|
IPL HANDS & ARMS SECOND
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 00137
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Aetna Medicare |
$115.00
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
|
|
IPL NECK
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 00138
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
|
|
IPL NOSE & CHEEKS FIRST
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00127
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
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 |
$2.38
|
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Commercial |
$2.62
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: Aetna Medicare |
$1.46
|
| Rate for Payer: Aetna Medicare |
$2.21
|
| Rate for Payer: Aetna Medicare |
$1.45
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: Aetna Medicare |
$1.21
|
| Rate for Payer: ASR ASR |
$3.42
|
| Rate for Payer: ASR ASR |
$2.81
|
| Rate for Payer: ASR ASR |
$2.60
|
| Rate for Payer: ASR ASR |
$2.35
|
| Rate for Payer: ASR ASR |
$2.57
|
| Rate for Payer: ASR ASR |
$4.29
|
| Rate for Payer: ASR ASR |
$2.82
|
| Rate for Payer: ASR Commercial |
$2.35
|
| Rate for Payer: ASR Commercial |
$2.81
|
| Rate for Payer: ASR Commercial |
$2.57
|
| Rate for Payer: ASR Commercial |
$2.60
|
| Rate for Payer: ASR Commercial |
$4.29
|
| Rate for Payer: ASR Commercial |
$3.42
|
| Rate for Payer: ASR Commercial |
$2.82
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Complete |
$0.97
|
| Rate for Payer: BCBS Complete |
$1.77
|
| Rate for Payer: BCBS Complete |
$1.41
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.98
|
| Rate for Payer: BCBS Trust/PPO |
$3.62
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.89
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCBS Trust/PPO |
$2.38
|
| Rate for Payer: BCN Commercial |
$3.43
|
| Rate for Payer: BCN Commercial |
$2.05
|
| Rate for Payer: BCN Commercial |
$2.26
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: BCN Commercial |
$2.08
|
| Rate for Payer: BCN Commercial |
$2.25
|
| Rate for Payer: BCN Commercial |
$2.74
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$2.14
|
| 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 |
$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 |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.33
|
| Rate for Payer: Healthscope Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.65
|
| Rate for Payer: Healthscope Commercial |
$3.53
|
| Rate for Payer: Healthscope Commercial |
$2.91
|
| Rate for Payer: Healthscope Commercial |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$4.42
|
| Rate for Payer: Healthscope Whirlpool |
$2.81
|
| Rate for Payer: Healthscope Whirlpool |
$2.60
|
| Rate for Payer: Healthscope Whirlpool |
$2.57
|
| Rate for Payer: Healthscope Whirlpool |
$2.82
|
| Rate for Payer: Healthscope Whirlpool |
$3.42
|
| Rate for Payer: Healthscope Whirlpool |
$4.29
|
| Rate for Payer: Healthscope Whirlpool |
$2.35
|
| Rate for Payer: Mclaren Commercial |
$3.18
|
| Rate for Payer: Mclaren Commercial |
$2.61
|
| Rate for Payer: Mclaren Commercial |
$2.41
|
| Rate for Payer: Mclaren Commercial |
$3.98
|
| Rate for Payer: Mclaren Commercial |
$2.62
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: Mclaren Commercial |
$2.18
|
| 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 |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: Nomi Health Commercial |
$1.98
|
| Rate for Payer: Nomi Health Commercial |
$2.38
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: Nomi Health Commercial |
$2.39
|
| Rate for Payer: Nomi Health Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.20
|
| Rate for Payer: 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: Priority Health Narrow Network |
$0.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.33
|
|
|
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 |
$1.72 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: Aetna Commercial |
$2.62
|
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: ASR ASR |
$2.81
|
| Rate for Payer: ASR ASR |
$2.60
|
| Rate for Payer: ASR ASR |
$4.29
|
| Rate for Payer: ASR ASR |
$2.82
|
| Rate for Payer: ASR ASR |
$2.57
|
| Rate for Payer: ASR ASR |
$2.35
|
| Rate for Payer: ASR ASR |
$3.42
|
| Rate for Payer: ASR Commercial |
$4.29
|
| Rate for Payer: ASR Commercial |
$3.42
|
| Rate for Payer: ASR Commercial |
$2.60
|
| Rate for Payer: ASR Commercial |
$2.82
|
| Rate for Payer: ASR Commercial |
$2.81
|
| Rate for Payer: ASR Commercial |
$2.57
|
| Rate for Payer: ASR Commercial |
$2.35
|
| Rate for Payer: BCBS Trust/PPO |
$2.88
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCBS Trust/PPO |
$1.97
|
| Rate for Payer: BCBS Trust/PPO |
$2.16
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCBS Trust/PPO |
$2.18
|
| Rate for Payer: BCBS Trust/PPO |
$3.60
|
| Rate for Payer: BCN Commercial |
$2.08
|
| Rate for Payer: BCN Commercial |
$3.43
|
| Rate for Payer: BCN Commercial |
$2.26
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: BCN Commercial |
$2.05
|
| Rate for Payer: BCN Commercial |
$2.74
|
| Rate for Payer: BCN Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.33
|
| Rate for Payer: Healthscope Commercial |
$2.91
|
| Rate for Payer: Healthscope Commercial |
$4.42
|
| Rate for Payer: Healthscope Commercial |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.53
|
| Rate for Payer: Healthscope Commercial |
$2.65
|
| Rate for Payer: Healthscope Commercial |
$2.42
|
| Rate for Payer: Healthscope Whirlpool |
$3.42
|
| Rate for Payer: Healthscope Whirlpool |
$2.82
|
| Rate for Payer: Healthscope Whirlpool |
$2.81
|
| Rate for Payer: Healthscope Whirlpool |
$2.57
|
| Rate for Payer: Healthscope Whirlpool |
$2.60
|
| Rate for Payer: Healthscope Whirlpool |
$2.35
|
| Rate for Payer: Healthscope Whirlpool |
$4.29
|
| Rate for Payer: Mclaren Commercial |
$2.62
|
| Rate for Payer: Mclaren Commercial |
$3.98
|
| Rate for Payer: Mclaren Commercial |
$2.18
|
| Rate for Payer: Mclaren Commercial |
$3.18
|
| Rate for Payer: Mclaren Commercial |
$2.41
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: Mclaren Commercial |
$2.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.06
|
| 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 |
$2.46
|
| 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 |
$1.98
|
| Rate for Payer: Nomi Health Commercial |
$2.89
|
| Rate for Payer: Nomi Health Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$2.38
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: Nomi Health Commercial |
$2.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.36
|
|
|
IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION
|
Facility
|
OP
|
$1,640.59
|
|
|
Service Code
|
NDC 00597002402
|
| Hospital Charge Code |
172696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$656.24 |
| Max. Negotiated Rate |
$1,640.59 |
| Rate for Payer: Aetna Commercial |
$1,476.53
|
| Rate for Payer: Aetna Medicare |
$820.30
|
| Rate for Payer: ASR ASR |
$1,591.37
|
| Rate for Payer: ASR Commercial |
$1,591.37
|
| Rate for Payer: BCBS Complete |
$656.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,343.48
|
| Rate for Payer: BCN Commercial |
$1,271.95
|
| Rate for Payer: Cash Price |
$1,312.47
|
| Rate for Payer: Cofinity Commercial |
$1,542.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,312.47
|
| Rate for Payer: Healthscope Commercial |
$1,640.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,591.37
|
| Rate for Payer: Mclaren Commercial |
$1,476.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,394.50
|
| Rate for Payer: Nomi Health Commercial |
$1,345.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,066.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,437.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,150.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,443.72
|
|
|
IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION
|
Facility
|
IP
|
$1,640.59
|
|
|
Service Code
|
NDC 00597002402
|
| Hospital Charge Code |
172696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,066.38 |
| Max. Negotiated Rate |
$1,640.59 |
| Rate for Payer: Aetna Commercial |
$1,476.53
|
| Rate for Payer: ASR ASR |
$1,591.37
|
| Rate for Payer: ASR Commercial |
$1,591.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,336.92
|
| Rate for Payer: BCN Commercial |
$1,271.95
|
| Rate for Payer: Cash Price |
$1,312.47
|
| Rate for Payer: Cofinity Commercial |
$1,542.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,312.47
|
| Rate for Payer: Healthscope Commercial |
$1,640.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,591.37
|
| Rate for Payer: Mclaren Commercial |
$1,476.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,394.50
|
| Rate for Payer: Nomi Health Commercial |
$1,345.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,066.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,443.72
|
|
|
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 |
$0.30 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: Aetna Commercial |
$6.08
|
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: Aetna Medicare |
$3.38
|
| Rate for Payer: Aetna Medicare |
$2.29
|
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: ASR ASR |
$5.81
|
| Rate for Payer: ASR ASR |
$4.44
|
| Rate for Payer: ASR ASR |
$6.56
|
| Rate for Payer: ASR Commercial |
$5.81
|
| Rate for Payer: ASR Commercial |
$4.44
|
| Rate for Payer: ASR Commercial |
$6.56
|
| Rate for Payer: BCBS Complete |
$1.83
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS Complete |
$2.70
|
| Rate for Payer: BCBS Trust/PPO |
$5.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.75
|
| Rate for Payer: BCBS Trust/PPO |
$4.91
|
| Rate for Payer: BCN Commercial |
$4.64
|
| Rate for Payer: BCN Commercial |
$5.24
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Cofinity Commercial |
$6.35
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Cofinity Commercial |
$5.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.79
|
| Rate for Payer: Healthscope Commercial |
$6.76
|
| Rate for Payer: Healthscope Commercial |
$5.99
|
| Rate for Payer: Healthscope Commercial |
$4.58
|
| Rate for Payer: Healthscope Whirlpool |
$6.56
|
| Rate for Payer: Healthscope Whirlpool |
$5.81
|
| Rate for Payer: Healthscope Whirlpool |
$4.44
|
| Rate for Payer: Mclaren Commercial |
$5.39
|
| Rate for Payer: Mclaren Commercial |
$6.08
|
| Rate for Payer: Mclaren Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.89
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Nomi Health Commercial |
$5.54
|
| Rate for Payer: Nomi Health Commercial |
$4.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.38
|
| Rate for Payer: Priority Health Narrow Network |
$0.30
|
| Rate for Payer: Priority Health Narrow Network |
$0.30
|
| Rate for Payer: Priority Health Narrow Network |
$0.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.95
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION
|
Facility
|
IP
|
$5.99
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
12580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$5.99 |
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: Aetna Commercial |
$6.08
|
| Rate for Payer: ASR ASR |
$4.44
|
| Rate for Payer: ASR ASR |
$5.81
|
| Rate for Payer: ASR ASR |
$6.56
|
| Rate for Payer: ASR Commercial |
$5.81
|
| Rate for Payer: ASR Commercial |
$4.44
|
| Rate for Payer: ASR Commercial |
$6.56
|
| Rate for Payer: BCBS Trust/PPO |
$5.51
|
| Rate for Payer: BCBS Trust/PPO |
$3.73
|
| Rate for Payer: BCBS Trust/PPO |
$4.88
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: BCN Commercial |
$5.24
|
| Rate for Payer: BCN Commercial |
$4.64
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Cofinity Commercial |
$6.35
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Cofinity Commercial |
$5.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.41
|
| Rate for Payer: Healthscope Commercial |
$4.58
|
| Rate for Payer: Healthscope Commercial |
$5.99
|
| Rate for Payer: Healthscope Commercial |
$6.76
|
| Rate for Payer: Healthscope Whirlpool |
$5.81
|
| Rate for Payer: Healthscope Whirlpool |
$4.44
|
| Rate for Payer: Healthscope Whirlpool |
$6.56
|
| Rate for Payer: Mclaren Commercial |
$5.39
|
| Rate for Payer: Mclaren Commercial |
$4.12
|
| Rate for Payer: Mclaren Commercial |
$6.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.89
|
| Rate for Payer: Nomi Health Commercial |
$4.91
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Nomi Health Commercial |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.03
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY
|
Facility
|
IP
|
$61.95
|
|
|
Service Code
|
NDC 69238201603
|
| Hospital Charge Code |
16070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.27 |
| Max. Negotiated Rate |
$61.95 |
| Rate for Payer: Aetna Commercial |
$55.76
|
| Rate for Payer: ASR ASR |
$60.09
|
| Rate for Payer: ASR Commercial |
$60.09
|
| Rate for Payer: BCBS Trust/PPO |
$50.48
|
| Rate for Payer: BCN Commercial |
$48.03
|
| Rate for Payer: Cash Price |
$49.56
|
| Rate for Payer: Cofinity Commercial |
$58.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.56
|
| Rate for Payer: Healthscope Commercial |
$61.95
|
| Rate for Payer: Healthscope Whirlpool |
$60.09
|
| Rate for Payer: Mclaren Commercial |
$55.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.66
|
| Rate for Payer: Nomi Health Commercial |
$50.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.52
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY
|
Facility
|
OP
|
$61.95
|
|
|
Service Code
|
NDC 69238201603
|
| Hospital Charge Code |
16070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.78 |
| Max. Negotiated Rate |
$61.95 |
| Rate for Payer: Aetna Commercial |
$55.76
|
| Rate for Payer: Aetna Medicare |
$30.98
|
| Rate for Payer: ASR ASR |
$60.09
|
| Rate for Payer: ASR Commercial |
$60.09
|
| Rate for Payer: BCBS Complete |
$24.78
|
| Rate for Payer: BCBS Trust/PPO |
$50.73
|
| Rate for Payer: BCN Commercial |
$48.03
|
| Rate for Payer: Cash Price |
$49.56
|
| Rate for Payer: Cofinity Commercial |
$58.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.56
|
| Rate for Payer: Healthscope Commercial |
$61.95
|
| Rate for Payer: Healthscope Whirlpool |
$60.09
|
| Rate for Payer: Mclaren Commercial |
$55.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.66
|
| Rate for Payer: Nomi Health Commercial |
$50.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.28
|
| Rate for Payer: Priority Health Narrow Network |
$43.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.52
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
IP
|
$67.68
|
|
|
Service Code
|
NDC 43547027803
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.99 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$60.91
|
| Rate for Payer: ASR ASR |
$65.65
|
| Rate for Payer: ASR Commercial |
$65.65
|
| Rate for Payer: BCBS Trust/PPO |
$55.15
|
| Rate for Payer: BCN Commercial |
$52.47
|
| 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 |
$67.68
|
| Rate for Payer: Healthscope Whirlpool |
$65.65
|
| 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: Priority Health Cigna Priority Health |
$43.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.56
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
OP
|
$67.68
|
|
|
Service Code
|
NDC 43547027803
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$60.91
|
| Rate for Payer: Aetna Medicare |
$33.84
|
| Rate for Payer: ASR ASR |
$65.65
|
| Rate for Payer: ASR Commercial |
$65.65
|
| Rate for Payer: BCBS Complete |
$27.07
|
| Rate for Payer: BCBS Trust/PPO |
$55.42
|
| Rate for Payer: BCN Commercial |
$52.47
|
| 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 |
$67.68
|
| Rate for Payer: Healthscope Whirlpool |
$65.65
|
| 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: Priority Health Cigna Priority Health |
$43.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.30
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.56
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
OP
|
$790.21
|
|
|
Service Code
|
NDC 00024585130
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$316.08 |
| Max. Negotiated Rate |
$790.21 |
| Rate for Payer: Aetna Commercial |
$711.19
|
| Rate for Payer: Aetna Medicare |
$395.10
|
| Rate for Payer: ASR ASR |
$766.50
|
| Rate for Payer: ASR Commercial |
$766.50
|
| Rate for Payer: BCBS Complete |
$316.08
|
| Rate for Payer: BCBS Trust/PPO |
$647.10
|
| Rate for Payer: BCN Commercial |
$612.65
|
| 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 |
$790.21
|
| Rate for Payer: Healthscope Whirlpool |
$766.50
|
| Rate for Payer: Mclaren Commercial |
$711.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.68
|
| Rate for Payer: Nomi Health Commercial |
$647.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.64
|
| Rate for Payer: 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
|
IP
|
$79.67
|
|
|
Service Code
|
NDC 43547037503
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.79 |
| Max. Negotiated Rate |
$79.67 |
| Rate for Payer: Aetna Commercial |
$71.70
|
| Rate for Payer: ASR ASR |
$77.28
|
| Rate for Payer: ASR Commercial |
$77.28
|
| Rate for Payer: BCBS Trust/PPO |
$64.92
|
| Rate for Payer: BCN Commercial |
$61.77
|
| Rate for Payer: Cash Price |
$63.73
|
| Rate for Payer: Cofinity Commercial |
$74.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.74
|
| Rate for Payer: Healthscope Commercial |
$79.67
|
| Rate for Payer: Healthscope Whirlpool |
$77.28
|
| Rate for Payer: Mclaren Commercial |
$71.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.72
|
| Rate for Payer: Nomi Health Commercial |
$65.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.11
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
IP
|
$790.21
|
|
|
Service Code
|
NDC 00024585130
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$513.64 |
| Max. Negotiated Rate |
$790.21 |
| Rate for Payer: Aetna Commercial |
$711.19
|
| Rate for Payer: ASR ASR |
$766.50
|
| Rate for Payer: ASR Commercial |
$766.50
|
| Rate for Payer: BCBS Trust/PPO |
$643.94
|
| Rate for Payer: BCN Commercial |
$612.65
|
| 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 |
$790.21
|
| Rate for Payer: Healthscope Whirlpool |
$766.50
|
| Rate for Payer: Mclaren Commercial |
$711.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.68
|
| Rate for Payer: Nomi Health Commercial |
$647.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.64
|
| 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 |
$31.87 |
| Max. Negotiated Rate |
$79.67 |
| Rate for Payer: Aetna Commercial |
$71.70
|
| Rate for Payer: Aetna Medicare |
$39.84
|
| Rate for Payer: ASR ASR |
$77.28
|
| Rate for Payer: ASR Commercial |
$77.28
|
| Rate for Payer: BCBS Complete |
$31.87
|
| Rate for Payer: BCBS Trust/PPO |
$65.24
|
| Rate for Payer: BCN Commercial |
$61.77
|
| Rate for Payer: Cash Price |
$63.73
|
| Rate for Payer: Cofinity Commercial |
$74.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.74
|
| Rate for Payer: Healthscope Commercial |
$79.67
|
| Rate for Payer: Healthscope Whirlpool |
$77.28
|
| Rate for Payer: Mclaren Commercial |
$71.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.72
|
| Rate for Payer: Nomi Health Commercial |
$65.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.81
|
| Rate for Payer: Priority Health Narrow Network |
$55.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.11
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$161.68
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$161.68 |
| Rate for Payer: Aetna Commercial |
$145.51
|
| Rate for Payer: Aetna Medicare |
$17.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.75
|
| Rate for Payer: ASR ASR |
$156.83
|
| Rate for Payer: ASR Commercial |
$156.83
|
| Rate for Payer: BCBS Complete |
$9.79
|
| Rate for Payer: BCBS MAPPO |
$17.40
|
| Rate for Payer: BCBS Trust/PPO |
$132.40
|
| Rate for Payer: BCN Commercial |
$125.35
|
| Rate for Payer: BCN Medicare Advantage |
$17.40
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cofinity Commercial |
$151.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.40
|
| Rate for Payer: Healthscope Commercial |
$161.68
|
| Rate for Payer: Healthscope Whirlpool |
$156.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.40
|
| Rate for Payer: Mclaren Commercial |
$145.51
|
| Rate for Payer: Mclaren Medicaid |
$9.33
|
| Rate for Payer: Mclaren Medicare |
$17.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.27
|
| Rate for Payer: Meridian Medicaid |
$9.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.43
|
| Rate for Payer: Nomi Health Commercial |
$132.58
|
| Rate for Payer: PACE Medicare |
$16.53
|
| Rate for Payer: PACE SWMI |
$17.40
|
| Rate for Payer: PHP Commercial |
$19.14
|
| Rate for Payer: PHP Medicaid |
$9.33
|
| Rate for Payer: PHP Medicare Advantage |
$17.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.88
|
| Rate for Payer: Priority Health Medicare |
$17.40
|
| Rate for Payer: Priority Health Narrow Network |
$14.30
|
| Rate for Payer: Railroad Medicare Medicare |
$17.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.40
|
| Rate for Payer: UHC Exchange |
$26.97
|
| Rate for Payer: UHC Medicare Advantage |
$17.40
|
| Rate for Payer: UHCCP DNSP |
$17.40
|
| Rate for Payer: UHCCP Medicaid |
$9.33
|
| Rate for Payer: VA VA |
$17.40
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$161.68
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$161.68 |
| Rate for Payer: Aetna Commercial |
$145.51
|
| Rate for Payer: ASR ASR |
$156.83
|
| Rate for Payer: ASR Commercial |
$156.83
|
| Rate for Payer: BCBS Trust/PPO |
$131.75
|
| Rate for Payer: BCN Commercial |
$125.35
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cofinity Commercial |
$151.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.34
|
| Rate for Payer: Healthscope Commercial |
$161.68
|
| Rate for Payer: Healthscope Whirlpool |
$156.83
|
| Rate for Payer: Mclaren Commercial |
$145.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.43
|
| Rate for Payer: Nomi Health Commercial |
$132.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.28
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$154.04
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.13 |
| Max. Negotiated Rate |
$154.04 |
| Rate for Payer: Aetna Commercial |
$138.64
|
| Rate for Payer: ASR ASR |
$149.42
|
| Rate for Payer: ASR Commercial |
$149.42
|
| Rate for Payer: BCBS Trust/PPO |
$125.53
|
| Rate for Payer: BCN Commercial |
$119.43
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cofinity Commercial |
$144.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.23
|
| Rate for Payer: Healthscope Commercial |
$154.04
|
| Rate for Payer: Healthscope Whirlpool |
$149.42
|
| Rate for Payer: Mclaren Commercial |
$138.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.93
|
| Rate for Payer: Nomi Health Commercial |
$126.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.56
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$154.04
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$154.04 |
| Rate for Payer: Aetna Commercial |
$138.64
|
| Rate for Payer: Aetna Medicare |
$77.02
|
| Rate for Payer: ASR ASR |
$149.42
|
| Rate for Payer: ASR Commercial |
$149.42
|
| Rate for Payer: BCBS Complete |
$61.62
|
| Rate for Payer: BCBS Trust/PPO |
$126.14
|
| Rate for Payer: BCN Commercial |
$119.43
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cofinity Commercial |
$144.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.23
|
| Rate for Payer: Healthscope Commercial |
$154.04
|
| Rate for Payer: Healthscope Whirlpool |
$149.42
|
| Rate for Payer: Mclaren Commercial |
$138.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.93
|
| Rate for Payer: Nomi Health Commercial |
$126.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.25
|
| Rate for Payer: Priority Health Narrow Network |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.56
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
OP
|
$3.29
|
|
|
Service Code
|
NDC 68084008311
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna Medicare |
$1.64
|
| Rate for Payer: ASR ASR |
$3.19
|
| Rate for Payer: ASR Commercial |
$3.19
|
| Rate for Payer: BCBS Complete |
$1.32
|
| Rate for Payer: BCBS Trust/PPO |
$2.69
|
| Rate for Payer: BCN Commercial |
$2.55
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.63
|
| Rate for Payer: Healthscope Commercial |
$3.29
|
| Rate for Payer: Healthscope Whirlpool |
$3.19
|
| Rate for Payer: Mclaren Commercial |
$2.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.80
|
| Rate for Payer: Nomi Health Commercial |
$2.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.88
|
| Rate for Payer: Priority Health Narrow Network |
$2.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.90
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
IP
|
$329.28
|
|
|
Service Code
|
NDC 68084008301
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.03 |
| Max. Negotiated Rate |
$329.28 |
| Rate for Payer: Aetna Commercial |
$296.35
|
| Rate for Payer: ASR ASR |
$319.40
|
| Rate for Payer: ASR Commercial |
$319.40
|
| Rate for Payer: BCBS Trust/PPO |
$268.33
|
| Rate for Payer: BCN Commercial |
$255.29
|
| Rate for Payer: Cash Price |
$263.42
|
| Rate for Payer: Cofinity Commercial |
$309.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.42
|
| Rate for Payer: Healthscope Commercial |
$329.28
|
| Rate for Payer: Healthscope Whirlpool |
$319.40
|
| Rate for Payer: Mclaren Commercial |
$296.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.89
|
| Rate for Payer: Nomi Health Commercial |
$270.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.77
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
IP
|
$242.88
|
|
|
Service Code
|
NDC 00904662061
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.87 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$218.59
|
| Rate for Payer: ASR ASR |
$235.59
|
| Rate for Payer: ASR Commercial |
$235.59
|
| Rate for Payer: BCBS Trust/PPO |
$197.92
|
| Rate for Payer: BCN Commercial |
$188.30
|
| Rate for Payer: Cash Price |
$194.30
|
| Rate for Payer: Cofinity Commercial |
$228.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.30
|
| Rate for Payer: Healthscope Commercial |
$242.88
|
| Rate for Payer: Healthscope Whirlpool |
$235.59
|
| Rate for Payer: Mclaren Commercial |
$218.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.45
|
| Rate for Payer: Nomi Health Commercial |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.73
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
IP
|
$3.29
|
|
|
Service Code
|
NDC 68084008311
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: ASR ASR |
$3.19
|
| Rate for Payer: ASR Commercial |
$3.19
|
| Rate for Payer: BCBS Trust/PPO |
$2.68
|
| Rate for Payer: BCN Commercial |
$2.55
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.63
|
| Rate for Payer: Healthscope Commercial |
$3.29
|
| Rate for Payer: Healthscope Whirlpool |
$3.19
|
| Rate for Payer: Mclaren Commercial |
$2.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.80
|
| Rate for Payer: Nomi Health Commercial |
$2.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.90
|
|
