|
VALSARTAN 80 MG TABLET
|
Facility
|
IP
|
$2,862.81
|
|
|
Service Code
|
NDC 00078035834
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,803.57 |
| Max. Negotiated Rate |
$2,576.53 |
| Rate for Payer: Aetna Commercial |
$2,433.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,860.83
|
| Rate for Payer: Cash Price |
$2,290.25
|
| Rate for Payer: Cofinity Commercial |
$2,003.97
|
| Rate for Payer: Cofinity Commercial |
$2,462.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,003.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,290.25
|
| Rate for Payer: Healthscope Commercial |
$2,576.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,433.39
|
| Rate for Payer: PHP Commercial |
$2,433.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,860.83
|
| Rate for Payer: Priority Health SBD |
$1,803.57
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION
|
Facility
|
OP
|
$24.42
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$21.98 |
| Rate for Payer: Aetna Commercial |
$20.76
|
| Rate for Payer: Aetna Commercial |
$14.50
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Commercial |
$14.48
|
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Commercial |
$15.76
|
| Rate for Payer: Aetna Commercial |
$16.06
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Commercial |
$20.64
|
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Aetna Medicare |
$12.14
|
| Rate for Payer: Aetna Medicare |
$8.53
|
| Rate for Payer: Aetna Medicare |
$9.27
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Aetna Medicare |
$12.21
|
| Rate for Payer: Aetna Medicare |
$8.32
|
| Rate for Payer: Aetna Medicare |
$8.71
|
| Rate for Payer: Aetna Medicare |
$8.52
|
| Rate for Payer: Aetna Medicare |
$8.82
|
| Rate for Payer: Aetna Medicare |
$9.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.05
|
| Rate for Payer: BCBS Complete |
$6.82
|
| Rate for Payer: BCBS Complete |
$9.22
|
| Rate for Payer: BCBS Complete |
$6.66
|
| Rate for Payer: BCBS Complete |
$7.56
|
| Rate for Payer: BCBS Complete |
$6.81
|
| Rate for Payer: BCBS Complete |
$6.97
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS Complete |
$7.06
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS Complete |
$9.71
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cash Price |
$19.42
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$19.42
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$15.94
|
| Rate for Payer: Cofinity Commercial |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$16.14
|
| Rate for Payer: Cofinity Commercial |
$13.23
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Cofinity Commercial |
$11.92
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Cofinity Commercial |
$20.88
|
| Rate for Payer: Cofinity Commercial |
$17.00
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$16.25
|
| Rate for Payer: Cofinity Commercial |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$15.18
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$12.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Healthscope Commercial |
$15.68
|
| Rate for Payer: Healthscope Commercial |
$15.35
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.69
|
| Rate for Payer: Healthscope Commercial |
$21.98
|
| Rate for Payer: Healthscope Commercial |
$15.33
|
| Rate for Payer: Healthscope Commercial |
$17.01
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$21.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.00
|
| Rate for Payer: PHP Commercial |
$15.76
|
| Rate for Payer: PHP Commercial |
$14.48
|
| Rate for Payer: PHP Commercial |
$16.06
|
| Rate for Payer: PHP Commercial |
$20.76
|
| Rate for Payer: PHP Commercial |
$14.50
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$15.00
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Commercial |
$20.64
|
| Rate for Payer: PHP Commercial |
$14.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.47
|
| Rate for Payer: Priority Health SBD |
$10.49
|
| Rate for Payer: Priority Health SBD |
$15.30
|
| Rate for Payer: Priority Health SBD |
$14.53
|
| Rate for Payer: Priority Health SBD |
$15.38
|
| Rate for Payer: Priority Health SBD |
$10.97
|
| Rate for Payer: Priority Health SBD |
$10.75
|
| Rate for Payer: Priority Health SBD |
$11.68
|
| Rate for Payer: Priority Health SBD |
$10.73
|
| Rate for Payer: Priority Health SBD |
$11.12
|
| Rate for Payer: Priority Health SBD |
$11.91
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION
|
Facility
|
IP
|
$17.65
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Commercial |
$14.50
|
| Rate for Payer: Aetna Commercial |
$14.48
|
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Commercial |
$20.76
|
| Rate for Payer: Aetna Commercial |
$20.64
|
| Rate for Payer: Aetna Commercial |
$15.76
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Commercial |
$16.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.78
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cash Price |
$19.42
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cofinity Commercial |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$11.92
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$15.18
|
| Rate for Payer: Cofinity Commercial |
$12.98
|
| Rate for Payer: Cofinity Commercial |
$15.94
|
| Rate for Payer: Cofinity Commercial |
$13.23
|
| Rate for Payer: Cofinity Commercial |
$16.25
|
| Rate for Payer: Cofinity Commercial |
$16.14
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$17.00
|
| Rate for Payer: Cofinity Commercial |
$20.88
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.54
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Healthscope Commercial |
$15.68
|
| Rate for Payer: Healthscope Commercial |
$15.33
|
| Rate for Payer: Healthscope Commercial |
$21.85
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$21.98
|
| Rate for Payer: Healthscope Commercial |
$16.69
|
| Rate for Payer: Healthscope Commercial |
$17.01
|
| Rate for Payer: Healthscope Commercial |
$15.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.76
|
| Rate for Payer: PHP Commercial |
$14.81
|
| Rate for Payer: PHP Commercial |
$15.00
|
| Rate for Payer: PHP Commercial |
$15.76
|
| Rate for Payer: PHP Commercial |
$16.06
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$20.76
|
| Rate for Payer: PHP Commercial |
$20.64
|
| Rate for Payer: PHP Commercial |
$14.50
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Commercial |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health SBD |
$15.38
|
| Rate for Payer: Priority Health SBD |
$11.68
|
| Rate for Payer: Priority Health SBD |
$11.12
|
| Rate for Payer: Priority Health SBD |
$15.30
|
| Rate for Payer: Priority Health SBD |
$10.97
|
| Rate for Payer: Priority Health SBD |
$10.49
|
| Rate for Payer: Priority Health SBD |
$10.75
|
| Rate for Payer: Priority Health SBD |
$10.73
|
| Rate for Payer: Priority Health SBD |
$14.53
|
| Rate for Payer: Priority Health SBD |
$11.91
|
|
|
VANCOMYCIN 100 MG/ML PF IV SOLN CUSTOM
|
Facility
|
OP
|
$17.03
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
150719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Aetna Commercial |
$14.48
|
| Rate for Payer: Aetna Commercial |
$20.76
|
| Rate for Payer: Aetna Medicare |
$12.21
|
| Rate for Payer: Aetna Medicare |
$8.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.87
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS Complete |
$6.81
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cofinity Commercial |
$11.92
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.54
|
| Rate for Payer: Healthscope Commercial |
$15.33
|
| Rate for Payer: Healthscope Commercial |
$21.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.48
|
| Rate for Payer: PHP Commercial |
$20.76
|
| Rate for Payer: PHP Commercial |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.87
|
| Rate for Payer: Priority Health SBD |
$15.38
|
| Rate for Payer: Priority Health SBD |
$10.73
|
|
|
VANCOMYCIN 100 MG/ML PF IV SOLN CUSTOM
|
Facility
|
IP
|
$17.03
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
150719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Aetna Commercial |
$14.48
|
| Rate for Payer: Aetna Commercial |
$20.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.87
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cofinity Commercial |
$11.92
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.54
|
| Rate for Payer: Healthscope Commercial |
$15.33
|
| Rate for Payer: Healthscope Commercial |
$21.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.76
|
| Rate for Payer: PHP Commercial |
$14.48
|
| Rate for Payer: PHP Commercial |
$20.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.07
|
| Rate for Payer: Priority Health SBD |
$15.38
|
| Rate for Payer: Priority Health SBD |
$10.73
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$116.15
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.17 |
| Max. Negotiated Rate |
$104.54 |
| Rate for Payer: Aetna Commercial |
$98.73
|
| Rate for Payer: Aetna Commercial |
$175.89
|
| Rate for Payer: Aetna Commercial |
$71.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.47
|
| Rate for Payer: Cash Price |
$92.92
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$67.04
|
| Rate for Payer: Cofinity Commercial |
$58.66
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Cofinity Commercial |
$99.89
|
| Rate for Payer: Cofinity Commercial |
$72.07
|
| Rate for Payer: Cofinity Commercial |
$144.85
|
| Rate for Payer: Cofinity Commercial |
$177.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.04
|
| Rate for Payer: Healthscope Commercial |
$186.24
|
| Rate for Payer: Healthscope Commercial |
$75.42
|
| Rate for Payer: Healthscope Commercial |
$104.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.23
|
| Rate for Payer: PHP Commercial |
$71.23
|
| Rate for Payer: PHP Commercial |
$98.73
|
| Rate for Payer: PHP Commercial |
$175.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health SBD |
$52.79
|
| Rate for Payer: Priority Health SBD |
$73.17
|
| Rate for Payer: Priority Health SBD |
$130.37
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$83.80
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$75.42 |
| Rate for Payer: Aetna Commercial |
$71.23
|
| Rate for Payer: Aetna Commercial |
$98.73
|
| Rate for Payer: Aetna Commercial |
$175.89
|
| Rate for Payer: Aetna Medicare |
$58.08
|
| Rate for Payer: Aetna Medicare |
$103.46
|
| Rate for Payer: Aetna Medicare |
$41.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.47
|
| Rate for Payer: BCBS Complete |
$82.77
|
| Rate for Payer: BCBS Complete |
$46.46
|
| Rate for Payer: BCBS Complete |
$33.52
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$92.92
|
| Rate for Payer: Cash Price |
$67.04
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$92.92
|
| Rate for Payer: Cash Price |
$67.04
|
| Rate for Payer: Cofinity Commercial |
$144.85
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Cofinity Commercial |
$99.89
|
| Rate for Payer: Cofinity Commercial |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$58.66
|
| Rate for Payer: Cofinity Commercial |
$72.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.04
|
| Rate for Payer: Healthscope Commercial |
$186.24
|
| Rate for Payer: Healthscope Commercial |
$104.54
|
| Rate for Payer: Healthscope Commercial |
$75.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.23
|
| Rate for Payer: PHP Commercial |
$175.89
|
| Rate for Payer: PHP Commercial |
$71.23
|
| Rate for Payer: PHP Commercial |
$98.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.50
|
| Rate for Payer: Priority Health SBD |
$73.17
|
| Rate for Payer: Priority Health SBD |
$52.79
|
| Rate for Payer: Priority Health SBD |
$130.37
|
|
|
VANCOMYCIN 1.25 GRAM/250 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$68.98
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$58.63
|
| Rate for Payer: Aetna Medicare |
$34.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.84
|
| Rate for Payer: BCBS Complete |
$27.59
|
| Rate for Payer: BCBS Trust/PPO |
$18.10
|
| Rate for Payer: BCN Commercial |
$18.10
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cofinity Commercial |
$48.29
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.18
|
| Rate for Payer: Healthscope Commercial |
$62.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.63
|
| Rate for Payer: PHP Commercial |
$58.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.84
|
| Rate for Payer: Priority Health SBD |
$43.46
|
|
|
VANCOMYCIN 1.25 GRAM/250 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$68.98
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$58.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.84
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cofinity Commercial |
$48.29
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.18
|
| Rate for Payer: Healthscope Commercial |
$62.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.63
|
| Rate for Payer: PHP Commercial |
$58.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.84
|
| Rate for Payer: Priority Health SBD |
$43.46
|
|
|
VANCOMYCIN 1.5 GRAM/300 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$82.77
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
189877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$74.49 |
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna Medicare |
$41.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.80
|
| Rate for Payer: BCBS Complete |
$33.11
|
| Rate for Payer: BCBS Trust/PPO |
$18.10
|
| Rate for Payer: BCN Commercial |
$18.10
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: Priority Health SBD |
$52.15
|
|
|
VANCOMYCIN 1.5 GRAM/300 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$82.77
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
189877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.15 |
| Max. Negotiated Rate |
$74.49 |
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.80
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: Priority Health SBD |
$52.15
|
|
|
VANCOMYCIN 1.75 GRAM/350 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$96.57
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$86.91 |
| Rate for Payer: Aetna Commercial |
$82.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.77
|
| Rate for Payer: Cash Price |
$77.26
|
| Rate for Payer: Cofinity Commercial |
$67.60
|
| Rate for Payer: Cofinity Commercial |
$83.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.26
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.08
|
| Rate for Payer: PHP Commercial |
$82.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.77
|
| Rate for Payer: Priority Health SBD |
$60.84
|
|
|
VANCOMYCIN 1.75 GRAM/350 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$96.57
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$86.91 |
| Rate for Payer: Aetna Commercial |
$82.08
|
| Rate for Payer: Aetna Medicare |
$48.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.77
|
| Rate for Payer: BCBS Complete |
$38.63
|
| Rate for Payer: BCBS Trust/PPO |
$18.10
|
| Rate for Payer: BCN Commercial |
$18.10
|
| Rate for Payer: Cash Price |
$77.26
|
| Rate for Payer: Cash Price |
$77.26
|
| Rate for Payer: Cofinity Commercial |
$67.60
|
| Rate for Payer: Cofinity Commercial |
$83.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.26
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.08
|
| Rate for Payer: PHP Commercial |
$82.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.77
|
| Rate for Payer: Priority Health SBD |
$60.84
|
|
|
VANCOMYCIN 1 G POWDER (INTRA-OP)
|
Facility
|
OP
|
$17.03
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
154997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Aetna Commercial |
$14.48
|
| Rate for Payer: Aetna Commercial |
$20.76
|
| Rate for Payer: Aetna Medicare |
$12.21
|
| Rate for Payer: Aetna Medicare |
$8.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.87
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS Complete |
$6.81
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Cofinity Commercial |
$11.92
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.54
|
| Rate for Payer: Healthscope Commercial |
$21.98
|
| Rate for Payer: Healthscope Commercial |
$15.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.48
|
| Rate for Payer: PHP Commercial |
$20.76
|
| Rate for Payer: PHP Commercial |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.07
|
| Rate for Payer: Priority Health SBD |
$15.38
|
| Rate for Payer: Priority Health SBD |
$10.73
|
|
|
VANCOMYCIN 1 G POWDER (INTRA-OP)
|
Facility
|
IP
|
$24.42
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
154997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$21.98 |
| Rate for Payer: Aetna Commercial |
$20.76
|
| Rate for Payer: Aetna Commercial |
$14.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$11.92
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.54
|
| Rate for Payer: Healthscope Commercial |
$21.98
|
| Rate for Payer: Healthscope Commercial |
$15.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.48
|
| Rate for Payer: PHP Commercial |
$14.48
|
| Rate for Payer: PHP Commercial |
$20.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.87
|
| Rate for Payer: Priority Health SBD |
$15.38
|
| Rate for Payer: Priority Health SBD |
$10.73
|
|
|
VANCOMYCIN 1 G WITH GELATIN POWDER 1 G IN 6ML NS IRRIGATION
|
Facility
|
OP
|
$84.70
|
|
|
Service Code
|
NDC 00009000300
|
| Hospital Charge Code |
500529
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Medicare |
$42.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.06
|
| Rate for Payer: BCBS Complete |
$33.88
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Commercial |
$59.29
|
| Rate for Payer: Cofinity Commercial |
$72.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.76
|
| Rate for Payer: Healthscope Commercial |
$76.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.00
|
| Rate for Payer: PHP Commercial |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.06
|
| Rate for Payer: Priority Health SBD |
$53.36
|
|
|
VANCOMYCIN 1 G WITH GELATIN POWDER 1 G IN 6ML NS IRRIGATION
|
Facility
|
IP
|
$84.70
|
|
|
Service Code
|
NDC 00009000300
|
| Hospital Charge Code |
500529
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.06
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Commercial |
$59.29
|
| Rate for Payer: Cofinity Commercial |
$72.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.76
|
| Rate for Payer: Healthscope Commercial |
$76.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.00
|
| Rate for Payer: PHP Commercial |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.06
|
| Rate for Payer: Priority Health SBD |
$53.36
|
|
|
VANCOMYCIN 2 GRAM/400 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$110.36
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
190617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.53 |
| Max. Negotiated Rate |
$99.32 |
| Rate for Payer: Aetna Commercial |
$93.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.73
|
| Rate for Payer: Cash Price |
$88.29
|
| Rate for Payer: Cofinity Commercial |
$77.25
|
| Rate for Payer: Cofinity Commercial |
$94.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.29
|
| Rate for Payer: Healthscope Commercial |
$99.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.81
|
| Rate for Payer: PHP Commercial |
$93.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.73
|
| Rate for Payer: Priority Health SBD |
$69.53
|
|
|
VANCOMYCIN 2 GRAM/400 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$110.36
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
190617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$99.32 |
| Rate for Payer: Aetna Commercial |
$93.81
|
| Rate for Payer: Aetna Medicare |
$55.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.73
|
| Rate for Payer: BCBS Complete |
$44.14
|
| Rate for Payer: BCBS Trust/PPO |
$18.10
|
| Rate for Payer: BCN Commercial |
$18.10
|
| Rate for Payer: Cash Price |
$88.29
|
| Rate for Payer: Cash Price |
$88.29
|
| Rate for Payer: Cofinity Commercial |
$77.25
|
| Rate for Payer: Cofinity Commercial |
$94.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.29
|
| Rate for Payer: Healthscope Commercial |
$99.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.81
|
| Rate for Payer: PHP Commercial |
$93.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.73
|
| Rate for Payer: Priority Health SBD |
$69.53
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
301723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.27 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Aetna Commercial |
$24.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.85
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$20.30
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Healthscope Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health SBD |
$18.27
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
301723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Aetna Commercial |
$24.65
|
| Rate for Payer: Aetna Medicare |
$14.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.85
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$20.30
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Healthscope Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health SBD |
$18.27
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.27 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Aetna Commercial |
$24.65
|
| Rate for Payer: Aetna Commercial |
$13.75
|
| Rate for Payer: Aetna Commercial |
$23.25
|
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna Commercial |
$10.32
|
| Rate for Payer: Aetna Commercial |
$23.20
|
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.83
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$21.88
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: Cofinity Commercial |
$23.00
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Cofinity Commercial |
$10.44
|
| Rate for Payer: Cofinity Commercial |
$8.50
|
| Rate for Payer: Cofinity Commercial |
$11.33
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$19.10
|
| Rate for Payer: Cofinity Commercial |
$23.47
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$23.52
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$24.91
|
| Rate for Payer: Cofinity Commercial |
$20.30
|
| Rate for Payer: Cofinity Commercial |
$28.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Healthscope Commercial |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$26.07
|
| Rate for Payer: Healthscope Commercial |
$24.56
|
| Rate for Payer: Healthscope Commercial |
$24.62
|
| Rate for Payer: Healthscope Commercial |
$10.93
|
| Rate for Payer: Healthscope Commercial |
$26.10
|
| Rate for Payer: Healthscope Commercial |
$29.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.93
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: PHP Commercial |
$23.20
|
| Rate for Payer: PHP Commercial |
$10.32
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: PHP Commercial |
$23.25
|
| Rate for Payer: PHP Commercial |
$13.75
|
| Rate for Payer: PHP Commercial |
$27.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.52
|
| Rate for Payer: Priority Health SBD |
$18.25
|
| Rate for Payer: Priority Health SBD |
$10.19
|
| Rate for Payer: Priority Health SBD |
$20.70
|
| Rate for Payer: Priority Health SBD |
$7.65
|
| Rate for Payer: Priority Health SBD |
$17.19
|
| Rate for Payer: Priority Health SBD |
$17.23
|
| Rate for Payer: Priority Health SBD |
$18.27
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.35
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$24.62 |
| Rate for Payer: Aetna Commercial |
$23.25
|
| Rate for Payer: Aetna Commercial |
$23.20
|
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna Commercial |
$13.75
|
| Rate for Payer: Aetna Commercial |
$10.32
|
| Rate for Payer: Aetna Commercial |
$24.65
|
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna Medicare |
$14.48
|
| Rate for Payer: Aetna Medicare |
$13.64
|
| Rate for Payer: Aetna Medicare |
$6.07
|
| Rate for Payer: Aetna Medicare |
$13.68
|
| Rate for Payer: Aetna Medicare |
$8.09
|
| Rate for Payer: Aetna Medicare |
$16.43
|
| Rate for Payer: Aetna Medicare |
$14.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.36
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: BCBS Complete |
$4.86
|
| Rate for Payer: BCBS Complete |
$11.59
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Complete |
$13.14
|
| Rate for Payer: BCBS Complete |
$10.92
|
| Rate for Payer: BCBS Complete |
$10.94
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: Cash Price |
$21.88
|
| Rate for Payer: Cash Price |
$21.88
|
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cofinity Commercial |
$23.52
|
| Rate for Payer: Cofinity Commercial |
$10.44
|
| Rate for Payer: Cofinity Commercial |
$8.50
|
| Rate for Payer: Cofinity Commercial |
$11.33
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$19.10
|
| Rate for Payer: Cofinity Commercial |
$23.47
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$28.26
|
| Rate for Payer: Cofinity Commercial |
$23.00
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$24.91
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Cofinity Commercial |
$20.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Healthscope Commercial |
$26.07
|
| Rate for Payer: Healthscope Commercial |
$24.56
|
| Rate for Payer: Healthscope Commercial |
$24.62
|
| Rate for Payer: Healthscope Commercial |
$29.57
|
| Rate for Payer: Healthscope Commercial |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$26.10
|
| Rate for Payer: Healthscope Commercial |
$10.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.20
|
| Rate for Payer: PHP Commercial |
$23.25
|
| Rate for Payer: PHP Commercial |
$13.75
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: PHP Commercial |
$27.93
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: PHP Commercial |
$23.20
|
| Rate for Payer: PHP Commercial |
$10.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.89
|
| Rate for Payer: Priority Health SBD |
$18.25
|
| Rate for Payer: Priority Health SBD |
$18.27
|
| Rate for Payer: Priority Health SBD |
$17.23
|
| Rate for Payer: Priority Health SBD |
$17.19
|
| Rate for Payer: Priority Health SBD |
$7.65
|
| Rate for Payer: Priority Health SBD |
$10.19
|
| Rate for Payer: Priority Health SBD |
$20.70
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$957.60
|
|
|
Service Code
|
NDC 65628020110
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$383.04 |
| Max. Negotiated Rate |
$861.84 |
| Rate for Payer: Aetna Commercial |
$813.96
|
| Rate for Payer: Aetna Medicare |
$478.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.44
|
| Rate for Payer: BCBS Complete |
$383.04
|
| Rate for Payer: Cash Price |
$766.08
|
| Rate for Payer: Cofinity Commercial |
$670.32
|
| Rate for Payer: Cofinity Commercial |
$823.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$670.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.08
|
| Rate for Payer: Healthscope Commercial |
$861.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$813.96
|
| Rate for Payer: PHP Commercial |
$813.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.44
|
| Rate for Payer: Priority Health SBD |
$603.29
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$891.36
|
|
|
Service Code
|
NDC 65628020810
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$561.56 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: Aetna Commercial |
$757.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.38
|
| Rate for Payer: Cash Price |
$713.09
|
| Rate for Payer: Cofinity Commercial |
$766.57
|
| Rate for Payer: Cofinity Commercial |
$623.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$623.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.09
|
| Rate for Payer: Healthscope Commercial |
$802.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$757.66
|
| Rate for Payer: PHP Commercial |
$757.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.38
|
| Rate for Payer: Priority Health SBD |
$561.56
|
|
