|
IOPAMIDOL 370 MG IODINE/ML (76 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10328
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Commercial |
$252.00
|
| Rate for Payer: Aetna Commercial |
$630.00
|
| Rate for Payer: Aetna Medicare |
$103.60
|
| Rate for Payer: Aetna Medicare |
$51.80
|
| Rate for Payer: Aetna Medicare |
$259.00
|
| Rate for Payer: ASR ASR |
$679.00
|
| Rate for Payer: ASR ASR |
$135.80
|
| Rate for Payer: ASR ASR |
$271.60
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCBS Complete |
$280.00
|
| Rate for Payer: BCBS Complete |
$112.00
|
| Rate for Payer: BCBS Trust/PPO |
$115.43
|
| Rate for Payer: BCBS Trust/PPO |
$230.86
|
| Rate for Payer: BCBS Trust/PPO |
$577.15
|
| Rate for Payer: BCN Commercial |
$115.43
|
| Rate for Payer: BCN Commercial |
$230.86
|
| Rate for Payer: BCN Commercial |
$577.15
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$658.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.00
|
| Rate for Payer: Healthscope Commercial |
$679.00
|
| Rate for Payer: Healthscope Commercial |
$135.80
|
| Rate for Payer: Healthscope Commercial |
$271.60
|
| Rate for Payer: Healthscope Whirlpool |
$280.00
|
| Rate for Payer: Healthscope Whirlpool |
$140.00
|
| Rate for Payer: Healthscope Whirlpool |
$700.00
|
| Rate for Payer: Mclaren Commercial |
$630.00
|
| Rate for Payer: Mclaren Commercial |
$252.00
|
| Rate for Payer: Mclaren Commercial |
$126.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$560.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.00
|
| Rate for Payer: Nomi Health Commercial |
$574.00
|
| Rate for Payer: Nomi Health Commercial |
$114.80
|
| Rate for Payer: Nomi Health Commercial |
$229.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$525.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.42
|
| Rate for Payer: Priority Health Narrow Network |
$1.93
|
| Rate for Payer: Priority Health Narrow Network |
$1.93
|
| Rate for Payer: Priority Health Narrow Network |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$616.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.20
|
|
|
IPL CHEEKS FIRST
|
Professional
|
Both
|
$132.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.00
|
|
|
IPL CHEST FIRST
|
Professional
|
Both
|
$315.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
|
|
IPL CHEST SECOND
|
Professional
|
Both
|
$210.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
|
|
IPL FACE FIRST
|
Professional
|
Both
|
$237.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$177.75 |
| Rate for Payer: BCBS Complete |
$94.80
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.75
|
|
|
IPL FACE, NECK, CHEST FIRST
|
Professional
|
Both
|
$420.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: BCBS Complete |
$168.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.00
|
|
|
IPL FACE, NECK, CHEST SECOND
|
Professional
|
Both
|
$289.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: BCBS Complete |
$115.60
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
|
|
IPL FACE & NECK FIRST
|
Professional
|
Both
|
$263.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
|
|
IPL FACE & NECK SECOND
|
Professional
|
Both
|
$184.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.00
|
|
|
IPL FACE SECOND
|
Professional
|
Both
|
$105.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
|
|
IPL HANDS & ARMS FIRST
|
Professional
|
Both
|
$368.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$147.20 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: BCBS Complete |
$147.20
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.00
|
|
|
IPL HANDS & ARMS SECOND
|
Professional
|
Both
|
$237.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$177.75 |
| Rate for Payer: BCBS Complete |
$94.80
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.75
|
|
|
IPL NECK
|
Professional
|
Both
|
$105.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
|
|
IPL NOSE & CHEEKS FIRST
|
Professional
|
Both
|
$158.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN
|
Facility
|
IP
|
$2.65
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
30510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.39
|
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: Aetna Commercial |
$2.62
|
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: ASR ASR |
$2.81
|
| Rate for Payer: ASR ASR |
$2.57
|
| Rate for Payer: ASR ASR |
$3.43
|
| Rate for Payer: ASR ASR |
$2.60
|
| Rate for Payer: ASR ASR |
$2.82
|
| Rate for Payer: ASR ASR |
$4.29
|
| Rate for Payer: BCBS Trust/PPO |
$2.18
|
| Rate for Payer: BCBS Trust/PPO |
$2.39
|
| Rate for Payer: BCBS Trust/PPO |
$2.38
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCBS Trust/PPO |
$2.90
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.90
|
| Rate for Payer: BCN Commercial |
$2.18
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: BCN Commercial |
$2.38
|
| Rate for Payer: BCN Commercial |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.53
|
| Rate for Payer: Healthscope Commercial |
$2.57
|
| Rate for Payer: Healthscope Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Healthscope Commercial |
$3.43
|
| Rate for Payer: Healthscope Whirlpool |
$2.90
|
| Rate for Payer: Healthscope Whirlpool |
$2.91
|
| Rate for Payer: Healthscope Whirlpool |
$2.68
|
| Rate for Payer: Healthscope Whirlpool |
$3.53
|
| Rate for Payer: Healthscope Whirlpool |
$2.65
|
| Rate for Payer: Healthscope Whirlpool |
$4.42
|
| Rate for Payer: Mclaren Commercial |
$3.18
|
| Rate for Payer: Mclaren Commercial |
$3.98
|
| Rate for Payer: Mclaren Commercial |
$2.61
|
| Rate for Payer: Mclaren Commercial |
$2.39
|
| Rate for Payer: Mclaren Commercial |
$2.41
|
| Rate for Payer: Mclaren Commercial |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: Nomi Health Commercial |
$2.39
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: Nomi Health Commercial |
$2.90
|
| Rate for Payer: Nomi Health Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$2.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.11
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN
|
Facility
|
OP
|
$4.42
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
30510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: Aetna Commercial |
$2.62
|
| Rate for Payer: Aetna Commercial |
$2.39
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: Aetna Medicare |
$0.99
|
| Rate for Payer: Aetna Medicare |
$1.31
|
| Rate for Payer: Aetna Medicare |
$1.63
|
| Rate for Payer: Aetna Medicare |
$0.98
|
| Rate for Payer: ASR ASR |
$2.60
|
| Rate for Payer: ASR ASR |
$4.29
|
| Rate for Payer: ASR ASR |
$3.43
|
| Rate for Payer: ASR ASR |
$2.57
|
| Rate for Payer: ASR ASR |
$2.81
|
| Rate for Payer: ASR ASR |
$2.82
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Complete |
$1.41
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS Complete |
$1.77
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$2.91
|
| Rate for Payer: BCBS Trust/PPO |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$2.39
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCBS Trust/PPO |
$2.21
|
| Rate for Payer: BCBS Trust/PPO |
$3.64
|
| Rate for Payer: BCN Commercial |
$3.64
|
| Rate for Payer: BCN Commercial |
$2.21
|
| Rate for Payer: BCN Commercial |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: BCN Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Healthscope Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$2.57
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$3.43
|
| Rate for Payer: Healthscope Commercial |
$4.29
|
| Rate for Payer: Healthscope Whirlpool |
$2.91
|
| Rate for Payer: Healthscope Whirlpool |
$2.68
|
| Rate for Payer: Healthscope Whirlpool |
$2.65
|
| Rate for Payer: Healthscope Whirlpool |
$2.90
|
| Rate for Payer: Healthscope Whirlpool |
$3.53
|
| Rate for Payer: Healthscope Whirlpool |
$4.42
|
| Rate for Payer: Mclaren Commercial |
$2.41
|
| Rate for Payer: Mclaren Commercial |
$3.98
|
| Rate for Payer: Mclaren Commercial |
$3.18
|
| Rate for Payer: Mclaren Commercial |
$2.39
|
| Rate for Payer: Mclaren Commercial |
$2.61
|
| Rate for Payer: Mclaren Commercial |
$2.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: Nomi Health Commercial |
$2.90
|
| Rate for Payer: Nomi Health Commercial |
$2.39
|
| Rate for Payer: Nomi Health Commercial |
$2.37
|
| Rate for Payer: Nomi Health Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.20
|
| Rate for Payer: Priority Health Narrow Network |
$0.16
|
| Rate for Payer: Priority Health Narrow Network |
$0.16
|
| Rate for Payer: Priority Health Narrow Network |
$0.16
|
| Rate for Payer: Priority Health Narrow Network |
$0.16
|
| Rate for Payer: Priority Health Narrow Network |
$0.16
|
| Rate for Payer: Priority Health Narrow Network |
$0.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.89
|
|
|
IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION
|
Facility
|
OP
|
$1,689.80
|
|
|
Service Code
|
NDC 597002402
|
| Hospital Charge Code |
172696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$625.23 |
| Max. Negotiated Rate |
$1,689.80 |
| Rate for Payer: Aetna Commercial |
$1,520.82
|
| Rate for Payer: Aetna Medicare |
$625.23
|
| Rate for Payer: ASR ASR |
$1,639.11
|
| Rate for Payer: BCBS Complete |
$675.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,393.24
|
| Rate for Payer: BCN Commercial |
$1,393.24
|
| Rate for Payer: Cash Price |
$1,351.84
|
| Rate for Payer: Cofinity Commercial |
$1,588.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,351.84
|
| Rate for Payer: Healthscope Commercial |
$1,639.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,689.80
|
| Rate for Payer: Mclaren Commercial |
$1,520.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,351.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,436.33
|
| Rate for Payer: Nomi Health Commercial |
$1,385.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,267.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,480.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,184.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,487.02
|
|
|
IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION
|
Facility
|
IP
|
$1,689.80
|
|
|
Service Code
|
NDC 597002402
|
| Hospital Charge Code |
172696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,267.35 |
| Max. Negotiated Rate |
$1,689.80 |
| Rate for Payer: Aetna Commercial |
$1,520.82
|
| Rate for Payer: ASR ASR |
$1,639.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,387.66
|
| Rate for Payer: BCN Commercial |
$1,387.66
|
| Rate for Payer: Cash Price |
$1,351.84
|
| Rate for Payer: Cofinity Commercial |
$1,588.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,351.84
|
| Rate for Payer: Healthscope Commercial |
$1,639.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,689.80
|
| Rate for Payer: Mclaren Commercial |
$1,520.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,436.33
|
| Rate for Payer: Nomi Health Commercial |
$1,385.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,267.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,487.02
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION
|
Facility
|
OP
|
$4.58
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
12580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: Aetna Commercial |
$5.76
|
| Rate for Payer: Aetna Commercial |
$6.08
|
| Rate for Payer: Aetna Medicare |
$2.37
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: ASR ASR |
$6.55
|
| Rate for Payer: ASR ASR |
$4.45
|
| Rate for Payer: ASR ASR |
$6.21
|
| Rate for Payer: BCBS Complete |
$1.83
|
| Rate for Payer: BCBS Complete |
$2.70
|
| Rate for Payer: BCBS Complete |
$2.56
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCBS Trust/PPO |
$5.28
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$3.78
|
| Rate for Payer: BCN Commercial |
$5.28
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$6.02
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Cofinity Commercial |
$6.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.12
|
| Rate for Payer: Healthscope Commercial |
$6.55
|
| Rate for Payer: Healthscope Commercial |
$4.45
|
| Rate for Payer: Healthscope Commercial |
$6.21
|
| Rate for Payer: Healthscope Whirlpool |
$6.40
|
| Rate for Payer: Healthscope Whirlpool |
$4.58
|
| Rate for Payer: Healthscope Whirlpool |
$6.76
|
| Rate for Payer: Mclaren Commercial |
$6.08
|
| Rate for Payer: Mclaren Commercial |
$5.76
|
| Rate for Payer: Mclaren Commercial |
$4.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$5.54
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Nomi Health Commercial |
$5.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.42
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.03
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION
|
Facility
|
IP
|
$4.58
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
12580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: Aetna Commercial |
$6.08
|
| Rate for Payer: Aetna Commercial |
$5.76
|
| Rate for Payer: ASR ASR |
$6.55
|
| Rate for Payer: ASR ASR |
$4.45
|
| Rate for Payer: ASR ASR |
$6.21
|
| Rate for Payer: BCBS Trust/PPO |
$5.55
|
| Rate for Payer: BCBS Trust/PPO |
$3.76
|
| Rate for Payer: BCBS Trust/PPO |
$5.26
|
| Rate for Payer: BCN Commercial |
$5.26
|
| Rate for Payer: BCN Commercial |
$3.76
|
| Rate for Payer: BCN Commercial |
$5.55
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Cofinity Commercial |
$6.02
|
| Rate for Payer: Cofinity Commercial |
$6.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.12
|
| Rate for Payer: Healthscope Commercial |
$6.21
|
| Rate for Payer: Healthscope Commercial |
$4.45
|
| Rate for Payer: Healthscope Commercial |
$6.55
|
| Rate for Payer: Healthscope Whirlpool |
$6.40
|
| Rate for Payer: Healthscope Whirlpool |
$6.76
|
| Rate for Payer: Healthscope Whirlpool |
$4.58
|
| Rate for Payer: Mclaren Commercial |
$5.76
|
| Rate for Payer: Mclaren Commercial |
$4.12
|
| Rate for Payer: Mclaren Commercial |
$6.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$5.25
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Nomi Health Commercial |
$5.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.03
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY
|
Facility
|
OP
|
$111.30
|
|
|
Service Code
|
NDC 69238201603
|
| Hospital Charge Code |
16070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.18 |
| Max. Negotiated Rate |
$111.30 |
| Rate for Payer: Aetna Commercial |
$100.17
|
| Rate for Payer: Aetna Medicare |
$41.18
|
| Rate for Payer: ASR ASR |
$107.96
|
| Rate for Payer: BCBS Complete |
$44.52
|
| Rate for Payer: BCBS Trust/PPO |
$91.77
|
| Rate for Payer: BCN Commercial |
$91.77
|
| Rate for Payer: Cash Price |
$89.04
|
| Rate for Payer: Cofinity Commercial |
$104.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.04
|
| Rate for Payer: Healthscope Commercial |
$107.96
|
| Rate for Payer: Healthscope Whirlpool |
$111.30
|
| Rate for Payer: Mclaren Commercial |
$100.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.61
|
| Rate for Payer: Nomi Health Commercial |
$91.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.52
|
| Rate for Payer: Priority Health Narrow Network |
$78.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.94
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY
|
Facility
|
IP
|
$111.30
|
|
|
Service Code
|
NDC 69238201603
|
| Hospital Charge Code |
16070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.47 |
| Max. Negotiated Rate |
$111.30 |
| Rate for Payer: Aetna Commercial |
$100.17
|
| Rate for Payer: ASR ASR |
$107.96
|
| Rate for Payer: BCBS Trust/PPO |
$91.40
|
| Rate for Payer: BCN Commercial |
$91.40
|
| Rate for Payer: Cash Price |
$89.04
|
| Rate for Payer: Cofinity Commercial |
$104.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.04
|
| Rate for Payer: Healthscope Commercial |
$107.96
|
| Rate for Payer: Healthscope Whirlpool |
$111.30
|
| Rate for Payer: Mclaren Commercial |
$100.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.61
|
| Rate for Payer: Nomi Health Commercial |
$91.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.94
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
OP
|
$790.21
|
|
|
Service Code
|
NDC 24585130
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.38 |
| Max. Negotiated Rate |
$790.21 |
| Rate for Payer: Aetna Commercial |
$711.19
|
| Rate for Payer: Aetna Medicare |
$292.38
|
| Rate for Payer: ASR ASR |
$766.50
|
| Rate for Payer: BCBS Complete |
$316.08
|
| Rate for Payer: BCBS Trust/PPO |
$651.53
|
| Rate for Payer: BCN Commercial |
$651.53
|
| Rate for Payer: Cash Price |
$632.17
|
| Rate for Payer: Cofinity Commercial |
$742.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.17
|
| Rate for Payer: Healthscope Commercial |
$766.50
|
| Rate for Payer: Healthscope Whirlpool |
$790.21
|
| Rate for Payer: Mclaren Commercial |
$711.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$632.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.68
|
| Rate for Payer: Nomi Health Commercial |
$647.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$592.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$692.38
|
| Rate for Payer: Priority Health Narrow Network |
$553.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$695.38
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
OP
|
$79.67
|
|
|
Service Code
|
NDC 43547037503
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$79.67 |
| Rate for Payer: Aetna Commercial |
$71.70
|
| Rate for Payer: Aetna Medicare |
$29.48
|
| Rate for Payer: ASR ASR |
$77.28
|
| Rate for Payer: BCBS Complete |
$31.87
|
| Rate for Payer: BCBS Trust/PPO |
$65.68
|
| Rate for Payer: BCN Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$63.73
|
| Rate for Payer: Cofinity Commercial |
$74.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.73
|
| Rate for Payer: Healthscope Commercial |
$77.28
|
| Rate for Payer: Healthscope Whirlpool |
$79.67
|
| Rate for Payer: Mclaren Commercial |
$71.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.72
|
| Rate for Payer: Nomi Health Commercial |
$65.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$69.80
|
| Rate for Payer: Priority Health Narrow Network |
$55.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.11
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
IP
|
$67.68
|
|
|
Service Code
|
NDC 43547027803
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.76 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$60.91
|
| Rate for Payer: ASR ASR |
$65.65
|
| Rate for Payer: BCBS Trust/PPO |
$55.58
|
| Rate for Payer: BCN Commercial |
$55.58
|
| Rate for Payer: Cash Price |
$54.14
|
| Rate for Payer: Cofinity Commercial |
$63.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.14
|
| Rate for Payer: Healthscope Commercial |
$65.65
|
| Rate for Payer: Healthscope Whirlpool |
$67.68
|
| Rate for Payer: Mclaren Commercial |
$60.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.53
|
| Rate for Payer: Nomi Health Commercial |
$55.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.56
|
|
