| Rate for Payer: ASR ASR |
$275.48
|
| Rate for Payer: ASR Commercial |
$262.05
|
| Rate for Payer: ASR Commercial |
$275.48
|
| Rate for Payer: ASR Commercial |
$234.51
|
| Rate for Payer: ASR Commercial |
$228.30
|
| Rate for Payer: BCBS Trust/PPO |
$231.43
|
| Rate for Payer: BCBS Trust/PPO |
$191.79
|
| Rate for Payer: BCBS Trust/PPO |
$197.01
|
| Rate for Payer: BCBS Trust/PPO |
$220.15
|
| Rate for Payer: BCN Commercial |
$220.19
|
| Rate for Payer: BCN Commercial |
$182.47
|
| Rate for Payer: BCN Commercial |
$209.45
|
| Rate for Payer: BCN Commercial |
$187.44
|
| Rate for Payer: Cash Price |
$193.40
|
| Rate for Payer: Cash Price |
$188.29
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$216.12
|
| Rate for Payer: Cofinity Commercial |
$253.94
|
| Rate for Payer: Cofinity Commercial |
$227.25
|
| Rate for Payer: Cofinity Commercial |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$221.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.12
|
| Rate for Payer: Healthscope Commercial |
$241.76
|
| Rate for Payer: Healthscope Commercial |
$235.36
|
| Rate for Payer: Healthscope Commercial |
$270.15
|
| Rate for Payer: Healthscope Commercial |
$284.00
|
| Rate for Payer: Healthscope Whirlpool |
$275.48
|
| Rate for Payer: Healthscope Whirlpool |
$234.51
|
| Rate for Payer: Healthscope Whirlpool |
$262.05
|
| Rate for Payer: Healthscope Whirlpool |
$228.30
|
| Rate for Payer: Mclaren Commercial |
$243.14
|
| Rate for Payer: Mclaren Commercial |
$255.60
|
| Rate for Payer: Mclaren Commercial |
$217.58
|
| Rate for Payer: Mclaren Commercial |
$211.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.06
|
| Rate for Payer: Nomi Health Commercial |
$193.00
|
| Rate for Payer: Nomi Health Commercial |
$232.88
|
| Rate for Payer: Nomi Health Commercial |
$221.52
|
| Rate for Payer: Nomi Health Commercial |
$198.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.12
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
8981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: Aetna Commercial |
$255.60
|
| Rate for Payer: Aetna Commercial |
$243.14
|
| Rate for Payer: Aetna Commercial |
$211.82
|
| Rate for Payer: Aetna Commercial |
$217.58
|
| Rate for Payer: Aetna Medicare |
$135.08
|
| Rate for Payer: Aetna Medicare |
$117.68
|
| Rate for Payer: Aetna Medicare |
$120.88
|
| Rate for Payer: Aetna Medicare |
$142.00
|
| Rate for Payer: ASR ASR |
$228.30
|
| Rate for Payer: ASR ASR |
$234.51
|
| Rate for Payer: ASR ASR |
$262.05
|
| Rate for Payer: ASR ASR |
$275.48
|
| Rate for Payer: ASR Commercial |
$228.30
|
| Rate for Payer: ASR Commercial |
$262.05
|
| Rate for Payer: ASR Commercial |
$275.48
|
| Rate for Payer: ASR Commercial |
$234.51
|
| Rate for Payer: BCBS Complete |
$108.06
|
| Rate for Payer: BCBS Complete |
$113.60
|
| Rate for Payer: BCBS Complete |
$94.14
|
| Rate for Payer: BCBS Complete |
$96.70
|
| Rate for Payer: BCBS Trust/PPO |
$232.57
|
| Rate for Payer: BCBS Trust/PPO |
$197.98
|
| Rate for Payer: BCBS Trust/PPO |
$192.74
|
| Rate for Payer: BCBS Trust/PPO |
$221.23
|
| Rate for Payer: BCN Commercial |
$182.47
|
| Rate for Payer: BCN Commercial |
$220.19
|
| Rate for Payer: BCN Commercial |
$187.44
|
| Rate for Payer: BCN Commercial |
$209.45
|
| Rate for Payer: Cash Price |
$216.12
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$188.29
|
| Rate for Payer: Cash Price |
$193.40
|
| Rate for Payer: Cash Price |
$193.40
|
| Rate for Payer: Cash Price |
$188.29
|
| Rate for Payer: Cash Price |
$216.12
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cofinity Commercial |
$227.25
|
| Rate for Payer: Cofinity Commercial |
$221.24
|
| Rate for Payer: Cofinity Commercial |
$253.94
|
| Rate for Payer: Cofinity Commercial |
$266.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.29
|
| Rate for Payer: Healthscope Commercial |
$284.00
|
| Rate for Payer: Healthscope Commercial |
$241.76
|
| Rate for Payer: Healthscope Commercial |
$235.36
|
| Rate for Payer: Healthscope Commercial |
$270.15
|
| Rate for Payer: Healthscope Whirlpool |
$234.51
|
| Rate for Payer: Healthscope Whirlpool |
$228.30
|
| Rate for Payer: Healthscope Whirlpool |
$262.05
|
| Rate for Payer: Healthscope Whirlpool |
$275.48
|
| Rate for Payer: Mclaren Commercial |
$243.14
|
| Rate for Payer: Mclaren Commercial |
$255.60
|
| Rate for Payer: Mclaren Commercial |
$211.82
|
| Rate for Payer: Mclaren Commercial |
$217.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.40
|
| Rate for Payer: Nomi Health Commercial |
$198.24
|
| Rate for Payer: Nomi Health Commercial |
$221.52
|
| Rate for Payer: Nomi Health Commercial |
$232.88
|
| Rate for Payer: Nomi Health Commercial |
$193.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.90
|
| Rate for Payer: Priority Health Narrow Network |
$36.72
|
| Rate for Payer: Priority Health Narrow Network |
$36.72
|
| Rate for Payer: Priority Health Narrow Network |
$36.72
|
| Rate for Payer: Priority Health Narrow Network |
$36.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.75
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$2.54
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Aetna Commercial |
$3.17
|
| Rate for Payer: Aetna Commercial |
$1.93
|
| Rate for Payer: Aetna Commercial |
$3.93
|
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna Medicare |
$1.68
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: Aetna Medicare |
$1.27
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: Aetna Medicare |
$2.18
|
| Rate for Payer: ASR ASR |
$2.08
|
| Rate for Payer: ASR ASR |
$3.41
|
| Rate for Payer: ASR ASR |
$2.46
|
| Rate for Payer: ASR ASR |
$3.26
|
| Rate for Payer: ASR ASR |
$4.24
|
| Rate for Payer: ASR Commercial |
$2.08
|
| Rate for Payer: ASR Commercial |
$2.46
|
| Rate for Payer: ASR Commercial |
$4.24
|
| Rate for Payer: ASR Commercial |
$3.41
|
| Rate for Payer: ASR Commercial |
$3.26
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: BCBS Complete |
$1.41
|
| Rate for Payer: BCBS Trust/PPO |
$2.88
|
| Rate for Payer: BCBS Trust/PPO |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.08
|
| Rate for Payer: BCBS Trust/PPO |
$3.58
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$1.66
|
| Rate for Payer: BCN Commercial |
$1.97
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: BCN Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Cofinity Commercial |
$4.11
|
| Rate for Payer: Cofinity Commercial |
$2.01
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Healthscope Commercial |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$3.36
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Healthscope Commercial |
$4.37
|
| Rate for Payer: Healthscope Commercial |
$2.14
|
| Rate for Payer: Healthscope Whirlpool |
$4.24
|
| Rate for Payer: Healthscope Whirlpool |
$2.46
|
| Rate for Payer: Healthscope Whirlpool |
$2.08
|
| Rate for Payer: Healthscope Whirlpool |
$3.41
|
| Rate for Payer: Healthscope Whirlpool |
$3.26
|
| Rate for Payer: Mclaren Commercial |
$3.17
|
| Rate for Payer: Mclaren Commercial |
$1.93
|
| Rate for Payer: Mclaren Commercial |
$2.29
|
| Rate for Payer: Mclaren Commercial |
$3.02
|
| Rate for Payer: Mclaren Commercial |
$3.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Nomi Health Commercial |
$1.75
|
| Rate for Payer: Nomi Health Commercial |
$2.08
|
| Rate for Payer: Nomi Health Commercial |
$3.58
|
| Rate for Payer: Nomi Health Commercial |
$2.89
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.96
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$2.54
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Aetna Commercial |
$3.17
|
| Rate for Payer: Aetna Commercial |
$3.93
|
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna Commercial |
$1.93
|
| Rate for Payer: ASR ASR |
$4.24
|
| Rate for Payer: ASR ASR |
$3.41
|
| Rate for Payer: ASR ASR |
$3.26
|
| Rate for Payer: ASR ASR |
$2.46
|
| Rate for Payer: ASR ASR |
$2.08
|
| Rate for Payer: ASR Commercial |
$3.26
|
| Rate for Payer: ASR Commercial |
$4.24
|
| Rate for Payer: ASR Commercial |
$3.41
|
| Rate for Payer: ASR Commercial |
$2.46
|
| Rate for Payer: ASR Commercial |
$2.08
|
| Rate for Payer: BCBS Trust/PPO |
$3.56
|
| Rate for Payer: BCBS Trust/PPO |
$1.74
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCBS Trust/PPO |
$2.87
|
| Rate for Payer: BCBS Trust/PPO |
$2.74
|
| Rate for Payer: BCN Commercial |
$1.97
|
| Rate for Payer: BCN Commercial |
$3.39
|
| Rate for Payer: BCN Commercial |
$1.66
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$2.01
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Cofinity Commercial |
$4.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Healthscope Commercial |
$3.36
|
| Rate for Payer: Healthscope Commercial |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Healthscope Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$4.37
|
| Rate for Payer: Healthscope Whirlpool |
$4.24
|
| Rate for Payer: Healthscope Whirlpool |
$2.08
|
| Rate for Payer: Healthscope Whirlpool |
$3.26
|
| Rate for Payer: Healthscope Whirlpool |
$2.46
|
| Rate for Payer: Healthscope Whirlpool |
$3.41
|
| Rate for Payer: Mclaren Commercial |
$2.29
|
| Rate for Payer: Mclaren Commercial |
$3.02
|
| Rate for Payer: Mclaren Commercial |
$1.93
|
| Rate for Payer: Mclaren Commercial |
$3.17
|
| Rate for Payer: Mclaren Commercial |
$3.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: Nomi Health Commercial |
$1.75
|
| Rate for Payer: Nomi Health Commercial |
$2.08
|
| Rate for Payer: Nomi Health Commercial |
$3.58
|
| Rate for Payer: Nomi Health Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.10
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.35
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
115221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: ASR ASR |
$3.25
|
| Rate for Payer: ASR Commercial |
$3.25
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$3.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Healthscope Whirlpool |
$3.25
|
| Rate for Payer: Mclaren Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.85
|
| Rate for Payer: Nomi Health Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.95
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$3.35
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
115221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna Medicare |
$1.68
|
| Rate for Payer: ASR ASR |
$3.25
|
| Rate for Payer: ASR Commercial |
$3.25
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: BCBS Trust/PPO |
$2.74
|
| Rate for Payer: BCN Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$3.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Healthscope Whirlpool |
$3.25
|
| Rate for Payer: Mclaren Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.85
|
| Rate for Payer: Nomi Health Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.18
|
| Rate for Payer: Priority Health Narrow Network |
$0.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.95
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$166.20
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.03 |
| Max. Negotiated Rate |
$166.20 |
| Rate for Payer: Aetna Commercial |
$149.58
|
| Rate for Payer: ASR ASR |
$161.21
|
| Rate for Payer: ASR Commercial |
$161.21
|
| Rate for Payer: BCBS Trust/PPO |
$135.44
|
| Rate for Payer: BCN Commercial |
$128.85
|
| Rate for Payer: Cash Price |
$132.96
|
| Rate for Payer: Cofinity Commercial |
$156.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.96
|
| Rate for Payer: Healthscope Commercial |
$166.20
|
| Rate for Payer: Healthscope Whirlpool |
$161.21
|
| Rate for Payer: Mclaren Commercial |
$149.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.27
|
| Rate for Payer: Nomi Health Commercial |
$136.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.26
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$166.20
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$166.20 |
| Rate for Payer: Aetna Commercial |
$149.58
|
| Rate for Payer: Aetna Medicare |
$83.10
|
| Rate for Payer: ASR ASR |
$161.21
|
| Rate for Payer: ASR Commercial |
$161.21
|
| Rate for Payer: BCBS Complete |
$66.48
|
| Rate for Payer: BCBS Trust/PPO |
$136.10
|
| Rate for Payer: BCN Commercial |
$128.85
|
| Rate for Payer: Cash Price |
$132.96
|
| Rate for Payer: Cash Price |
$132.96
|
| Rate for Payer: Cofinity Commercial |
$156.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.96
|
| Rate for Payer: Healthscope Commercial |
$166.20
|
| Rate for Payer: Healthscope Whirlpool |
$161.21
|
| Rate for Payer: Mclaren Commercial |
$149.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.27
|
| Rate for Payer: Nomi Health Commercial |
$136.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.18
|
| Rate for Payer: Priority Health Narrow Network |
$0.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.26
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$109.20
|
|
|
Service Code
|
NDC 09900001169
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$109.20 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: ASR ASR |
$105.92
|
| Rate for Payer: ASR Commercial |
$105.92
|
| Rate for Payer: BCBS Trust/PPO |
$88.99
|
| Rate for Payer: BCN Commercial |
$84.66
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Cofinity Commercial |
$102.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.36
|
| Rate for Payer: Healthscope Commercial |
$109.20
|
| Rate for Payer: Healthscope Whirlpool |
$105.92
|
| Rate for Payer: Mclaren Commercial |
$98.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.82
|
| Rate for Payer: Nomi Health Commercial |
$89.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.10
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$109.20
|
|
|
Service Code
|
NDC 09900001169
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$109.20 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Medicare |
$54.60
|
| Rate for Payer: ASR ASR |
$105.92
|
| Rate for Payer: ASR Commercial |
$105.92
|
| Rate for Payer: BCBS Complete |
$43.68
|
| Rate for Payer: BCBS Trust/PPO |
$89.42
|
| Rate for Payer: BCN Commercial |
$84.66
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Cofinity Commercial |
$102.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.36
|
| Rate for Payer: Healthscope Commercial |
$109.20
|
| Rate for Payer: Healthscope Whirlpool |
$105.92
|
| Rate for Payer: Mclaren Commercial |
$98.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.82
|
| Rate for Payer: Nomi Health Commercial |
$89.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.68
|
| Rate for Payer: Priority Health Narrow Network |
$76.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.10
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$116.90
|
|
|
Service Code
|
NDC 00781729685
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.76 |
| Max. Negotiated Rate |
$116.90 |
| Rate for Payer: Aetna Commercial |
$105.21
|
| Rate for Payer: Aetna Medicare |
$58.45
|
| Rate for Payer: ASR ASR |
$113.39
|
| Rate for Payer: ASR Commercial |
$113.39
|
| Rate for Payer: BCBS Complete |
$46.76
|
| Rate for Payer: BCBS Trust/PPO |
$95.73
|
| Rate for Payer: BCN Commercial |
$90.63
|
| Rate for Payer: Cash Price |
$93.52
|
| Rate for Payer: Cofinity Commercial |
$109.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.52
|
| Rate for Payer: Healthscope Commercial |
$116.90
|
| Rate for Payer: Healthscope Whirlpool |
$113.39
|
| Rate for Payer: Mclaren Commercial |
$105.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.36
|
| Rate for Payer: Nomi Health Commercial |
$95.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.43
|
| Rate for Payer: Priority Health Narrow Network |
$81.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.87
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$163.10
|
|
|
Service Code
|
NDC 68180096301
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.02 |
| Max. Negotiated Rate |
$163.10 |
| Rate for Payer: Aetna Commercial |
$146.79
|
| Rate for Payer: ASR ASR |
$158.21
|
| Rate for Payer: ASR Commercial |
$158.21
|
| Rate for Payer: BCBS Trust/PPO |
$132.91
|
| Rate for Payer: BCN Commercial |
$126.45
|
| Rate for Payer: Cash Price |
$130.48
|
| Rate for Payer: Cofinity Commercial |
$153.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.48
|
| Rate for Payer: Healthscope Commercial |
$163.10
|
| Rate for Payer: Healthscope Whirlpool |
$158.21
|
| Rate for Payer: Mclaren Commercial |
$146.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.64
|
| Rate for Payer: Nomi Health Commercial |
$133.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.53
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$163.10
|
|
|
Service Code
|
NDC 68180096301
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.24 |
| Max. Negotiated Rate |
$163.10 |
| Rate for Payer: Aetna Commercial |
$146.79
|
| Rate for Payer: Aetna Medicare |
$81.55
|
| Rate for Payer: ASR ASR |
$158.21
|
| Rate for Payer: ASR Commercial |
$158.21
|
| Rate for Payer: BCBS Complete |
$65.24
|
| Rate for Payer: BCBS Trust/PPO |
$133.56
|
| Rate for Payer: BCN Commercial |
$126.45
|
| Rate for Payer: Cash Price |
$130.48
|
| Rate for Payer: Cofinity Commercial |
$153.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.48
|
| Rate for Payer: Healthscope Commercial |
$163.10
|
| Rate for Payer: Healthscope Whirlpool |
$158.21
|
| Rate for Payer: Mclaren Commercial |
$146.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.64
|
| Rate for Payer: Nomi Health Commercial |
$133.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.91
|
| Rate for Payer: Priority Health Narrow Network |
$114.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.53
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$116.90
|
|
|
Service Code
|
NDC 00781729685
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.98 |
| Max. Negotiated Rate |
$116.90 |
| Rate for Payer: Aetna Commercial |
$105.21
|
| Rate for Payer: ASR ASR |
$113.39
|
| Rate for Payer: ASR Commercial |
$113.39
|
| Rate for Payer: BCBS Trust/PPO |
$95.26
|
| Rate for Payer: BCN Commercial |
$90.63
|
| Rate for Payer: Cash Price |
$93.52
|
| Rate for Payer: Cofinity Commercial |
$109.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.52
|
| Rate for Payer: Healthscope Commercial |
$116.90
|
| Rate for Payer: Healthscope Whirlpool |
$113.39
|
| Rate for Payer: Mclaren Commercial |
$105.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.36
|
| Rate for Payer: Nomi Health Commercial |
$95.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.87
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$364.80
|
|
|
Service Code
|
NDC 62584098801
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.12 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna Commercial |
$328.32
|
| Rate for Payer: ASR ASR |
$353.86
|
| Rate for Payer: ASR Commercial |
$353.86
|
| Rate for Payer: BCBS Trust/PPO |
$297.28
|
| Rate for Payer: BCN Commercial |
$282.83
|
| Rate for Payer: Cash Price |
$291.84
|
| Rate for Payer: Cofinity Commercial |
$342.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.84
|
| Rate for Payer: Healthscope Commercial |
$364.80
|
| Rate for Payer: Healthscope Whirlpool |
$353.86
|
| Rate for Payer: Mclaren Commercial |
$328.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.08
|
| Rate for Payer: Nomi Health Commercial |
$299.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.02
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$205.20
|
|
|
Service Code
|
NDC 60687067701
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.38 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$184.68
|
| Rate for Payer: ASR ASR |
$199.04
|
| Rate for Payer: ASR Commercial |
$199.04
|
| Rate for Payer: BCBS Trust/PPO |
$167.22
|
| Rate for Payer: BCN Commercial |
$159.09
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$192.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Healthscope Whirlpool |
$199.04
|
| Rate for Payer: Mclaren Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.58
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$205.20
|
|
|
Service Code
|
NDC 60687067701
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.08 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$184.68
|
| Rate for Payer: Aetna Medicare |
$102.60
|
| Rate for Payer: ASR ASR |
$199.04
|
| Rate for Payer: ASR Commercial |
$199.04
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: BCBS Trust/PPO |
$168.04
|
| Rate for Payer: BCN Commercial |
$159.09
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$192.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Healthscope Whirlpool |
$199.04
|
| Rate for Payer: Mclaren Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.80
|
| Rate for Payer: Priority Health Narrow Network |
$143.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.58
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: ASR ASR |
$2.65
|
| Rate for Payer: ASR Commercial |
$2.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Healthscope Whirlpool |
$2.65
|
| Rate for Payer: Mclaren Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: Nomi Health Commercial |
$2.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.40
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$451.20
|
|
|
Service Code
|
NDC 00904704161
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.28 |
| Max. Negotiated Rate |
$451.20 |
| Rate for Payer: Aetna Commercial |
$406.08
|
| Rate for Payer: ASR ASR |
$437.66
|
| Rate for Payer: ASR Commercial |
$437.66
|
| Rate for Payer: BCBS Trust/PPO |
$367.68
|
| Rate for Payer: BCN Commercial |
$349.82
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$424.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$451.20
|
| Rate for Payer: Healthscope Whirlpool |
$437.66
|
| Rate for Payer: Mclaren Commercial |
$406.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: Nomi Health Commercial |
$369.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.06
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Medicare |
$1.36
|
| Rate for Payer: ASR ASR |
$2.65
|
| Rate for Payer: ASR Commercial |
$2.65
|
| Rate for Payer: BCBS Complete |
$1.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Healthscope Whirlpool |
$2.65
|
| Rate for Payer: Mclaren Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: Nomi Health Commercial |
$2.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.39
|
| Rate for Payer: Priority Health Narrow Network |
$1.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.40
|
|
