|
ROPINIROLE 1 MG TABLET
|
Facility
|
IP
|
$360.05
|
|
|
Service Code
|
NDC 00904637461
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.03 |
| Max. Negotiated Rate |
$360.05 |
| Rate for Payer: Aetna Commercial |
$324.05
|
| Rate for Payer: ASR ASR |
$349.25
|
| Rate for Payer: ASR Commercial |
$349.25
|
| Rate for Payer: BCBS Trust/PPO |
$293.40
|
| Rate for Payer: BCN Commercial |
$279.15
|
| Rate for Payer: Cash Price |
$288.04
|
| Rate for Payer: Cofinity Commercial |
$338.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.04
|
| Rate for Payer: Healthscope Commercial |
$360.05
|
| Rate for Payer: Healthscope Whirlpool |
$349.25
|
| Rate for Payer: Mclaren Commercial |
$324.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.04
|
| Rate for Payer: Nomi Health Commercial |
$295.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.84
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
OP
|
$360.05
|
|
|
Service Code
|
NDC 00904637461
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.02 |
| Max. Negotiated Rate |
$360.05 |
| Rate for Payer: Aetna Commercial |
$324.05
|
| Rate for Payer: Aetna Medicare |
$180.03
|
| Rate for Payer: ASR ASR |
$349.25
|
| Rate for Payer: ASR Commercial |
$349.25
|
| Rate for Payer: BCBS Complete |
$144.02
|
| Rate for Payer: BCBS Trust/PPO |
$294.84
|
| Rate for Payer: BCN Commercial |
$279.15
|
| Rate for Payer: Cash Price |
$288.04
|
| Rate for Payer: Cofinity Commercial |
$338.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.04
|
| Rate for Payer: Healthscope Commercial |
$360.05
|
| Rate for Payer: Healthscope Whirlpool |
$349.25
|
| Rate for Payer: Mclaren Commercial |
$324.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.04
|
| Rate for Payer: Nomi Health Commercial |
$295.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$315.48
|
| Rate for Payer: Priority Health Narrow Network |
$252.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.84
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) CUSTOM INJECTION
|
Facility
|
OP
|
$18.12
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
300612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$18.12 |
| Rate for Payer: Aetna Commercial |
$16.31
|
| Rate for Payer: Aetna Medicare |
$9.06
|
| Rate for Payer: ASR ASR |
$17.58
|
| Rate for Payer: ASR Commercial |
$17.58
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS Trust/PPO |
$14.84
|
| Rate for Payer: BCN Commercial |
$14.05
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Healthscope Commercial |
$18.12
|
| Rate for Payer: Healthscope Whirlpool |
$17.58
|
| Rate for Payer: Mclaren Commercial |
$16.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: Nomi Health Commercial |
$14.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.88
|
| Rate for Payer: Priority Health Narrow Network |
$12.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.95
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) CUSTOM INJECTION
|
Facility
|
IP
|
$18.12
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
300612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.78 |
| Max. Negotiated Rate |
$18.12 |
| Rate for Payer: Aetna Commercial |
$16.31
|
| Rate for Payer: ASR ASR |
$17.58
|
| Rate for Payer: ASR Commercial |
$17.58
|
| Rate for Payer: BCBS Trust/PPO |
$14.77
|
| Rate for Payer: BCN Commercial |
$14.05
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Healthscope Commercial |
$18.12
|
| Rate for Payer: Healthscope Whirlpool |
$17.58
|
| Rate for Payer: Mclaren Commercial |
$16.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: Nomi Health Commercial |
$14.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.95
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$147.20
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
18192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.68 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Aetna Commercial |
$132.48
|
| Rate for Payer: Aetna Commercial |
$5.76
|
| Rate for Payer: Aetna Commercial |
$65.16
|
| Rate for Payer: Aetna Commercial |
$16.31
|
| Rate for Payer: Aetna Commercial |
$10.98
|
| Rate for Payer: ASR ASR |
$70.23
|
| Rate for Payer: ASR ASR |
$6.21
|
| Rate for Payer: ASR ASR |
$17.58
|
| Rate for Payer: ASR ASR |
$142.78
|
| Rate for Payer: ASR ASR |
$11.83
|
| Rate for Payer: ASR Commercial |
$17.58
|
| Rate for Payer: ASR Commercial |
$70.23
|
| Rate for Payer: ASR Commercial |
$6.21
|
| Rate for Payer: ASR Commercial |
$142.78
|
| Rate for Payer: ASR Commercial |
$11.83
|
| Rate for Payer: BCBS Trust/PPO |
$59.00
|
| Rate for Payer: BCBS Trust/PPO |
$9.94
|
| Rate for Payer: BCBS Trust/PPO |
$119.95
|
| Rate for Payer: BCBS Trust/PPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$14.77
|
| Rate for Payer: BCN Commercial |
$114.12
|
| Rate for Payer: BCN Commercial |
$56.13
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: BCN Commercial |
$14.05
|
| Rate for Payer: BCN Commercial |
$4.96
|
| Rate for Payer: Cash Price |
$117.76
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cash Price |
$57.92
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Cofinity Commercial |
$138.37
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$6.02
|
| Rate for Payer: Cofinity Commercial |
$68.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.76
|
| Rate for Payer: Healthscope Commercial |
$18.12
|
| Rate for Payer: Healthscope Commercial |
$6.40
|
| Rate for Payer: Healthscope Commercial |
$147.20
|
| Rate for Payer: Healthscope Commercial |
$12.20
|
| Rate for Payer: Healthscope Commercial |
$72.40
|
| Rate for Payer: Healthscope Whirlpool |
$70.23
|
| Rate for Payer: Healthscope Whirlpool |
$11.83
|
| Rate for Payer: Healthscope Whirlpool |
$17.58
|
| Rate for Payer: Healthscope Whirlpool |
$142.78
|
| Rate for Payer: Healthscope Whirlpool |
$6.21
|
| Rate for Payer: Mclaren Commercial |
$132.48
|
| Rate for Payer: Mclaren Commercial |
$16.31
|
| Rate for Payer: Mclaren Commercial |
$10.98
|
| Rate for Payer: Mclaren Commercial |
$5.76
|
| Rate for Payer: Mclaren Commercial |
$65.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: Nomi Health Commercial |
$14.86
|
| Rate for Payer: Nomi Health Commercial |
$10.00
|
| Rate for Payer: Nomi Health Commercial |
$120.70
|
| Rate for Payer: Nomi Health Commercial |
$59.37
|
| Rate for Payer: Nomi Health Commercial |
$5.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.63
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$12.20
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
18192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$12.20 |
| Rate for Payer: Aetna Commercial |
$10.98
|
| Rate for Payer: Aetna Commercial |
$5.76
|
| Rate for Payer: Aetna Commercial |
$65.16
|
| Rate for Payer: Aetna Commercial |
$132.48
|
| Rate for Payer: Aetna Commercial |
$16.31
|
| Rate for Payer: Aetna Medicare |
$73.60
|
| Rate for Payer: Aetna Medicare |
$9.06
|
| Rate for Payer: Aetna Medicare |
$6.10
|
| Rate for Payer: Aetna Medicare |
$36.20
|
| Rate for Payer: Aetna Medicare |
$3.20
|
| Rate for Payer: ASR ASR |
$70.23
|
| Rate for Payer: ASR ASR |
$17.58
|
| Rate for Payer: ASR ASR |
$11.83
|
| Rate for Payer: ASR ASR |
$6.21
|
| Rate for Payer: ASR ASR |
$142.78
|
| Rate for Payer: ASR Commercial |
$70.23
|
| Rate for Payer: ASR Commercial |
$142.78
|
| Rate for Payer: ASR Commercial |
$17.58
|
| Rate for Payer: ASR Commercial |
$6.21
|
| Rate for Payer: ASR Commercial |
$11.83
|
| Rate for Payer: BCBS Complete |
$28.96
|
| Rate for Payer: BCBS Complete |
$58.88
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS Complete |
$2.56
|
| Rate for Payer: BCBS Complete |
$4.88
|
| Rate for Payer: BCBS Trust/PPO |
$5.24
|
| Rate for Payer: BCBS Trust/PPO |
$9.99
|
| Rate for Payer: BCBS Trust/PPO |
$120.54
|
| Rate for Payer: BCBS Trust/PPO |
$14.84
|
| Rate for Payer: BCBS Trust/PPO |
$59.29
|
| Rate for Payer: BCN Commercial |
$56.13
|
| Rate for Payer: BCN Commercial |
$4.96
|
| Rate for Payer: BCN Commercial |
$114.12
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: BCN Commercial |
$14.05
|
| Rate for Payer: Cash Price |
$57.92
|
| Rate for Payer: Cash Price |
$117.76
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Cofinity Commercial |
$68.06
|
| Rate for Payer: Cofinity Commercial |
$6.02
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Cofinity Commercial |
$138.37
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.12
|
| Rate for Payer: Healthscope Commercial |
$18.12
|
| Rate for Payer: Healthscope Commercial |
$6.40
|
| Rate for Payer: Healthscope Commercial |
$72.40
|
| Rate for Payer: Healthscope Commercial |
$12.20
|
| Rate for Payer: Healthscope Commercial |
$147.20
|
| Rate for Payer: Healthscope Whirlpool |
$6.21
|
| Rate for Payer: Healthscope Whirlpool |
$17.58
|
| Rate for Payer: Healthscope Whirlpool |
$142.78
|
| Rate for Payer: Healthscope Whirlpool |
$11.83
|
| Rate for Payer: Healthscope Whirlpool |
$70.23
|
| Rate for Payer: Mclaren Commercial |
$65.16
|
| Rate for Payer: Mclaren Commercial |
$16.31
|
| Rate for Payer: Mclaren Commercial |
$132.48
|
| Rate for Payer: Mclaren Commercial |
$5.76
|
| Rate for Payer: Mclaren Commercial |
$10.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.54
|
| Rate for Payer: Nomi Health Commercial |
$5.25
|
| Rate for Payer: Nomi Health Commercial |
$14.86
|
| Rate for Payer: Nomi Health Commercial |
$10.00
|
| Rate for Payer: Nomi Health Commercial |
$120.70
|
| Rate for Payer: Nomi Health Commercial |
$59.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.44
|
| Rate for Payer: Priority Health Narrow Network |
$50.75
|
| Rate for Payer: Priority Health Narrow Network |
$4.49
|
| Rate for Payer: Priority Health Narrow Network |
$103.19
|
| Rate for Payer: Priority Health Narrow Network |
$8.55
|
| Rate for Payer: Priority Health Narrow Network |
$12.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.95
|
|
|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
|
IP
|
$24.83
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
153276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$24.83 |
| Rate for Payer: Aetna Commercial |
$22.35
|
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: ASR ASR |
$24.09
|
| Rate for Payer: ASR ASR |
$26.41
|
| Rate for Payer: ASR Commercial |
$24.09
|
| Rate for Payer: ASR Commercial |
$20.07
|
| Rate for Payer: ASR Commercial |
$26.41
|
| Rate for Payer: BCBS Trust/PPO |
$22.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.86
|
| Rate for Payer: BCBS Trust/PPO |
$20.23
|
| Rate for Payer: BCN Commercial |
$16.04
|
| Rate for Payer: BCN Commercial |
$21.11
|
| Rate for Payer: BCN Commercial |
$19.25
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$21.79
|
| Rate for Payer: Cofinity Commercial |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$23.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.78
|
| Rate for Payer: Healthscope Commercial |
$20.69
|
| Rate for Payer: Healthscope Commercial |
$24.83
|
| Rate for Payer: Healthscope Commercial |
$27.23
|
| Rate for Payer: Healthscope Whirlpool |
$24.09
|
| Rate for Payer: Healthscope Whirlpool |
$20.07
|
| Rate for Payer: Healthscope Whirlpool |
$26.41
|
| Rate for Payer: Mclaren Commercial |
$22.35
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$24.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Nomi Health Commercial |
$20.36
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$22.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
|
|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
|
OP
|
$20.69
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
153276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$20.69 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Commercial |
$22.35
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna Medicare |
$12.41
|
| Rate for Payer: Aetna Medicare |
$13.62
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: ASR ASR |
$24.09
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: ASR ASR |
$26.41
|
| Rate for Payer: ASR Commercial |
$26.41
|
| Rate for Payer: ASR Commercial |
$24.09
|
| Rate for Payer: ASR Commercial |
$20.07
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Complete |
$9.93
|
| Rate for Payer: BCBS Complete |
$10.89
|
| Rate for Payer: BCBS Trust/PPO |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$20.33
|
| Rate for Payer: BCBS Trust/PPO |
$22.30
|
| Rate for Payer: BCN Commercial |
$21.11
|
| Rate for Payer: BCN Commercial |
$16.04
|
| Rate for Payer: BCN Commercial |
$19.25
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$21.79
|
| Rate for Payer: Cofinity Commercial |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$23.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.78
|
| Rate for Payer: Healthscope Commercial |
$20.69
|
| Rate for Payer: Healthscope Commercial |
$24.83
|
| Rate for Payer: Healthscope Commercial |
$27.23
|
| Rate for Payer: Healthscope Whirlpool |
$24.09
|
| Rate for Payer: Healthscope Whirlpool |
$20.07
|
| Rate for Payer: Healthscope Whirlpool |
$26.41
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$22.35
|
| Rate for Payer: Mclaren Commercial |
$24.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.15
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$20.36
|
| Rate for Payer: Nomi Health Commercial |
$22.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.86
|
| Rate for Payer: Priority Health Narrow Network |
$19.09
|
| Rate for Payer: Priority Health Narrow Network |
$14.50
|
| Rate for Payer: Priority Health Narrow Network |
$17.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.96
|
|
|
ROSUVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$232.65
|
|
|
Service Code
|
NDC 68462026290
|
| Hospital Charge Code |
35134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.22 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna Commercial |
$209.38
|
| Rate for Payer: ASR ASR |
$225.67
|
| Rate for Payer: ASR Commercial |
$225.67
|
| Rate for Payer: BCBS Trust/PPO |
$189.59
|
| Rate for Payer: BCN Commercial |
$180.37
|
| Rate for Payer: Cash Price |
$186.12
|
| Rate for Payer: Cofinity Commercial |
$218.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.12
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Healthscope Whirlpool |
$225.67
|
| Rate for Payer: Mclaren Commercial |
$209.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.75
|
| Rate for Payer: Nomi Health Commercial |
$190.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.73
|
|
|
ROSUVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$232.65
|
|
|
Service Code
|
NDC 68462026290
|
| Hospital Charge Code |
35134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna Commercial |
$209.38
|
| Rate for Payer: Aetna Medicare |
$116.33
|
| Rate for Payer: ASR ASR |
$225.67
|
| Rate for Payer: ASR Commercial |
$225.67
|
| Rate for Payer: BCBS Complete |
$93.06
|
| Rate for Payer: BCBS Trust/PPO |
$190.52
|
| Rate for Payer: BCN Commercial |
$180.37
|
| Rate for Payer: Cash Price |
$186.12
|
| Rate for Payer: Cofinity Commercial |
$218.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.12
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Healthscope Whirlpool |
$225.67
|
| Rate for Payer: Mclaren Commercial |
$209.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.75
|
| Rate for Payer: Nomi Health Commercial |
$190.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$203.85
|
| Rate for Payer: Priority Health Narrow Network |
$163.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.73
|
|
|
SACCHAROMYCES BOULARDII 250 MG CAPSULE
|
Facility
|
OP
|
$125.76
|
|
|
Service Code
|
NDC 00904723006
|
| Hospital Charge Code |
37343
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.30 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$113.18
|
| Rate for Payer: Aetna Medicare |
$62.88
|
| Rate for Payer: ASR ASR |
$121.99
|
| Rate for Payer: ASR Commercial |
$121.99
|
| Rate for Payer: BCBS Complete |
$50.30
|
| Rate for Payer: BCBS Trust/PPO |
$102.98
|
| Rate for Payer: BCN Commercial |
$97.50
|
| Rate for Payer: Cash Price |
$100.61
|
| Rate for Payer: Cofinity Commercial |
$118.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.61
|
| Rate for Payer: Healthscope Commercial |
$125.76
|
| Rate for Payer: Healthscope Whirlpool |
$121.99
|
| Rate for Payer: Mclaren Commercial |
$113.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.90
|
| Rate for Payer: Nomi Health Commercial |
$103.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.19
|
| Rate for Payer: Priority Health Narrow Network |
$88.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.67
|
|
|
SACCHAROMYCES BOULARDII 250 MG CAPSULE
|
Facility
|
IP
|
$125.76
|
|
|
Service Code
|
NDC 00904723006
|
| Hospital Charge Code |
37343
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.74 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$113.18
|
| Rate for Payer: ASR ASR |
$121.99
|
| Rate for Payer: ASR Commercial |
$121.99
|
| Rate for Payer: BCBS Trust/PPO |
$102.48
|
| Rate for Payer: BCN Commercial |
$97.50
|
| Rate for Payer: Cash Price |
$100.61
|
| Rate for Payer: Cofinity Commercial |
$118.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.61
|
| Rate for Payer: Healthscope Commercial |
$125.76
|
| Rate for Payer: Healthscope Whirlpool |
$121.99
|
| Rate for Payer: Mclaren Commercial |
$113.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.90
|
| Rate for Payer: Nomi Health Commercial |
$103.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.67
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
OP
|
$2,367.41
|
|
|
Service Code
|
NDC 00078065920
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$946.96 |
| Max. Negotiated Rate |
$2,367.41 |
| Rate for Payer: Aetna Commercial |
$2,130.67
|
| Rate for Payer: Aetna Medicare |
$1,183.70
|
| Rate for Payer: ASR ASR |
$2,296.39
|
| Rate for Payer: ASR Commercial |
$2,296.39
|
| Rate for Payer: BCBS Complete |
$946.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,938.67
|
| Rate for Payer: BCN Commercial |
$1,835.45
|
| Rate for Payer: Cash Price |
$1,893.93
|
| Rate for Payer: Cofinity Commercial |
$2,225.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,893.93
|
| Rate for Payer: Healthscope Commercial |
$2,367.41
|
| Rate for Payer: Healthscope Whirlpool |
$2,296.39
|
| Rate for Payer: Mclaren Commercial |
$2,130.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,012.30
|
| Rate for Payer: Nomi Health Commercial |
$1,941.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,538.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,074.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,659.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,083.32
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
IP
|
$2,367.41
|
|
|
Service Code
|
NDC 00078065920
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,538.82 |
| Max. Negotiated Rate |
$2,367.41 |
| Rate for Payer: Aetna Commercial |
$2,130.67
|
| Rate for Payer: ASR ASR |
$2,296.39
|
| Rate for Payer: ASR Commercial |
$2,296.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,929.20
|
| Rate for Payer: BCN Commercial |
$1,835.45
|
| Rate for Payer: Cash Price |
$1,893.93
|
| Rate for Payer: Cofinity Commercial |
$2,225.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,893.93
|
| Rate for Payer: Healthscope Commercial |
$2,367.41
|
| Rate for Payer: Healthscope Whirlpool |
$2,296.39
|
| Rate for Payer: Mclaren Commercial |
$2,130.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,012.30
|
| Rate for Payer: Nomi Health Commercial |
$1,941.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,538.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,083.32
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$732.78
|
|
|
Service Code
|
NDC 10019055303
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$476.31 |
| Max. Negotiated Rate |
$732.78 |
| Rate for Payer: Aetna Commercial |
$659.50
|
| Rate for Payer: ASR ASR |
$710.80
|
| Rate for Payer: ASR Commercial |
$710.80
|
| Rate for Payer: BCBS Trust/PPO |
$597.14
|
| Rate for Payer: BCN Commercial |
$568.12
|
| Rate for Payer: Cash Price |
$586.23
|
| Rate for Payer: Cofinity Commercial |
$688.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.22
|
| Rate for Payer: Healthscope Commercial |
$732.78
|
| Rate for Payer: Healthscope Whirlpool |
$710.80
|
| Rate for Payer: Mclaren Commercial |
$659.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$622.86
|
| Rate for Payer: Nomi Health Commercial |
$600.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$644.85
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$732.78
|
|
|
Service Code
|
NDC 10019055303
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.11 |
| Max. Negotiated Rate |
$732.78 |
| Rate for Payer: Aetna Commercial |
$659.50
|
| Rate for Payer: Aetna Medicare |
$366.39
|
| Rate for Payer: ASR ASR |
$710.80
|
| Rate for Payer: ASR Commercial |
$710.80
|
| Rate for Payer: BCBS Complete |
$293.11
|
| Rate for Payer: BCBS Trust/PPO |
$600.07
|
| Rate for Payer: BCN Commercial |
$568.12
|
| Rate for Payer: Cash Price |
$586.23
|
| Rate for Payer: Cofinity Commercial |
$688.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.22
|
| Rate for Payer: Healthscope Commercial |
$732.78
|
| Rate for Payer: Healthscope Whirlpool |
$710.80
|
| Rate for Payer: Mclaren Commercial |
$659.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$622.86
|
| Rate for Payer: Nomi Health Commercial |
$600.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$642.06
|
| Rate for Payer: Priority Health Narrow Network |
$513.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$644.85
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$73.28
|
|
|
Service Code
|
NDC 10019055390
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.31 |
| Max. Negotiated Rate |
$73.28 |
| Rate for Payer: Aetna Commercial |
$65.95
|
| Rate for Payer: Aetna Medicare |
$36.64
|
| Rate for Payer: ASR ASR |
$71.08
|
| Rate for Payer: ASR Commercial |
$71.08
|
| Rate for Payer: BCBS Complete |
$29.31
|
| Rate for Payer: BCBS Trust/PPO |
$60.01
|
| Rate for Payer: BCN Commercial |
$56.81
|
| Rate for Payer: Cash Price |
$58.62
|
| Rate for Payer: Cofinity Commercial |
$68.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.62
|
| Rate for Payer: Healthscope Commercial |
$73.28
|
| Rate for Payer: Healthscope Whirlpool |
$71.08
|
| Rate for Payer: Mclaren Commercial |
$65.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.29
|
| Rate for Payer: Nomi Health Commercial |
$60.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.21
|
| Rate for Payer: Priority Health Narrow Network |
$51.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.49
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$73.28
|
|
|
Service Code
|
NDC 10019055390
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$73.28 |
| Rate for Payer: Aetna Commercial |
$65.95
|
| Rate for Payer: ASR ASR |
$71.08
|
| Rate for Payer: ASR Commercial |
$71.08
|
| Rate for Payer: BCBS Trust/PPO |
$59.72
|
| Rate for Payer: BCN Commercial |
$56.81
|
| Rate for Payer: Cash Price |
$58.62
|
| Rate for Payer: Cofinity Commercial |
$68.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.62
|
| Rate for Payer: Healthscope Commercial |
$73.28
|
| Rate for Payer: Healthscope Whirlpool |
$71.08
|
| Rate for Payer: Mclaren Commercial |
$65.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.29
|
| Rate for Payer: Nomi Health Commercial |
$60.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.49
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$96.91
|
|
|
Service Code
|
NDC 50742050504
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.76 |
| Max. Negotiated Rate |
$96.91 |
| Rate for Payer: Aetna Commercial |
$87.22
|
| Rate for Payer: Aetna Medicare |
$48.45
|
| Rate for Payer: ASR ASR |
$94.00
|
| Rate for Payer: ASR Commercial |
$94.00
|
| Rate for Payer: BCBS Complete |
$38.76
|
| Rate for Payer: BCBS Trust/PPO |
$79.36
|
| Rate for Payer: BCN Commercial |
$75.13
|
| Rate for Payer: Cash Price |
$77.53
|
| Rate for Payer: Cofinity Commercial |
$91.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.53
|
| Rate for Payer: Healthscope Commercial |
$96.91
|
| Rate for Payer: Healthscope Whirlpool |
$94.00
|
| Rate for Payer: Mclaren Commercial |
$87.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.37
|
| Rate for Payer: Nomi Health Commercial |
$79.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.91
|
| Rate for Payer: Priority Health Narrow Network |
$67.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.28
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$96.91
|
|
|
Service Code
|
NDC 50742050504
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.99 |
| Max. Negotiated Rate |
$96.91 |
| Rate for Payer: Aetna Commercial |
$87.22
|
| Rate for Payer: ASR ASR |
$94.00
|
| Rate for Payer: ASR Commercial |
$94.00
|
| Rate for Payer: BCBS Trust/PPO |
$78.97
|
| Rate for Payer: BCN Commercial |
$75.13
|
| Rate for Payer: Cash Price |
$77.53
|
| Rate for Payer: Cofinity Commercial |
$91.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.53
|
| Rate for Payer: Healthscope Commercial |
$96.91
|
| Rate for Payer: Healthscope Whirlpool |
$94.00
|
| Rate for Payer: Mclaren Commercial |
$87.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.37
|
| Rate for Payer: Nomi Health Commercial |
$79.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.28
|
|
|
SCREENING OF A PATIENT
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS D0190
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$163.80
|
|
|
Service Code
|
NDC 51645085101
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.47 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna Commercial |
$147.42
|
| Rate for Payer: ASR ASR |
$158.89
|
| Rate for Payer: ASR Commercial |
$158.89
|
| Rate for Payer: BCBS Trust/PPO |
$133.48
|
| Rate for Payer: BCN Commercial |
$126.99
|
| Rate for Payer: Cash Price |
$131.04
|
| Rate for Payer: Cofinity Commercial |
$153.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.04
|
| Rate for Payer: Healthscope Commercial |
$163.80
|
| Rate for Payer: Healthscope Whirlpool |
$158.89
|
| Rate for Payer: Mclaren Commercial |
$147.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.23
|
| Rate for Payer: Nomi Health Commercial |
$134.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.14
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
NDC 00904652261
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: ASR ASR |
$128.04
|
| Rate for Payer: ASR Commercial |
$128.04
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS Trust/PPO |
$108.09
|
| Rate for Payer: BCN Commercial |
$102.34
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$124.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Healthscope Commercial |
$132.00
|
| Rate for Payer: Healthscope Whirlpool |
$128.04
|
| Rate for Payer: Mclaren Commercial |
$118.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.20
|
| Rate for Payer: Nomi Health Commercial |
$108.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.66
|
| Rate for Payer: Priority Health Narrow Network |
$92.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.16
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$113.40
|
|
|
Service Code
|
NDC 49483008001
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.36 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna Commercial |
$102.06
|
| Rate for Payer: Aetna Medicare |
$56.70
|
| Rate for Payer: ASR ASR |
$110.00
|
| Rate for Payer: ASR Commercial |
$110.00
|
| Rate for Payer: BCBS Complete |
$45.36
|
| Rate for Payer: BCBS Trust/PPO |
$92.86
|
| Rate for Payer: BCN Commercial |
$87.92
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cofinity Commercial |
$106.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.72
|
| Rate for Payer: Healthscope Commercial |
$113.40
|
| Rate for Payer: Healthscope Whirlpool |
$110.00
|
| Rate for Payer: Mclaren Commercial |
$102.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.39
|
| Rate for Payer: Nomi Health Commercial |
$92.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.36
|
| Rate for Payer: Priority Health Narrow Network |
$79.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.79
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
NDC 00904725261
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: ASR ASR |
$135.80
|
| Rate for Payer: ASR Commercial |
$135.80
|
| Rate for Payer: BCBS Trust/PPO |
$114.09
|
| Rate for Payer: BCN Commercial |
$108.54
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$131.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Healthscope Commercial |
$140.00
|
| Rate for Payer: Healthscope Whirlpool |
$135.80
|
| Rate for Payer: Mclaren Commercial |
$126.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.00
|
| Rate for Payer: Nomi Health Commercial |
$114.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.20
|
|
