|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$102.31
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.92 |
| Max. Negotiated Rate |
$102.31 |
| Rate for Payer: Aetna Commercial |
$92.08
|
| Rate for Payer: Aetna Commercial |
$110.72
|
| Rate for Payer: Aetna Commercial |
$82.24
|
| Rate for Payer: Aetna Medicare |
$61.51
|
| Rate for Payer: Aetna Medicare |
$45.69
|
| Rate for Payer: Aetna Medicare |
$51.16
|
| Rate for Payer: ASR ASR |
$119.33
|
| Rate for Payer: ASR ASR |
$99.24
|
| Rate for Payer: ASR ASR |
$88.64
|
| Rate for Payer: ASR Commercial |
$88.64
|
| Rate for Payer: ASR Commercial |
$119.33
|
| Rate for Payer: ASR Commercial |
$99.24
|
| Rate for Payer: BCBS Complete |
$40.92
|
| Rate for Payer: BCBS Complete |
$49.21
|
| Rate for Payer: BCBS Complete |
$36.55
|
| Rate for Payer: BCBS Trust/PPO |
$83.78
|
| Rate for Payer: BCBS Trust/PPO |
$100.74
|
| Rate for Payer: BCBS Trust/PPO |
$74.83
|
| Rate for Payer: BCN Commercial |
$70.85
|
| Rate for Payer: BCN Commercial |
$79.32
|
| Rate for Payer: BCN Commercial |
$95.38
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cash Price |
$73.10
|
| Rate for Payer: Cofinity Commercial |
$85.90
|
| Rate for Payer: Cofinity Commercial |
$96.17
|
| Rate for Payer: Cofinity Commercial |
$115.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.10
|
| Rate for Payer: Healthscope Commercial |
$102.31
|
| Rate for Payer: Healthscope Commercial |
$123.02
|
| Rate for Payer: Healthscope Commercial |
$91.38
|
| Rate for Payer: Healthscope Whirlpool |
$119.33
|
| Rate for Payer: Healthscope Whirlpool |
$99.24
|
| Rate for Payer: Healthscope Whirlpool |
$88.64
|
| Rate for Payer: Mclaren Commercial |
$92.08
|
| Rate for Payer: Mclaren Commercial |
$110.72
|
| Rate for Payer: Mclaren Commercial |
$82.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.67
|
| Rate for Payer: Nomi Health Commercial |
$83.89
|
| Rate for Payer: Nomi Health Commercial |
$100.88
|
| Rate for Payer: Nomi Health Commercial |
$74.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.07
|
| Rate for Payer: Priority Health Narrow Network |
$64.06
|
| Rate for Payer: Priority Health Narrow Network |
$71.72
|
| Rate for Payer: Priority Health Narrow Network |
$86.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.41
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$123.02
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.96 |
| Max. Negotiated Rate |
$123.02 |
| Rate for Payer: Aetna Commercial |
$110.72
|
| Rate for Payer: Aetna Commercial |
$92.08
|
| Rate for Payer: Aetna Commercial |
$82.24
|
| Rate for Payer: ASR ASR |
$99.24
|
| Rate for Payer: ASR ASR |
$119.33
|
| Rate for Payer: ASR ASR |
$88.64
|
| Rate for Payer: ASR Commercial |
$119.33
|
| Rate for Payer: ASR Commercial |
$99.24
|
| Rate for Payer: ASR Commercial |
$88.64
|
| Rate for Payer: BCBS Trust/PPO |
$74.47
|
| Rate for Payer: BCBS Trust/PPO |
$83.37
|
| Rate for Payer: BCBS Trust/PPO |
$100.25
|
| Rate for Payer: BCN Commercial |
$79.32
|
| Rate for Payer: BCN Commercial |
$70.85
|
| Rate for Payer: BCN Commercial |
$95.38
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cash Price |
$73.10
|
| Rate for Payer: Cofinity Commercial |
$85.90
|
| Rate for Payer: Cofinity Commercial |
$96.17
|
| Rate for Payer: Cofinity Commercial |
$115.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.10
|
| Rate for Payer: Healthscope Commercial |
$102.31
|
| Rate for Payer: Healthscope Commercial |
$123.02
|
| Rate for Payer: Healthscope Commercial |
$91.38
|
| Rate for Payer: Healthscope Whirlpool |
$119.33
|
| Rate for Payer: Healthscope Whirlpool |
$99.24
|
| Rate for Payer: Healthscope Whirlpool |
$88.64
|
| Rate for Payer: Mclaren Commercial |
$110.72
|
| Rate for Payer: Mclaren Commercial |
$92.08
|
| Rate for Payer: Mclaren Commercial |
$82.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.96
|
| Rate for Payer: Nomi Health Commercial |
$100.88
|
| Rate for Payer: Nomi Health Commercial |
$83.89
|
| Rate for Payer: Nomi Health Commercial |
$74.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.03
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS CUSTOM
|
Facility
|
IP
|
$102.31
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$102.31 |
| Rate for Payer: Aetna Commercial |
$92.08
|
| Rate for Payer: ASR ASR |
$99.24
|
| Rate for Payer: ASR Commercial |
$99.24
|
| Rate for Payer: BCBS Trust/PPO |
$83.37
|
| Rate for Payer: BCN Commercial |
$79.32
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cofinity Commercial |
$96.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.85
|
| Rate for Payer: Healthscope Commercial |
$102.31
|
| Rate for Payer: Healthscope Whirlpool |
$99.24
|
| Rate for Payer: Mclaren Commercial |
$92.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.96
|
| Rate for Payer: Nomi Health Commercial |
$83.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.03
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS CUSTOM
|
Facility
|
OP
|
$102.31
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.92 |
| Max. Negotiated Rate |
$102.31 |
| Rate for Payer: Aetna Commercial |
$92.08
|
| Rate for Payer: Aetna Medicare |
$51.16
|
| Rate for Payer: ASR ASR |
$99.24
|
| Rate for Payer: ASR Commercial |
$99.24
|
| Rate for Payer: BCBS Complete |
$40.92
|
| Rate for Payer: BCBS Trust/PPO |
$83.78
|
| Rate for Payer: BCN Commercial |
$79.32
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cofinity Commercial |
$96.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.85
|
| Rate for Payer: Healthscope Commercial |
$102.31
|
| Rate for Payer: Healthscope Whirlpool |
$99.24
|
| Rate for Payer: Mclaren Commercial |
$92.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.96
|
| Rate for Payer: Nomi Health Commercial |
$83.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.64
|
| Rate for Payer: Priority Health Narrow Network |
$71.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.03
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$196.28
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.58 |
| Max. Negotiated Rate |
$196.28 |
| Rate for Payer: Aetna Commercial |
$176.65
|
| Rate for Payer: Aetna Commercial |
$167.90
|
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: ASR ASR |
$180.96
|
| Rate for Payer: ASR ASR |
$190.39
|
| Rate for Payer: ASR ASR |
$202.60
|
| Rate for Payer: ASR Commercial |
$190.39
|
| Rate for Payer: ASR Commercial |
$180.96
|
| Rate for Payer: ASR Commercial |
$202.60
|
| Rate for Payer: BCBS Trust/PPO |
$170.21
|
| Rate for Payer: BCBS Trust/PPO |
$152.03
|
| Rate for Payer: BCBS Trust/PPO |
$159.95
|
| Rate for Payer: BCN Commercial |
$144.64
|
| Rate for Payer: BCN Commercial |
$161.94
|
| Rate for Payer: BCN Commercial |
$152.18
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Cofinity Commercial |
$175.37
|
| Rate for Payer: Cofinity Commercial |
$184.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Healthscope Commercial |
$186.56
|
| Rate for Payer: Healthscope Commercial |
$196.28
|
| Rate for Payer: Healthscope Commercial |
$208.87
|
| Rate for Payer: Healthscope Whirlpool |
$190.39
|
| Rate for Payer: Healthscope Whirlpool |
$180.96
|
| Rate for Payer: Healthscope Whirlpool |
$202.60
|
| Rate for Payer: Mclaren Commercial |
$176.65
|
| Rate for Payer: Mclaren Commercial |
$167.90
|
| Rate for Payer: Mclaren Commercial |
$187.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.58
|
| Rate for Payer: Nomi Health Commercial |
$160.95
|
| Rate for Payer: Nomi Health Commercial |
$152.98
|
| Rate for Payer: Nomi Health Commercial |
$171.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.17
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$186.56
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.62 |
| Max. Negotiated Rate |
$186.56 |
| Rate for Payer: Aetna Commercial |
$167.90
|
| Rate for Payer: Aetna Commercial |
$176.65
|
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: Aetna Medicare |
$98.14
|
| Rate for Payer: Aetna Medicare |
$104.44
|
| Rate for Payer: Aetna Medicare |
$93.28
|
| Rate for Payer: ASR ASR |
$190.39
|
| Rate for Payer: ASR ASR |
$180.96
|
| Rate for Payer: ASR ASR |
$202.60
|
| Rate for Payer: ASR Commercial |
$202.60
|
| Rate for Payer: ASR Commercial |
$190.39
|
| Rate for Payer: ASR Commercial |
$180.96
|
| Rate for Payer: BCBS Complete |
$74.62
|
| Rate for Payer: BCBS Complete |
$78.51
|
| Rate for Payer: BCBS Complete |
$83.55
|
| Rate for Payer: BCBS Trust/PPO |
$152.77
|
| Rate for Payer: BCBS Trust/PPO |
$160.73
|
| Rate for Payer: BCBS Trust/PPO |
$171.04
|
| Rate for Payer: BCN Commercial |
$161.94
|
| Rate for Payer: BCN Commercial |
$144.64
|
| Rate for Payer: BCN Commercial |
$152.18
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Cofinity Commercial |
$175.37
|
| Rate for Payer: Cofinity Commercial |
$184.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Healthscope Commercial |
$186.56
|
| Rate for Payer: Healthscope Commercial |
$196.28
|
| Rate for Payer: Healthscope Commercial |
$208.87
|
| Rate for Payer: Healthscope Whirlpool |
$190.39
|
| Rate for Payer: Healthscope Whirlpool |
$180.96
|
| Rate for Payer: Healthscope Whirlpool |
$202.60
|
| Rate for Payer: Mclaren Commercial |
$167.90
|
| Rate for Payer: Mclaren Commercial |
$176.65
|
| Rate for Payer: Mclaren Commercial |
$187.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Nomi Health Commercial |
$152.98
|
| Rate for Payer: Nomi Health Commercial |
$160.95
|
| Rate for Payer: Nomi Health Commercial |
$171.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.01
|
| Rate for Payer: Priority Health Narrow Network |
$146.42
|
| Rate for Payer: Priority Health Narrow Network |
$130.78
|
| Rate for Payer: Priority Health Narrow Network |
$137.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.81
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$208.87
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.55 |
| Max. Negotiated Rate |
$208.87 |
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: Aetna Medicare |
$104.44
|
| Rate for Payer: ASR ASR |
$202.60
|
| Rate for Payer: ASR Commercial |
$202.60
|
| Rate for Payer: BCBS Complete |
$83.55
|
| Rate for Payer: BCBS Trust/PPO |
$171.04
|
| Rate for Payer: BCN Commercial |
$161.94
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Healthscope Commercial |
$208.87
|
| Rate for Payer: Healthscope Whirlpool |
$202.60
|
| Rate for Payer: Mclaren Commercial |
$187.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Nomi Health Commercial |
$171.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.01
|
| Rate for Payer: Priority Health Narrow Network |
$146.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.81
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$208.87
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.77 |
| Max. Negotiated Rate |
$208.87 |
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: ASR ASR |
$202.60
|
| Rate for Payer: ASR Commercial |
$202.60
|
| Rate for Payer: BCBS Trust/PPO |
$170.21
|
| Rate for Payer: BCN Commercial |
$161.94
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Healthscope Commercial |
$208.87
|
| Rate for Payer: Healthscope Whirlpool |
$202.60
|
| Rate for Payer: Mclaren Commercial |
$187.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Nomi Health Commercial |
$171.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.81
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$9.90
|
|
|
Service Code
|
NDC 16784011631
|
| Hospital Charge Code |
850
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: ASR ASR |
$9.60
|
| Rate for Payer: ASR Commercial |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$8.07
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Healthscope Whirlpool |
$9.60
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.41
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$9.90
|
|
|
Service Code
|
NDC 16784011631
|
| Hospital Charge Code |
850
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: ASR ASR |
$9.60
|
| Rate for Payer: ASR Commercial |
$9.60
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$8.11
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Healthscope Whirlpool |
$9.60
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.41
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.67
|
| Rate for Payer: Priority Health Narrow Network |
$6.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.22
|
|
|
Service Code
|
NDC 16784011731
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: Aetna Commercial |
$9.20
|
| Rate for Payer: ASR ASR |
$9.91
|
| Rate for Payer: ASR Commercial |
$9.91
|
| Rate for Payer: BCBS Trust/PPO |
$8.33
|
| Rate for Payer: BCN Commercial |
$7.92
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$9.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$10.22
|
| Rate for Payer: Healthscope Whirlpool |
$9.91
|
| Rate for Payer: Mclaren Commercial |
$9.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.69
|
| Rate for Payer: Nomi Health Commercial |
$8.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.99
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$10.22
|
|
|
Service Code
|
NDC 16784011731
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: Aetna Commercial |
$9.20
|
| Rate for Payer: Aetna Medicare |
$5.11
|
| Rate for Payer: ASR ASR |
$9.91
|
| Rate for Payer: ASR Commercial |
$9.91
|
| Rate for Payer: BCBS Complete |
$4.09
|
| Rate for Payer: BCBS Trust/PPO |
$8.37
|
| Rate for Payer: BCN Commercial |
$7.92
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$9.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$10.22
|
| Rate for Payer: Healthscope Whirlpool |
$9.91
|
| Rate for Payer: Mclaren Commercial |
$9.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.69
|
| Rate for Payer: Nomi Health Commercial |
$8.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.95
|
| Rate for Payer: Priority Health Narrow Network |
$7.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.99
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$341.05
|
|
|
Service Code
|
NDC 00904647561
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.68 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna Commercial |
$306.94
|
| Rate for Payer: ASR ASR |
$330.82
|
| Rate for Payer: ASR Commercial |
$330.82
|
| Rate for Payer: BCBS Trust/PPO |
$277.92
|
| Rate for Payer: BCN Commercial |
$264.42
|
| Rate for Payer: Cash Price |
$272.84
|
| Rate for Payer: Cofinity Commercial |
$320.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.84
|
| Rate for Payer: Healthscope Commercial |
$341.05
|
| Rate for Payer: Healthscope Whirlpool |
$330.82
|
| Rate for Payer: Mclaren Commercial |
$306.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.89
|
| Rate for Payer: Nomi Health Commercial |
$279.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$300.12
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$341.05
|
|
|
Service Code
|
NDC 00904647561
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.42 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna Commercial |
$306.94
|
| Rate for Payer: Aetna Medicare |
$170.53
|
| Rate for Payer: ASR ASR |
$330.82
|
| Rate for Payer: ASR Commercial |
$330.82
|
| Rate for Payer: BCBS Complete |
$136.42
|
| Rate for Payer: BCBS Trust/PPO |
$279.29
|
| Rate for Payer: BCN Commercial |
$264.42
|
| Rate for Payer: Cash Price |
$272.84
|
| Rate for Payer: Cofinity Commercial |
$320.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.84
|
| Rate for Payer: Healthscope Commercial |
$341.05
|
| Rate for Payer: Healthscope Whirlpool |
$330.82
|
| Rate for Payer: Mclaren Commercial |
$306.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.89
|
| Rate for Payer: Nomi Health Commercial |
$279.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.83
|
| Rate for Payer: Priority Health Narrow Network |
$239.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$300.12
|
|
|
BARIUM SULFATE 700 MG TABLET
|
Facility
|
IP
|
$340.32
|
|
|
Service Code
|
NDC 10361077831
|
| Hospital Charge Code |
100992
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.21 |
| Max. Negotiated Rate |
$340.32 |
| Rate for Payer: Aetna Commercial |
$306.29
|
| Rate for Payer: ASR ASR |
$330.11
|
| Rate for Payer: ASR Commercial |
$330.11
|
| Rate for Payer: BCBS Trust/PPO |
$277.33
|
| Rate for Payer: BCN Commercial |
$263.85
|
| Rate for Payer: Cash Price |
$272.26
|
| Rate for Payer: Cofinity Commercial |
$319.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.26
|
| Rate for Payer: Healthscope Commercial |
$340.32
|
| Rate for Payer: Healthscope Whirlpool |
$330.11
|
| Rate for Payer: Mclaren Commercial |
$306.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.27
|
| Rate for Payer: Nomi Health Commercial |
$279.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.48
|
|
|
BARIUM SULFATE 700 MG TABLET
|
Facility
|
OP
|
$340.32
|
|
|
Service Code
|
NDC 10361077831
|
| Hospital Charge Code |
100992
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.13 |
| Max. Negotiated Rate |
$340.32 |
| Rate for Payer: Aetna Commercial |
$306.29
|
| Rate for Payer: Aetna Medicare |
$170.16
|
| Rate for Payer: ASR ASR |
$330.11
|
| Rate for Payer: ASR Commercial |
$330.11
|
| Rate for Payer: BCBS Complete |
$136.13
|
| Rate for Payer: BCBS Trust/PPO |
$278.69
|
| Rate for Payer: BCN Commercial |
$263.85
|
| Rate for Payer: Cash Price |
$272.26
|
| Rate for Payer: Cofinity Commercial |
$319.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.26
|
| Rate for Payer: Healthscope Commercial |
$340.32
|
| Rate for Payer: Healthscope Whirlpool |
$330.11
|
| Rate for Payer: Mclaren Commercial |
$306.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.27
|
| Rate for Payer: Nomi Health Commercial |
$279.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.19
|
| Rate for Payer: Priority Health Narrow Network |
$238.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.48
|
|
|
BARIUM SULFATE 98 % ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$5.38
|
|
|
Service Code
|
NDC 32909076401
|
| Hospital Charge Code |
19436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: ASR ASR |
$5.22
|
| Rate for Payer: ASR Commercial |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.38
|
| Rate for Payer: BCN Commercial |
$4.17
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Commercial |
$5.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Healthscope Commercial |
$5.38
|
| Rate for Payer: Healthscope Whirlpool |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.57
|
| Rate for Payer: Nomi Health Commercial |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.73
|
|
|
BARIUM SULFATE 98 % ORAL POWDER FOR SUSPENSION
|
Facility
|
OP
|
$5.38
|
|
|
Service Code
|
NDC 32909076401
|
| Hospital Charge Code |
19436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna Medicare |
$2.69
|
| Rate for Payer: ASR ASR |
$5.22
|
| Rate for Payer: ASR Commercial |
$5.22
|
| Rate for Payer: BCBS Complete |
$2.15
|
| Rate for Payer: BCBS Trust/PPO |
$4.41
|
| Rate for Payer: BCN Commercial |
$4.17
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Commercial |
$5.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Healthscope Commercial |
$5.38
|
| Rate for Payer: Healthscope Whirlpool |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.57
|
| Rate for Payer: Nomi Health Commercial |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.71
|
| Rate for Payer: Priority Health Narrow Network |
$3.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.73
|
|
|
BENAZEPRIL 5 MG TABLET
|
Facility
|
OP
|
$152.75
|
|
|
Service Code
|
NDC 65162075110
|
| Hospital Charge Code |
9223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$152.75 |
| Rate for Payer: Aetna Commercial |
$137.47
|
| Rate for Payer: Aetna Medicare |
$76.38
|
| Rate for Payer: ASR ASR |
$148.17
|
| Rate for Payer: ASR Commercial |
$148.17
|
| Rate for Payer: BCBS Complete |
$61.10
|
| Rate for Payer: BCBS Trust/PPO |
$125.09
|
| Rate for Payer: BCN Commercial |
$118.43
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Commercial |
$143.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$152.75
|
| Rate for Payer: Healthscope Whirlpool |
$148.17
|
| Rate for Payer: Mclaren Commercial |
$137.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Nomi Health Commercial |
$125.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.84
|
| Rate for Payer: Priority Health Narrow Network |
$107.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.42
|
|
|
BENAZEPRIL 5 MG TABLET
|
Facility
|
IP
|
$152.75
|
|
|
Service Code
|
NDC 65162075110
|
| Hospital Charge Code |
9223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.29 |
| Max. Negotiated Rate |
$152.75 |
| Rate for Payer: Aetna Commercial |
$137.47
|
| Rate for Payer: ASR ASR |
$148.17
|
| Rate for Payer: ASR Commercial |
$148.17
|
| Rate for Payer: BCBS Trust/PPO |
$124.48
|
| Rate for Payer: BCN Commercial |
$118.43
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Commercial |
$143.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$152.75
|
| Rate for Payer: Healthscope Whirlpool |
$148.17
|
| Rate for Payer: Mclaren Commercial |
$137.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Nomi Health Commercial |
$125.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.42
|
|
|
BENAZEPRIL 5 MG TABLET
|
Facility
|
OP
|
$4.63
|
|
|
Service Code
|
NDC 50268010911
|
| Hospital Charge Code |
9223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Aetna Commercial |
$4.17
|
| Rate for Payer: Aetna Medicare |
$2.31
|
| Rate for Payer: ASR ASR |
$4.49
|
| Rate for Payer: ASR Commercial |
$4.49
|
| Rate for Payer: BCBS Complete |
$1.85
|
| Rate for Payer: BCBS Trust/PPO |
$3.79
|
| Rate for Payer: BCN Commercial |
$3.59
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cofinity Commercial |
$4.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.70
|
| Rate for Payer: Healthscope Commercial |
$4.63
|
| Rate for Payer: Healthscope Whirlpool |
$4.49
|
| Rate for Payer: Mclaren Commercial |
$4.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Nomi Health Commercial |
$3.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.06
|
| Rate for Payer: Priority Health Narrow Network |
$3.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.07
|
|
|
BENAZEPRIL 5 MG TABLET
|
Facility
|
OP
|
$231.32
|
|
|
Service Code
|
NDC 50268010915
|
| Hospital Charge Code |
9223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.53 |
| Max. Negotiated Rate |
$231.32 |
| Rate for Payer: Aetna Commercial |
$208.19
|
| Rate for Payer: Aetna Medicare |
$115.66
|
| Rate for Payer: ASR ASR |
$224.38
|
| Rate for Payer: ASR Commercial |
$224.38
|
| Rate for Payer: BCBS Complete |
$92.53
|
| Rate for Payer: BCBS Trust/PPO |
$189.43
|
| Rate for Payer: BCN Commercial |
$179.34
|
| Rate for Payer: Cash Price |
$185.06
|
| Rate for Payer: Cofinity Commercial |
$217.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.06
|
| Rate for Payer: Healthscope Commercial |
$231.32
|
| Rate for Payer: Healthscope Whirlpool |
$224.38
|
| Rate for Payer: Mclaren Commercial |
$208.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.62
|
| Rate for Payer: Nomi Health Commercial |
$189.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.68
|
| Rate for Payer: Priority Health Narrow Network |
$162.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.56
|
|
|
BENAZEPRIL 5 MG TABLET
|
Facility
|
IP
|
$4.63
|
|
|
Service Code
|
NDC 50268010911
|
| Hospital Charge Code |
9223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Aetna Commercial |
$4.17
|
| Rate for Payer: ASR ASR |
$4.49
|
| Rate for Payer: ASR Commercial |
$4.49
|
| Rate for Payer: BCBS Trust/PPO |
$3.77
|
| Rate for Payer: BCN Commercial |
$3.59
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cofinity Commercial |
$4.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.70
|
| Rate for Payer: Healthscope Commercial |
$4.63
|
| Rate for Payer: Healthscope Whirlpool |
$4.49
|
| Rate for Payer: Mclaren Commercial |
$4.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Nomi Health Commercial |
$3.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.07
|
|
|
BENAZEPRIL 5 MG TABLET
|
Facility
|
IP
|
$231.32
|
|
|
Service Code
|
NDC 50268010915
|
| Hospital Charge Code |
9223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.36 |
| Max. Negotiated Rate |
$231.32 |
| Rate for Payer: Aetna Commercial |
$208.19
|
| Rate for Payer: ASR ASR |
$224.38
|
| Rate for Payer: ASR Commercial |
$224.38
|
| Rate for Payer: BCBS Trust/PPO |
$188.50
|
| Rate for Payer: BCN Commercial |
$179.34
|
| Rate for Payer: Cash Price |
$185.06
|
| Rate for Payer: Cofinity Commercial |
$217.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.06
|
| Rate for Payer: Healthscope Commercial |
$231.32
|
| Rate for Payer: Healthscope Whirlpool |
$224.38
|
| Rate for Payer: Mclaren Commercial |
$208.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.62
|
| Rate for Payer: Nomi Health Commercial |
$189.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.56
|
|
|
BENRALIZUMAB 30 MG/ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
|
IP
|
$21,634.08
|
|
|
Service Code
|
HCPCS J0517
|
| Hospital Charge Code |
191757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,062.15 |
| Max. Negotiated Rate |
$21,634.08 |
| Rate for Payer: Aetna Commercial |
$19,470.67
|
| Rate for Payer: ASR ASR |
$20,985.06
|
| Rate for Payer: ASR Commercial |
$20,985.06
|
| Rate for Payer: BCBS Trust/PPO |
$17,629.61
|
| Rate for Payer: BCN Commercial |
$16,772.90
|
| Rate for Payer: Cash Price |
$17,307.27
|
| Rate for Payer: Cofinity Commercial |
$20,336.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,307.26
|
| Rate for Payer: Healthscope Commercial |
$21,634.08
|
| Rate for Payer: Healthscope Whirlpool |
$20,985.06
|
| Rate for Payer: Mclaren Commercial |
$19,470.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,388.97
|
| Rate for Payer: Nomi Health Commercial |
$17,739.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,062.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19,037.99
|
|
