|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
OP
|
$326.65
|
|
|
Service Code
|
NDC 77333093810
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.66 |
| Max. Negotiated Rate |
$326.65 |
| Rate for Payer: Aetna Commercial |
$293.98
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: ASR ASR |
$316.85
|
| Rate for Payer: ASR Commercial |
$316.85
|
| Rate for Payer: BCBS Complete |
$130.66
|
| Rate for Payer: BCBS Trust/PPO |
$267.49
|
| Rate for Payer: BCN Commercial |
$253.25
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$307.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$326.65
|
| Rate for Payer: Healthscope Whirlpool |
$316.85
|
| Rate for Payer: Mclaren Commercial |
$293.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Nomi Health Commercial |
$267.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.21
|
| Rate for Payer: Priority Health Narrow Network |
$228.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.45
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$186.82
|
|
|
Service Code
|
NDC 50268085515
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.43 |
| Max. Negotiated Rate |
$186.82 |
| Rate for Payer: Aetna Commercial |
$168.14
|
| Rate for Payer: ASR ASR |
$181.22
|
| Rate for Payer: ASR Commercial |
$181.22
|
| Rate for Payer: BCBS Trust/PPO |
$152.24
|
| Rate for Payer: BCN Commercial |
$144.84
|
| Rate for Payer: Cash Price |
$149.46
|
| Rate for Payer: Cofinity Commercial |
$175.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.46
|
| Rate for Payer: Healthscope Commercial |
$186.82
|
| Rate for Payer: Healthscope Whirlpool |
$181.22
|
| Rate for Payer: Mclaren Commercial |
$168.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.80
|
| Rate for Payer: Nomi Health Commercial |
$153.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.40
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$99.36
|
|
|
Service Code
|
NDC 00065039602
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$99.36 |
| Rate for Payer: Aetna Commercial |
$89.42
|
| Rate for Payer: ASR ASR |
$96.38
|
| Rate for Payer: ASR Commercial |
$96.38
|
| Rate for Payer: BCBS Trust/PPO |
$80.97
|
| Rate for Payer: BCN Commercial |
$77.03
|
| Rate for Payer: Cash Price |
$79.49
|
| Rate for Payer: Cofinity Commercial |
$93.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.49
|
| Rate for Payer: Healthscope Commercial |
$99.36
|
| Rate for Payer: Healthscope Whirlpool |
$96.38
|
| Rate for Payer: Mclaren Commercial |
$89.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.46
|
| Rate for Payer: Nomi Health Commercial |
$81.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.44
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$40.25
|
|
|
Service Code
|
NDC 24208073501
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna Commercial |
$36.22
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: ASR ASR |
$39.04
|
| Rate for Payer: ASR Commercial |
$39.04
|
| Rate for Payer: BCBS Complete |
$16.10
|
| Rate for Payer: BCBS Trust/PPO |
$32.96
|
| Rate for Payer: BCN Commercial |
$31.21
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Healthscope Commercial |
$40.25
|
| Rate for Payer: Healthscope Whirlpool |
$39.04
|
| Rate for Payer: Mclaren Commercial |
$36.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Nomi Health Commercial |
$33.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.27
|
| Rate for Payer: Priority Health Narrow Network |
$28.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.42
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$18.86
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna Medicare |
$9.43
|
| Rate for Payer: ASR ASR |
$18.29
|
| Rate for Payer: ASR Commercial |
$18.29
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: BCBS Trust/PPO |
$15.44
|
| Rate for Payer: BCN Commercial |
$14.62
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$17.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.09
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Healthscope Whirlpool |
$18.29
|
| Rate for Payer: Mclaren Commercial |
$16.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.03
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.53
|
| Rate for Payer: Priority Health Narrow Network |
$13.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.60
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$99.36
|
|
|
Service Code
|
NDC 00065039602
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.74 |
| Max. Negotiated Rate |
$99.36 |
| Rate for Payer: Aetna Commercial |
$89.42
|
| Rate for Payer: Aetna Medicare |
$49.68
|
| Rate for Payer: ASR ASR |
$96.38
|
| Rate for Payer: ASR Commercial |
$96.38
|
| Rate for Payer: BCBS Complete |
$39.74
|
| Rate for Payer: BCBS Trust/PPO |
$81.37
|
| Rate for Payer: BCN Commercial |
$77.03
|
| Rate for Payer: Cash Price |
$79.49
|
| Rate for Payer: Cofinity Commercial |
$93.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.49
|
| Rate for Payer: Healthscope Commercial |
$99.36
|
| Rate for Payer: Healthscope Whirlpool |
$96.38
|
| Rate for Payer: Mclaren Commercial |
$89.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.46
|
| Rate for Payer: Nomi Health Commercial |
$81.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.06
|
| Rate for Payer: Priority Health Narrow Network |
$69.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.44
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$40.25
|
|
|
Service Code
|
NDC 24208073501
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.16 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna Commercial |
$36.22
|
| Rate for Payer: ASR ASR |
$39.04
|
| Rate for Payer: ASR Commercial |
$39.04
|
| Rate for Payer: BCBS Trust/PPO |
$32.80
|
| Rate for Payer: BCN Commercial |
$31.21
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Healthscope Commercial |
$40.25
|
| Rate for Payer: Healthscope Whirlpool |
$39.04
|
| Rate for Payer: Mclaren Commercial |
$36.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Nomi Health Commercial |
$33.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.42
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$15.21
|
|
|
Service Code
|
NDC 61314039601
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$15.21 |
| Rate for Payer: Aetna Commercial |
$13.69
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: ASR ASR |
$14.75
|
| Rate for Payer: ASR Commercial |
$14.75
|
| Rate for Payer: BCBS Complete |
$6.08
|
| Rate for Payer: BCBS Trust/PPO |
$12.46
|
| Rate for Payer: BCN Commercial |
$11.79
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$14.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.17
|
| Rate for Payer: Healthscope Commercial |
$15.21
|
| Rate for Payer: Healthscope Whirlpool |
$14.75
|
| Rate for Payer: Mclaren Commercial |
$13.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.93
|
| Rate for Payer: Nomi Health Commercial |
$12.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.33
|
| Rate for Payer: Priority Health Narrow Network |
$10.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.38
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$18.86
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: ASR ASR |
$18.29
|
| Rate for Payer: ASR Commercial |
$18.29
|
| Rate for Payer: BCBS Trust/PPO |
$15.37
|
| Rate for Payer: BCN Commercial |
$14.62
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$17.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.09
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Healthscope Whirlpool |
$18.29
|
| Rate for Payer: Mclaren Commercial |
$16.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.03
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.60
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$15.21
|
|
|
Service Code
|
NDC 61314039601
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$15.21 |
| Rate for Payer: Aetna Commercial |
$13.69
|
| Rate for Payer: ASR ASR |
$14.75
|
| Rate for Payer: ASR Commercial |
$14.75
|
| Rate for Payer: BCBS Trust/PPO |
$12.39
|
| Rate for Payer: BCN Commercial |
$11.79
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$14.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.17
|
| Rate for Payer: Healthscope Commercial |
$15.21
|
| Rate for Payer: Healthscope Whirlpool |
$14.75
|
| Rate for Payer: Mclaren Commercial |
$13.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.93
|
| Rate for Payer: Nomi Health Commercial |
$12.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.38
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE
|
Facility
|
OP
|
$7.31
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$7.31 |
| Rate for Payer: Aetna Commercial |
$6.58
|
| Rate for Payer: Aetna Commercial |
$197.38
|
| Rate for Payer: Aetna Medicare |
$109.66
|
| Rate for Payer: Aetna Medicare |
$3.66
|
| Rate for Payer: ASR ASR |
$7.09
|
| Rate for Payer: ASR ASR |
$212.73
|
| Rate for Payer: ASR Commercial |
$212.73
|
| Rate for Payer: ASR Commercial |
$7.09
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS Complete |
$87.72
|
| Rate for Payer: BCBS Trust/PPO |
$5.99
|
| Rate for Payer: BCBS Trust/PPO |
$179.59
|
| Rate for Payer: BCN Commercial |
$170.03
|
| Rate for Payer: BCN Commercial |
$5.67
|
| Rate for Payer: Cash Price |
$175.45
|
| Rate for Payer: Cash Price |
$175.45
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cofinity Commercial |
$206.15
|
| Rate for Payer: Cofinity Commercial |
$6.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.45
|
| Rate for Payer: Healthscope Commercial |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$219.31
|
| Rate for Payer: Healthscope Whirlpool |
$7.09
|
| Rate for Payer: Healthscope Whirlpool |
$212.73
|
| Rate for Payer: Mclaren Commercial |
$197.38
|
| Rate for Payer: Mclaren Commercial |
$6.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.41
|
| Rate for Payer: Nomi Health Commercial |
$5.99
|
| Rate for Payer: Nomi Health Commercial |
$179.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.10
|
| Rate for Payer: Priority Health Narrow Network |
$1.68
|
| Rate for Payer: Priority Health Narrow Network |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$192.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.43
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE
|
Facility
|
IP
|
$7.31
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$7.31 |
| Rate for Payer: Aetna Commercial |
$6.58
|
| Rate for Payer: Aetna Commercial |
$197.38
|
| Rate for Payer: ASR ASR |
$7.09
|
| Rate for Payer: ASR ASR |
$212.73
|
| Rate for Payer: ASR Commercial |
$212.73
|
| Rate for Payer: ASR Commercial |
$7.09
|
| Rate for Payer: BCBS Trust/PPO |
$178.72
|
| Rate for Payer: BCBS Trust/PPO |
$5.96
|
| Rate for Payer: BCN Commercial |
$5.67
|
| Rate for Payer: BCN Commercial |
$170.03
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$175.45
|
| Rate for Payer: Cofinity Commercial |
$206.15
|
| Rate for Payer: Cofinity Commercial |
$6.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.85
|
| Rate for Payer: Healthscope Commercial |
$219.31
|
| Rate for Payer: Healthscope Commercial |
$7.31
|
| Rate for Payer: Healthscope Whirlpool |
$212.73
|
| Rate for Payer: Healthscope Whirlpool |
$7.09
|
| Rate for Payer: Mclaren Commercial |
$197.38
|
| Rate for Payer: Mclaren Commercial |
$6.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.21
|
| Rate for Payer: Nomi Health Commercial |
$179.83
|
| Rate for Payer: Nomi Health Commercial |
$5.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$192.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.43
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE
|
Facility
|
IP
|
$4.06
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
28842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna Commercial |
$109.52
|
| Rate for Payer: ASR ASR |
$3.94
|
| Rate for Payer: ASR ASR |
$118.04
|
| Rate for Payer: ASR Commercial |
$118.04
|
| Rate for Payer: ASR Commercial |
$3.94
|
| Rate for Payer: BCBS Trust/PPO |
$99.17
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.15
|
| Rate for Payer: BCN Commercial |
$94.35
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cash Price |
$97.36
|
| Rate for Payer: Cofinity Commercial |
$114.39
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.25
|
| Rate for Payer: Healthscope Commercial |
$121.69
|
| Rate for Payer: Healthscope Commercial |
$4.06
|
| Rate for Payer: Healthscope Whirlpool |
$118.04
|
| Rate for Payer: Healthscope Whirlpool |
$3.94
|
| Rate for Payer: Mclaren Commercial |
$109.52
|
| Rate for Payer: Mclaren Commercial |
$3.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.45
|
| Rate for Payer: Nomi Health Commercial |
$99.79
|
| Rate for Payer: Nomi Health Commercial |
$3.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.57
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE
|
Facility
|
OP
|
$4.06
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
28842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna Commercial |
$109.52
|
| Rate for Payer: Aetna Medicare |
$60.84
|
| Rate for Payer: Aetna Medicare |
$2.03
|
| Rate for Payer: ASR ASR |
$3.94
|
| Rate for Payer: ASR ASR |
$118.04
|
| Rate for Payer: ASR Commercial |
$118.04
|
| Rate for Payer: ASR Commercial |
$3.94
|
| Rate for Payer: BCBS Complete |
$1.62
|
| Rate for Payer: BCBS Complete |
$48.68
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$99.65
|
| Rate for Payer: BCN Commercial |
$94.35
|
| Rate for Payer: BCN Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$97.36
|
| Rate for Payer: Cash Price |
$97.36
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$114.39
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.35
|
| Rate for Payer: Healthscope Commercial |
$4.06
|
| Rate for Payer: Healthscope Commercial |
$121.69
|
| Rate for Payer: Healthscope Whirlpool |
$3.94
|
| Rate for Payer: Healthscope Whirlpool |
$118.04
|
| Rate for Payer: Mclaren Commercial |
$109.52
|
| Rate for Payer: Mclaren Commercial |
$3.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.44
|
| Rate for Payer: Nomi Health Commercial |
$3.33
|
| Rate for Payer: Nomi Health Commercial |
$99.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.77
|
| Rate for Payer: Priority Health Narrow Network |
$0.62
|
| Rate for Payer: Priority Health Narrow Network |
$0.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.57
|
|
|
DALBAVANCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,029.95
|
|
|
Service Code
|
HCPCS J0875
|
| Hospital Charge Code |
171111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$5,029.95 |
| Rate for Payer: Aetna Commercial |
$4,526.96
|
| Rate for Payer: Aetna Medicare |
$15.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.50
|
| Rate for Payer: ASR ASR |
$4,879.05
|
| Rate for Payer: ASR Commercial |
$4,879.05
|
| Rate for Payer: BCBS Complete |
$8.78
|
| Rate for Payer: BCBS MAPPO |
$15.60
|
| Rate for Payer: BCBS Trust/PPO |
$4,119.03
|
| Rate for Payer: BCN Commercial |
$3,899.72
|
| Rate for Payer: BCN Medicare Advantage |
$15.60
|
| Rate for Payer: Cash Price |
$4,023.96
|
| Rate for Payer: Cash Price |
$4,023.96
|
| Rate for Payer: Cofinity Commercial |
$4,728.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,023.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.60
|
| Rate for Payer: Healthscope Commercial |
$5,029.95
|
| Rate for Payer: Healthscope Whirlpool |
$4,879.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.60
|
| Rate for Payer: Mclaren Commercial |
$4,526.96
|
| Rate for Payer: Mclaren Medicaid |
$8.36
|
| Rate for Payer: Mclaren Medicare |
$15.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.38
|
| Rate for Payer: Meridian Medicaid |
$8.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,275.46
|
| Rate for Payer: Nomi Health Commercial |
$4,124.56
|
| Rate for Payer: PACE Medicare |
$14.82
|
| Rate for Payer: PACE SWMI |
$15.60
|
| Rate for Payer: PHP Commercial |
$17.16
|
| Rate for Payer: PHP Medicaid |
$8.36
|
| Rate for Payer: PHP Medicare Advantage |
$15.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,269.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.15
|
| Rate for Payer: Priority Health Medicare |
$15.60
|
| Rate for Payer: Priority Health Narrow Network |
$12.92
|
| Rate for Payer: Railroad Medicare Medicare |
$15.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,426.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.60
|
| Rate for Payer: UHC Exchange |
$24.18
|
| Rate for Payer: UHC Medicare Advantage |
$15.60
|
| Rate for Payer: UHCCP DNSP |
$15.60
|
| Rate for Payer: UHCCP Medicaid |
$8.36
|
| Rate for Payer: VA VA |
$15.60
|
|
|
DALBAVANCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,029.95
|
|
|
Service Code
|
HCPCS J0875
|
| Hospital Charge Code |
171111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,269.47 |
| Max. Negotiated Rate |
$5,029.95 |
| Rate for Payer: Aetna Commercial |
$4,526.96
|
| Rate for Payer: ASR ASR |
$4,879.05
|
| Rate for Payer: ASR Commercial |
$4,879.05
|
| Rate for Payer: BCBS Trust/PPO |
$4,098.91
|
| Rate for Payer: BCN Commercial |
$3,899.72
|
| Rate for Payer: Cash Price |
$4,023.96
|
| Rate for Payer: Cofinity Commercial |
$4,728.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,023.96
|
| Rate for Payer: Healthscope Commercial |
$5,029.95
|
| Rate for Payer: Healthscope Whirlpool |
$4,879.05
|
| Rate for Payer: Mclaren Commercial |
$4,526.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,275.46
|
| Rate for Payer: Nomi Health Commercial |
$4,124.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,269.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,426.36
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$292.64
|
|
|
Service Code
|
NDC 42023012306
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$190.22 |
| Max. Negotiated Rate |
$292.64 |
| Rate for Payer: Aetna Commercial |
$263.38
|
| Rate for Payer: ASR ASR |
$283.86
|
| Rate for Payer: ASR Commercial |
$283.86
|
| Rate for Payer: BCBS Trust/PPO |
$238.47
|
| Rate for Payer: BCN Commercial |
$226.88
|
| Rate for Payer: Cash Price |
$234.12
|
| Rate for Payer: Cofinity Commercial |
$275.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.11
|
| Rate for Payer: Healthscope Commercial |
$292.64
|
| Rate for Payer: Healthscope Whirlpool |
$283.86
|
| Rate for Payer: Mclaren Commercial |
$263.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.74
|
| Rate for Payer: Nomi Health Commercial |
$239.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.52
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$292.64
|
|
|
Service Code
|
NDC 42023012306
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$117.06 |
| Max. Negotiated Rate |
$292.64 |
| Rate for Payer: Aetna Commercial |
$263.38
|
| Rate for Payer: Aetna Medicare |
$146.32
|
| Rate for Payer: ASR ASR |
$283.86
|
| Rate for Payer: ASR Commercial |
$283.86
|
| Rate for Payer: BCBS Complete |
$117.06
|
| Rate for Payer: BCBS Trust/PPO |
$239.64
|
| Rate for Payer: BCN Commercial |
$226.88
|
| Rate for Payer: Cash Price |
$234.12
|
| Rate for Payer: Cofinity Commercial |
$275.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.11
|
| Rate for Payer: Healthscope Commercial |
$292.64
|
| Rate for Payer: Healthscope Whirlpool |
$283.86
|
| Rate for Payer: Mclaren Commercial |
$263.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.74
|
| Rate for Payer: Nomi Health Commercial |
$239.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$256.41
|
| Rate for Payer: Priority Health Narrow Network |
$205.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.52
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
IP
|
$1,692.19
|
|
|
Service Code
|
NDC 00310621030
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,099.92 |
| Max. Negotiated Rate |
$1,692.19 |
| Rate for Payer: Aetna Commercial |
$1,522.97
|
| Rate for Payer: ASR ASR |
$1,641.42
|
| Rate for Payer: ASR Commercial |
$1,641.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,378.97
|
| Rate for Payer: BCN Commercial |
$1,311.95
|
| Rate for Payer: Cash Price |
$1,353.76
|
| Rate for Payer: Cofinity Commercial |
$1,590.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,353.75
|
| Rate for Payer: Healthscope Commercial |
$1,692.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,641.42
|
| Rate for Payer: Mclaren Commercial |
$1,522.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,438.36
|
| Rate for Payer: Nomi Health Commercial |
$1,387.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,489.13
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
OP
|
$1,692.19
|
|
|
Service Code
|
NDC 00310621030
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$676.88 |
| Max. Negotiated Rate |
$1,692.19 |
| Rate for Payer: Aetna Commercial |
$1,522.97
|
| Rate for Payer: Aetna Medicare |
$846.10
|
| Rate for Payer: ASR ASR |
$1,641.42
|
| Rate for Payer: ASR Commercial |
$1,641.42
|
| Rate for Payer: BCBS Complete |
$676.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,385.73
|
| Rate for Payer: BCN Commercial |
$1,311.95
|
| Rate for Payer: Cash Price |
$1,353.76
|
| Rate for Payer: Cofinity Commercial |
$1,590.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,353.75
|
| Rate for Payer: Healthscope Commercial |
$1,692.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,641.42
|
| Rate for Payer: Mclaren Commercial |
$1,522.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,438.36
|
| Rate for Payer: Nomi Health Commercial |
$1,387.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,482.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,186.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,489.13
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$93.12
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.53 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$83.81
|
| Rate for Payer: Aetna Commercial |
$48.42
|
| Rate for Payer: ASR ASR |
$90.33
|
| Rate for Payer: ASR ASR |
$52.19
|
| Rate for Payer: ASR Commercial |
$52.19
|
| Rate for Payer: ASR Commercial |
$90.33
|
| Rate for Payer: BCBS Trust/PPO |
$43.84
|
| Rate for Payer: BCBS Trust/PPO |
$75.88
|
| Rate for Payer: BCN Commercial |
$72.20
|
| Rate for Payer: BCN Commercial |
$41.71
|
| Rate for Payer: Cash Price |
$74.49
|
| Rate for Payer: Cash Price |
$43.04
|
| Rate for Payer: Cofinity Commercial |
$50.57
|
| Rate for Payer: Cofinity Commercial |
$87.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$53.80
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Healthscope Whirlpool |
$52.19
|
| Rate for Payer: Healthscope Whirlpool |
$90.33
|
| Rate for Payer: Mclaren Commercial |
$48.42
|
| Rate for Payer: Mclaren Commercial |
$83.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Nomi Health Commercial |
$44.12
|
| Rate for Payer: Nomi Health Commercial |
$76.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.95
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$93.12
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$83.81
|
| Rate for Payer: Aetna Commercial |
$48.42
|
| Rate for Payer: Aetna Medicare |
$26.90
|
| Rate for Payer: Aetna Medicare |
$46.56
|
| Rate for Payer: ASR ASR |
$90.33
|
| Rate for Payer: ASR ASR |
$52.19
|
| Rate for Payer: ASR Commercial |
$52.19
|
| Rate for Payer: ASR Commercial |
$90.33
|
| Rate for Payer: BCBS Complete |
$37.25
|
| Rate for Payer: BCBS Complete |
$21.52
|
| Rate for Payer: BCBS Trust/PPO |
$76.26
|
| Rate for Payer: BCBS Trust/PPO |
$44.06
|
| Rate for Payer: BCN Commercial |
$41.71
|
| Rate for Payer: BCN Commercial |
$72.20
|
| Rate for Payer: Cash Price |
$43.04
|
| Rate for Payer: Cash Price |
$43.04
|
| Rate for Payer: Cash Price |
$74.49
|
| Rate for Payer: Cash Price |
$74.49
|
| Rate for Payer: Cofinity Commercial |
$50.57
|
| Rate for Payer: Cofinity Commercial |
$87.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.04
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Healthscope Commercial |
$53.80
|
| Rate for Payer: Healthscope Whirlpool |
$90.33
|
| Rate for Payer: Healthscope Whirlpool |
$52.19
|
| Rate for Payer: Mclaren Commercial |
$48.42
|
| Rate for Payer: Mclaren Commercial |
$83.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.73
|
| Rate for Payer: Nomi Health Commercial |
$76.36
|
| Rate for Payer: Nomi Health Commercial |
$44.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.95
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$51.26
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$51.26 |
| Rate for Payer: Aetna Commercial |
$46.13
|
| Rate for Payer: Aetna Commercial |
$60.60
|
| Rate for Payer: Aetna Commercial |
$1,196.41
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Commercial |
$116.26
|
| Rate for Payer: Aetna Commercial |
$78.22
|
| Rate for Payer: Aetna Commercial |
$77.75
|
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Aetna Commercial |
$59.60
|
| Rate for Payer: Aetna Medicare |
$664.67
|
| Rate for Payer: Aetna Medicare |
$25.63
|
| Rate for Payer: Aetna Medicare |
$33.66
|
| Rate for Payer: Aetna Medicare |
$33.11
|
| Rate for Payer: Aetna Medicare |
$43.20
|
| Rate for Payer: Aetna Medicare |
$43.28
|
| Rate for Payer: Aetna Medicare |
$43.46
|
| Rate for Payer: Aetna Medicare |
$28.24
|
| Rate for Payer: Aetna Medicare |
$64.59
|
| Rate for Payer: ASR ASR |
$64.23
|
| Rate for Payer: ASR ASR |
$54.78
|
| Rate for Payer: ASR ASR |
$1,289.46
|
| Rate for Payer: ASR ASR |
$49.72
|
| Rate for Payer: ASR ASR |
$125.30
|
| Rate for Payer: ASR ASR |
$84.30
|
| Rate for Payer: ASR ASR |
$83.95
|
| Rate for Payer: ASR ASR |
$83.80
|
| Rate for Payer: ASR ASR |
$65.31
|
| Rate for Payer: ASR Commercial |
$84.30
|
| Rate for Payer: ASR Commercial |
$64.23
|
| Rate for Payer: ASR Commercial |
$54.78
|
| Rate for Payer: ASR Commercial |
$1,289.46
|
| Rate for Payer: ASR Commercial |
$83.95
|
| Rate for Payer: ASR Commercial |
$83.80
|
| Rate for Payer: ASR Commercial |
$49.72
|
| Rate for Payer: ASR Commercial |
$125.30
|
| Rate for Payer: ASR Commercial |
$65.31
|
| Rate for Payer: BCBS Complete |
$51.67
|
| Rate for Payer: BCBS Complete |
$34.56
|
| Rate for Payer: BCBS Complete |
$26.49
|
| Rate for Payer: BCBS Complete |
$26.93
|
| Rate for Payer: BCBS Complete |
$22.59
|
| Rate for Payer: BCBS Complete |
$531.74
|
| Rate for Payer: BCBS Complete |
$34.76
|
| Rate for Payer: BCBS Complete |
$34.62
|
| Rate for Payer: BCBS Complete |
$20.50
|
| Rate for Payer: BCBS Trust/PPO |
$41.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,088.60
|
| Rate for Payer: BCBS Trust/PPO |
$71.17
|
| Rate for Payer: BCBS Trust/PPO |
$70.88
|
| Rate for Payer: BCBS Trust/PPO |
$54.23
|
| Rate for Payer: BCBS Trust/PPO |
$70.74
|
| Rate for Payer: BCBS Trust/PPO |
$55.14
|
| Rate for Payer: BCBS Trust/PPO |
$46.24
|
| Rate for Payer: BCBS Trust/PPO |
$105.79
|
| Rate for Payer: BCN Commercial |
$66.98
|
| Rate for Payer: BCN Commercial |
$67.10
|
| Rate for Payer: BCN Commercial |
$100.15
|
| Rate for Payer: BCN Commercial |
$51.34
|
| Rate for Payer: BCN Commercial |
$67.38
|
| Rate for Payer: BCN Commercial |
$39.74
|
| Rate for Payer: BCN Commercial |
$52.20
|
| Rate for Payer: BCN Commercial |
$1,030.64
|
| Rate for Payer: BCN Commercial |
$43.78
|
| Rate for Payer: Cash Price |
$52.97
|
| Rate for Payer: Cash Price |
$41.01
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$1,063.48
|
| Rate for Payer: Cash Price |
$1,063.48
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$41.01
|
| Rate for Payer: Cash Price |
$45.18
|
| Rate for Payer: Cash Price |
$45.18
|
| Rate for Payer: Cash Price |
$52.97
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cash Price |
$69.11
|
| Rate for Payer: Cash Price |
$69.11
|
| Rate for Payer: Cash Price |
$69.24
|
| Rate for Payer: Cash Price |
$69.24
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$81.21
|
| Rate for Payer: Cofinity Commercial |
$1,249.58
|
| Rate for Payer: Cofinity Commercial |
$62.25
|
| Rate for Payer: Cofinity Commercial |
$81.36
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Cofinity Commercial |
$48.18
|
| Rate for Payer: Cofinity Commercial |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$53.08
|
| Rate for Payer: Cofinity Commercial |
$63.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,063.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.11
|
| Rate for Payer: Healthscope Commercial |
$67.33
|
| Rate for Payer: Healthscope Commercial |
$129.18
|
| Rate for Payer: Healthscope Commercial |
$1,329.34
|
| Rate for Payer: Healthscope Commercial |
$56.47
|
| Rate for Payer: Healthscope Commercial |
$51.26
|
| Rate for Payer: Healthscope Commercial |
$86.39
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: Healthscope Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$86.55
|
| Rate for Payer: Healthscope Whirlpool |
$49.72
|
| Rate for Payer: Healthscope Whirlpool |
$84.30
|
| Rate for Payer: Healthscope Whirlpool |
$65.31
|
| Rate for Payer: Healthscope Whirlpool |
$83.95
|
| Rate for Payer: Healthscope Whirlpool |
$54.78
|
| Rate for Payer: Healthscope Whirlpool |
$125.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.23
|
| Rate for Payer: Healthscope Whirlpool |
$83.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,289.46
|
| Rate for Payer: Mclaren Commercial |
$46.13
|
| Rate for Payer: Mclaren Commercial |
$59.60
|
| Rate for Payer: Mclaren Commercial |
$60.60
|
| Rate for Payer: Mclaren Commercial |
$77.90
|
| Rate for Payer: Mclaren Commercial |
$116.26
|
| Rate for Payer: Mclaren Commercial |
$78.22
|
| Rate for Payer: Mclaren Commercial |
$77.75
|
| Rate for Payer: Mclaren Commercial |
$50.82
|
| Rate for Payer: Mclaren Commercial |
$1,196.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.57
|
| Rate for Payer: Nomi Health Commercial |
$42.03
|
| Rate for Payer: Nomi Health Commercial |
$105.93
|
| Rate for Payer: Nomi Health Commercial |
$70.84
|
| Rate for Payer: Nomi Health Commercial |
$54.30
|
| Rate for Payer: Nomi Health Commercial |
$71.27
|
| Rate for Payer: Nomi Health Commercial |
$1,090.06
|
| Rate for Payer: Nomi Health Commercial |
$55.21
|
| Rate for Payer: Nomi Health Commercial |
$46.31
|
| Rate for Payer: Nomi Health Commercial |
$70.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,169.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.48
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$129.18
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.97 |
| Max. Negotiated Rate |
$129.18 |
| Rate for Payer: Aetna Commercial |
$116.26
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Commercial |
$77.75
|
| Rate for Payer: Aetna Commercial |
$60.60
|
| Rate for Payer: Aetna Commercial |
$59.60
|
| Rate for Payer: Aetna Commercial |
$46.13
|
| Rate for Payer: Aetna Commercial |
$78.22
|
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Aetna Commercial |
$1,196.41
|
| Rate for Payer: ASR ASR |
$84.30
|
| Rate for Payer: ASR ASR |
$64.23
|
| Rate for Payer: ASR ASR |
$54.78
|
| Rate for Payer: ASR ASR |
$1,289.46
|
| Rate for Payer: ASR ASR |
$125.30
|
| Rate for Payer: ASR ASR |
$65.31
|
| Rate for Payer: ASR ASR |
$49.72
|
| Rate for Payer: ASR ASR |
$83.80
|
| Rate for Payer: ASR ASR |
$83.95
|
| Rate for Payer: ASR Commercial |
$84.30
|
| Rate for Payer: ASR Commercial |
$65.31
|
| Rate for Payer: ASR Commercial |
$64.23
|
| Rate for Payer: ASR Commercial |
$83.95
|
| Rate for Payer: ASR Commercial |
$83.80
|
| Rate for Payer: ASR Commercial |
$125.30
|
| Rate for Payer: ASR Commercial |
$1,289.46
|
| Rate for Payer: ASR Commercial |
$54.78
|
| Rate for Payer: ASR Commercial |
$49.72
|
| Rate for Payer: BCBS Trust/PPO |
$46.02
|
| Rate for Payer: BCBS Trust/PPO |
$54.87
|
| Rate for Payer: BCBS Trust/PPO |
$53.96
|
| Rate for Payer: BCBS Trust/PPO |
$105.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,083.28
|
| Rate for Payer: BCBS Trust/PPO |
$41.77
|
| Rate for Payer: BCBS Trust/PPO |
$70.82
|
| Rate for Payer: BCBS Trust/PPO |
$70.53
|
| Rate for Payer: BCBS Trust/PPO |
$70.40
|
| Rate for Payer: BCN Commercial |
$100.15
|
| Rate for Payer: BCN Commercial |
$51.34
|
| Rate for Payer: BCN Commercial |
$67.38
|
| Rate for Payer: BCN Commercial |
$52.20
|
| Rate for Payer: BCN Commercial |
$67.10
|
| Rate for Payer: BCN Commercial |
$43.78
|
| Rate for Payer: BCN Commercial |
$39.74
|
| Rate for Payer: BCN Commercial |
$66.98
|
| Rate for Payer: BCN Commercial |
$1,030.64
|
| Rate for Payer: Cash Price |
$45.18
|
| Rate for Payer: Cash Price |
$69.11
|
| Rate for Payer: Cash Price |
$52.97
|
| Rate for Payer: Cash Price |
$1,063.48
|
| Rate for Payer: Cash Price |
$69.24
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cash Price |
$41.01
|
| Rate for Payer: Cofinity Commercial |
$63.29
|
| Rate for Payer: Cofinity Commercial |
$53.08
|
| Rate for Payer: Cofinity Commercial |
$81.36
|
| Rate for Payer: Cofinity Commercial |
$81.21
|
| Rate for Payer: Cofinity Commercial |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$62.25
|
| Rate for Payer: Cofinity Commercial |
$1,249.58
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Cofinity Commercial |
$48.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,063.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.01
|
| Rate for Payer: Healthscope Commercial |
$67.33
|
| Rate for Payer: Healthscope Commercial |
$51.26
|
| Rate for Payer: Healthscope Commercial |
$56.47
|
| Rate for Payer: Healthscope Commercial |
$1,329.34
|
| Rate for Payer: Healthscope Commercial |
$129.18
|
| Rate for Payer: Healthscope Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$86.39
|
| Rate for Payer: Healthscope Commercial |
$86.55
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: Healthscope Whirlpool |
$83.80
|
| Rate for Payer: Healthscope Whirlpool |
$84.30
|
| Rate for Payer: Healthscope Whirlpool |
$125.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.23
|
| Rate for Payer: Healthscope Whirlpool |
$54.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,289.46
|
| Rate for Payer: Healthscope Whirlpool |
$83.95
|
| Rate for Payer: Healthscope Whirlpool |
$65.31
|
| Rate for Payer: Healthscope Whirlpool |
$49.72
|
| Rate for Payer: Mclaren Commercial |
$59.60
|
| Rate for Payer: Mclaren Commercial |
$77.90
|
| Rate for Payer: Mclaren Commercial |
$78.22
|
| Rate for Payer: Mclaren Commercial |
$1,196.41
|
| Rate for Payer: Mclaren Commercial |
$46.13
|
| Rate for Payer: Mclaren Commercial |
$77.75
|
| Rate for Payer: Mclaren Commercial |
$116.26
|
| Rate for Payer: Mclaren Commercial |
$50.82
|
| Rate for Payer: Mclaren Commercial |
$60.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.57
|
| Rate for Payer: Nomi Health Commercial |
$54.30
|
| Rate for Payer: Nomi Health Commercial |
$55.21
|
| Rate for Payer: Nomi Health Commercial |
$71.27
|
| Rate for Payer: Nomi Health Commercial |
$70.84
|
| Rate for Payer: Nomi Health Commercial |
$105.93
|
| Rate for Payer: Nomi Health Commercial |
$46.31
|
| Rate for Payer: Nomi Health Commercial |
$42.03
|
| Rate for Payer: Nomi Health Commercial |
$1,090.06
|
| Rate for Payer: Nomi Health Commercial |
$70.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,169.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.27
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$1,279.89
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$831.93 |
| Max. Negotiated Rate |
$1,279.89 |
| Rate for Payer: Aetna Commercial |
$1,151.90
|
| Rate for Payer: ASR ASR |
$1,241.49
|
| Rate for Payer: ASR Commercial |
$1,241.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.98
|
| Rate for Payer: BCN Commercial |
$992.30
|
| Rate for Payer: Cash Price |
$1,023.91
|
| Rate for Payer: Cofinity Commercial |
$1,203.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,023.91
|
| Rate for Payer: Healthscope Commercial |
$1,279.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,241.49
|
| Rate for Payer: Mclaren Commercial |
$1,151.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,087.91
|
| Rate for Payer: Nomi Health Commercial |
$1,049.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$831.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,126.30
|
|
