|
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 |
$247.10
|
| 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
|
$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 |
$1.92
|
| 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
|
$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
|
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
|
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 |
$247.10
|
| 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 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 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 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 |
$0.34 |
| 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: 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 |
$0.43
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| 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 |
$0.34 |
| Max. Negotiated Rate |
$84.50 |
| Rate for Payer: Aetna Commercial |
$76.05
|
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Commercial |
$288.40
|
| Rate for Payer: Aetna Commercial |
$41.40
|
| Rate for Payer: Aetna Commercial |
$47.25
|
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Commercial |
$43.65
|
| Rate for Payer: Aetna Medicare |
$21.25
|
| Rate for Payer: Aetna Medicare |
$26.25
|
| Rate for Payer: Aetna Medicare |
$24.25
|
| Rate for Payer: Aetna Medicare |
$42.25
|
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: Aetna Medicare |
$160.22
|
| Rate for Payer: Aetna Medicare |
$78.50
|
| Rate for Payer: ASR ASR |
$50.92
|
| Rate for Payer: ASR ASR |
$44.62
|
| Rate for Payer: ASR ASR |
$41.22
|
| Rate for Payer: ASR ASR |
$152.29
|
| Rate for Payer: ASR ASR |
$310.84
|
| Rate for Payer: ASR ASR |
$81.96
|
| Rate for Payer: ASR ASR |
$47.04
|
| Rate for Payer: ASR Commercial |
$152.29
|
| Rate for Payer: ASR Commercial |
$44.62
|
| Rate for Payer: ASR Commercial |
$310.84
|
| Rate for Payer: ASR Commercial |
$41.22
|
| Rate for Payer: ASR Commercial |
$81.96
|
| Rate for Payer: ASR Commercial |
$50.92
|
| Rate for Payer: ASR Commercial |
$47.04
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS Complete |
$128.18
|
| Rate for Payer: BCBS Complete |
$62.80
|
| Rate for Payer: BCBS Complete |
$33.80
|
| Rate for Payer: BCBS Complete |
$21.00
|
| Rate for Payer: BCBS Complete |
$19.40
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$34.80
|
| Rate for Payer: BCBS Trust/PPO |
$128.57
|
| Rate for Payer: BCBS Trust/PPO |
$69.20
|
| Rate for Payer: BCBS Trust/PPO |
$262.42
|
| Rate for Payer: BCBS Trust/PPO |
$42.99
|
| Rate for Payer: BCBS Trust/PPO |
$37.67
|
| Rate for Payer: BCBS Trust/PPO |
$39.72
|
| Rate for Payer: BCN Commercial |
$65.51
|
| Rate for Payer: BCN Commercial |
$248.44
|
| Rate for Payer: BCN Commercial |
$37.60
|
| Rate for Payer: BCN Commercial |
$121.72
|
| Rate for Payer: BCN Commercial |
$32.95
|
| Rate for Payer: BCN Commercial |
$35.66
|
| Rate for Payer: BCN Commercial |
$40.70
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$256.36
|
| Rate for Payer: Cash Price |
$256.36
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cofinity Commercial |
$301.22
|
| Rate for Payer: Cofinity Commercial |
$79.43
|
| Rate for Payer: Cofinity Commercial |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$147.58
|
| Rate for Payer: Cofinity Commercial |
$43.24
|
| Rate for Payer: Cofinity Commercial |
$45.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.36
|
| 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 |
$46.00
|
| Rate for Payer: Healthscope Commercial |
$157.00
|
| Rate for Payer: Healthscope Commercial |
$320.45
|
| Rate for Payer: Healthscope Commercial |
$52.50
|
| Rate for Payer: Healthscope Commercial |
$48.50
|
| Rate for Payer: Healthscope Commercial |
$42.50
|
| Rate for Payer: Healthscope Commercial |
$84.50
|
| Rate for Payer: Healthscope Whirlpool |
$44.62
|
| Rate for Payer: Healthscope Whirlpool |
$41.22
|
| Rate for Payer: Healthscope Whirlpool |
$310.84
|
| Rate for Payer: Healthscope Whirlpool |
$47.04
|
| Rate for Payer: Healthscope Whirlpool |
$50.92
|
| Rate for Payer: Healthscope Whirlpool |
$81.96
|
| Rate for Payer: Healthscope Whirlpool |
$152.29
|
| Rate for Payer: Mclaren Commercial |
$47.25
|
| Rate for Payer: Mclaren Commercial |
$41.40
|
| Rate for Payer: Mclaren Commercial |
$38.25
|
| Rate for Payer: Mclaren Commercial |
$76.05
|
| Rate for Payer: Mclaren Commercial |
$43.65
|
| Rate for Payer: Mclaren Commercial |
$288.40
|
| Rate for Payer: Mclaren Commercial |
$141.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.82
|
| 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 |
$41.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.62
|
| Rate for Payer: Nomi Health Commercial |
$128.74
|
| 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: Nomi Health Commercial |
$69.29
|
| Rate for Payer: Nomi Health Commercial |
$43.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| 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 |
$27.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.43
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.68
|
| 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 |
$46.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$282.00
|
|
|
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 |
$41.22
|
| Rate for Payer: ASR ASR |
$81.96
|
| Rate for Payer: ASR ASR |
$47.04
|
| 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 |
$81.96
|
| Rate for Payer: ASR Commercial |
$50.92
|
| Rate for Payer: ASR Commercial |
$41.22
|
| Rate for Payer: ASR Commercial |
$47.04
|
| 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 |
$47.04
|
| Rate for Payer: Healthscope Whirlpool |
$44.62
|
| Rate for Payer: Healthscope Whirlpool |
$310.84
|
| Rate for Payer: Healthscope Whirlpool |
$41.22
|
| Rate for Payer: Healthscope Whirlpool |
$152.29
|
| Rate for Payer: Healthscope Whirlpool |
$81.96
|
| 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 |
$71.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.22
|
| 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 |
$1.91 |
| 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: 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 |
$2.39
|
| Rate for Payer: Priority Health Narrow Network |
$1.91
|
| 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 |
$45.45 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$56.98
|
| 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: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: ASR Commercial |
$65.16
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$54.74
|
| Rate for Payer: BCBS Trust/PPO |
$56.98
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: BCN Commercial |
$52.08
|
| 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 |
$53.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.10
|
| 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: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| 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
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: ASR Commercial |
$65.16
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Complete |
$26.87
|
| Rate for Payer: BCBS Trust/PPO |
$57.26
|
| Rate for Payer: BCBS Trust/PPO |
$55.01
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| 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 |
$53.74
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.10
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.39
|
| Rate for Payer: Priority Health Narrow Network |
$1.91
|
| Rate for Payer: Priority Health Narrow Network |
$1.91
|
| 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 |
$45.45 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$56.98
|
| 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: 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 |
$1.91 |
| 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: 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 |
$2.39
|
| Rate for Payer: Priority Health Narrow Network |
$1.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTATED RINGERS IV -DKA
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
301462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: ASR Commercial |
$65.16
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$54.74
|
| Rate for Payer: BCBS Trust/PPO |
$56.98
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: BCN Commercial |
$52.08
|
| 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 |
$53.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.10
|
| 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: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| 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
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
301462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: ASR Commercial |
$65.16
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Complete |
$26.87
|
| Rate for Payer: BCBS Trust/PPO |
$57.26
|
| Rate for Payer: BCBS Trust/PPO |
$55.01
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| 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 |
$53.74
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.10
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.39
|
| Rate for Payer: Priority Health Narrow Network |
$1.91
|
| Rate for Payer: Priority Health Narrow Network |
$1.91
|
| 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 |
$1.91 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: ASR Commercial |
$65.16
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Complete |
$26.87
|
| Rate for Payer: BCBS Trust/PPO |
$57.26
|
| Rate for Payer: BCBS Trust/PPO |
$55.01
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| 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 |
$53.74
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.10
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.39
|
| Rate for Payer: Priority Health Narrow Network |
$1.91
|
| Rate for Payer: Priority Health Narrow Network |
$1.91
|
| 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
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
163717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: ASR Commercial |
$65.16
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$54.74
|
| Rate for Payer: BCBS Trust/PPO |
$56.98
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: BCN Commercial |
$52.08
|
| 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 |
$53.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.10
|
| 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: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| 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 00116400511
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Aetna Commercial |
$5.44
|
| Rate for Payer: Aetna Medicare |
$3.02
|
| Rate for Payer: ASR ASR |
$5.87
|
| Rate for Payer: ASR Commercial |
$5.87
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$4.95
|
| Rate for Payer: BCN Commercial |
$4.69
|
| 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 |
$6.05
|
| Rate for Payer: Healthscope Whirlpool |
$5.87
|
| 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: Priority Health Cigna Priority Health |
$3.93
|
| Rate for Payer: 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
|
$6.62
|
|
|
Service Code
|
NDC 00121115400
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: Aetna Medicare |
$3.31
|
| Rate for Payer: ASR ASR |
$6.42
|
| Rate for Payer: ASR Commercial |
$6.42
|
| Rate for Payer: BCBS Complete |
$2.65
|
| Rate for Payer: BCBS Trust/PPO |
$5.42
|
| Rate for Payer: BCN Commercial |
$5.13
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cofinity Commercial |
$6.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$6.62
|
| Rate for Payer: Healthscope Whirlpool |
$6.42
|
| Rate for Payer: Mclaren Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.63
|
| Rate for Payer: Nomi Health Commercial |
$5.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.80
|
| Rate for Payer: Priority Health Narrow Network |
$4.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.83
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$2.59
|
|
|
Service Code
|
NDC 50383077933
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: ASR ASR |
$2.51
|
| Rate for Payer: ASR Commercial |
$2.51
|
| Rate for Payer: BCBS Trust/PPO |
$2.11
|
| Rate for Payer: BCN Commercial |
$2.01
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Healthscope Whirlpool |
$2.51
|
| Rate for Payer: Mclaren Commercial |
$2.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.28
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$2.59
|
|
|
Service Code
|
NDC 50383077933
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: ASR ASR |
$2.51
|
| Rate for Payer: ASR Commercial |
$2.51
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: BCBS Trust/PPO |
$2.12
|
| Rate for Payer: BCN Commercial |
$2.01
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Healthscope Whirlpool |
$2.51
|
| Rate for Payer: Mclaren Commercial |
$2.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.27
|
| Rate for Payer: Priority Health Narrow Network |
$1.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.28
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$6.05
|
|
|
Service Code
|
NDC 00116400530
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Aetna Commercial |
$5.44
|
| Rate for Payer: Aetna Medicare |
$3.02
|
| Rate for Payer: ASR ASR |
$5.87
|
| Rate for Payer: ASR Commercial |
$5.87
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$4.95
|
| Rate for Payer: BCN Commercial |
$4.69
|
| 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 |
$6.05
|
| Rate for Payer: Healthscope Whirlpool |
$5.87
|
| 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: Priority Health Cigna Priority Health |
$3.93
|
| Rate for Payer: 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
|
|
