|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$270.24
|
|
|
Service Code
|
NDC 60687045001
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.68 |
| Max. Negotiated Rate |
$270.24 |
| Rate for Payer: Aetna Commercial |
$243.22
|
| Rate for Payer: ASR ASR |
$262.13
|
| Rate for Payer: BCBS Trust/PPO |
$221.92
|
| Rate for Payer: BCN Commercial |
$221.92
|
| 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: 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: UHC All Payor (Choice/PPO) + Core |
$237.81
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 60687045011
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: ASR ASR |
$2.62
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: BCBS Trust/PPO |
$2.23
|
| Rate for Payer: BCN Commercial |
$2.23
|
| 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: MI Amish Medical Board Commercial |
$2.16
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.37
|
| Rate for Payer: Priority Health Narrow Network |
$1.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.38
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$434.75
|
|
|
Service Code
|
NDC 70377006112
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.86 |
| Max. Negotiated Rate |
$434.75 |
| Rate for Payer: Aetna Commercial |
$391.27
|
| Rate for Payer: Aetna Medicare |
$160.86
|
| Rate for Payer: ASR ASR |
$421.71
|
| Rate for Payer: BCBS Complete |
$173.90
|
| Rate for Payer: BCBS Trust/PPO |
$358.45
|
| Rate for Payer: BCN Commercial |
$358.45
|
| 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: MI Amish Medical Board Commercial |
$347.80
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$380.93
|
| Rate for Payer: Priority Health Narrow Network |
$304.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$382.58
|
|
|
LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$28.78
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
155884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.59 |
| Max. Negotiated Rate |
$28.78 |
| Rate for Payer: Aetna Commercial |
$25.90
|
| Rate for Payer: ASR ASR |
$27.92
|
| Rate for Payer: BCBS Trust/PPO |
$23.64
|
| Rate for Payer: BCN Commercial |
$23.64
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$27.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$27.92
|
| Rate for Payer: Healthscope Whirlpool |
$28.78
|
| Rate for Payer: Mclaren Commercial |
$25.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Nomi Health Commercial |
$23.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.33
|
|
|
LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$28.78
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
155884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$28.78 |
| Rate for Payer: Aetna Commercial |
$25.90
|
| Rate for Payer: Aetna Medicare |
$10.65
|
| Rate for Payer: ASR ASR |
$27.92
|
| Rate for Payer: BCBS Complete |
$11.51
|
| Rate for Payer: BCBS Trust/PPO |
$23.73
|
| Rate for Payer: BCN Commercial |
$23.73
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$27.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$27.92
|
| Rate for Payer: Healthscope Whirlpool |
$28.78
|
| Rate for Payer: Mclaren Commercial |
$25.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Nomi Health Commercial |
$23.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.36
|
| Rate for Payer: Priority Health Narrow Network |
$0.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.33
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
10372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna Commercial |
$41.40
|
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Commercial |
$288.40
|
| Rate for Payer: Aetna Commercial |
$44.55
|
| Rate for Payer: Aetna Commercial |
$47.25
|
| Rate for Payer: Aetna Commercial |
$76.05
|
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Medicare |
$15.72
|
| Rate for Payer: Aetna Medicare |
$58.09
|
| Rate for Payer: Aetna Medicare |
$19.43
|
| Rate for Payer: Aetna Medicare |
$18.32
|
| Rate for Payer: Aetna Medicare |
$31.27
|
| Rate for Payer: Aetna Medicare |
$17.02
|
| Rate for Payer: Aetna Medicare |
$118.57
|
| Rate for Payer: ASR ASR |
$44.62
|
| Rate for Payer: ASR ASR |
$310.84
|
| Rate for Payer: ASR ASR |
$152.29
|
| Rate for Payer: ASR ASR |
$41.23
|
| Rate for Payer: ASR ASR |
$50.92
|
| Rate for Payer: ASR ASR |
$81.97
|
| Rate for Payer: ASR ASR |
$48.02
|
| Rate for Payer: BCBS Complete |
$62.80
|
| Rate for Payer: BCBS Complete |
$21.00
|
| Rate for Payer: BCBS Complete |
$33.80
|
| Rate for Payer: BCBS Complete |
$19.80
|
| Rate for Payer: BCBS Complete |
$128.18
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$40.81
|
| Rate for Payer: BCBS Trust/PPO |
$37.93
|
| Rate for Payer: BCBS Trust/PPO |
$35.04
|
| Rate for Payer: BCBS Trust/PPO |
$129.45
|
| Rate for Payer: BCBS Trust/PPO |
$264.21
|
| Rate for Payer: BCBS Trust/PPO |
$69.67
|
| Rate for Payer: BCBS Trust/PPO |
$43.29
|
| Rate for Payer: BCN Commercial |
$43.29
|
| Rate for Payer: BCN Commercial |
$40.81
|
| Rate for Payer: BCN Commercial |
$264.21
|
| Rate for Payer: BCN Commercial |
$129.45
|
| Rate for Payer: BCN Commercial |
$37.93
|
| Rate for Payer: BCN Commercial |
$35.04
|
| Rate for Payer: BCN Commercial |
$69.67
|
| Rate for Payer: Cash Price |
$256.36
|
| Rate for Payer: Cash Price |
$256.36
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cofinity Commercial |
$43.24
|
| Rate for Payer: Cofinity Commercial |
$301.22
|
| Rate for Payer: Cofinity Commercial |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$147.58
|
| Rate for Payer: Cofinity Commercial |
$46.53
|
| Rate for Payer: Cofinity Commercial |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$79.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.00
|
| Rate for Payer: Healthscope Commercial |
$50.92
|
| Rate for Payer: Healthscope Commercial |
$41.23
|
| Rate for Payer: Healthscope Commercial |
$310.84
|
| Rate for Payer: Healthscope Commercial |
$152.29
|
| Rate for Payer: Healthscope Commercial |
$81.97
|
| Rate for Payer: Healthscope Commercial |
$48.02
|
| Rate for Payer: Healthscope Commercial |
$44.62
|
| Rate for Payer: Healthscope Whirlpool |
$52.50
|
| Rate for Payer: Healthscope Whirlpool |
$46.00
|
| Rate for Payer: Healthscope Whirlpool |
$320.45
|
| Rate for Payer: Healthscope Whirlpool |
$84.50
|
| Rate for Payer: Healthscope Whirlpool |
$157.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.50
|
| Rate for Payer: Healthscope Whirlpool |
$42.50
|
| Rate for Payer: Mclaren Commercial |
$141.30
|
| Rate for Payer: Mclaren Commercial |
$38.25
|
| Rate for Payer: Mclaren Commercial |
$288.40
|
| Rate for Payer: Mclaren Commercial |
$44.55
|
| Rate for Payer: Mclaren Commercial |
$41.40
|
| Rate for Payer: Mclaren Commercial |
$47.25
|
| Rate for Payer: Mclaren Commercial |
$76.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.62
|
| Rate for Payer: Nomi Health Commercial |
$262.77
|
| Rate for Payer: Nomi Health Commercial |
$34.85
|
| Rate for Payer: Nomi Health Commercial |
$69.29
|
| Rate for Payer: Nomi Health Commercial |
$37.72
|
| Rate for Payer: Nomi Health Commercial |
$128.74
|
| Rate for Payer: Nomi Health Commercial |
$43.05
|
| Rate for Payer: Nomi Health Commercial |
$40.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.36
|
| Rate for Payer: Priority Health Narrow Network |
$0.29
|
| Rate for Payer: Priority Health Narrow Network |
$0.29
|
| Rate for Payer: Priority Health Narrow Network |
$0.29
|
| Rate for Payer: Priority Health Narrow Network |
$0.29
|
| Rate for Payer: Priority Health Narrow Network |
$0.29
|
| Rate for Payer: Priority Health Narrow Network |
$0.29
|
| Rate for Payer: Priority Health Narrow Network |
$0.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$282.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.16
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$320.45
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
10372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$240.34 |
| Max. Negotiated Rate |
$320.45 |
| Rate for Payer: Aetna Commercial |
$288.40
|
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Commercial |
$44.55
|
| Rate for Payer: Aetna Commercial |
$76.05
|
| Rate for Payer: Aetna Commercial |
$41.40
|
| Rate for Payer: Aetna Commercial |
$47.25
|
| Rate for Payer: ASR ASR |
$48.02
|
| Rate for Payer: ASR ASR |
$41.23
|
| Rate for Payer: ASR ASR |
$81.97
|
| Rate for Payer: ASR ASR |
$152.29
|
| Rate for Payer: ASR ASR |
$310.84
|
| Rate for Payer: ASR ASR |
$44.62
|
| Rate for Payer: ASR ASR |
$50.92
|
| Rate for Payer: BCBS Trust/PPO |
$69.39
|
| Rate for Payer: BCBS Trust/PPO |
$43.11
|
| Rate for Payer: BCBS Trust/PPO |
$40.65
|
| Rate for Payer: BCBS Trust/PPO |
$263.15
|
| Rate for Payer: BCBS Trust/PPO |
$128.93
|
| Rate for Payer: BCBS Trust/PPO |
$37.78
|
| Rate for Payer: BCBS Trust/PPO |
$34.90
|
| Rate for Payer: BCN Commercial |
$43.11
|
| Rate for Payer: BCN Commercial |
$34.90
|
| Rate for Payer: BCN Commercial |
$263.15
|
| Rate for Payer: BCN Commercial |
$37.78
|
| Rate for Payer: BCN Commercial |
$40.65
|
| Rate for Payer: BCN Commercial |
$128.93
|
| Rate for Payer: BCN Commercial |
$69.39
|
| Rate for Payer: Cash Price |
$256.36
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$301.22
|
| Rate for Payer: Cofinity Commercial |
$43.24
|
| Rate for Payer: Cofinity Commercial |
$46.53
|
| Rate for Payer: Cofinity Commercial |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$147.58
|
| Rate for Payer: Cofinity Commercial |
$79.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.60
|
| Rate for Payer: Healthscope Commercial |
$310.84
|
| Rate for Payer: Healthscope Commercial |
$41.23
|
| Rate for Payer: Healthscope Commercial |
$44.62
|
| Rate for Payer: Healthscope Commercial |
$152.29
|
| Rate for Payer: Healthscope Commercial |
$48.02
|
| Rate for Payer: Healthscope Commercial |
$50.92
|
| Rate for Payer: Healthscope Commercial |
$81.97
|
| Rate for Payer: Healthscope Whirlpool |
$49.50
|
| Rate for Payer: Healthscope Whirlpool |
$157.00
|
| Rate for Payer: Healthscope Whirlpool |
$320.45
|
| Rate for Payer: Healthscope Whirlpool |
$52.50
|
| Rate for Payer: Healthscope Whirlpool |
$42.50
|
| Rate for Payer: Healthscope Whirlpool |
$84.50
|
| Rate for Payer: Healthscope Whirlpool |
$46.00
|
| Rate for Payer: Mclaren Commercial |
$141.30
|
| Rate for Payer: Mclaren Commercial |
$41.40
|
| Rate for Payer: Mclaren Commercial |
$288.40
|
| Rate for Payer: Mclaren Commercial |
$44.55
|
| Rate for Payer: Mclaren Commercial |
$47.25
|
| Rate for Payer: Mclaren Commercial |
$38.25
|
| Rate for Payer: Mclaren Commercial |
$76.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.12
|
| Rate for Payer: Nomi Health Commercial |
$128.74
|
| Rate for Payer: Nomi Health Commercial |
$40.59
|
| Rate for Payer: Nomi Health Commercial |
$34.85
|
| Rate for Payer: Nomi Health Commercial |
$43.05
|
| Rate for Payer: Nomi Health Commercial |
$69.29
|
| Rate for Payer: Nomi Health Commercial |
$262.77
|
| Rate for Payer: Nomi Health Commercial |
$37.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$282.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.56
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$129.39
|
|
|
Service Code
|
NDC 62332017260
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.87 |
| Max. Negotiated Rate |
$129.39 |
| Rate for Payer: Aetna Commercial |
$116.45
|
| Rate for Payer: Aetna Medicare |
$47.87
|
| Rate for Payer: ASR ASR |
$125.51
|
| Rate for Payer: BCBS Complete |
$51.76
|
| Rate for Payer: BCBS Trust/PPO |
$106.68
|
| Rate for Payer: BCN Commercial |
$106.68
|
| Rate for Payer: Cash Price |
$103.51
|
| Rate for Payer: Cofinity Commercial |
$121.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.51
|
| Rate for Payer: Healthscope Commercial |
$125.51
|
| Rate for Payer: Healthscope Whirlpool |
$129.39
|
| Rate for Payer: Mclaren Commercial |
$116.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.98
|
| Rate for Payer: Nomi Health Commercial |
$106.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$113.37
|
| Rate for Payer: Priority Health Narrow Network |
$90.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.86
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$129.39
|
|
|
Service Code
|
NDC 62332017260
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.04 |
| Max. Negotiated Rate |
$129.39 |
| Rate for Payer: Aetna Commercial |
$116.45
|
| Rate for Payer: ASR ASR |
$125.51
|
| Rate for Payer: BCBS Trust/PPO |
$106.26
|
| Rate for Payer: BCN Commercial |
$106.26
|
| Rate for Payer: Cash Price |
$103.51
|
| Rate for Payer: Cofinity Commercial |
$121.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.51
|
| Rate for Payer: Healthscope Commercial |
$125.51
|
| Rate for Payer: Healthscope Whirlpool |
$129.39
|
| Rate for Payer: Mclaren Commercial |
$116.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.98
|
| Rate for Payer: Nomi Health Commercial |
$106.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.86
|
|
|
LACTATED RINGERS EYE BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
300324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Medicare |
$25.87
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$57.65
|
| Rate for Payer: BCN Commercial |
$57.65
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.47
|
| Rate for Payer: Priority Health Narrow Network |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTATED RINGERS EYE BOLUS
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
300324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.44 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$57.42
|
| Rate for Payer: BCN Commercial |
$57.42
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Commercial |
$60.47
|
| Rate for Payer: Aetna Medicare |
$24.86
|
| Rate for Payer: Aetna Medicare |
$25.87
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR ASR |
$65.17
|
| Rate for Payer: BCBS Complete |
$26.87
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$57.65
|
| Rate for Payer: BCBS Trust/PPO |
$55.39
|
| Rate for Payer: BCN Commercial |
$55.39
|
| Rate for Payer: BCN Commercial |
$57.65
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$67.82
|
| Rate for Payer: Healthscope Commercial |
$65.17
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.19
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Mclaren Commercial |
$60.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.47
|
| Rate for Payer: Priority Health Narrow Network |
$1.98
|
| Rate for Payer: Priority Health Narrow Network |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$67.19 |
| Rate for Payer: Aetna Commercial |
$60.47
|
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR ASR |
$65.17
|
| Rate for Payer: BCBS Trust/PPO |
$57.42
|
| Rate for Payer: BCBS Trust/PPO |
$55.17
|
| Rate for Payer: BCN Commercial |
$57.42
|
| Rate for Payer: BCN Commercial |
$55.17
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$65.17
|
| Rate for Payer: Healthscope Commercial |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.19
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Mclaren Commercial |
$60.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTATED RINGERS IV BOLUS
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
400296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.44 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$57.42
|
| Rate for Payer: BCN Commercial |
$57.42
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTATED RINGERS IV BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
400296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Medicare |
$25.87
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$57.65
|
| Rate for Payer: BCN Commercial |
$57.65
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.47
|
| Rate for Payer: Priority Health Narrow Network |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTATED RINGERS IV -DKA
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
301462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Commercial |
$60.47
|
| Rate for Payer: Aetna Medicare |
$24.86
|
| Rate for Payer: Aetna Medicare |
$25.87
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR ASR |
$65.17
|
| Rate for Payer: BCBS Complete |
$26.87
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$57.65
|
| Rate for Payer: BCBS Trust/PPO |
$55.39
|
| Rate for Payer: BCN Commercial |
$55.39
|
| Rate for Payer: BCN Commercial |
$57.65
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$67.82
|
| Rate for Payer: Healthscope Commercial |
$65.17
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.19
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Mclaren Commercial |
$60.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.47
|
| Rate for Payer: Priority Health Narrow Network |
$1.98
|
| Rate for Payer: Priority Health Narrow Network |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTATED RINGERS IV -DKA
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
301462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$67.19 |
| Rate for Payer: Aetna Commercial |
$60.47
|
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR ASR |
$65.17
|
| Rate for Payer: BCBS Trust/PPO |
$57.42
|
| Rate for Payer: BCBS Trust/PPO |
$55.17
|
| Rate for Payer: BCN Commercial |
$57.42
|
| Rate for Payer: BCN Commercial |
$55.17
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$65.17
|
| Rate for Payer: Healthscope Commercial |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.19
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Mclaren Commercial |
$60.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTATED RINGERS IV INFUSION/BOLUS (CODE)
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
163717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$67.19 |
| Rate for Payer: Aetna Commercial |
$60.47
|
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR ASR |
$65.17
|
| Rate for Payer: BCBS Trust/PPO |
$57.42
|
| Rate for Payer: BCBS Trust/PPO |
$55.17
|
| Rate for Payer: BCN Commercial |
$57.42
|
| Rate for Payer: BCN Commercial |
$55.17
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$65.17
|
| Rate for Payer: Healthscope Commercial |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.19
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Mclaren Commercial |
$60.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTATED RINGERS IV INFUSION/BOLUS (CODE)
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
163717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Commercial |
$60.47
|
| Rate for Payer: Aetna Medicare |
$24.86
|
| Rate for Payer: Aetna Medicare |
$25.87
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR ASR |
$65.17
|
| Rate for Payer: BCBS Complete |
$26.87
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$57.65
|
| Rate for Payer: BCBS Trust/PPO |
$55.39
|
| Rate for Payer: BCN Commercial |
$55.39
|
| Rate for Payer: BCN Commercial |
$57.65
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$67.82
|
| Rate for Payer: Healthscope Commercial |
$65.17
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.19
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Mclaren Commercial |
$60.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.47
|
| Rate for Payer: Priority Health Narrow Network |
$1.98
|
| Rate for Payer: Priority Health Narrow Network |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$6.05
|
|
|
Service Code
|
NDC 116400511
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Aetna Commercial |
$5.44
|
| Rate for Payer: Aetna Medicare |
$2.24
|
| Rate for Payer: ASR ASR |
$5.87
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$4.99
|
| Rate for Payer: BCN Commercial |
$4.99
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cofinity Commercial |
$5.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.84
|
| Rate for Payer: Healthscope Commercial |
$5.87
|
| Rate for Payer: Healthscope Whirlpool |
$6.05
|
| Rate for Payer: Mclaren Commercial |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.14
|
| Rate for Payer: Nomi Health Commercial |
$4.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.30
|
| Rate for Payer: Priority Health Narrow Network |
$4.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.32
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$7.06
|
|
|
Service Code
|
NDC 121115400
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$7.06 |
| Rate for Payer: Aetna Commercial |
$6.35
|
| Rate for Payer: ASR ASR |
$6.84
|
| Rate for Payer: BCBS Trust/PPO |
$5.79
|
| Rate for Payer: BCN Commercial |
$5.79
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Healthscope Commercial |
$6.84
|
| Rate for Payer: Healthscope Whirlpool |
$7.06
|
| Rate for Payer: Mclaren Commercial |
$6.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Nomi Health Commercial |
$5.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.21
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$7.06
|
|
|
Service Code
|
NDC 121115430
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$7.06 |
| Rate for Payer: Aetna Commercial |
$6.35
|
| Rate for Payer: ASR ASR |
$6.84
|
| Rate for Payer: BCBS Trust/PPO |
$5.79
|
| Rate for Payer: BCN Commercial |
$5.79
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Healthscope Commercial |
$6.84
|
| Rate for Payer: Healthscope Whirlpool |
$7.06
|
| Rate for Payer: Mclaren Commercial |
$6.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Nomi Health Commercial |
$5.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.21
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$6.05
|
|
|
Service Code
|
NDC 116400530
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Aetna Commercial |
$5.44
|
| Rate for Payer: ASR ASR |
$5.87
|
| Rate for Payer: BCBS Trust/PPO |
$4.97
|
| Rate for Payer: BCN Commercial |
$4.97
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cofinity Commercial |
$5.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.84
|
| Rate for Payer: Healthscope Commercial |
$5.87
|
| Rate for Payer: Healthscope Whirlpool |
$6.05
|
| Rate for Payer: Mclaren Commercial |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.14
|
| Rate for Payer: Nomi Health Commercial |
$4.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.32
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$6.05
|
|
|
Service Code
|
NDC 116400530
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Aetna Commercial |
$5.44
|
| Rate for Payer: Aetna Medicare |
$2.24
|
| Rate for Payer: ASR ASR |
$5.87
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$4.99
|
| Rate for Payer: BCN Commercial |
$4.99
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cofinity Commercial |
$5.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.84
|
| Rate for Payer: Healthscope Commercial |
$5.87
|
| Rate for Payer: Healthscope Whirlpool |
$6.05
|
| Rate for Payer: Mclaren Commercial |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.14
|
| Rate for Payer: Nomi Health Commercial |
$4.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.30
|
| Rate for Payer: Priority Health Narrow Network |
$4.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.32
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$7.06
|
|
|
Service Code
|
NDC 121115400
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$7.06 |
| Rate for Payer: Aetna Commercial |
$6.35
|
| Rate for Payer: Aetna Medicare |
$2.61
|
| Rate for Payer: ASR ASR |
$6.84
|
| Rate for Payer: BCBS Complete |
$2.82
|
| Rate for Payer: BCBS Trust/PPO |
$5.82
|
| Rate for Payer: BCN Commercial |
$5.82
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Healthscope Commercial |
$6.84
|
| Rate for Payer: Healthscope Whirlpool |
$7.06
|
| Rate for Payer: Mclaren Commercial |
$6.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Nomi Health Commercial |
$5.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.18
|
| Rate for Payer: Priority Health Narrow Network |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.21
|
|
