|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
IP
|
$322.35
|
|
|
Service Code
|
NDC 45802026937
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.53 |
| Max. Negotiated Rate |
$322.35 |
| Rate for Payer: Aetna Commercial |
$290.12
|
| Rate for Payer: ASR ASR |
$312.68
|
| Rate for Payer: ASR Commercial |
$312.68
|
| Rate for Payer: BCBS Trust/PPO |
$262.68
|
| Rate for Payer: BCN Commercial |
$249.92
|
| Rate for Payer: Cash Price |
$257.88
|
| Rate for Payer: Cofinity Commercial |
$303.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.88
|
| Rate for Payer: Healthscope Commercial |
$322.35
|
| Rate for Payer: Healthscope Whirlpool |
$312.68
|
| Rate for Payer: Mclaren Commercial |
$290.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.00
|
| Rate for Payer: Nomi Health Commercial |
$264.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.67
|
|
|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
OP
|
$83.16
|
|
|
Service Code
|
NDC 21922002107
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.26 |
| Max. Negotiated Rate |
$83.16 |
| Rate for Payer: Aetna Commercial |
$74.84
|
| Rate for Payer: Aetna Medicare |
$41.58
|
| Rate for Payer: ASR ASR |
$80.67
|
| Rate for Payer: ASR Commercial |
$80.67
|
| Rate for Payer: BCBS Complete |
$33.26
|
| Rate for Payer: BCBS Trust/PPO |
$68.10
|
| Rate for Payer: BCN Commercial |
$64.47
|
| Rate for Payer: Cash Price |
$66.53
|
| Rate for Payer: Cofinity Commercial |
$78.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.53
|
| Rate for Payer: Healthscope Commercial |
$83.16
|
| Rate for Payer: Healthscope Whirlpool |
$80.67
|
| Rate for Payer: Mclaren Commercial |
$74.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.69
|
| Rate for Payer: Nomi Health Commercial |
$68.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.86
|
| Rate for Payer: Priority Health Narrow Network |
$58.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.18
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
IP
|
$326.80
|
|
|
Service Code
|
NDC 75826011510
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.42 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna Commercial |
$294.12
|
| Rate for Payer: ASR ASR |
$317.00
|
| Rate for Payer: ASR Commercial |
$317.00
|
| Rate for Payer: BCBS Trust/PPO |
$266.31
|
| Rate for Payer: BCN Commercial |
$253.37
|
| Rate for Payer: Cash Price |
$261.44
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.44
|
| Rate for Payer: Healthscope Commercial |
$326.80
|
| Rate for Payer: Healthscope Whirlpool |
$317.00
|
| Rate for Payer: Mclaren Commercial |
$294.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.78
|
| Rate for Payer: Nomi Health Commercial |
$267.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.58
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
OP
|
$353.40
|
|
|
Service Code
|
NDC 65162068210
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.36 |
| Max. Negotiated Rate |
$353.40 |
| Rate for Payer: Aetna Commercial |
$318.06
|
| Rate for Payer: Aetna Medicare |
$176.70
|
| Rate for Payer: ASR ASR |
$342.80
|
| Rate for Payer: ASR Commercial |
$342.80
|
| Rate for Payer: BCBS Complete |
$141.36
|
| Rate for Payer: BCBS Trust/PPO |
$289.40
|
| Rate for Payer: BCN Commercial |
$273.99
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Commercial |
$332.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$353.40
|
| Rate for Payer: Healthscope Whirlpool |
$342.80
|
| Rate for Payer: Mclaren Commercial |
$318.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: Nomi Health Commercial |
$289.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$309.65
|
| Rate for Payer: Priority Health Narrow Network |
$247.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$310.99
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
OP
|
$326.80
|
|
|
Service Code
|
NDC 75826011510
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.72 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna Commercial |
$294.12
|
| Rate for Payer: Aetna Medicare |
$163.40
|
| Rate for Payer: ASR ASR |
$317.00
|
| Rate for Payer: ASR Commercial |
$317.00
|
| Rate for Payer: BCBS Complete |
$130.72
|
| Rate for Payer: BCBS Trust/PPO |
$267.62
|
| Rate for Payer: BCN Commercial |
$253.37
|
| Rate for Payer: Cash Price |
$261.44
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.44
|
| Rate for Payer: Healthscope Commercial |
$326.80
|
| Rate for Payer: Healthscope Whirlpool |
$317.00
|
| Rate for Payer: Mclaren Commercial |
$294.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.78
|
| Rate for Payer: Nomi Health Commercial |
$267.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.34
|
| Rate for Payer: Priority Health Narrow Network |
$229.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.58
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
OP
|
$318.25
|
|
|
Service Code
|
NDC 42192080201
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.30 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Aetna Commercial |
$286.43
|
| Rate for Payer: Aetna Medicare |
$159.12
|
| Rate for Payer: ASR ASR |
$308.70
|
| Rate for Payer: ASR Commercial |
$308.70
|
| Rate for Payer: BCBS Complete |
$127.30
|
| Rate for Payer: BCBS Trust/PPO |
$260.61
|
| Rate for Payer: BCN Commercial |
$246.74
|
| 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 |
$318.25
|
| Rate for Payer: Healthscope Whirlpool |
$308.70
|
| 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: Priority Health Cigna Priority Health |
$206.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$278.85
|
| Rate for Payer: Priority Health Narrow Network |
$223.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$280.06
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
IP
|
$318.25
|
|
|
Service Code
|
NDC 42192080201
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.86 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Aetna Commercial |
$286.43
|
| Rate for Payer: ASR ASR |
$308.70
|
| Rate for Payer: ASR Commercial |
$308.70
|
| Rate for Payer: BCBS Trust/PPO |
$259.34
|
| Rate for Payer: BCN Commercial |
$246.74
|
| 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 |
$318.25
|
| Rate for Payer: Healthscope Whirlpool |
$308.70
|
| 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: Priority Health Cigna Priority Health |
$206.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$280.06
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
IP
|
$353.40
|
|
|
Service Code
|
NDC 65162068210
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.71 |
| Max. Negotiated Rate |
$353.40 |
| Rate for Payer: Aetna Commercial |
$318.06
|
| Rate for Payer: ASR ASR |
$342.80
|
| Rate for Payer: ASR Commercial |
$342.80
|
| Rate for Payer: BCBS Trust/PPO |
$287.99
|
| Rate for Payer: BCN Commercial |
$273.99
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Commercial |
$332.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$353.40
|
| Rate for Payer: Healthscope Whirlpool |
$342.80
|
| Rate for Payer: Mclaren Commercial |
$318.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: Nomi Health Commercial |
$289.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$310.99
|
|
|
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 |
$237.41
|
| 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 |
$237.41
|
| 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
|
$130.01
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
6221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$130.01 |
| Rate for Payer: Aetna Commercial |
$117.01
|
| Rate for Payer: Aetna Commercial |
$239.38
|
| Rate for Payer: Aetna Commercial |
$254.83
|
| Rate for Payer: Aetna Commercial |
$164.05
|
| Rate for Payer: Aetna Commercial |
$184.14
|
| Rate for Payer: Aetna Medicare |
$91.14
|
| Rate for Payer: Aetna Medicare |
$102.30
|
| Rate for Payer: Aetna Medicare |
$65.00
|
| Rate for Payer: Aetna Medicare |
$141.57
|
| Rate for Payer: Aetna Medicare |
$132.99
|
| Rate for Payer: ASR ASR |
$274.65
|
| Rate for Payer: ASR ASR |
$198.46
|
| 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 Commercial |
$274.65
|
| Rate for Payer: ASR Commercial |
$176.81
|
| Rate for Payer: ASR Commercial |
$198.46
|
| Rate for Payer: ASR Commercial |
$258.00
|
| Rate for Payer: ASR Commercial |
$126.11
|
| Rate for Payer: BCBS Complete |
$113.26
|
| 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 Complete |
$52.00
|
| Rate for Payer: BCBS Trust/PPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$106.47
|
| Rate for Payer: BCBS Trust/PPO |
$149.27
|
| Rate for Payer: BCBS Trust/PPO |
$167.55
|
| Rate for Payer: BCBS Trust/PPO |
$231.86
|
| Rate for Payer: BCN Commercial |
$219.52
|
| Rate for Payer: BCN Commercial |
$206.21
|
| Rate for Payer: BCN Commercial |
$141.32
|
| Rate for Payer: BCN Commercial |
$100.80
|
| Rate for Payer: BCN Commercial |
$158.63
|
| 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 |
$163.68
|
| Rate for Payer: Cash Price |
$104.01
|
| Rate for Payer: Cofinity Commercial |
$266.15
|
| Rate for Payer: Cofinity Commercial |
$250.02
|
| Rate for Payer: Cofinity Commercial |
$192.32
|
| Rate for Payer: Cofinity Commercial |
$171.34
|
| Rate for Payer: Cofinity Commercial |
$122.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.78
|
| Rate for Payer: Healthscope Commercial |
$204.60
|
| Rate for Payer: Healthscope Commercial |
$265.98
|
| Rate for Payer: Healthscope Commercial |
$283.14
|
| Rate for Payer: Healthscope Commercial |
$130.01
|
| Rate for Payer: Healthscope Commercial |
$182.28
|
| Rate for Payer: Healthscope Whirlpool |
$258.00
|
| Rate for Payer: Healthscope Whirlpool |
$198.46
|
| Rate for Payer: Healthscope Whirlpool |
$176.81
|
| Rate for Payer: Healthscope Whirlpool |
$126.11
|
| Rate for Payer: Healthscope Whirlpool |
$274.65
|
| Rate for Payer: Mclaren Commercial |
$254.83
|
| Rate for Payer: Mclaren Commercial |
$184.14
|
| Rate for Payer: Mclaren Commercial |
$164.05
|
| Rate for Payer: Mclaren Commercial |
$239.38
|
| Rate for Payer: Mclaren Commercial |
$117.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.94
|
| 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 |
$226.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.67
|
| Rate for Payer: Nomi Health Commercial |
$218.10
|
| 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: Priority Health Cigna Priority Health |
$132.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.09
|
| Rate for Payer: Priority Health Narrow Network |
$198.48
|
| Rate for Payer: Priority Health Narrow Network |
$186.45
|
| Rate for Payer: Priority Health Narrow Network |
$127.78
|
| Rate for Payer: Priority Health Narrow Network |
$91.14
|
| Rate for Payer: Priority Health Narrow Network |
$143.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.16
|
| 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 |
$114.41
|
| 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
|
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
|
|
|
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
|
|
|
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
|
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 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 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 % 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 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$13.48
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
6242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.76 |
| 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: 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 Trust/PPO |
$10.98
|
| Rate for Payer: BCBS Trust/PPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$13.63
|
| Rate for Payer: BCN Commercial |
$12.54
|
| Rate for Payer: BCN Commercial |
$10.45
|
| Rate for Payer: BCN Commercial |
$12.96
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cofinity Commercial |
$15.72
|
| Rate for Payer: Cofinity Commercial |
$15.21
|
| Rate for Payer: Cofinity Commercial |
$12.67
|
| 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 |
$16.72
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$13.48
|
| 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 |
$12.13
|
| Rate for Payer: Mclaren Commercial |
$14.56
|
| Rate for Payer: Mclaren Commercial |
$15.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.75
|
| Rate for Payer: Nomi Health Commercial |
$13.71
|
| Rate for Payer: Nomi Health Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$11.05
|
| 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: 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
|
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 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
|
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
|
$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
|
|
