|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$91.05
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$91.05 |
| Rate for Payer: Aetna Commercial |
$81.94
|
| Rate for Payer: Aetna Medicare |
$45.52
|
| Rate for Payer: ASR ASR |
$88.32
|
| Rate for Payer: ASR Commercial |
$88.32
|
| Rate for Payer: BCBS Complete |
$36.42
|
| Rate for Payer: BCBS Trust/PPO |
$74.56
|
| Rate for Payer: BCN Commercial |
$70.59
|
| Rate for Payer: Cash Price |
$72.84
|
| Rate for Payer: Cofinity Commercial |
$85.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.84
|
| Rate for Payer: Healthscope Commercial |
$91.05
|
| Rate for Payer: Healthscope Whirlpool |
$88.32
|
| Rate for Payer: Mclaren Commercial |
$81.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.39
|
| Rate for Payer: Nomi Health Commercial |
$74.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.78
|
| Rate for Payer: Priority Health Narrow Network |
$63.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.12
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$22.16
|
|
|
Service Code
|
NDC 17478007035
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$22.16 |
| Rate for Payer: Aetna Commercial |
$19.94
|
| Rate for Payer: ASR ASR |
$21.50
|
| Rate for Payer: ASR Commercial |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$18.06
|
| Rate for Payer: BCN Commercial |
$17.18
|
| Rate for Payer: Cash Price |
$17.73
|
| Rate for Payer: Cofinity Commercial |
$20.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.73
|
| Rate for Payer: Healthscope Commercial |
$22.16
|
| Rate for Payer: Healthscope Whirlpool |
$21.50
|
| Rate for Payer: Mclaren Commercial |
$19.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.84
|
| Rate for Payer: Nomi Health Commercial |
$18.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.50
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$26.03
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$26.03 |
| Rate for Payer: Aetna Commercial |
$23.43
|
| Rate for Payer: ASR ASR |
$25.25
|
| Rate for Payer: ASR Commercial |
$25.25
|
| Rate for Payer: BCBS Trust/PPO |
$21.21
|
| Rate for Payer: BCN Commercial |
$20.18
|
| Rate for Payer: Cash Price |
$20.82
|
| Rate for Payer: Cofinity Commercial |
$24.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.82
|
| Rate for Payer: Healthscope Commercial |
$26.03
|
| Rate for Payer: Healthscope Whirlpool |
$25.25
|
| Rate for Payer: Mclaren Commercial |
$23.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: Nomi Health Commercial |
$21.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.91
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$38.29
|
|
|
Service Code
|
NDC 24208091055
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$38.29 |
| Rate for Payer: Aetna Commercial |
$34.46
|
| Rate for Payer: Aetna Medicare |
$19.14
|
| Rate for Payer: ASR ASR |
$37.14
|
| Rate for Payer: ASR Commercial |
$37.14
|
| Rate for Payer: BCBS Complete |
$15.32
|
| Rate for Payer: BCBS Trust/PPO |
$31.36
|
| Rate for Payer: BCN Commercial |
$29.69
|
| Rate for Payer: Cash Price |
$30.64
|
| Rate for Payer: Cofinity Commercial |
$35.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.63
|
| Rate for Payer: Healthscope Commercial |
$38.29
|
| Rate for Payer: Healthscope Whirlpool |
$37.14
|
| Rate for Payer: Mclaren Commercial |
$34.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.55
|
| Rate for Payer: Nomi Health Commercial |
$31.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.55
|
| Rate for Payer: Priority Health Narrow Network |
$26.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.70
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$35.98
|
|
|
Service Code
|
NDC 72485067035
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$35.98 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: ASR ASR |
$34.90
|
| Rate for Payer: ASR Commercial |
$34.90
|
| Rate for Payer: BCBS Trust/PPO |
$29.32
|
| Rate for Payer: BCN Commercial |
$27.90
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: Cofinity Commercial |
$33.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.78
|
| Rate for Payer: Healthscope Commercial |
$35.98
|
| Rate for Payer: Healthscope Whirlpool |
$34.90
|
| Rate for Payer: Mclaren Commercial |
$32.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.58
|
| Rate for Payer: Nomi Health Commercial |
$29.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.66
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$26.03
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$26.03 |
| Rate for Payer: Aetna Commercial |
$23.43
|
| Rate for Payer: Aetna Medicare |
$13.02
|
| Rate for Payer: ASR ASR |
$25.25
|
| Rate for Payer: ASR Commercial |
$25.25
|
| Rate for Payer: BCBS Complete |
$10.41
|
| Rate for Payer: BCBS Trust/PPO |
$21.32
|
| Rate for Payer: BCN Commercial |
$20.18
|
| Rate for Payer: Cash Price |
$20.82
|
| Rate for Payer: Cofinity Commercial |
$24.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.82
|
| Rate for Payer: Healthscope Commercial |
$26.03
|
| Rate for Payer: Healthscope Whirlpool |
$25.25
|
| Rate for Payer: Mclaren Commercial |
$23.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: Nomi Health Commercial |
$21.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.81
|
| Rate for Payer: Priority Health Narrow Network |
$18.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.91
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$35.98
|
|
|
Service Code
|
NDC 72485067035
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$35.98 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: Aetna Medicare |
$17.99
|
| Rate for Payer: ASR ASR |
$34.90
|
| Rate for Payer: ASR Commercial |
$34.90
|
| Rate for Payer: BCBS Complete |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$29.46
|
| Rate for Payer: BCN Commercial |
$27.90
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: Cofinity Commercial |
$33.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.78
|
| Rate for Payer: Healthscope Commercial |
$35.98
|
| Rate for Payer: Healthscope Whirlpool |
$34.90
|
| Rate for Payer: Mclaren Commercial |
$32.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.58
|
| Rate for Payer: Nomi Health Commercial |
$29.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.53
|
| Rate for Payer: Priority Health Narrow Network |
$25.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.66
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$38.29
|
|
|
Service Code
|
NDC 24208091055
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$38.29 |
| Rate for Payer: Aetna Commercial |
$34.46
|
| Rate for Payer: ASR ASR |
$37.14
|
| Rate for Payer: ASR Commercial |
$37.14
|
| Rate for Payer: BCBS Trust/PPO |
$31.20
|
| Rate for Payer: BCN Commercial |
$29.69
|
| Rate for Payer: Cash Price |
$30.64
|
| Rate for Payer: Cofinity Commercial |
$35.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.63
|
| Rate for Payer: Healthscope Commercial |
$38.29
|
| Rate for Payer: Healthscope Whirlpool |
$37.14
|
| Rate for Payer: Mclaren Commercial |
$34.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.55
|
| Rate for Payer: Nomi Health Commercial |
$31.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.70
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$48.72
|
|
|
Service Code
|
NDC 00574402435
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$48.72 |
| Rate for Payer: Aetna Commercial |
$43.85
|
| Rate for Payer: Aetna Medicare |
$24.36
|
| Rate for Payer: ASR ASR |
$47.26
|
| Rate for Payer: ASR Commercial |
$47.26
|
| Rate for Payer: BCBS Complete |
$19.49
|
| Rate for Payer: BCBS Trust/PPO |
$39.90
|
| Rate for Payer: BCN Commercial |
$37.77
|
| Rate for Payer: Cash Price |
$38.98
|
| Rate for Payer: Cofinity Commercial |
$45.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.98
|
| Rate for Payer: Healthscope Commercial |
$48.72
|
| Rate for Payer: Healthscope Whirlpool |
$47.26
|
| Rate for Payer: Mclaren Commercial |
$43.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.41
|
| Rate for Payer: Nomi Health Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.69
|
| Rate for Payer: Priority Health Narrow Network |
$34.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.87
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$48.72
|
|
|
Service Code
|
NDC 00574402435
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.67 |
| Max. Negotiated Rate |
$48.72 |
| Rate for Payer: Aetna Commercial |
$43.85
|
| Rate for Payer: ASR ASR |
$47.26
|
| Rate for Payer: ASR Commercial |
$47.26
|
| Rate for Payer: BCBS Trust/PPO |
$39.70
|
| Rate for Payer: BCN Commercial |
$37.77
|
| Rate for Payer: Cash Price |
$38.98
|
| Rate for Payer: Cofinity Commercial |
$45.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.98
|
| Rate for Payer: Healthscope Commercial |
$48.72
|
| Rate for Payer: Healthscope Whirlpool |
$47.26
|
| Rate for Payer: Mclaren Commercial |
$43.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.41
|
| Rate for Payer: Nomi Health Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.87
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$22.16
|
|
|
Service Code
|
NDC 17478007035
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$22.16 |
| Rate for Payer: Aetna Commercial |
$19.94
|
| Rate for Payer: Aetna Medicare |
$11.08
|
| Rate for Payer: ASR ASR |
$21.50
|
| Rate for Payer: ASR Commercial |
$21.50
|
| Rate for Payer: BCBS Complete |
$8.86
|
| Rate for Payer: BCBS Trust/PPO |
$18.15
|
| Rate for Payer: BCN Commercial |
$17.18
|
| Rate for Payer: Cash Price |
$17.73
|
| Rate for Payer: Cofinity Commercial |
$20.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.73
|
| Rate for Payer: Healthscope Commercial |
$22.16
|
| Rate for Payer: Healthscope Whirlpool |
$21.50
|
| Rate for Payer: Mclaren Commercial |
$19.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.84
|
| Rate for Payer: Nomi Health Commercial |
$18.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.42
|
| Rate for Payer: Priority Health Narrow Network |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.50
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$333.70
|
|
|
Service Code
|
NDC 00904642661
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.91 |
| Max. Negotiated Rate |
$333.70 |
| Rate for Payer: Aetna Commercial |
$300.33
|
| Rate for Payer: ASR ASR |
$323.69
|
| Rate for Payer: ASR Commercial |
$323.69
|
| Rate for Payer: BCBS Trust/PPO |
$271.93
|
| Rate for Payer: BCN Commercial |
$258.72
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$313.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$333.70
|
| Rate for Payer: Healthscope Whirlpool |
$323.69
|
| Rate for Payer: Mclaren Commercial |
$300.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Nomi Health Commercial |
$273.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.66
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$333.70
|
|
|
Service Code
|
NDC 00904642661
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.48 |
| Max. Negotiated Rate |
$333.70 |
| Rate for Payer: Aetna Commercial |
$300.33
|
| Rate for Payer: Aetna Medicare |
$166.85
|
| Rate for Payer: ASR ASR |
$323.69
|
| Rate for Payer: ASR Commercial |
$323.69
|
| Rate for Payer: BCBS Complete |
$133.48
|
| Rate for Payer: BCBS Trust/PPO |
$273.27
|
| Rate for Payer: BCN Commercial |
$258.72
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$313.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$333.70
|
| Rate for Payer: Healthscope Whirlpool |
$323.69
|
| Rate for Payer: Mclaren Commercial |
$300.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Nomi Health Commercial |
$273.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.39
|
| Rate for Payer: Priority Health Narrow Network |
$233.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.66
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV
|
Facility
|
OP
|
$366.56
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.62 |
| Max. Negotiated Rate |
$366.56 |
| Rate for Payer: Aetna Commercial |
$329.90
|
| Rate for Payer: Aetna Commercial |
$564.44
|
| Rate for Payer: Aetna Medicare |
$183.28
|
| Rate for Payer: Aetna Medicare |
$313.58
|
| Rate for Payer: ASR ASR |
$355.56
|
| Rate for Payer: ASR ASR |
$608.35
|
| Rate for Payer: ASR Commercial |
$608.35
|
| Rate for Payer: ASR Commercial |
$355.56
|
| Rate for Payer: BCBS Complete |
$146.62
|
| Rate for Payer: BCBS Complete |
$250.86
|
| Rate for Payer: BCBS Trust/PPO |
$300.18
|
| Rate for Payer: BCBS Trust/PPO |
$513.58
|
| Rate for Payer: BCN Commercial |
$486.24
|
| Rate for Payer: BCN Commercial |
$284.19
|
| Rate for Payer: Cash Price |
$293.25
|
| Rate for Payer: Cash Price |
$501.73
|
| Rate for Payer: Cofinity Commercial |
$344.57
|
| Rate for Payer: Cofinity Commercial |
$589.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.73
|
| Rate for Payer: Healthscope Commercial |
$366.56
|
| Rate for Payer: Healthscope Commercial |
$627.16
|
| Rate for Payer: Healthscope Whirlpool |
$355.56
|
| Rate for Payer: Healthscope Whirlpool |
$608.35
|
| Rate for Payer: Mclaren Commercial |
$329.90
|
| Rate for Payer: Mclaren Commercial |
$564.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$533.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.58
|
| Rate for Payer: Nomi Health Commercial |
$300.58
|
| Rate for Payer: Nomi Health Commercial |
$514.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$407.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$321.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$549.52
|
| Rate for Payer: Priority Health Narrow Network |
$439.64
|
| Rate for Payer: Priority Health Narrow Network |
$256.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$551.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.57
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV
|
Facility
|
IP
|
$627.16
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$407.65 |
| Max. Negotiated Rate |
$627.16 |
| Rate for Payer: Aetna Commercial |
$564.44
|
| Rate for Payer: Aetna Commercial |
$329.90
|
| Rate for Payer: ASR ASR |
$355.56
|
| Rate for Payer: ASR ASR |
$608.35
|
| Rate for Payer: ASR Commercial |
$355.56
|
| Rate for Payer: ASR Commercial |
$608.35
|
| Rate for Payer: BCBS Trust/PPO |
$298.71
|
| Rate for Payer: BCBS Trust/PPO |
$511.07
|
| Rate for Payer: BCN Commercial |
$486.24
|
| Rate for Payer: BCN Commercial |
$284.19
|
| Rate for Payer: Cash Price |
$501.73
|
| Rate for Payer: Cash Price |
$293.25
|
| Rate for Payer: Cofinity Commercial |
$344.57
|
| Rate for Payer: Cofinity Commercial |
$589.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.73
|
| Rate for Payer: Healthscope Commercial |
$366.56
|
| Rate for Payer: Healthscope Commercial |
$627.16
|
| Rate for Payer: Healthscope Whirlpool |
$608.35
|
| Rate for Payer: Healthscope Whirlpool |
$355.56
|
| Rate for Payer: Mclaren Commercial |
$329.90
|
| Rate for Payer: Mclaren Commercial |
$564.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$533.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.58
|
| Rate for Payer: Nomi Health Commercial |
$514.27
|
| Rate for Payer: Nomi Health Commercial |
$300.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$407.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$551.90
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM
|
Facility
|
IP
|
$544.42
|
|
|
Service Code
|
NDC 47781010444
|
| Hospital Charge Code |
9969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$353.87 |
| Max. Negotiated Rate |
$544.42 |
| Rate for Payer: Aetna Commercial |
$489.98
|
| Rate for Payer: ASR ASR |
$528.09
|
| Rate for Payer: ASR Commercial |
$528.09
|
| Rate for Payer: BCBS Trust/PPO |
$443.65
|
| Rate for Payer: BCN Commercial |
$422.09
|
| Rate for Payer: Cash Price |
$435.54
|
| Rate for Payer: Cofinity Commercial |
$511.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.54
|
| Rate for Payer: Healthscope Commercial |
$544.42
|
| Rate for Payer: Healthscope Whirlpool |
$528.09
|
| Rate for Payer: Mclaren Commercial |
$489.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$462.76
|
| Rate for Payer: Nomi Health Commercial |
$446.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$479.09
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM
|
Facility
|
OP
|
$544.42
|
|
|
Service Code
|
NDC 47781010444
|
| Hospital Charge Code |
9969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.77 |
| Max. Negotiated Rate |
$544.42 |
| Rate for Payer: Aetna Commercial |
$489.98
|
| Rate for Payer: Aetna Medicare |
$272.21
|
| Rate for Payer: ASR ASR |
$528.09
|
| Rate for Payer: ASR Commercial |
$528.09
|
| Rate for Payer: BCBS Complete |
$217.77
|
| Rate for Payer: BCBS Trust/PPO |
$445.83
|
| Rate for Payer: BCN Commercial |
$422.09
|
| Rate for Payer: Cash Price |
$435.54
|
| Rate for Payer: Cofinity Commercial |
$511.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.54
|
| Rate for Payer: Healthscope Commercial |
$544.42
|
| Rate for Payer: Healthscope Whirlpool |
$528.09
|
| Rate for Payer: Mclaren Commercial |
$489.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$462.76
|
| Rate for Payer: Nomi Health Commercial |
$446.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.02
|
| Rate for Payer: Priority Health Narrow Network |
$381.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$479.09
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
OP
|
$271.70
|
|
|
Service Code
|
NDC 00555088602
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$244.53
|
| Rate for Payer: Aetna Medicare |
$135.85
|
| Rate for Payer: ASR ASR |
$263.55
|
| Rate for Payer: ASR Commercial |
$263.55
|
| Rate for Payer: BCBS Complete |
$108.68
|
| Rate for Payer: BCBS Trust/PPO |
$222.50
|
| Rate for Payer: BCN Commercial |
$210.65
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Commercial |
$255.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$271.70
|
| Rate for Payer: Healthscope Whirlpool |
$263.55
|
| Rate for Payer: Mclaren Commercial |
$244.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: Nomi Health Commercial |
$222.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.06
|
| Rate for Payer: Priority Health Narrow Network |
$190.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.10
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
IP
|
$190.35
|
|
|
Service Code
|
NDC 70954056510
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$171.31
|
| Rate for Payer: ASR ASR |
$184.64
|
| Rate for Payer: ASR Commercial |
$184.64
|
| Rate for Payer: BCBS Trust/PPO |
$155.12
|
| Rate for Payer: BCN Commercial |
$147.58
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$178.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Healthscope Whirlpool |
$184.64
|
| Rate for Payer: Mclaren Commercial |
$171.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.51
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
IP
|
$271.70
|
|
|
Service Code
|
NDC 00555088602
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.60 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$244.53
|
| Rate for Payer: ASR ASR |
$263.55
|
| Rate for Payer: ASR Commercial |
$263.55
|
| Rate for Payer: BCBS Trust/PPO |
$221.41
|
| Rate for Payer: BCN Commercial |
$210.65
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Commercial |
$255.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$271.70
|
| Rate for Payer: Healthscope Whirlpool |
$263.55
|
| Rate for Payer: Mclaren Commercial |
$244.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: Nomi Health Commercial |
$222.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.10
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
OP
|
$190.35
|
|
|
Service Code
|
NDC 70954056510
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.14 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$171.31
|
| Rate for Payer: Aetna Medicare |
$95.17
|
| Rate for Payer: ASR ASR |
$184.64
|
| Rate for Payer: ASR Commercial |
$184.64
|
| Rate for Payer: BCBS Complete |
$76.14
|
| Rate for Payer: BCBS Trust/PPO |
$155.88
|
| Rate for Payer: BCN Commercial |
$147.58
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$178.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Healthscope Whirlpool |
$184.64
|
| Rate for Payer: Mclaren Commercial |
$171.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.78
|
| Rate for Payer: Priority Health Narrow Network |
$133.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.51
|
|
|
ETODOLAC 200 MG CAPSULE
|
Facility
|
IP
|
$480.96
|
|
|
Service Code
|
NDC 51672401601
|
| Hospital Charge Code |
9997
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.62 |
| Max. Negotiated Rate |
$480.96 |
| Rate for Payer: Aetna Commercial |
$432.86
|
| Rate for Payer: ASR ASR |
$466.53
|
| Rate for Payer: ASR Commercial |
$466.53
|
| Rate for Payer: BCBS Trust/PPO |
$391.93
|
| Rate for Payer: BCN Commercial |
$372.89
|
| Rate for Payer: Cash Price |
$384.77
|
| Rate for Payer: Cofinity Commercial |
$452.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.77
|
| Rate for Payer: Healthscope Commercial |
$480.96
|
| Rate for Payer: Healthscope Whirlpool |
$466.53
|
| Rate for Payer: Mclaren Commercial |
$432.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.82
|
| Rate for Payer: Nomi Health Commercial |
$394.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.24
|
|
|
ETODOLAC 200 MG CAPSULE
|
Facility
|
OP
|
$480.96
|
|
|
Service Code
|
NDC 51672401601
|
| Hospital Charge Code |
9997
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.38 |
| Max. Negotiated Rate |
$480.96 |
| Rate for Payer: Aetna Commercial |
$432.86
|
| Rate for Payer: Aetna Medicare |
$240.48
|
| Rate for Payer: ASR ASR |
$466.53
|
| Rate for Payer: ASR Commercial |
$466.53
|
| Rate for Payer: BCBS Complete |
$192.38
|
| Rate for Payer: BCBS Trust/PPO |
$393.86
|
| Rate for Payer: BCN Commercial |
$372.89
|
| Rate for Payer: Cash Price |
$384.77
|
| Rate for Payer: Cofinity Commercial |
$452.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.77
|
| Rate for Payer: Healthscope Commercial |
$480.96
|
| Rate for Payer: Healthscope Whirlpool |
$466.53
|
| Rate for Payer: Mclaren Commercial |
$432.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.82
|
| Rate for Payer: Nomi Health Commercial |
$394.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.42
|
| Rate for Payer: Priority Health Narrow Network |
$337.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.24
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
NDC 65219044510
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.59
|
| Rate for Payer: ASR ASR |
$17.88
|
| Rate for Payer: ASR Commercial |
$17.88
|
| Rate for Payer: BCBS Trust/PPO |
$15.02
|
| Rate for Payer: BCN Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$18.43
|
| Rate for Payer: Healthscope Whirlpool |
$17.88
|
| Rate for Payer: Mclaren Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.22
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.23
|
|
|
Service Code
|
NDC 00143931001
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Medicare |
$12.62
|
| Rate for Payer: ASR ASR |
$24.47
|
| Rate for Payer: ASR Commercial |
$24.47
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$20.66
|
| Rate for Payer: BCN Commercial |
$19.56
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$23.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.18
|
| Rate for Payer: Healthscope Commercial |
$25.23
|
| Rate for Payer: Healthscope Whirlpool |
$24.47
|
| Rate for Payer: Mclaren Commercial |
$22.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$20.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.11
|
| Rate for Payer: Priority Health Narrow Network |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.20
|
|
