|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$32.30
|
|
|
Service Code
|
NDC 09629513673
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$29.07
|
| Rate for Payer: ASR ASR |
$31.33
|
| Rate for Payer: ASR Commercial |
$31.33
|
| Rate for Payer: BCBS Trust/PPO |
$26.32
|
| Rate for Payer: BCN Commercial |
$25.04
|
| Rate for Payer: Cash Price |
$25.84
|
| Rate for Payer: Cofinity Commercial |
$30.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.84
|
| Rate for Payer: Healthscope Commercial |
$32.30
|
| Rate for Payer: Healthscope Whirlpool |
$31.33
|
| Rate for Payer: Mclaren Commercial |
$29.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.45
|
| Rate for Payer: Nomi Health Commercial |
$26.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.42
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$28.78
|
|
|
Service Code
|
NDC 00810067013
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$28.78 |
| Rate for Payer: Aetna Commercial |
$25.90
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: ASR ASR |
$27.92
|
| Rate for Payer: ASR Commercial |
$27.92
|
| Rate for Payer: BCBS Complete |
$11.51
|
| Rate for Payer: BCBS Trust/PPO |
$23.57
|
| Rate for Payer: BCN Commercial |
$22.31
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$27.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Healthscope Commercial |
$28.78
|
| Rate for Payer: Healthscope Whirlpool |
$27.92
|
| Rate for Payer: Mclaren Commercial |
$25.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.46
|
| Rate for Payer: Nomi Health Commercial |
$23.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.22
|
| Rate for Payer: Priority Health Narrow Network |
$20.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.33
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$32.30
|
|
|
Service Code
|
NDC 70000047501
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$29.07
|
| Rate for Payer: ASR ASR |
$31.33
|
| Rate for Payer: ASR Commercial |
$31.33
|
| Rate for Payer: BCBS Trust/PPO |
$26.32
|
| Rate for Payer: BCN Commercial |
$25.04
|
| Rate for Payer: Cash Price |
$25.84
|
| Rate for Payer: Cofinity Commercial |
$30.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.84
|
| Rate for Payer: Healthscope Commercial |
$32.30
|
| Rate for Payer: Healthscope Whirlpool |
$31.33
|
| Rate for Payer: Mclaren Commercial |
$29.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.45
|
| Rate for Payer: Nomi Health Commercial |
$26.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.42
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
IP
|
$8.85
|
|
|
Service Code
|
NDC 37000002410
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: ASR ASR |
$8.58
|
| Rate for Payer: ASR Commercial |
$8.58
|
| Rate for Payer: BCBS Trust/PPO |
$7.21
|
| Rate for Payer: BCN Commercial |
$6.86
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$8.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Healthscope Commercial |
$8.85
|
| Rate for Payer: Healthscope Whirlpool |
$8.58
|
| Rate for Payer: Mclaren Commercial |
$7.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.52
|
| Rate for Payer: Nomi Health Commercial |
$7.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.79
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
OP
|
$8.85
|
|
|
Service Code
|
NDC 37000002410
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: Aetna Medicare |
$4.42
|
| Rate for Payer: ASR ASR |
$8.58
|
| Rate for Payer: ASR Commercial |
$8.58
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: BCBS Trust/PPO |
$7.25
|
| Rate for Payer: BCN Commercial |
$6.86
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$8.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Healthscope Commercial |
$8.85
|
| Rate for Payer: Healthscope Whirlpool |
$8.58
|
| Rate for Payer: Mclaren Commercial |
$7.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.52
|
| Rate for Payer: Nomi Health Commercial |
$7.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.75
|
| Rate for Payer: Priority Health Narrow Network |
$6.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.79
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$50.16
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
6744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$50.16 |
| Rate for Payer: Aetna Commercial |
$45.14
|
| Rate for Payer: Aetna Medicare |
$25.08
|
| Rate for Payer: ASR ASR |
$48.66
|
| Rate for Payer: ASR Commercial |
$48.66
|
| Rate for Payer: BCBS Complete |
$20.06
|
| Rate for Payer: BCBS Trust/PPO |
$41.08
|
| Rate for Payer: BCN Commercial |
$38.89
|
| Rate for Payer: Cash Price |
$40.13
|
| Rate for Payer: Cofinity Commercial |
$47.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.13
|
| Rate for Payer: Healthscope Commercial |
$50.16
|
| Rate for Payer: Healthscope Whirlpool |
$48.66
|
| Rate for Payer: Mclaren Commercial |
$45.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.64
|
| Rate for Payer: Nomi Health Commercial |
$41.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.95
|
| Rate for Payer: Priority Health Narrow Network |
$35.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.14
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$50.16
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
6744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$50.16 |
| Rate for Payer: Aetna Commercial |
$45.14
|
| Rate for Payer: ASR ASR |
$48.66
|
| Rate for Payer: ASR Commercial |
$48.66
|
| Rate for Payer: BCBS Trust/PPO |
$40.88
|
| Rate for Payer: BCN Commercial |
$38.89
|
| Rate for Payer: Cash Price |
$40.13
|
| Rate for Payer: Cofinity Commercial |
$47.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.13
|
| Rate for Payer: Healthscope Commercial |
$50.16
|
| Rate for Payer: Healthscope Whirlpool |
$48.66
|
| Rate for Payer: Mclaren Commercial |
$45.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.64
|
| Rate for Payer: Nomi Health Commercial |
$41.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.14
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$1.24
|
|
|
Service Code
|
NDC 77333094025
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Aetna Commercial |
$1.12
|
| Rate for Payer: Aetna Medicare |
$0.62
|
| Rate for Payer: ASR ASR |
$1.20
|
| Rate for Payer: ASR Commercial |
$1.20
|
| Rate for Payer: BCBS Complete |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCN Commercial |
$0.96
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cofinity Commercial |
$1.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.99
|
| Rate for Payer: Healthscope Commercial |
$1.24
|
| Rate for Payer: Healthscope Whirlpool |
$1.20
|
| Rate for Payer: Mclaren Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.05
|
| Rate for Payer: Nomi Health Commercial |
$1.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.09
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$1.52
|
|
|
Service Code
|
NDC 50268085811
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna Commercial |
$1.37
|
| Rate for Payer: ASR ASR |
$1.47
|
| Rate for Payer: ASR Commercial |
$1.47
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cofinity Commercial |
$1.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.22
|
| Rate for Payer: Healthscope Commercial |
$1.52
|
| Rate for Payer: Healthscope Whirlpool |
$1.47
|
| Rate for Payer: Mclaren Commercial |
$1.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.29
|
| Rate for Payer: Nomi Health Commercial |
$1.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.34
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$124.30
|
|
|
Service Code
|
NDC 77333094010
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.72 |
| Max. Negotiated Rate |
$124.30 |
| Rate for Payer: Aetna Commercial |
$111.87
|
| Rate for Payer: Aetna Medicare |
$62.15
|
| Rate for Payer: ASR ASR |
$120.57
|
| Rate for Payer: ASR Commercial |
$120.57
|
| Rate for Payer: BCBS Complete |
$49.72
|
| Rate for Payer: BCBS Trust/PPO |
$101.79
|
| Rate for Payer: BCN Commercial |
$96.37
|
| Rate for Payer: Cash Price |
$99.44
|
| Rate for Payer: Cofinity Commercial |
$116.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.44
|
| Rate for Payer: Healthscope Commercial |
$124.30
|
| Rate for Payer: Healthscope Whirlpool |
$120.57
|
| Rate for Payer: Mclaren Commercial |
$111.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.66
|
| Rate for Payer: Nomi Health Commercial |
$101.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.91
|
| Rate for Payer: Priority Health Narrow Network |
$87.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.38
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$1.52
|
|
|
Service Code
|
NDC 50268085811
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna Commercial |
$1.37
|
| Rate for Payer: Aetna Medicare |
$0.76
|
| Rate for Payer: ASR ASR |
$1.47
|
| Rate for Payer: ASR Commercial |
$1.47
|
| Rate for Payer: BCBS Complete |
$0.61
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cofinity Commercial |
$1.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.22
|
| Rate for Payer: Healthscope Commercial |
$1.52
|
| Rate for Payer: Healthscope Whirlpool |
$1.47
|
| Rate for Payer: Mclaren Commercial |
$1.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.29
|
| Rate for Payer: Nomi Health Commercial |
$1.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.33
|
| Rate for Payer: Priority Health Narrow Network |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.34
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$124.30
|
|
|
Service Code
|
NDC 77333094010
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$124.30 |
| Rate for Payer: Aetna Commercial |
$111.87
|
| Rate for Payer: ASR ASR |
$120.57
|
| Rate for Payer: ASR Commercial |
$120.57
|
| Rate for Payer: BCBS Trust/PPO |
$101.29
|
| Rate for Payer: BCN Commercial |
$96.37
|
| Rate for Payer: Cash Price |
$99.44
|
| Rate for Payer: Cofinity Commercial |
$116.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.44
|
| Rate for Payer: Healthscope Commercial |
$124.30
|
| Rate for Payer: Healthscope Whirlpool |
$120.57
|
| Rate for Payer: Mclaren Commercial |
$111.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.66
|
| Rate for Payer: Nomi Health Commercial |
$101.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.38
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$75.95
|
|
|
Service Code
|
NDC 50268085815
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$75.95 |
| Rate for Payer: Aetna Commercial |
$68.36
|
| Rate for Payer: ASR ASR |
$73.67
|
| Rate for Payer: ASR Commercial |
$73.67
|
| Rate for Payer: BCBS Trust/PPO |
$61.89
|
| Rate for Payer: BCN Commercial |
$58.88
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$71.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$75.95
|
| Rate for Payer: Healthscope Whirlpool |
$73.67
|
| Rate for Payer: Mclaren Commercial |
$68.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.84
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$75.95
|
|
|
Service Code
|
NDC 50268085815
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.38 |
| Max. Negotiated Rate |
$75.95 |
| Rate for Payer: Aetna Commercial |
$68.36
|
| Rate for Payer: Aetna Medicare |
$37.98
|
| Rate for Payer: ASR ASR |
$73.67
|
| Rate for Payer: ASR Commercial |
$73.67
|
| Rate for Payer: BCBS Complete |
$30.38
|
| Rate for Payer: BCBS Trust/PPO |
$62.20
|
| Rate for Payer: BCN Commercial |
$58.88
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$71.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$75.95
|
| Rate for Payer: Healthscope Whirlpool |
$73.67
|
| Rate for Payer: Mclaren Commercial |
$68.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.55
|
| Rate for Payer: Priority Health Narrow Network |
$53.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.84
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$1.24
|
|
|
Service Code
|
NDC 77333094025
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Aetna Commercial |
$1.12
|
| Rate for Payer: ASR ASR |
$1.20
|
| Rate for Payer: ASR Commercial |
$1.20
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCN Commercial |
$0.96
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cofinity Commercial |
$1.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.99
|
| Rate for Payer: Healthscope Commercial |
$1.24
|
| Rate for Payer: Healthscope Whirlpool |
$1.20
|
| Rate for Payer: Mclaren Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.05
|
| Rate for Payer: Nomi Health Commercial |
$1.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.09
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$451.20
|
|
|
Service Code
|
NDC 00904664061
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.28 |
| Max. Negotiated Rate |
$451.20 |
| Rate for Payer: Aetna Commercial |
$406.08
|
| Rate for Payer: ASR ASR |
$437.66
|
| Rate for Payer: ASR Commercial |
$437.66
|
| Rate for Payer: BCBS Trust/PPO |
$367.68
|
| Rate for Payer: BCN Commercial |
$349.82
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$424.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$451.20
|
| Rate for Payer: Healthscope Whirlpool |
$437.66
|
| Rate for Payer: Mclaren Commercial |
$406.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: Nomi Health Commercial |
$369.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.06
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$451.20
|
|
|
Service Code
|
NDC 00904664061
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.48 |
| Max. Negotiated Rate |
$451.20 |
| Rate for Payer: Aetna Commercial |
$406.08
|
| Rate for Payer: Aetna Medicare |
$225.60
|
| Rate for Payer: ASR ASR |
$437.66
|
| Rate for Payer: ASR Commercial |
$437.66
|
| Rate for Payer: BCBS Complete |
$180.48
|
| Rate for Payer: BCBS Trust/PPO |
$369.49
|
| Rate for Payer: BCN Commercial |
$349.82
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$424.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$451.20
|
| Rate for Payer: Healthscope Whirlpool |
$437.66
|
| Rate for Payer: Mclaren Commercial |
$406.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: Nomi Health Commercial |
$369.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$395.34
|
| Rate for Payer: Priority Health Narrow Network |
$316.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.06
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 67877025001
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: ASR ASR |
$136.77
|
| Rate for Payer: ASR Commercial |
$136.77
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS Trust/PPO |
$115.46
|
| Rate for Payer: BCN Commercial |
$109.32
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$141.00
|
| Rate for Payer: Healthscope Whirlpool |
$136.77
|
| Rate for Payer: Mclaren Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.54
|
| Rate for Payer: Priority Health Narrow Network |
$98.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.08
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 67877025001
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: ASR ASR |
$136.77
|
| Rate for Payer: ASR Commercial |
$136.77
|
| Rate for Payer: BCBS Trust/PPO |
$114.90
|
| Rate for Payer: BCN Commercial |
$109.32
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$141.00
|
| Rate for Payer: Healthscope Whirlpool |
$136.77
|
| Rate for Payer: Mclaren Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.08
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
OP
|
$401.85
|
|
|
Service Code
|
NDC 67877024238
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.74 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna Commercial |
$361.67
|
| Rate for Payer: Aetna Medicare |
$200.93
|
| Rate for Payer: ASR ASR |
$389.79
|
| Rate for Payer: ASR Commercial |
$389.79
|
| Rate for Payer: BCBS Complete |
$160.74
|
| Rate for Payer: BCBS Trust/PPO |
$329.07
|
| Rate for Payer: BCN Commercial |
$311.55
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Commercial |
$377.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Healthscope Whirlpool |
$389.79
|
| Rate for Payer: Mclaren Commercial |
$361.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: Nomi Health Commercial |
$329.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$352.10
|
| Rate for Payer: Priority Health Narrow Network |
$281.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$353.63
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
OP
|
$361.90
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.76 |
| Max. Negotiated Rate |
$361.90 |
| Rate for Payer: Aetna Commercial |
$325.71
|
| Rate for Payer: Aetna Medicare |
$180.95
|
| Rate for Payer: ASR ASR |
$351.04
|
| Rate for Payer: ASR Commercial |
$351.04
|
| Rate for Payer: BCBS Complete |
$144.76
|
| Rate for Payer: BCBS Trust/PPO |
$296.36
|
| Rate for Payer: BCN Commercial |
$280.58
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$340.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$361.90
|
| Rate for Payer: Healthscope Whirlpool |
$351.04
|
| Rate for Payer: Mclaren Commercial |
$325.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Nomi Health Commercial |
$296.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$317.10
|
| Rate for Payer: Priority Health Narrow Network |
$253.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$318.47
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$401.85
|
|
|
Service Code
|
NDC 67877024238
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.20 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna Commercial |
$361.67
|
| Rate for Payer: ASR ASR |
$389.79
|
| Rate for Payer: ASR Commercial |
$389.79
|
| Rate for Payer: BCBS Trust/PPO |
$327.47
|
| Rate for Payer: BCN Commercial |
$311.55
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Commercial |
$377.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Healthscope Whirlpool |
$389.79
|
| Rate for Payer: Mclaren Commercial |
$361.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: Nomi Health Commercial |
$329.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$353.63
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$361.90
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.24 |
| Max. Negotiated Rate |
$361.90 |
| Rate for Payer: Aetna Commercial |
$325.71
|
| Rate for Payer: ASR ASR |
$351.04
|
| Rate for Payer: ASR Commercial |
$351.04
|
| Rate for Payer: BCBS Trust/PPO |
$294.91
|
| Rate for Payer: BCN Commercial |
$280.58
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$340.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$361.90
|
| Rate for Payer: Healthscope Whirlpool |
$351.04
|
| Rate for Payer: Mclaren Commercial |
$325.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Nomi Health Commercial |
$296.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$318.47
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$6,049.47
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,932.16 |
| Max. Negotiated Rate |
$6,049.47 |
| Rate for Payer: Aetna Commercial |
$5,444.52
|
| Rate for Payer: Aetna Commercial |
$1,814.83
|
| Rate for Payer: Aetna Commercial |
$7,372.78
|
| Rate for Payer: ASR ASR |
$1,955.99
|
| Rate for Payer: ASR ASR |
$5,867.99
|
| Rate for Payer: ASR ASR |
$7,946.22
|
| Rate for Payer: ASR Commercial |
$5,867.99
|
| Rate for Payer: ASR Commercial |
$1,955.99
|
| Rate for Payer: ASR Commercial |
$7,946.22
|
| Rate for Payer: BCBS Trust/PPO |
$6,675.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,643.23
|
| Rate for Payer: BCBS Trust/PPO |
$4,929.71
|
| Rate for Payer: BCN Commercial |
$1,563.38
|
| Rate for Payer: BCN Commercial |
$6,351.24
|
| Rate for Payer: BCN Commercial |
$4,690.15
|
| Rate for Payer: Cash Price |
$4,839.58
|
| Rate for Payer: Cash Price |
$1,613.18
|
| Rate for Payer: Cash Price |
$6,553.58
|
| Rate for Payer: Cofinity Commercial |
$7,700.46
|
| Rate for Payer: Cofinity Commercial |
$1,895.49
|
| Rate for Payer: Cofinity Commercial |
$5,686.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,839.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,613.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,553.58
|
| Rate for Payer: Healthscope Commercial |
$2,016.48
|
| Rate for Payer: Healthscope Commercial |
$6,049.47
|
| Rate for Payer: Healthscope Commercial |
$8,191.98
|
| Rate for Payer: Healthscope Whirlpool |
$5,867.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,955.99
|
| Rate for Payer: Healthscope Whirlpool |
$7,946.22
|
| Rate for Payer: Mclaren Commercial |
$5,444.52
|
| Rate for Payer: Mclaren Commercial |
$1,814.83
|
| Rate for Payer: Mclaren Commercial |
$7,372.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,963.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,142.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,714.01
|
| Rate for Payer: Nomi Health Commercial |
$4,960.57
|
| Rate for Payer: Nomi Health Commercial |
$1,653.51
|
| Rate for Payer: Nomi Health Commercial |
$6,717.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,310.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,324.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,932.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,323.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,208.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,774.50
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$8,191.98
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$8,191.98 |
| Rate for Payer: Aetna Commercial |
$7,372.78
|
| Rate for Payer: Aetna Commercial |
$5,444.52
|
| Rate for Payer: Aetna Commercial |
$1,814.83
|
| Rate for Payer: Aetna Medicare |
$279.85
|
| Rate for Payer: Aetna Medicare |
$279.85
|
| Rate for Payer: Aetna Medicare |
$279.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.81
|
| Rate for Payer: ASR ASR |
$1,955.99
|
| Rate for Payer: ASR ASR |
$7,946.22
|
| Rate for Payer: ASR ASR |
$5,867.99
|
| Rate for Payer: ASR Commercial |
$7,946.22
|
| Rate for Payer: ASR Commercial |
$1,955.99
|
| Rate for Payer: ASR Commercial |
$5,867.99
|
| Rate for Payer: BCBS Complete |
$157.50
|
| Rate for Payer: BCBS Complete |
$157.50
|
| Rate for Payer: BCBS Complete |
$157.50
|
| Rate for Payer: BCBS MAPPO |
$279.85
|
| Rate for Payer: BCBS MAPPO |
$279.85
|
| Rate for Payer: BCBS MAPPO |
$279.85
|
| Rate for Payer: BCBS Trust/PPO |
$4,953.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,651.30
|
| Rate for Payer: BCBS Trust/PPO |
$6,708.41
|
| Rate for Payer: BCN Commercial |
$6,351.24
|
| Rate for Payer: BCN Commercial |
$4,690.15
|
| Rate for Payer: BCN Commercial |
$1,563.38
|
| Rate for Payer: BCN Medicare Advantage |
$279.85
|
| Rate for Payer: BCN Medicare Advantage |
$279.85
|
| Rate for Payer: BCN Medicare Advantage |
$279.85
|
| Rate for Payer: Cash Price |
$4,839.58
|
| Rate for Payer: Cash Price |
$1,613.18
|
| Rate for Payer: Cash Price |
$1,613.18
|
| Rate for Payer: Cash Price |
$6,553.58
|
| Rate for Payer: Cash Price |
$6,553.58
|
| Rate for Payer: Cash Price |
$4,839.58
|
| Rate for Payer: Cofinity Commercial |
$1,895.49
|
| Rate for Payer: Cofinity Commercial |
$5,686.50
|
| Rate for Payer: Cofinity Commercial |
$7,700.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,553.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,839.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,613.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.85
|
| Rate for Payer: Healthscope Commercial |
$6,049.47
|
| Rate for Payer: Healthscope Commercial |
$2,016.48
|
| Rate for Payer: Healthscope Commercial |
$8,191.98
|
| Rate for Payer: Healthscope Whirlpool |
$5,867.99
|
| Rate for Payer: Healthscope Whirlpool |
$7,946.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,955.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.85
|
| Rate for Payer: Mclaren Commercial |
$1,814.83
|
| Rate for Payer: Mclaren Commercial |
$7,372.78
|
| Rate for Payer: Mclaren Commercial |
$5,444.52
|
| Rate for Payer: Mclaren Medicaid |
$150.00
|
| Rate for Payer: Mclaren Medicaid |
$150.00
|
| Rate for Payer: Mclaren Medicaid |
$150.00
|
| Rate for Payer: Mclaren Medicare |
$279.85
|
| Rate for Payer: Mclaren Medicare |
$279.85
|
| Rate for Payer: Mclaren Medicare |
$279.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.84
|
| Rate for Payer: Meridian Medicaid |
$157.50
|
| Rate for Payer: Meridian Medicaid |
$157.50
|
| Rate for Payer: Meridian Medicaid |
$157.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,714.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,963.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,142.05
|
| Rate for Payer: Nomi Health Commercial |
$4,960.57
|
| Rate for Payer: Nomi Health Commercial |
$1,653.51
|
| Rate for Payer: Nomi Health Commercial |
$6,717.42
|
| Rate for Payer: PACE Medicare |
$265.86
|
| Rate for Payer: PACE Medicare |
$265.86
|
| Rate for Payer: PACE Medicare |
$265.86
|
| Rate for Payer: PACE SWMI |
$279.85
|
| Rate for Payer: PACE SWMI |
$279.85
|
| Rate for Payer: PACE SWMI |
$279.85
|
| Rate for Payer: PHP Commercial |
$307.83
|
| Rate for Payer: PHP Commercial |
$307.83
|
| Rate for Payer: PHP Commercial |
$307.83
|
| Rate for Payer: PHP Medicaid |
$150.00
|
| Rate for Payer: PHP Medicaid |
$150.00
|
| Rate for Payer: PHP Medicaid |
$150.00
|
| Rate for Payer: PHP Medicare Advantage |
$279.85
|
| Rate for Payer: PHP Medicare Advantage |
$279.85
|
| Rate for Payer: PHP Medicare Advantage |
$279.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,324.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,310.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,932.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,766.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,300.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,177.81
|
| Rate for Payer: Priority Health Medicare |
$279.85
|
| Rate for Payer: Priority Health Medicare |
$279.85
|
| Rate for Payer: Priority Health Medicare |
$279.85
|
| Rate for Payer: Priority Health Narrow Network |
$4,240.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,413.55
|
| Rate for Payer: Priority Health Narrow Network |
$5,742.58
|
| Rate for Payer: Railroad Medicare Medicare |
$279.85
|
| Rate for Payer: Railroad Medicare Medicare |
$279.85
|
| Rate for Payer: Railroad Medicare Medicare |
$279.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,774.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,323.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,208.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.85
|
| Rate for Payer: UHC Exchange |
$433.77
|
| Rate for Payer: UHC Exchange |
$433.77
|
| Rate for Payer: UHC Exchange |
$433.77
|
| Rate for Payer: UHC Medicare Advantage |
$279.85
|
| Rate for Payer: UHC Medicare Advantage |
$279.85
|
| Rate for Payer: UHC Medicare Advantage |
$279.85
|
| Rate for Payer: UHCCP DNSP |
$279.85
|
| Rate for Payer: UHCCP DNSP |
$279.85
|
| Rate for Payer: UHCCP DNSP |
$279.85
|
| Rate for Payer: UHCCP Medicaid |
$150.00
|
| Rate for Payer: UHCCP Medicaid |
$150.00
|
| Rate for Payer: UHCCP Medicaid |
$150.00
|
| Rate for Payer: VA VA |
$279.85
|
| Rate for Payer: VA VA |
$279.85
|
| Rate for Payer: VA VA |
$279.85
|
|
