|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$33.11
|
|
|
Service Code
|
NDC 64253090030
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$33.11 |
| Rate for Payer: Aetna Commercial |
$29.80
|
| Rate for Payer: Aetna Medicare |
$16.56
|
| Rate for Payer: ASR ASR |
$32.12
|
| Rate for Payer: ASR Commercial |
$32.12
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$27.11
|
| Rate for Payer: BCN Commercial |
$25.67
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$33.11
|
| Rate for Payer: Healthscope Whirlpool |
$32.12
|
| Rate for Payer: Mclaren Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.01
|
| Rate for Payer: Priority Health Narrow Network |
$23.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.14
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$70.53
|
|
|
Service Code
|
NDC 00409492834
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$70.53 |
| Rate for Payer: Aetna Commercial |
$63.48
|
| Rate for Payer: Aetna Medicare |
$35.26
|
| Rate for Payer: ASR ASR |
$68.41
|
| Rate for Payer: ASR Commercial |
$68.41
|
| Rate for Payer: BCBS Complete |
$28.21
|
| Rate for Payer: BCBS Trust/PPO |
$57.76
|
| Rate for Payer: BCN Commercial |
$54.68
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cofinity Commercial |
$66.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.42
|
| Rate for Payer: Healthscope Commercial |
$70.53
|
| Rate for Payer: Healthscope Whirlpool |
$68.41
|
| Rate for Payer: Mclaren Commercial |
$63.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.95
|
| Rate for Payer: Nomi Health Commercial |
$57.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.80
|
| Rate for Payer: Priority Health Narrow Network |
$49.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.07
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$39.34
|
|
|
Service Code
|
NDC 76329330401
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.74 |
| Max. Negotiated Rate |
$39.34 |
| Rate for Payer: Aetna Commercial |
$35.41
|
| Rate for Payer: Aetna Medicare |
$19.67
|
| Rate for Payer: ASR ASR |
$38.16
|
| Rate for Payer: ASR Commercial |
$38.16
|
| Rate for Payer: BCBS Complete |
$15.74
|
| Rate for Payer: BCBS Trust/PPO |
$32.22
|
| Rate for Payer: BCN Commercial |
$30.50
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$39.34
|
| Rate for Payer: Healthscope Whirlpool |
$38.16
|
| Rate for Payer: Mclaren Commercial |
$35.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Nomi Health Commercial |
$32.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.47
|
| Rate for Payer: Priority Health Narrow Network |
$27.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.62
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$52.20
|
|
|
Service Code
|
NDC 00409163110
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna Commercial |
$46.98
|
| Rate for Payer: Aetna Medicare |
$26.10
|
| Rate for Payer: ASR ASR |
$50.63
|
| Rate for Payer: ASR Commercial |
$50.63
|
| Rate for Payer: BCBS Complete |
$20.88
|
| Rate for Payer: BCBS Trust/PPO |
$42.75
|
| Rate for Payer: BCN Commercial |
$40.47
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cofinity Commercial |
$49.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.76
|
| Rate for Payer: Healthscope Commercial |
$52.20
|
| Rate for Payer: Healthscope Whirlpool |
$50.63
|
| Rate for Payer: Mclaren Commercial |
$46.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.37
|
| Rate for Payer: Nomi Health Commercial |
$42.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.74
|
| Rate for Payer: Priority Health Narrow Network |
$36.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.94
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
NDC 64253090036
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$33.11 |
| Rate for Payer: Aetna Commercial |
$29.80
|
| Rate for Payer: ASR ASR |
$32.12
|
| Rate for Payer: ASR Commercial |
$32.12
|
| Rate for Payer: BCBS Trust/PPO |
$26.98
|
| Rate for Payer: BCN Commercial |
$25.67
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$33.11
|
| Rate for Payer: Healthscope Whirlpool |
$32.12
|
| Rate for Payer: Mclaren Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.14
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$70.53
|
|
|
Service Code
|
NDC 00409492834
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.84 |
| Max. Negotiated Rate |
$70.53 |
| Rate for Payer: Aetna Commercial |
$63.48
|
| Rate for Payer: ASR ASR |
$68.41
|
| Rate for Payer: ASR Commercial |
$68.41
|
| Rate for Payer: BCBS Trust/PPO |
$57.47
|
| Rate for Payer: BCN Commercial |
$54.68
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cofinity Commercial |
$66.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.42
|
| Rate for Payer: Healthscope Commercial |
$70.53
|
| Rate for Payer: Healthscope Whirlpool |
$68.41
|
| Rate for Payer: Mclaren Commercial |
$63.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.95
|
| Rate for Payer: Nomi Health Commercial |
$57.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.07
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$39.34
|
|
|
Service Code
|
NDC 76329330401
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.74 |
| Max. Negotiated Rate |
$39.34 |
| Rate for Payer: Aetna Commercial |
$35.41
|
| Rate for Payer: Aetna Medicare |
$19.67
|
| Rate for Payer: ASR ASR |
$38.16
|
| Rate for Payer: ASR Commercial |
$38.16
|
| Rate for Payer: BCBS Complete |
$15.74
|
| Rate for Payer: BCBS Trust/PPO |
$32.22
|
| Rate for Payer: BCN Commercial |
$30.50
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$39.34
|
| Rate for Payer: Healthscope Whirlpool |
$38.16
|
| Rate for Payer: Mclaren Commercial |
$35.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Nomi Health Commercial |
$32.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.47
|
| Rate for Payer: Priority Health Narrow Network |
$27.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.62
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$39.34
|
|
|
Service Code
|
NDC 76329330401
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$39.34 |
| Rate for Payer: Aetna Commercial |
$35.41
|
| Rate for Payer: ASR ASR |
$38.16
|
| Rate for Payer: ASR Commercial |
$38.16
|
| Rate for Payer: BCBS Trust/PPO |
$32.06
|
| Rate for Payer: BCN Commercial |
$30.50
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$39.34
|
| Rate for Payer: Healthscope Whirlpool |
$38.16
|
| Rate for Payer: Mclaren Commercial |
$35.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Nomi Health Commercial |
$32.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.62
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$70.53
|
|
|
Service Code
|
NDC 00409492834
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$70.53 |
| Rate for Payer: Aetna Commercial |
$63.48
|
| Rate for Payer: Aetna Medicare |
$35.26
|
| Rate for Payer: ASR ASR |
$68.41
|
| Rate for Payer: ASR Commercial |
$68.41
|
| Rate for Payer: BCBS Complete |
$28.21
|
| Rate for Payer: BCBS Trust/PPO |
$57.76
|
| Rate for Payer: BCN Commercial |
$54.68
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cofinity Commercial |
$66.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.42
|
| Rate for Payer: Healthscope Commercial |
$70.53
|
| Rate for Payer: Healthscope Whirlpool |
$68.41
|
| Rate for Payer: Mclaren Commercial |
$63.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.95
|
| Rate for Payer: Nomi Health Commercial |
$57.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.80
|
| Rate for Payer: Priority Health Narrow Network |
$49.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.07
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$33.11 |
| Rate for Payer: Aetna Commercial |
$29.80
|
| Rate for Payer: ASR ASR |
$32.12
|
| Rate for Payer: ASR Commercial |
$32.12
|
| Rate for Payer: BCBS Trust/PPO |
$26.98
|
| Rate for Payer: BCN Commercial |
$25.67
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$33.11
|
| Rate for Payer: Healthscope Whirlpool |
$32.12
|
| Rate for Payer: Mclaren Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.14
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33.11
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$33.11 |
| Rate for Payer: Aetna Commercial |
$29.80
|
| Rate for Payer: Aetna Medicare |
$16.56
|
| Rate for Payer: ASR ASR |
$32.12
|
| Rate for Payer: ASR Commercial |
$32.12
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$27.11
|
| Rate for Payer: BCN Commercial |
$25.67
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$33.11
|
| Rate for Payer: Healthscope Whirlpool |
$32.12
|
| Rate for Payer: Mclaren Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.05
|
| Rate for Payer: Priority Health Narrow Network |
$0.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.14
|
|
|
CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION
|
Facility
|
IP
|
$35.38
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
189461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$35.38 |
| Rate for Payer: Aetna Commercial |
$31.84
|
| Rate for Payer: ASR ASR |
$34.32
|
| Rate for Payer: ASR Commercial |
$34.32
|
| Rate for Payer: BCBS Trust/PPO |
$28.83
|
| Rate for Payer: BCN Commercial |
$27.43
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$35.38
|
| Rate for Payer: Healthscope Whirlpool |
$34.32
|
| Rate for Payer: Mclaren Commercial |
$31.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.07
|
| Rate for Payer: Nomi Health Commercial |
$29.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.13
|
|
|
CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION
|
Facility
|
OP
|
$35.38
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
189461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$35.38 |
| Rate for Payer: Aetna Commercial |
$31.84
|
| Rate for Payer: Aetna Medicare |
$17.69
|
| Rate for Payer: ASR ASR |
$34.32
|
| Rate for Payer: ASR Commercial |
$34.32
|
| Rate for Payer: BCBS Complete |
$14.15
|
| Rate for Payer: BCBS Trust/PPO |
$28.97
|
| Rate for Payer: BCN Commercial |
$27.43
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$35.38
|
| Rate for Payer: Healthscope Whirlpool |
$34.32
|
| Rate for Payer: Mclaren Commercial |
$31.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.07
|
| Rate for Payer: Nomi Health Commercial |
$29.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.05
|
| Rate for Payer: Priority Health Narrow Network |
$0.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.13
|
|
|
CAPSAICIN 0.025 % TOPICAL CREAM
|
Facility
|
IP
|
$15.12
|
|
|
Service Code
|
NDC 00536252525
|
| Hospital Charge Code |
1350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$15.12 |
| Rate for Payer: Aetna Commercial |
$13.61
|
| Rate for Payer: ASR ASR |
$14.67
|
| Rate for Payer: ASR Commercial |
$14.67
|
| Rate for Payer: BCBS Trust/PPO |
$12.32
|
| Rate for Payer: BCN Commercial |
$11.72
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$14.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.10
|
| Rate for Payer: Healthscope Commercial |
$15.12
|
| Rate for Payer: Healthscope Whirlpool |
$14.67
|
| Rate for Payer: Mclaren Commercial |
$13.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.85
|
| Rate for Payer: Nomi Health Commercial |
$12.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.31
|
|
|
CAPSAICIN 0.025 % TOPICAL CREAM
|
Facility
|
OP
|
$15.12
|
|
|
Service Code
|
NDC 00536252525
|
| Hospital Charge Code |
1350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$15.12 |
| Rate for Payer: Aetna Commercial |
$13.61
|
| Rate for Payer: Aetna Medicare |
$7.56
|
| Rate for Payer: ASR ASR |
$14.67
|
| Rate for Payer: ASR Commercial |
$14.67
|
| Rate for Payer: BCBS Complete |
$6.05
|
| Rate for Payer: BCBS Trust/PPO |
$12.38
|
| Rate for Payer: BCN Commercial |
$11.72
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$14.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.10
|
| Rate for Payer: Healthscope Commercial |
$15.12
|
| Rate for Payer: Healthscope Whirlpool |
$14.67
|
| Rate for Payer: Mclaren Commercial |
$13.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.85
|
| Rate for Payer: Nomi Health Commercial |
$12.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$10.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.31
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$595.20
|
|
|
Service Code
|
NDC 51079086420
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$386.88 |
| Max. Negotiated Rate |
$595.20 |
| Rate for Payer: Aetna Commercial |
$535.68
|
| Rate for Payer: ASR ASR |
$577.34
|
| Rate for Payer: ASR Commercial |
$577.34
|
| Rate for Payer: BCBS Trust/PPO |
$485.03
|
| Rate for Payer: BCN Commercial |
$461.46
|
| Rate for Payer: Cash Price |
$476.16
|
| Rate for Payer: Cofinity Commercial |
$559.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.16
|
| Rate for Payer: Healthscope Commercial |
$595.20
|
| Rate for Payer: Healthscope Whirlpool |
$577.34
|
| Rate for Payer: Mclaren Commercial |
$535.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.92
|
| Rate for Payer: Nomi Health Commercial |
$488.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.78
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$6.57
|
|
|
Service Code
|
NDC 60687031511
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$6.57 |
| Rate for Payer: Aetna Commercial |
$5.91
|
| Rate for Payer: ASR ASR |
$6.37
|
| Rate for Payer: ASR Commercial |
$6.37
|
| Rate for Payer: BCBS Trust/PPO |
$5.35
|
| Rate for Payer: BCN Commercial |
$5.09
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Cofinity Commercial |
$6.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.26
|
| Rate for Payer: Healthscope Commercial |
$6.57
|
| Rate for Payer: Healthscope Whirlpool |
$6.37
|
| Rate for Payer: Mclaren Commercial |
$5.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.58
|
| Rate for Payer: Nomi Health Commercial |
$5.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.78
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$5.95
|
|
|
Service Code
|
NDC 51079086401
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$5.95 |
| Rate for Payer: Aetna Commercial |
$5.36
|
| Rate for Payer: ASR ASR |
$5.77
|
| Rate for Payer: ASR Commercial |
$5.77
|
| Rate for Payer: BCBS Trust/PPO |
$4.85
|
| Rate for Payer: BCN Commercial |
$4.61
|
| Rate for Payer: Cash Price |
$4.76
|
| Rate for Payer: Cofinity Commercial |
$5.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.76
|
| Rate for Payer: Healthscope Commercial |
$5.95
|
| Rate for Payer: Healthscope Whirlpool |
$5.77
|
| Rate for Payer: Mclaren Commercial |
$5.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.06
|
| Rate for Payer: Nomi Health Commercial |
$4.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.24
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
OP
|
$6.57
|
|
|
Service Code
|
NDC 60687031511
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$6.57 |
| Rate for Payer: Aetna Commercial |
$5.91
|
| Rate for Payer: Aetna Medicare |
$3.28
|
| Rate for Payer: ASR ASR |
$6.37
|
| Rate for Payer: ASR Commercial |
$6.37
|
| Rate for Payer: BCBS Complete |
$2.63
|
| Rate for Payer: BCBS Trust/PPO |
$5.38
|
| Rate for Payer: BCN Commercial |
$5.09
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Cofinity Commercial |
$6.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.26
|
| Rate for Payer: Healthscope Commercial |
$6.57
|
| Rate for Payer: Healthscope Whirlpool |
$6.37
|
| Rate for Payer: Mclaren Commercial |
$5.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.58
|
| Rate for Payer: Nomi Health Commercial |
$5.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.76
|
| Rate for Payer: Priority Health Narrow Network |
$4.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.78
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
OP
|
$196.99
|
|
|
Service Code
|
NDC 60687031521
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$196.99 |
| Rate for Payer: Aetna Commercial |
$177.29
|
| Rate for Payer: Aetna Medicare |
$98.50
|
| Rate for Payer: ASR ASR |
$191.08
|
| Rate for Payer: ASR Commercial |
$191.08
|
| Rate for Payer: BCBS Complete |
$78.80
|
| Rate for Payer: BCBS Trust/PPO |
$161.32
|
| Rate for Payer: BCN Commercial |
$152.73
|
| Rate for Payer: Cash Price |
$157.59
|
| Rate for Payer: Cofinity Commercial |
$185.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.59
|
| Rate for Payer: Healthscope Commercial |
$196.99
|
| Rate for Payer: Healthscope Whirlpool |
$191.08
|
| Rate for Payer: Mclaren Commercial |
$177.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.44
|
| Rate for Payer: Nomi Health Commercial |
$161.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.60
|
| Rate for Payer: Priority Health Narrow Network |
$138.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.35
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
OP
|
$5.95
|
|
|
Service Code
|
NDC 51079086401
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$5.95 |
| Rate for Payer: Aetna Commercial |
$5.36
|
| Rate for Payer: Aetna Medicare |
$2.98
|
| Rate for Payer: ASR ASR |
$5.77
|
| Rate for Payer: ASR Commercial |
$5.77
|
| Rate for Payer: BCBS Complete |
$2.38
|
| Rate for Payer: BCBS Trust/PPO |
$4.87
|
| Rate for Payer: BCN Commercial |
$4.61
|
| Rate for Payer: Cash Price |
$4.76
|
| Rate for Payer: Cofinity Commercial |
$5.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.76
|
| Rate for Payer: Healthscope Commercial |
$5.95
|
| Rate for Payer: Healthscope Whirlpool |
$5.77
|
| Rate for Payer: Mclaren Commercial |
$5.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.06
|
| Rate for Payer: Nomi Health Commercial |
$4.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.21
|
| Rate for Payer: Priority Health Narrow Network |
$4.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.24
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
OP
|
$595.20
|
|
|
Service Code
|
NDC 51079086420
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.08 |
| Max. Negotiated Rate |
$595.20 |
| Rate for Payer: Aetna Commercial |
$535.68
|
| Rate for Payer: Aetna Medicare |
$297.60
|
| Rate for Payer: ASR ASR |
$577.34
|
| Rate for Payer: ASR Commercial |
$577.34
|
| Rate for Payer: BCBS Complete |
$238.08
|
| Rate for Payer: BCBS Trust/PPO |
$487.41
|
| Rate for Payer: BCN Commercial |
$461.46
|
| Rate for Payer: Cash Price |
$476.16
|
| Rate for Payer: Cofinity Commercial |
$559.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.16
|
| Rate for Payer: Healthscope Commercial |
$595.20
|
| Rate for Payer: Healthscope Whirlpool |
$577.34
|
| Rate for Payer: Mclaren Commercial |
$535.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.92
|
| Rate for Payer: Nomi Health Commercial |
$488.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$521.51
|
| Rate for Payer: Priority Health Narrow Network |
$417.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.78
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$196.99
|
|
|
Service Code
|
NDC 60687031521
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$196.99 |
| Rate for Payer: Aetna Commercial |
$177.29
|
| Rate for Payer: ASR ASR |
$191.08
|
| Rate for Payer: ASR Commercial |
$191.08
|
| Rate for Payer: BCBS Trust/PPO |
$160.53
|
| Rate for Payer: BCN Commercial |
$152.73
|
| Rate for Payer: Cash Price |
$157.59
|
| Rate for Payer: Cofinity Commercial |
$185.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.59
|
| Rate for Payer: Healthscope Commercial |
$196.99
|
| Rate for Payer: Healthscope Whirlpool |
$191.08
|
| Rate for Payer: Mclaren Commercial |
$177.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.44
|
| Rate for Payer: Nomi Health Commercial |
$161.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.35
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
OP
|
$320.15
|
|
|
Service Code
|
NDC 00904385461
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.06 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna Commercial |
$288.14
|
| Rate for Payer: Aetna Medicare |
$160.08
|
| Rate for Payer: ASR ASR |
$310.55
|
| Rate for Payer: ASR Commercial |
$310.55
|
| Rate for Payer: BCBS Complete |
$128.06
|
| Rate for Payer: BCBS Trust/PPO |
$262.17
|
| Rate for Payer: BCN Commercial |
$248.21
|
| Rate for Payer: Cash Price |
$256.12
|
| Rate for Payer: Cofinity Commercial |
$300.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.12
|
| Rate for Payer: Healthscope Commercial |
$320.15
|
| Rate for Payer: Healthscope Whirlpool |
$310.55
|
| Rate for Payer: Mclaren Commercial |
$288.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.13
|
| Rate for Payer: Nomi Health Commercial |
$262.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.52
|
| Rate for Payer: Priority Health Narrow Network |
$224.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$281.73
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
IP
|
$3.13
|
|
|
Service Code
|
NDC 51079087001
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: ASR ASR |
$3.04
|
| Rate for Payer: ASR Commercial |
$3.04
|
| Rate for Payer: BCBS Trust/PPO |
$2.55
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$3.13
|
| Rate for Payer: Healthscope Whirlpool |
$3.04
|
| Rate for Payer: Mclaren Commercial |
$2.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.66
|
| Rate for Payer: Nomi Health Commercial |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.75
|
|
