|
PR XTRNL ECG REC<48 HRS RECORDING
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 93225
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$2,547.99 |
| Rate for Payer: Aetna Commercial |
$24.92
|
| Rate for Payer: Aetna Medicare |
$60.00
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,547.99
|
| Rate for Payer: BCN Commercial |
$26.88
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.90
|
| Rate for Payer: Priority Health Narrow Network |
$25.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.19
|
| Rate for Payer: UHC Exchange |
$38.19
|
|
|
PR XTRNL ECG REC<48 HRS RECORDING SCAN A/R R&I
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 93224
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$1,872.30 |
| Rate for Payer: Aetna Commercial |
$100.86
|
| Rate for Payer: Aetna Medicare |
$117.50
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,872.30
|
| Rate for Payer: BCN Commercial |
$106.04
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.70
|
| Rate for Payer: Priority Health Narrow Network |
$101.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.55
|
| Rate for Payer: UHC Exchange |
$130.55
|
|
|
PR XTRNL ECG REC<48 HRS RVW&INTERPJ PHYS/QHP
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 93227
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$2,081.50 |
| Rate for Payer: Aetna Commercial |
$24.84
|
| Rate for Payer: Aetna Medicare |
$100.00
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,081.50
|
| Rate for Payer: BCN Commercial |
$26.39
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.43
|
| Rate for Payer: Priority Health Narrow Network |
$25.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.11
|
| Rate for Payer: UHC Exchange |
$35.11
|
| Rate for Payer: UHCCP Medicaid |
$11.50
|
|
|
PR XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 93228
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$454.34 |
| Rate for Payer: Aetna Commercial |
$34.49
|
| Rate for Payer: Aetna Medicare |
$29.00
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS Trust/PPO |
$454.34
|
| Rate for Payer: BCN Commercial |
$36.65
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.84
|
| Rate for Payer: Priority Health Narrow Network |
$34.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.95
|
| Rate for Payer: UHC Exchange |
$32.95
|
| Rate for Payer: UHCCP Medicaid |
$15.98
|
|
|
PR XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS
|
Professional
|
Both
|
$654.00
|
|
|
Service Code
|
HCPCS 93271
|
| Min. Negotiated Rate |
$201.98 |
| Max. Negotiated Rate |
$867.47 |
| Rate for Payer: Aetna Commercial |
$206.02
|
| Rate for Payer: Aetna Medicare |
$327.00
|
| Rate for Payer: BCBS Complete |
$261.60
|
| Rate for Payer: BCBS Trust/PPO |
$867.47
|
| Rate for Payer: BCN Commercial |
$213.55
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.98
|
| Rate for Payer: Priority Health Narrow Network |
$201.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.03
|
| Rate for Payer: UHC Exchange |
$247.03
|
|
|
PR XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 93270
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$1,098.86 |
| Rate for Payer: Aetna Commercial |
$11.19
|
| Rate for Payer: Aetna Medicare |
$61.50
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.86
|
| Rate for Payer: BCN Commercial |
$12.22
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.77
|
| Rate for Payer: Priority Health Narrow Network |
$11.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.45
|
| Rate for Payer: UHC Exchange |
$20.45
|
|
|
PR XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS
|
Professional
|
Both
|
$871.00
|
|
|
Service Code
|
HCPCS 93268
|
| Min. Negotiated Rate |
$247.19 |
| Max. Negotiated Rate |
$869.58 |
| Rate for Payer: Aetna Commercial |
$250.35
|
| Rate for Payer: Aetna Medicare |
$435.50
|
| Rate for Payer: BCBS Complete |
$348.40
|
| Rate for Payer: BCBS Trust/PPO |
$869.58
|
| Rate for Payer: BCN Commercial |
$260.46
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.19
|
| Rate for Payer: Priority Health Narrow Network |
$247.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.26
|
| Rate for Payer: UHC Exchange |
$301.26
|
|
|
PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS 93272
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$934.03 |
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: Aetna Medicare |
$87.00
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS Trust/PPO |
$934.03
|
| Rate for Payer: BCN Commercial |
$34.70
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$15.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.42
|
| Rate for Payer: Priority Health Narrow Network |
$33.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.78
|
| Rate for Payer: UHC Exchange |
$33.78
|
| Rate for Payer: UHCCP Medicaid |
$15.12
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 41015
|
| Min. Negotiated Rate |
$194.90 |
| Max. Negotiated Rate |
$1,058.71 |
| Rate for Payer: Aetna Commercial |
$398.41
|
| Rate for Payer: Aetna Medicare |
$304.00
|
| Rate for Payer: BCBS Complete |
$204.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.71
|
| Rate for Payer: BCN Commercial |
$583.48
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Meridian Medicaid |
$204.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$535.74
|
| Rate for Payer: Priority Health Narrow Network |
$535.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.24
|
| Rate for Payer: UHC Exchange |
$397.24
|
| Rate for Payer: UHCCP Medicaid |
$194.90
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB
|
Professional
|
Both
|
$902.00
|
|
|
Service Code
|
HCPCS 41017
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$686.10 |
| Rate for Payer: Aetna Commercial |
$454.51
|
| Rate for Payer: Aetna Medicare |
$451.00
|
| Rate for Payer: BCBS Complete |
$232.38
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: BCN Commercial |
$686.10
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Meridian Medicaid |
$232.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$221.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.49
|
| Rate for Payer: Priority Health Narrow Network |
$614.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$411.23
|
| Rate for Payer: UHC Exchange |
$411.23
|
| Rate for Payer: UHCCP Medicaid |
$221.31
|
|
|
PR ZINC PASTE BAND W >=3""<5""/YD
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS A6456
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna Commercial |
$1.18
|
| Rate for Payer: Aetna Medicare |
$9.00
|
| 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 |
$11.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.80
|
| Rate for Payer: UHC Exchange |
$0.80
|
|
|
PR ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 90736
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$262.86 |
| Rate for Payer: Aetna Commercial |
$216.92
|
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: BCBS Trust/PPO |
$221.01
|
| Rate for Payer: BCN Commercial |
$216.92
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.86
|
| Rate for Payer: UHC Exchange |
$262.86
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$32.02
|
|
|
Service Code
|
NDC 00904675415
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$32.02 |
| Rate for Payer: Aetna Commercial |
$28.82
|
| Rate for Payer: Aetna Medicare |
$16.01
|
| Rate for Payer: ASR ASR |
$31.06
|
| Rate for Payer: ASR Commercial |
$31.06
|
| Rate for Payer: BCBS Complete |
$12.81
|
| Rate for Payer: BCBS Trust/PPO |
$26.22
|
| Rate for Payer: BCN Commercial |
$24.83
|
| Rate for Payer: Cash Price |
$25.61
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.62
|
| Rate for Payer: Healthscope Commercial |
$32.02
|
| Rate for Payer: Healthscope Whirlpool |
$31.06
|
| Rate for Payer: Mclaren Commercial |
$28.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.22
|
| Rate for Payer: Nomi Health Commercial |
$26.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.06
|
| Rate for Payer: Priority Health Narrow Network |
$22.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.18
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$32.30
|
|
|
Service Code
|
NDC 09629513673
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$29.07
|
| Rate for Payer: Aetna Medicare |
$16.15
|
| Rate for Payer: ASR ASR |
$31.33
|
| Rate for Payer: ASR Commercial |
$31.33
|
| Rate for Payer: BCBS Complete |
$12.92
|
| Rate for Payer: BCBS Trust/PPO |
$26.45
|
| 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 Commercial |
$27.46
|
| Rate for Payer: Nomi Health Commercial |
$26.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.30
|
| Rate for Payer: Priority Health Narrow Network |
$22.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.42
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$28.78
|
|
|
Service Code
|
NDC 00810067013
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.71 |
| Max. Negotiated Rate |
$28.78 |
| Rate for Payer: Aetna Commercial |
$25.90
|
| Rate for Payer: ASR ASR |
$27.92
|
| Rate for Payer: ASR Commercial |
$27.92
|
| Rate for Payer: BCBS Trust/PPO |
$23.45
|
| 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 Commercial |
$24.46
|
| Rate for Payer: Nomi Health Commercial |
$23.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.33
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$32.30
|
|
|
Service Code
|
NDC 70000047501
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$29.07
|
| Rate for Payer: ASR ASR |
$31.33
|
| Rate for Payer: ASR Commercial |
$31.33
|
| Rate for Payer: BCBS Trust/PPO |
$26.32
|
| 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 Commercial |
$27.46
|
| Rate for Payer: Nomi Health Commercial |
$26.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.42
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$28.78
|
|
|
Service Code
|
NDC 00810067013
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$28.78 |
| Rate for Payer: Aetna Commercial |
$25.90
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: ASR ASR |
$27.92
|
| Rate for Payer: ASR Commercial |
$27.92
|
| Rate for Payer: BCBS Complete |
$11.51
|
| Rate for Payer: BCBS Trust/PPO |
$23.57
|
| 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 Commercial |
$24.46
|
| Rate for Payer: Nomi Health Commercial |
$23.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.22
|
| Rate for Payer: Priority Health Narrow Network |
$20.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.33
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$32.30
|
|
|
Service Code
|
NDC 09629513673
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$29.07
|
| Rate for Payer: ASR ASR |
$31.33
|
| Rate for Payer: ASR Commercial |
$31.33
|
| Rate for Payer: BCBS Trust/PPO |
$26.32
|
| 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 Commercial |
$27.46
|
| Rate for Payer: Nomi Health Commercial |
$26.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.42
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$32.30
|
|
|
Service Code
|
NDC 70000047501
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$29.07
|
| Rate for Payer: Aetna Medicare |
$16.15
|
| Rate for Payer: ASR ASR |
$31.33
|
| Rate for Payer: ASR Commercial |
$31.33
|
| Rate for Payer: BCBS Complete |
$12.92
|
| Rate for Payer: BCBS Trust/PPO |
$26.45
|
| 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 Commercial |
$27.46
|
| Rate for Payer: Nomi Health Commercial |
$26.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.30
|
| Rate for Payer: Priority Health Narrow Network |
$22.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.42
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$32.02
|
|
|
Service Code
|
NDC 00904675415
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$32.02 |
| Rate for Payer: Aetna Commercial |
$28.82
|
| Rate for Payer: ASR ASR |
$31.06
|
| Rate for Payer: ASR Commercial |
$31.06
|
| Rate for Payer: BCBS Trust/PPO |
$26.09
|
| Rate for Payer: BCN Commercial |
$24.83
|
| Rate for Payer: Cash Price |
$25.61
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.62
|
| Rate for Payer: Healthscope Commercial |
$32.02
|
| Rate for Payer: Healthscope Whirlpool |
$31.06
|
| Rate for Payer: Mclaren Commercial |
$28.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.22
|
| Rate for Payer: Nomi Health Commercial |
$26.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.18
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
IP
|
$8.85
|
|
|
Service Code
|
NDC 37000002410
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: ASR ASR |
$8.58
|
| Rate for Payer: ASR Commercial |
$8.58
|
| Rate for Payer: BCBS Trust/PPO |
$7.21
|
| 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 Commercial |
$7.52
|
| Rate for Payer: Nomi Health Commercial |
$7.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.79
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
OP
|
$8.85
|
|
|
Service Code
|
NDC 37000002410
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: Aetna Medicare |
$4.42
|
| Rate for Payer: ASR ASR |
$8.58
|
| Rate for Payer: ASR Commercial |
$8.58
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: BCBS Trust/PPO |
$7.25
|
| 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 Commercial |
$7.52
|
| Rate for Payer: Nomi Health Commercial |
$7.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.75
|
| Rate for Payer: Priority Health Narrow Network |
$6.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.79
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$50.16
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
6744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$50.16 |
| Rate for Payer: Aetna Commercial |
$45.14
|
| Rate for Payer: Aetna Medicare |
$25.08
|
| Rate for Payer: ASR ASR |
$48.66
|
| Rate for Payer: ASR Commercial |
$48.66
|
| Rate for Payer: BCBS Complete |
$20.06
|
| Rate for Payer: BCBS Trust/PPO |
$41.08
|
| Rate for Payer: BCN Commercial |
$38.89
|
| Rate for Payer: Cash Price |
$40.13
|
| Rate for Payer: Cash Price |
$40.13
|
| Rate for Payer: Cofinity Commercial |
$47.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.13
|
| Rate for Payer: Healthscope Commercial |
$50.16
|
| Rate for Payer: Healthscope Whirlpool |
$48.66
|
| Rate for Payer: Mclaren Commercial |
$45.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.64
|
| Rate for Payer: Nomi Health Commercial |
$41.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.04
|
| Rate for Payer: Priority Health Narrow Network |
$10.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.14
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$50.16
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
6744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$50.16 |
| Rate for Payer: Aetna Commercial |
$45.14
|
| Rate for Payer: ASR ASR |
$48.66
|
| Rate for Payer: ASR Commercial |
$48.66
|
| Rate for Payer: BCBS Trust/PPO |
$40.88
|
| Rate for Payer: BCN Commercial |
$38.89
|
| Rate for Payer: Cash Price |
$40.13
|
| Rate for Payer: Cofinity Commercial |
$47.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.13
|
| Rate for Payer: Healthscope Commercial |
$50.16
|
| Rate for Payer: Healthscope Whirlpool |
$48.66
|
| Rate for Payer: Mclaren Commercial |
$45.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.64
|
| Rate for Payer: Nomi Health Commercial |
$41.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.14
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$124.30
|
|
|
Service Code
|
NDC 77333094010
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.72 |
| Max. Negotiated Rate |
$124.30 |
| Rate for Payer: Aetna Commercial |
$111.87
|
| Rate for Payer: Aetna Medicare |
$62.15
|
| Rate for Payer: ASR ASR |
$120.57
|
| Rate for Payer: ASR Commercial |
$120.57
|
| Rate for Payer: BCBS Complete |
$49.72
|
| Rate for Payer: BCBS Trust/PPO |
$101.79
|
| 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 Commercial |
$105.66
|
| Rate for Payer: Nomi Health Commercial |
$101.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.91
|
| Rate for Payer: Priority Health Narrow Network |
$87.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.38
|
|
