|
VALACYCLOVIR 500 MG TABLET
|
Facility
IP
|
$256.63
|
|
|
Service Code
|
NDC 0904-6565-07
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.64 |
| Max. Negotiated Rate |
$256.63 |
| Rate for Payer: Aetna Commercial |
$230.97
|
| Rate for Payer: ASR ASR |
$248.93
|
| Rate for Payer: BCBS Trust/PPO |
$198.97
|
| Rate for Payer: BCN Commercial |
$198.97
|
| Rate for Payer: Cash Price |
$205.31
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.30
|
| Rate for Payer: Healthscope Commercial |
$256.63
|
| Rate for Payer: Healthscope Whirlpool |
$248.93
|
| Rate for Payer: Mclaren Commercial |
$230.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.83
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$16.50
|
|
|
Service Code
|
NDC 0143-9637-01
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: ASR ASR |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$12.79
|
| Rate for Payer: BCN Commercial |
$12.79
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.20
|
| Rate for Payer: Healthscope Commercial |
$16.50
|
| Rate for Payer: Healthscope Whirlpool |
$16.00
|
| Rate for Payer: Mclaren Commercial |
$14.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.52
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$16.50
|
|
|
Service Code
|
NDC 0143-9637-10
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: ASR ASR |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$12.79
|
| Rate for Payer: BCN Commercial |
$12.79
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.20
|
| Rate for Payer: Healthscope Commercial |
$16.50
|
| Rate for Payer: Healthscope Whirlpool |
$16.00
|
| Rate for Payer: Mclaren Commercial |
$14.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.52
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
IP
|
$1.76
|
|
|
Service Code
|
NDC 9900-0019-51
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna Commercial |
$1.58
|
| Rate for Payer: ASR ASR |
$1.71
|
| Rate for Payer: BCBS Trust/PPO |
$1.36
|
| Rate for Payer: BCN Commercial |
$1.36
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cofinity Commercial |
$1.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.41
|
| Rate for Payer: Healthscope Commercial |
$1.76
|
| Rate for Payer: Healthscope Whirlpool |
$1.71
|
| Rate for Payer: Mclaren Commercial |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.55
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
IP
|
$3.67
|
|
|
Service Code
|
NDC 0121-4675-05
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: ASR ASR |
$3.56
|
| Rate for Payer: BCBS Trust/PPO |
$2.85
|
| Rate for Payer: BCN Commercial |
$2.85
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Healthscope Whirlpool |
$3.56
|
| Rate for Payer: Mclaren Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.23
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION
|
Facility
IP
|
$222.31
|
|
|
Service Code
|
NDC 0121-0675-85
|
| Hospital Charge Code |
8428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.62 |
| Max. Negotiated Rate |
$222.31 |
| Rate for Payer: Aetna Commercial |
$200.08
|
| Rate for Payer: ASR ASR |
$215.64
|
| Rate for Payer: BCBS Trust/PPO |
$172.36
|
| Rate for Payer: BCN Commercial |
$172.36
|
| Rate for Payer: Cash Price |
$177.85
|
| Rate for Payer: Cofinity Commercial |
$208.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.85
|
| Rate for Payer: Healthscope Commercial |
$222.31
|
| Rate for Payer: Healthscope Whirlpool |
$215.64
|
| Rate for Payer: Mclaren Commercial |
$200.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.63
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
IP
|
$410.31
|
|
|
Service Code
|
NDC 65862-571-90
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.22 |
| Max. Negotiated Rate |
$410.31 |
| Rate for Payer: Aetna Commercial |
$369.28
|
| Rate for Payer: ASR ASR |
$398.00
|
| Rate for Payer: BCBS Trust/PPO |
$318.11
|
| Rate for Payer: BCN Commercial |
$318.11
|
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Cofinity Commercial |
$385.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.25
|
| Rate for Payer: Healthscope Commercial |
$410.31
|
| Rate for Payer: Healthscope Whirlpool |
$398.00
|
| Rate for Payer: Mclaren Commercial |
$369.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$348.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.07
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
IP
|
$2,806.86
|
|
|
Service Code
|
NDC 0078-0358-34
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,964.80 |
| Max. Negotiated Rate |
$2,806.86 |
| Rate for Payer: Aetna Commercial |
$2,526.17
|
| Rate for Payer: ASR ASR |
$2,722.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,176.16
|
| Rate for Payer: BCN Commercial |
$2,176.16
|
| Rate for Payer: Cash Price |
$2,245.49
|
| Rate for Payer: Cofinity Commercial |
$2,638.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,245.49
|
| Rate for Payer: Healthscope Commercial |
$2,806.86
|
| Rate for Payer: Healthscope Whirlpool |
$2,722.65
|
| Rate for Payer: Mclaren Commercial |
$2,526.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,385.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,964.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,470.04
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
IP
|
$408.20
|
|
|
Service Code
|
NDC 43547-368-09
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$285.74 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna Commercial |
$367.38
|
| Rate for Payer: ASR ASR |
$395.95
|
| Rate for Payer: BCBS Trust/PPO |
$316.48
|
| Rate for Payer: BCN Commercial |
$316.48
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$383.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Healthscope Whirlpool |
$395.95
|
| Rate for Payer: Mclaren Commercial |
$367.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$346.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.22
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
IP
|
$4.73
|
|
|
Service Code
|
NDC 60687-623-11
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$4.73 |
| Rate for Payer: Aetna Commercial |
$4.26
|
| Rate for Payer: ASR ASR |
$4.59
|
| Rate for Payer: BCBS Trust/PPO |
$3.67
|
| Rate for Payer: BCN Commercial |
$3.67
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cofinity Commercial |
$4.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.78
|
| Rate for Payer: Healthscope Commercial |
$4.73
|
| Rate for Payer: Healthscope Whirlpool |
$4.59
|
| Rate for Payer: Mclaren Commercial |
$4.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.16
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
IP
|
$472.80
|
|
|
Service Code
|
NDC 60687-623-01
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$330.96 |
| Max. Negotiated Rate |
$472.80 |
| Rate for Payer: Aetna Commercial |
$425.52
|
| Rate for Payer: ASR ASR |
$458.62
|
| Rate for Payer: BCBS Trust/PPO |
$366.56
|
| Rate for Payer: BCN Commercial |
$366.56
|
| Rate for Payer: Cash Price |
$378.24
|
| Rate for Payer: Cofinity Commercial |
$444.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.24
|
| Rate for Payer: Healthscope Commercial |
$472.80
|
| Rate for Payer: Healthscope Whirlpool |
$458.62
|
| Rate for Payer: Mclaren Commercial |
$425.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$416.06
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION
|
Facility
IP
|
$27.60
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$24.84
|
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: Aetna Commercial |
$16.69
|
| Rate for Payer: Aetna Commercial |
$59.74
|
| Rate for Payer: Aetna Commercial |
$22.35
|
| Rate for Payer: Aetna Commercial |
$27.94
|
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Commercial |
$19.35
|
| Rate for Payer: Aetna Commercial |
$15.92
|
| Rate for Payer: Aetna Commercial |
$17.63
|
| Rate for Payer: Aetna Commercial |
$17.35
|
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna Commercial |
$16.16
|
| Rate for Payer: ASR ASR |
$16.91
|
| Rate for Payer: ASR ASR |
$17.98
|
| Rate for Payer: ASR ASR |
$22.37
|
| Rate for Payer: ASR ASR |
$30.11
|
| Rate for Payer: ASR ASR |
$20.86
|
| Rate for Payer: ASR ASR |
$18.32
|
| Rate for Payer: ASR ASR |
$17.16
|
| Rate for Payer: ASR ASR |
$26.77
|
| Rate for Payer: ASR ASR |
$16.70
|
| Rate for Payer: ASR ASR |
$19.00
|
| Rate for Payer: ASR ASR |
$24.09
|
| Rate for Payer: ASR ASR |
$17.41
|
| Rate for Payer: ASR ASR |
$64.39
|
| Rate for Payer: ASR ASR |
$18.70
|
| Rate for Payer: BCBS Trust/PPO |
$13.72
|
| Rate for Payer: BCBS Trust/PPO |
$13.51
|
| Rate for Payer: BCBS Trust/PPO |
$14.37
|
| Rate for Payer: BCBS Trust/PPO |
$17.88
|
| Rate for Payer: BCBS Trust/PPO |
$13.35
|
| Rate for Payer: BCBS Trust/PPO |
$13.92
|
| Rate for Payer: BCBS Trust/PPO |
$51.46
|
| Rate for Payer: BCBS Trust/PPO |
$15.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.67
|
| Rate for Payer: BCBS Trust/PPO |
$21.40
|
| Rate for Payer: BCBS Trust/PPO |
$14.65
|
| Rate for Payer: BCBS Trust/PPO |
$24.07
|
| Rate for Payer: BCBS Trust/PPO |
$14.95
|
| Rate for Payer: BCBS Trust/PPO |
$19.25
|
| Rate for Payer: BCN Commercial |
$13.92
|
| Rate for Payer: BCN Commercial |
$13.35
|
| Rate for Payer: BCN Commercial |
$13.51
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: BCN Commercial |
$14.37
|
| Rate for Payer: BCN Commercial |
$14.65
|
| Rate for Payer: BCN Commercial |
$14.95
|
| Rate for Payer: BCN Commercial |
$24.07
|
| Rate for Payer: BCN Commercial |
$15.19
|
| Rate for Payer: BCN Commercial |
$51.46
|
| Rate for Payer: BCN Commercial |
$16.67
|
| Rate for Payer: BCN Commercial |
$17.88
|
| Rate for Payer: BCN Commercial |
$19.25
|
| Rate for Payer: BCN Commercial |
$21.40
|
| Rate for Payer: Cash Price |
$22.08
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cash Price |
$18.44
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cash Price |
$13.78
|
| Rate for Payer: Cash Price |
$15.67
|
| Rate for Payer: Cash Price |
$15.11
|
| Rate for Payer: Cash Price |
$15.43
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$16.63
|
| Rate for Payer: Cofinity Commercial |
$16.87
|
| Rate for Payer: Cofinity Commercial |
$23.34
|
| Rate for Payer: Cofinity Commercial |
$29.18
|
| Rate for Payer: Cofinity Commercial |
$17.43
|
| Rate for Payer: Cofinity Commercial |
$21.68
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$16.19
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Cofinity Commercial |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$18.41
|
| Rate for Payer: Cofinity Commercial |
$25.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.36
|
| Rate for Payer: Healthscope Commercial |
$17.22
|
| Rate for Payer: Healthscope Commercial |
$19.59
|
| Rate for Payer: Healthscope Commercial |
$17.95
|
| Rate for Payer: Healthscope Commercial |
$24.83
|
| Rate for Payer: Healthscope Commercial |
$17.43
|
| Rate for Payer: Healthscope Commercial |
$18.54
|
| Rate for Payer: Healthscope Commercial |
$19.28
|
| Rate for Payer: Healthscope Commercial |
$18.89
|
| Rate for Payer: Healthscope Commercial |
$27.60
|
| Rate for Payer: Healthscope Commercial |
$21.50
|
| Rate for Payer: Healthscope Commercial |
$31.04
|
| Rate for Payer: Healthscope Commercial |
$66.38
|
| Rate for Payer: Healthscope Commercial |
$23.06
|
| Rate for Payer: Healthscope Commercial |
$17.69
|
| Rate for Payer: Healthscope Whirlpool |
$22.37
|
| Rate for Payer: Healthscope Whirlpool |
$24.09
|
| Rate for Payer: Healthscope Whirlpool |
$16.70
|
| Rate for Payer: Healthscope Whirlpool |
$19.00
|
| Rate for Payer: Healthscope Whirlpool |
$64.39
|
| Rate for Payer: Healthscope Whirlpool |
$17.98
|
| Rate for Payer: Healthscope Whirlpool |
$20.86
|
| Rate for Payer: Healthscope Whirlpool |
$17.16
|
| Rate for Payer: Healthscope Whirlpool |
$18.70
|
| Rate for Payer: Healthscope Whirlpool |
$16.91
|
| Rate for Payer: Healthscope Whirlpool |
$30.11
|
| Rate for Payer: Healthscope Whirlpool |
$18.32
|
| Rate for Payer: Healthscope Whirlpool |
$26.77
|
| Rate for Payer: Healthscope Whirlpool |
$17.41
|
| Rate for Payer: Mclaren Commercial |
$16.16
|
| Rate for Payer: Mclaren Commercial |
$17.63
|
| Rate for Payer: Mclaren Commercial |
$59.74
|
| Rate for Payer: Mclaren Commercial |
$15.69
|
| Rate for Payer: Mclaren Commercial |
$15.92
|
| Rate for Payer: Mclaren Commercial |
$19.35
|
| Rate for Payer: Mclaren Commercial |
$17.00
|
| Rate for Payer: Mclaren Commercial |
$20.75
|
| Rate for Payer: Mclaren Commercial |
$27.94
|
| Rate for Payer: Mclaren Commercial |
$15.50
|
| Rate for Payer: Mclaren Commercial |
$24.84
|
| Rate for Payer: Mclaren Commercial |
$22.35
|
| Rate for Payer: Mclaren Commercial |
$16.69
|
| Rate for Payer: Mclaren Commercial |
$17.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.29
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
IP
|
$117.79
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.45 |
| Max. Negotiated Rate |
$117.79 |
| Rate for Payer: Aetna Commercial |
$106.01
|
| Rate for Payer: ASR ASR |
$114.26
|
| Rate for Payer: BCBS Trust/PPO |
$91.32
|
| Rate for Payer: BCN Commercial |
$91.32
|
| Rate for Payer: Cash Price |
$94.23
|
| Rate for Payer: Cofinity Commercial |
$110.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.23
|
| Rate for Payer: Healthscope Commercial |
$117.79
|
| Rate for Payer: Healthscope Whirlpool |
$114.26
|
| Rate for Payer: Mclaren Commercial |
$106.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.66
|
|
|
VANCOMYCIN 1.5 GRAM INTRAVENOUS SOLUTION
|
Facility
IP
|
$49.66
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
189183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.76 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna Commercial |
$44.69
|
| Rate for Payer: Aetna Commercial |
$46.94
|
| Rate for Payer: ASR ASR |
$48.17
|
| Rate for Payer: ASR ASR |
$50.59
|
| Rate for Payer: BCBS Trust/PPO |
$38.50
|
| Rate for Payer: BCBS Trust/PPO |
$40.43
|
| Rate for Payer: BCN Commercial |
$38.50
|
| Rate for Payer: BCN Commercial |
$40.43
|
| Rate for Payer: Cash Price |
$39.73
|
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: Cofinity Commercial |
$49.02
|
| Rate for Payer: Cofinity Commercial |
$46.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.73
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: Healthscope Whirlpool |
$48.17
|
| Rate for Payer: Healthscope Whirlpool |
$50.59
|
| Rate for Payer: Mclaren Commercial |
$46.94
|
| Rate for Payer: Mclaren Commercial |
$44.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.70
|
|
|
VANCOMYCIN 25 MG/ML ORAL SOLUTION
|
Facility
IP
|
$576.00
|
|
|
Service Code
|
NDC 65628-204-05
|
| Hospital Charge Code |
186107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$403.20 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$518.40
|
| Rate for Payer: ASR ASR |
$558.72
|
| Rate for Payer: BCBS Trust/PPO |
$446.57
|
| Rate for Payer: BCN Commercial |
$446.57
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cofinity Commercial |
$541.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.80
|
| Rate for Payer: Healthscope Commercial |
$576.00
|
| Rate for Payer: Healthscope Whirlpool |
$558.72
|
| Rate for Payer: Mclaren Commercial |
$518.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$506.88
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$18.83
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$18.83 |
| Rate for Payer: Aetna Commercial |
$16.95
|
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Commercial |
$29.94
|
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: Aetna Commercial |
$15.05
|
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Commercial |
$14.56
|
| Rate for Payer: ASR ASR |
$16.22
|
| Rate for Payer: ASR ASR |
$18.27
|
| Rate for Payer: ASR ASR |
$16.70
|
| Rate for Payer: ASR ASR |
$22.50
|
| Rate for Payer: ASR ASR |
$15.69
|
| Rate for Payer: ASR ASR |
$26.53
|
| Rate for Payer: ASR ASR |
$25.38
|
| Rate for Payer: ASR ASR |
$32.27
|
| Rate for Payer: BCBS Trust/PPO |
$25.79
|
| Rate for Payer: BCBS Trust/PPO |
$14.60
|
| Rate for Payer: BCBS Trust/PPO |
$20.28
|
| Rate for Payer: BCBS Trust/PPO |
$13.35
|
| Rate for Payer: BCBS Trust/PPO |
$12.96
|
| Rate for Payer: BCBS Trust/PPO |
$12.54
|
| Rate for Payer: BCBS Trust/PPO |
$17.99
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$20.28
|
| Rate for Payer: BCN Commercial |
$21.20
|
| Rate for Payer: BCN Commercial |
$12.54
|
| Rate for Payer: BCN Commercial |
$12.96
|
| Rate for Payer: BCN Commercial |
$13.35
|
| Rate for Payer: BCN Commercial |
$14.60
|
| Rate for Payer: BCN Commercial |
$25.79
|
| Rate for Payer: BCN Commercial |
$17.99
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$15.07
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$13.78
|
| Rate for Payer: Cash Price |
$26.62
|
| Rate for Payer: Cash Price |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$16.19
|
| Rate for Payer: Cofinity Commercial |
$31.27
|
| Rate for Payer: Cofinity Commercial |
$17.70
|
| Rate for Payer: Cofinity Commercial |
$25.71
|
| Rate for Payer: Cofinity Commercial |
$15.72
|
| Rate for Payer: Cofinity Commercial |
$21.81
|
| Rate for Payer: Cofinity Commercial |
$15.21
|
| Rate for Payer: Cofinity Commercial |
$24.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Healthscope Commercial |
$33.27
|
| Rate for Payer: Healthscope Commercial |
$17.22
|
| Rate for Payer: Healthscope Commercial |
$27.35
|
| Rate for Payer: Healthscope Commercial |
$18.83
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$16.72
|
| Rate for Payer: Healthscope Commercial |
$23.20
|
| Rate for Payer: Healthscope Commercial |
$26.16
|
| Rate for Payer: Healthscope Whirlpool |
$18.27
|
| Rate for Payer: Healthscope Whirlpool |
$16.22
|
| Rate for Payer: Healthscope Whirlpool |
$32.27
|
| Rate for Payer: Healthscope Whirlpool |
$22.50
|
| Rate for Payer: Healthscope Whirlpool |
$15.69
|
| Rate for Payer: Healthscope Whirlpool |
$16.70
|
| Rate for Payer: Healthscope Whirlpool |
$25.38
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$20.88
|
| Rate for Payer: Mclaren Commercial |
$29.94
|
| Rate for Payer: Mclaren Commercial |
$16.95
|
| Rate for Payer: Mclaren Commercial |
$24.62
|
| Rate for Payer: Mclaren Commercial |
$23.54
|
| Rate for Payer: Mclaren Commercial |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$15.50
|
| Rate for Payer: Mclaren Commercial |
$14.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.07
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
IP
|
$609.84
|
|
|
Service Code
|
NDC 65628-206-05
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$426.89 |
| Max. Negotiated Rate |
$609.84 |
| Rate for Payer: Aetna Commercial |
$548.86
|
| Rate for Payer: ASR ASR |
$591.54
|
| Rate for Payer: BCBS Trust/PPO |
$472.81
|
| Rate for Payer: BCN Commercial |
$472.81
|
| Rate for Payer: Cash Price |
$487.87
|
| Rate for Payer: Cofinity Commercial |
$573.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$487.87
|
| Rate for Payer: Healthscope Commercial |
$609.84
|
| Rate for Payer: Healthscope Whirlpool |
$591.54
|
| Rate for Payer: Mclaren Commercial |
$548.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$518.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$536.66
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
IP
|
$262.49
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$183.74 |
| Max. Negotiated Rate |
$262.49 |
| Rate for Payer: Aetna Commercial |
$236.24
|
| Rate for Payer: Aetna Commercial |
$65.20
|
| Rate for Payer: Aetna Commercial |
$61.24
|
| Rate for Payer: Aetna Commercial |
$73.58
|
| Rate for Payer: Aetna Commercial |
$264.22
|
| Rate for Payer: ASR ASR |
$79.30
|
| Rate for Payer: ASR ASR |
$254.62
|
| Rate for Payer: ASR ASR |
$284.77
|
| Rate for Payer: ASR ASR |
$70.28
|
| Rate for Payer: ASR ASR |
$66.00
|
| Rate for Payer: BCBS Trust/PPO |
$52.75
|
| Rate for Payer: BCBS Trust/PPO |
$203.51
|
| Rate for Payer: BCBS Trust/PPO |
$63.38
|
| Rate for Payer: BCBS Trust/PPO |
$227.61
|
| Rate for Payer: BCBS Trust/PPO |
$56.17
|
| Rate for Payer: BCN Commercial |
$56.17
|
| Rate for Payer: BCN Commercial |
$203.51
|
| Rate for Payer: BCN Commercial |
$227.61
|
| Rate for Payer: BCN Commercial |
$63.38
|
| Rate for Payer: BCN Commercial |
$52.75
|
| Rate for Payer: Cash Price |
$234.87
|
| Rate for Payer: Cash Price |
$57.96
|
| Rate for Payer: Cash Price |
$209.99
|
| Rate for Payer: Cash Price |
$54.43
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cofinity Commercial |
$246.74
|
| Rate for Payer: Cofinity Commercial |
$76.84
|
| Rate for Payer: Cofinity Commercial |
$275.97
|
| Rate for Payer: Cofinity Commercial |
$68.10
|
| Rate for Payer: Cofinity Commercial |
$63.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.99
|
| Rate for Payer: Healthscope Commercial |
$293.58
|
| Rate for Payer: Healthscope Commercial |
$81.75
|
| Rate for Payer: Healthscope Commercial |
$72.45
|
| Rate for Payer: Healthscope Commercial |
$68.04
|
| Rate for Payer: Healthscope Commercial |
$262.49
|
| Rate for Payer: Healthscope Whirlpool |
$79.30
|
| Rate for Payer: Healthscope Whirlpool |
$254.62
|
| Rate for Payer: Healthscope Whirlpool |
$284.77
|
| Rate for Payer: Healthscope Whirlpool |
$66.00
|
| Rate for Payer: Healthscope Whirlpool |
$70.28
|
| Rate for Payer: Mclaren Commercial |
$236.24
|
| Rate for Payer: Mclaren Commercial |
$73.58
|
| Rate for Payer: Mclaren Commercial |
$61.24
|
| Rate for Payer: Mclaren Commercial |
$264.22
|
| Rate for Payer: Mclaren Commercial |
$65.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.94
|
|
|
VANCOMYCIN 750 MG/150 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
IP
|
$42.05
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.44 |
| Max. Negotiated Rate |
$42.05 |
| Rate for Payer: Aetna Commercial |
$37.84
|
| Rate for Payer: ASR ASR |
$40.79
|
| Rate for Payer: BCBS Trust/PPO |
$32.60
|
| Rate for Payer: BCN Commercial |
$32.60
|
| Rate for Payer: Cash Price |
$33.64
|
| Rate for Payer: Cofinity Commercial |
$39.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.64
|
| Rate for Payer: Healthscope Commercial |
$42.05
|
| Rate for Payer: Healthscope Whirlpool |
$40.79
|
| Rate for Payer: Mclaren Commercial |
$37.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.00
|
|
|
VANCOMYCIN 750 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$40.10
|
|
|
Service Code
|
HCPCS J3371
|
| Hospital Charge Code |
97371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$40.10 |
| Rate for Payer: Aetna Commercial |
$36.09
|
| Rate for Payer: ASR ASR |
$38.90
|
| Rate for Payer: BCBS Trust/PPO |
$31.09
|
| Rate for Payer: BCN Commercial |
$31.09
|
| Rate for Payer: Cash Price |
$32.08
|
| Rate for Payer: Cofinity Commercial |
$37.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.08
|
| Rate for Payer: Healthscope Commercial |
$40.10
|
| Rate for Payer: Healthscope Whirlpool |
$38.90
|
| Rate for Payer: Mclaren Commercial |
$36.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.29
|
|
|
VANCOMYCIN 750 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$30.91
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
97371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$30.91 |
| Rate for Payer: Aetna Commercial |
$27.82
|
| Rate for Payer: ASR ASR |
$29.98
|
| Rate for Payer: BCBS Trust/PPO |
$23.96
|
| Rate for Payer: BCN Commercial |
$23.96
|
| Rate for Payer: Cash Price |
$24.73
|
| Rate for Payer: Cofinity Commercial |
$29.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.73
|
| Rate for Payer: Healthscope Commercial |
$30.91
|
| Rate for Payer: Healthscope Whirlpool |
$29.98
|
| Rate for Payer: Mclaren Commercial |
$27.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.20
|
|
|
VANTAS IMPLANT
|
Professional
|
$3,334.00
|
|
|
Service Code
|
HCPCS J9225
|
| Min. Negotiated Rate |
$1,333.60 |
| Max. Negotiated Rate |
$5,264.35 |
| Rate for Payer: Aetna Commercial |
$4,678.90
|
| Rate for Payer: BCBS Complete |
$1,333.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,264.35
|
| Rate for Payer: BCN Commercial |
$5,264.35
|
| Rate for Payer: Cash Price |
$2,667.20
|
| Rate for Payer: Cash Price |
$2,667.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,333.80
|
|
|
VASOPRESSIN 20 UNIT/ML INJECTION (CODE)
|
Facility
IP
|
$267.42
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
163709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.19 |
| Max. Negotiated Rate |
$267.42 |
| Rate for Payer: Aetna Commercial |
$240.68
|
| Rate for Payer: ASR ASR |
$259.40
|
| Rate for Payer: BCBS Trust/PPO |
$207.33
|
| Rate for Payer: BCN Commercial |
$207.33
|
| Rate for Payer: Cash Price |
$213.94
|
| Rate for Payer: Cofinity Commercial |
$251.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.94
|
| Rate for Payer: Healthscope Commercial |
$267.42
|
| Rate for Payer: Healthscope Whirlpool |
$259.40
|
| Rate for Payer: Mclaren Commercial |
$240.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.33
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$116.96
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
173104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.87 |
| Max. Negotiated Rate |
$116.96 |
| Rate for Payer: Aetna Commercial |
$105.26
|
| Rate for Payer: Aetna Commercial |
$240.68
|
| Rate for Payer: Aetna Commercial |
$87.90
|
| Rate for Payer: ASR ASR |
$259.40
|
| Rate for Payer: ASR ASR |
$113.45
|
| Rate for Payer: ASR ASR |
$94.74
|
| Rate for Payer: BCBS Trust/PPO |
$207.33
|
| Rate for Payer: BCBS Trust/PPO |
$90.68
|
| Rate for Payer: BCBS Trust/PPO |
$75.72
|
| Rate for Payer: BCN Commercial |
$75.72
|
| Rate for Payer: BCN Commercial |
$90.68
|
| Rate for Payer: BCN Commercial |
$207.33
|
| Rate for Payer: Cash Price |
$213.94
|
| Rate for Payer: Cash Price |
$93.57
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cofinity Commercial |
$251.37
|
| Rate for Payer: Cofinity Commercial |
$91.81
|
| Rate for Payer: Cofinity Commercial |
$109.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.57
|
| Rate for Payer: Healthscope Commercial |
$267.42
|
| Rate for Payer: Healthscope Commercial |
$116.96
|
| Rate for Payer: Healthscope Commercial |
$97.67
|
| Rate for Payer: Healthscope Whirlpool |
$94.74
|
| Rate for Payer: Healthscope Whirlpool |
$259.40
|
| Rate for Payer: Healthscope Whirlpool |
$113.45
|
| Rate for Payer: Mclaren Commercial |
$240.68
|
| Rate for Payer: Mclaren Commercial |
$105.26
|
| Rate for Payer: Mclaren Commercial |
$87.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.95
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$18.32
|
|
|
Service Code
|
NDC 0409-1632-49
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$18.32 |
| Rate for Payer: Aetna Commercial |
$16.49
|
| Rate for Payer: ASR ASR |
$17.77
|
| Rate for Payer: BCBS Trust/PPO |
$14.20
|
| Rate for Payer: BCN Commercial |
$14.20
|
| Rate for Payer: Cash Price |
$14.65
|
| Rate for Payer: Cofinity Commercial |
$17.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.66
|
| Rate for Payer: Healthscope Commercial |
$18.32
|
| Rate for Payer: Healthscope Whirlpool |
$17.77
|
| Rate for Payer: Mclaren Commercial |
$16.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.12
|
|
