|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
IP
|
$326.80
|
|
|
Service Code
|
NDC 75826-115-10
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.76 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna Commercial |
$294.12
|
| Rate for Payer: ASR ASR |
$317.00
|
| Rate for Payer: BCBS Trust/PPO |
$253.37
|
| Rate for Payer: BCN Commercial |
$253.37
|
| Rate for Payer: Cash Price |
$261.44
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.44
|
| Rate for Payer: Healthscope Commercial |
$326.80
|
| Rate for Payer: Healthscope Whirlpool |
$317.00
|
| Rate for Payer: Mclaren Commercial |
$294.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.58
|
|
|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
IP
|
$274.55
|
|
|
Service Code
|
NDC 0904-6575-61
|
| Hospital Charge Code |
6217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.18 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Aetna Commercial |
$247.10
|
| Rate for Payer: ASR ASR |
$266.31
|
| Rate for Payer: BCBS Trust/PPO |
$212.86
|
| Rate for Payer: BCN Commercial |
$212.86
|
| Rate for Payer: Cash Price |
$219.64
|
| Rate for Payer: Cofinity Commercial |
$258.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.64
|
| Rate for Payer: Healthscope Commercial |
$274.55
|
| Rate for Payer: Healthscope Whirlpool |
$266.31
|
| Rate for Payer: Mclaren Commercial |
$247.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.60
|
|
|
PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$258.96
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
6221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.27 |
| Max. Negotiated Rate |
$258.96 |
| Rate for Payer: Aetna Commercial |
$233.06
|
| Rate for Payer: Aetna Commercial |
$271.94
|
| Rate for Payer: Aetna Commercial |
$254.83
|
| Rate for Payer: ASR ASR |
$274.65
|
| Rate for Payer: ASR ASR |
$293.09
|
| Rate for Payer: ASR ASR |
$251.19
|
| Rate for Payer: BCBS Trust/PPO |
$200.77
|
| Rate for Payer: BCBS Trust/PPO |
$219.52
|
| Rate for Payer: BCBS Trust/PPO |
$234.26
|
| Rate for Payer: BCN Commercial |
$234.26
|
| Rate for Payer: BCN Commercial |
$219.52
|
| Rate for Payer: BCN Commercial |
$200.77
|
| Rate for Payer: Cash Price |
$241.72
|
| Rate for Payer: Cash Price |
$226.51
|
| Rate for Payer: Cash Price |
$207.16
|
| Rate for Payer: Cofinity Commercial |
$266.15
|
| Rate for Payer: Cofinity Commercial |
$243.42
|
| Rate for Payer: Cofinity Commercial |
$284.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.17
|
| Rate for Payer: Healthscope Commercial |
$283.14
|
| Rate for Payer: Healthscope Commercial |
$258.96
|
| Rate for Payer: Healthscope Commercial |
$302.15
|
| Rate for Payer: Healthscope Whirlpool |
$293.09
|
| Rate for Payer: Healthscope Whirlpool |
$274.65
|
| Rate for Payer: Healthscope Whirlpool |
$251.19
|
| Rate for Payer: Mclaren Commercial |
$271.94
|
| Rate for Payer: Mclaren Commercial |
$254.83
|
| Rate for Payer: Mclaren Commercial |
$233.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$220.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$240.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$256.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.89
|
|
|
PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$93.14
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
6224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$93.14 |
| Rate for Payer: Aetna Commercial |
$83.83
|
| Rate for Payer: ASR ASR |
$90.35
|
| Rate for Payer: BCBS Trust/PPO |
$72.21
|
| Rate for Payer: BCN Commercial |
$72.21
|
| Rate for Payer: Cash Price |
$74.51
|
| Rate for Payer: Cofinity Commercial |
$87.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.51
|
| Rate for Payer: Healthscope Commercial |
$93.14
|
| Rate for Payer: Healthscope Whirlpool |
$90.35
|
| Rate for Payer: Mclaren Commercial |
$83.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.96
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$10.98
|
|
|
Service Code
|
NDC 7811269480
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$10.98 |
| Rate for Payer: Aetna Commercial |
$9.88
|
| Rate for Payer: ASR ASR |
$10.65
|
| Rate for Payer: BCBS Trust/PPO |
$8.51
|
| Rate for Payer: BCN Commercial |
$8.51
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Healthscope Commercial |
$10.98
|
| Rate for Payer: Healthscope Whirlpool |
$10.65
|
| Rate for Payer: Mclaren Commercial |
$9.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.66
|
|
|
PHENYLEPHRINE 0.25 % NASAL SPRAY
|
Facility
|
IP
|
$17.95
|
|
|
Service Code
|
NDC 69536-025-15
|
| Hospital Charge Code |
6243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$17.95 |
| Rate for Payer: Aetna Commercial |
$16.16
|
| Rate for Payer: ASR ASR |
$17.41
|
| Rate for Payer: BCBS Trust/PPO |
$13.92
|
| Rate for Payer: BCN Commercial |
$13.92
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cofinity Commercial |
$16.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.36
|
| Rate for Payer: Healthscope Commercial |
$17.95
|
| Rate for Payer: Healthscope Whirlpool |
$17.41
|
| Rate for Payer: Mclaren Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.80
|
|
|
PHENYLEPHRINE 0.5 % NASAL SPRAY
|
Facility
|
IP
|
$17.95
|
|
|
Service Code
|
NDC 5032300603
|
| Hospital Charge Code |
6244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$17.95 |
| Rate for Payer: Aetna Commercial |
$16.16
|
| Rate for Payer: ASR ASR |
$17.41
|
| Rate for Payer: BCBS Trust/PPO |
$13.92
|
| Rate for Payer: BCN Commercial |
$13.92
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cofinity Commercial |
$16.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.36
|
| Rate for Payer: Healthscope Commercial |
$17.95
|
| Rate for Payer: Healthscope Whirlpool |
$17.41
|
| Rate for Payer: Mclaren Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.80
|
|
|
PHENYLEPHRINE 0.5 % NASAL SPRAY
|
Facility
|
IP
|
$18.70
|
|
|
Service Code
|
NDC 0225-0805-47
|
| Hospital Charge Code |
6244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Aetna Commercial |
$16.83
|
| Rate for Payer: ASR ASR |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$14.50
|
| Rate for Payer: BCN Commercial |
$14.50
|
| Rate for Payer: Cash Price |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$17.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.96
|
| Rate for Payer: Healthscope Commercial |
$18.70
|
| Rate for Payer: Healthscope Whirlpool |
$18.14
|
| Rate for Payer: Mclaren Commercial |
$16.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.46
|
|
|
PHENYLEPHRINE 0.5 % NASAL SPRAY
|
Facility
|
IP
|
$17.95
|
|
|
Service Code
|
NDC 69536-050-15
|
| Hospital Charge Code |
6244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$17.95 |
| Rate for Payer: Aetna Commercial |
$16.16
|
| Rate for Payer: ASR ASR |
$17.41
|
| Rate for Payer: BCBS Trust/PPO |
$13.92
|
| Rate for Payer: BCN Commercial |
$13.92
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cofinity Commercial |
$16.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.36
|
| Rate for Payer: Healthscope Commercial |
$17.95
|
| Rate for Payer: Healthscope Whirlpool |
$17.41
|
| Rate for Payer: Mclaren Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.80
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
IP
|
$130.20
|
|
|
Service Code
|
NDC 42702-103-05
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$117.18
|
| Rate for Payer: ASR ASR |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$100.94
|
| Rate for Payer: BCN Commercial |
$100.94
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cofinity Commercial |
$122.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.16
|
| Rate for Payer: Healthscope Commercial |
$130.20
|
| Rate for Payer: Healthscope Whirlpool |
$126.29
|
| Rate for Payer: Mclaren Commercial |
$117.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.58
|
|
|
PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$16.59
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Commercial |
$14.56
|
| Rate for Payer: ASR ASR |
$16.09
|
| Rate for Payer: ASR ASR |
$15.69
|
| Rate for Payer: BCBS Trust/PPO |
$12.54
|
| Rate for Payer: BCBS Trust/PPO |
$12.86
|
| Rate for Payer: BCN Commercial |
$12.54
|
| Rate for Payer: BCN Commercial |
$12.86
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.21
|
| Rate for Payer: Cofinity Commercial |
$15.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.27
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Healthscope Whirlpool |
$15.69
|
| Rate for Payer: Healthscope Whirlpool |
$16.09
|
| Rate for Payer: Mclaren Commercial |
$14.93
|
| Rate for Payer: Mclaren Commercial |
$14.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.60
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
IP
|
$100.42
|
|
|
Service Code
|
NDC 17478-201-02
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$100.42 |
| Rate for Payer: Aetna Commercial |
$90.38
|
| Rate for Payer: ASR ASR |
$97.41
|
| Rate for Payer: BCBS Trust/PPO |
$77.86
|
| Rate for Payer: BCN Commercial |
$77.86
|
| Rate for Payer: Cash Price |
$80.33
|
| Rate for Payer: Cofinity Commercial |
$94.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.34
|
| Rate for Payer: Healthscope Commercial |
$100.42
|
| Rate for Payer: Healthscope Whirlpool |
$97.41
|
| Rate for Payer: Mclaren Commercial |
$90.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.37
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
IP
|
$294.63
|
|
|
Service Code
|
NDC 42702-102-15
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.24 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna Commercial |
$265.17
|
| Rate for Payer: ASR ASR |
$285.79
|
| Rate for Payer: BCBS Trust/PPO |
$228.43
|
| Rate for Payer: BCN Commercial |
$228.43
|
| Rate for Payer: Cash Price |
$235.70
|
| Rate for Payer: Cofinity Commercial |
$276.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.70
|
| Rate for Payer: Healthscope Commercial |
$294.63
|
| Rate for Payer: Healthscope Whirlpool |
$285.79
|
| Rate for Payer: Mclaren Commercial |
$265.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.27
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
IP
|
$276.68
|
|
|
Service Code
|
NDC 17478-201-15
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.68 |
| Max. Negotiated Rate |
$276.68 |
| Rate for Payer: Aetna Commercial |
$249.01
|
| Rate for Payer: ASR ASR |
$268.38
|
| Rate for Payer: BCBS Trust/PPO |
$214.51
|
| Rate for Payer: BCN Commercial |
$214.51
|
| Rate for Payer: Cash Price |
$221.34
|
| Rate for Payer: Cofinity Commercial |
$260.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.34
|
| Rate for Payer: Healthscope Commercial |
$276.68
|
| Rate for Payer: Healthscope Whirlpool |
$268.38
|
| Rate for Payer: Mclaren Commercial |
$249.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.48
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
IP
|
$155.66
|
|
|
Service Code
|
NDC 60687-156-25
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.96 |
| Max. Negotiated Rate |
$155.66 |
| Rate for Payer: Aetna Commercial |
$140.09
|
| Rate for Payer: ASR ASR |
$150.99
|
| Rate for Payer: BCBS Trust/PPO |
$120.68
|
| Rate for Payer: BCN Commercial |
$120.68
|
| Rate for Payer: Cash Price |
$124.53
|
| Rate for Payer: Cofinity Commercial |
$146.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.53
|
| Rate for Payer: Healthscope Commercial |
$155.66
|
| Rate for Payer: Healthscope Whirlpool |
$150.99
|
| Rate for Payer: Mclaren Commercial |
$140.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.98
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
IP
|
$5.19
|
|
|
Service Code
|
NDC 60687-156-95
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$5.19 |
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: ASR ASR |
$5.03
|
| Rate for Payer: BCBS Trust/PPO |
$4.02
|
| Rate for Payer: BCN Commercial |
$4.02
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$4.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.15
|
| Rate for Payer: Healthscope Commercial |
$5.19
|
| Rate for Payer: Healthscope Whirlpool |
$5.03
|
| Rate for Payer: Mclaren Commercial |
$4.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.57
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
IP
|
$950.40
|
|
|
Service Code
|
NDC 0071-0007-40
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$665.28 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Aetna Commercial |
$855.36
|
| Rate for Payer: ASR ASR |
$921.89
|
| Rate for Payer: BCBS Trust/PPO |
$736.85
|
| Rate for Payer: BCN Commercial |
$736.85
|
| Rate for Payer: Cash Price |
$760.32
|
| Rate for Payer: Cofinity Commercial |
$893.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.32
|
| Rate for Payer: Healthscope Commercial |
$950.40
|
| Rate for Payer: Healthscope Whirlpool |
$921.89
|
| Rate for Payer: Mclaren Commercial |
$855.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$807.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$836.35
|
|
|
PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.37
|
|
|
Service Code
|
HCPCS J1165
|
| Hospital Charge Code |
6256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$15.37 |
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Aetna Commercial |
$19.90
|
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: Aetna Commercial |
$22.97
|
| Rate for Payer: ASR ASR |
$21.38
|
| Rate for Payer: ASR ASR |
$14.91
|
| Rate for Payer: ASR ASR |
$21.45
|
| Rate for Payer: ASR ASR |
$24.75
|
| Rate for Payer: BCBS Trust/PPO |
$19.79
|
| Rate for Payer: BCBS Trust/PPO |
$11.92
|
| Rate for Payer: BCBS Trust/PPO |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$17.09
|
| Rate for Payer: BCN Commercial |
$19.79
|
| Rate for Payer: BCN Commercial |
$11.92
|
| Rate for Payer: BCN Commercial |
$17.09
|
| Rate for Payer: BCN Commercial |
$17.14
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$17.69
|
| Rate for Payer: Cash Price |
$17.63
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cofinity Commercial |
$20.78
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Healthscope Commercial |
$25.52
|
| Rate for Payer: Healthscope Commercial |
$15.37
|
| Rate for Payer: Healthscope Commercial |
$22.04
|
| Rate for Payer: Healthscope Commercial |
$22.11
|
| Rate for Payer: Healthscope Whirlpool |
$21.45
|
| Rate for Payer: Healthscope Whirlpool |
$24.75
|
| Rate for Payer: Healthscope Whirlpool |
$21.38
|
| Rate for Payer: Healthscope Whirlpool |
$14.91
|
| Rate for Payer: Mclaren Commercial |
$22.97
|
| Rate for Payer: Mclaren Commercial |
$13.83
|
| Rate for Payer: Mclaren Commercial |
$19.90
|
| Rate for Payer: Mclaren Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.53
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$382.85
|
|
|
Service Code
|
NDC 0904-6187-61
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.00 |
| Max. Negotiated Rate |
$382.85 |
| Rate for Payer: Aetna Commercial |
$344.56
|
| Rate for Payer: ASR ASR |
$371.36
|
| Rate for Payer: BCBS Trust/PPO |
$296.82
|
| Rate for Payer: BCN Commercial |
$296.82
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Commercial |
$359.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$382.85
|
| Rate for Payer: Healthscope Whirlpool |
$371.36
|
| Rate for Payer: Mclaren Commercial |
$344.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$336.91
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$107.60
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
11023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.32 |
| Max. Negotiated Rate |
$107.60 |
| Rate for Payer: Aetna Commercial |
$96.84
|
| Rate for Payer: Aetna Commercial |
$88.50
|
| Rate for Payer: ASR ASR |
$95.38
|
| Rate for Payer: ASR ASR |
$104.37
|
| Rate for Payer: BCBS Trust/PPO |
$83.42
|
| Rate for Payer: BCBS Trust/PPO |
$76.24
|
| Rate for Payer: BCN Commercial |
$76.24
|
| Rate for Payer: BCN Commercial |
$83.42
|
| Rate for Payer: Cash Price |
$78.67
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cofinity Commercial |
$101.14
|
| Rate for Payer: Cofinity Commercial |
$92.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.66
|
| Rate for Payer: Healthscope Commercial |
$107.60
|
| Rate for Payer: Healthscope Commercial |
$98.33
|
| Rate for Payer: Healthscope Whirlpool |
$95.38
|
| Rate for Payer: Healthscope Whirlpool |
$104.37
|
| Rate for Payer: Mclaren Commercial |
$96.84
|
| Rate for Payer: Mclaren Commercial |
$88.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.69
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION
|
Facility
|
IP
|
$20.69
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
108266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$20.69 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: BCBS Trust/PPO |
$16.04
|
| Rate for Payer: BCN Commercial |
$16.04
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Healthscope Commercial |
$20.69
|
| Rate for Payer: Healthscope Whirlpool |
$20.07
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET
|
Facility
|
IP
|
$2,904.32
|
|
|
Service Code
|
NDC 70710-1014-3
|
| Hospital Charge Code |
11024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,033.02 |
| Max. Negotiated Rate |
$2,904.32 |
| Rate for Payer: Aetna Commercial |
$2,613.89
|
| Rate for Payer: ASR ASR |
$2,817.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,251.72
|
| Rate for Payer: BCN Commercial |
$2,251.72
|
| Rate for Payer: Cash Price |
$2,323.45
|
| Rate for Payer: Cofinity Commercial |
$2,730.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,323.46
|
| Rate for Payer: Healthscope Commercial |
$2,904.32
|
| Rate for Payer: Healthscope Whirlpool |
$2,817.19
|
| Rate for Payer: Mclaren Commercial |
$2,613.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,468.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,033.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,555.80
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET
|
Facility
|
IP
|
$4,014.87
|
|
|
Service Code
|
NDC 69238-1051-3
|
| Hospital Charge Code |
11024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,810.41 |
| Max. Negotiated Rate |
$4,014.87 |
| Rate for Payer: Aetna Commercial |
$3,613.38
|
| Rate for Payer: ASR ASR |
$3,894.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,112.73
|
| Rate for Payer: BCN Commercial |
$3,112.73
|
| Rate for Payer: Cash Price |
$3,211.90
|
| Rate for Payer: Cofinity Commercial |
$3,773.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,211.90
|
| Rate for Payer: Healthscope Commercial |
$4,014.87
|
| Rate for Payer: Healthscope Whirlpool |
$3,894.42
|
| Rate for Payer: Mclaren Commercial |
$3,613.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,412.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,810.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,533.09
|
|
|
PILOCARPINE 2 % EYE DROPS
|
Facility
|
IP
|
$133.24
|
|
|
Service Code
|
NDC 61314-204-15
|
| Hospital Charge Code |
6280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.27 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna Commercial |
$119.92
|
| Rate for Payer: ASR ASR |
$129.24
|
| Rate for Payer: BCBS Trust/PPO |
$103.30
|
| Rate for Payer: BCN Commercial |
$103.30
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Cofinity Commercial |
$125.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.59
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Healthscope Whirlpool |
$129.24
|
| Rate for Payer: Mclaren Commercial |
$119.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.25
|
|
|
PILOCARPINE 5 MG TABLET
|
Facility
|
IP
|
$460.60
|
|
|
Service Code
|
NDC 0574-0792-01
|
| Hospital Charge Code |
12803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$322.42 |
| Max. Negotiated Rate |
$460.60 |
| Rate for Payer: Aetna Commercial |
$414.54
|
| Rate for Payer: ASR ASR |
$446.78
|
| Rate for Payer: BCBS Trust/PPO |
$357.10
|
| Rate for Payer: BCN Commercial |
$357.10
|
| Rate for Payer: Cash Price |
$368.48
|
| Rate for Payer: Cofinity Commercial |
$432.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.48
|
| Rate for Payer: Healthscope Commercial |
$460.60
|
| Rate for Payer: Healthscope Whirlpool |
$446.78
|
| Rate for Payer: Mclaren Commercial |
$414.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$391.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$405.33
|
|
