|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.88
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
9065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$25.88 |
| Rate for Payer: Aetna Commercial |
$23.29
|
| Rate for Payer: Aetna Commercial |
$24.16
|
| Rate for Payer: Aetna Commercial |
$23.73
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: Aetna Medicare |
$12.94
|
| Rate for Payer: Aetna Medicare |
$13.18
|
| Rate for Payer: ASR ASR |
$25.58
|
| Rate for Payer: ASR ASR |
$25.10
|
| 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 Complete |
$10.35
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS Complete |
$10.74
|
| Rate for Payer: BCBS Trust/PPO |
$21.98
|
| Rate for Payer: BCBS Trust/PPO |
$21.19
|
| Rate for Payer: BCBS Trust/PPO |
$21.59
|
| Rate for Payer: BCN Commercial |
$20.44
|
| Rate for Payer: BCN Commercial |
$20.81
|
| Rate for Payer: BCN Commercial |
$20.06
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$21.47
|
| 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 |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.10
|
| Rate for Payer: Healthscope Commercial |
$26.84
|
| Rate for Payer: Healthscope Commercial |
$26.37
|
| Rate for Payer: Healthscope Commercial |
$25.88
|
| Rate for Payer: Healthscope Whirlpool |
$26.03
|
| Rate for Payer: Healthscope Whirlpool |
$25.58
|
| Rate for Payer: Healthscope Whirlpool |
$25.10
|
| Rate for Payer: Mclaren Commercial |
$23.73
|
| Rate for Payer: Mclaren Commercial |
$24.16
|
| Rate for Payer: Mclaren Commercial |
$23.29
|
| 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 |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$22.01
|
| Rate for Payer: Nomi Health Commercial |
$21.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.34
|
| Rate for Payer: Priority Health Narrow Network |
$0.27
|
| Rate for Payer: Priority Health Narrow Network |
$0.27
|
| Rate for Payer: Priority Health Narrow Network |
$0.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.62
|
|
|
AMIODARONE 50 MG/ML IV (CODE)
|
Facility
|
OP
|
$26.84
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
163703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$26.84 |
| Rate for Payer: Aetna Commercial |
$24.16
|
| Rate for Payer: Aetna Commercial |
$23.73
|
| Rate for Payer: Aetna Medicare |
$13.18
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: ASR ASR |
$26.03
|
| Rate for Payer: ASR ASR |
$25.58
|
| Rate for Payer: ASR Commercial |
$25.58
|
| Rate for Payer: ASR Commercial |
$26.03
|
| Rate for Payer: BCBS Complete |
$10.74
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS Trust/PPO |
$21.98
|
| Rate for Payer: BCBS Trust/PPO |
$21.59
|
| Rate for Payer: BCN Commercial |
$20.44
|
| Rate for Payer: BCN Commercial |
$20.81
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$24.79
|
| Rate for Payer: Cofinity Commercial |
$25.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.10
|
| Rate for Payer: Healthscope Commercial |
$26.84
|
| Rate for Payer: Healthscope Commercial |
$26.37
|
| Rate for Payer: Healthscope Whirlpool |
$26.03
|
| Rate for Payer: Healthscope Whirlpool |
$25.58
|
| Rate for Payer: Mclaren Commercial |
$23.73
|
| 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: Nomi Health Commercial |
$22.01
|
| Rate for Payer: Nomi Health Commercial |
$21.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.34
|
| Rate for Payer: Priority Health Narrow Network |
$0.27
|
| Rate for Payer: Priority Health Narrow Network |
$0.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.62
|
|
|
AMIODARONE 50 MG/ML IV (CODE)
|
Facility
|
IP
|
$26.84
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
163703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.45 |
| Max. Negotiated Rate |
$26.84 |
| Rate for Payer: Aetna Commercial |
$24.16
|
| Rate for Payer: Aetna Commercial |
$23.73
|
| Rate for Payer: ASR ASR |
$26.03
|
| Rate for Payer: ASR ASR |
$25.58
|
| Rate for Payer: ASR Commercial |
$25.58
|
| Rate for Payer: ASR Commercial |
$26.03
|
| Rate for Payer: BCBS Trust/PPO |
$21.49
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$20.81
|
| Rate for Payer: BCN Commercial |
$20.44
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cofinity Commercial |
$24.79
|
| Rate for Payer: Cofinity Commercial |
$25.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.47
|
| 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 |
$26.03
|
| Rate for Payer: Mclaren Commercial |
$23.73
|
| Rate for Payer: Mclaren Commercial |
$24.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Nomi Health Commercial |
$21.62
|
| Rate for Payer: Nomi Health Commercial |
$22.01
|
| 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
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$143.35
|
|
|
Service Code
|
NDC 16729017101
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.18 |
| Max. Negotiated Rate |
$143.35 |
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: ASR ASR |
$139.05
|
| Rate for Payer: ASR Commercial |
$139.05
|
| Rate for Payer: BCBS Trust/PPO |
$116.82
|
| Rate for Payer: BCN Commercial |
$111.14
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Commercial |
$134.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$143.35
|
| Rate for Payer: Healthscope Whirlpool |
$139.05
|
| Rate for Payer: Mclaren Commercial |
$129.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: Nomi Health Commercial |
$117.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.15
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$143.35
|
|
|
Service Code
|
NDC 16729017101
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.34 |
| Max. Negotiated Rate |
$143.35 |
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: Aetna Medicare |
$71.68
|
| Rate for Payer: ASR ASR |
$139.05
|
| Rate for Payer: ASR Commercial |
$139.05
|
| Rate for Payer: BCBS Complete |
$57.34
|
| Rate for Payer: BCBS Trust/PPO |
$117.39
|
| Rate for Payer: BCN Commercial |
$111.14
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Commercial |
$134.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$143.35
|
| Rate for Payer: Healthscope Whirlpool |
$139.05
|
| Rate for Payer: Mclaren Commercial |
$129.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: Nomi Health Commercial |
$117.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.60
|
| Rate for Payer: Priority Health Narrow Network |
$100.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.15
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$176.22
|
|
|
Service Code
|
NDC 50268003715
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.54 |
| Max. Negotiated Rate |
$176.22 |
| Rate for Payer: Aetna Commercial |
$158.60
|
| Rate for Payer: ASR ASR |
$170.93
|
| Rate for Payer: ASR Commercial |
$170.93
|
| Rate for Payer: BCBS Trust/PPO |
$143.60
|
| Rate for Payer: BCN Commercial |
$136.62
|
| Rate for Payer: Cash Price |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$165.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.98
|
| Rate for Payer: Healthscope Commercial |
$176.22
|
| Rate for Payer: Healthscope Whirlpool |
$170.93
|
| Rate for Payer: Mclaren Commercial |
$158.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.79
|
| Rate for Payer: Nomi Health Commercial |
$144.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.07
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$176.22
|
|
|
Service Code
|
NDC 50268003715
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.49 |
| Max. Negotiated Rate |
$176.22 |
| Rate for Payer: Aetna Commercial |
$158.60
|
| Rate for Payer: Aetna Medicare |
$88.11
|
| Rate for Payer: ASR ASR |
$170.93
|
| Rate for Payer: ASR Commercial |
$170.93
|
| Rate for Payer: BCBS Complete |
$70.49
|
| Rate for Payer: BCBS Trust/PPO |
$144.31
|
| Rate for Payer: BCN Commercial |
$136.62
|
| Rate for Payer: Cash Price |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$165.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.98
|
| Rate for Payer: Healthscope Commercial |
$176.22
|
| Rate for Payer: Healthscope Whirlpool |
$170.93
|
| Rate for Payer: Mclaren Commercial |
$158.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.79
|
| Rate for Payer: Nomi Health Commercial |
$144.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.40
|
| Rate for Payer: Priority Health Narrow Network |
$123.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.07
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
OP
|
$3.52
|
|
|
Service Code
|
NDC 50268003711
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna Commercial |
$3.17
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: ASR ASR |
$3.41
|
| Rate for Payer: ASR Commercial |
$3.41
|
| Rate for Payer: BCBS Complete |
$1.41
|
| Rate for Payer: BCBS Trust/PPO |
$2.88
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$3.52
|
| Rate for Payer: Healthscope Whirlpool |
$3.41
|
| Rate for Payer: Mclaren Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.99
|
| Rate for Payer: Nomi Health Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.08
|
| Rate for Payer: Priority Health Narrow Network |
$2.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.10
|
|
|
AMITRIPTYLINE 10 MG TABLET
|
Facility
|
IP
|
$3.52
|
|
|
Service Code
|
NDC 50268003711
|
| Hospital Charge Code |
432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna Commercial |
$3.17
|
| Rate for Payer: ASR ASR |
$3.41
|
| Rate for Payer: ASR Commercial |
$3.41
|
| Rate for Payer: BCBS Trust/PPO |
$2.87
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$3.52
|
| Rate for Payer: Healthscope Whirlpool |
$3.41
|
| Rate for Payer: Mclaren Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.99
|
| Rate for Payer: Nomi Health Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.10
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
IP
|
$2.81
|
|
|
Service Code
|
NDC 60687043311
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna Commercial |
$2.53
|
| Rate for Payer: ASR ASR |
$2.73
|
| Rate for Payer: ASR Commercial |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.29
|
| Rate for Payer: BCN Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Healthscope Whirlpool |
$2.73
|
| Rate for Payer: Mclaren Commercial |
$2.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.39
|
| Rate for Payer: Nomi Health Commercial |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.47
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
IP
|
$240.35
|
|
|
Service Code
|
NDC 00904020161
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.23 |
| Max. Negotiated Rate |
$240.35 |
| Rate for Payer: Aetna Commercial |
$216.32
|
| Rate for Payer: ASR ASR |
$233.14
|
| Rate for Payer: ASR Commercial |
$233.14
|
| Rate for Payer: BCBS Trust/PPO |
$195.86
|
| Rate for Payer: BCN Commercial |
$186.34
|
| Rate for Payer: Cash Price |
$192.28
|
| Rate for Payer: Cofinity Commercial |
$225.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.28
|
| Rate for Payer: Healthscope Commercial |
$240.35
|
| Rate for Payer: Healthscope Whirlpool |
$233.14
|
| Rate for Payer: Mclaren Commercial |
$216.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.30
|
| Rate for Payer: Nomi Health Commercial |
$197.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.51
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
OP
|
$281.20
|
|
|
Service Code
|
NDC 60687043301
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Aetna Commercial |
$253.08
|
| Rate for Payer: Aetna Medicare |
$140.60
|
| Rate for Payer: ASR ASR |
$272.76
|
| Rate for Payer: ASR Commercial |
$272.76
|
| Rate for Payer: BCBS Complete |
$112.48
|
| Rate for Payer: BCBS Trust/PPO |
$230.27
|
| Rate for Payer: BCN Commercial |
$218.01
|
| Rate for Payer: Cash Price |
$224.96
|
| Rate for Payer: Cofinity Commercial |
$264.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.96
|
| Rate for Payer: Healthscope Commercial |
$281.20
|
| Rate for Payer: Healthscope Whirlpool |
$272.76
|
| Rate for Payer: Mclaren Commercial |
$253.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.02
|
| Rate for Payer: Nomi Health Commercial |
$230.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$246.39
|
| Rate for Payer: Priority Health Narrow Network |
$197.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.46
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
OP
|
$225.15
|
|
|
Service Code
|
NDC 00904718461
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.06 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Aetna Commercial |
$202.64
|
| Rate for Payer: Aetna Medicare |
$112.58
|
| Rate for Payer: ASR ASR |
$218.40
|
| Rate for Payer: ASR Commercial |
$218.40
|
| Rate for Payer: BCBS Complete |
$90.06
|
| Rate for Payer: BCBS Trust/PPO |
$184.38
|
| Rate for Payer: BCN Commercial |
$174.56
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$211.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$225.15
|
| Rate for Payer: Healthscope Whirlpool |
$218.40
|
| Rate for Payer: Mclaren Commercial |
$202.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Nomi Health Commercial |
$184.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.28
|
| Rate for Payer: Priority Health Narrow Network |
$157.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.13
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 00904718461
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.35 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Aetna Commercial |
$202.64
|
| Rate for Payer: ASR ASR |
$218.40
|
| Rate for Payer: ASR Commercial |
$218.40
|
| Rate for Payer: BCBS Trust/PPO |
$183.47
|
| Rate for Payer: BCN Commercial |
$174.56
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$211.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$225.15
|
| Rate for Payer: Healthscope Whirlpool |
$218.40
|
| Rate for Payer: Mclaren Commercial |
$202.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Nomi Health Commercial |
$184.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.13
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
IP
|
$281.20
|
|
|
Service Code
|
NDC 60687043301
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.78 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Aetna Commercial |
$253.08
|
| Rate for Payer: ASR ASR |
$272.76
|
| Rate for Payer: ASR Commercial |
$272.76
|
| Rate for Payer: BCBS Trust/PPO |
$229.15
|
| Rate for Payer: BCN Commercial |
$218.01
|
| Rate for Payer: Cash Price |
$224.96
|
| Rate for Payer: Cofinity Commercial |
$264.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.96
|
| Rate for Payer: Healthscope Commercial |
$281.20
|
| Rate for Payer: Healthscope Whirlpool |
$272.76
|
| Rate for Payer: Mclaren Commercial |
$253.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.02
|
| Rate for Payer: Nomi Health Commercial |
$230.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.46
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
OP
|
$240.35
|
|
|
Service Code
|
NDC 00904020161
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.14 |
| Max. Negotiated Rate |
$240.35 |
| Rate for Payer: Aetna Commercial |
$216.32
|
| Rate for Payer: Aetna Medicare |
$120.18
|
| Rate for Payer: ASR ASR |
$233.14
|
| Rate for Payer: ASR Commercial |
$233.14
|
| Rate for Payer: BCBS Complete |
$96.14
|
| Rate for Payer: BCBS Trust/PPO |
$196.82
|
| Rate for Payer: BCN Commercial |
$186.34
|
| Rate for Payer: Cash Price |
$192.28
|
| Rate for Payer: Cofinity Commercial |
$225.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.28
|
| Rate for Payer: Healthscope Commercial |
$240.35
|
| Rate for Payer: Healthscope Whirlpool |
$233.14
|
| Rate for Payer: Mclaren Commercial |
$216.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.30
|
| Rate for Payer: Nomi Health Commercial |
$197.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.59
|
| Rate for Payer: Priority Health Narrow Network |
$168.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.51
|
|
|
AMITRIPTYLINE 25 MG TABLET
|
Facility
|
OP
|
$2.81
|
|
|
Service Code
|
NDC 60687043311
|
| Hospital Charge Code |
435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna Commercial |
$2.53
|
| Rate for Payer: Aetna Medicare |
$1.40
|
| Rate for Payer: ASR ASR |
$2.73
|
| Rate for Payer: ASR Commercial |
$2.73
|
| Rate for Payer: BCBS Complete |
$1.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Healthscope Whirlpool |
$2.73
|
| Rate for Payer: Mclaren Commercial |
$2.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.39
|
| Rate for Payer: Nomi Health Commercial |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.46
|
| Rate for Payer: Priority Health Narrow Network |
$1.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.47
|
|
|
AMLODIPINE 5 MG TABLET
|
Facility
|
IP
|
$1.83
|
|
|
Service Code
|
NDC 51079045101
|
| Hospital Charge Code |
9071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Aetna Commercial |
$1.65
|
| Rate for Payer: ASR ASR |
$1.78
|
| Rate for Payer: ASR Commercial |
$1.78
|
| Rate for Payer: BCBS Trust/PPO |
$1.49
|
| Rate for Payer: BCN Commercial |
$1.42
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.46
|
| Rate for Payer: Healthscope Commercial |
$1.83
|
| Rate for Payer: Healthscope Whirlpool |
$1.78
|
| Rate for Payer: Mclaren Commercial |
$1.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.56
|
| Rate for Payer: Nomi Health Commercial |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.61
|
|
|
AMLODIPINE 5 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 00904637061
|
| Hospital Charge Code |
9071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.04 |
| Max. Negotiated Rate |
$173.90 |
| Rate for Payer: Aetna Commercial |
$156.51
|
| Rate for Payer: ASR ASR |
$168.68
|
| Rate for Payer: ASR Commercial |
$168.68
|
| Rate for Payer: BCBS Trust/PPO |
$141.71
|
| Rate for Payer: BCN Commercial |
$134.82
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$163.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$173.90
|
| Rate for Payer: Healthscope Whirlpool |
$168.68
|
| Rate for Payer: Mclaren Commercial |
$156.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.82
|
| Rate for Payer: Nomi Health Commercial |
$142.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.03
|
|
|
AMLODIPINE 5 MG TABLET
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 00904637061
|
| Hospital Charge Code |
9071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.56 |
| Max. Negotiated Rate |
$173.90 |
| Rate for Payer: Aetna Commercial |
$156.51
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: ASR ASR |
$168.68
|
| Rate for Payer: ASR Commercial |
$168.68
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: BCBS Trust/PPO |
$142.41
|
| Rate for Payer: BCN Commercial |
$134.82
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$163.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$173.90
|
| Rate for Payer: Healthscope Whirlpool |
$168.68
|
| Rate for Payer: Mclaren Commercial |
$156.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.82
|
| Rate for Payer: Nomi Health Commercial |
$142.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.37
|
| Rate for Payer: Priority Health Narrow Network |
$121.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.03
|
|
|
AMLODIPINE 5 MG TABLET
|
Facility
|
OP
|
$1.83
|
|
|
Service Code
|
NDC 51079045101
|
| Hospital Charge Code |
9071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Aetna Commercial |
$1.65
|
| Rate for Payer: Aetna Medicare |
$0.92
|
| Rate for Payer: ASR ASR |
$1.78
|
| Rate for Payer: ASR Commercial |
$1.78
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.42
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.46
|
| Rate for Payer: Healthscope Commercial |
$1.83
|
| Rate for Payer: Healthscope Whirlpool |
$1.78
|
| Rate for Payer: Mclaren Commercial |
$1.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.56
|
| Rate for Payer: Nomi Health Commercial |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.60
|
| Rate for Payer: Priority Health Narrow Network |
$1.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.61
|
|
|
AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$54.05
|
|
|
Service Code
|
NDC 00143988801
|
| Hospital Charge Code |
453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.62 |
| Max. Negotiated Rate |
$54.05 |
| Rate for Payer: Aetna Commercial |
$48.64
|
| Rate for Payer: Aetna Medicare |
$27.02
|
| Rate for Payer: ASR ASR |
$52.43
|
| Rate for Payer: ASR Commercial |
$52.43
|
| Rate for Payer: BCBS Complete |
$21.62
|
| Rate for Payer: BCBS Trust/PPO |
$44.26
|
| Rate for Payer: BCN Commercial |
$41.90
|
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Cofinity Commercial |
$50.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.24
|
| Rate for Payer: Healthscope Commercial |
$54.05
|
| Rate for Payer: Healthscope Whirlpool |
$52.43
|
| Rate for Payer: Mclaren Commercial |
$48.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.94
|
| Rate for Payer: Nomi Health Commercial |
$44.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.36
|
| Rate for Payer: Priority Health Narrow Network |
$37.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.56
|
|
|
AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$70.50
|
|
|
Service Code
|
NDC 00143988815
|
| Hospital Charge Code |
453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna Commercial |
$63.45
|
| Rate for Payer: Aetna Medicare |
$35.25
|
| Rate for Payer: ASR ASR |
$68.38
|
| Rate for Payer: ASR Commercial |
$68.38
|
| Rate for Payer: BCBS Complete |
$28.20
|
| Rate for Payer: BCBS Trust/PPO |
$57.73
|
| Rate for Payer: BCN Commercial |
$54.66
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$66.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$70.50
|
| Rate for Payer: Healthscope Whirlpool |
$68.38
|
| Rate for Payer: Mclaren Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Nomi Health Commercial |
$57.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.77
|
| Rate for Payer: Priority Health Narrow Network |
$49.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.04
|
|
|
AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 00143988815
|
| Hospital Charge Code |
453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.82 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna Commercial |
$63.45
|
| Rate for Payer: ASR ASR |
$68.38
|
| Rate for Payer: ASR Commercial |
$68.38
|
| Rate for Payer: BCBS Trust/PPO |
$57.45
|
| Rate for Payer: BCN Commercial |
$54.66
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$66.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$70.50
|
| Rate for Payer: Healthscope Whirlpool |
$68.38
|
| Rate for Payer: Mclaren Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Nomi Health Commercial |
$57.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.04
|
|
|
AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$54.05
|
|
|
Service Code
|
NDC 00143988801
|
| Hospital Charge Code |
453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.13 |
| Max. Negotiated Rate |
$54.05 |
| Rate for Payer: Aetna Commercial |
$48.64
|
| Rate for Payer: ASR ASR |
$52.43
|
| Rate for Payer: ASR Commercial |
$52.43
|
| Rate for Payer: BCBS Trust/PPO |
$44.05
|
| Rate for Payer: BCN Commercial |
$41.90
|
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Cofinity Commercial |
$50.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.24
|
| Rate for Payer: Healthscope Commercial |
$54.05
|
| Rate for Payer: Healthscope Whirlpool |
$52.43
|
| Rate for Payer: Mclaren Commercial |
$48.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.94
|
| Rate for Payer: Nomi Health Commercial |
$44.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.56
|
|
