|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$13.23
|
|
|
Service Code
|
NDC 66689006099
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$13.23 |
| Rate for Payer: Aetna Commercial |
$11.91
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: ASR ASR |
$12.83
|
| Rate for Payer: ASR Commercial |
$12.83
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: BCBS Trust/PPO |
$10.83
|
| Rate for Payer: BCN Commercial |
$10.26
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$12.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$13.23
|
| Rate for Payer: Healthscope Whirlpool |
$12.83
|
| Rate for Payer: Mclaren Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Nomi Health Commercial |
$10.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.59
|
| Rate for Payer: Priority Health Narrow Network |
$9.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.64
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 66689006099
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$13.23 |
| Rate for Payer: Aetna Commercial |
$11.91
|
| Rate for Payer: ASR ASR |
$12.83
|
| Rate for Payer: ASR Commercial |
$12.83
|
| Rate for Payer: BCBS Trust/PPO |
$10.78
|
| Rate for Payer: BCN Commercial |
$10.26
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$12.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$13.23
|
| Rate for Payer: Healthscope Whirlpool |
$12.83
|
| Rate for Payer: Mclaren Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Nomi Health Commercial |
$10.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.64
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$13.23
|
|
|
Service Code
|
NDC 66689006001
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$13.23 |
| Rate for Payer: Aetna Commercial |
$11.91
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: ASR ASR |
$12.83
|
| Rate for Payer: ASR Commercial |
$12.83
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: BCBS Trust/PPO |
$10.83
|
| Rate for Payer: BCN Commercial |
$10.26
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$12.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$13.23
|
| Rate for Payer: Healthscope Whirlpool |
$12.83
|
| Rate for Payer: Mclaren Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Nomi Health Commercial |
$10.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.59
|
| Rate for Payer: Priority Health Narrow Network |
$9.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.64
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
IP
|
$10.26
|
|
|
Service Code
|
NDC 00904683873
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Aetna Commercial |
$9.23
|
| Rate for Payer: ASR ASR |
$9.95
|
| Rate for Payer: ASR Commercial |
$9.95
|
| Rate for Payer: BCBS Trust/PPO |
$8.36
|
| Rate for Payer: BCN Commercial |
$7.95
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$9.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$10.26
|
| Rate for Payer: Healthscope Whirlpool |
$9.95
|
| Rate for Payer: Mclaren Commercial |
$9.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: Nomi Health Commercial |
$8.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.03
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$10.26
|
|
|
Service Code
|
NDC 00904683873
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Aetna Commercial |
$9.23
|
| Rate for Payer: Aetna Medicare |
$5.13
|
| Rate for Payer: ASR ASR |
$9.95
|
| Rate for Payer: ASR Commercial |
$9.95
|
| Rate for Payer: BCBS Complete |
$4.10
|
| Rate for Payer: BCBS Trust/PPO |
$8.40
|
| Rate for Payer: BCN Commercial |
$7.95
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$9.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$10.26
|
| Rate for Payer: Healthscope Whirlpool |
$9.95
|
| Rate for Payer: Mclaren Commercial |
$9.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: Nomi Health Commercial |
$8.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.99
|
| Rate for Payer: Priority Health Narrow Network |
$7.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.03
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 66689006001
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$13.23 |
| Rate for Payer: Aetna Commercial |
$11.91
|
| Rate for Payer: ASR ASR |
$12.83
|
| Rate for Payer: ASR Commercial |
$12.83
|
| Rate for Payer: BCBS Trust/PPO |
$10.78
|
| Rate for Payer: BCN Commercial |
$10.26
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$12.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$13.23
|
| Rate for Payer: Healthscope Whirlpool |
$12.83
|
| Rate for Payer: Mclaren Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Nomi Health Commercial |
$10.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.64
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP
|
Facility
|
IP
|
$79.67
|
|
|
Service Code
|
NDC 00121176230
|
| Hospital Charge Code |
9015
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.79 |
| Max. Negotiated Rate |
$79.67 |
| Rate for Payer: Aetna Commercial |
$71.70
|
| Rate for Payer: ASR ASR |
$77.28
|
| Rate for Payer: ASR Commercial |
$77.28
|
| Rate for Payer: BCBS Trust/PPO |
$64.92
|
| Rate for Payer: BCN Commercial |
$61.77
|
| Rate for Payer: Cash Price |
$63.73
|
| Rate for Payer: Cofinity Commercial |
$74.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.74
|
| Rate for Payer: Healthscope Commercial |
$79.67
|
| Rate for Payer: Healthscope Whirlpool |
$77.28
|
| Rate for Payer: Mclaren Commercial |
$71.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.72
|
| Rate for Payer: Nomi Health Commercial |
$65.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.11
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$79.67
|
|
|
Service Code
|
NDC 00121176230
|
| Hospital Charge Code |
9015
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.87 |
| Max. Negotiated Rate |
$79.67 |
| Rate for Payer: Aetna Commercial |
$71.70
|
| Rate for Payer: Aetna Medicare |
$39.84
|
| Rate for Payer: ASR ASR |
$77.28
|
| Rate for Payer: ASR Commercial |
$77.28
|
| Rate for Payer: BCBS Complete |
$31.87
|
| Rate for Payer: BCBS Trust/PPO |
$65.24
|
| Rate for Payer: BCN Commercial |
$61.77
|
| Rate for Payer: Cash Price |
$63.73
|
| Rate for Payer: Cofinity Commercial |
$74.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.74
|
| Rate for Payer: Healthscope Commercial |
$79.67
|
| Rate for Payer: Healthscope Whirlpool |
$77.28
|
| Rate for Payer: Mclaren Commercial |
$71.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.72
|
| Rate for Payer: Nomi Health Commercial |
$65.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.81
|
| Rate for Payer: Priority Health Narrow Network |
$55.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.11
|
|
|
AMANTADINE HCL 100 MG TABLET
|
Facility
|
IP
|
$250.08
|
|
|
Service Code
|
NDC 00832011100
|
| Hospital Charge Code |
20506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.55 |
| Max. Negotiated Rate |
$250.08 |
| Rate for Payer: Aetna Commercial |
$225.07
|
| Rate for Payer: ASR ASR |
$242.58
|
| Rate for Payer: ASR Commercial |
$242.58
|
| Rate for Payer: BCBS Trust/PPO |
$203.79
|
| Rate for Payer: BCN Commercial |
$193.89
|
| Rate for Payer: Cash Price |
$200.06
|
| Rate for Payer: Cofinity Commercial |
$235.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.06
|
| Rate for Payer: Healthscope Commercial |
$250.08
|
| Rate for Payer: Healthscope Whirlpool |
$242.58
|
| Rate for Payer: Mclaren Commercial |
$225.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.57
|
| Rate for Payer: Nomi Health Commercial |
$205.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.07
|
|
|
AMANTADINE HCL 100 MG TABLET
|
Facility
|
OP
|
$250.08
|
|
|
Service Code
|
NDC 00832011100
|
| Hospital Charge Code |
20506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.03 |
| Max. Negotiated Rate |
$250.08 |
| Rate for Payer: Aetna Commercial |
$225.07
|
| Rate for Payer: Aetna Medicare |
$125.04
|
| Rate for Payer: ASR ASR |
$242.58
|
| Rate for Payer: ASR Commercial |
$242.58
|
| Rate for Payer: BCBS Complete |
$100.03
|
| Rate for Payer: BCBS Trust/PPO |
$204.79
|
| Rate for Payer: BCN Commercial |
$193.89
|
| Rate for Payer: Cash Price |
$200.06
|
| Rate for Payer: Cofinity Commercial |
$235.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.06
|
| Rate for Payer: Healthscope Commercial |
$250.08
|
| Rate for Payer: Healthscope Whirlpool |
$242.58
|
| Rate for Payer: Mclaren Commercial |
$225.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.57
|
| Rate for Payer: Nomi Health Commercial |
$205.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.12
|
| Rate for Payer: Priority Health Narrow Network |
$175.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.07
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$167.76
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$167.76 |
| Rate for Payer: Aetna Commercial |
$150.98
|
| Rate for Payer: Aetna Medicare |
$83.88
|
| Rate for Payer: ASR ASR |
$162.73
|
| Rate for Payer: ASR Commercial |
$162.73
|
| Rate for Payer: BCBS Complete |
$67.10
|
| Rate for Payer: BCBS Trust/PPO |
$137.38
|
| Rate for Payer: BCN Commercial |
$130.06
|
| Rate for Payer: Cash Price |
$134.21
|
| Rate for Payer: Cash Price |
$134.21
|
| Rate for Payer: Cofinity Commercial |
$157.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.21
|
| Rate for Payer: Healthscope Commercial |
$167.76
|
| Rate for Payer: Healthscope Whirlpool |
$162.73
|
| Rate for Payer: Mclaren Commercial |
$150.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.60
|
| Rate for Payer: Nomi Health Commercial |
$137.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.47
|
| Rate for Payer: Priority Health Narrow Network |
$9.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.63
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$167.76
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.04 |
| Max. Negotiated Rate |
$167.76 |
| Rate for Payer: Aetna Commercial |
$150.98
|
| Rate for Payer: ASR ASR |
$162.73
|
| Rate for Payer: ASR Commercial |
$162.73
|
| Rate for Payer: BCBS Trust/PPO |
$136.71
|
| Rate for Payer: BCN Commercial |
$130.06
|
| Rate for Payer: Cash Price |
$134.21
|
| Rate for Payer: Cofinity Commercial |
$157.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.21
|
| Rate for Payer: Healthscope Commercial |
$167.76
|
| Rate for Payer: Healthscope Whirlpool |
$162.73
|
| Rate for Payer: Mclaren Commercial |
$150.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.60
|
| Rate for Payer: Nomi Health Commercial |
$137.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.63
|
|
|
AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33.20
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
113386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$33.20 |
| Rate for Payer: Aetna Commercial |
$29.88
|
| Rate for Payer: Aetna Medicare |
$16.60
|
| Rate for Payer: ASR ASR |
$32.20
|
| Rate for Payer: ASR Commercial |
$32.20
|
| Rate for Payer: BCBS Complete |
$13.28
|
| Rate for Payer: BCBS Trust/PPO |
$27.19
|
| Rate for Payer: BCN Commercial |
$25.74
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cofinity Commercial |
$31.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.56
|
| Rate for Payer: Healthscope Commercial |
$33.20
|
| Rate for Payer: Healthscope Whirlpool |
$32.20
|
| Rate for Payer: Mclaren Commercial |
$29.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.22
|
| Rate for Payer: Nomi Health Commercial |
$27.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.47
|
| Rate for Payer: Priority Health Narrow Network |
$9.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.22
|
|
|
AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.20
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
113386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.58 |
| Max. Negotiated Rate |
$33.20 |
| Rate for Payer: Aetna Commercial |
$29.88
|
| Rate for Payer: ASR ASR |
$32.20
|
| Rate for Payer: ASR Commercial |
$32.20
|
| Rate for Payer: BCBS Trust/PPO |
$27.05
|
| Rate for Payer: BCN Commercial |
$25.74
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cofinity Commercial |
$31.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.56
|
| Rate for Payer: Healthscope Commercial |
$33.20
|
| Rate for Payer: Healthscope Whirlpool |
$32.20
|
| Rate for Payer: Mclaren Commercial |
$29.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.22
|
| Rate for Payer: Nomi Health Commercial |
$27.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.22
|
|
|
AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV
|
Facility
|
IP
|
$143.74
|
|
|
Service Code
|
HCPCS J0283
|
| Hospital Charge Code |
152869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.43 |
| Max. Negotiated Rate |
$143.74 |
| Rate for Payer: Aetna Commercial |
$129.37
|
| Rate for Payer: ASR ASR |
$139.43
|
| Rate for Payer: ASR Commercial |
$139.43
|
| Rate for Payer: BCBS Trust/PPO |
$117.13
|
| Rate for Payer: BCN Commercial |
$111.44
|
| Rate for Payer: Cash Price |
$114.99
|
| Rate for Payer: Cofinity Commercial |
$135.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.99
|
| Rate for Payer: Healthscope Commercial |
$143.74
|
| Rate for Payer: Healthscope Whirlpool |
$139.43
|
| Rate for Payer: Mclaren Commercial |
$129.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.18
|
| Rate for Payer: Nomi Health Commercial |
$117.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.49
|
|
|
AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV
|
Facility
|
OP
|
$143.74
|
|
|
Service Code
|
HCPCS J0283
|
| Hospital Charge Code |
152869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$143.74 |
| Rate for Payer: Aetna Commercial |
$129.37
|
| Rate for Payer: Aetna Medicare |
$71.87
|
| Rate for Payer: ASR ASR |
$139.43
|
| Rate for Payer: ASR Commercial |
$139.43
|
| Rate for Payer: BCBS Complete |
$57.50
|
| Rate for Payer: BCBS Trust/PPO |
$117.71
|
| Rate for Payer: BCN Commercial |
$111.44
|
| Rate for Payer: Cash Price |
$114.99
|
| Rate for Payer: Cash Price |
$114.99
|
| Rate for Payer: Cofinity Commercial |
$135.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.99
|
| Rate for Payer: Healthscope Commercial |
$143.74
|
| Rate for Payer: Healthscope Whirlpool |
$139.43
|
| Rate for Payer: Mclaren Commercial |
$129.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.18
|
| Rate for Payer: Nomi Health Commercial |
$117.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.69
|
| Rate for Payer: Priority Health Narrow Network |
$2.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.49
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$2.05
|
|
|
Service Code
|
NDC 00245014789
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: ASR ASR |
$1.99
|
| Rate for Payer: ASR Commercial |
$1.99
|
| Rate for Payer: BCBS Trust/PPO |
$1.67
|
| Rate for Payer: BCN Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$1.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.64
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Healthscope Whirlpool |
$1.99
|
| Rate for Payer: Mclaren Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.74
|
| Rate for Payer: Nomi Health Commercial |
$1.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.80
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$2.05
|
|
|
Service Code
|
NDC 00245014789
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: ASR ASR |
$1.99
|
| Rate for Payer: ASR Commercial |
$1.99
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: BCBS Trust/PPO |
$1.68
|
| Rate for Payer: BCN Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$1.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.64
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Healthscope Whirlpool |
$1.99
|
| Rate for Payer: Mclaren Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.74
|
| Rate for Payer: Nomi Health Commercial |
$1.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.80
|
| Rate for Payer: Priority Health Narrow Network |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.80
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$327.75
|
|
|
Service Code
|
NDC 68084037111
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.10 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna Commercial |
$294.98
|
| Rate for Payer: Aetna Medicare |
$163.88
|
| Rate for Payer: ASR ASR |
$317.92
|
| Rate for Payer: ASR Commercial |
$317.92
|
| Rate for Payer: BCBS Complete |
$131.10
|
| Rate for Payer: BCBS Trust/PPO |
$268.39
|
| Rate for Payer: BCN Commercial |
$254.10
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cofinity Commercial |
$308.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.20
|
| Rate for Payer: Healthscope Commercial |
$327.75
|
| Rate for Payer: Healthscope Whirlpool |
$317.92
|
| Rate for Payer: Mclaren Commercial |
$294.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.59
|
| Rate for Payer: Nomi Health Commercial |
$268.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.17
|
| Rate for Payer: Priority Health Narrow Network |
$229.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.42
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
OP
|
$327.75
|
|
|
Service Code
|
NDC 68084037101
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.10 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna Commercial |
$294.98
|
| Rate for Payer: Aetna Medicare |
$163.88
|
| Rate for Payer: ASR ASR |
$317.92
|
| Rate for Payer: ASR Commercial |
$317.92
|
| Rate for Payer: BCBS Complete |
$131.10
|
| Rate for Payer: BCBS Trust/PPO |
$268.39
|
| Rate for Payer: BCN Commercial |
$254.10
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cofinity Commercial |
$308.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.20
|
| Rate for Payer: Healthscope Commercial |
$327.75
|
| Rate for Payer: Healthscope Whirlpool |
$317.92
|
| Rate for Payer: Mclaren Commercial |
$294.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.59
|
| Rate for Payer: Nomi Health Commercial |
$268.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.17
|
| Rate for Payer: Priority Health Narrow Network |
$229.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.42
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$327.75
|
|
|
Service Code
|
NDC 68084037101
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.04 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna Commercial |
$294.98
|
| Rate for Payer: ASR ASR |
$317.92
|
| Rate for Payer: ASR Commercial |
$317.92
|
| Rate for Payer: BCBS Trust/PPO |
$267.08
|
| Rate for Payer: BCN Commercial |
$254.10
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cofinity Commercial |
$308.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.20
|
| Rate for Payer: Healthscope Commercial |
$327.75
|
| Rate for Payer: Healthscope Whirlpool |
$317.92
|
| Rate for Payer: Mclaren Commercial |
$294.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.59
|
| Rate for Payer: Nomi Health Commercial |
$268.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.42
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
|
IP
|
$327.75
|
|
|
Service Code
|
NDC 68084037111
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.04 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna Commercial |
$294.98
|
| Rate for Payer: ASR ASR |
$317.92
|
| Rate for Payer: ASR Commercial |
$317.92
|
| Rate for Payer: BCBS Trust/PPO |
$267.08
|
| Rate for Payer: BCN Commercial |
$254.10
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cofinity Commercial |
$308.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.20
|
| Rate for Payer: Healthscope Commercial |
$327.75
|
| Rate for Payer: Healthscope Whirlpool |
$317.92
|
| Rate for Payer: Mclaren Commercial |
$294.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.59
|
| Rate for Payer: Nomi Health Commercial |
$268.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.42
|
|
|
AMIODARONE 360 MG/200 ML (1.8 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV
|
Facility
|
OP
|
$76.54
|
|
|
Service Code
|
HCPCS J0283
|
| Hospital Charge Code |
152870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$68.89
|
| Rate for Payer: Aetna Medicare |
$38.27
|
| Rate for Payer: ASR ASR |
$74.24
|
| Rate for Payer: ASR Commercial |
$74.24
|
| Rate for Payer: BCBS Complete |
$30.62
|
| Rate for Payer: BCBS Trust/PPO |
$62.68
|
| Rate for Payer: BCN Commercial |
$59.34
|
| Rate for Payer: Cash Price |
$61.23
|
| Rate for Payer: Cash Price |
$61.23
|
| Rate for Payer: Cofinity Commercial |
$71.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.23
|
| Rate for Payer: Healthscope Commercial |
$76.54
|
| Rate for Payer: Healthscope Whirlpool |
$74.24
|
| Rate for Payer: Mclaren Commercial |
$68.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.06
|
| Rate for Payer: Nomi Health Commercial |
$62.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.69
|
| Rate for Payer: Priority Health Narrow Network |
$2.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.36
|
|
|
AMIODARONE 360 MG/200 ML (1.8 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV
|
Facility
|
IP
|
$76.54
|
|
|
Service Code
|
HCPCS J0283
|
| Hospital Charge Code |
152870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.75 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$68.89
|
| Rate for Payer: ASR ASR |
$74.24
|
| Rate for Payer: ASR Commercial |
$74.24
|
| Rate for Payer: BCBS Trust/PPO |
$62.37
|
| Rate for Payer: BCN Commercial |
$59.34
|
| Rate for Payer: Cash Price |
$61.23
|
| Rate for Payer: Cofinity Commercial |
$71.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.23
|
| Rate for Payer: Healthscope Commercial |
$76.54
|
| Rate for Payer: Healthscope Whirlpool |
$74.24
|
| Rate for Payer: Mclaren Commercial |
$68.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.06
|
| Rate for Payer: Nomi Health Commercial |
$62.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.36
|
|
|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.37
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
9065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$26.37 |
| Rate for Payer: Aetna Commercial |
$23.73
|
| Rate for Payer: Aetna Commercial |
$23.29
|
| Rate for Payer: Aetna Commercial |
$24.16
|
| Rate for Payer: ASR ASR |
$25.10
|
| Rate for Payer: ASR ASR |
$25.58
|
| Rate for Payer: ASR ASR |
$26.03
|
| Rate for Payer: ASR Commercial |
$25.58
|
| Rate for Payer: ASR Commercial |
$25.10
|
| Rate for Payer: ASR Commercial |
$26.03
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCBS Trust/PPO |
$21.09
|
| Rate for Payer: BCBS Trust/PPO |
$21.49
|
| Rate for Payer: BCN Commercial |
$20.06
|
| Rate for Payer: BCN Commercial |
$20.81
|
| Rate for Payer: BCN Commercial |
$20.44
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$25.23
|
| Rate for Payer: Cofinity Commercial |
$24.33
|
| Rate for Payer: Cofinity Commercial |
$24.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.47
|
| Rate for Payer: Healthscope Commercial |
$25.88
|
| Rate for Payer: Healthscope Commercial |
$26.37
|
| Rate for Payer: Healthscope Commercial |
$26.84
|
| Rate for Payer: Healthscope Whirlpool |
$25.58
|
| Rate for Payer: Healthscope Whirlpool |
$25.10
|
| Rate for Payer: Healthscope Whirlpool |
$26.03
|
| Rate for Payer: Mclaren Commercial |
$23.73
|
| Rate for Payer: Mclaren Commercial |
$23.29
|
| Rate for Payer: Mclaren Commercial |
$24.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.00
|
| Rate for Payer: Nomi Health Commercial |
$21.62
|
| Rate for Payer: Nomi Health Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$22.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.77
|
|
