|
VALGANCICLOVIR 450 MG TABLET
|
Facility
IP
|
$3,201.91
|
|
|
Service Code
|
NDC 0904-6796-04
|
| Hospital Charge Code |
30148
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,017.20 |
| Max. Negotiated Rate |
$2,881.72 |
| Rate for Payer: Aetna Commercial |
$2,721.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,081.24
|
| Rate for Payer: Cash Price |
$2,561.53
|
| Rate for Payer: Cofinity Commercial |
$2,241.34
|
| Rate for Payer: Cofinity Commercial |
$2,753.64
|
| Rate for Payer: Healthscope Commercial |
$2,881.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,721.62
|
| Rate for Payer: PHP Commercial |
$2,721.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,241.34
|
| Rate for Payer: Priority Health SBD |
$2,017.20
|
|
|
VALGANCICLOVIR 450 MG TABLET
|
Facility
IP
|
$112.13
|
|
|
Service Code
|
NDC 68084-965-95
|
| Hospital Charge Code |
30148
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.64 |
| Max. Negotiated Rate |
$100.92 |
| Rate for Payer: Aetna Commercial |
$95.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.88
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cofinity Commercial |
$78.49
|
| Rate for Payer: Cofinity Commercial |
$96.43
|
| Rate for Payer: Healthscope Commercial |
$100.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.31
|
| Rate for Payer: PHP Commercial |
$95.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.49
|
| Rate for Payer: Priority Health SBD |
$70.64
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$16.17
|
|
|
Service Code
|
NDC 0143-9785-10
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.51
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.74
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.32
|
| Rate for Payer: Priority Health SBD |
$10.19
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
IP
|
$250.80
|
|
|
Service Code
|
NDC 63739-086-10
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$225.72 |
| Rate for Payer: Aetna Commercial |
$213.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.02
|
| Rate for Payer: Cash Price |
$200.64
|
| Rate for Payer: Cofinity Commercial |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$215.69
|
| Rate for Payer: Healthscope Commercial |
$225.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.18
|
| Rate for Payer: PHP Commercial |
$213.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.56
|
| Rate for Payer: Priority Health SBD |
$158.00
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
IP
|
$352.50
|
|
|
Service Code
|
NDC 69452-150-20
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.08 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.12
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$246.75
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.62
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.75
|
| Rate for Payer: Priority Health SBD |
$222.08
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION
|
Facility
IP
|
$17.63
|
|
|
Service Code
|
NDC 68094-701-59
|
| Hospital Charge Code |
156035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$15.87 |
| Rate for Payer: Aetna Commercial |
$14.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.46
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cofinity Commercial |
$12.34
|
| Rate for Payer: Cofinity Commercial |
$15.16
|
| Rate for Payer: Healthscope Commercial |
$15.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.99
|
| Rate for Payer: PHP Commercial |
$14.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.34
|
| Rate for Payer: Priority Health SBD |
$11.11
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION
|
Facility
IP
|
$17.63
|
|
|
Service Code
|
NDC 68094-701-61
|
| Hospital Charge Code |
156035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$15.87 |
| Rate for Payer: Aetna Commercial |
$14.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.46
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cofinity Commercial |
$12.34
|
| Rate for Payer: Cofinity Commercial |
$15.16
|
| Rate for Payer: Healthscope Commercial |
$15.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.99
|
| Rate for Payer: PHP Commercial |
$14.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.34
|
| Rate for Payer: Priority Health SBD |
$11.11
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION
|
Facility
IP
|
$18.33
|
|
|
Service Code
|
NDC 60687-262-48
|
| Hospital Charge Code |
156035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Aetna Commercial |
$15.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.91
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$12.83
|
| Rate for Payer: Cofinity Commercial |
$15.76
|
| Rate for Payer: Healthscope Commercial |
$16.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.58
|
| Rate for Payer: PHP Commercial |
$15.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.83
|
| Rate for Payer: Priority Health SBD |
$11.55
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION
|
Facility
IP
|
$18.33
|
|
|
Service Code
|
NDC 60687-262-42
|
| Hospital Charge Code |
156035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Aetna Commercial |
$15.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.91
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$12.83
|
| Rate for Payer: Cofinity Commercial |
$15.76
|
| Rate for Payer: Healthscope Commercial |
$16.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.58
|
| Rate for Payer: PHP Commercial |
$15.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.83
|
| Rate for Payer: Priority Health SBD |
$11.55
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION
|
Facility
IP
|
$22.56
|
|
|
Service Code
|
NDC 68094-701-62
|
| Hospital Charge Code |
156035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$20.30 |
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.66
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Cofinity Commercial |
$19.40
|
| Rate for Payer: Healthscope Commercial |
$20.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.18
|
| Rate for Payer: PHP Commercial |
$19.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.79
|
| Rate for Payer: Priority Health SBD |
$14.21
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION
|
Facility
IP
|
$18.33
|
|
|
Service Code
|
NDC 60687-262-56
|
| Hospital Charge Code |
156035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Aetna Commercial |
$15.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.91
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$12.83
|
| Rate for Payer: Cofinity Commercial |
$15.76
|
| Rate for Payer: Healthscope Commercial |
$16.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.58
|
| Rate for Payer: PHP Commercial |
$15.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.83
|
| Rate for Payer: Priority Health SBD |
$11.55
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION
|
Facility
IP
|
$19.38
|
|
|
Service Code
|
NDC 0121-1350-10
|
| Hospital Charge Code |
156035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$17.44 |
| Rate for Payer: Aetna Commercial |
$16.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.60
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cofinity Commercial |
$13.57
|
| Rate for Payer: Cofinity Commercial |
$16.67
|
| Rate for Payer: Healthscope Commercial |
$17.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.47
|
| Rate for Payer: PHP Commercial |
$16.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: Priority Health SBD |
$12.21
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION
|
Facility
IP
|
$19.38
|
|
|
Service Code
|
NDC 0121-1350-00
|
| Hospital Charge Code |
156035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$17.44 |
| Rate for Payer: Aetna Commercial |
$16.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.60
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cofinity Commercial |
$13.57
|
| Rate for Payer: Cofinity Commercial |
$16.67
|
| Rate for Payer: Healthscope Commercial |
$17.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.47
|
| Rate for Payer: PHP Commercial |
$16.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: Priority Health SBD |
$12.21
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
IP
|
$342.63
|
|
|
Service Code
|
NDC 43547-367-09
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.86 |
| Max. Negotiated Rate |
$308.37 |
| Rate for Payer: Aetna Commercial |
$291.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.71
|
| Rate for Payer: Cash Price |
$274.10
|
| Rate for Payer: Cofinity Commercial |
$239.84
|
| Rate for Payer: Cofinity Commercial |
$294.66
|
| Rate for Payer: Healthscope Commercial |
$308.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.24
|
| Rate for Payer: PHP Commercial |
$291.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.84
|
| Rate for Payer: Priority Health SBD |
$215.86
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
IP
|
$111.60
|
|
|
Service Code
|
NDC 60687-612-21
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.31 |
| Max. Negotiated Rate |
$100.44 |
| Rate for Payer: Aetna Commercial |
$94.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.54
|
| Rate for Payer: Cash Price |
$89.28
|
| Rate for Payer: Cofinity Commercial |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$95.98
|
| Rate for Payer: Healthscope Commercial |
$100.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.86
|
| Rate for Payer: PHP Commercial |
$94.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.12
|
| Rate for Payer: Priority Health SBD |
$70.31
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
IP
|
$3.72
|
|
|
Service Code
|
NDC 60687-612-11
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.16
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: Priority Health SBD |
$2.34
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
IP
|
$2,806.86
|
|
|
Service Code
|
NDC 0078-0358-34
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,768.32 |
| Max. Negotiated Rate |
$2,526.17 |
| Rate for Payer: Aetna Commercial |
$2,385.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,824.46
|
| Rate for Payer: Cash Price |
$2,245.49
|
| Rate for Payer: Cofinity Commercial |
$1,964.80
|
| Rate for Payer: Cofinity Commercial |
$2,413.90
|
| Rate for Payer: Healthscope Commercial |
$2,526.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,385.83
|
| Rate for Payer: PHP Commercial |
$2,385.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,964.80
|
| Rate for Payer: Priority Health SBD |
$1,768.32
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
IP
|
$265.05
|
|
|
Service Code
|
NDC 0378-5813-77
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.98 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Commercial |
$185.54
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.29
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.54
|
| Rate for Payer: Priority Health SBD |
$166.98
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION
|
Facility
IP
|
$18.90
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$17.01 |
| Rate for Payer: Aetna Commercial |
$16.06
|
| Rate for Payer: Aetna Commercial |
$14.82
|
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Commercial |
$15.26
|
| Rate for Payer: Aetna Commercial |
$15.76
|
| Rate for Payer: Aetna Commercial |
$19.02
|
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$18.28
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Commercial |
$14.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.28
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$13.78
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cofinity Commercial |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$15.18
|
| Rate for Payer: Cofinity Commercial |
$15.67
|
| Rate for Payer: Cofinity Commercial |
$16.25
|
| Rate for Payer: Cofinity Commercial |
$19.25
|
| Rate for Payer: Cofinity Commercial |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Cofinity Commercial |
$16.14
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$15.94
|
| Rate for Payer: Cofinity Commercial |
$12.56
|
| Rate for Payer: Cofinity Commercial |
$15.44
|
| Rate for Payer: Cofinity Commercial |
$14.81
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| Rate for Payer: Cofinity Commercial |
$12.98
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$13.23
|
| Rate for Payer: Cofinity Commercial |
$15.05
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Cofinity Commercial |
$15.00
|
| Rate for Payer: Cofinity Commercial |
$12.21
|
| Rate for Payer: Healthscope Commercial |
$17.39
|
| Rate for Payer: Healthscope Commercial |
$15.50
|
| Rate for Payer: Healthscope Commercial |
$15.68
|
| Rate for Payer: Healthscope Commercial |
$15.70
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: Healthscope Commercial |
$16.69
|
| Rate for Payer: Healthscope Commercial |
$17.01
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$20.14
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.42
|
| Rate for Payer: PHP Commercial |
$14.82
|
| Rate for Payer: PHP Commercial |
$15.26
|
| Rate for Payer: PHP Commercial |
$16.42
|
| Rate for Payer: PHP Commercial |
$15.00
|
| Rate for Payer: PHP Commercial |
$15.76
|
| Rate for Payer: PHP Commercial |
$18.28
|
| Rate for Payer: PHP Commercial |
$14.81
|
| Rate for Payer: PHP Commercial |
$19.02
|
| Rate for Payer: PHP Commercial |
$14.64
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$16.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.67
|
| Rate for Payer: Priority Health SBD |
$14.53
|
| Rate for Payer: Priority Health SBD |
$13.54
|
| Rate for Payer: Priority Health SBD |
$11.12
|
| Rate for Payer: Priority Health SBD |
$10.97
|
| Rate for Payer: Priority Health SBD |
$14.10
|
| Rate for Payer: Priority Health SBD |
$10.85
|
| Rate for Payer: Priority Health SBD |
$11.68
|
| Rate for Payer: Priority Health SBD |
$11.91
|
| Rate for Payer: Priority Health SBD |
$12.17
|
| Rate for Payer: Priority Health SBD |
$10.99
|
| Rate for Payer: Priority Health SBD |
$11.31
|
|
|
VANCOMYCIN 100 MG/ML PF IV SOLN CUSTOM
|
Facility
IP
|
$19.32
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
150719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$17.39 |
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$19.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$15.67
|
| Rate for Payer: Cofinity Commercial |
$19.25
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| Rate for Payer: Healthscope Commercial |
$20.14
|
| Rate for Payer: Healthscope Commercial |
$17.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.02
|
| Rate for Payer: PHP Commercial |
$19.02
|
| Rate for Payer: PHP Commercial |
$16.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.67
|
| Rate for Payer: Priority Health SBD |
$12.17
|
| Rate for Payer: Priority Health SBD |
$14.10
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
IP
|
$206.93
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.37 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$175.89
|
| Rate for Payer: Aetna Commercial |
$114.35
|
| Rate for Payer: Aetna Commercial |
$98.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: Cash Price |
$92.92
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$107.62
|
| Rate for Payer: Cofinity Commercial |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Cofinity Commercial |
$99.89
|
| Rate for Payer: Cofinity Commercial |
$115.70
|
| Rate for Payer: Cofinity Commercial |
$94.17
|
| Rate for Payer: Cofinity Commercial |
$144.85
|
| Rate for Payer: Healthscope Commercial |
$104.54
|
| Rate for Payer: Healthscope Commercial |
$121.08
|
| Rate for Payer: Healthscope Commercial |
$186.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.89
|
| Rate for Payer: PHP Commercial |
$98.73
|
| Rate for Payer: PHP Commercial |
$114.35
|
| Rate for Payer: PHP Commercial |
$175.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.30
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: Priority Health SBD |
$84.75
|
| Rate for Payer: Priority Health SBD |
$73.17
|
|
|
VANCOMYCIN 1 G POWDER (INTRA-OP)
|
Facility
IP
|
$19.32
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
154997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$17.39 |
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$19.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.56
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| Rate for Payer: Cofinity Commercial |
$15.67
|
| Rate for Payer: Cofinity Commercial |
$19.25
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Healthscope Commercial |
$20.14
|
| Rate for Payer: Healthscope Commercial |
$17.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.02
|
| Rate for Payer: PHP Commercial |
$16.42
|
| Rate for Payer: PHP Commercial |
$19.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.52
|
| Rate for Payer: Priority Health SBD |
$12.17
|
| Rate for Payer: Priority Health SBD |
$14.10
|
|
|
VANCOMYCIN 1 G WITH GELATIN POWDER 1 G IN 6ML NS IRRIGATION
|
Facility
IP
|
$84.70
|
|
|
Service Code
|
NDC 0009-0003-00
|
| 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: Healthscope Commercial |
$76.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.00
|
| Rate for Payer: PHP Commercial |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.29
|
| Rate for Payer: Priority Health SBD |
$53.36
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$16.18
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$14.56 |
| Rate for Payer: Aetna Commercial |
$13.75
|
| Rate for Payer: Aetna Commercial |
$16.01
|
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna Commercial |
$14.64
|
| Rate for Payer: Aetna Commercial |
$23.25
|
| Rate for Payer: Aetna Commercial |
$24.65
|
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.36
|
| Rate for Payer: Cash Price |
$15.07
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$21.88
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cash Price |
$13.78
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cofinity Commercial |
$24.91
|
| Rate for Payer: Cofinity Commercial |
$11.33
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$14.81
|
| Rate for Payer: Cofinity Commercial |
$13.19
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| 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 |
$20.30
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Cofinity Commercial |
$23.00
|
| Rate for Payer: Cofinity Commercial |
$28.26
|
| Rate for Payer: Healthscope Commercial |
$26.10
|
| Rate for Payer: Healthscope Commercial |
$29.57
|
| Rate for Payer: Healthscope Commercial |
$24.62
|
| Rate for Payer: Healthscope Commercial |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$26.07
|
| Rate for Payer: Healthscope Commercial |
$15.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.93
|
| Rate for Payer: PHP Commercial |
$23.25
|
| Rate for Payer: PHP Commercial |
$16.01
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: PHP Commercial |
$27.93
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: PHP Commercial |
$13.75
|
| Rate for Payer: PHP Commercial |
$14.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: Priority Health SBD |
$18.27
|
| Rate for Payer: Priority Health SBD |
$17.23
|
| Rate for Payer: Priority Health SBD |
$10.85
|
| 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 |
$11.87
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
IP
|
$972.00
|
|
|
Service Code
|
NDC 65628-208-10
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$612.36 |
| Max. Negotiated Rate |
$874.80 |
| Rate for Payer: Aetna Commercial |
$826.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.80
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cofinity Commercial |
$680.40
|
| Rate for Payer: Cofinity Commercial |
$835.92
|
| Rate for Payer: Healthscope Commercial |
$874.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$826.20
|
| Rate for Payer: PHP Commercial |
$826.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.40
|
| Rate for Payer: Priority Health SBD |
$612.36
|
|
