|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.99
|
|
|
Service Code
|
NDC 00781315270
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$19.79 |
| Rate for Payer: Aetna Commercial |
$18.69
|
| Rate for Payer: Aetna Medicare |
$10.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.29
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: Cash Price |
$17.59
|
| Rate for Payer: Cofinity Advantage |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$18.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.59
|
| Rate for Payer: Healthscope Commercial |
$19.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.49
|
| Rate for Payer: PHP Commercial |
$18.69
|
| Rate for Payer: Priority Health SBD |
$13.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.29
|
| Rate for Payer: UHC Core |
$11.46
|
| Rate for Payer: UHC Exchange |
$8.64
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$114.50
|
|
|
Service Code
|
NDC 00074438010
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$103.05 |
| Rate for Payer: Aetna Commercial |
$97.33
|
| Rate for Payer: Aetna Medicare |
$57.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.42
|
| Rate for Payer: BCBS Complete |
$45.80
|
| Rate for Payer: Cash Price |
$91.60
|
| Rate for Payer: Cofinity Advantage |
$80.15
|
| Rate for Payer: Cofinity Commercial |
$98.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.60
|
| Rate for Payer: Healthscope Commercial |
$103.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.88
|
| Rate for Payer: PHP Commercial |
$97.33
|
| Rate for Payer: Priority Health SBD |
$72.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.42
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Exchange |
$45.00
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.99
|
|
|
Service Code
|
NDC 00781315270
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$19.79 |
| Rate for Payer: Aetna Commercial |
$18.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.29
|
| Rate for Payer: Cash Price |
$17.59
|
| Rate for Payer: Cofinity Advantage |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$18.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.59
|
| Rate for Payer: Healthscope Commercial |
$19.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.49
|
| Rate for Payer: PHP Commercial |
$18.69
|
| Rate for Payer: Priority Health SBD |
$13.85
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$114.50
|
|
|
Service Code
|
NDC 00074438010
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$103.05 |
| Rate for Payer: Aetna Commercial |
$97.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.42
|
| Rate for Payer: Cash Price |
$91.60
|
| Rate for Payer: Cofinity Advantage |
$80.15
|
| Rate for Payer: Cofinity Commercial |
$98.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.60
|
| Rate for Payer: Healthscope Commercial |
$103.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.88
|
| Rate for Payer: PHP Commercial |
$97.33
|
| Rate for Payer: Priority Health SBD |
$72.14
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.99
|
|
|
Service Code
|
NDC 00781315295
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$19.79 |
| Rate for Payer: Aetna Commercial |
$18.69
|
| Rate for Payer: Aetna Medicare |
$10.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.29
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: Cash Price |
$17.59
|
| Rate for Payer: Cofinity Advantage |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$18.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.59
|
| Rate for Payer: Healthscope Commercial |
$19.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.49
|
| Rate for Payer: PHP Commercial |
$18.69
|
| Rate for Payer: Priority Health SBD |
$13.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.29
|
| Rate for Payer: UHC Core |
$11.46
|
| Rate for Payer: UHC Exchange |
$8.64
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$190.38
|
|
|
Service Code
|
NDC 70069015110
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$171.34 |
| Rate for Payer: Aetna Commercial |
$161.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.75
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Cofinity Advantage |
$133.27
|
| Rate for Payer: Cofinity Commercial |
$163.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.30
|
| Rate for Payer: Healthscope Commercial |
$171.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.78
|
| Rate for Payer: PHP Commercial |
$161.82
|
| Rate for Payer: Priority Health SBD |
$119.94
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$192.33
|
|
|
Service Code
|
NDC 00781315380
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$121.17 |
| Max. Negotiated Rate |
$173.10 |
| Rate for Payer: Aetna Commercial |
$163.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.01
|
| Rate for Payer: Cash Price |
$153.86
|
| Rate for Payer: Cofinity Advantage |
$134.63
|
| Rate for Payer: Cofinity Commercial |
$165.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.86
|
| Rate for Payer: Healthscope Commercial |
$173.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.25
|
| Rate for Payer: PHP Commercial |
$163.48
|
| Rate for Payer: Priority Health SBD |
$121.17
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$982.43
|
|
|
Service Code
|
NDC 00074438220
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$386.09 |
| Max. Negotiated Rate |
$884.19 |
| Rate for Payer: Aetna Commercial |
$835.07
|
| Rate for Payer: Aetna Medicare |
$491.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.58
|
| Rate for Payer: BCBS Complete |
$392.97
|
| Rate for Payer: Cash Price |
$785.94
|
| Rate for Payer: Cofinity Advantage |
$687.70
|
| Rate for Payer: Cofinity Commercial |
$844.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.94
|
| Rate for Payer: Healthscope Commercial |
$884.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$785.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$835.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$736.82
|
| Rate for Payer: PHP Commercial |
$835.07
|
| Rate for Payer: Priority Health SBD |
$618.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$638.58
|
| Rate for Payer: UHC Core |
$511.85
|
| Rate for Payer: UHC Exchange |
$386.09
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$192.33
|
|
|
Service Code
|
NDC 00781315380
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.59 |
| Max. Negotiated Rate |
$173.10 |
| Rate for Payer: Aetna Commercial |
$163.48
|
| Rate for Payer: Aetna Medicare |
$96.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.01
|
| Rate for Payer: BCBS Complete |
$76.93
|
| Rate for Payer: Cash Price |
$153.86
|
| Rate for Payer: Cofinity Advantage |
$134.63
|
| Rate for Payer: Cofinity Commercial |
$165.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.86
|
| Rate for Payer: Healthscope Commercial |
$173.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.25
|
| Rate for Payer: PHP Commercial |
$163.48
|
| Rate for Payer: Priority Health SBD |
$121.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.01
|
| Rate for Payer: UHC Core |
$100.20
|
| Rate for Payer: UHC Exchange |
$75.59
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$192.33
|
|
|
Service Code
|
NDC 00781315395
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.59 |
| Max. Negotiated Rate |
$173.10 |
| Rate for Payer: Aetna Commercial |
$163.48
|
| Rate for Payer: Aetna Medicare |
$96.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.01
|
| Rate for Payer: BCBS Complete |
$76.93
|
| Rate for Payer: Cash Price |
$153.86
|
| Rate for Payer: Cofinity Advantage |
$134.63
|
| Rate for Payer: Cofinity Commercial |
$165.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.86
|
| Rate for Payer: Healthscope Commercial |
$173.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.25
|
| Rate for Payer: PHP Commercial |
$163.48
|
| Rate for Payer: Priority Health SBD |
$121.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.01
|
| Rate for Payer: UHC Core |
$100.20
|
| Rate for Payer: UHC Exchange |
$75.59
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$982.43
|
|
|
Service Code
|
NDC 00074438220
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$618.93 |
| Max. Negotiated Rate |
$884.19 |
| Rate for Payer: Aetna Commercial |
$835.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.58
|
| Rate for Payer: Cash Price |
$785.94
|
| Rate for Payer: Cofinity Advantage |
$687.70
|
| Rate for Payer: Cofinity Commercial |
$844.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.94
|
| Rate for Payer: Healthscope Commercial |
$884.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$835.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$736.82
|
| Rate for Payer: PHP Commercial |
$835.07
|
| Rate for Payer: Priority Health SBD |
$618.93
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$190.38
|
|
|
Service Code
|
NDC 70069015110
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.82 |
| Max. Negotiated Rate |
$171.34 |
| Rate for Payer: Aetna Commercial |
$161.82
|
| Rate for Payer: Aetna Medicare |
$95.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.75
|
| Rate for Payer: BCBS Complete |
$76.15
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Cofinity Advantage |
$133.27
|
| Rate for Payer: Cofinity Commercial |
$163.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.30
|
| Rate for Payer: Healthscope Commercial |
$171.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.78
|
| Rate for Payer: PHP Commercial |
$161.82
|
| Rate for Payer: Priority Health SBD |
$119.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.75
|
| Rate for Payer: UHC Core |
$99.19
|
| Rate for Payer: UHC Exchange |
$74.82
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$192.33
|
|
|
Service Code
|
NDC 00781315395
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$121.17 |
| Max. Negotiated Rate |
$173.10 |
| Rate for Payer: Aetna Commercial |
$163.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.01
|
| Rate for Payer: Cash Price |
$153.86
|
| Rate for Payer: Cofinity Advantage |
$134.63
|
| Rate for Payer: Cofinity Commercial |
$165.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.86
|
| Rate for Payer: Healthscope Commercial |
$173.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.25
|
| Rate for Payer: PHP Commercial |
$163.48
|
| Rate for Payer: Priority Health SBD |
$121.17
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$190.38
|
|
|
Service Code
|
NDC 70069015101
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$171.34 |
| Rate for Payer: Aetna Commercial |
$161.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.75
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Cofinity Advantage |
$133.27
|
| Rate for Payer: Cofinity Commercial |
$163.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.30
|
| Rate for Payer: Healthscope Commercial |
$171.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.78
|
| Rate for Payer: PHP Commercial |
$161.82
|
| Rate for Payer: Priority Health SBD |
$119.94
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$190.38
|
|
|
Service Code
|
NDC 70069015101
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.82 |
| Max. Negotiated Rate |
$171.34 |
| Rate for Payer: Aetna Commercial |
$161.82
|
| Rate for Payer: Aetna Medicare |
$95.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.75
|
| Rate for Payer: BCBS Complete |
$76.15
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Cofinity Advantage |
$133.27
|
| Rate for Payer: Cofinity Commercial |
$163.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.30
|
| Rate for Payer: Healthscope Commercial |
$171.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.78
|
| Rate for Payer: PHP Commercial |
$161.82
|
| Rate for Payer: Priority Health SBD |
$119.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.75
|
| Rate for Payer: UHC Core |
$99.19
|
| Rate for Payer: UHC Exchange |
$74.82
|
|
|
CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$428.45
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
9612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$385.61 |
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna Commercial |
$261.38
|
| Rate for Payer: Aetna Commercial |
$528.36
|
| Rate for Payer: Aetna Commercial |
$249.18
|
| Rate for Payer: Aetna Commercial |
$207.19
|
| Rate for Payer: Aetna Commercial |
$252.88
|
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: Aetna Commercial |
$209.10
|
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: Aetna Medicare |
$310.80
|
| Rate for Payer: Aetna Medicare |
$148.75
|
| Rate for Payer: Aetna Medicare |
$146.57
|
| Rate for Payer: Aetna Medicare |
$153.75
|
| Rate for Payer: Aetna Medicare |
$214.22
|
| Rate for Payer: Aetna Medicare |
$123.00
|
| Rate for Payer: Aetna Medicare |
$121.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.88
|
| Rate for Payer: BCBS Complete |
$117.26
|
| Rate for Payer: BCBS Complete |
$98.40
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: BCBS Complete |
$97.50
|
| Rate for Payer: BCBS Complete |
$248.64
|
| Rate for Payer: BCBS Complete |
$171.38
|
| Rate for Payer: BCBS Complete |
$123.00
|
| Rate for Payer: BCBS Complete |
$119.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCN Commercial |
$5.20
|
| Rate for Payer: BCN Commercial |
$5.20
|
| Rate for Payer: BCN Commercial |
$5.20
|
| Rate for Payer: BCN Commercial |
$5.20
|
| Rate for Payer: BCN Commercial |
$5.20
|
| Rate for Payer: BCN Commercial |
$5.20
|
| Rate for Payer: BCN Commercial |
$5.20
|
| Rate for Payer: BCN Commercial |
$5.20
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$234.52
|
| Rate for Payer: Cash Price |
$234.52
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cash Price |
$497.28
|
| Rate for Payer: Cash Price |
$497.28
|
| Rate for Payer: Cofinity Advantage |
$172.20
|
| Rate for Payer: Cofinity Advantage |
$299.92
|
| Rate for Payer: Cofinity Advantage |
$170.62
|
| Rate for Payer: Cofinity Advantage |
$435.12
|
| Rate for Payer: Cofinity Advantage |
$205.21
|
| Rate for Payer: Cofinity Advantage |
$215.25
|
| Rate for Payer: Cofinity Advantage |
$208.25
|
| Rate for Payer: Cofinity Advantage |
$147.00
|
| Rate for Payer: Cofinity Commercial |
$252.11
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Cofinity Commercial |
$534.58
|
| Rate for Payer: Cofinity Commercial |
$264.45
|
| Rate for Payer: Cofinity Commercial |
$211.56
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Cofinity Commercial |
$255.85
|
| Rate for Payer: Cofinity Commercial |
$209.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.00
|
| Rate for Payer: Healthscope Commercial |
$221.40
|
| Rate for Payer: Healthscope Commercial |
$219.38
|
| Rate for Payer: Healthscope Commercial |
$385.61
|
| Rate for Payer: Healthscope Commercial |
$559.44
|
| Rate for Payer: Healthscope Commercial |
$263.83
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Healthscope Commercial |
$267.75
|
| Rate for Payer: Healthscope Commercial |
$276.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$238.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$497.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$466.20
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: PHP Commercial |
$249.18
|
| Rate for Payer: PHP Commercial |
$207.19
|
| Rate for Payer: PHP Commercial |
$252.88
|
| Rate for Payer: PHP Commercial |
$261.38
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: PHP Commercial |
$528.36
|
| Rate for Payer: PHP Commercial |
$209.10
|
| Rate for Payer: Priority Health SBD |
$154.98
|
| Rate for Payer: Priority Health SBD |
$391.61
|
| Rate for Payer: Priority Health SBD |
$269.92
|
| Rate for Payer: Priority Health SBD |
$193.72
|
| Rate for Payer: Priority Health SBD |
$184.68
|
| Rate for Payer: Priority Health SBD |
$187.43
|
| Rate for Payer: Priority Health SBD |
$153.56
|
| Rate for Payer: Priority Health SBD |
$132.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
|
|
CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$297.50
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
9612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.43 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Aetna Commercial |
$252.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.38
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cofinity Advantage |
$208.25
|
| Rate for Payer: Cofinity Commercial |
$255.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.00
|
| Rate for Payer: Healthscope Commercial |
$267.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.12
|
| Rate for Payer: PHP Commercial |
$252.88
|
| Rate for Payer: Priority Health SBD |
$187.43
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
NDC 00378623101
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.55
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Advantage |
$32.90
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.25
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health SBD |
$29.61
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
NDC 00378623101
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.55
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Advantage |
$32.90
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.25
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health SBD |
$29.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.55
|
| Rate for Payer: UHC Core |
$24.49
|
| Rate for Payer: UHC Exchange |
$18.47
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$138.65
|
|
|
Service Code
|
NDC 00904608461
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.49 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna Medicare |
$69.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Advantage |
$97.06
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.12
|
| Rate for Payer: UHC Core |
$72.24
|
| Rate for Payer: UHC Exchange |
$54.49
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 00904608461
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.35 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Advantage |
$97.06
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health SBD |
$87.35
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$752.00
|
|
|
Service Code
|
NDC 57664050818
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$295.54 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna Commercial |
$639.20
|
| Rate for Payer: Aetna Medicare |
$376.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.80
|
| Rate for Payer: BCBS Complete |
$300.80
|
| Rate for Payer: Cash Price |
$601.60
|
| Rate for Payer: Cofinity Advantage |
$526.40
|
| Rate for Payer: Cofinity Commercial |
$646.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.60
|
| Rate for Payer: Healthscope Commercial |
$676.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$601.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$639.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$564.00
|
| Rate for Payer: PHP Commercial |
$639.20
|
| Rate for Payer: Priority Health SBD |
$473.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.80
|
| Rate for Payer: UHC Core |
$391.79
|
| Rate for Payer: UHC Exchange |
$295.54
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$14.34
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.32
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Advantage |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.76
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: Priority Health SBD |
$9.03
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$14.34
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: Aetna Medicare |
$7.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.32
|
| Rate for Payer: BCBS Complete |
$5.74
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Advantage |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.76
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: Priority Health SBD |
$9.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.32
|
| Rate for Payer: UHC Core |
$7.47
|
| Rate for Payer: UHC Exchange |
$5.64
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$54.05
|
|
|
Service Code
|
NDC 00378623201
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.24 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna Commercial |
$45.94
|
| Rate for Payer: Aetna Medicare |
$27.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.13
|
| Rate for Payer: BCBS Complete |
$21.62
|
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Cofinity Advantage |
$37.84
|
| Rate for Payer: Cofinity Commercial |
$46.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.24
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.54
|
| Rate for Payer: PHP Commercial |
$45.94
|
| Rate for Payer: Priority Health SBD |
$34.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.13
|
| Rate for Payer: UHC Core |
$28.16
|
| Rate for Payer: UHC Exchange |
$21.24
|
|
