|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.04
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Aetna Commercial |
$17.14
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Commercial |
$18.18
|
| Rate for Payer: Aetna Commercial |
$23.48
|
| Rate for Payer: Aetna Commercial |
$25.57
|
| Rate for Payer: Aetna Commercial |
$15.88
|
| Rate for Payer: Aetna Commercial |
$23.84
|
| Rate for Payer: ASR ASR |
$23.26
|
| Rate for Payer: ASR ASR |
$19.59
|
| Rate for Payer: ASR ASR |
$27.56
|
| Rate for Payer: ASR ASR |
$25.31
|
| Rate for Payer: ASR ASR |
$18.47
|
| Rate for Payer: ASR ASR |
$17.12
|
| Rate for Payer: ASR ASR |
$25.70
|
| Rate for Payer: ASR Commercial |
$27.56
|
| Rate for Payer: ASR Commercial |
$25.70
|
| Rate for Payer: ASR Commercial |
$19.59
|
| Rate for Payer: ASR Commercial |
$25.31
|
| Rate for Payer: ASR Commercial |
$23.26
|
| Rate for Payer: ASR Commercial |
$18.47
|
| Rate for Payer: ASR Commercial |
$17.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.59
|
| Rate for Payer: BCBS Trust/PPO |
$21.26
|
| Rate for Payer: BCBS Trust/PPO |
$14.38
|
| Rate for Payer: BCBS Trust/PPO |
$15.52
|
| Rate for Payer: BCBS Trust/PPO |
$19.54
|
| Rate for Payer: BCBS Trust/PPO |
$16.46
|
| Rate for Payer: BCBS Trust/PPO |
$23.15
|
| Rate for Payer: BCN Commercial |
$15.66
|
| Rate for Payer: BCN Commercial |
$22.03
|
| Rate for Payer: BCN Commercial |
$20.23
|
| Rate for Payer: BCN Commercial |
$13.68
|
| Rate for Payer: BCN Commercial |
$14.76
|
| Rate for Payer: BCN Commercial |
$20.54
|
| Rate for Payer: BCN Commercial |
$18.59
|
| Rate for Payer: Cash Price |
$21.19
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Cash Price |
$20.87
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$24.52
|
| Rate for Payer: Cofinity Commercial |
$18.99
|
| Rate for Payer: Cofinity Commercial |
$16.59
|
| Rate for Payer: Cofinity Commercial |
$22.54
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$24.90
|
| Rate for Payer: Cofinity Commercial |
$26.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.87
|
| Rate for Payer: Healthscope Commercial |
$26.09
|
| Rate for Payer: Healthscope Commercial |
$28.41
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Healthscope Commercial |
$23.98
|
| Rate for Payer: Healthscope Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: Healthscope Commercial |
$17.65
|
| Rate for Payer: Healthscope Whirlpool |
$25.70
|
| Rate for Payer: Healthscope Whirlpool |
$25.31
|
| Rate for Payer: Healthscope Whirlpool |
$23.26
|
| Rate for Payer: Healthscope Whirlpool |
$18.47
|
| Rate for Payer: Healthscope Whirlpool |
$19.59
|
| Rate for Payer: Healthscope Whirlpool |
$17.12
|
| Rate for Payer: Healthscope Whirlpool |
$27.56
|
| Rate for Payer: Mclaren Commercial |
$23.48
|
| Rate for Payer: Mclaren Commercial |
$25.57
|
| Rate for Payer: Mclaren Commercial |
$15.88
|
| Rate for Payer: Mclaren Commercial |
$23.84
|
| Rate for Payer: Mclaren Commercial |
$18.18
|
| Rate for Payer: Mclaren Commercial |
$17.14
|
| Rate for Payer: Mclaren Commercial |
$21.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.52
|
| Rate for Payer: Nomi Health Commercial |
$14.47
|
| Rate for Payer: Nomi Health Commercial |
$21.72
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: Nomi Health Commercial |
$19.66
|
| Rate for Payer: Nomi Health Commercial |
$16.56
|
| Rate for Payer: Nomi Health Commercial |
$15.61
|
| Rate for Payer: Nomi Health Commercial |
$21.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.78
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$19.04
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Aetna Commercial |
$17.14
|
| Rate for Payer: ASR ASR |
$18.47
|
| Rate for Payer: ASR Commercial |
$18.47
|
| Rate for Payer: BCBS Trust/PPO |
$15.52
|
| Rate for Payer: BCN Commercial |
$14.76
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: Healthscope Whirlpool |
$18.47
|
| Rate for Payer: Mclaren Commercial |
$17.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: Nomi Health Commercial |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.76
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$19.04
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Aetna Commercial |
$17.14
|
| Rate for Payer: Aetna Medicare |
$9.52
|
| Rate for Payer: ASR ASR |
$18.47
|
| Rate for Payer: ASR Commercial |
$18.47
|
| Rate for Payer: BCBS Complete |
$7.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.59
|
| Rate for Payer: BCN Commercial |
$14.76
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: Healthscope Whirlpool |
$18.47
|
| Rate for Payer: Mclaren Commercial |
$17.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: Nomi Health Commercial |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.68
|
| Rate for Payer: Priority Health Narrow Network |
$13.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.76
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
IP
|
$801.98
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
197781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$521.29 |
| Max. Negotiated Rate |
$801.98 |
| Rate for Payer: Aetna Commercial |
$721.78
|
| Rate for Payer: Aetna Commercial |
$699.86
|
| Rate for Payer: ASR ASR |
$754.29
|
| Rate for Payer: ASR ASR |
$777.92
|
| Rate for Payer: ASR Commercial |
$754.29
|
| Rate for Payer: ASR Commercial |
$777.92
|
| Rate for Payer: BCBS Trust/PPO |
$633.68
|
| Rate for Payer: BCBS Trust/PPO |
$653.53
|
| Rate for Payer: BCN Commercial |
$621.78
|
| Rate for Payer: BCN Commercial |
$602.89
|
| Rate for Payer: Cash Price |
$641.58
|
| Rate for Payer: Cash Price |
$622.10
|
| Rate for Payer: Cofinity Commercial |
$730.96
|
| Rate for Payer: Cofinity Commercial |
$753.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.58
|
| Rate for Payer: Healthscope Commercial |
$777.62
|
| Rate for Payer: Healthscope Commercial |
$801.98
|
| Rate for Payer: Healthscope Whirlpool |
$777.92
|
| Rate for Payer: Healthscope Whirlpool |
$754.29
|
| Rate for Payer: Mclaren Commercial |
$699.86
|
| Rate for Payer: Mclaren Commercial |
$721.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.98
|
| Rate for Payer: Nomi Health Commercial |
$657.62
|
| Rate for Payer: Nomi Health Commercial |
$637.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$705.74
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
OP
|
$777.62
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
197781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$311.05 |
| Max. Negotiated Rate |
$777.62 |
| Rate for Payer: Aetna Commercial |
$699.86
|
| Rate for Payer: Aetna Commercial |
$721.78
|
| Rate for Payer: Aetna Medicare |
$388.81
|
| Rate for Payer: Aetna Medicare |
$400.99
|
| Rate for Payer: ASR ASR |
$754.29
|
| Rate for Payer: ASR ASR |
$777.92
|
| Rate for Payer: ASR Commercial |
$777.92
|
| Rate for Payer: ASR Commercial |
$754.29
|
| Rate for Payer: BCBS Complete |
$311.05
|
| Rate for Payer: BCBS Complete |
$320.79
|
| Rate for Payer: BCBS Trust/PPO |
$636.79
|
| Rate for Payer: BCBS Trust/PPO |
$656.74
|
| Rate for Payer: BCN Commercial |
$621.78
|
| Rate for Payer: BCN Commercial |
$602.89
|
| Rate for Payer: Cash Price |
$622.10
|
| Rate for Payer: Cash Price |
$641.58
|
| Rate for Payer: Cofinity Commercial |
$730.96
|
| Rate for Payer: Cofinity Commercial |
$753.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.58
|
| Rate for Payer: Healthscope Commercial |
$777.62
|
| Rate for Payer: Healthscope Commercial |
$801.98
|
| Rate for Payer: Healthscope Whirlpool |
$754.29
|
| Rate for Payer: Healthscope Whirlpool |
$777.92
|
| Rate for Payer: Mclaren Commercial |
$699.86
|
| Rate for Payer: Mclaren Commercial |
$721.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.98
|
| Rate for Payer: Nomi Health Commercial |
$637.65
|
| Rate for Payer: Nomi Health Commercial |
$657.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$681.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$702.69
|
| Rate for Payer: Priority Health Narrow Network |
$562.19
|
| Rate for Payer: Priority Health Narrow Network |
$545.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$705.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.31
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$69.89
|
|
|
Service Code
|
NDC 68084043098
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$69.89 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: ASR ASR |
$67.79
|
| Rate for Payer: ASR Commercial |
$67.79
|
| Rate for Payer: BCBS Trust/PPO |
$56.95
|
| Rate for Payer: BCN Commercial |
$54.19
|
| Rate for Payer: Cash Price |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$65.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$69.89
|
| Rate for Payer: Healthscope Whirlpool |
$67.79
|
| Rate for Payer: Mclaren Commercial |
$62.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.41
|
| Rate for Payer: Nomi Health Commercial |
$57.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.50
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$54.19
|
|
|
Service Code
|
NDC 41100080676
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$54.19 |
| Rate for Payer: Aetna Commercial |
$48.77
|
| Rate for Payer: ASR ASR |
$52.56
|
| Rate for Payer: ASR Commercial |
$52.56
|
| Rate for Payer: BCBS Trust/PPO |
$44.16
|
| Rate for Payer: BCN Commercial |
$42.01
|
| Rate for Payer: Cash Price |
$43.35
|
| Rate for Payer: Cofinity Commercial |
$50.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.35
|
| Rate for Payer: Healthscope Commercial |
$54.19
|
| Rate for Payer: Healthscope Whirlpool |
$52.56
|
| Rate for Payer: Mclaren Commercial |
$48.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.06
|
| Rate for Payer: Nomi Health Commercial |
$44.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.69
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
NDC 00904693186
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.03
|
| Rate for Payer: Aetna Medicare |
$3.35
|
| Rate for Payer: ASR ASR |
$6.50
|
| Rate for Payer: ASR Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$2.68
|
| Rate for Payer: BCBS Trust/PPO |
$5.49
|
| Rate for Payer: BCN Commercial |
$5.19
|
| Rate for Payer: Cash Price |
$5.36
|
| Rate for Payer: Cofinity Commercial |
$6.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.36
|
| Rate for Payer: Healthscope Commercial |
$6.70
|
| Rate for Payer: Healthscope Whirlpool |
$6.50
|
| Rate for Payer: Mclaren Commercial |
$6.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.70
|
| Rate for Payer: Nomi Health Commercial |
$5.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.87
|
| Rate for Payer: Priority Health Narrow Network |
$4.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.90
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$691.20
|
|
|
Service Code
|
NDC 17856031201
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.48 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Aetna Commercial |
$622.08
|
| Rate for Payer: Aetna Medicare |
$345.60
|
| Rate for Payer: ASR ASR |
$670.46
|
| Rate for Payer: ASR Commercial |
$670.46
|
| Rate for Payer: BCBS Complete |
$276.48
|
| Rate for Payer: BCBS Trust/PPO |
$566.02
|
| Rate for Payer: BCN Commercial |
$535.89
|
| Rate for Payer: Cash Price |
$552.96
|
| Rate for Payer: Cofinity Commercial |
$649.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.96
|
| Rate for Payer: Healthscope Commercial |
$691.20
|
| Rate for Payer: Healthscope Whirlpool |
$670.46
|
| Rate for Payer: Mclaren Commercial |
$622.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.52
|
| Rate for Payer: Nomi Health Commercial |
$566.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$605.63
|
| Rate for Payer: Priority Health Narrow Network |
$484.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.26
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$520.80
|
|
|
Service Code
|
NDC 00904693181
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$338.52 |
| Max. Negotiated Rate |
$520.80 |
| Rate for Payer: Aetna Commercial |
$468.72
|
| Rate for Payer: ASR ASR |
$505.18
|
| Rate for Payer: ASR Commercial |
$505.18
|
| Rate for Payer: BCBS Trust/PPO |
$424.40
|
| Rate for Payer: BCN Commercial |
$403.78
|
| Rate for Payer: Cash Price |
$416.64
|
| Rate for Payer: Cofinity Commercial |
$489.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.64
|
| Rate for Payer: Healthscope Commercial |
$520.80
|
| Rate for Payer: Healthscope Whirlpool |
$505.18
|
| Rate for Payer: Mclaren Commercial |
$468.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.68
|
| Rate for Payer: Nomi Health Commercial |
$427.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.30
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$6.84
|
|
|
Service Code
|
NDC 51079030601
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: ASR ASR |
$6.63
|
| Rate for Payer: ASR Commercial |
$6.63
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.30
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$6.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.47
|
| Rate for Payer: Healthscope Commercial |
$6.84
|
| Rate for Payer: Healthscope Whirlpool |
$6.63
|
| Rate for Payer: Mclaren Commercial |
$6.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.81
|
| Rate for Payer: Nomi Health Commercial |
$5.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.02
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$6.84
|
|
|
Service Code
|
NDC 51079030601
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Aetna Medicare |
$3.42
|
| Rate for Payer: ASR ASR |
$6.63
|
| Rate for Payer: ASR Commercial |
$6.63
|
| Rate for Payer: BCBS Complete |
$2.74
|
| Rate for Payer: BCBS Trust/PPO |
$5.60
|
| Rate for Payer: BCN Commercial |
$5.30
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$6.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.47
|
| Rate for Payer: Healthscope Commercial |
$6.84
|
| Rate for Payer: Healthscope Whirlpool |
$6.63
|
| Rate for Payer: Mclaren Commercial |
$6.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.81
|
| Rate for Payer: Nomi Health Commercial |
$5.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.99
|
| Rate for Payer: Priority Health Narrow Network |
$4.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.02
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$69.89
|
|
|
Service Code
|
NDC 68084043099
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.96 |
| Max. Negotiated Rate |
$69.89 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: Aetna Medicare |
$34.95
|
| Rate for Payer: ASR ASR |
$67.79
|
| Rate for Payer: ASR Commercial |
$67.79
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS Trust/PPO |
$57.23
|
| Rate for Payer: BCN Commercial |
$54.19
|
| Rate for Payer: Cash Price |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$65.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$69.89
|
| Rate for Payer: Healthscope Whirlpool |
$67.79
|
| Rate for Payer: Mclaren Commercial |
$62.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.41
|
| Rate for Payer: Nomi Health Commercial |
$57.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.24
|
| Rate for Payer: Priority Health Narrow Network |
$48.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.50
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$103.22
|
|
|
Service Code
|
NDC 45802086866
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.09 |
| Max. Negotiated Rate |
$103.22 |
| Rate for Payer: Aetna Commercial |
$92.90
|
| Rate for Payer: ASR ASR |
$100.12
|
| Rate for Payer: ASR Commercial |
$100.12
|
| Rate for Payer: BCBS Trust/PPO |
$84.11
|
| Rate for Payer: BCN Commercial |
$80.03
|
| Rate for Payer: Cash Price |
$82.58
|
| Rate for Payer: Cofinity Commercial |
$97.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.58
|
| Rate for Payer: Healthscope Commercial |
$103.22
|
| Rate for Payer: Healthscope Whirlpool |
$100.12
|
| Rate for Payer: Mclaren Commercial |
$92.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.74
|
| Rate for Payer: Nomi Health Commercial |
$84.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.83
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 00904693186
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.03
|
| Rate for Payer: ASR ASR |
$6.50
|
| Rate for Payer: ASR Commercial |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$5.46
|
| Rate for Payer: BCN Commercial |
$5.19
|
| Rate for Payer: Cash Price |
$5.36
|
| Rate for Payer: Cofinity Commercial |
$6.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.36
|
| Rate for Payer: Healthscope Commercial |
$6.70
|
| Rate for Payer: Healthscope Whirlpool |
$6.50
|
| Rate for Payer: Mclaren Commercial |
$6.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.70
|
| Rate for Payer: Nomi Health Commercial |
$5.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.90
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$54.19
|
|
|
Service Code
|
NDC 41100080676
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$54.19 |
| Rate for Payer: Aetna Commercial |
$48.77
|
| Rate for Payer: Aetna Medicare |
$27.09
|
| Rate for Payer: ASR ASR |
$52.56
|
| Rate for Payer: ASR Commercial |
$52.56
|
| Rate for Payer: BCBS Complete |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$44.38
|
| Rate for Payer: BCN Commercial |
$42.01
|
| Rate for Payer: Cash Price |
$43.35
|
| Rate for Payer: Cofinity Commercial |
$50.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.35
|
| Rate for Payer: Healthscope Commercial |
$54.19
|
| Rate for Payer: Healthscope Whirlpool |
$52.56
|
| Rate for Payer: Mclaren Commercial |
$48.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.06
|
| Rate for Payer: Nomi Health Commercial |
$44.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.48
|
| Rate for Payer: Priority Health Narrow Network |
$37.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.69
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$7.37
|
|
|
Service Code
|
NDC 45802086800
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Aetna Commercial |
$6.63
|
| Rate for Payer: ASR ASR |
$7.15
|
| Rate for Payer: ASR Commercial |
$7.15
|
| Rate for Payer: BCBS Trust/PPO |
$6.01
|
| Rate for Payer: BCN Commercial |
$5.71
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cofinity Commercial |
$6.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.90
|
| Rate for Payer: Healthscope Commercial |
$7.37
|
| Rate for Payer: Healthscope Whirlpool |
$7.15
|
| Rate for Payer: Mclaren Commercial |
$6.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.26
|
| Rate for Payer: Nomi Health Commercial |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.49
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$205.20
|
|
|
Service Code
|
NDC 51079030630
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.38 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$184.68
|
| Rate for Payer: ASR ASR |
$199.04
|
| Rate for Payer: ASR Commercial |
$199.04
|
| Rate for Payer: BCBS Trust/PPO |
$167.22
|
| Rate for Payer: BCN Commercial |
$159.09
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$192.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Healthscope Whirlpool |
$199.04
|
| Rate for Payer: Mclaren Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.58
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$7.37
|
|
|
Service Code
|
NDC 45802086800
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Aetna Commercial |
$6.63
|
| Rate for Payer: Aetna Medicare |
$3.69
|
| Rate for Payer: ASR ASR |
$7.15
|
| Rate for Payer: ASR Commercial |
$7.15
|
| Rate for Payer: BCBS Complete |
$2.95
|
| Rate for Payer: BCBS Trust/PPO |
$6.04
|
| Rate for Payer: BCN Commercial |
$5.71
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cofinity Commercial |
$6.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.90
|
| Rate for Payer: Healthscope Commercial |
$7.37
|
| Rate for Payer: Healthscope Whirlpool |
$7.15
|
| Rate for Payer: Mclaren Commercial |
$6.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.26
|
| Rate for Payer: Nomi Health Commercial |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.46
|
| Rate for Payer: Priority Health Narrow Network |
$5.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.49
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$520.80
|
|
|
Service Code
|
NDC 00904693181
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.32 |
| Max. Negotiated Rate |
$520.80 |
| Rate for Payer: Aetna Commercial |
$468.72
|
| Rate for Payer: Aetna Medicare |
$260.40
|
| Rate for Payer: ASR ASR |
$505.18
|
| Rate for Payer: ASR Commercial |
$505.18
|
| Rate for Payer: BCBS Complete |
$208.32
|
| Rate for Payer: BCBS Trust/PPO |
$426.48
|
| Rate for Payer: BCN Commercial |
$403.78
|
| Rate for Payer: Cash Price |
$416.64
|
| Rate for Payer: Cofinity Commercial |
$489.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.64
|
| Rate for Payer: Healthscope Commercial |
$520.80
|
| Rate for Payer: Healthscope Whirlpool |
$505.18
|
| Rate for Payer: Mclaren Commercial |
$468.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.68
|
| Rate for Payer: Nomi Health Commercial |
$427.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.32
|
| Rate for Payer: Priority Health Narrow Network |
$365.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.30
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$205.20
|
|
|
Service Code
|
NDC 51079030630
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.08 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$184.68
|
| Rate for Payer: Aetna Medicare |
$102.60
|
| Rate for Payer: ASR ASR |
$199.04
|
| Rate for Payer: ASR Commercial |
$199.04
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: BCBS Trust/PPO |
$168.04
|
| Rate for Payer: BCN Commercial |
$159.09
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$192.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Healthscope Whirlpool |
$199.04
|
| Rate for Payer: Mclaren Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.80
|
| Rate for Payer: Priority Health Narrow Network |
$143.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.58
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$103.22
|
|
|
Service Code
|
NDC 45802086866
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.29 |
| Max. Negotiated Rate |
$103.22 |
| Rate for Payer: Aetna Commercial |
$92.90
|
| Rate for Payer: Aetna Medicare |
$51.61
|
| Rate for Payer: ASR ASR |
$100.12
|
| Rate for Payer: ASR Commercial |
$100.12
|
| Rate for Payer: BCBS Complete |
$41.29
|
| Rate for Payer: BCBS Trust/PPO |
$84.53
|
| Rate for Payer: BCN Commercial |
$80.03
|
| Rate for Payer: Cash Price |
$82.58
|
| Rate for Payer: Cofinity Commercial |
$97.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.58
|
| Rate for Payer: Healthscope Commercial |
$103.22
|
| Rate for Payer: Healthscope Whirlpool |
$100.12
|
| Rate for Payer: Mclaren Commercial |
$92.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.74
|
| Rate for Payer: Nomi Health Commercial |
$84.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.44
|
| Rate for Payer: Priority Health Narrow Network |
$72.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.83
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$69.89
|
|
|
Service Code
|
NDC 68084043099
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$69.89 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: ASR ASR |
$67.79
|
| Rate for Payer: ASR Commercial |
$67.79
|
| Rate for Payer: BCBS Trust/PPO |
$56.95
|
| Rate for Payer: BCN Commercial |
$54.19
|
| Rate for Payer: Cash Price |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$65.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$69.89
|
| Rate for Payer: Healthscope Whirlpool |
$67.79
|
| Rate for Payer: Mclaren Commercial |
$62.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.41
|
| Rate for Payer: Nomi Health Commercial |
$57.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.50
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$691.20
|
|
|
Service Code
|
NDC 17856031201
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$449.28 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Aetna Commercial |
$622.08
|
| Rate for Payer: ASR ASR |
$670.46
|
| Rate for Payer: ASR Commercial |
$670.46
|
| Rate for Payer: BCBS Trust/PPO |
$563.26
|
| Rate for Payer: BCN Commercial |
$535.89
|
| Rate for Payer: Cash Price |
$552.96
|
| Rate for Payer: Cofinity Commercial |
$649.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.96
|
| Rate for Payer: Healthscope Commercial |
$691.20
|
| Rate for Payer: Healthscope Whirlpool |
$670.46
|
| Rate for Payer: Mclaren Commercial |
$622.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.52
|
| Rate for Payer: Nomi Health Commercial |
$566.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.26
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$69.89
|
|
|
Service Code
|
NDC 68084043098
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.96 |
| Max. Negotiated Rate |
$69.89 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: Aetna Medicare |
$34.95
|
| Rate for Payer: ASR ASR |
$67.79
|
| Rate for Payer: ASR Commercial |
$67.79
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS Trust/PPO |
$57.23
|
| Rate for Payer: BCN Commercial |
$54.19
|
| Rate for Payer: Cash Price |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$65.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$69.89
|
| Rate for Payer: Healthscope Whirlpool |
$67.79
|
| Rate for Payer: Mclaren Commercial |
$62.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.41
|
| Rate for Payer: Nomi Health Commercial |
$57.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.24
|
| Rate for Payer: Priority Health Narrow Network |
$48.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.50
|
|
