|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15.84
|
|
|
Service Code
|
NDC 81284061200
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.26
|
| Rate for Payer: Aetna Medicare |
$7.92
|
| Rate for Payer: ASR ASR |
$15.36
|
| Rate for Payer: ASR Commercial |
$15.36
|
| Rate for Payer: BCBS Complete |
$6.34
|
| Rate for Payer: BCBS Trust/PPO |
$12.97
|
| Rate for Payer: BCN Commercial |
$12.28
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$15.84
|
| Rate for Payer: Healthscope Whirlpool |
$15.36
|
| Rate for Payer: Mclaren Commercial |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Nomi Health Commercial |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.88
|
| Rate for Payer: Priority Health Narrow Network |
$11.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.94
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15.84
|
|
|
Service Code
|
NDC 81284061110
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.26
|
| Rate for Payer: Aetna Medicare |
$7.92
|
| Rate for Payer: ASR ASR |
$15.36
|
| Rate for Payer: ASR Commercial |
$15.36
|
| Rate for Payer: BCBS Complete |
$6.34
|
| Rate for Payer: BCBS Trust/PPO |
$12.97
|
| Rate for Payer: BCN Commercial |
$12.28
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$15.84
|
| Rate for Payer: Healthscope Whirlpool |
$15.36
|
| Rate for Payer: Mclaren Commercial |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Nomi Health Commercial |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.88
|
| Rate for Payer: Priority Health Narrow Network |
$11.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.94
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.74
|
|
|
Service Code
|
NDC 47781060122
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: ASR ASR |
$22.06
|
| Rate for Payer: ASR Commercial |
$22.06
|
| Rate for Payer: BCBS Trust/PPO |
$18.53
|
| Rate for Payer: BCN Commercial |
$17.63
|
| Rate for Payer: Cash Price |
$18.19
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.19
|
| Rate for Payer: Healthscope Commercial |
$22.74
|
| Rate for Payer: Healthscope Whirlpool |
$22.06
|
| Rate for Payer: Mclaren Commercial |
$20.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.33
|
| Rate for Payer: Nomi Health Commercial |
$18.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.01
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.84
|
|
|
Service Code
|
NDC 81284061200
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.26
|
| Rate for Payer: ASR ASR |
$15.36
|
| Rate for Payer: ASR Commercial |
$15.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.91
|
| Rate for Payer: BCN Commercial |
$12.28
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$15.84
|
| Rate for Payer: Healthscope Whirlpool |
$15.36
|
| Rate for Payer: Mclaren Commercial |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Nomi Health Commercial |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.94
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.39
|
|
|
Service Code
|
NDC 61990061102
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Aetna Commercial |
$17.45
|
| Rate for Payer: Aetna Medicare |
$9.70
|
| Rate for Payer: ASR ASR |
$18.81
|
| Rate for Payer: ASR Commercial |
$18.81
|
| Rate for Payer: BCBS Complete |
$7.76
|
| Rate for Payer: BCBS Trust/PPO |
$15.88
|
| Rate for Payer: BCN Commercial |
$15.03
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.51
|
| Rate for Payer: Healthscope Commercial |
$19.39
|
| Rate for Payer: Healthscope Whirlpool |
$18.81
|
| Rate for Payer: Mclaren Commercial |
$17.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.48
|
| Rate for Payer: Nomi Health Commercial |
$15.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.99
|
| Rate for Payer: Priority Health Narrow Network |
$13.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.06
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$62.08
|
|
|
Service Code
|
NDC 67457019710
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$55.87
|
| Rate for Payer: Aetna Medicare |
$31.04
|
| Rate for Payer: ASR ASR |
$60.22
|
| Rate for Payer: ASR Commercial |
$60.22
|
| Rate for Payer: BCBS Complete |
$24.83
|
| Rate for Payer: BCBS Trust/PPO |
$50.84
|
| Rate for Payer: BCN Commercial |
$48.13
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cofinity Commercial |
$58.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Healthscope Commercial |
$62.08
|
| Rate for Payer: Healthscope Whirlpool |
$60.22
|
| Rate for Payer: Mclaren Commercial |
$55.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.77
|
| Rate for Payer: Nomi Health Commercial |
$50.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.39
|
| Rate for Payer: Priority Health Narrow Network |
$43.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.63
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) NEBULIZED SOLUTION CUSTOM
|
Facility
|
OP
|
$15.84
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
301846
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.26
|
| Rate for Payer: Aetna Medicare |
$7.92
|
| Rate for Payer: ASR ASR |
$15.36
|
| Rate for Payer: ASR Commercial |
$15.36
|
| Rate for Payer: BCBS Complete |
$6.34
|
| Rate for Payer: BCBS Trust/PPO |
$12.97
|
| Rate for Payer: BCN Commercial |
$12.28
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$15.84
|
| Rate for Payer: Healthscope Whirlpool |
$15.36
|
| Rate for Payer: Mclaren Commercial |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Nomi Health Commercial |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.88
|
| Rate for Payer: Priority Health Narrow Network |
$11.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.94
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) NEBULIZED SOLUTION CUSTOM
|
Facility
|
IP
|
$15.84
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
301846
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.26
|
| Rate for Payer: ASR ASR |
$15.36
|
| Rate for Payer: ASR Commercial |
$15.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.91
|
| Rate for Payer: BCN Commercial |
$12.28
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$15.84
|
| Rate for Payer: Healthscope Whirlpool |
$15.36
|
| Rate for Payer: Mclaren Commercial |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Nomi Health Commercial |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.94
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) SOLUTION CUSTOM
|
Facility
|
IP
|
$22.74
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
300870
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: ASR ASR |
$22.06
|
| Rate for Payer: ASR Commercial |
$22.06
|
| Rate for Payer: BCBS Trust/PPO |
$18.53
|
| Rate for Payer: BCN Commercial |
$17.63
|
| Rate for Payer: Cash Price |
$18.19
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.19
|
| Rate for Payer: Healthscope Commercial |
$22.74
|
| Rate for Payer: Healthscope Whirlpool |
$22.06
|
| Rate for Payer: Mclaren Commercial |
$20.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.33
|
| Rate for Payer: Nomi Health Commercial |
$18.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.01
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) SOLUTION CUSTOM
|
Facility
|
OP
|
$22.74
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
300870
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: Aetna Medicare |
$11.37
|
| Rate for Payer: ASR ASR |
$22.06
|
| Rate for Payer: ASR Commercial |
$22.06
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.62
|
| Rate for Payer: BCN Commercial |
$17.63
|
| Rate for Payer: Cash Price |
$18.19
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.19
|
| Rate for Payer: Healthscope Commercial |
$22.74
|
| Rate for Payer: Healthscope Whirlpool |
$22.06
|
| Rate for Payer: Mclaren Commercial |
$20.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.33
|
| Rate for Payer: Nomi Health Commercial |
$18.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.92
|
| Rate for Payer: Priority Health Narrow Network |
$15.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.01
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$270.25
|
|
|
Service Code
|
NDC 60687044301
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.10 |
| Max. Negotiated Rate |
$270.25 |
| Rate for Payer: Aetna Commercial |
$243.22
|
| Rate for Payer: Aetna Medicare |
$135.12
|
| Rate for Payer: ASR ASR |
$262.14
|
| Rate for Payer: ASR Commercial |
$262.14
|
| Rate for Payer: BCBS Complete |
$108.10
|
| Rate for Payer: BCBS Trust/PPO |
$221.31
|
| Rate for Payer: BCN Commercial |
$209.52
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$254.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$270.25
|
| Rate for Payer: Healthscope Whirlpool |
$262.14
|
| Rate for Payer: Mclaren Commercial |
$243.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: Nomi Health Commercial |
$221.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.79
|
| Rate for Payer: Priority Health Narrow Network |
$189.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.82
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$244.40
|
|
|
Service Code
|
NDC 00904686861
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.76 |
| Max. Negotiated Rate |
$244.40 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Medicare |
$122.20
|
| Rate for Payer: ASR ASR |
$237.07
|
| Rate for Payer: ASR Commercial |
$237.07
|
| Rate for Payer: BCBS Complete |
$97.76
|
| Rate for Payer: BCBS Trust/PPO |
$200.14
|
| Rate for Payer: BCN Commercial |
$189.48
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$229.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$244.40
|
| Rate for Payer: Healthscope Whirlpool |
$237.07
|
| Rate for Payer: Mclaren Commercial |
$219.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.74
|
| Rate for Payer: Nomi Health Commercial |
$200.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.14
|
| Rate for Payer: Priority Health Narrow Network |
$171.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.07
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$126.90
|
|
|
Service Code
|
NDC 50111056001
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.76 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna Commercial |
$114.21
|
| Rate for Payer: Aetna Medicare |
$63.45
|
| Rate for Payer: ASR ASR |
$123.09
|
| Rate for Payer: ASR Commercial |
$123.09
|
| Rate for Payer: BCBS Complete |
$50.76
|
| Rate for Payer: BCBS Trust/PPO |
$103.92
|
| Rate for Payer: BCN Commercial |
$98.39
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Commercial |
$119.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Healthscope Whirlpool |
$123.09
|
| Rate for Payer: Mclaren Commercial |
$114.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: Nomi Health Commercial |
$104.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.19
|
| Rate for Payer: Priority Health Narrow Network |
$88.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.67
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$244.40
|
|
|
Service Code
|
NDC 00904686861
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.86 |
| Max. Negotiated Rate |
$244.40 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: ASR ASR |
$237.07
|
| Rate for Payer: ASR Commercial |
$237.07
|
| Rate for Payer: BCBS Trust/PPO |
$199.16
|
| Rate for Payer: BCN Commercial |
$189.48
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$229.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$244.40
|
| Rate for Payer: Healthscope Whirlpool |
$237.07
|
| Rate for Payer: Mclaren Commercial |
$219.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.74
|
| Rate for Payer: Nomi Health Commercial |
$200.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.07
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 60687044311
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: Aetna Medicare |
$1.35
|
| Rate for Payer: ASR ASR |
$2.62
|
| Rate for Payer: ASR Commercial |
$2.62
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: BCBS Trust/PPO |
$2.21
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$2.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.16
|
| Rate for Payer: Healthscope Commercial |
$2.70
|
| Rate for Payer: Healthscope Whirlpool |
$2.62
|
| Rate for Payer: Mclaren Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.30
|
| Rate for Payer: Nomi Health Commercial |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.37
|
| Rate for Payer: Priority Health Narrow Network |
$1.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.38
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
NDC 60687044311
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: ASR ASR |
$2.62
|
| Rate for Payer: ASR Commercial |
$2.62
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$2.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.16
|
| Rate for Payer: Healthscope Commercial |
$2.70
|
| Rate for Payer: Healthscope Whirlpool |
$2.62
|
| Rate for Payer: Mclaren Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.30
|
| Rate for Payer: Nomi Health Commercial |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.38
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$270.25
|
|
|
Service Code
|
NDC 60687044301
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.66 |
| Max. Negotiated Rate |
$270.25 |
| Rate for Payer: Aetna Commercial |
$243.22
|
| Rate for Payer: ASR ASR |
$262.14
|
| Rate for Payer: ASR Commercial |
$262.14
|
| Rate for Payer: BCBS Trust/PPO |
$220.23
|
| Rate for Payer: BCN Commercial |
$209.52
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$254.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$270.25
|
| Rate for Payer: Healthscope Whirlpool |
$262.14
|
| Rate for Payer: Mclaren Commercial |
$243.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: Nomi Health Commercial |
$221.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.82
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$126.90
|
|
|
Service Code
|
NDC 50111056001
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.48 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna Commercial |
$114.21
|
| Rate for Payer: ASR ASR |
$123.09
|
| Rate for Payer: ASR Commercial |
$123.09
|
| Rate for Payer: BCBS Trust/PPO |
$103.41
|
| Rate for Payer: BCN Commercial |
$98.39
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Commercial |
$119.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Healthscope Whirlpool |
$123.09
|
| Rate for Payer: Mclaren Commercial |
$114.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: Nomi Health Commercial |
$104.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.67
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$10.33
|
|
|
Service Code
|
NDC 67877025115
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$10.33 |
| Rate for Payer: Aetna Commercial |
$9.30
|
| Rate for Payer: ASR ASR |
$10.02
|
| Rate for Payer: ASR Commercial |
$10.02
|
| Rate for Payer: BCBS Trust/PPO |
$8.42
|
| Rate for Payer: BCN Commercial |
$8.01
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$10.33
|
| Rate for Payer: Healthscope Whirlpool |
$10.02
|
| Rate for Payer: Mclaren Commercial |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.78
|
| Rate for Payer: Nomi Health Commercial |
$8.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.09
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$10.33
|
|
|
Service Code
|
NDC 67877025115
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$10.33 |
| Rate for Payer: Aetna Commercial |
$9.30
|
| Rate for Payer: Aetna Medicare |
$5.16
|
| Rate for Payer: ASR ASR |
$10.02
|
| Rate for Payer: ASR Commercial |
$10.02
|
| Rate for Payer: BCBS Complete |
$4.13
|
| Rate for Payer: BCBS Trust/PPO |
$8.46
|
| Rate for Payer: BCN Commercial |
$8.01
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$10.33
|
| Rate for Payer: Healthscope Whirlpool |
$10.02
|
| Rate for Payer: Mclaren Commercial |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.78
|
| Rate for Payer: Nomi Health Commercial |
$8.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.05
|
| Rate for Payer: Priority Health Narrow Network |
$7.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.09
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$24.01
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
8120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$24.01 |
| Rate for Payer: Aetna Commercial |
$21.61
|
| Rate for Payer: Aetna Commercial |
$264.29
|
| Rate for Payer: Aetna Commercial |
$176.94
|
| Rate for Payer: Aetna Commercial |
$34.85
|
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Medicare |
$12.02
|
| Rate for Payer: Aetna Medicare |
$98.30
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: Aetna Medicare |
$146.83
|
| Rate for Payer: Aetna Medicare |
$19.36
|
| Rate for Payer: ASR ASR |
$190.70
|
| Rate for Payer: ASR ASR |
$284.85
|
| Rate for Payer: ASR ASR |
$23.29
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: ASR ASR |
$37.56
|
| Rate for Payer: ASR Commercial |
$190.70
|
| Rate for Payer: ASR Commercial |
$23.29
|
| Rate for Payer: ASR Commercial |
$37.56
|
| Rate for Payer: ASR Commercial |
$284.85
|
| Rate for Payer: ASR Commercial |
$23.33
|
| Rate for Payer: BCBS Complete |
$15.49
|
| Rate for Payer: BCBS Complete |
$78.64
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Complete |
$117.46
|
| Rate for Payer: BCBS Trust/PPO |
$240.48
|
| Rate for Payer: BCBS Trust/PPO |
$19.69
|
| Rate for Payer: BCBS Trust/PPO |
$161.00
|
| Rate for Payer: BCBS Trust/PPO |
$19.66
|
| Rate for Payer: BCBS Trust/PPO |
$31.71
|
| Rate for Payer: BCN Commercial |
$227.67
|
| Rate for Payer: BCN Commercial |
$152.42
|
| Rate for Payer: BCN Commercial |
$18.61
|
| Rate for Payer: BCN Commercial |
$18.65
|
| Rate for Payer: BCN Commercial |
$30.02
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Cash Price |
$234.92
|
| Rate for Payer: Cash Price |
$157.28
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$234.92
|
| Rate for Payer: Cash Price |
$157.28
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Cofinity Commercial |
$22.57
|
| Rate for Payer: Cofinity Commercial |
$276.04
|
| Rate for Payer: Cofinity Commercial |
$36.40
|
| Rate for Payer: Cofinity Commercial |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$22.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$293.66
|
| Rate for Payer: Healthscope Commercial |
$24.05
|
| Rate for Payer: Healthscope Commercial |
$24.01
|
| Rate for Payer: Healthscope Commercial |
$38.72
|
| Rate for Payer: Healthscope Commercial |
$196.60
|
| Rate for Payer: Healthscope Whirlpool |
$37.56
|
| Rate for Payer: Healthscope Whirlpool |
$23.29
|
| Rate for Payer: Healthscope Whirlpool |
$190.70
|
| Rate for Payer: Healthscope Whirlpool |
$284.85
|
| Rate for Payer: Healthscope Whirlpool |
$23.33
|
| Rate for Payer: Mclaren Commercial |
$264.29
|
| Rate for Payer: Mclaren Commercial |
$176.94
|
| Rate for Payer: Mclaren Commercial |
$21.61
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Mclaren Commercial |
$34.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Nomi Health Commercial |
$161.21
|
| Rate for Payer: Nomi Health Commercial |
$19.69
|
| Rate for Payer: Nomi Health Commercial |
$31.75
|
| Rate for Payer: Nomi Health Commercial |
$240.80
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.90
|
| Rate for Payer: Priority Health Narrow Network |
$0.72
|
| Rate for Payer: Priority Health Narrow Network |
$0.72
|
| Rate for Payer: Priority Health Narrow Network |
$0.72
|
| Rate for Payer: Priority Health Narrow Network |
$0.72
|
| Rate for Payer: Priority Health Narrow Network |
$0.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$24.01
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
8120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.61 |
| Max. Negotiated Rate |
$24.01 |
| Rate for Payer: Aetna Commercial |
$21.61
|
| Rate for Payer: Aetna Commercial |
$264.29
|
| Rate for Payer: Aetna Commercial |
$34.85
|
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Commercial |
$176.94
|
| Rate for Payer: ASR ASR |
$37.56
|
| Rate for Payer: ASR ASR |
$284.85
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: ASR ASR |
$23.29
|
| Rate for Payer: ASR ASR |
$190.70
|
| Rate for Payer: ASR Commercial |
$23.33
|
| Rate for Payer: ASR Commercial |
$37.56
|
| Rate for Payer: ASR Commercial |
$284.85
|
| Rate for Payer: ASR Commercial |
$23.29
|
| Rate for Payer: ASR Commercial |
$190.70
|
| Rate for Payer: BCBS Trust/PPO |
$31.55
|
| Rate for Payer: BCBS Trust/PPO |
$160.21
|
| Rate for Payer: BCBS Trust/PPO |
$19.57
|
| Rate for Payer: BCBS Trust/PPO |
$239.30
|
| Rate for Payer: BCBS Trust/PPO |
$19.60
|
| Rate for Payer: BCN Commercial |
$18.61
|
| Rate for Payer: BCN Commercial |
$30.02
|
| Rate for Payer: BCN Commercial |
$152.42
|
| Rate for Payer: BCN Commercial |
$18.65
|
| Rate for Payer: BCN Commercial |
$227.67
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$234.92
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cash Price |
$157.28
|
| Rate for Payer: Cofinity Commercial |
$22.57
|
| Rate for Payer: Cofinity Commercial |
$22.61
|
| Rate for Payer: Cofinity Commercial |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$276.04
|
| Rate for Payer: Cofinity Commercial |
$36.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.21
|
| Rate for Payer: Healthscope Commercial |
$24.05
|
| Rate for Payer: Healthscope Commercial |
$293.66
|
| Rate for Payer: Healthscope Commercial |
$24.01
|
| Rate for Payer: Healthscope Commercial |
$196.60
|
| Rate for Payer: Healthscope Commercial |
$38.72
|
| Rate for Payer: Healthscope Whirlpool |
$37.56
|
| Rate for Payer: Healthscope Whirlpool |
$190.70
|
| Rate for Payer: Healthscope Whirlpool |
$23.33
|
| Rate for Payer: Healthscope Whirlpool |
$23.29
|
| Rate for Payer: Healthscope Whirlpool |
$284.85
|
| Rate for Payer: Mclaren Commercial |
$21.61
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Mclaren Commercial |
$176.94
|
| Rate for Payer: Mclaren Commercial |
$264.29
|
| Rate for Payer: Mclaren Commercial |
$34.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Nomi Health Commercial |
$161.21
|
| Rate for Payer: Nomi Health Commercial |
$19.69
|
| Rate for Payer: Nomi Health Commercial |
$31.75
|
| Rate for Payer: Nomi Health Commercial |
$240.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.42
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$109.01
|
|
|
Service Code
|
NDC 68084075025
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.86 |
| Max. Negotiated Rate |
$109.01 |
| Rate for Payer: Aetna Commercial |
$98.11
|
| Rate for Payer: ASR ASR |
$105.74
|
| Rate for Payer: ASR Commercial |
$105.74
|
| Rate for Payer: BCBS Trust/PPO |
$88.83
|
| Rate for Payer: BCN Commercial |
$84.52
|
| Rate for Payer: Cash Price |
$87.21
|
| Rate for Payer: Cofinity Commercial |
$102.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.21
|
| Rate for Payer: Healthscope Commercial |
$109.01
|
| Rate for Payer: Healthscope Whirlpool |
$105.74
|
| Rate for Payer: Mclaren Commercial |
$98.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.66
|
| Rate for Payer: Nomi Health Commercial |
$89.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.93
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$109.01
|
|
|
Service Code
|
NDC 68084075025
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$109.01 |
| Rate for Payer: Aetna Commercial |
$98.11
|
| Rate for Payer: Aetna Medicare |
$54.50
|
| Rate for Payer: ASR ASR |
$105.74
|
| Rate for Payer: ASR Commercial |
$105.74
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS Trust/PPO |
$89.27
|
| Rate for Payer: BCN Commercial |
$84.52
|
| Rate for Payer: Cash Price |
$87.21
|
| Rate for Payer: Cofinity Commercial |
$102.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.21
|
| Rate for Payer: Healthscope Commercial |
$109.01
|
| Rate for Payer: Healthscope Whirlpool |
$105.74
|
| Rate for Payer: Mclaren Commercial |
$98.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.66
|
| Rate for Payer: Nomi Health Commercial |
$89.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.51
|
| Rate for Payer: Priority Health Narrow Network |
$76.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.93
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$3.63
|
|
|
Service Code
|
NDC 68084075095
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: ASR ASR |
$3.52
|
| Rate for Payer: ASR Commercial |
$3.52
|
| Rate for Payer: BCBS Trust/PPO |
$2.96
|
| Rate for Payer: BCN Commercial |
$2.81
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.63
|
| Rate for Payer: Healthscope Whirlpool |
$3.52
|
| Rate for Payer: Mclaren Commercial |
$3.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Nomi Health Commercial |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.19
|
|
