|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$965.26
|
|
|
Service Code
|
NDC 00002327030
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$386.10 |
| Max. Negotiated Rate |
$965.26 |
| Rate for Payer: Aetna Commercial |
$868.73
|
| Rate for Payer: Aetna Medicare |
$482.63
|
| Rate for Payer: ASR ASR |
$936.30
|
| Rate for Payer: ASR Commercial |
$936.30
|
| Rate for Payer: BCBS Complete |
$386.10
|
| Rate for Payer: BCBS Trust/PPO |
$790.45
|
| Rate for Payer: BCN Commercial |
$748.37
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cofinity Commercial |
$907.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.21
|
| Rate for Payer: Healthscope Commercial |
$965.26
|
| Rate for Payer: Healthscope Whirlpool |
$936.30
|
| Rate for Payer: Mclaren Commercial |
$868.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.47
|
| Rate for Payer: Nomi Health Commercial |
$791.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.76
|
| Rate for Payer: Priority Health Narrow Network |
$676.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.43
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$965.26
|
|
|
Service Code
|
NDC 00002327030
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$627.42 |
| Max. Negotiated Rate |
$965.26 |
| Rate for Payer: Aetna Commercial |
$868.73
|
| Rate for Payer: ASR ASR |
$936.30
|
| Rate for Payer: ASR Commercial |
$936.30
|
| Rate for Payer: BCBS Trust/PPO |
$786.59
|
| Rate for Payer: BCN Commercial |
$748.37
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cofinity Commercial |
$907.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.21
|
| Rate for Payer: Healthscope Commercial |
$965.26
|
| Rate for Payer: Healthscope Whirlpool |
$936.30
|
| Rate for Payer: Mclaren Commercial |
$868.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.47
|
| Rate for Payer: Nomi Health Commercial |
$791.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.43
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$3.42
|
|
|
Service Code
|
NDC 50268028811
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Aetna Medicare |
$1.71
|
| Rate for Payer: ASR ASR |
$3.32
|
| Rate for Payer: ASR Commercial |
$3.32
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: BCBS Trust/PPO |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.65
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.42
|
| Rate for Payer: Healthscope Whirlpool |
$3.32
|
| Rate for Payer: Mclaren Commercial |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.91
|
| Rate for Payer: Nomi Health Commercial |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.00
|
| Rate for Payer: Priority Health Narrow Network |
$2.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.01
|
|
|
EMOLLIENT COMBINATION NO.117 TOPICAL CREAM
|
Facility
|
OP
|
$18.95
|
|
|
Service Code
|
NDC 72140063382
|
| Hospital Charge Code |
203300
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Aetna Commercial |
$17.06
|
| Rate for Payer: Aetna Medicare |
$9.48
|
| Rate for Payer: ASR ASR |
$18.38
|
| Rate for Payer: ASR Commercial |
$18.38
|
| Rate for Payer: BCBS Complete |
$7.58
|
| Rate for Payer: BCBS Trust/PPO |
$15.52
|
| Rate for Payer: BCN Commercial |
$14.69
|
| Rate for Payer: Cash Price |
$15.16
|
| Rate for Payer: Cofinity Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.16
|
| Rate for Payer: Healthscope Commercial |
$18.95
|
| Rate for Payer: Healthscope Whirlpool |
$18.38
|
| Rate for Payer: Mclaren Commercial |
$17.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.11
|
| Rate for Payer: Nomi Health Commercial |
$15.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.60
|
| Rate for Payer: Priority Health Narrow Network |
$13.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.68
|
|
|
EMOLLIENT COMBINATION NO.117 TOPICAL CREAM
|
Facility
|
IP
|
$18.95
|
|
|
Service Code
|
NDC 72140063382
|
| Hospital Charge Code |
203300
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Aetna Commercial |
$17.06
|
| Rate for Payer: ASR ASR |
$18.38
|
| Rate for Payer: ASR Commercial |
$18.38
|
| Rate for Payer: BCBS Trust/PPO |
$15.44
|
| Rate for Payer: BCN Commercial |
$14.69
|
| Rate for Payer: Cash Price |
$15.16
|
| Rate for Payer: Cofinity Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.16
|
| Rate for Payer: Healthscope Commercial |
$18.95
|
| Rate for Payer: Healthscope Whirlpool |
$18.38
|
| Rate for Payer: Mclaren Commercial |
$17.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.11
|
| Rate for Payer: Nomi Health Commercial |
$15.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.68
|
|
|
EMPAGLIFLOZIN 10 MG TABLET
|
Facility
|
IP
|
$2,165.83
|
|
|
Service Code
|
NDC 00597015237
|
| Hospital Charge Code |
171967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,407.79 |
| Max. Negotiated Rate |
$2,165.83 |
| Rate for Payer: Aetna Commercial |
$1,949.25
|
| Rate for Payer: ASR ASR |
$2,100.86
|
| Rate for Payer: ASR Commercial |
$2,100.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,764.93
|
| Rate for Payer: BCN Commercial |
$1,679.17
|
| Rate for Payer: Cash Price |
$1,732.67
|
| Rate for Payer: Cofinity Commercial |
$2,035.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,732.66
|
| Rate for Payer: Healthscope Commercial |
$2,165.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,100.86
|
| Rate for Payer: Mclaren Commercial |
$1,949.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,840.96
|
| Rate for Payer: Nomi Health Commercial |
$1,775.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,407.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,905.93
|
|
|
EMPAGLIFLOZIN 10 MG TABLET
|
Facility
|
OP
|
$2,165.83
|
|
|
Service Code
|
NDC 00597015237
|
| Hospital Charge Code |
171967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$866.33 |
| Max. Negotiated Rate |
$2,165.83 |
| Rate for Payer: Aetna Commercial |
$1,949.25
|
| Rate for Payer: Aetna Medicare |
$1,082.92
|
| Rate for Payer: ASR ASR |
$2,100.86
|
| Rate for Payer: ASR Commercial |
$2,100.86
|
| Rate for Payer: BCBS Complete |
$866.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,773.60
|
| Rate for Payer: BCN Commercial |
$1,679.17
|
| Rate for Payer: Cash Price |
$1,732.67
|
| Rate for Payer: Cofinity Commercial |
$2,035.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,732.66
|
| Rate for Payer: Healthscope Commercial |
$2,165.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,100.86
|
| Rate for Payer: Mclaren Commercial |
$1,949.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,840.96
|
| Rate for Payer: Nomi Health Commercial |
$1,775.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,407.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,897.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,518.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,905.93
|
|
|
EMPTY CONTAINER BOTTLE
|
Facility
|
IP
|
$50.98
|
|
|
Service Code
|
NDC 00264975706
|
| Hospital Charge Code |
113131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$50.98 |
| Rate for Payer: Aetna Commercial |
$45.88
|
| Rate for Payer: ASR ASR |
$49.45
|
| Rate for Payer: ASR Commercial |
$49.45
|
| Rate for Payer: BCBS Trust/PPO |
$41.54
|
| Rate for Payer: BCN Commercial |
$39.52
|
| Rate for Payer: Cash Price |
$40.79
|
| Rate for Payer: Cofinity Commercial |
$47.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$50.98
|
| Rate for Payer: Healthscope Whirlpool |
$49.45
|
| Rate for Payer: Mclaren Commercial |
$45.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$41.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.86
|
|
|
EMPTY CONTAINER BOTTLE
|
Facility
|
IP
|
$45.41
|
|
|
Service Code
|
NDC 85412046162
|
| Hospital Charge Code |
113131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.52 |
| Max. Negotiated Rate |
$45.41 |
| Rate for Payer: Aetna Commercial |
$40.87
|
| Rate for Payer: ASR ASR |
$44.05
|
| Rate for Payer: ASR Commercial |
$44.05
|
| Rate for Payer: BCBS Trust/PPO |
$37.00
|
| Rate for Payer: BCN Commercial |
$35.21
|
| Rate for Payer: Cash Price |
$36.33
|
| Rate for Payer: Cofinity Commercial |
$42.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.33
|
| Rate for Payer: Healthscope Commercial |
$45.41
|
| Rate for Payer: Healthscope Whirlpool |
$44.05
|
| Rate for Payer: Mclaren Commercial |
$40.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.60
|
| Rate for Payer: Nomi Health Commercial |
$37.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.96
|
|
|
EMPTY CONTAINER BOTTLE
|
Facility
|
OP
|
$45.41
|
|
|
Service Code
|
NDC 85412046162
|
| Hospital Charge Code |
113131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.16 |
| Max. Negotiated Rate |
$45.41 |
| Rate for Payer: Aetna Commercial |
$40.87
|
| Rate for Payer: Aetna Medicare |
$22.70
|
| Rate for Payer: ASR ASR |
$44.05
|
| Rate for Payer: ASR Commercial |
$44.05
|
| Rate for Payer: BCBS Complete |
$18.16
|
| Rate for Payer: BCBS Trust/PPO |
$37.19
|
| Rate for Payer: BCN Commercial |
$35.21
|
| Rate for Payer: Cash Price |
$36.33
|
| Rate for Payer: Cofinity Commercial |
$42.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.33
|
| Rate for Payer: Healthscope Commercial |
$45.41
|
| Rate for Payer: Healthscope Whirlpool |
$44.05
|
| Rate for Payer: Mclaren Commercial |
$40.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.60
|
| Rate for Payer: Nomi Health Commercial |
$37.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.79
|
| Rate for Payer: Priority Health Narrow Network |
$31.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.96
|
|
|
EMPTY CONTAINER BOTTLE
|
Facility
|
OP
|
$50.98
|
|
|
Service Code
|
NDC 00264975706
|
| Hospital Charge Code |
113131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.39 |
| Max. Negotiated Rate |
$50.98 |
| Rate for Payer: Aetna Commercial |
$45.88
|
| Rate for Payer: Aetna Medicare |
$25.49
|
| Rate for Payer: ASR ASR |
$49.45
|
| Rate for Payer: ASR Commercial |
$49.45
|
| Rate for Payer: BCBS Complete |
$20.39
|
| Rate for Payer: BCBS Trust/PPO |
$41.75
|
| Rate for Payer: BCN Commercial |
$39.52
|
| Rate for Payer: Cash Price |
$40.79
|
| Rate for Payer: Cofinity Commercial |
$47.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$50.98
|
| Rate for Payer: Healthscope Whirlpool |
$49.45
|
| Rate for Payer: Mclaren Commercial |
$45.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$41.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.67
|
| Rate for Payer: Priority Health Narrow Network |
$35.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.86
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
IP
|
$87.84
|
|
|
Service Code
|
NDC 42385095330
|
| Hospital Charge Code |
39255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.10 |
| Max. Negotiated Rate |
$87.84 |
| Rate for Payer: Aetna Commercial |
$79.06
|
| Rate for Payer: ASR ASR |
$85.20
|
| Rate for Payer: ASR Commercial |
$85.20
|
| Rate for Payer: BCBS Trust/PPO |
$71.58
|
| Rate for Payer: BCN Commercial |
$68.10
|
| Rate for Payer: Cash Price |
$70.27
|
| Rate for Payer: Cofinity Commercial |
$82.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.27
|
| Rate for Payer: Healthscope Commercial |
$87.84
|
| Rate for Payer: Healthscope Whirlpool |
$85.20
|
| Rate for Payer: Mclaren Commercial |
$79.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.66
|
| Rate for Payer: Nomi Health Commercial |
$72.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.30
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
OP
|
$6,646.01
|
|
|
Service Code
|
NDC 61958070101
|
| Hospital Charge Code |
39255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,658.40 |
| Max. Negotiated Rate |
$6,646.01 |
| Rate for Payer: Aetna Commercial |
$5,981.41
|
| Rate for Payer: Aetna Medicare |
$3,323.00
|
| Rate for Payer: ASR ASR |
$6,446.63
|
| Rate for Payer: ASR Commercial |
$6,446.63
|
| Rate for Payer: BCBS Complete |
$2,658.40
|
| Rate for Payer: BCBS Trust/PPO |
$5,442.42
|
| Rate for Payer: BCN Commercial |
$5,152.65
|
| Rate for Payer: Cash Price |
$5,316.81
|
| Rate for Payer: Cofinity Commercial |
$6,247.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,316.81
|
| Rate for Payer: Healthscope Commercial |
$6,646.01
|
| Rate for Payer: Healthscope Whirlpool |
$6,446.63
|
| Rate for Payer: Mclaren Commercial |
$5,981.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,649.11
|
| Rate for Payer: Nomi Health Commercial |
$5,449.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,319.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,823.23
|
| Rate for Payer: Priority Health Narrow Network |
$4,658.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,848.49
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
IP
|
$6,646.01
|
|
|
Service Code
|
NDC 61958070101
|
| Hospital Charge Code |
39255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,319.91 |
| Max. Negotiated Rate |
$6,646.01 |
| Rate for Payer: Aetna Commercial |
$5,981.41
|
| Rate for Payer: ASR ASR |
$6,446.63
|
| Rate for Payer: ASR Commercial |
$6,446.63
|
| Rate for Payer: BCBS Trust/PPO |
$5,415.83
|
| Rate for Payer: BCN Commercial |
$5,152.65
|
| Rate for Payer: Cash Price |
$5,316.81
|
| Rate for Payer: Cofinity Commercial |
$6,247.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,316.81
|
| Rate for Payer: Healthscope Commercial |
$6,646.01
|
| Rate for Payer: Healthscope Whirlpool |
$6,446.63
|
| Rate for Payer: Mclaren Commercial |
$5,981.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,649.11
|
| Rate for Payer: Nomi Health Commercial |
$5,449.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,319.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,848.49
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
OP
|
$87.84
|
|
|
Service Code
|
NDC 42385095330
|
| Hospital Charge Code |
39255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.14 |
| Max. Negotiated Rate |
$87.84 |
| Rate for Payer: Aetna Commercial |
$79.06
|
| Rate for Payer: Aetna Medicare |
$43.92
|
| Rate for Payer: ASR ASR |
$85.20
|
| Rate for Payer: ASR Commercial |
$85.20
|
| Rate for Payer: BCBS Complete |
$35.14
|
| Rate for Payer: BCBS Trust/PPO |
$71.93
|
| Rate for Payer: BCN Commercial |
$68.10
|
| Rate for Payer: Cash Price |
$70.27
|
| Rate for Payer: Cofinity Commercial |
$82.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.27
|
| Rate for Payer: Healthscope Commercial |
$87.84
|
| Rate for Payer: Healthscope Whirlpool |
$85.20
|
| Rate for Payer: Mclaren Commercial |
$79.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.66
|
| Rate for Payer: Nomi Health Commercial |
$72.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.97
|
| Rate for Payer: Priority Health Narrow Network |
$61.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.30
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$58.74
|
|
|
Service Code
|
NDC 00143978610
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$58.74 |
| Rate for Payer: Aetna Commercial |
$52.87
|
| Rate for Payer: Aetna Medicare |
$29.37
|
| Rate for Payer: ASR ASR |
$56.98
|
| Rate for Payer: ASR Commercial |
$56.98
|
| Rate for Payer: BCBS Complete |
$23.50
|
| Rate for Payer: BCBS Trust/PPO |
$48.10
|
| Rate for Payer: BCN Commercial |
$45.54
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cofinity Commercial |
$55.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.99
|
| Rate for Payer: Healthscope Commercial |
$58.74
|
| Rate for Payer: Healthscope Whirlpool |
$56.98
|
| Rate for Payer: Mclaren Commercial |
$52.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.93
|
| Rate for Payer: Nomi Health Commercial |
$48.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.47
|
| Rate for Payer: Priority Health Narrow Network |
$41.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.69
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$58.74
|
|
|
Service Code
|
NDC 00143978601
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.18 |
| Max. Negotiated Rate |
$58.74 |
| Rate for Payer: Aetna Commercial |
$52.87
|
| Rate for Payer: ASR ASR |
$56.98
|
| Rate for Payer: ASR Commercial |
$56.98
|
| Rate for Payer: BCBS Trust/PPO |
$47.87
|
| Rate for Payer: BCN Commercial |
$45.54
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cofinity Commercial |
$55.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.99
|
| Rate for Payer: Healthscope Commercial |
$58.74
|
| Rate for Payer: Healthscope Whirlpool |
$56.98
|
| Rate for Payer: Mclaren Commercial |
$52.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.93
|
| Rate for Payer: Nomi Health Commercial |
$48.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.69
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$52.13
|
|
|
Service Code
|
NDC 43598016911
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$52.13 |
| Rate for Payer: Aetna Commercial |
$46.92
|
| Rate for Payer: ASR ASR |
$50.57
|
| Rate for Payer: ASR Commercial |
$50.57
|
| Rate for Payer: BCBS Trust/PPO |
$42.48
|
| Rate for Payer: BCN Commercial |
$40.42
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.70
|
| Rate for Payer: Healthscope Commercial |
$52.13
|
| Rate for Payer: Healthscope Whirlpool |
$50.57
|
| Rate for Payer: Mclaren Commercial |
$46.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.31
|
| Rate for Payer: Nomi Health Commercial |
$42.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.87
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$58.74
|
|
|
Service Code
|
NDC 00143978601
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$58.74 |
| Rate for Payer: Aetna Commercial |
$52.87
|
| Rate for Payer: Aetna Medicare |
$29.37
|
| Rate for Payer: ASR ASR |
$56.98
|
| Rate for Payer: ASR Commercial |
$56.98
|
| Rate for Payer: BCBS Complete |
$23.50
|
| Rate for Payer: BCBS Trust/PPO |
$48.10
|
| Rate for Payer: BCN Commercial |
$45.54
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cofinity Commercial |
$55.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.99
|
| Rate for Payer: Healthscope Commercial |
$58.74
|
| Rate for Payer: Healthscope Whirlpool |
$56.98
|
| Rate for Payer: Mclaren Commercial |
$52.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.93
|
| Rate for Payer: Nomi Health Commercial |
$48.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.47
|
| Rate for Payer: Priority Health Narrow Network |
$41.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.69
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$52.13
|
|
|
Service Code
|
NDC 43598016958
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$52.13 |
| Rate for Payer: Aetna Commercial |
$46.92
|
| Rate for Payer: Aetna Medicare |
$26.06
|
| Rate for Payer: ASR ASR |
$50.57
|
| Rate for Payer: ASR Commercial |
$50.57
|
| Rate for Payer: BCBS Complete |
$20.85
|
| Rate for Payer: BCBS Trust/PPO |
$42.69
|
| Rate for Payer: BCN Commercial |
$40.42
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.70
|
| Rate for Payer: Healthscope Commercial |
$52.13
|
| Rate for Payer: Healthscope Whirlpool |
$50.57
|
| Rate for Payer: Mclaren Commercial |
$46.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.31
|
| Rate for Payer: Nomi Health Commercial |
$42.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.68
|
| Rate for Payer: Priority Health Narrow Network |
$36.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.87
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$52.13
|
|
|
Service Code
|
NDC 43598016911
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$52.13 |
| Rate for Payer: Aetna Commercial |
$46.92
|
| Rate for Payer: Aetna Medicare |
$26.06
|
| Rate for Payer: ASR ASR |
$50.57
|
| Rate for Payer: ASR Commercial |
$50.57
|
| Rate for Payer: BCBS Complete |
$20.85
|
| Rate for Payer: BCBS Trust/PPO |
$42.69
|
| Rate for Payer: BCN Commercial |
$40.42
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.70
|
| Rate for Payer: Healthscope Commercial |
$52.13
|
| Rate for Payer: Healthscope Whirlpool |
$50.57
|
| Rate for Payer: Mclaren Commercial |
$46.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.31
|
| Rate for Payer: Nomi Health Commercial |
$42.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.68
|
| Rate for Payer: Priority Health Narrow Network |
$36.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.87
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$52.13
|
|
|
Service Code
|
NDC 43598016958
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$52.13 |
| Rate for Payer: Aetna Commercial |
$46.92
|
| Rate for Payer: ASR ASR |
$50.57
|
| Rate for Payer: ASR Commercial |
$50.57
|
| Rate for Payer: BCBS Trust/PPO |
$42.48
|
| Rate for Payer: BCN Commercial |
$40.42
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.70
|
| Rate for Payer: Healthscope Commercial |
$52.13
|
| Rate for Payer: Healthscope Whirlpool |
$50.57
|
| Rate for Payer: Mclaren Commercial |
$46.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.31
|
| Rate for Payer: Nomi Health Commercial |
$42.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.87
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$58.74
|
|
|
Service Code
|
NDC 00143978610
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.18 |
| Max. Negotiated Rate |
$58.74 |
| Rate for Payer: Aetna Commercial |
$52.87
|
| Rate for Payer: ASR ASR |
$56.98
|
| Rate for Payer: ASR Commercial |
$56.98
|
| Rate for Payer: BCBS Trust/PPO |
$47.87
|
| Rate for Payer: BCN Commercial |
$45.54
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cofinity Commercial |
$55.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.99
|
| Rate for Payer: Healthscope Commercial |
$58.74
|
| Rate for Payer: Healthscope Whirlpool |
$56.98
|
| Rate for Payer: Mclaren Commercial |
$52.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.93
|
| Rate for Payer: Nomi Health Commercial |
$48.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.69
|
|
|
ENALAPRIL MALEATE 10 MG TABLET
|
Facility
|
OP
|
$442.70
|
|
|
Service Code
|
NDC 00904561061
|
| Hospital Charge Code |
9924
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.08 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Aetna Commercial |
$398.43
|
| Rate for Payer: Aetna Medicare |
$221.35
|
| Rate for Payer: ASR ASR |
$429.42
|
| Rate for Payer: ASR Commercial |
$429.42
|
| Rate for Payer: BCBS Complete |
$177.08
|
| Rate for Payer: BCBS Trust/PPO |
$362.53
|
| Rate for Payer: BCN Commercial |
$343.23
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$416.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$442.70
|
| Rate for Payer: Healthscope Whirlpool |
$429.42
|
| Rate for Payer: Mclaren Commercial |
$398.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.30
|
| Rate for Payer: Nomi Health Commercial |
$363.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.89
|
| Rate for Payer: Priority Health Narrow Network |
$310.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.58
|
|
|
ENALAPRIL MALEATE 10 MG TABLET
|
Facility
|
IP
|
$442.70
|
|
|
Service Code
|
NDC 00904561061
|
| Hospital Charge Code |
9924
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.76 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Aetna Commercial |
$398.43
|
| Rate for Payer: ASR ASR |
$429.42
|
| Rate for Payer: ASR Commercial |
$429.42
|
| Rate for Payer: BCBS Trust/PPO |
$360.76
|
| Rate for Payer: BCN Commercial |
$343.23
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$416.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$442.70
|
| Rate for Payer: Healthscope Whirlpool |
$429.42
|
| Rate for Payer: Mclaren Commercial |
$398.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.30
|
| Rate for Payer: Nomi Health Commercial |
$363.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.58
|
|
