|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$15,343.49
|
|
|
Service Code
|
MSDRG 489
|
| Min. Negotiated Rate |
$9,306.97 |
| Max. Negotiated Rate |
$15,343.49 |
| Rate for Payer: Aetna Medicare |
$9,796.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,246.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,246.01
|
| Rate for Payer: BCBS MAPPO |
$9,796.81
|
| Rate for Payer: BCN Medicare Advantage |
$9,796.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,796.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,796.81
|
| Rate for Payer: Mclaren Medicare |
$9,796.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,286.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,266.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,776.49
|
| Rate for Payer: PACE Medicare |
$9,306.97
|
| Rate for Payer: PACE SWMI |
$9,796.81
|
| Rate for Payer: PHP Commercial |
$10,776.49
|
| Rate for Payer: PHP Medicare Advantage |
$9,796.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15,343.49
|
| Rate for Payer: Priority Health Medicare |
$9,796.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,274.79
|
| Rate for Payer: Railroad Medicare Medicare |
$9,796.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,796.81
|
| Rate for Payer: UHC Exchange |
$15,185.06
|
| Rate for Payer: UHCCP DNSP |
$9,796.81
|
| Rate for Payer: VA VA |
$9,796.81
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC
|
Facility
|
IP
|
$28,729.20
|
|
|
Service Code
|
MSDRG 486
|
| Min. Negotiated Rate |
$15,972.32 |
| Max. Negotiated Rate |
$28,729.20 |
| Rate for Payer: Aetna Medicare |
$16,812.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,016.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,016.21
|
| Rate for Payer: BCBS MAPPO |
$16,812.97
|
| Rate for Payer: BCN Medicare Advantage |
$16,812.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,812.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,812.97
|
| Rate for Payer: Mclaren Medicare |
$16,812.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,653.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,334.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,494.27
|
| Rate for Payer: PACE Medicare |
$15,972.32
|
| Rate for Payer: PACE SWMI |
$16,812.97
|
| Rate for Payer: PHP Commercial |
$18,494.27
|
| Rate for Payer: PHP Medicare Advantage |
$16,812.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28,729.20
|
| Rate for Payer: Priority Health Medicare |
$16,812.97
|
| Rate for Payer: Priority Health Narrow Network |
$22,983.36
|
| Rate for Payer: Railroad Medicare Medicare |
$16,812.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,812.97
|
| Rate for Payer: UHC Exchange |
$26,060.10
|
| Rate for Payer: UHCCP DNSP |
$16,812.97
|
| Rate for Payer: VA VA |
$16,812.97
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC
|
Facility
|
IP
|
$44,336.48
|
|
|
Service Code
|
MSDRG 485
|
| Min. Negotiated Rate |
$23,743.91 |
| Max. Negotiated Rate |
$44,336.48 |
| Rate for Payer: Aetna Medicare |
$24,993.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,241.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,241.99
|
| Rate for Payer: BCBS MAPPO |
$24,993.59
|
| Rate for Payer: BCN Medicare Advantage |
$24,993.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,993.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,993.59
|
| Rate for Payer: Mclaren Medicare |
$24,993.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26,243.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,742.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$27,492.95
|
| Rate for Payer: PACE Medicare |
$23,743.91
|
| Rate for Payer: PACE SWMI |
$24,993.59
|
| Rate for Payer: PHP Commercial |
$27,492.95
|
| Rate for Payer: PHP Medicare Advantage |
$24,993.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44,336.48
|
| Rate for Payer: Priority Health Medicare |
$24,993.59
|
| Rate for Payer: Priority Health Narrow Network |
$35,469.19
|
| Rate for Payer: Railroad Medicare Medicare |
$24,993.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,993.59
|
| Rate for Payer: UHC Exchange |
$38,740.06
|
| Rate for Payer: UHCCP DNSP |
$24,993.59
|
| Rate for Payer: VA VA |
$24,993.59
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$21,517.71
|
|
|
Service Code
|
MSDRG 487
|
| Min. Negotiated Rate |
$12,381.40 |
| Max. Negotiated Rate |
$21,517.71 |
| Rate for Payer: Aetna Medicare |
$13,033.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,291.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,291.31
|
| Rate for Payer: BCBS MAPPO |
$13,033.05
|
| Rate for Payer: BCN Medicare Advantage |
$13,033.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,033.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,033.05
|
| Rate for Payer: Mclaren Medicare |
$13,033.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,684.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,988.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,336.35
|
| Rate for Payer: PACE Medicare |
$12,381.40
|
| Rate for Payer: PACE SWMI |
$13,033.05
|
| Rate for Payer: PHP Commercial |
$14,336.35
|
| Rate for Payer: PHP Medicare Advantage |
$13,033.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21,517.71
|
| Rate for Payer: Priority Health Medicare |
$13,033.05
|
| Rate for Payer: Priority Health Narrow Network |
$17,214.17
|
| Rate for Payer: Railroad Medicare Medicare |
$13,033.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,033.05
|
| Rate for Payer: UHC Exchange |
$20,201.23
|
| Rate for Payer: UHCCP DNSP |
$13,033.05
|
| Rate for Payer: VA VA |
$13,033.05
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$2.85
|
|
|
Service Code
|
NDC 51079092801
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: ASR ASR |
$2.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.34
|
| Rate for Payer: BCN Commercial |
$2.34
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$2.76
|
| Rate for Payer: Healthscope Whirlpool |
$2.85
|
| Rate for Payer: Mclaren Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: Nomi Health Commercial |
$2.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.51
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$373.35
|
|
|
Service Code
|
NDC 60687043901
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.14 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Aetna Commercial |
$336.01
|
| Rate for Payer: Aetna Medicare |
$138.14
|
| Rate for Payer: ASR ASR |
$362.15
|
| Rate for Payer: BCBS Complete |
$149.34
|
| Rate for Payer: BCBS Trust/PPO |
$307.83
|
| Rate for Payer: BCN Commercial |
$307.83
|
| Rate for Payer: Cash Price |
$298.68
|
| Rate for Payer: Cofinity Commercial |
$350.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.68
|
| Rate for Payer: Healthscope Commercial |
$362.15
|
| Rate for Payer: Healthscope Whirlpool |
$373.35
|
| Rate for Payer: Mclaren Commercial |
$336.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.35
|
| Rate for Payer: Nomi Health Commercial |
$306.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$327.13
|
| Rate for Payer: Priority Health Narrow Network |
$261.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.55
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$3.73
|
|
|
Service Code
|
NDC 60687043911
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: ASR ASR |
$3.62
|
| Rate for Payer: BCBS Complete |
$1.49
|
| Rate for Payer: BCBS Trust/PPO |
$3.08
|
| Rate for Payer: BCN Commercial |
$3.08
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.62
|
| Rate for Payer: Healthscope Whirlpool |
$3.73
|
| Rate for Payer: Mclaren Commercial |
$3.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.17
|
| Rate for Payer: Nomi Health Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.27
|
| Rate for Payer: Priority Health Narrow Network |
$2.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.29
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$3.73
|
|
|
Service Code
|
NDC 60687043911
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: ASR ASR |
$3.62
|
| Rate for Payer: BCBS Trust/PPO |
$3.07
|
| Rate for Payer: BCN Commercial |
$3.07
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.62
|
| Rate for Payer: Healthscope Whirlpool |
$3.73
|
| Rate for Payer: Mclaren Commercial |
$3.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.17
|
| Rate for Payer: Nomi Health Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.29
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
NDC 51079092820
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.75 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: ASR ASR |
$276.45
|
| Rate for Payer: BCBS Trust/PPO |
$234.04
|
| Rate for Payer: BCN Commercial |
$234.04
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$267.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Healthscope Commercial |
$276.45
|
| Rate for Payer: Healthscope Whirlpool |
$285.00
|
| Rate for Payer: Mclaren Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.25
|
| Rate for Payer: Nomi Health Commercial |
$233.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.80
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
NDC 51079092820
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.45 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Medicare |
$105.45
|
| Rate for Payer: ASR ASR |
$276.45
|
| Rate for Payer: BCBS Complete |
$114.00
|
| Rate for Payer: BCBS Trust/PPO |
$234.98
|
| Rate for Payer: BCN Commercial |
$234.98
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$267.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Healthscope Commercial |
$276.45
|
| Rate for Payer: Healthscope Whirlpool |
$285.00
|
| Rate for Payer: Mclaren Commercial |
$256.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.25
|
| Rate for Payer: Nomi Health Commercial |
$233.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$249.72
|
| Rate for Payer: Priority Health Narrow Network |
$199.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.80
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$373.35
|
|
|
Service Code
|
NDC 60687043901
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.01 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Aetna Commercial |
$336.01
|
| Rate for Payer: ASR ASR |
$362.15
|
| Rate for Payer: BCBS Trust/PPO |
$306.60
|
| Rate for Payer: BCN Commercial |
$306.60
|
| Rate for Payer: Cash Price |
$298.68
|
| Rate for Payer: Cofinity Commercial |
$350.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.68
|
| Rate for Payer: Healthscope Commercial |
$362.15
|
| Rate for Payer: Healthscope Whirlpool |
$373.35
|
| Rate for Payer: Mclaren Commercial |
$336.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.35
|
| Rate for Payer: Nomi Health Commercial |
$306.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.55
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$2.85
|
|
|
Service Code
|
NDC 51079092801
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: Aetna Medicare |
$1.05
|
| Rate for Payer: ASR ASR |
$2.76
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.35
|
| Rate for Payer: BCN Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$2.76
|
| Rate for Payer: Healthscope Whirlpool |
$2.85
|
| Rate for Payer: Mclaren Commercial |
$2.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: Nomi Health Commercial |
$2.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.50
|
| Rate for Payer: Priority Health Narrow Network |
$2.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.51
|
|
|
LABETALOL 10 MG/2 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$21.68
|
|
|
Service Code
|
HCPCS J1921
|
| Hospital Charge Code |
190443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$19.51
|
| Rate for Payer: Aetna Medicare |
$8.02
|
| Rate for Payer: ASR ASR |
$21.03
|
| Rate for Payer: BCBS Complete |
$8.67
|
| Rate for Payer: BCBS Trust/PPO |
$17.88
|
| Rate for Payer: BCN Commercial |
$17.88
|
| Rate for Payer: Cash Price |
$17.35
|
| Rate for Payer: Cash Price |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$20.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.35
|
| Rate for Payer: Healthscope Commercial |
$21.03
|
| Rate for Payer: Healthscope Whirlpool |
$21.68
|
| Rate for Payer: Mclaren Commercial |
$19.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.43
|
| Rate for Payer: Nomi Health Commercial |
$17.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.13
|
| Rate for Payer: Priority Health Narrow Network |
$0.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.08
|
|
|
LABETALOL 10 MG/2 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$21.68
|
|
|
Service Code
|
HCPCS J1921
|
| Hospital Charge Code |
190443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$19.51
|
| Rate for Payer: ASR ASR |
$21.03
|
| Rate for Payer: BCBS Trust/PPO |
$17.81
|
| Rate for Payer: BCN Commercial |
$17.81
|
| Rate for Payer: Cash Price |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$20.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.35
|
| Rate for Payer: Healthscope Commercial |
$21.03
|
| Rate for Payer: Healthscope Whirlpool |
$21.68
|
| Rate for Payer: Mclaren Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.43
|
| Rate for Payer: Nomi Health Commercial |
$17.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.08
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$251.75
|
|
|
Service Code
|
NDC 68382079901
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.15 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Aetna Commercial |
$226.57
|
| Rate for Payer: Aetna Medicare |
$93.15
|
| Rate for Payer: ASR ASR |
$244.20
|
| Rate for Payer: BCBS Complete |
$100.70
|
| Rate for Payer: BCBS Trust/PPO |
$207.57
|
| Rate for Payer: BCN Commercial |
$207.57
|
| Rate for Payer: Cash Price |
$201.40
|
| Rate for Payer: Cofinity Commercial |
$236.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.40
|
| Rate for Payer: Healthscope Commercial |
$244.20
|
| Rate for Payer: Healthscope Whirlpool |
$251.75
|
| Rate for Payer: Mclaren Commercial |
$226.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.99
|
| Rate for Payer: Nomi Health Commercial |
$206.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$220.58
|
| Rate for Payer: Priority Health Narrow Network |
$176.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.54
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
NDC 60687045011
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: ASR ASR |
$2.62
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$2.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.16
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: Healthscope Whirlpool |
$2.70
|
| Rate for Payer: Mclaren Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.30
|
| Rate for Payer: Nomi Health Commercial |
$2.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.38
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$3.85
|
|
|
Service Code
|
NDC 51079092901
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Aetna Medicare |
$1.42
|
| Rate for Payer: ASR ASR |
$3.73
|
| Rate for Payer: BCBS Complete |
$1.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.17
|
| Rate for Payer: BCN Commercial |
$3.17
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$3.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.08
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Healthscope Whirlpool |
$3.85
|
| Rate for Payer: Mclaren Commercial |
$3.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.27
|
| Rate for Payer: Nomi Health Commercial |
$3.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.37
|
| Rate for Payer: Priority Health Narrow Network |
$2.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.39
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$384.75
|
|
|
Service Code
|
NDC 51079092920
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.36 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Aetna Commercial |
$346.27
|
| Rate for Payer: Aetna Medicare |
$142.36
|
| Rate for Payer: ASR ASR |
$373.21
|
| Rate for Payer: BCBS Complete |
$153.90
|
| Rate for Payer: BCBS Trust/PPO |
$317.23
|
| Rate for Payer: BCN Commercial |
$317.23
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cofinity Commercial |
$361.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.80
|
| Rate for Payer: Healthscope Commercial |
$373.21
|
| Rate for Payer: Healthscope Whirlpool |
$384.75
|
| Rate for Payer: Mclaren Commercial |
$346.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$307.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.04
|
| Rate for Payer: Nomi Health Commercial |
$315.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$337.12
|
| Rate for Payer: Priority Health Narrow Network |
$269.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$338.58
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$434.75
|
|
|
Service Code
|
NDC 70377006112
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$326.06 |
| Max. Negotiated Rate |
$434.75 |
| Rate for Payer: Aetna Commercial |
$391.27
|
| Rate for Payer: ASR ASR |
$421.71
|
| Rate for Payer: BCBS Trust/PPO |
$357.02
|
| Rate for Payer: BCN Commercial |
$357.02
|
| Rate for Payer: Cash Price |
$347.80
|
| Rate for Payer: Cofinity Commercial |
$408.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.80
|
| Rate for Payer: Healthscope Commercial |
$421.71
|
| Rate for Payer: Healthscope Whirlpool |
$434.75
|
| Rate for Payer: Mclaren Commercial |
$391.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.54
|
| Rate for Payer: Nomi Health Commercial |
$356.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$326.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$382.58
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$384.75
|
|
|
Service Code
|
NDC 51079092920
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$288.56 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Aetna Commercial |
$346.27
|
| Rate for Payer: ASR ASR |
$373.21
|
| Rate for Payer: BCBS Trust/PPO |
$315.96
|
| Rate for Payer: BCN Commercial |
$315.96
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cofinity Commercial |
$361.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.80
|
| Rate for Payer: Healthscope Commercial |
$373.21
|
| Rate for Payer: Healthscope Whirlpool |
$384.75
|
| Rate for Payer: Mclaren Commercial |
$346.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.04
|
| Rate for Payer: Nomi Health Commercial |
$315.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$338.58
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$290.70
|
|
|
Service Code
|
NDC 904711061
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$218.03 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: ASR ASR |
$281.98
|
| Rate for Payer: BCBS Trust/PPO |
$238.72
|
| Rate for Payer: BCN Commercial |
$238.72
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$273.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$281.98
|
| Rate for Payer: Healthscope Whirlpool |
$290.70
|
| Rate for Payer: Mclaren Commercial |
$261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.09
|
| Rate for Payer: Nomi Health Commercial |
$238.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.82
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$251.75
|
|
|
Service Code
|
NDC 68382079901
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.81 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Aetna Commercial |
$226.57
|
| Rate for Payer: ASR ASR |
$244.20
|
| Rate for Payer: BCBS Trust/PPO |
$206.74
|
| Rate for Payer: BCN Commercial |
$206.74
|
| Rate for Payer: Cash Price |
$201.40
|
| Rate for Payer: Cofinity Commercial |
$236.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.40
|
| Rate for Payer: Healthscope Commercial |
$244.20
|
| Rate for Payer: Healthscope Whirlpool |
$251.75
|
| Rate for Payer: Mclaren Commercial |
$226.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.99
|
| Rate for Payer: Nomi Health Commercial |
$206.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.54
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$3.85
|
|
|
Service Code
|
NDC 51079092901
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: ASR ASR |
$3.73
|
| Rate for Payer: BCBS Trust/PPO |
$3.16
|
| Rate for Payer: BCN Commercial |
$3.16
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$3.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.08
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Healthscope Whirlpool |
$3.85
|
| Rate for Payer: Mclaren Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.27
|
| Rate for Payer: Nomi Health Commercial |
$3.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.39
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$290.70
|
|
|
Service Code
|
NDC 904711061
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.56 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna Medicare |
$107.56
|
| Rate for Payer: ASR ASR |
$281.98
|
| Rate for Payer: BCBS Complete |
$116.28
|
| Rate for Payer: BCBS Trust/PPO |
$239.68
|
| Rate for Payer: BCN Commercial |
$239.68
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$273.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$281.98
|
| Rate for Payer: Healthscope Whirlpool |
$290.70
|
| Rate for Payer: Mclaren Commercial |
$261.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.09
|
| Rate for Payer: Nomi Health Commercial |
$238.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$254.71
|
| Rate for Payer: Priority Health Narrow Network |
$203.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.82
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$270.24
|
|
|
Service Code
|
NDC 60687045001
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.99 |
| Max. Negotiated Rate |
$270.24 |
| Rate for Payer: Aetna Commercial |
$243.22
|
| Rate for Payer: Aetna Medicare |
$99.99
|
| Rate for Payer: ASR ASR |
$262.13
|
| Rate for Payer: BCBS Complete |
$108.10
|
| Rate for Payer: BCBS Trust/PPO |
$222.81
|
| Rate for Payer: BCN Commercial |
$222.81
|
| Rate for Payer: Cash Price |
$216.19
|
| Rate for Payer: Cofinity Commercial |
$254.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.19
|
| Rate for Payer: Healthscope Commercial |
$262.13
|
| Rate for Payer: Healthscope Whirlpool |
$270.24
|
| Rate for Payer: Mclaren Commercial |
$243.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.70
|
| Rate for Payer: Nomi Health Commercial |
$221.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$236.78
|
| Rate for Payer: Priority Health Narrow Network |
$189.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.81
|
|
