|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
OP
|
$312.80
|
|
|
Service Code
|
NDC 00998035515
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.12 |
| Max. Negotiated Rate |
$312.80 |
| Rate for Payer: Aetna Commercial |
$281.52
|
| Rate for Payer: Aetna Medicare |
$156.40
|
| Rate for Payer: ASR ASR |
$303.42
|
| Rate for Payer: ASR Commercial |
$303.42
|
| Rate for Payer: BCBS Complete |
$125.12
|
| Rate for Payer: BCBS Trust/PPO |
$256.15
|
| Rate for Payer: BCN Commercial |
$242.51
|
| Rate for Payer: Cash Price |
$250.24
|
| Rate for Payer: Cofinity Commercial |
$294.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.24
|
| Rate for Payer: Healthscope Commercial |
$312.80
|
| Rate for Payer: Healthscope Whirlpool |
$303.42
|
| Rate for Payer: Mclaren Commercial |
$281.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.88
|
| Rate for Payer: Nomi Health Commercial |
$256.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$274.08
|
| Rate for Payer: Priority Health Narrow Network |
$219.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$275.26
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
OP
|
$23.13
|
|
|
Service Code
|
NDC 24208058559
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$23.13 |
| Rate for Payer: Aetna Commercial |
$20.82
|
| Rate for Payer: Aetna Medicare |
$11.56
|
| Rate for Payer: ASR ASR |
$22.44
|
| Rate for Payer: ASR Commercial |
$22.44
|
| Rate for Payer: BCBS Complete |
$9.25
|
| Rate for Payer: BCBS Trust/PPO |
$18.94
|
| Rate for Payer: BCN Commercial |
$17.93
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cofinity Commercial |
$21.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.50
|
| Rate for Payer: Healthscope Commercial |
$23.13
|
| Rate for Payer: Healthscope Whirlpool |
$22.44
|
| Rate for Payer: Mclaren Commercial |
$20.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.66
|
| Rate for Payer: Nomi Health Commercial |
$18.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.27
|
| Rate for Payer: Priority Health Narrow Network |
$16.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.35
|
|
|
TUBE THORACOSTOMY, INCLUDES CONNECTION TO DRAINAGE SYSTEM (EG, WATER SEAL), WHEN PERFORMED, OPEN (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,348.31
|
|
|
Service Code
|
CPT 32551
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$812.06 |
| Max. Negotiated Rate |
$2,348.31 |
| Rate for Payer: Aetna Medicare |
$1,515.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,893.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,893.80
|
| Rate for Payer: BCBS Complete |
$852.66
|
| Rate for Payer: BCBS MAPPO |
$1,515.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,515.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,515.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,515.04
|
| Rate for Payer: Mclaren Medicaid |
$812.06
|
| Rate for Payer: Mclaren Medicare |
$1,515.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,590.79
|
| Rate for Payer: Meridian Medicaid |
$852.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,742.30
|
| Rate for Payer: PACE Medicare |
$1,439.29
|
| Rate for Payer: PACE SWMI |
$1,515.04
|
| Rate for Payer: PHP Commercial |
$1,666.54
|
| Rate for Payer: PHP Medicaid |
$812.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,515.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$812.06
|
| Rate for Payer: Priority Health Medicare |
$1,515.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,515.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,515.04
|
| Rate for Payer: UHC Exchange |
$2,348.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,515.04
|
| Rate for Payer: UHCCP DNSP |
$1,515.04
|
| Rate for Payer: UHCCP Medicaid |
$812.06
|
| Rate for Payer: VA VA |
$1,515.04
|
|
|
UMECLIDINIUM 62.5 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
OP
|
$134.68
|
|
|
Service Code
|
NDC 00173087306
|
| Hospital Charge Code |
173272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.87 |
| Max. Negotiated Rate |
$134.68 |
| Rate for Payer: Aetna Commercial |
$121.21
|
| Rate for Payer: Aetna Medicare |
$67.34
|
| Rate for Payer: ASR ASR |
$130.64
|
| Rate for Payer: ASR Commercial |
$130.64
|
| Rate for Payer: BCBS Complete |
$53.87
|
| Rate for Payer: BCBS Trust/PPO |
$110.29
|
| Rate for Payer: BCN Commercial |
$104.42
|
| Rate for Payer: Cash Price |
$107.74
|
| Rate for Payer: Cofinity Commercial |
$126.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.74
|
| Rate for Payer: Healthscope Commercial |
$134.68
|
| Rate for Payer: Healthscope Whirlpool |
$130.64
|
| Rate for Payer: Mclaren Commercial |
$121.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.48
|
| Rate for Payer: Nomi Health Commercial |
$110.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.01
|
| Rate for Payer: Priority Health Narrow Network |
$94.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.52
|
|
|
UMECLIDINIUM 62.5 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$134.68
|
|
|
Service Code
|
NDC 00173087306
|
| Hospital Charge Code |
173272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.54 |
| Max. Negotiated Rate |
$134.68 |
| Rate for Payer: Aetna Commercial |
$121.21
|
| Rate for Payer: ASR ASR |
$130.64
|
| Rate for Payer: ASR Commercial |
$130.64
|
| Rate for Payer: BCBS Trust/PPO |
$109.75
|
| Rate for Payer: BCN Commercial |
$104.42
|
| Rate for Payer: Cash Price |
$107.74
|
| Rate for Payer: Cofinity Commercial |
$126.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.74
|
| Rate for Payer: Healthscope Commercial |
$134.68
|
| Rate for Payer: Healthscope Whirlpool |
$130.64
|
| Rate for Payer: Mclaren Commercial |
$121.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.48
|
| Rate for Payer: Nomi Health Commercial |
$110.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.52
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
IP
|
$365.75
|
|
|
Service Code
|
NDC 42806050301
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.74 |
| Max. Negotiated Rate |
$365.75 |
| Rate for Payer: Aetna Commercial |
$329.18
|
| Rate for Payer: ASR ASR |
$354.78
|
| Rate for Payer: ASR Commercial |
$354.78
|
| Rate for Payer: BCBS Trust/PPO |
$298.05
|
| Rate for Payer: BCN Commercial |
$283.57
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cofinity Commercial |
$343.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.60
|
| Rate for Payer: Healthscope Commercial |
$365.75
|
| Rate for Payer: Healthscope Whirlpool |
$354.78
|
| Rate for Payer: Mclaren Commercial |
$329.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.89
|
| Rate for Payer: Nomi Health Commercial |
$299.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.86
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
OP
|
$365.75
|
|
|
Service Code
|
NDC 42806050301
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.30 |
| Max. Negotiated Rate |
$365.75 |
| Rate for Payer: Aetna Commercial |
$329.18
|
| Rate for Payer: Aetna Medicare |
$182.88
|
| Rate for Payer: ASR ASR |
$354.78
|
| Rate for Payer: ASR Commercial |
$354.78
|
| Rate for Payer: BCBS Complete |
$146.30
|
| Rate for Payer: BCBS Trust/PPO |
$299.51
|
| Rate for Payer: BCN Commercial |
$283.57
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cofinity Commercial |
$343.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.60
|
| Rate for Payer: Healthscope Commercial |
$365.75
|
| Rate for Payer: Healthscope Whirlpool |
$354.78
|
| Rate for Payer: Mclaren Commercial |
$329.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.89
|
| Rate for Payer: Nomi Health Commercial |
$299.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.47
|
| Rate for Payer: Priority Health Narrow Network |
$256.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.86
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$274.61
|
|
|
Service Code
|
NDC 00904656507
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.50 |
| Max. Negotiated Rate |
$274.61 |
| Rate for Payer: Aetna Commercial |
$247.15
|
| Rate for Payer: ASR ASR |
$266.37
|
| Rate for Payer: ASR Commercial |
$266.37
|
| Rate for Payer: BCBS Trust/PPO |
$223.78
|
| Rate for Payer: BCN Commercial |
$212.91
|
| Rate for Payer: Cash Price |
$219.69
|
| Rate for Payer: Cofinity Commercial |
$258.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.69
|
| Rate for Payer: Healthscope Commercial |
$274.61
|
| Rate for Payer: Healthscope Whirlpool |
$266.37
|
| Rate for Payer: Mclaren Commercial |
$247.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.42
|
| Rate for Payer: Nomi Health Commercial |
$225.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.66
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$76.75
|
|
|
Service Code
|
NDC 59746032430
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.70 |
| Max. Negotiated Rate |
$76.75 |
| Rate for Payer: Aetna Commercial |
$69.08
|
| Rate for Payer: Aetna Medicare |
$38.38
|
| Rate for Payer: ASR ASR |
$74.45
|
| Rate for Payer: ASR Commercial |
$74.45
|
| Rate for Payer: BCBS Complete |
$30.70
|
| Rate for Payer: BCBS Trust/PPO |
$62.85
|
| Rate for Payer: BCN Commercial |
$59.50
|
| Rate for Payer: Cash Price |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$72.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.40
|
| Rate for Payer: Healthscope Commercial |
$76.75
|
| Rate for Payer: Healthscope Whirlpool |
$74.45
|
| Rate for Payer: Mclaren Commercial |
$69.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.24
|
| Rate for Payer: Nomi Health Commercial |
$62.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.25
|
| Rate for Payer: Priority Health Narrow Network |
$53.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.54
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$6.15
|
|
|
Service Code
|
NDC 50268078811
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.54
|
| Rate for Payer: ASR ASR |
$5.97
|
| Rate for Payer: ASR Commercial |
$5.97
|
| Rate for Payer: BCBS Trust/PPO |
$5.01
|
| Rate for Payer: BCN Commercial |
$4.77
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: Cofinity Commercial |
$5.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.92
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Healthscope Whirlpool |
$5.97
|
| Rate for Payer: Mclaren Commercial |
$5.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.23
|
| Rate for Payer: Nomi Health Commercial |
$5.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.41
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$76.75
|
|
|
Service Code
|
NDC 59746032430
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.89 |
| Max. Negotiated Rate |
$76.75 |
| Rate for Payer: Aetna Commercial |
$69.08
|
| Rate for Payer: ASR ASR |
$74.45
|
| Rate for Payer: ASR Commercial |
$74.45
|
| Rate for Payer: BCBS Trust/PPO |
$62.54
|
| Rate for Payer: BCN Commercial |
$59.50
|
| Rate for Payer: Cash Price |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$72.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.40
|
| Rate for Payer: Healthscope Commercial |
$76.75
|
| Rate for Payer: Healthscope Whirlpool |
$74.45
|
| Rate for Payer: Mclaren Commercial |
$69.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.24
|
| Rate for Payer: Nomi Health Commercial |
$62.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.54
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$73.53
|
|
|
Service Code
|
NDC 00378427593
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$73.53 |
| Rate for Payer: Aetna Commercial |
$66.18
|
| Rate for Payer: Aetna Medicare |
$36.77
|
| Rate for Payer: ASR ASR |
$71.32
|
| Rate for Payer: ASR Commercial |
$71.32
|
| Rate for Payer: BCBS Complete |
$29.41
|
| Rate for Payer: BCBS Trust/PPO |
$60.21
|
| Rate for Payer: BCN Commercial |
$57.01
|
| Rate for Payer: Cash Price |
$58.82
|
| Rate for Payer: Cofinity Commercial |
$69.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.82
|
| Rate for Payer: Healthscope Commercial |
$73.53
|
| Rate for Payer: Healthscope Whirlpool |
$71.32
|
| Rate for Payer: Mclaren Commercial |
$66.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.50
|
| Rate for Payer: Nomi Health Commercial |
$60.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.43
|
| Rate for Payer: Priority Health Narrow Network |
$51.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.71
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$6.15
|
|
|
Service Code
|
NDC 50268078811
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.54
|
| Rate for Payer: Aetna Medicare |
$3.08
|
| Rate for Payer: ASR ASR |
$5.97
|
| Rate for Payer: ASR Commercial |
$5.97
|
| Rate for Payer: BCBS Complete |
$2.46
|
| Rate for Payer: BCBS Trust/PPO |
$5.04
|
| Rate for Payer: BCN Commercial |
$4.77
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: Cofinity Commercial |
$5.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.92
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Healthscope Whirlpool |
$5.97
|
| Rate for Payer: Mclaren Commercial |
$5.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.23
|
| Rate for Payer: Nomi Health Commercial |
$5.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.39
|
| Rate for Payer: Priority Health Narrow Network |
$4.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.41
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$307.68
|
|
|
Service Code
|
NDC 50268078815
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.99 |
| Max. Negotiated Rate |
$307.68 |
| Rate for Payer: Aetna Commercial |
$276.91
|
| Rate for Payer: ASR ASR |
$298.45
|
| Rate for Payer: ASR Commercial |
$298.45
|
| Rate for Payer: BCBS Trust/PPO |
$250.73
|
| Rate for Payer: BCN Commercial |
$238.54
|
| Rate for Payer: Cash Price |
$246.14
|
| Rate for Payer: Cofinity Commercial |
$289.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.14
|
| Rate for Payer: Healthscope Commercial |
$307.68
|
| Rate for Payer: Healthscope Whirlpool |
$298.45
|
| Rate for Payer: Mclaren Commercial |
$276.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.53
|
| Rate for Payer: Nomi Health Commercial |
$252.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.76
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$307.68
|
|
|
Service Code
|
NDC 50268078815
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.07 |
| Max. Negotiated Rate |
$307.68 |
| Rate for Payer: Aetna Commercial |
$276.91
|
| Rate for Payer: Aetna Medicare |
$153.84
|
| Rate for Payer: ASR ASR |
$298.45
|
| Rate for Payer: ASR Commercial |
$298.45
|
| Rate for Payer: BCBS Complete |
$123.07
|
| Rate for Payer: BCBS Trust/PPO |
$251.96
|
| Rate for Payer: BCN Commercial |
$238.54
|
| Rate for Payer: Cash Price |
$246.14
|
| Rate for Payer: Cofinity Commercial |
$289.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.14
|
| Rate for Payer: Healthscope Commercial |
$307.68
|
| Rate for Payer: Healthscope Whirlpool |
$298.45
|
| Rate for Payer: Mclaren Commercial |
$276.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.53
|
| Rate for Payer: Nomi Health Commercial |
$252.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.59
|
| Rate for Payer: Priority Health Narrow Network |
$215.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.76
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$73.53
|
|
|
Service Code
|
NDC 00378427593
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.79 |
| Max. Negotiated Rate |
$73.53 |
| Rate for Payer: Aetna Commercial |
$66.18
|
| Rate for Payer: ASR ASR |
$71.32
|
| Rate for Payer: ASR Commercial |
$71.32
|
| Rate for Payer: BCBS Trust/PPO |
$59.92
|
| Rate for Payer: BCN Commercial |
$57.01
|
| Rate for Payer: Cash Price |
$58.82
|
| Rate for Payer: Cofinity Commercial |
$69.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.82
|
| Rate for Payer: Healthscope Commercial |
$73.53
|
| Rate for Payer: Healthscope Whirlpool |
$71.32
|
| Rate for Payer: Mclaren Commercial |
$66.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.50
|
| Rate for Payer: Nomi Health Commercial |
$60.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.71
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$274.61
|
|
|
Service Code
|
NDC 00904656507
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.84 |
| Max. Negotiated Rate |
$274.61 |
| Rate for Payer: Aetna Commercial |
$247.15
|
| Rate for Payer: Aetna Medicare |
$137.31
|
| Rate for Payer: ASR ASR |
$266.37
|
| Rate for Payer: ASR Commercial |
$266.37
|
| Rate for Payer: BCBS Complete |
$109.84
|
| Rate for Payer: BCBS Trust/PPO |
$224.88
|
| Rate for Payer: BCN Commercial |
$212.91
|
| Rate for Payer: Cash Price |
$219.69
|
| Rate for Payer: Cofinity Commercial |
$258.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.69
|
| Rate for Payer: Healthscope Commercial |
$274.61
|
| Rate for Payer: Healthscope Whirlpool |
$266.37
|
| Rate for Payer: Mclaren Commercial |
$247.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.42
|
| Rate for Payer: Nomi Health Commercial |
$225.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.61
|
| Rate for Payer: Priority Health Narrow Network |
$192.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.66
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.50
|
|
|
Service Code
|
NDC 00143963710
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Medicare |
$8.25
|
| Rate for Payer: ASR ASR |
$16.00
|
| Rate for Payer: ASR Commercial |
$16.00
|
| Rate for Payer: BCBS Complete |
$6.60
|
| Rate for Payer: BCBS Trust/PPO |
$13.51
|
| 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 Commercial |
$14.03
|
| Rate for Payer: Nomi Health Commercial |
$13.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.46
|
| Rate for Payer: Priority Health Narrow Network |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.52
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.50
|
|
|
Service Code
|
NDC 00143963701
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Medicare |
$8.25
|
| Rate for Payer: ASR ASR |
$16.00
|
| Rate for Payer: ASR Commercial |
$16.00
|
| Rate for Payer: BCBS Complete |
$6.60
|
| Rate for Payer: BCBS Trust/PPO |
$13.51
|
| 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 Commercial |
$14.03
|
| Rate for Payer: Nomi Health Commercial |
$13.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.46
|
| Rate for Payer: Priority Health Narrow Network |
$11.57
|
| 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 00143963710
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: ASR ASR |
$16.00
|
| Rate for Payer: ASR Commercial |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$13.45
|
| 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 Commercial |
$14.03
|
| Rate for Payer: Nomi Health Commercial |
$13.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.72
|
| 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 00143963701
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: ASR ASR |
$16.00
|
| Rate for Payer: ASR Commercial |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$13.45
|
| 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 Commercial |
$14.03
|
| Rate for Payer: Nomi Health Commercial |
$13.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.72
|
| 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
|
$5.57
|
|
|
Service Code
|
NDC 00121467505
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: Aetna Commercial |
$5.01
|
| Rate for Payer: ASR ASR |
$5.40
|
| Rate for Payer: ASR Commercial |
$5.40
|
| Rate for Payer: BCBS Trust/PPO |
$4.54
|
| Rate for Payer: BCN Commercial |
$4.32
|
| Rate for Payer: Cash Price |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.57
|
| Rate for Payer: Healthscope Whirlpool |
$5.40
|
| Rate for Payer: Mclaren Commercial |
$5.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.73
|
| Rate for Payer: Nomi Health Commercial |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.90
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
NDC 09900001951
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna Commercial |
$1.58
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: ASR ASR |
$1.71
|
| Rate for Payer: ASR Commercial |
$1.71
|
| Rate for Payer: BCBS Complete |
$0.70
|
| Rate for Payer: BCBS Trust/PPO |
$1.44
|
| 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 Commercial |
$1.50
|
| Rate for Payer: Nomi Health Commercial |
$1.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$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
|
$1.76
|
|
|
Service Code
|
NDC 09900001951
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna Commercial |
$1.58
|
| Rate for Payer: ASR ASR |
$1.71
|
| Rate for Payer: ASR Commercial |
$1.71
|
| Rate for Payer: BCBS Trust/PPO |
$1.43
|
| 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 Commercial |
$1.50
|
| Rate for Payer: Nomi Health Commercial |
$1.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.14
|
| 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
|
OP
|
$5.57
|
|
|
Service Code
|
NDC 00121467505
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: Aetna Commercial |
$5.01
|
| Rate for Payer: Aetna Medicare |
$2.79
|
| Rate for Payer: ASR ASR |
$5.40
|
| Rate for Payer: ASR Commercial |
$5.40
|
| Rate for Payer: BCBS Complete |
$2.23
|
| Rate for Payer: BCBS Trust/PPO |
$4.56
|
| Rate for Payer: BCN Commercial |
$4.32
|
| Rate for Payer: Cash Price |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.57
|
| Rate for Payer: Healthscope Whirlpool |
$5.40
|
| Rate for Payer: Mclaren Commercial |
$5.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.73
|
| Rate for Payer: Nomi Health Commercial |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.88
|
| Rate for Payer: Priority Health Narrow Network |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.90
|
|
