|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$2.85
|
|
|
Service Code
|
NDC 51079092801
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: Aetna Medicare |
$1.43
|
| Rate for Payer: ASR ASR |
$2.76
|
| Rate for Payer: ASR Commercial |
$2.76
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.21
|
| 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 |
$2.85
|
| Rate for Payer: Healthscope Whirlpool |
$2.76
|
| 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: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: 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 100 MG TABLET
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
NDC 60687043911
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: ASR ASR |
$3.14
|
| Rate for Payer: ASR Commercial |
$3.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.64
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Healthscope Whirlpool |
$3.14
|
| Rate for Payer: Mclaren Commercial |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.85
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$3.24
|
|
|
Service Code
|
NDC 60687043911
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.62
|
| Rate for Payer: ASR ASR |
$3.14
|
| Rate for Payer: ASR Commercial |
$3.14
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$2.65
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Healthscope Whirlpool |
$3.14
|
| Rate for Payer: Mclaren Commercial |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.84
|
| Rate for Payer: Priority Health Narrow Network |
$2.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.85
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$323.95
|
|
|
Service Code
|
NDC 60687043901
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.58 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Aetna Commercial |
$291.56
|
| Rate for Payer: Aetna Medicare |
$161.97
|
| Rate for Payer: ASR ASR |
$314.23
|
| Rate for Payer: ASR Commercial |
$314.23
|
| Rate for Payer: BCBS Complete |
$129.58
|
| Rate for Payer: BCBS Trust/PPO |
$265.28
|
| Rate for Payer: BCN Commercial |
$251.16
|
| Rate for Payer: Cash Price |
$259.16
|
| Rate for Payer: Cofinity Commercial |
$304.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.16
|
| Rate for Payer: Healthscope Commercial |
$323.95
|
| Rate for Payer: Healthscope Whirlpool |
$314.23
|
| Rate for Payer: Mclaren Commercial |
$291.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.36
|
| Rate for Payer: Nomi Health Commercial |
$265.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.84
|
| Rate for Payer: Priority Health Narrow Network |
$227.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.08
|
|
|
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 |
$8.67 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$19.51
|
| Rate for Payer: Aetna Medicare |
$10.84
|
| Rate for Payer: ASR ASR |
$21.03
|
| Rate for Payer: ASR Commercial |
$21.03
|
| Rate for Payer: BCBS Complete |
$8.67
|
| Rate for Payer: BCBS Trust/PPO |
$17.75
|
| Rate for Payer: BCN Commercial |
$16.81
|
| Rate for Payer: Cash Price |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$20.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Healthscope Whirlpool |
$21.03
|
| 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: Priority Health Cigna Priority Health |
$14.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.00
|
| Rate for Payer: Priority Health Narrow Network |
$15.20
|
| 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 |
$14.09 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$19.51
|
| Rate for Payer: ASR ASR |
$21.03
|
| Rate for Payer: ASR Commercial |
$21.03
|
| Rate for Payer: BCBS Trust/PPO |
$17.67
|
| Rate for Payer: BCN Commercial |
$16.81
|
| Rate for Payer: Cash Price |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$20.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Healthscope Whirlpool |
$21.03
|
| 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: Priority Health Cigna Priority Health |
$14.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.08
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$384.75
|
|
|
Service Code
|
NDC 51079092920
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Aetna Commercial |
$346.27
|
| Rate for Payer: Aetna Medicare |
$192.38
|
| Rate for Payer: ASR ASR |
$373.21
|
| Rate for Payer: ASR Commercial |
$373.21
|
| Rate for Payer: BCBS Complete |
$153.90
|
| Rate for Payer: BCBS Trust/PPO |
$315.07
|
| Rate for Payer: BCN Commercial |
$298.30
|
| 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 |
$384.75
|
| Rate for Payer: Healthscope Whirlpool |
$373.21
|
| 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: Priority Health Cigna Priority Health |
$250.09
|
| Rate for Payer: 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
|
OP
|
$245.76
|
|
|
Service Code
|
NDC 60687045001
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.30 |
| Max. Negotiated Rate |
$245.76 |
| Rate for Payer: Aetna Commercial |
$221.18
|
| Rate for Payer: Aetna Medicare |
$122.88
|
| Rate for Payer: ASR ASR |
$238.39
|
| Rate for Payer: ASR Commercial |
$238.39
|
| Rate for Payer: BCBS Complete |
$98.30
|
| Rate for Payer: BCBS Trust/PPO |
$201.25
|
| Rate for Payer: BCN Commercial |
$190.54
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cofinity Commercial |
$231.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.61
|
| Rate for Payer: Healthscope Commercial |
$245.76
|
| Rate for Payer: Healthscope Whirlpool |
$238.39
|
| Rate for Payer: Mclaren Commercial |
$221.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.90
|
| Rate for Payer: Nomi Health Commercial |
$201.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.33
|
| Rate for Payer: Priority Health Narrow Network |
$172.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.27
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$427.70
|
|
|
Service Code
|
NDC 70377006112
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.08 |
| Max. Negotiated Rate |
$427.70 |
| Rate for Payer: Aetna Commercial |
$384.93
|
| Rate for Payer: Aetna Medicare |
$213.85
|
| Rate for Payer: ASR ASR |
$414.87
|
| Rate for Payer: ASR Commercial |
$414.87
|
| Rate for Payer: BCBS Complete |
$171.08
|
| Rate for Payer: BCBS Trust/PPO |
$350.24
|
| Rate for Payer: BCN Commercial |
$331.60
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$402.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$427.70
|
| Rate for Payer: Healthscope Whirlpool |
$414.87
|
| Rate for Payer: Mclaren Commercial |
$384.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.55
|
| Rate for Payer: Nomi Health Commercial |
$350.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$374.75
|
| Rate for Payer: Priority Health Narrow Network |
$299.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.38
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$384.75
|
|
|
Service Code
|
NDC 51079092920
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.09 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Aetna Commercial |
$346.27
|
| Rate for Payer: ASR ASR |
$373.21
|
| Rate for Payer: ASR Commercial |
$373.21
|
| Rate for Payer: BCBS Trust/PPO |
$313.53
|
| Rate for Payer: BCN Commercial |
$298.30
|
| 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 |
$384.75
|
| Rate for Payer: Healthscope Whirlpool |
$373.21
|
| 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: Priority Health Cigna Priority Health |
$250.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$338.58
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$245.76
|
|
|
Service Code
|
NDC 60687045001
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.74 |
| Max. Negotiated Rate |
$245.76 |
| Rate for Payer: Aetna Commercial |
$221.18
|
| Rate for Payer: ASR ASR |
$238.39
|
| Rate for Payer: ASR Commercial |
$238.39
|
| Rate for Payer: BCBS Trust/PPO |
$200.27
|
| Rate for Payer: BCN Commercial |
$190.54
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cofinity Commercial |
$231.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.61
|
| Rate for Payer: Healthscope Commercial |
$245.76
|
| Rate for Payer: Healthscope Whirlpool |
$238.39
|
| Rate for Payer: Mclaren Commercial |
$221.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.90
|
| Rate for Payer: Nomi Health Commercial |
$201.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.27
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$251.75
|
|
|
Service Code
|
NDC 68382079901
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.64 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Aetna Commercial |
$226.57
|
| Rate for Payer: ASR ASR |
$244.20
|
| Rate for Payer: ASR Commercial |
$244.20
|
| Rate for Payer: BCBS Trust/PPO |
$205.15
|
| Rate for Payer: BCN Commercial |
$195.18
|
| 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 |
$251.75
|
| Rate for Payer: Healthscope Whirlpool |
$244.20
|
| 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: Priority Health Cigna Priority Health |
$163.64
|
| 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 |
$2.50 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: ASR ASR |
$3.73
|
| Rate for Payer: ASR Commercial |
$3.73
|
| Rate for Payer: BCBS Trust/PPO |
$3.14
|
| Rate for Payer: BCN Commercial |
$2.98
|
| 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 |
$3.85
|
| Rate for Payer: Healthscope Whirlpool |
$3.73
|
| 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: Priority Health Cigna Priority Health |
$2.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.39
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$2.46
|
|
|
Service Code
|
NDC 60687045011
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna Medicare |
$1.23
|
| Rate for Payer: ASR ASR |
$2.39
|
| Rate for Payer: ASR Commercial |
$2.39
|
| Rate for Payer: BCBS Complete |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.01
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Healthscope Whirlpool |
$2.39
|
| Rate for Payer: Mclaren Commercial |
$2.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.09
|
| Rate for Payer: Nomi Health Commercial |
$2.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.16
|
| Rate for Payer: Priority Health Narrow Network |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.16
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$2.46
|
|
|
Service Code
|
NDC 60687045011
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: ASR ASR |
$2.39
|
| Rate for Payer: ASR Commercial |
$2.39
|
| Rate for Payer: BCBS Trust/PPO |
$2.00
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Healthscope Whirlpool |
$2.39
|
| Rate for Payer: Mclaren Commercial |
$2.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.09
|
| Rate for Payer: Nomi Health Commercial |
$2.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.16
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$3.85
|
|
|
Service Code
|
NDC 51079092901
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Aetna Medicare |
$1.93
|
| Rate for Payer: ASR ASR |
$3.73
|
| Rate for Payer: ASR Commercial |
$3.73
|
| Rate for Payer: BCBS Complete |
$1.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$2.98
|
| 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 |
$3.85
|
| Rate for Payer: Healthscope Whirlpool |
$3.73
|
| 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: Priority Health Cigna Priority Health |
$2.50
|
| Rate for Payer: 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
|
$290.70
|
|
|
Service Code
|
NDC 00904711061
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.28 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna Medicare |
$145.35
|
| Rate for Payer: ASR ASR |
$281.98
|
| Rate for Payer: ASR Commercial |
$281.98
|
| Rate for Payer: BCBS Complete |
$116.28
|
| Rate for Payer: BCBS Trust/PPO |
$238.05
|
| Rate for Payer: BCN Commercial |
$225.38
|
| 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 |
$290.70
|
| Rate for Payer: Healthscope Whirlpool |
$281.98
|
| 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: Priority Health Cigna Priority Health |
$188.96
|
| Rate for Payer: 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
|
$251.75
|
|
|
Service Code
|
NDC 68382079901
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.70 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Aetna Commercial |
$226.57
|
| Rate for Payer: Aetna Medicare |
$125.88
|
| Rate for Payer: ASR ASR |
$244.20
|
| Rate for Payer: ASR Commercial |
$244.20
|
| Rate for Payer: BCBS Complete |
$100.70
|
| Rate for Payer: BCBS Trust/PPO |
$206.16
|
| Rate for Payer: BCN Commercial |
$195.18
|
| 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 |
$251.75
|
| Rate for Payer: Healthscope Whirlpool |
$244.20
|
| 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: Priority Health Cigna Priority Health |
$163.64
|
| Rate for Payer: 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
|
$427.70
|
|
|
Service Code
|
NDC 70377006112
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$427.70 |
| Rate for Payer: Aetna Commercial |
$384.93
|
| Rate for Payer: ASR ASR |
$414.87
|
| Rate for Payer: ASR Commercial |
$414.87
|
| Rate for Payer: BCBS Trust/PPO |
$348.53
|
| Rate for Payer: BCN Commercial |
$331.60
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$402.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$427.70
|
| Rate for Payer: Healthscope Whirlpool |
$414.87
|
| Rate for Payer: Mclaren Commercial |
$384.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.55
|
| Rate for Payer: Nomi Health Commercial |
$350.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.38
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$290.70
|
|
|
Service Code
|
NDC 00904711061
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.96 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: ASR ASR |
$281.98
|
| Rate for Payer: ASR Commercial |
$281.98
|
| Rate for Payer: BCBS Trust/PPO |
$236.89
|
| Rate for Payer: BCN Commercial |
$225.38
|
| 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 |
$290.70
|
| Rate for Payer: Healthscope Whirlpool |
$281.98
|
| 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: Priority Health Cigna Priority Health |
$188.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.82
|
|
|
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 |
$11.51 |
| Max. Negotiated Rate |
$28.78 |
| Rate for Payer: Aetna Commercial |
$25.90
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: ASR ASR |
$27.92
|
| Rate for Payer: ASR Commercial |
$27.92
|
| Rate for Payer: BCBS Complete |
$11.51
|
| Rate for Payer: BCBS Trust/PPO |
$23.57
|
| Rate for Payer: BCN Commercial |
$22.31
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$27.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Healthscope Commercial |
$28.78
|
| Rate for Payer: Healthscope Whirlpool |
$27.92
|
| Rate for Payer: Mclaren Commercial |
$25.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.46
|
| Rate for Payer: Nomi Health Commercial |
$23.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.22
|
| Rate for Payer: Priority Health Narrow Network |
$20.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.33
|
|
|
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 |
$18.71 |
| Max. Negotiated Rate |
$28.78 |
| Rate for Payer: Aetna Commercial |
$25.90
|
| Rate for Payer: ASR ASR |
$27.92
|
| Rate for Payer: ASR Commercial |
$27.92
|
| Rate for Payer: BCBS Trust/PPO |
$23.45
|
| Rate for Payer: BCN Commercial |
$22.31
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$27.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Healthscope Commercial |
$28.78
|
| Rate for Payer: Healthscope Whirlpool |
$27.92
|
| Rate for Payer: Mclaren Commercial |
$25.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.46
|
| Rate for Payer: Nomi Health Commercial |
$23.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.33
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$84.50
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
10372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$84.50 |
| Rate for Payer: Aetna Commercial |
$76.05
|
| Rate for Payer: Aetna Commercial |
$288.40
|
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Commercial |
$43.65
|
| Rate for Payer: Aetna Commercial |
$41.40
|
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Commercial |
$47.25
|
| Rate for Payer: Aetna Medicare |
$42.25
|
| Rate for Payer: Aetna Medicare |
$160.22
|
| Rate for Payer: Aetna Medicare |
$26.25
|
| Rate for Payer: Aetna Medicare |
$78.50
|
| Rate for Payer: Aetna Medicare |
$24.25
|
| Rate for Payer: Aetna Medicare |
$21.25
|
| Rate for Payer: Aetna Medicare |
$23.00
|
| 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 |
$47.05
|
| Rate for Payer: ASR ASR |
$310.84
|
| Rate for Payer: ASR ASR |
$44.62
|
| Rate for Payer: ASR ASR |
$152.29
|
| Rate for Payer: ASR Commercial |
$41.23
|
| Rate for Payer: ASR Commercial |
$152.29
|
| Rate for Payer: ASR Commercial |
$47.05
|
| Rate for Payer: ASR Commercial |
$81.97
|
| Rate for Payer: ASR Commercial |
$50.92
|
| Rate for Payer: ASR Commercial |
$310.84
|
| Rate for Payer: ASR Commercial |
$44.62
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Complete |
$62.80
|
| Rate for Payer: BCBS Complete |
$19.40
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS Complete |
$128.18
|
| Rate for Payer: BCBS Complete |
$33.80
|
| Rate for Payer: BCBS Complete |
$21.00
|
| Rate for Payer: BCBS Trust/PPO |
$42.99
|
| Rate for Payer: BCBS Trust/PPO |
$37.67
|
| Rate for Payer: BCBS Trust/PPO |
$128.57
|
| Rate for Payer: BCBS Trust/PPO |
$262.42
|
| Rate for Payer: BCBS Trust/PPO |
$34.80
|
| Rate for Payer: BCBS Trust/PPO |
$39.72
|
| Rate for Payer: BCBS Trust/PPO |
$69.20
|
| Rate for Payer: BCN Commercial |
$40.70
|
| Rate for Payer: BCN Commercial |
$37.60
|
| Rate for Payer: BCN Commercial |
$65.51
|
| Rate for Payer: BCN Commercial |
$35.66
|
| Rate for Payer: BCN Commercial |
$248.44
|
| Rate for Payer: BCN Commercial |
$121.72
|
| Rate for Payer: BCN Commercial |
$32.95
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Cash Price |
$256.36
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cofinity Commercial |
$79.43
|
| Rate for Payer: Cofinity Commercial |
$45.59
|
| Rate for Payer: Cofinity Commercial |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$147.58
|
| Rate for Payer: Cofinity Commercial |
$301.22
|
| Rate for Payer: Cofinity Commercial |
$43.24
|
| Rate for Payer: Cofinity Commercial |
$39.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.00
|
| 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 |
$38.80
|
| Rate for Payer: Healthscope Commercial |
$157.00
|
| Rate for Payer: Healthscope Commercial |
$84.50
|
| Rate for Payer: Healthscope Commercial |
$52.50
|
| Rate for Payer: Healthscope Commercial |
$46.00
|
| Rate for Payer: Healthscope Commercial |
$320.45
|
| Rate for Payer: Healthscope Commercial |
$48.50
|
| Rate for Payer: Healthscope Commercial |
$42.50
|
| Rate for Payer: Healthscope Whirlpool |
$41.23
|
| Rate for Payer: Healthscope Whirlpool |
$152.29
|
| Rate for Payer: Healthscope Whirlpool |
$44.62
|
| Rate for Payer: Healthscope Whirlpool |
$47.05
|
| Rate for Payer: Healthscope Whirlpool |
$50.92
|
| Rate for Payer: Healthscope Whirlpool |
$81.97
|
| Rate for Payer: Healthscope Whirlpool |
$310.84
|
| Rate for Payer: Mclaren Commercial |
$38.25
|
| Rate for Payer: Mclaren Commercial |
$43.65
|
| Rate for Payer: Mclaren Commercial |
$47.25
|
| Rate for Payer: Mclaren Commercial |
$76.05
|
| Rate for Payer: Mclaren Commercial |
$41.40
|
| Rate for Payer: Mclaren Commercial |
$141.30
|
| Rate for Payer: Mclaren Commercial |
$288.40
|
| 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 |
$36.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.83
|
| Rate for Payer: Nomi Health Commercial |
$34.85
|
| Rate for Payer: Nomi Health Commercial |
$43.05
|
| Rate for Payer: Nomi Health Commercial |
$39.77
|
| Rate for Payer: Nomi Health Commercial |
$69.29
|
| Rate for Payer: Nomi Health Commercial |
$262.77
|
| Rate for Payer: Nomi Health Commercial |
$128.74
|
| Rate for Payer: Nomi Health Commercial |
$37.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.78
|
| Rate for Payer: Priority Health Narrow Network |
$224.64
|
| Rate for Payer: Priority Health Narrow Network |
$32.25
|
| Rate for Payer: Priority Health Narrow Network |
$29.79
|
| Rate for Payer: Priority Health Narrow Network |
$110.06
|
| Rate for Payer: Priority Health Narrow Network |
$36.80
|
| Rate for Payer: Priority Health Narrow Network |
$34.00
|
| Rate for Payer: Priority Health Narrow Network |
$59.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$282.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.48
|
| 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 |
$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 |
$208.29 |
| Max. Negotiated Rate |
$320.45 |
| Rate for Payer: Aetna Commercial |
$288.40
|
| Rate for Payer: Aetna Commercial |
$41.40
|
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Commercial |
$43.65
|
| Rate for Payer: Aetna Commercial |
$76.05
|
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Commercial |
$47.25
|
| Rate for Payer: ASR ASR |
$44.62
|
| Rate for Payer: ASR ASR |
$41.23
|
| Rate for Payer: ASR ASR |
$81.97
|
| Rate for Payer: ASR ASR |
$47.05
|
| Rate for Payer: ASR ASR |
$310.84
|
| Rate for Payer: ASR ASR |
$152.29
|
| Rate for Payer: ASR ASR |
$50.92
|
| Rate for Payer: ASR Commercial |
$81.97
|
| Rate for Payer: ASR Commercial |
$50.92
|
| Rate for Payer: ASR Commercial |
$41.23
|
| Rate for Payer: ASR Commercial |
$47.05
|
| Rate for Payer: ASR Commercial |
$44.62
|
| Rate for Payer: ASR Commercial |
$310.84
|
| Rate for Payer: ASR Commercial |
$152.29
|
| Rate for Payer: BCBS Trust/PPO |
$42.78
|
| Rate for Payer: BCBS Trust/PPO |
$39.52
|
| Rate for Payer: BCBS Trust/PPO |
$127.94
|
| Rate for Payer: BCBS Trust/PPO |
$261.13
|
| Rate for Payer: BCBS Trust/PPO |
$37.49
|
| Rate for Payer: BCBS Trust/PPO |
$34.63
|
| Rate for Payer: BCBS Trust/PPO |
$68.86
|
| Rate for Payer: BCN Commercial |
$32.95
|
| Rate for Payer: BCN Commercial |
$65.51
|
| Rate for Payer: BCN Commercial |
$37.60
|
| Rate for Payer: BCN Commercial |
$121.72
|
| Rate for Payer: BCN Commercial |
$248.44
|
| Rate for Payer: BCN Commercial |
$40.70
|
| Rate for Payer: BCN Commercial |
$35.66
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Cash Price |
$256.36
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cofinity Commercial |
$45.59
|
| Rate for Payer: Cofinity Commercial |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$147.58
|
| Rate for Payer: Cofinity Commercial |
$43.24
|
| Rate for Payer: Cofinity Commercial |
$301.22
|
| Rate for Payer: Cofinity Commercial |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$79.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.60
|
| 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 |
$42.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.80
|
| Rate for Payer: Healthscope Commercial |
$48.50
|
| Rate for Payer: Healthscope Commercial |
$84.50
|
| Rate for Payer: Healthscope Commercial |
$42.50
|
| Rate for Payer: Healthscope Commercial |
$46.00
|
| Rate for Payer: Healthscope Commercial |
$52.50
|
| Rate for Payer: Healthscope Commercial |
$320.45
|
| Rate for Payer: Healthscope Commercial |
$157.00
|
| Rate for Payer: Healthscope Whirlpool |
$50.92
|
| Rate for Payer: Healthscope Whirlpool |
$47.05
|
| Rate for Payer: Healthscope Whirlpool |
$44.62
|
| Rate for Payer: Healthscope Whirlpool |
$310.84
|
| Rate for Payer: Healthscope Whirlpool |
$41.23
|
| Rate for Payer: Healthscope Whirlpool |
$152.29
|
| Rate for Payer: Healthscope Whirlpool |
$81.97
|
| Rate for Payer: Mclaren Commercial |
$43.65
|
| Rate for Payer: Mclaren Commercial |
$76.05
|
| Rate for Payer: Mclaren Commercial |
$141.30
|
| Rate for Payer: Mclaren Commercial |
$47.25
|
| Rate for Payer: Mclaren Commercial |
$38.25
|
| Rate for Payer: Mclaren Commercial |
$288.40
|
| Rate for Payer: Mclaren Commercial |
$41.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.12
|
| 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 |
$44.62
|
| Rate for Payer: Nomi Health Commercial |
$128.74
|
| Rate for Payer: Nomi Health Commercial |
$43.05
|
| Rate for Payer: Nomi Health Commercial |
$69.29
|
| Rate for Payer: Nomi Health Commercial |
$37.72
|
| Rate for Payer: Nomi Health Commercial |
$34.85
|
| Rate for Payer: Nomi Health Commercial |
$262.77
|
| Rate for Payer: Nomi Health Commercial |
$39.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.68
|
| 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 |
$37.40
|
|
|
LACTATED RINGERS EYE BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
300324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$57.26
|
| Rate for Payer: BCN Commercial |
$54.21
|
| 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 |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| 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: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.26
|
| Rate for Payer: Priority Health Narrow Network |
$49.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
