|
PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 93272
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$934.03 |
| Rate for Payer: Aetna Commercial |
$31.62
|
| Rate for Payer: Aetna Medicare |
$23.60
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS MAPPO |
$23.60
|
| Rate for Payer: BCBS Trust/PPO |
$934.03
|
| Rate for Payer: BCN Commercial |
$34.70
|
| Rate for Payer: BCN Medicare Advantage |
$23.60
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$31.62
|
| Rate for Payer: Cofinity Commercial |
$33.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.60
|
| Rate for Payer: Healthscope Commercial |
$28.32
|
| Rate for Payer: Healthscope Whirlpool |
$28.32
|
| Rate for Payer: Meridian Medicaid |
$15.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.78
|
| Rate for Payer: PACE SWMI |
$23.60
|
| Rate for Payer: PHP Medicare Advantage |
$23.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.57
|
| Rate for Payer: Priority Health Medicare |
$23.60
|
| Rate for Payer: Priority Health Narrow Network |
$33.57
|
| Rate for Payer: UHC Medicare Advantage |
$24.31
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 41015
|
| Min. Negotiated Rate |
$191.27 |
| Max. Negotiated Rate |
$1,058.71 |
| Rate for Payer: Aetna Commercial |
$387.43
|
| Rate for Payer: Aetna Medicare |
$289.13
|
| Rate for Payer: BCBS Complete |
$200.83
|
| Rate for Payer: BCBS MAPPO |
$289.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.71
|
| Rate for Payer: BCN Commercial |
$583.48
|
| Rate for Payer: BCN Medicare Advantage |
$289.13
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cofinity Commercial |
$416.35
|
| Rate for Payer: Cofinity Commercial |
$387.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.13
|
| Rate for Payer: Healthscope Commercial |
$346.96
|
| Rate for Payer: Healthscope Whirlpool |
$346.96
|
| Rate for Payer: Meridian Medicaid |
$200.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$303.59
|
| Rate for Payer: PACE SWMI |
$289.13
|
| Rate for Payer: PHP Medicare Advantage |
$289.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$523.30
|
| Rate for Payer: Priority Health Medicare |
$289.13
|
| Rate for Payer: Priority Health Narrow Network |
$523.30
|
| Rate for Payer: UHC Medicare Advantage |
$297.80
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 41017
|
| Min. Negotiated Rate |
$219.39 |
| Max. Negotiated Rate |
$686.10 |
| Rate for Payer: Aetna Commercial |
$445.48
|
| Rate for Payer: Aetna Medicare |
$332.45
|
| Rate for Payer: BCBS Complete |
$230.36
|
| Rate for Payer: BCBS MAPPO |
$332.45
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: BCN Commercial |
$686.10
|
| Rate for Payer: BCN Medicare Advantage |
$332.45
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cofinity Commercial |
$478.73
|
| Rate for Payer: Cofinity Commercial |
$445.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$332.45
|
| Rate for Payer: Healthscope Commercial |
$398.94
|
| Rate for Payer: Healthscope Whirlpool |
$398.94
|
| Rate for Payer: Meridian Medicaid |
$230.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$349.07
|
| Rate for Payer: PACE SWMI |
$332.45
|
| Rate for Payer: PHP Medicare Advantage |
$332.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$604.44
|
| Rate for Payer: Priority Health Medicare |
$332.45
|
| Rate for Payer: Priority Health Narrow Network |
$604.44
|
| Rate for Payer: UHC Medicare Advantage |
$342.42
|
|
|
PR ZINC PASTE BAND W >=3<5/YD
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS A6456
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna Commercial |
$1.18
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: BCN Commercial |
$1.39
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
|
|
PR ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 90736
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$221.01 |
| Rate for Payer: Aetna Commercial |
$216.92
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: BCBS Trust/PPO |
$221.01
|
| Rate for Payer: BCN Commercial |
$216.92
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.40
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$28.78
|
|
|
Service Code
|
NDC 81067013
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$28.78 |
| Rate for Payer: Aetna Commercial |
$25.90
|
| Rate for Payer: ASR ASR |
$27.92
|
| Rate for Payer: BCBS Trust/PPO |
$22.31
|
| Rate for Payer: BCN Commercial |
$22.31
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$27.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Healthscope Commercial |
$28.78
|
| Rate for Payer: Healthscope Whirlpool |
$27.92
|
| Rate for Payer: Mclaren Commercial |
$25.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.33
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$31.82
|
|
|
Service Code
|
NDC 0904-6754-15
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$31.82 |
| Rate for Payer: Aetna Commercial |
$28.64
|
| Rate for Payer: ASR ASR |
$30.87
|
| Rate for Payer: BCBS Trust/PPO |
$24.67
|
| Rate for Payer: BCN Commercial |
$24.67
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$29.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$31.82
|
| Rate for Payer: Healthscope Whirlpool |
$30.87
|
| Rate for Payer: Mclaren Commercial |
$28.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.00
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$32.30
|
|
|
Service Code
|
NDC 96295-13673
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$29.07
|
| Rate for Payer: ASR ASR |
$31.33
|
| Rate for Payer: BCBS Trust/PPO |
$25.04
|
| Rate for Payer: BCN Commercial |
$25.04
|
| Rate for Payer: Cash Price |
$25.84
|
| Rate for Payer: Cofinity Commercial |
$30.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.84
|
| Rate for Payer: Healthscope Commercial |
$32.30
|
| Rate for Payer: Healthscope Whirlpool |
$31.33
|
| Rate for Payer: Mclaren Commercial |
$29.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.42
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$32.30
|
|
|
Service Code
|
NDC 70000-0475-1
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$29.07
|
| Rate for Payer: ASR ASR |
$31.33
|
| Rate for Payer: BCBS Trust/PPO |
$25.04
|
| Rate for Payer: BCN Commercial |
$25.04
|
| Rate for Payer: Cash Price |
$25.84
|
| Rate for Payer: Cofinity Commercial |
$30.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.84
|
| Rate for Payer: Healthscope Commercial |
$32.30
|
| Rate for Payer: Healthscope Whirlpool |
$31.33
|
| Rate for Payer: Mclaren Commercial |
$29.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.42
|
|
|
PSYCHOSES
|
Facility
|
IP
|
$17,544.58
|
|
|
Service Code
|
MS-DRG 885
|
| Min. Negotiated Rate |
$12,586.96 |
| Max. Negotiated Rate |
$17,544.58 |
| Rate for Payer: Aetna Medicare |
$13,249.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,561.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,561.79
|
| Rate for Payer: BCBS MAPPO |
$13,249.43
|
| Rate for Payer: BCN Medicare Advantage |
$13,249.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,249.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,249.43
|
| Rate for Payer: Mclaren Medicare |
$13,249.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,911.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,236.84
|
| Rate for Payer: PACE Medicare |
$12,586.96
|
| Rate for Payer: PACE SWMI |
$13,249.43
|
| Rate for Payer: PHP Commercial |
$14,574.37
|
| Rate for Payer: PHP Medicare Advantage |
$13,249.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,544.58
|
| Rate for Payer: Priority Health Medicare |
$13,249.43
|
| Rate for Payer: Priority Health Narrow Network |
$14,035.66
|
| Rate for Payer: Railroad Medicare Medicare |
$13,249.43
|
| Rate for Payer: UHC Medicare Advantage |
$13,646.91
|
| Rate for Payer: VA VA |
$13,249.43
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
IP
|
$8.85
|
|
|
Service Code
|
NDC 37000-024-10
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: ASR ASR |
$8.58
|
| Rate for Payer: BCBS Trust/PPO |
$6.86
|
| Rate for Payer: BCN Commercial |
$6.86
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$8.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Healthscope Commercial |
$8.85
|
| Rate for Payer: Healthscope Whirlpool |
$8.58
|
| Rate for Payer: Mclaren Commercial |
$7.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.79
|
|
|
PULMONARY EDEMA AND RESPIRATORY FAILURE
|
Facility
|
IP
|
$15,818.88
|
|
|
Service Code
|
MS-DRG 189
|
| Min. Negotiated Rate |
$11,505.96 |
| Max. Negotiated Rate |
$15,818.88 |
| Rate for Payer: Aetna Medicare |
$12,111.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,139.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,139.42
|
| Rate for Payer: BCBS MAPPO |
$12,111.54
|
| Rate for Payer: BCN Medicare Advantage |
$12,111.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,111.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,111.54
|
| Rate for Payer: Mclaren Medicare |
$12,111.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,717.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,928.27
|
| Rate for Payer: PACE Medicare |
$11,505.96
|
| Rate for Payer: PACE SWMI |
$12,111.54
|
| Rate for Payer: PHP Commercial |
$13,322.69
|
| Rate for Payer: PHP Medicare Advantage |
$12,111.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,818.88
|
| Rate for Payer: Priority Health Medicare |
$12,111.54
|
| Rate for Payer: Priority Health Narrow Network |
$12,655.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12,111.54
|
| Rate for Payer: UHC Medicare Advantage |
$12,474.89
|
| Rate for Payer: VA VA |
$12,111.54
|
|
|
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE
|
Facility
|
IP
|
$18,014.52
|
|
|
Service Code
|
MS-DRG 175
|
| Min. Negotiated Rate |
$12,881.33 |
| Max. Negotiated Rate |
$18,014.52 |
| Rate for Payer: Aetna Medicare |
$13,559.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,949.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,949.11
|
| Rate for Payer: BCBS MAPPO |
$13,559.29
|
| Rate for Payer: BCN Medicare Advantage |
$13,559.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,559.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,559.29
|
| Rate for Payer: Mclaren Medicare |
$13,559.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,237.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,593.18
|
| Rate for Payer: PACE Medicare |
$12,881.33
|
| Rate for Payer: PACE SWMI |
$13,559.29
|
| Rate for Payer: PHP Commercial |
$14,915.22
|
| Rate for Payer: PHP Medicare Advantage |
$13,559.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,014.52
|
| Rate for Payer: Priority Health Medicare |
$13,559.29
|
| Rate for Payer: Priority Health Narrow Network |
$14,411.62
|
| Rate for Payer: Railroad Medicare Medicare |
$13,559.29
|
| Rate for Payer: UHC Medicare Advantage |
$13,966.07
|
| Rate for Payer: VA VA |
$13,559.29
|
|
|
PULMONARY EMBOLISM WITHOUT MCC
|
Facility
|
IP
|
$10,732.66
|
|
|
Service Code
|
MS-DRG 176
|
| Min. Negotiated Rate |
$8,156.82 |
| Max. Negotiated Rate |
$10,732.66 |
| Rate for Payer: Aetna Medicare |
$8,586.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,732.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,732.66
|
| Rate for Payer: BCBS MAPPO |
$8,586.13
|
| Rate for Payer: BCN Medicare Advantage |
$8,586.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,586.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,586.13
|
| Rate for Payer: Mclaren Medicare |
$8,586.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,015.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,874.05
|
| Rate for Payer: PACE Medicare |
$8,156.82
|
| Rate for Payer: PACE SWMI |
$8,586.13
|
| Rate for Payer: PHP Commercial |
$9,444.74
|
| Rate for Payer: PHP Medicare Advantage |
$8,586.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,472.30
|
| Rate for Payer: Priority Health Medicare |
$8,586.13
|
| Rate for Payer: Priority Health Narrow Network |
$8,377.84
|
| Rate for Payer: Railroad Medicare Medicare |
$8,586.13
|
| Rate for Payer: UHC Medicare Advantage |
$8,843.71
|
| Rate for Payer: VA VA |
$8,586.13
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$78.84
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
6744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.19 |
| Max. Negotiated Rate |
$78.84 |
| Rate for Payer: Aetna Commercial |
$70.96
|
| Rate for Payer: ASR ASR |
$76.47
|
| Rate for Payer: BCBS Trust/PPO |
$61.12
|
| Rate for Payer: BCN Commercial |
$61.12
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cofinity Commercial |
$74.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.07
|
| Rate for Payer: Healthscope Commercial |
$78.84
|
| Rate for Payer: Healthscope Whirlpool |
$76.47
|
| Rate for Payer: Mclaren Commercial |
$70.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.38
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$76.30
|
|
|
Service Code
|
NDC 5026885815
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$76.30 |
| Rate for Payer: Aetna Commercial |
$68.67
|
| Rate for Payer: ASR ASR |
$74.01
|
| Rate for Payer: BCBS Trust/PPO |
$59.16
|
| Rate for Payer: BCN Commercial |
$59.16
|
| Rate for Payer: Cash Price |
$61.04
|
| Rate for Payer: Cofinity Commercial |
$71.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.04
|
| Rate for Payer: Healthscope Commercial |
$76.30
|
| Rate for Payer: Healthscope Whirlpool |
$74.01
|
| Rate for Payer: Mclaren Commercial |
$68.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.14
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$1.24
|
|
|
Service Code
|
NDC 7733394025
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Aetna Commercial |
$1.12
|
| Rate for Payer: ASR ASR |
$1.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.96
|
| Rate for Payer: BCN Commercial |
$0.96
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cofinity Commercial |
$1.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.99
|
| Rate for Payer: Healthscope Commercial |
$1.24
|
| Rate for Payer: Healthscope Whirlpool |
$1.20
|
| Rate for Payer: Mclaren Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.09
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$124.30
|
|
|
Service Code
|
NDC 7733394010
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.01 |
| Max. Negotiated Rate |
$124.30 |
| Rate for Payer: Aetna Commercial |
$111.87
|
| Rate for Payer: ASR ASR |
$120.57
|
| Rate for Payer: BCBS Trust/PPO |
$96.37
|
| Rate for Payer: BCN Commercial |
$96.37
|
| Rate for Payer: Cash Price |
$99.44
|
| Rate for Payer: Cofinity Commercial |
$116.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.44
|
| Rate for Payer: Healthscope Commercial |
$124.30
|
| Rate for Payer: Healthscope Whirlpool |
$120.57
|
| Rate for Payer: Mclaren Commercial |
$111.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.38
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$1.53
|
|
|
Service Code
|
NDC 5026885811
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna Commercial |
$1.38
|
| Rate for Payer: ASR ASR |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.22
|
| Rate for Payer: Healthscope Commercial |
$1.53
|
| Rate for Payer: Healthscope Whirlpool |
$1.48
|
| Rate for Payer: Mclaren Commercial |
$1.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.35
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$314.90
|
|
|
Service Code
|
NDC 0904-6640-61
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.43 |
| Max. Negotiated Rate |
$314.90 |
| Rate for Payer: Aetna Commercial |
$283.41
|
| Rate for Payer: ASR ASR |
$305.45
|
| Rate for Payer: BCBS Trust/PPO |
$244.14
|
| Rate for Payer: BCN Commercial |
$244.14
|
| Rate for Payer: Cash Price |
$251.92
|
| Rate for Payer: Cofinity Commercial |
$296.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.92
|
| Rate for Payer: Healthscope Commercial |
$314.90
|
| Rate for Payer: Healthscope Whirlpool |
$305.45
|
| Rate for Payer: Mclaren Commercial |
$283.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.11
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$101.05
|
|
|
Service Code
|
NDC 67877-250-01
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.74 |
| Max. Negotiated Rate |
$101.05 |
| Rate for Payer: Aetna Commercial |
$90.94
|
| Rate for Payer: ASR ASR |
$98.02
|
| Rate for Payer: BCBS Trust/PPO |
$78.34
|
| Rate for Payer: BCN Commercial |
$78.34
|
| Rate for Payer: Cash Price |
$80.84
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.84
|
| Rate for Payer: Healthscope Commercial |
$101.05
|
| Rate for Payer: Healthscope Whirlpool |
$98.02
|
| Rate for Payer: Mclaren Commercial |
$90.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.92
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$401.85
|
|
|
Service Code
|
NDC 67877-242-38
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.30 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna Commercial |
$361.66
|
| Rate for Payer: ASR ASR |
$389.79
|
| Rate for Payer: BCBS Trust/PPO |
$311.55
|
| Rate for Payer: BCN Commercial |
$311.55
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Commercial |
$377.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Healthscope Whirlpool |
$389.79
|
| Rate for Payer: Mclaren Commercial |
$361.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$341.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$353.63
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$244.40
|
|
|
Service Code
|
NDC 0904-6638-61
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.08 |
| Max. Negotiated Rate |
$244.40 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: ASR ASR |
$237.07
|
| Rate for Payer: BCBS Trust/PPO |
$189.48
|
| Rate for Payer: BCN Commercial |
$189.48
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$229.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$244.40
|
| Rate for Payer: Healthscope Whirlpool |
$237.07
|
| Rate for Payer: Mclaren Commercial |
$219.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.07
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$8,185.27
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,729.69 |
| Max. Negotiated Rate |
$8,185.27 |
| Rate for Payer: Aetna Commercial |
$7,366.74
|
| Rate for Payer: Aetna Commercial |
$1,813.36
|
| Rate for Payer: ASR ASR |
$1,954.40
|
| Rate for Payer: ASR ASR |
$7,939.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,562.11
|
| Rate for Payer: BCBS Trust/PPO |
$6,346.04
|
| Rate for Payer: BCN Commercial |
$6,346.04
|
| Rate for Payer: BCN Commercial |
$1,562.11
|
| Rate for Payer: Cash Price |
$1,611.88
|
| Rate for Payer: Cash Price |
$6,548.21
|
| Rate for Payer: Cofinity Commercial |
$1,893.96
|
| Rate for Payer: Cofinity Commercial |
$7,694.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,548.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,611.88
|
| Rate for Payer: Healthscope Commercial |
$8,185.27
|
| Rate for Payer: Healthscope Commercial |
$2,014.85
|
| Rate for Payer: Healthscope Whirlpool |
$7,939.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,954.40
|
| Rate for Payer: Mclaren Commercial |
$1,813.36
|
| Rate for Payer: Mclaren Commercial |
$7,366.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,957.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,712.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,410.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,729.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,773.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,203.04
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
IP
|
$1,212.93
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$849.05 |
| Max. Negotiated Rate |
$1,212.93 |
| Rate for Payer: Aetna Commercial |
$1,091.64
|
| Rate for Payer: ASR ASR |
$1,176.54
|
| Rate for Payer: BCBS Trust/PPO |
$940.38
|
| Rate for Payer: BCN Commercial |
$940.38
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cofinity Commercial |
$1,140.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.34
|
| Rate for Payer: Healthscope Commercial |
$1,212.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,176.54
|
| Rate for Payer: Mclaren Commercial |
$1,091.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,030.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,067.38
|
|
