VALACYCLOVIR 500 MG TABLET
|
Facility
IP
|
$487.20
|
|
Service Code
|
NDC 0904-6565-61
|
Hospital Charge Code |
13133
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$297.14 |
Max. Negotiated Rate |
$438.48 |
Rate for Payer: Aetna Commercial |
$414.12
|
Rate for Payer: BCBS Trust/PPO |
$376.51
|
Rate for Payer: BCN Commercial |
$376.51
|
Rate for Payer: Cash Price |
$389.76
|
Rate for Payer: Cofinity Commercial |
$418.99
|
Rate for Payer: Encore Health Key Benefits Commercial |
$389.76
|
Rate for Payer: Healthscope Commercial |
$438.48
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$365.40
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$414.12
|
Rate for Payer: PHP Commercial |
$414.12
|
Rate for Payer: Priority Health Cigna Priority Health |
$341.04
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$423.86
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$297.14
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$428.74
|
Rate for Payer: UHC Core |
$406.81
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$365.40
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
IP
|
$76.76
|
|
Service Code
|
NDC 59746-324-30
|
Hospital Charge Code |
13133
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$46.82 |
Max. Negotiated Rate |
$69.08 |
Rate for Payer: Aetna Commercial |
$65.25
|
Rate for Payer: BCBS Trust/PPO |
$59.32
|
Rate for Payer: BCN Commercial |
$59.32
|
Rate for Payer: Cash Price |
$61.41
|
Rate for Payer: Cofinity Commercial |
$66.01
|
Rate for Payer: Encore Health Key Benefits Commercial |
$61.41
|
Rate for Payer: Healthscope Commercial |
$69.08
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.57
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.25
|
Rate for Payer: PHP Commercial |
$65.25
|
Rate for Payer: Priority Health Cigna Priority Health |
$53.73
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.78
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$46.82
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$67.55
|
Rate for Payer: UHC Core |
$64.09
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.57
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$16.17
|
|
Service Code
|
NDC 0143-9637-01
|
Hospital Charge Code |
20887
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$9.86 |
Max. Negotiated Rate |
$14.55 |
Rate for Payer: Aetna Commercial |
$13.74
|
Rate for Payer: BCBS Trust/PPO |
$12.50
|
Rate for Payer: BCN Commercial |
$12.50
|
Rate for Payer: Cash Price |
$12.94
|
Rate for Payer: Cofinity Commercial |
$13.91
|
Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
Rate for Payer: Healthscope Commercial |
$14.55
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
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 HMO/PPO/Tiered Network |
$14.07
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$9.86
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$14.23
|
Rate for Payer: UHC Core |
$13.50
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$16.17
|
|
Service Code
|
NDC 0143-9637-10
|
Hospital Charge Code |
20887
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$9.86 |
Max. Negotiated Rate |
$14.55 |
Rate for Payer: Aetna Commercial |
$13.74
|
Rate for Payer: BCBS Trust/PPO |
$12.50
|
Rate for Payer: BCN Commercial |
$12.50
|
Rate for Payer: Cash Price |
$12.94
|
Rate for Payer: Cofinity Commercial |
$13.91
|
Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
Rate for Payer: Healthscope Commercial |
$14.55
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
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 HMO/PPO/Tiered Network |
$14.07
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$9.86
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$14.23
|
Rate for Payer: UHC Core |
$13.50
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
IP
|
$3.85
|
|
Service Code
|
NDC 68094-193-59
|
Hospital Charge Code |
150931
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$2.35 |
Max. Negotiated Rate |
$3.46 |
Rate for Payer: Aetna Commercial |
$3.27
|
Rate for Payer: BCBS Trust/PPO |
$2.98
|
Rate for Payer: BCN Commercial |
$2.98
|
Rate for Payer: Cash Price |
$3.08
|
Rate for Payer: Cofinity Commercial |
$3.31
|
Rate for Payer: Encore Health Key Benefits Commercial |
$3.08
|
Rate for Payer: Healthscope Commercial |
$3.46
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.89
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.27
|
Rate for Payer: PHP Commercial |
$3.27
|
Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.35
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$2.35
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$3.39
|
Rate for Payer: UHC Core |
$3.21
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.89
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
IP
|
$5.57
|
|
Service Code
|
NDC 0121-4675-05
|
Hospital Charge Code |
150931
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$3.40 |
Max. Negotiated Rate |
$5.01 |
Rate for Payer: Aetna Commercial |
$4.73
|
Rate for Payer: BCBS Trust/PPO |
$4.30
|
Rate for Payer: BCN Commercial |
$4.30
|
Rate for Payer: Cash Price |
$4.46
|
Rate for Payer: Cofinity Commercial |
$4.79
|
Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
Rate for Payer: Healthscope Commercial |
$5.01
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.18
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.73
|
Rate for Payer: PHP Commercial |
$4.73
|
Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.85
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$3.40
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$4.90
|
Rate for Payer: UHC Core |
$4.65
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.18
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
IP
|
$5.57
|
|
Service Code
|
NDC 0121-4675-00
|
Hospital Charge Code |
150931
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$3.40 |
Max. Negotiated Rate |
$5.01 |
Rate for Payer: Aetna Commercial |
$4.73
|
Rate for Payer: BCBS Trust/PPO |
$4.30
|
Rate for Payer: BCN Commercial |
$4.30
|
Rate for Payer: Cash Price |
$4.46
|
Rate for Payer: Cofinity Commercial |
$4.79
|
Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
Rate for Payer: Healthscope Commercial |
$5.01
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.18
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.73
|
Rate for Payer: PHP Commercial |
$4.73
|
Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.85
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$3.40
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$4.90
|
Rate for Payer: UHC Core |
$4.65
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.18
|
|
VALSARTAN 160 MG TABLET
|
Facility
IP
|
$3,018.32
|
|
Service Code
|
NDC 0078-0359-34
|
Hospital Charge Code |
31210
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$1,840.87 |
Max. Negotiated Rate |
$2,716.49 |
Rate for Payer: Aetna Commercial |
$2,565.57
|
Rate for Payer: BCBS Trust/PPO |
$2,332.56
|
Rate for Payer: BCN Commercial |
$2,332.56
|
Rate for Payer: Cash Price |
$2,414.66
|
Rate for Payer: Cofinity Commercial |
$2,595.76
|
Rate for Payer: Encore Health Key Benefits Commercial |
$2,414.66
|
Rate for Payer: Healthscope Commercial |
$2,716.49
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,263.74
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,565.57
|
Rate for Payer: PHP Commercial |
$2,565.57
|
Rate for Payer: Priority Health Cigna Priority Health |
$2,112.82
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,625.94
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$1,840.87
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$2,656.12
|
Rate for Payer: UHC Core |
$2,520.30
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,263.74
|
|
VALSARTAN 160 MG TABLET
|
Facility
IP
|
$233.42
|
|
Service Code
|
NDC 65862-572-90
|
Hospital Charge Code |
31210
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$142.36 |
Max. Negotiated Rate |
$210.08 |
Rate for Payer: Aetna Commercial |
$198.41
|
Rate for Payer: BCBS Trust/PPO |
$180.39
|
Rate for Payer: BCN Commercial |
$180.39
|
Rate for Payer: Cash Price |
$186.74
|
Rate for Payer: Cofinity Commercial |
$200.74
|
Rate for Payer: Encore Health Key Benefits Commercial |
$186.74
|
Rate for Payer: Healthscope Commercial |
$210.08
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.06
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$198.41
|
Rate for Payer: PHP Commercial |
$198.41
|
Rate for Payer: Priority Health Cigna Priority Health |
$163.39
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$203.08
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$142.36
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$205.41
|
Rate for Payer: UHC Core |
$194.91
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.06
|
|
VALSARTAN 160 MG TABLET
|
Facility
IP
|
$5.33
|
|
Service Code
|
NDC 60687-634-11
|
Hospital Charge Code |
31210
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$3.25 |
Max. Negotiated Rate |
$4.80 |
Rate for Payer: Aetna Commercial |
$4.53
|
Rate for Payer: BCBS Trust/PPO |
$4.12
|
Rate for Payer: BCN Commercial |
$4.12
|
Rate for Payer: Cash Price |
$4.26
|
Rate for Payer: Cofinity Commercial |
$4.58
|
Rate for Payer: Encore Health Key Benefits Commercial |
$4.26
|
Rate for Payer: Healthscope Commercial |
$4.80
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.53
|
Rate for Payer: PHP Commercial |
$4.53
|
Rate for Payer: Priority Health Cigna Priority Health |
$3.73
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.64
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$3.25
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$4.69
|
Rate for Payer: UHC Core |
$4.45
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.00
|
|
VALSARTAN 160 MG TABLET
|
Facility
IP
|
$532.32
|
|
Service Code
|
NDC 60687-634-01
|
Hospital Charge Code |
31210
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$324.66 |
Max. Negotiated Rate |
$479.09 |
Rate for Payer: Aetna Commercial |
$452.47
|
Rate for Payer: BCBS Trust/PPO |
$411.38
|
Rate for Payer: BCN Commercial |
$411.38
|
Rate for Payer: Cash Price |
$425.86
|
Rate for Payer: Cofinity Commercial |
$457.80
|
Rate for Payer: Encore Health Key Benefits Commercial |
$425.86
|
Rate for Payer: Healthscope Commercial |
$479.09
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$399.24
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$452.47
|
Rate for Payer: PHP Commercial |
$452.47
|
Rate for Payer: Priority Health Cigna Priority Health |
$372.62
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$463.12
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$324.66
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$468.44
|
Rate for Payer: UHC Core |
$444.49
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$399.24
|
|
VALSARTAN 40 MG TABLET
|
Facility
IP
|
$782.67
|
|
Service Code
|
NDC 0078-0423-15
|
Hospital Charge Code |
33541
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$477.35 |
Max. Negotiated Rate |
$704.40 |
Rate for Payer: Aetna Commercial |
$665.27
|
Rate for Payer: BCBS Trust/PPO |
$604.85
|
Rate for Payer: BCN Commercial |
$604.85
|
Rate for Payer: Cash Price |
$626.14
|
Rate for Payer: Cofinity Commercial |
$673.10
|
Rate for Payer: Encore Health Key Benefits Commercial |
$626.14
|
Rate for Payer: Healthscope Commercial |
$704.40
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$587.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$665.27
|
Rate for Payer: PHP Commercial |
$665.27
|
Rate for Payer: Priority Health Cigna Priority Health |
$547.87
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$680.92
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$477.35
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$688.75
|
Rate for Payer: UHC Core |
$653.53
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$587.00
|
|
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 |
$68.06 |
Max. Negotiated Rate |
$100.44 |
Rate for Payer: Aetna Commercial |
$94.86
|
Rate for Payer: BCBS Trust/PPO |
$86.24
|
Rate for Payer: BCN Commercial |
$86.24
|
Rate for Payer: Cash Price |
$89.28
|
Rate for Payer: Cofinity Commercial |
$95.98
|
Rate for Payer: Encore Health Key Benefits Commercial |
$89.28
|
Rate for Payer: Healthscope Commercial |
$100.44
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.70
|
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 HMO/PPO/Tiered Network |
$97.09
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$68.06
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$98.21
|
Rate for Payer: UHC Core |
$93.19
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.70
|
|
VALSARTAN 40 MG TABLET
|
Facility
IP
|
$70.68
|
|
Service Code
|
NDC 0378-5807-93
|
Hospital Charge Code |
33541
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$43.11 |
Max. Negotiated Rate |
$63.61 |
Rate for Payer: Aetna Commercial |
$60.08
|
Rate for Payer: BCBS Trust/PPO |
$54.62
|
Rate for Payer: BCN Commercial |
$54.62
|
Rate for Payer: Cash Price |
$56.54
|
Rate for Payer: Cofinity Commercial |
$60.78
|
Rate for Payer: Encore Health Key Benefits Commercial |
$56.54
|
Rate for Payer: Healthscope Commercial |
$63.61
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.01
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.08
|
Rate for Payer: PHP Commercial |
$60.08
|
Rate for Payer: Priority Health Cigna Priority Health |
$49.48
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.49
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$43.11
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$62.20
|
Rate for Payer: UHC Core |
$59.02
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.01
|
|
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 |
$2.27 |
Max. Negotiated Rate |
$3.35 |
Rate for Payer: Aetna Commercial |
$3.16
|
Rate for Payer: BCBS Trust/PPO |
$2.87
|
Rate for Payer: BCN Commercial |
$2.87
|
Rate for Payer: Cash Price |
$2.98
|
Rate for Payer: Cofinity Commercial |
$3.20
|
Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
Rate for Payer: Healthscope Commercial |
$3.35
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
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 HMO/PPO/Tiered Network |
$3.24
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$2.27
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$3.27
|
Rate for Payer: UHC Core |
$3.11
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION
|
Facility
IP
|
$18.54
|
|
Service Code
|
HCPCS J3370
|
Hospital Charge Code |
8442
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$11.31 |
Max. Negotiated Rate |
$16.69 |
Rate for Payer: Aetna Commercial |
$15.76
|
Rate for Payer: Aetna Commercial |
$26.38
|
Rate for Payer: Aetna Commercial |
$15.00
|
Rate for Payer: Aetna Commercial |
$14.64
|
Rate for Payer: Aetna Commercial |
$14.81
|
Rate for Payer: Aetna Commercial |
$20.09
|
Rate for Payer: Aetna Commercial |
$16.42
|
Rate for Payer: BCBS Trust/PPO |
$23.99
|
Rate for Payer: BCBS Trust/PPO |
$14.93
|
Rate for Payer: BCBS Trust/PPO |
$13.46
|
Rate for Payer: BCBS Trust/PPO |
$13.31
|
Rate for Payer: BCBS Trust/PPO |
$13.64
|
Rate for Payer: BCBS Trust/PPO |
$14.33
|
Rate for Payer: BCBS Trust/PPO |
$18.26
|
Rate for Payer: BCN Commercial |
$13.64
|
Rate for Payer: BCN Commercial |
$13.31
|
Rate for Payer: BCN Commercial |
$23.99
|
Rate for Payer: BCN Commercial |
$18.26
|
Rate for Payer: BCN Commercial |
$14.93
|
Rate for Payer: BCN Commercial |
$13.46
|
Rate for Payer: BCN Commercial |
$14.33
|
Rate for Payer: Cash Price |
$15.46
|
Rate for Payer: Cash Price |
$14.83
|
Rate for Payer: Cash Price |
$13.78
|
Rate for Payer: Cash Price |
$18.90
|
Rate for Payer: Cash Price |
$24.83
|
Rate for Payer: Cash Price |
$14.12
|
Rate for Payer: Cash Price |
$13.94
|
Rate for Payer: Cofinity Commercial |
$14.98
|
Rate for Payer: Cofinity Commercial |
$14.81
|
Rate for Payer: Cofinity Commercial |
$15.18
|
Rate for Payer: Cofinity Commercial |
$15.94
|
Rate for Payer: Cofinity Commercial |
$16.62
|
Rate for Payer: Cofinity Commercial |
$20.32
|
Rate for Payer: Cofinity Commercial |
$26.69
|
Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
Rate for Payer: Encore Health Key Benefits Commercial |
$14.83
|
Rate for Payer: Encore Health Key Benefits Commercial |
$18.90
|
Rate for Payer: Encore Health Key Benefits Commercial |
$13.78
|
Rate for Payer: Encore Health Key Benefits Commercial |
$14.12
|
Rate for Payer: Encore Health Key Benefits Commercial |
$15.46
|
Rate for Payer: Healthscope Commercial |
$15.50
|
Rate for Payer: Healthscope Commercial |
$15.68
|
Rate for Payer: Healthscope Commercial |
$21.27
|
Rate for Payer: Healthscope Commercial |
$16.69
|
Rate for Payer: Healthscope Commercial |
$15.88
|
Rate for Payer: Healthscope Commercial |
$27.94
|
Rate for Payer: Healthscope Commercial |
$17.39
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.49
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.92
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.72
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.28
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.06
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.90
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.24
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.76
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.09
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.38
|
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 |
$16.42
|
Rate for Payer: PHP Commercial |
$26.38
|
Rate for Payer: PHP Commercial |
$15.00
|
Rate for Payer: PHP Commercial |
$14.81
|
Rate for Payer: PHP Commercial |
$15.76
|
Rate for Payer: PHP Commercial |
$16.42
|
Rate for Payer: PHP Commercial |
$14.64
|
Rate for Payer: PHP Commercial |
$20.09
|
Rate for Payer: Priority Health Cigna Priority Health |
$12.98
|
Rate for Payer: Priority Health Cigna Priority Health |
$12.05
|
Rate for Payer: Priority Health Cigna Priority Health |
$16.54
|
Rate for Payer: Priority Health Cigna Priority Health |
$21.73
|
Rate for Payer: Priority Health Cigna Priority Health |
$13.52
|
Rate for Payer: Priority Health Cigna Priority Health |
$12.36
|
Rate for Payer: Priority Health Cigna Priority Health |
$12.19
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.16
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.81
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.98
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.00
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.13
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.56
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.36
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$11.78
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$14.41
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$10.50
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$11.31
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$18.93
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$10.76
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$10.62
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$15.15
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$17.00
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$16.32
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$15.33
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$20.79
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$15.53
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$27.32
|
Rate for Payer: UHC Core |
$15.48
|
Rate for Payer: UHC Core |
$25.92
|
Rate for Payer: UHC Core |
$19.73
|
Rate for Payer: UHC Core |
$14.74
|
Rate for Payer: UHC Core |
$14.55
|
Rate for Payer: UHC Core |
$16.13
|
Rate for Payer: UHC Core |
$14.38
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.24
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.90
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.92
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.49
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.06
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.72
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.28
|
|
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 |
$42.07 |
Max. Negotiated Rate |
$62.08 |
Rate for Payer: Aetna Commercial |
$58.63
|
Rate for Payer: BCBS Trust/PPO |
$53.31
|
Rate for Payer: BCN Commercial |
$53.31
|
Rate for Payer: Cash Price |
$55.18
|
Rate for Payer: Cofinity Commercial |
$59.32
|
Rate for Payer: Encore Health Key Benefits Commercial |
$55.18
|
Rate for Payer: Healthscope Commercial |
$62.08
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.74
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.63
|
Rate for Payer: PHP Commercial |
$58.63
|
Rate for Payer: Priority Health Cigna Priority Health |
$48.29
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.01
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$42.07
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$60.70
|
Rate for Payer: UHC Core |
$57.60
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.74
|
|
VANCOMYCIN 125 MG CAPSULE
|
Facility
IP
|
$120.20
|
|
Service Code
|
NDC 0121-0867-20
|
Hospital Charge Code |
11628
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$73.31 |
Max. Negotiated Rate |
$108.18 |
Rate for Payer: Aetna Commercial |
$102.17
|
Rate for Payer: BCBS Trust/PPO |
$92.89
|
Rate for Payer: BCN Commercial |
$92.89
|
Rate for Payer: Cash Price |
$96.16
|
Rate for Payer: Cofinity Commercial |
$103.37
|
Rate for Payer: Encore Health Key Benefits Commercial |
$96.16
|
Rate for Payer: Healthscope Commercial |
$108.18
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.15
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.17
|
Rate for Payer: PHP Commercial |
$102.17
|
Rate for Payer: Priority Health Cigna Priority Health |
$84.14
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.57
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$73.31
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$105.78
|
Rate for Payer: UHC Core |
$100.37
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.15
|
|
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 |
$50.48 |
Max. Negotiated Rate |
$74.49 |
Rate for Payer: Aetna Commercial |
$70.35
|
Rate for Payer: BCBS Trust/PPO |
$63.96
|
Rate for Payer: BCN Commercial |
$63.96
|
Rate for Payer: Cash Price |
$66.22
|
Rate for Payer: Cofinity Commercial |
$71.18
|
Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
Rate for Payer: Healthscope Commercial |
$74.49
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.08
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.35
|
Rate for Payer: PHP Commercial |
$70.35
|
Rate for Payer: Priority Health Cigna Priority Health |
$57.94
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.01
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$50.48
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$72.84
|
Rate for Payer: UHC Core |
$69.11
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.08
|
|
VANCOMYCIN 1.5 GRAM INTRAVENOUS SOLUTION
|
Facility
IP
|
$51.37
|
|
Service Code
|
HCPCS J3370
|
Hospital Charge Code |
189183
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$31.33 |
Max. Negotiated Rate |
$46.23 |
Rate for Payer: Aetna Commercial |
$43.66
|
Rate for Payer: BCBS Trust/PPO |
$39.70
|
Rate for Payer: BCN Commercial |
$39.70
|
Rate for Payer: Cash Price |
$41.10
|
Rate for Payer: Cofinity Commercial |
$44.18
|
Rate for Payer: Encore Health Key Benefits Commercial |
$41.10
|
Rate for Payer: Healthscope Commercial |
$46.23
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.53
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.66
|
Rate for Payer: PHP Commercial |
$43.66
|
Rate for Payer: Priority Health Cigna Priority Health |
$35.96
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.69
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$31.33
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$45.21
|
Rate for Payer: UHC Core |
$42.89
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.53
|
|
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 |
$11.78 |
Max. Negotiated Rate |
$17.39 |
Rate for Payer: Aetna Commercial |
$16.42
|
Rate for Payer: BCBS Trust/PPO |
$14.93
|
Rate for Payer: BCN Commercial |
$14.93
|
Rate for Payer: Cash Price |
$15.46
|
Rate for Payer: Cofinity Commercial |
$16.62
|
Rate for Payer: Encore Health Key Benefits Commercial |
$15.46
|
Rate for Payer: Healthscope Commercial |
$17.39
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.49
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.42
|
Rate for Payer: PHP Commercial |
$16.42
|
Rate for Payer: Priority Health Cigna Priority Health |
$13.52
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.81
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$11.78
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$17.00
|
Rate for Payer: UHC Core |
$16.13
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.49
|
|
VANCOMYCIN 1 GRAM/200 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
IP
|
$55.18
|
|
Service Code
|
HCPCS J3372
|
Hospital Charge Code |
189876
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$33.65 |
Max. Negotiated Rate |
$49.66 |
Rate for Payer: Aetna Commercial |
$46.90
|
Rate for Payer: BCBS Trust/PPO |
$42.64
|
Rate for Payer: BCN Commercial |
$42.64
|
Rate for Payer: Cash Price |
$44.14
|
Rate for Payer: Cofinity Commercial |
$47.45
|
Rate for Payer: Encore Health Key Benefits Commercial |
$44.14
|
Rate for Payer: Healthscope Commercial |
$49.66
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.38
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.90
|
Rate for Payer: PHP Commercial |
$46.90
|
Rate for Payer: Priority Health Cigna Priority Health |
$38.63
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.01
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$33.65
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$48.56
|
Rate for Payer: UHC Core |
$46.08
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.38
|
|
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 |
$51.66 |
Max. Negotiated Rate |
$76.23 |
Rate for Payer: Aetna Commercial |
$72.00
|
Rate for Payer: BCBS Trust/PPO |
$65.46
|
Rate for Payer: BCN Commercial |
$65.46
|
Rate for Payer: Cash Price |
$67.76
|
Rate for Payer: Cofinity Commercial |
$72.84
|
Rate for Payer: Encore Health Key Benefits Commercial |
$67.76
|
Rate for Payer: Healthscope Commercial |
$76.23
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.52
|
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 HMO/PPO/Tiered Network |
$73.69
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$51.66
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$74.54
|
Rate for Payer: UHC Core |
$70.72
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.52
|
|
VANCOMYCIN 500 MG/100 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
IP
|
$27.59
|
|
Service Code
|
HCPCS J3372
|
Hospital Charge Code |
191707
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$16.83 |
Max. Negotiated Rate |
$24.83 |
Rate for Payer: Aetna Commercial |
$23.45
|
Rate for Payer: BCBS Trust/PPO |
$21.32
|
Rate for Payer: BCN Commercial |
$21.32
|
Rate for Payer: Cash Price |
$22.07
|
Rate for Payer: Cofinity Commercial |
$23.73
|
Rate for Payer: Encore Health Key Benefits Commercial |
$22.07
|
Rate for Payer: Healthscope Commercial |
$24.83
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.69
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.45
|
Rate for Payer: PHP Commercial |
$23.45
|
Rate for Payer: Priority Health Cigna Priority Health |
$19.31
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.00
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$16.83
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$24.28
|
Rate for Payer: UHC Core |
$23.04
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.69
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$16.18
|
|
Service Code
|
HCPCS J3370
|
Hospital Charge Code |
8443
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$9.87 |
Max. Negotiated Rate |
$14.56 |
Rate for Payer: Aetna Commercial |
$13.75
|
Rate for Payer: Aetna Commercial |
$22.24
|
Rate for Payer: Aetna Commercial |
$14.64
|
Rate for Payer: Aetna Commercial |
$24.65
|
Rate for Payer: BCBS Trust/PPO |
$22.41
|
Rate for Payer: BCBS Trust/PPO |
$12.50
|
Rate for Payer: BCBS Trust/PPO |
$13.31
|
Rate for Payer: BCBS Trust/PPO |
$20.22
|
Rate for Payer: BCN Commercial |
$12.50
|
Rate for Payer: BCN Commercial |
$13.31
|
Rate for Payer: BCN Commercial |
$20.22
|
Rate for Payer: BCN Commercial |
$22.41
|
Rate for Payer: Cash Price |
$23.20
|
Rate for Payer: Cash Price |
$20.93
|
Rate for Payer: Cash Price |
$12.94
|
Rate for Payer: Cash Price |
$13.78
|
Rate for Payer: Cofinity Commercial |
$24.94
|
Rate for Payer: Cofinity Commercial |
$13.91
|
Rate for Payer: Cofinity Commercial |
$14.81
|
Rate for Payer: Cofinity Commercial |
$22.50
|
Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
Rate for Payer: Encore Health Key Benefits Commercial |
$13.78
|
Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
Rate for Payer: Healthscope Commercial |
$26.10
|
Rate for Payer: Healthscope Commercial |
$14.56
|
Rate for Payer: Healthscope Commercial |
$15.50
|
Rate for Payer: Healthscope Commercial |
$23.54
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.92
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.62
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.75
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.14
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.64
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.24
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.65
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.75
|
Rate for Payer: PHP Commercial |
$22.24
|
Rate for Payer: PHP Commercial |
$14.64
|
Rate for Payer: PHP Commercial |
$24.65
|
Rate for Payer: PHP Commercial |
$13.75
|
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 Cigna Priority Health |
$12.05
|
Rate for Payer: Priority Health Cigna Priority Health |
$18.31
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.23
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.76
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.98
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.08
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$17.69
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$15.95
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$9.87
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$10.50
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$14.24
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$25.52
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$23.02
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$15.15
|
Rate for Payer: UHC Core |
$21.84
|
Rate for Payer: UHC Core |
$14.38
|
Rate for Payer: UHC Core |
$24.22
|
Rate for Payer: UHC Core |
$13.51
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.62
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.14
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.92
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.75
|
|