|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
IP
|
$422.75
|
|
|
Service Code
|
NDC 65162068210
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$317.06 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Aetna Commercial |
$380.48
|
| Rate for Payer: ASR ASR |
$410.07
|
| Rate for Payer: BCBS Trust/PPO |
$347.16
|
| Rate for Payer: BCN Commercial |
$347.16
|
| Rate for Payer: Cash Price |
$338.20
|
| Rate for Payer: Cofinity Commercial |
$397.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.20
|
| Rate for Payer: Healthscope Commercial |
$410.07
|
| Rate for Payer: Healthscope Whirlpool |
$422.75
|
| Rate for Payer: Mclaren Commercial |
$380.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.34
|
| Rate for Payer: Nomi Health Commercial |
$346.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.02
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
IP
|
$318.25
|
|
|
Service Code
|
NDC 42192080201
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.69 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Aetna Commercial |
$286.43
|
| Rate for Payer: ASR ASR |
$308.70
|
| Rate for Payer: BCBS Trust/PPO |
$261.35
|
| Rate for Payer: BCN Commercial |
$261.35
|
| Rate for Payer: Cash Price |
$254.60
|
| Rate for Payer: Cofinity Commercial |
$299.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Healthscope Commercial |
$308.70
|
| Rate for Payer: Healthscope Whirlpool |
$318.25
|
| Rate for Payer: Mclaren Commercial |
$286.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Nomi Health Commercial |
$260.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$280.06
|
|
|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
IP
|
$374.30
|
|
|
Service Code
|
NDC 904657561
|
| Hospital Charge Code |
6217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.73 |
| Max. Negotiated Rate |
$374.30 |
| Rate for Payer: Aetna Commercial |
$336.87
|
| Rate for Payer: ASR ASR |
$363.07
|
| Rate for Payer: BCBS Trust/PPO |
$307.38
|
| Rate for Payer: BCN Commercial |
$307.38
|
| Rate for Payer: Cash Price |
$299.44
|
| Rate for Payer: Cofinity Commercial |
$351.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.44
|
| Rate for Payer: Healthscope Commercial |
$363.07
|
| Rate for Payer: Healthscope Whirlpool |
$374.30
|
| Rate for Payer: Mclaren Commercial |
$336.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.15
|
| Rate for Payer: Nomi Health Commercial |
$306.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.38
|
|
|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
OP
|
$374.30
|
|
|
Service Code
|
NDC 904657561
|
| Hospital Charge Code |
6217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.49 |
| Max. Negotiated Rate |
$374.30 |
| Rate for Payer: Aetna Commercial |
$336.87
|
| Rate for Payer: Aetna Medicare |
$138.49
|
| Rate for Payer: ASR ASR |
$363.07
|
| Rate for Payer: BCBS Complete |
$149.72
|
| Rate for Payer: BCBS Trust/PPO |
$308.61
|
| Rate for Payer: BCN Commercial |
$308.61
|
| Rate for Payer: Cash Price |
$299.44
|
| Rate for Payer: Cofinity Commercial |
$351.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.44
|
| Rate for Payer: Healthscope Commercial |
$363.07
|
| Rate for Payer: Healthscope Whirlpool |
$374.30
|
| Rate for Payer: Mclaren Commercial |
$336.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.15
|
| Rate for Payer: Nomi Health Commercial |
$306.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$327.96
|
| Rate for Payer: Priority Health Narrow Network |
$262.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.38
|
|
|
PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$204.60
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
6221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$204.60 |
| Rate for Payer: Aetna Commercial |
$184.14
|
| Rate for Payer: Aetna Commercial |
$254.82
|
| Rate for Payer: Aetna Commercial |
$162.38
|
| Rate for Payer: Aetna Commercial |
$117.01
|
| Rate for Payer: Aetna Commercial |
$239.39
|
| Rate for Payer: Aetna Medicare |
$104.76
|
| Rate for Payer: Aetna Medicare |
$48.11
|
| Rate for Payer: Aetna Medicare |
$98.41
|
| Rate for Payer: Aetna Medicare |
$75.70
|
| Rate for Payer: Aetna Medicare |
$66.76
|
| Rate for Payer: ASR ASR |
$198.46
|
| Rate for Payer: ASR ASR |
$274.64
|
| Rate for Payer: ASR ASR |
$258.01
|
| Rate for Payer: ASR ASR |
$175.01
|
| Rate for Payer: ASR ASR |
$126.11
|
| Rate for Payer: BCBS Complete |
$106.39
|
| Rate for Payer: BCBS Complete |
$52.01
|
| Rate for Payer: BCBS Complete |
$113.25
|
| Rate for Payer: BCBS Complete |
$81.84
|
| Rate for Payer: BCBS Complete |
$72.17
|
| Rate for Payer: BCBS Trust/PPO |
$107.20
|
| Rate for Payer: BCBS Trust/PPO |
$148.76
|
| Rate for Payer: BCBS Trust/PPO |
$219.30
|
| Rate for Payer: BCBS Trust/PPO |
$233.44
|
| Rate for Payer: BCBS Trust/PPO |
$168.69
|
| Rate for Payer: BCN Commercial |
$219.30
|
| Rate for Payer: BCN Commercial |
$148.76
|
| Rate for Payer: BCN Commercial |
$107.20
|
| Rate for Payer: BCN Commercial |
$233.44
|
| Rate for Payer: BCN Commercial |
$168.69
|
| Rate for Payer: Cash Price |
$212.79
|
| Rate for Payer: Cash Price |
$163.68
|
| Rate for Payer: Cash Price |
$104.01
|
| Rate for Payer: Cash Price |
$144.34
|
| Rate for Payer: Cash Price |
$144.34
|
| Rate for Payer: Cash Price |
$104.01
|
| Rate for Payer: Cash Price |
$163.68
|
| Rate for Payer: Cash Price |
$212.79
|
| Rate for Payer: Cash Price |
$226.51
|
| Rate for Payer: Cash Price |
$226.51
|
| Rate for Payer: Cofinity Commercial |
$122.21
|
| Rate for Payer: Cofinity Commercial |
$266.15
|
| Rate for Payer: Cofinity Commercial |
$169.59
|
| Rate for Payer: Cofinity Commercial |
$192.32
|
| Rate for Payer: Cofinity Commercial |
$250.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.34
|
| Rate for Payer: Healthscope Commercial |
$126.11
|
| Rate for Payer: Healthscope Commercial |
$175.01
|
| Rate for Payer: Healthscope Commercial |
$274.64
|
| Rate for Payer: Healthscope Commercial |
$198.46
|
| Rate for Payer: Healthscope Commercial |
$258.01
|
| Rate for Payer: Healthscope Whirlpool |
$204.60
|
| Rate for Payer: Healthscope Whirlpool |
$130.01
|
| Rate for Payer: Healthscope Whirlpool |
$180.42
|
| Rate for Payer: Healthscope Whirlpool |
$283.13
|
| Rate for Payer: Healthscope Whirlpool |
$265.99
|
| Rate for Payer: Mclaren Commercial |
$162.38
|
| Rate for Payer: Mclaren Commercial |
$117.01
|
| Rate for Payer: Mclaren Commercial |
$254.82
|
| Rate for Payer: Mclaren Commercial |
$239.39
|
| Rate for Payer: Mclaren Commercial |
$184.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.91
|
| Rate for Payer: Nomi Health Commercial |
$147.94
|
| Rate for Payer: Nomi Health Commercial |
$106.61
|
| Rate for Payer: Nomi Health Commercial |
$232.17
|
| Rate for Payer: Nomi Health Commercial |
$218.11
|
| Rate for Payer: Nomi Health Commercial |
$167.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.17
|
| Rate for Payer: Priority Health Narrow Network |
$24.14
|
| Rate for Payer: Priority Health Narrow Network |
$24.14
|
| Rate for Payer: Priority Health Narrow Network |
$24.14
|
| Rate for Payer: Priority Health Narrow Network |
$24.14
|
| Rate for Payer: Priority Health Narrow Network |
$24.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$234.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.05
|
|
|
PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$283.14
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
6221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$212.35 |
| Max. Negotiated Rate |
$283.13 |
| Rate for Payer: Aetna Commercial |
$254.82
|
| Rate for Payer: Aetna Commercial |
$184.14
|
| Rate for Payer: Aetna Commercial |
$239.39
|
| Rate for Payer: Aetna Commercial |
$162.38
|
| Rate for Payer: Aetna Commercial |
$117.01
|
| Rate for Payer: ASR ASR |
$198.46
|
| Rate for Payer: ASR ASR |
$126.11
|
| Rate for Payer: ASR ASR |
$274.64
|
| Rate for Payer: ASR ASR |
$175.01
|
| Rate for Payer: ASR ASR |
$258.01
|
| Rate for Payer: BCBS Trust/PPO |
$232.51
|
| Rate for Payer: BCBS Trust/PPO |
$148.16
|
| Rate for Payer: BCBS Trust/PPO |
$106.77
|
| Rate for Payer: BCBS Trust/PPO |
$218.43
|
| Rate for Payer: BCBS Trust/PPO |
$168.02
|
| Rate for Payer: BCN Commercial |
$168.02
|
| Rate for Payer: BCN Commercial |
$148.16
|
| Rate for Payer: BCN Commercial |
$218.43
|
| Rate for Payer: BCN Commercial |
$232.51
|
| Rate for Payer: BCN Commercial |
$106.77
|
| Rate for Payer: Cash Price |
$104.01
|
| Rate for Payer: Cash Price |
$163.68
|
| Rate for Payer: Cash Price |
$212.79
|
| Rate for Payer: Cash Price |
$144.34
|
| Rate for Payer: Cash Price |
$226.51
|
| Rate for Payer: Cofinity Commercial |
$169.59
|
| Rate for Payer: Cofinity Commercial |
$250.03
|
| Rate for Payer: Cofinity Commercial |
$122.21
|
| Rate for Payer: Cofinity Commercial |
$192.32
|
| Rate for Payer: Cofinity Commercial |
$266.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.51
|
| Rate for Payer: Healthscope Commercial |
$198.46
|
| Rate for Payer: Healthscope Commercial |
$175.01
|
| Rate for Payer: Healthscope Commercial |
$258.01
|
| Rate for Payer: Healthscope Commercial |
$126.11
|
| Rate for Payer: Healthscope Commercial |
$274.64
|
| Rate for Payer: Healthscope Whirlpool |
$265.99
|
| Rate for Payer: Healthscope Whirlpool |
$283.13
|
| Rate for Payer: Healthscope Whirlpool |
$130.01
|
| Rate for Payer: Healthscope Whirlpool |
$180.42
|
| Rate for Payer: Healthscope Whirlpool |
$204.60
|
| Rate for Payer: Mclaren Commercial |
$162.38
|
| Rate for Payer: Mclaren Commercial |
$239.39
|
| Rate for Payer: Mclaren Commercial |
$117.01
|
| Rate for Payer: Mclaren Commercial |
$254.82
|
| Rate for Payer: Mclaren Commercial |
$184.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.66
|
| Rate for Payer: Nomi Health Commercial |
$218.11
|
| Rate for Payer: Nomi Health Commercial |
$167.77
|
| Rate for Payer: Nomi Health Commercial |
$147.94
|
| Rate for Payer: Nomi Health Commercial |
$106.61
|
| Rate for Payer: Nomi Health Commercial |
$232.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$234.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.41
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
OP
|
$10.98
|
|
|
Service Code
|
NDC 78112069480
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$10.98 |
| Rate for Payer: Aetna Commercial |
$9.88
|
| Rate for Payer: Aetna Medicare |
$4.06
|
| Rate for Payer: ASR ASR |
$10.65
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS Trust/PPO |
$9.05
|
| Rate for Payer: BCN Commercial |
$9.05
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Healthscope Commercial |
$10.65
|
| Rate for Payer: Healthscope Whirlpool |
$10.98
|
| Rate for Payer: Mclaren Commercial |
$9.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.33
|
| Rate for Payer: Nomi Health Commercial |
$9.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.62
|
| Rate for Payer: Priority Health Narrow Network |
$7.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.66
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$10.98
|
|
|
Service Code
|
NDC 78112069480
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$10.98 |
| Rate for Payer: Aetna Commercial |
$9.88
|
| Rate for Payer: ASR ASR |
$10.65
|
| Rate for Payer: BCBS Trust/PPO |
$9.02
|
| Rate for Payer: BCN Commercial |
$9.02
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Healthscope Commercial |
$10.65
|
| Rate for Payer: Healthscope Whirlpool |
$10.98
|
| Rate for Payer: Mclaren Commercial |
$9.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.33
|
| Rate for Payer: Nomi Health Commercial |
$9.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.66
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
OP
|
$10.36
|
|
|
Service Code
|
NDC 904630521
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$10.36 |
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Medicare |
$3.83
|
| Rate for Payer: ASR ASR |
$10.04
|
| Rate for Payer: BCBS Complete |
$4.14
|
| Rate for Payer: BCBS Trust/PPO |
$8.54
|
| Rate for Payer: BCN Commercial |
$8.54
|
| Rate for Payer: Cash Price |
$8.28
|
| Rate for Payer: Cofinity Commercial |
$9.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.28
|
| Rate for Payer: Healthscope Commercial |
$10.04
|
| Rate for Payer: Healthscope Whirlpool |
$10.36
|
| Rate for Payer: Mclaren Commercial |
$9.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.80
|
| Rate for Payer: Nomi Health Commercial |
$8.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.07
|
| Rate for Payer: Priority Health Narrow Network |
$7.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.11
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$10.36
|
|
|
Service Code
|
NDC 904630521
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$10.36 |
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: ASR ASR |
$10.04
|
| Rate for Payer: BCBS Trust/PPO |
$8.50
|
| Rate for Payer: BCN Commercial |
$8.50
|
| Rate for Payer: Cash Price |
$8.28
|
| Rate for Payer: Cofinity Commercial |
$9.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.28
|
| Rate for Payer: Healthscope Commercial |
$10.04
|
| Rate for Payer: Healthscope Whirlpool |
$10.36
|
| Rate for Payer: Mclaren Commercial |
$9.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.80
|
| Rate for Payer: Nomi Health Commercial |
$8.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.11
|
|
|
PHENYLEPHRINE 0.25 % NASAL SPRAY
|
Facility
|
IP
|
$19.78
|
|
|
Service Code
|
NDC 225080047
|
| Hospital Charge Code |
6243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Aetna Commercial |
$17.80
|
| Rate for Payer: ASR ASR |
$19.18
|
| Rate for Payer: BCBS Trust/PPO |
$16.24
|
| Rate for Payer: BCN Commercial |
$16.24
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Commercial |
$18.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$19.18
|
| Rate for Payer: Healthscope Whirlpool |
$19.78
|
| Rate for Payer: Mclaren Commercial |
$17.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.81
|
| Rate for Payer: Nomi Health Commercial |
$16.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.40
|
|
|
PHENYLEPHRINE 0.25 % NASAL SPRAY
|
Facility
|
OP
|
$19.78
|
|
|
Service Code
|
NDC 225080047
|
| Hospital Charge Code |
6243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Aetna Commercial |
$17.80
|
| Rate for Payer: Aetna Medicare |
$7.32
|
| Rate for Payer: ASR ASR |
$19.18
|
| Rate for Payer: BCBS Complete |
$7.91
|
| Rate for Payer: BCBS Trust/PPO |
$16.31
|
| Rate for Payer: BCN Commercial |
$16.31
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Commercial |
$18.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$19.18
|
| Rate for Payer: Healthscope Whirlpool |
$19.78
|
| Rate for Payer: Mclaren Commercial |
$17.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.81
|
| Rate for Payer: Nomi Health Commercial |
$16.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17.33
|
| Rate for Payer: Priority Health Narrow Network |
$13.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.40
|
|
|
PHENYLEPHRINE 0.5 % NASAL SPRAY
|
Facility
|
OP
|
$19.78
|
|
|
Service Code
|
NDC 225080547
|
| Hospital Charge Code |
6244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Aetna Commercial |
$17.80
|
| Rate for Payer: Aetna Medicare |
$7.32
|
| Rate for Payer: ASR ASR |
$19.18
|
| Rate for Payer: BCBS Complete |
$7.91
|
| Rate for Payer: BCBS Trust/PPO |
$16.31
|
| Rate for Payer: BCN Commercial |
$16.31
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Commercial |
$18.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$19.18
|
| Rate for Payer: Healthscope Whirlpool |
$19.78
|
| Rate for Payer: Mclaren Commercial |
$17.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.81
|
| Rate for Payer: Nomi Health Commercial |
$16.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17.33
|
| Rate for Payer: Priority Health Narrow Network |
$13.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.40
|
|
|
PHENYLEPHRINE 0.5 % NASAL SPRAY
|
Facility
|
IP
|
$19.78
|
|
|
Service Code
|
NDC 225080547
|
| Hospital Charge Code |
6244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Aetna Commercial |
$17.80
|
| Rate for Payer: ASR ASR |
$19.18
|
| Rate for Payer: BCBS Trust/PPO |
$16.24
|
| Rate for Payer: BCN Commercial |
$16.24
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Commercial |
$18.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$19.18
|
| Rate for Payer: Healthscope Whirlpool |
$19.78
|
| Rate for Payer: Mclaren Commercial |
$17.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.81
|
| Rate for Payer: Nomi Health Commercial |
$16.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.40
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
IP
|
$130.20
|
|
|
Service Code
|
NDC 42702010305
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.65 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$117.18
|
| Rate for Payer: ASR ASR |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$106.92
|
| Rate for Payer: BCN Commercial |
$106.92
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cofinity Commercial |
$122.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.16
|
| Rate for Payer: Healthscope Commercial |
$126.29
|
| Rate for Payer: Healthscope Whirlpool |
$130.20
|
| Rate for Payer: Mclaren Commercial |
$117.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.67
|
| Rate for Payer: Nomi Health Commercial |
$106.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.58
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
OP
|
$130.20
|
|
|
Service Code
|
NDC 42702010305
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.17 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$117.18
|
| Rate for Payer: Aetna Medicare |
$48.17
|
| Rate for Payer: ASR ASR |
$126.29
|
| Rate for Payer: BCBS Complete |
$52.08
|
| Rate for Payer: BCBS Trust/PPO |
$107.35
|
| Rate for Payer: BCN Commercial |
$107.35
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cofinity Commercial |
$122.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.16
|
| Rate for Payer: Healthscope Commercial |
$126.29
|
| Rate for Payer: Healthscope Whirlpool |
$130.20
|
| Rate for Payer: Mclaren Commercial |
$117.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.67
|
| Rate for Payer: Nomi Health Commercial |
$106.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$114.08
|
| Rate for Payer: Priority Health Narrow Network |
$91.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.58
|
|
|
PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$13.08
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$13.08 |
| Rate for Payer: Aetna Commercial |
$11.77
|
| Rate for Payer: Aetna Commercial |
$12.68
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Medicare |
$5.21
|
| Rate for Payer: Aetna Medicare |
$4.84
|
| Rate for Payer: Aetna Medicare |
$4.99
|
| Rate for Payer: Aetna Medicare |
$4.28
|
| Rate for Payer: ASR ASR |
$13.08
|
| Rate for Payer: ASR ASR |
$11.21
|
| Rate for Payer: ASR ASR |
$13.67
|
| Rate for Payer: ASR ASR |
$12.69
|
| Rate for Payer: BCBS Complete |
$5.23
|
| Rate for Payer: BCBS Complete |
$5.39
|
| Rate for Payer: BCBS Complete |
$5.64
|
| Rate for Payer: BCBS Complete |
$4.62
|
| Rate for Payer: BCBS Trust/PPO |
$9.53
|
| Rate for Payer: BCBS Trust/PPO |
$11.62
|
| Rate for Payer: BCBS Trust/PPO |
$11.12
|
| Rate for Payer: BCBS Trust/PPO |
$10.78
|
| Rate for Payer: BCN Commercial |
$10.78
|
| Rate for Payer: BCN Commercial |
$11.62
|
| Rate for Payer: BCN Commercial |
$9.53
|
| Rate for Payer: BCN Commercial |
$11.12
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$9.25
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cofinity Commercial |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$10.86
|
| Rate for Payer: Cofinity Commercial |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$13.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.28
|
| Rate for Payer: Healthscope Commercial |
$11.21
|
| Rate for Payer: Healthscope Commercial |
$13.67
|
| Rate for Payer: Healthscope Commercial |
$13.08
|
| Rate for Payer: Healthscope Commercial |
$12.69
|
| Rate for Payer: Healthscope Whirlpool |
$13.48
|
| Rate for Payer: Healthscope Whirlpool |
$11.56
|
| Rate for Payer: Healthscope Whirlpool |
$13.08
|
| Rate for Payer: Healthscope Whirlpool |
$14.09
|
| Rate for Payer: Mclaren Commercial |
$12.68
|
| Rate for Payer: Mclaren Commercial |
$12.14
|
| Rate for Payer: Mclaren Commercial |
$11.77
|
| Rate for Payer: Mclaren Commercial |
$10.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.46
|
| Rate for Payer: Nomi Health Commercial |
$11.06
|
| Rate for Payer: Nomi Health Commercial |
$10.72
|
| Rate for Payer: Nomi Health Commercial |
$11.56
|
| Rate for Payer: Nomi Health Commercial |
$9.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.13
|
| Rate for Payer: Priority Health Narrow Network |
$9.45
|
| Rate for Payer: Priority Health Narrow Network |
$9.17
|
| Rate for Payer: Priority Health Narrow Network |
$9.88
|
| Rate for Payer: Priority Health Narrow Network |
$8.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.51
|
|
|
PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$13.49
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$13.48 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Commercial |
$11.77
|
| Rate for Payer: Aetna Commercial |
$12.68
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: ASR ASR |
$13.67
|
| Rate for Payer: ASR ASR |
$13.08
|
| Rate for Payer: ASR ASR |
$12.69
|
| Rate for Payer: ASR ASR |
$11.21
|
| Rate for Payer: BCBS Trust/PPO |
$11.07
|
| Rate for Payer: BCBS Trust/PPO |
$9.49
|
| Rate for Payer: BCBS Trust/PPO |
$10.74
|
| Rate for Payer: BCBS Trust/PPO |
$11.57
|
| Rate for Payer: BCN Commercial |
$9.49
|
| Rate for Payer: BCN Commercial |
$11.57
|
| Rate for Payer: BCN Commercial |
$10.74
|
| Rate for Payer: BCN Commercial |
$11.07
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cash Price |
$9.25
|
| Rate for Payer: Cofinity Commercial |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$10.86
|
| Rate for Payer: Cofinity Commercial |
$13.25
|
| Rate for Payer: Cofinity Commercial |
$12.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.25
|
| Rate for Payer: Healthscope Commercial |
$13.08
|
| Rate for Payer: Healthscope Commercial |
$11.21
|
| Rate for Payer: Healthscope Commercial |
$12.69
|
| Rate for Payer: Healthscope Commercial |
$13.67
|
| Rate for Payer: Healthscope Whirlpool |
$13.48
|
| Rate for Payer: Healthscope Whirlpool |
$14.09
|
| Rate for Payer: Healthscope Whirlpool |
$11.56
|
| Rate for Payer: Healthscope Whirlpool |
$13.08
|
| Rate for Payer: Mclaren Commercial |
$10.40
|
| Rate for Payer: Mclaren Commercial |
$12.68
|
| Rate for Payer: Mclaren Commercial |
$11.77
|
| Rate for Payer: Mclaren Commercial |
$12.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.82
|
| Rate for Payer: Nomi Health Commercial |
$10.72
|
| Rate for Payer: Nomi Health Commercial |
$11.56
|
| Rate for Payer: Nomi Health Commercial |
$11.06
|
| Rate for Payer: Nomi Health Commercial |
$9.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.40
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
OP
|
$100.42
|
|
|
Service Code
|
NDC 17478020102
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$100.42 |
| Rate for Payer: Aetna Commercial |
$90.37
|
| Rate for Payer: Aetna Medicare |
$37.15
|
| Rate for Payer: ASR ASR |
$97.40
|
| Rate for Payer: BCBS Complete |
$40.17
|
| Rate for Payer: BCBS Trust/PPO |
$82.79
|
| Rate for Payer: BCN Commercial |
$82.79
|
| Rate for Payer: Cash Price |
$80.33
|
| Rate for Payer: Cofinity Commercial |
$94.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.33
|
| Rate for Payer: Healthscope Commercial |
$97.40
|
| Rate for Payer: Healthscope Whirlpool |
$100.42
|
| Rate for Payer: Mclaren Commercial |
$90.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.35
|
| Rate for Payer: Nomi Health Commercial |
$82.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$87.98
|
| Rate for Payer: Priority Health Narrow Network |
$70.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.37
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
IP
|
$100.42
|
|
|
Service Code
|
NDC 17478020102
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.31 |
| Max. Negotiated Rate |
$100.42 |
| Rate for Payer: Aetna Commercial |
$90.37
|
| Rate for Payer: ASR ASR |
$97.40
|
| Rate for Payer: BCBS Trust/PPO |
$82.46
|
| Rate for Payer: BCN Commercial |
$82.46
|
| Rate for Payer: Cash Price |
$80.33
|
| Rate for Payer: Cofinity Commercial |
$94.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.33
|
| Rate for Payer: Healthscope Commercial |
$97.40
|
| Rate for Payer: Healthscope Whirlpool |
$100.42
|
| Rate for Payer: Mclaren Commercial |
$90.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.35
|
| Rate for Payer: Nomi Health Commercial |
$82.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.37
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
OP
|
$276.68
|
|
|
Service Code
|
NDC 17478020115
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.37 |
| Max. Negotiated Rate |
$276.68 |
| Rate for Payer: Aetna Commercial |
$249.01
|
| Rate for Payer: Aetna Medicare |
$102.37
|
| Rate for Payer: ASR ASR |
$268.37
|
| Rate for Payer: BCBS Complete |
$110.67
|
| Rate for Payer: BCBS Trust/PPO |
$228.12
|
| Rate for Payer: BCN Commercial |
$228.12
|
| Rate for Payer: Cash Price |
$221.34
|
| Rate for Payer: Cofinity Commercial |
$260.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.34
|
| Rate for Payer: Healthscope Commercial |
$268.37
|
| Rate for Payer: Healthscope Whirlpool |
$276.68
|
| Rate for Payer: Mclaren Commercial |
$249.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.17
|
| Rate for Payer: Nomi Health Commercial |
$226.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$242.42
|
| Rate for Payer: Priority Health Narrow Network |
$193.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.47
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
IP
|
$276.68
|
|
|
Service Code
|
NDC 17478020115
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.51 |
| Max. Negotiated Rate |
$276.68 |
| Rate for Payer: Aetna Commercial |
$249.01
|
| Rate for Payer: ASR ASR |
$268.37
|
| Rate for Payer: BCBS Trust/PPO |
$227.21
|
| Rate for Payer: BCN Commercial |
$227.21
|
| Rate for Payer: Cash Price |
$221.34
|
| Rate for Payer: Cofinity Commercial |
$260.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.34
|
| Rate for Payer: Healthscope Commercial |
$268.37
|
| Rate for Payer: Healthscope Whirlpool |
$276.68
|
| Rate for Payer: Mclaren Commercial |
$249.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.17
|
| Rate for Payer: Nomi Health Commercial |
$226.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.47
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
OP
|
$5.54
|
|
|
Service Code
|
NDC 60687015695
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Aetna Commercial |
$4.99
|
| Rate for Payer: Aetna Medicare |
$2.05
|
| Rate for Payer: ASR ASR |
$5.37
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.57
|
| Rate for Payer: BCN Commercial |
$4.57
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$5.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$5.37
|
| Rate for Payer: Healthscope Whirlpool |
$5.54
|
| Rate for Payer: Mclaren Commercial |
$4.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: Nomi Health Commercial |
$4.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.85
|
| Rate for Payer: Priority Health Narrow Network |
$3.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.88
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
IP
|
$5.54
|
|
|
Service Code
|
NDC 60687015695
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Aetna Commercial |
$4.99
|
| Rate for Payer: ASR ASR |
$5.37
|
| Rate for Payer: BCBS Trust/PPO |
$4.55
|
| Rate for Payer: BCN Commercial |
$4.55
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$5.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$5.37
|
| Rate for Payer: Healthscope Whirlpool |
$5.54
|
| Rate for Payer: Mclaren Commercial |
$4.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: Nomi Health Commercial |
$4.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.88
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
OP
|
$166.18
|
|
|
Service Code
|
NDC 60687015625
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.49 |
| Max. Negotiated Rate |
$166.18 |
| Rate for Payer: Aetna Commercial |
$149.56
|
| Rate for Payer: Aetna Medicare |
$61.49
|
| Rate for Payer: ASR ASR |
$161.19
|
| Rate for Payer: BCBS Complete |
$66.47
|
| Rate for Payer: BCBS Trust/PPO |
$137.01
|
| Rate for Payer: BCN Commercial |
$137.01
|
| Rate for Payer: Cash Price |
$132.94
|
| Rate for Payer: Cofinity Commercial |
$156.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.94
|
| Rate for Payer: Healthscope Commercial |
$161.19
|
| Rate for Payer: Healthscope Whirlpool |
$166.18
|
| Rate for Payer: Mclaren Commercial |
$149.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.25
|
| Rate for Payer: Nomi Health Commercial |
$136.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$145.60
|
| Rate for Payer: Priority Health Narrow Network |
$116.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.23
|
|
