|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
OP
|
$279.30
|
|
|
Service Code
|
NDC 00904657561
|
| Hospital Charge Code |
6217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.72 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Aetna Commercial |
$251.37
|
| Rate for Payer: Aetna Medicare |
$139.65
|
| Rate for Payer: ASR ASR |
$270.92
|
| Rate for Payer: ASR Commercial |
$270.92
|
| Rate for Payer: BCBS Complete |
$111.72
|
| Rate for Payer: BCBS Trust/PPO |
$228.72
|
| Rate for Payer: BCN Commercial |
$216.54
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$262.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$279.30
|
| Rate for Payer: Healthscope Whirlpool |
$270.92
|
| Rate for Payer: Mclaren Commercial |
$251.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.40
|
| Rate for Payer: Nomi Health Commercial |
$229.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.72
|
| Rate for Payer: Priority Health Narrow Network |
$195.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.78
|
|
|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
NDC 00904657561
|
| Hospital Charge Code |
6217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.54 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Aetna Commercial |
$251.37
|
| Rate for Payer: ASR ASR |
$270.92
|
| Rate for Payer: ASR Commercial |
$270.92
|
| Rate for Payer: BCBS Trust/PPO |
$227.60
|
| Rate for Payer: BCN Commercial |
$216.54
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$262.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$279.30
|
| Rate for Payer: Healthscope Whirlpool |
$270.92
|
| Rate for Payer: Mclaren Commercial |
$251.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.40
|
| Rate for Payer: Nomi Health Commercial |
$229.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.78
|
|
|
PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$182.28
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
6221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$182.28 |
| Rate for Payer: Aetna Commercial |
$164.05
|
| Rate for Payer: Aetna Commercial |
$239.38
|
| Rate for Payer: Aetna Commercial |
$117.01
|
| Rate for Payer: Aetna Commercial |
$254.83
|
| Rate for Payer: Aetna Commercial |
$184.14
|
| Rate for Payer: Aetna Medicare |
$102.30
|
| Rate for Payer: Aetna Medicare |
$65.00
|
| Rate for Payer: Aetna Medicare |
$91.14
|
| Rate for Payer: Aetna Medicare |
$132.99
|
| Rate for Payer: Aetna Medicare |
$141.57
|
| Rate for Payer: ASR ASR |
$126.11
|
| Rate for Payer: ASR ASR |
$258.00
|
| Rate for Payer: ASR ASR |
$176.81
|
| Rate for Payer: ASR ASR |
$198.46
|
| Rate for Payer: ASR ASR |
$274.65
|
| Rate for Payer: ASR Commercial |
$126.11
|
| Rate for Payer: ASR Commercial |
$176.81
|
| Rate for Payer: ASR Commercial |
$274.65
|
| Rate for Payer: ASR Commercial |
$258.00
|
| Rate for Payer: ASR Commercial |
$198.46
|
| Rate for Payer: BCBS Complete |
$113.26
|
| Rate for Payer: BCBS Complete |
$52.00
|
| Rate for Payer: BCBS Complete |
$72.91
|
| Rate for Payer: BCBS Complete |
$81.84
|
| Rate for Payer: BCBS Complete |
$106.39
|
| Rate for Payer: BCBS Trust/PPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$167.55
|
| Rate for Payer: BCBS Trust/PPO |
$106.47
|
| Rate for Payer: BCBS Trust/PPO |
$149.27
|
| Rate for Payer: BCBS Trust/PPO |
$231.86
|
| Rate for Payer: BCN Commercial |
$206.21
|
| Rate for Payer: BCN Commercial |
$100.80
|
| Rate for Payer: BCN Commercial |
$141.32
|
| Rate for Payer: BCN Commercial |
$158.63
|
| Rate for Payer: BCN Commercial |
$219.52
|
| Rate for Payer: Cash Price |
$226.51
|
| Rate for Payer: Cash Price |
$145.82
|
| Rate for Payer: Cash Price |
$212.79
|
| Rate for Payer: Cash Price |
$104.01
|
| Rate for Payer: Cash Price |
$163.68
|
| Rate for Payer: Cash Price |
$163.68
|
| Rate for Payer: Cash Price |
$212.79
|
| Rate for Payer: Cash Price |
$104.01
|
| Rate for Payer: Cash Price |
$226.51
|
| Rate for Payer: Cash Price |
$145.82
|
| Rate for Payer: Cofinity Commercial |
$171.34
|
| Rate for Payer: Cofinity Commercial |
$250.02
|
| Rate for Payer: Cofinity Commercial |
$266.15
|
| Rate for Payer: Cofinity Commercial |
$122.21
|
| Rate for Payer: Cofinity Commercial |
$192.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.68
|
| Rate for Payer: Healthscope Commercial |
$265.98
|
| Rate for Payer: Healthscope Commercial |
$204.60
|
| Rate for Payer: Healthscope Commercial |
$182.28
|
| Rate for Payer: Healthscope Commercial |
$283.14
|
| Rate for Payer: Healthscope Commercial |
$130.01
|
| Rate for Payer: Healthscope Whirlpool |
$274.65
|
| Rate for Payer: Healthscope Whirlpool |
$176.81
|
| Rate for Payer: Healthscope Whirlpool |
$126.11
|
| Rate for Payer: Healthscope Whirlpool |
$258.00
|
| Rate for Payer: Healthscope Whirlpool |
$198.46
|
| Rate for Payer: Mclaren Commercial |
$239.38
|
| Rate for Payer: Mclaren Commercial |
$117.01
|
| Rate for Payer: Mclaren Commercial |
$164.05
|
| Rate for Payer: Mclaren Commercial |
$184.14
|
| Rate for Payer: Mclaren Commercial |
$254.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.91
|
| Rate for Payer: Nomi Health Commercial |
$106.61
|
| Rate for Payer: Nomi Health Commercial |
$149.47
|
| Rate for Payer: Nomi Health Commercial |
$232.17
|
| Rate for Payer: Nomi Health Commercial |
$218.10
|
| Rate for Payer: Nomi Health Commercial |
$167.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.55
|
| Rate for Payer: Priority Health Narrow Network |
$24.44
|
| Rate for Payer: Priority Health Narrow Network |
$24.44
|
| Rate for Payer: Priority Health Narrow Network |
$24.44
|
| Rate for Payer: Priority Health Narrow Network |
$24.44
|
| Rate for Payer: Priority Health Narrow Network |
$24.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$234.06
|
| 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
|
$182.28
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
6221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.48 |
| Max. Negotiated Rate |
$182.28 |
| Rate for Payer: Aetna Commercial |
$164.05
|
| Rate for Payer: Aetna Commercial |
$239.38
|
| Rate for Payer: Aetna Commercial |
$254.83
|
| Rate for Payer: Aetna Commercial |
$184.14
|
| Rate for Payer: Aetna Commercial |
$117.01
|
| Rate for Payer: ASR ASR |
$274.65
|
| Rate for Payer: ASR ASR |
$258.00
|
| Rate for Payer: ASR ASR |
$198.46
|
| Rate for Payer: ASR ASR |
$176.81
|
| Rate for Payer: ASR ASR |
$126.11
|
| Rate for Payer: ASR Commercial |
$198.46
|
| Rate for Payer: ASR Commercial |
$274.65
|
| Rate for Payer: ASR Commercial |
$258.00
|
| Rate for Payer: ASR Commercial |
$176.81
|
| Rate for Payer: ASR Commercial |
$126.11
|
| Rate for Payer: BCBS Trust/PPO |
$230.73
|
| Rate for Payer: BCBS Trust/PPO |
$105.95
|
| Rate for Payer: BCBS Trust/PPO |
$148.54
|
| Rate for Payer: BCBS Trust/PPO |
$216.75
|
| Rate for Payer: BCBS Trust/PPO |
$166.73
|
| Rate for Payer: BCN Commercial |
$141.32
|
| Rate for Payer: BCN Commercial |
$219.52
|
| Rate for Payer: BCN Commercial |
$100.80
|
| Rate for Payer: BCN Commercial |
$158.63
|
| Rate for Payer: BCN Commercial |
$206.21
|
| Rate for Payer: Cash Price |
$145.82
|
| 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 |
$104.01
|
| Rate for Payer: Cofinity Commercial |
$171.34
|
| Rate for Payer: Cofinity Commercial |
$192.32
|
| Rate for Payer: Cofinity Commercial |
$122.21
|
| Rate for Payer: Cofinity Commercial |
$250.02
|
| Rate for Payer: Cofinity Commercial |
$266.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.78
|
| 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 |
$104.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.82
|
| Rate for Payer: Healthscope Commercial |
$204.60
|
| Rate for Payer: Healthscope Commercial |
$265.98
|
| Rate for Payer: Healthscope Commercial |
$182.28
|
| Rate for Payer: Healthscope Commercial |
$130.01
|
| Rate for Payer: Healthscope Commercial |
$283.14
|
| Rate for Payer: Healthscope Whirlpool |
$274.65
|
| Rate for Payer: Healthscope Whirlpool |
$126.11
|
| Rate for Payer: Healthscope Whirlpool |
$198.46
|
| Rate for Payer: Healthscope Whirlpool |
$176.81
|
| Rate for Payer: Healthscope Whirlpool |
$258.00
|
| Rate for Payer: Mclaren Commercial |
$164.05
|
| Rate for Payer: Mclaren Commercial |
$184.14
|
| Rate for Payer: Mclaren Commercial |
$117.01
|
| Rate for Payer: Mclaren Commercial |
$239.38
|
| Rate for Payer: Mclaren Commercial |
$254.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.91
|
| Rate for Payer: Nomi Health Commercial |
$167.77
|
| Rate for Payer: Nomi Health Commercial |
$106.61
|
| Rate for Payer: Nomi Health Commercial |
$149.47
|
| Rate for Payer: Nomi Health Commercial |
$232.17
|
| Rate for Payer: Nomi Health Commercial |
$218.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$234.06
|
|
|
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 |
$4.39 |
| Max. Negotiated Rate |
$10.98 |
| Rate for Payer: Aetna Commercial |
$9.88
|
| Rate for Payer: Aetna Medicare |
$5.49
|
| Rate for Payer: ASR ASR |
$10.65
|
| Rate for Payer: ASR Commercial |
$10.65
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS Trust/PPO |
$8.99
|
| Rate for Payer: BCN Commercial |
$8.51
|
| 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 |
$10.98
|
| Rate for Payer: Healthscope Whirlpool |
$10.65
|
| 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: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: 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 |
$7.14 |
| Max. Negotiated Rate |
$10.98 |
| Rate for Payer: Aetna Commercial |
$9.88
|
| Rate for Payer: ASR ASR |
$10.65
|
| Rate for Payer: ASR Commercial |
$10.65
|
| Rate for Payer: BCBS Trust/PPO |
$8.95
|
| Rate for Payer: BCN Commercial |
$8.51
|
| 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 |
$10.98
|
| Rate for Payer: Healthscope Whirlpool |
$10.65
|
| 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: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.66
|
|
|
PHENYLEPHRINE 0.25 % NASAL SPRAY
|
Facility
|
OP
|
$19.78
|
|
|
Service Code
|
NDC 00225080047
|
| Hospital Charge Code |
6243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Aetna Commercial |
$17.80
|
| Rate for Payer: Aetna Medicare |
$9.89
|
| Rate for Payer: ASR ASR |
$19.19
|
| Rate for Payer: ASR Commercial |
$19.19
|
| Rate for Payer: BCBS Complete |
$7.91
|
| Rate for Payer: BCBS Trust/PPO |
$16.20
|
| Rate for Payer: BCN Commercial |
$15.34
|
| 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 |
$19.78
|
| Rate for Payer: Healthscope Whirlpool |
$19.19
|
| 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: Priority Health Cigna Priority Health |
$12.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.33
|
| Rate for Payer: Priority Health Narrow Network |
$13.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.41
|
|
|
PHENYLEPHRINE 0.25 % NASAL SPRAY
|
Facility
|
IP
|
$19.78
|
|
|
Service Code
|
NDC 00225080047
|
| Hospital Charge Code |
6243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Aetna Commercial |
$17.80
|
| Rate for Payer: ASR ASR |
$19.19
|
| Rate for Payer: ASR Commercial |
$19.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.12
|
| Rate for Payer: BCN Commercial |
$15.34
|
| 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 |
$19.78
|
| Rate for Payer: Healthscope Whirlpool |
$19.19
|
| 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: Priority Health Cigna Priority Health |
$12.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.41
|
|
|
PHENYLEPHRINE 0.5 % NASAL SPRAY
|
Facility
|
OP
|
$19.78
|
|
|
Service Code
|
NDC 00225080547
|
| Hospital Charge Code |
6244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Aetna Commercial |
$17.80
|
| Rate for Payer: Aetna Medicare |
$9.89
|
| Rate for Payer: ASR ASR |
$19.19
|
| Rate for Payer: ASR Commercial |
$19.19
|
| Rate for Payer: BCBS Complete |
$7.91
|
| Rate for Payer: BCBS Trust/PPO |
$16.20
|
| Rate for Payer: BCN Commercial |
$15.34
|
| 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 |
$19.78
|
| Rate for Payer: Healthscope Whirlpool |
$19.19
|
| 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: Priority Health Cigna Priority Health |
$12.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.33
|
| Rate for Payer: Priority Health Narrow Network |
$13.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.41
|
|
|
PHENYLEPHRINE 0.5 % NASAL SPRAY
|
Facility
|
IP
|
$19.78
|
|
|
Service Code
|
NDC 00225080547
|
| Hospital Charge Code |
6244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Aetna Commercial |
$17.80
|
| Rate for Payer: ASR ASR |
$19.19
|
| Rate for Payer: ASR Commercial |
$19.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.12
|
| Rate for Payer: BCN Commercial |
$15.34
|
| 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 |
$19.78
|
| Rate for Payer: Healthscope Whirlpool |
$19.19
|
| 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: Priority Health Cigna Priority Health |
$12.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.41
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
OP
|
$130.20
|
|
|
Service Code
|
NDC 42702010305
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$117.18
|
| Rate for Payer: Aetna Medicare |
$65.10
|
| Rate for Payer: ASR ASR |
$126.29
|
| Rate for Payer: ASR Commercial |
$126.29
|
| Rate for Payer: BCBS Complete |
$52.08
|
| Rate for Payer: BCBS Trust/PPO |
$106.62
|
| Rate for Payer: BCN Commercial |
$100.94
|
| 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 |
$130.20
|
| Rate for Payer: Healthscope Whirlpool |
$126.29
|
| 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: Priority Health Cigna Priority Health |
$84.63
|
| Rate for Payer: 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 % EYE DROPS
|
Facility
|
IP
|
$130.20
|
|
|
Service Code
|
NDC 42702010305
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$117.18
|
| Rate for Payer: ASR ASR |
$126.29
|
| Rate for Payer: ASR Commercial |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$106.10
|
| Rate for Payer: BCN Commercial |
$100.94
|
| 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 |
$130.20
|
| Rate for Payer: Healthscope Whirlpool |
$126.29
|
| 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: Priority Health Cigna Priority Health |
$84.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.58
|
|
|
PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$13.48
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$13.48 |
| Rate for Payer: Aetna Commercial |
$12.13
|
| Rate for Payer: Aetna Commercial |
$14.56
|
| Rate for Payer: Aetna Commercial |
$15.05
|
| Rate for Payer: Aetna Medicare |
$8.09
|
| Rate for Payer: Aetna Medicare |
$8.36
|
| Rate for Payer: Aetna Medicare |
$6.74
|
| Rate for Payer: ASR ASR |
$15.69
|
| Rate for Payer: ASR ASR |
$13.08
|
| Rate for Payer: ASR ASR |
$16.22
|
| Rate for Payer: ASR Commercial |
$16.22
|
| Rate for Payer: ASR Commercial |
$15.69
|
| Rate for Payer: ASR Commercial |
$13.08
|
| Rate for Payer: BCBS Complete |
$5.39
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCBS Trust/PPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$13.69
|
| Rate for Payer: BCN Commercial |
$12.96
|
| Rate for Payer: BCN Commercial |
$10.45
|
| Rate for Payer: BCN Commercial |
$12.54
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cofinity Commercial |
$15.72
|
| Rate for Payer: Cofinity Commercial |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$15.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Healthscope Commercial |
$13.48
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$16.72
|
| Rate for Payer: Healthscope Whirlpool |
$15.69
|
| Rate for Payer: Healthscope Whirlpool |
$13.08
|
| Rate for Payer: Healthscope Whirlpool |
$16.22
|
| Rate for Payer: Mclaren Commercial |
$12.13
|
| Rate for Payer: Mclaren Commercial |
$14.56
|
| Rate for Payer: Mclaren Commercial |
$15.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Nomi Health Commercial |
$11.05
|
| Rate for Payer: Nomi Health Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$13.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.65
|
| Rate for Payer: Priority Health Narrow Network |
$11.72
|
| Rate for Payer: Priority Health Narrow Network |
$9.45
|
| Rate for Payer: Priority Health Narrow Network |
$11.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.71
|
|
|
PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$16.18
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna Commercial |
$14.56
|
| Rate for Payer: Aetna Commercial |
$12.13
|
| Rate for Payer: Aetna Commercial |
$15.05
|
| Rate for Payer: ASR ASR |
$16.22
|
| Rate for Payer: ASR ASR |
$13.08
|
| Rate for Payer: ASR ASR |
$15.69
|
| Rate for Payer: ASR Commercial |
$13.08
|
| Rate for Payer: ASR Commercial |
$16.22
|
| Rate for Payer: ASR Commercial |
$15.69
|
| Rate for Payer: BCBS Trust/PPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$10.98
|
| Rate for Payer: BCBS Trust/PPO |
$13.63
|
| Rate for Payer: BCN Commercial |
$10.45
|
| Rate for Payer: BCN Commercial |
$12.54
|
| Rate for Payer: BCN Commercial |
$12.96
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cofinity Commercial |
$15.72
|
| Rate for Payer: Cofinity Commercial |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$15.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$13.48
|
| Rate for Payer: Healthscope Commercial |
$16.72
|
| Rate for Payer: Healthscope Whirlpool |
$13.08
|
| Rate for Payer: Healthscope Whirlpool |
$15.69
|
| Rate for Payer: Healthscope Whirlpool |
$16.22
|
| Rate for Payer: Mclaren Commercial |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$14.56
|
| Rate for Payer: Mclaren Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Nomi Health Commercial |
$11.05
|
| Rate for Payer: Nomi Health Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$13.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.24
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
IP
|
$276.68
|
|
|
Service Code
|
NDC 17478020115
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.84 |
| Max. Negotiated Rate |
$276.68 |
| Rate for Payer: Aetna Commercial |
$249.01
|
| Rate for Payer: ASR ASR |
$268.38
|
| Rate for Payer: ASR Commercial |
$268.38
|
| Rate for Payer: BCBS Trust/PPO |
$225.47
|
| Rate for Payer: BCN Commercial |
$214.51
|
| Rate for Payer: Cash Price |
$221.34
|
| Rate for Payer: Cofinity Commercial |
$260.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.34
|
| Rate for Payer: Healthscope Commercial |
$276.68
|
| Rate for Payer: Healthscope Whirlpool |
$268.38
|
| Rate for Payer: Mclaren Commercial |
$249.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.18
|
| Rate for Payer: Nomi Health Commercial |
$226.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.48
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
OP
|
$294.63
|
|
|
Service Code
|
NDC 42702010215
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna Commercial |
$265.17
|
| Rate for Payer: Aetna Medicare |
$147.32
|
| Rate for Payer: ASR ASR |
$285.79
|
| Rate for Payer: ASR Commercial |
$285.79
|
| Rate for Payer: BCBS Complete |
$117.85
|
| Rate for Payer: BCBS Trust/PPO |
$241.27
|
| Rate for Payer: BCN Commercial |
$228.43
|
| Rate for Payer: Cash Price |
$235.70
|
| Rate for Payer: Cofinity Commercial |
$276.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.70
|
| Rate for Payer: Healthscope Commercial |
$294.63
|
| Rate for Payer: Healthscope Whirlpool |
$285.79
|
| Rate for Payer: Mclaren Commercial |
$265.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.44
|
| Rate for Payer: Nomi Health Commercial |
$241.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$258.15
|
| Rate for Payer: Priority Health Narrow Network |
$206.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.27
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
OP
|
$276.68
|
|
|
Service Code
|
NDC 17478020115
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.67 |
| Max. Negotiated Rate |
$276.68 |
| Rate for Payer: Aetna Commercial |
$249.01
|
| Rate for Payer: Aetna Medicare |
$138.34
|
| Rate for Payer: ASR ASR |
$268.38
|
| Rate for Payer: ASR Commercial |
$268.38
|
| Rate for Payer: BCBS Complete |
$110.67
|
| Rate for Payer: BCBS Trust/PPO |
$226.57
|
| Rate for Payer: BCN Commercial |
$214.51
|
| Rate for Payer: Cash Price |
$221.34
|
| Rate for Payer: Cofinity Commercial |
$260.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.34
|
| Rate for Payer: Healthscope Commercial |
$276.68
|
| Rate for Payer: Healthscope Whirlpool |
$268.38
|
| Rate for Payer: Mclaren Commercial |
$249.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.18
|
| Rate for Payer: Nomi Health Commercial |
$226.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.43
|
| Rate for Payer: Priority Health Narrow Network |
$193.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.48
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
IP
|
$294.63
|
|
|
Service Code
|
NDC 42702010215
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.51 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna Commercial |
$265.17
|
| Rate for Payer: ASR ASR |
$285.79
|
| Rate for Payer: ASR Commercial |
$285.79
|
| Rate for Payer: BCBS Trust/PPO |
$240.09
|
| Rate for Payer: BCN Commercial |
$228.43
|
| Rate for Payer: Cash Price |
$235.70
|
| Rate for Payer: Cofinity Commercial |
$276.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.70
|
| Rate for Payer: Healthscope Commercial |
$294.63
|
| Rate for Payer: Healthscope Whirlpool |
$285.79
|
| Rate for Payer: Mclaren Commercial |
$265.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.44
|
| Rate for Payer: Nomi Health Commercial |
$241.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.27
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
IP
|
$100.42
|
|
|
Service Code
|
NDC 17478020102
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.27 |
| Max. Negotiated Rate |
$100.42 |
| Rate for Payer: Aetna Commercial |
$90.38
|
| Rate for Payer: ASR ASR |
$97.41
|
| Rate for Payer: ASR Commercial |
$97.41
|
| Rate for Payer: BCBS Trust/PPO |
$81.83
|
| Rate for Payer: BCN Commercial |
$77.86
|
| Rate for Payer: Cash Price |
$80.33
|
| Rate for Payer: Cofinity Commercial |
$94.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.34
|
| Rate for Payer: Healthscope Commercial |
$100.42
|
| Rate for Payer: Healthscope Whirlpool |
$97.41
|
| Rate for Payer: Mclaren Commercial |
$90.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.36
|
| Rate for Payer: Nomi Health Commercial |
$82.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.37
|
|
|
PHENYLEPHRINE 2.5 % EYE DROPS
|
Facility
|
OP
|
$100.42
|
|
|
Service Code
|
NDC 17478020102
|
| Hospital Charge Code |
6246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.17 |
| Max. Negotiated Rate |
$100.42 |
| Rate for Payer: Aetna Commercial |
$90.38
|
| Rate for Payer: Aetna Medicare |
$50.21
|
| Rate for Payer: ASR ASR |
$97.41
|
| Rate for Payer: ASR Commercial |
$97.41
|
| Rate for Payer: BCBS Complete |
$40.17
|
| Rate for Payer: BCBS Trust/PPO |
$82.23
|
| Rate for Payer: BCN Commercial |
$77.86
|
| Rate for Payer: Cash Price |
$80.33
|
| Rate for Payer: Cofinity Commercial |
$94.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.34
|
| Rate for Payer: Healthscope Commercial |
$100.42
|
| Rate for Payer: Healthscope Whirlpool |
$97.41
|
| Rate for Payer: Mclaren Commercial |
$90.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.36
|
| Rate for Payer: Nomi Health Commercial |
$82.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.99
|
| Rate for Payer: Priority Health Narrow Network |
$70.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.37
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
IP
|
$162.58
|
|
|
Service Code
|
NDC 60687015625
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.68 |
| Max. Negotiated Rate |
$162.58 |
| Rate for Payer: Aetna Commercial |
$146.32
|
| Rate for Payer: ASR ASR |
$157.70
|
| Rate for Payer: ASR Commercial |
$157.70
|
| Rate for Payer: BCBS Trust/PPO |
$132.49
|
| Rate for Payer: BCN Commercial |
$126.05
|
| Rate for Payer: Cash Price |
$130.06
|
| Rate for Payer: Cofinity Commercial |
$152.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.06
|
| Rate for Payer: Healthscope Commercial |
$162.58
|
| Rate for Payer: Healthscope Whirlpool |
$157.70
|
| Rate for Payer: Mclaren Commercial |
$146.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.19
|
| Rate for Payer: Nomi Health Commercial |
$133.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.07
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
IP
|
$769.60
|
|
|
Service Code
|
NDC 00071000740
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$500.24 |
| Max. Negotiated Rate |
$769.60 |
| Rate for Payer: Aetna Commercial |
$692.64
|
| Rate for Payer: ASR ASR |
$746.51
|
| Rate for Payer: ASR Commercial |
$746.51
|
| Rate for Payer: BCBS Trust/PPO |
$627.15
|
| Rate for Payer: BCN Commercial |
$596.67
|
| Rate for Payer: Cash Price |
$615.68
|
| Rate for Payer: Cofinity Commercial |
$723.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$615.68
|
| Rate for Payer: Healthscope Commercial |
$769.60
|
| Rate for Payer: Healthscope Whirlpool |
$746.51
|
| Rate for Payer: Mclaren Commercial |
$692.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$654.16
|
| Rate for Payer: Nomi Health Commercial |
$631.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$500.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$677.25
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
OP
|
$769.60
|
|
|
Service Code
|
NDC 00071000740
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$307.84 |
| Max. Negotiated Rate |
$769.60 |
| Rate for Payer: Aetna Commercial |
$692.64
|
| Rate for Payer: Aetna Medicare |
$384.80
|
| Rate for Payer: ASR ASR |
$746.51
|
| Rate for Payer: ASR Commercial |
$746.51
|
| Rate for Payer: BCBS Complete |
$307.84
|
| Rate for Payer: BCBS Trust/PPO |
$630.23
|
| Rate for Payer: BCN Commercial |
$596.67
|
| Rate for Payer: Cash Price |
$615.68
|
| Rate for Payer: Cofinity Commercial |
$723.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$615.68
|
| Rate for Payer: Healthscope Commercial |
$769.60
|
| Rate for Payer: Healthscope Whirlpool |
$746.51
|
| Rate for Payer: Mclaren Commercial |
$692.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$654.16
|
| Rate for Payer: Nomi Health Commercial |
$631.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$500.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$674.32
|
| Rate for Payer: Priority Health Narrow Network |
$539.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$677.25
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
OP
|
$162.58
|
|
|
Service Code
|
NDC 60687015625
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.03 |
| Max. Negotiated Rate |
$162.58 |
| Rate for Payer: Aetna Commercial |
$146.32
|
| Rate for Payer: Aetna Medicare |
$81.29
|
| Rate for Payer: ASR ASR |
$157.70
|
| Rate for Payer: ASR Commercial |
$157.70
|
| Rate for Payer: BCBS Complete |
$65.03
|
| Rate for Payer: BCBS Trust/PPO |
$133.14
|
| Rate for Payer: BCN Commercial |
$126.05
|
| Rate for Payer: Cash Price |
$130.06
|
| Rate for Payer: Cofinity Commercial |
$152.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.06
|
| Rate for Payer: Healthscope Commercial |
$162.58
|
| Rate for Payer: Healthscope Whirlpool |
$157.70
|
| Rate for Payer: Mclaren Commercial |
$146.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.19
|
| Rate for Payer: Nomi Health Commercial |
$133.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.45
|
| Rate for Payer: Priority Health Narrow Network |
$113.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.07
|
|
|
PHENYTOIN 50 MG CHEWABLE TABLET
|
Facility
|
OP
|
$5.42
|
|
|
Service Code
|
NDC 60687015695
|
| Hospital Charge Code |
11018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Aetna Commercial |
$4.88
|
| Rate for Payer: Aetna Medicare |
$2.71
|
| Rate for Payer: ASR ASR |
$5.26
|
| Rate for Payer: ASR Commercial |
$5.26
|
| Rate for Payer: BCBS Complete |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$4.44
|
| Rate for Payer: BCN Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cofinity Commercial |
$5.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.34
|
| Rate for Payer: Healthscope Commercial |
$5.42
|
| Rate for Payer: Healthscope Whirlpool |
$5.26
|
| Rate for Payer: Mclaren Commercial |
$4.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.61
|
| Rate for Payer: Nomi Health Commercial |
$4.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.75
|
| Rate for Payer: Priority Health Narrow Network |
$3.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.77
|
|
