|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$355.70
|
|
|
Service Code
|
NDC 00121067585
|
| Hospital Charge Code |
8428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.21 |
| Max. Negotiated Rate |
$355.70 |
| Rate for Payer: Aetna Commercial |
$320.13
|
| Rate for Payer: ASR ASR |
$345.03
|
| Rate for Payer: ASR Commercial |
$345.03
|
| Rate for Payer: BCBS Trust/PPO |
$289.86
|
| Rate for Payer: BCN Commercial |
$275.77
|
| Rate for Payer: Cash Price |
$284.56
|
| Rate for Payer: Cofinity Commercial |
$334.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.56
|
| Rate for Payer: Healthscope Commercial |
$355.70
|
| Rate for Payer: Healthscope Whirlpool |
$345.03
|
| Rate for Payer: Mclaren Commercial |
$320.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.35
|
| Rate for Payer: Nomi Health Commercial |
$291.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.02
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$355.70
|
|
|
Service Code
|
NDC 00121067585
|
| Hospital Charge Code |
8428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.28 |
| Max. Negotiated Rate |
$355.70 |
| Rate for Payer: Aetna Commercial |
$320.13
|
| Rate for Payer: Aetna Medicare |
$177.85
|
| Rate for Payer: ASR ASR |
$345.03
|
| Rate for Payer: ASR Commercial |
$345.03
|
| Rate for Payer: BCBS Complete |
$142.28
|
| Rate for Payer: BCBS Trust/PPO |
$291.28
|
| Rate for Payer: BCN Commercial |
$275.77
|
| Rate for Payer: Cash Price |
$284.56
|
| Rate for Payer: Cofinity Commercial |
$334.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.56
|
| Rate for Payer: Healthscope Commercial |
$355.70
|
| Rate for Payer: Healthscope Whirlpool |
$345.03
|
| Rate for Payer: Mclaren Commercial |
$320.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.35
|
| Rate for Payer: Nomi Health Commercial |
$291.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.66
|
| Rate for Payer: Priority Health Narrow Network |
$249.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.02
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
IP
|
$2,862.80
|
|
|
Service Code
|
NDC 00078035834
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,860.82 |
| Max. Negotiated Rate |
$2,862.80 |
| Rate for Payer: Aetna Commercial |
$2,576.52
|
| Rate for Payer: ASR ASR |
$2,776.92
|
| Rate for Payer: ASR Commercial |
$2,776.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,332.90
|
| Rate for Payer: BCN Commercial |
$2,219.53
|
| Rate for Payer: Cash Price |
$2,290.24
|
| Rate for Payer: Cofinity Commercial |
$2,691.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,290.24
|
| Rate for Payer: Healthscope Commercial |
$2,862.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,776.92
|
| Rate for Payer: Mclaren Commercial |
$2,576.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,433.38
|
| Rate for Payer: Nomi Health Commercial |
$2,347.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,860.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,519.26
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
IP
|
$4.78
|
|
|
Service Code
|
NDC 60687062311
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.30
|
| Rate for Payer: ASR ASR |
$4.64
|
| Rate for Payer: ASR Commercial |
$4.64
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.71
|
| Rate for Payer: Cash Price |
$3.82
|
| Rate for Payer: Cofinity Commercial |
$4.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.82
|
| Rate for Payer: Healthscope Commercial |
$4.78
|
| Rate for Payer: Healthscope Whirlpool |
$4.64
|
| Rate for Payer: Mclaren Commercial |
$4.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.06
|
| Rate for Payer: Nomi Health Commercial |
$3.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.21
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
IP
|
$420.88
|
|
|
Service Code
|
NDC 43547036809
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.57 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna Commercial |
$378.79
|
| Rate for Payer: ASR ASR |
$408.25
|
| Rate for Payer: ASR Commercial |
$408.25
|
| Rate for Payer: BCBS Trust/PPO |
$342.98
|
| Rate for Payer: BCN Commercial |
$326.31
|
| Rate for Payer: Cash Price |
$336.71
|
| Rate for Payer: Cofinity Commercial |
$395.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.70
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Healthscope Whirlpool |
$408.25
|
| Rate for Payer: Mclaren Commercial |
$378.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.75
|
| Rate for Payer: Nomi Health Commercial |
$345.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.37
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
OP
|
$420.88
|
|
|
Service Code
|
NDC 43547036809
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.35 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna Commercial |
$378.79
|
| Rate for Payer: Aetna Medicare |
$210.44
|
| Rate for Payer: ASR ASR |
$408.25
|
| Rate for Payer: ASR Commercial |
$408.25
|
| Rate for Payer: BCBS Complete |
$168.35
|
| Rate for Payer: BCBS Trust/PPO |
$344.66
|
| Rate for Payer: BCN Commercial |
$326.31
|
| Rate for Payer: Cash Price |
$336.71
|
| Rate for Payer: Cofinity Commercial |
$395.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.70
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Healthscope Whirlpool |
$408.25
|
| Rate for Payer: Mclaren Commercial |
$378.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.75
|
| Rate for Payer: Nomi Health Commercial |
$345.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$368.78
|
| Rate for Payer: Priority Health Narrow Network |
$295.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.37
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
IP
|
$478.08
|
|
|
Service Code
|
NDC 60687062301
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$310.75 |
| Max. Negotiated Rate |
$478.08 |
| Rate for Payer: Aetna Commercial |
$430.27
|
| Rate for Payer: ASR ASR |
$463.74
|
| Rate for Payer: ASR Commercial |
$463.74
|
| Rate for Payer: BCBS Trust/PPO |
$389.59
|
| Rate for Payer: BCN Commercial |
$370.66
|
| Rate for Payer: Cash Price |
$382.46
|
| Rate for Payer: Cofinity Commercial |
$449.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.46
|
| Rate for Payer: Healthscope Commercial |
$478.08
|
| Rate for Payer: Healthscope Whirlpool |
$463.74
|
| Rate for Payer: Mclaren Commercial |
$430.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$406.37
|
| Rate for Payer: Nomi Health Commercial |
$392.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$420.71
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
OP
|
$4.78
|
|
|
Service Code
|
NDC 60687062311
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.30
|
| Rate for Payer: Aetna Medicare |
$2.39
|
| Rate for Payer: ASR ASR |
$4.64
|
| Rate for Payer: ASR Commercial |
$4.64
|
| Rate for Payer: BCBS Complete |
$1.91
|
| Rate for Payer: BCBS Trust/PPO |
$3.91
|
| Rate for Payer: BCN Commercial |
$3.71
|
| Rate for Payer: Cash Price |
$3.82
|
| Rate for Payer: Cofinity Commercial |
$4.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.82
|
| Rate for Payer: Healthscope Commercial |
$4.78
|
| Rate for Payer: Healthscope Whirlpool |
$4.64
|
| Rate for Payer: Mclaren Commercial |
$4.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.06
|
| Rate for Payer: Nomi Health Commercial |
$3.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.19
|
| Rate for Payer: Priority Health Narrow Network |
$3.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.21
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
OP
|
$478.08
|
|
|
Service Code
|
NDC 60687062301
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.23 |
| Max. Negotiated Rate |
$478.08 |
| Rate for Payer: Aetna Commercial |
$430.27
|
| Rate for Payer: Aetna Medicare |
$239.04
|
| Rate for Payer: ASR ASR |
$463.74
|
| Rate for Payer: ASR Commercial |
$463.74
|
| Rate for Payer: BCBS Complete |
$191.23
|
| Rate for Payer: BCBS Trust/PPO |
$391.50
|
| Rate for Payer: BCN Commercial |
$370.66
|
| Rate for Payer: Cash Price |
$382.46
|
| Rate for Payer: Cofinity Commercial |
$449.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.46
|
| Rate for Payer: Healthscope Commercial |
$478.08
|
| Rate for Payer: Healthscope Whirlpool |
$463.74
|
| Rate for Payer: Mclaren Commercial |
$430.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$406.37
|
| Rate for Payer: Nomi Health Commercial |
$392.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$418.89
|
| Rate for Payer: Priority Health Narrow Network |
$335.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$420.71
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
OP
|
$410.31
|
|
|
Service Code
|
NDC 65862057190
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.12 |
| Max. Negotiated Rate |
$410.31 |
| Rate for Payer: Aetna Commercial |
$369.28
|
| Rate for Payer: Aetna Medicare |
$205.16
|
| Rate for Payer: ASR ASR |
$398.00
|
| Rate for Payer: ASR Commercial |
$398.00
|
| Rate for Payer: BCBS Complete |
$164.12
|
| Rate for Payer: BCBS Trust/PPO |
$336.00
|
| Rate for Payer: BCN Commercial |
$318.11
|
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Cofinity Commercial |
$385.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.25
|
| Rate for Payer: Healthscope Commercial |
$410.31
|
| Rate for Payer: Healthscope Whirlpool |
$398.00
|
| Rate for Payer: Mclaren Commercial |
$369.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.76
|
| Rate for Payer: Nomi Health Commercial |
$336.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$359.51
|
| Rate for Payer: Priority Health Narrow Network |
$287.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.07
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
OP
|
$2,862.80
|
|
|
Service Code
|
NDC 00078035834
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,145.12 |
| Max. Negotiated Rate |
$2,862.80 |
| Rate for Payer: Aetna Commercial |
$2,576.52
|
| Rate for Payer: Aetna Medicare |
$1,431.40
|
| Rate for Payer: ASR ASR |
$2,776.92
|
| Rate for Payer: ASR Commercial |
$2,776.92
|
| Rate for Payer: BCBS Complete |
$1,145.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,344.35
|
| Rate for Payer: BCN Commercial |
$2,219.53
|
| Rate for Payer: Cash Price |
$2,290.24
|
| Rate for Payer: Cofinity Commercial |
$2,691.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,290.24
|
| Rate for Payer: Healthscope Commercial |
$2,862.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,776.92
|
| Rate for Payer: Mclaren Commercial |
$2,576.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,433.38
|
| Rate for Payer: Nomi Health Commercial |
$2,347.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,860.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,508.39
|
| Rate for Payer: Priority Health Narrow Network |
$2,006.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,519.26
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
IP
|
$410.31
|
|
|
Service Code
|
NDC 65862057190
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.70 |
| Max. Negotiated Rate |
$410.31 |
| Rate for Payer: Aetna Commercial |
$369.28
|
| Rate for Payer: ASR ASR |
$398.00
|
| Rate for Payer: ASR Commercial |
$398.00
|
| Rate for Payer: BCBS Trust/PPO |
$334.36
|
| Rate for Payer: BCN Commercial |
$318.11
|
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Cofinity Commercial |
$385.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.25
|
| Rate for Payer: Healthscope Commercial |
$410.31
|
| Rate for Payer: Healthscope Whirlpool |
$398.00
|
| Rate for Payer: Mclaren Commercial |
$369.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.76
|
| Rate for Payer: Nomi Health Commercial |
$336.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.07
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION
|
Facility
|
IP
|
$18.89
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$18.89 |
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna Commercial |
$16.69
|
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Commercial |
$15.92
|
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Commercial |
$22.35
|
| Rate for Payer: Aetna Commercial |
$24.84
|
| Rate for Payer: Aetna Commercial |
$17.35
|
| Rate for Payer: Aetna Commercial |
$27.94
|
| Rate for Payer: Aetna Commercial |
$59.74
|
| Rate for Payer: ASR ASR |
$17.98
|
| Rate for Payer: ASR ASR |
$64.39
|
| Rate for Payer: ASR ASR |
$17.16
|
| Rate for Payer: ASR ASR |
$18.32
|
| Rate for Payer: ASR ASR |
$22.37
|
| Rate for Payer: ASR ASR |
$18.70
|
| Rate for Payer: ASR ASR |
$30.11
|
| Rate for Payer: ASR ASR |
$24.09
|
| Rate for Payer: ASR ASR |
$16.55
|
| Rate for Payer: ASR ASR |
$16.15
|
| Rate for Payer: ASR ASR |
$26.77
|
| Rate for Payer: ASR Commercial |
$17.16
|
| Rate for Payer: ASR Commercial |
$17.98
|
| Rate for Payer: ASR Commercial |
$16.55
|
| Rate for Payer: ASR Commercial |
$16.15
|
| Rate for Payer: ASR Commercial |
$22.37
|
| Rate for Payer: ASR Commercial |
$24.09
|
| Rate for Payer: ASR Commercial |
$30.11
|
| Rate for Payer: ASR Commercial |
$26.77
|
| Rate for Payer: ASR Commercial |
$64.39
|
| Rate for Payer: ASR Commercial |
$18.70
|
| Rate for Payer: ASR Commercial |
$18.32
|
| Rate for Payer: BCBS Trust/PPO |
$22.49
|
| Rate for Payer: BCBS Trust/PPO |
$20.23
|
| Rate for Payer: BCBS Trust/PPO |
$15.39
|
| Rate for Payer: BCBS Trust/PPO |
$13.57
|
| Rate for Payer: BCBS Trust/PPO |
$13.90
|
| Rate for Payer: BCBS Trust/PPO |
$15.11
|
| Rate for Payer: BCBS Trust/PPO |
$14.42
|
| Rate for Payer: BCBS Trust/PPO |
$54.09
|
| Rate for Payer: BCBS Trust/PPO |
$25.29
|
| Rate for Payer: BCBS Trust/PPO |
$15.71
|
| Rate for Payer: BCBS Trust/PPO |
$18.79
|
| Rate for Payer: BCN Commercial |
$14.65
|
| Rate for Payer: BCN Commercial |
$14.95
|
| Rate for Payer: BCN Commercial |
$14.37
|
| Rate for Payer: BCN Commercial |
$12.91
|
| Rate for Payer: BCN Commercial |
$21.40
|
| Rate for Payer: BCN Commercial |
$13.23
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: BCN Commercial |
$17.88
|
| Rate for Payer: BCN Commercial |
$24.07
|
| Rate for Payer: BCN Commercial |
$51.46
|
| Rate for Payer: BCN Commercial |
$19.25
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$15.43
|
| Rate for Payer: Cash Price |
$18.44
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cash Price |
$22.08
|
| Rate for Payer: Cash Price |
$15.11
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Cofinity Commercial |
$23.34
|
| Rate for Payer: Cofinity Commercial |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$29.18
|
| Rate for Payer: Cofinity Commercial |
$21.68
|
| Rate for Payer: Cofinity Commercial |
$17.43
|
| Rate for Payer: Cofinity Commercial |
$15.65
|
| Rate for Payer: Cofinity Commercial |
$16.63
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$25.94
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.08
|
| Rate for Payer: Healthscope Commercial |
$24.83
|
| Rate for Payer: Healthscope Commercial |
$27.60
|
| Rate for Payer: Healthscope Commercial |
$17.69
|
| Rate for Payer: Healthscope Commercial |
$19.28
|
| Rate for Payer: Healthscope Commercial |
$31.04
|
| Rate for Payer: Healthscope Commercial |
$18.89
|
| Rate for Payer: Healthscope Commercial |
$23.06
|
| Rate for Payer: Healthscope Commercial |
$66.38
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$18.54
|
| Rate for Payer: Healthscope Whirlpool |
$30.11
|
| Rate for Payer: Healthscope Whirlpool |
$16.15
|
| Rate for Payer: Healthscope Whirlpool |
$17.16
|
| Rate for Payer: Healthscope Whirlpool |
$16.55
|
| Rate for Payer: Healthscope Whirlpool |
$17.98
|
| Rate for Payer: Healthscope Whirlpool |
$18.32
|
| Rate for Payer: Healthscope Whirlpool |
$18.70
|
| Rate for Payer: Healthscope Whirlpool |
$22.37
|
| Rate for Payer: Healthscope Whirlpool |
$24.09
|
| Rate for Payer: Healthscope Whirlpool |
$26.77
|
| Rate for Payer: Healthscope Whirlpool |
$64.39
|
| Rate for Payer: Mclaren Commercial |
$59.74
|
| Rate for Payer: Mclaren Commercial |
$17.35
|
| Rate for Payer: Mclaren Commercial |
$17.00
|
| Rate for Payer: Mclaren Commercial |
$15.35
|
| Rate for Payer: Mclaren Commercial |
$15.92
|
| Rate for Payer: Mclaren Commercial |
$22.35
|
| Rate for Payer: Mclaren Commercial |
$20.75
|
| Rate for Payer: Mclaren Commercial |
$14.98
|
| Rate for Payer: Mclaren Commercial |
$16.69
|
| Rate for Payer: Mclaren Commercial |
$27.94
|
| Rate for Payer: Mclaren Commercial |
$24.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.42
|
| Rate for Payer: Nomi Health Commercial |
$15.20
|
| Rate for Payer: Nomi Health Commercial |
$14.51
|
| Rate for Payer: Nomi Health Commercial |
$20.36
|
| Rate for Payer: Nomi Health Commercial |
$18.91
|
| Rate for Payer: Nomi Health Commercial |
$25.45
|
| Rate for Payer: Nomi Health Commercial |
$22.63
|
| Rate for Payer: Nomi Health Commercial |
$13.99
|
| Rate for Payer: Nomi Health Commercial |
$15.81
|
| Rate for Payer: Nomi Health Commercial |
$54.43
|
| Rate for Payer: Nomi Health Commercial |
$15.49
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.29
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION
|
Facility
|
OP
|
$18.89
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$18.89 |
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Aetna Commercial |
$17.35
|
| Rate for Payer: Aetna Commercial |
$16.69
|
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Commercial |
$59.74
|
| Rate for Payer: Aetna Commercial |
$15.92
|
| Rate for Payer: Aetna Commercial |
$27.94
|
| Rate for Payer: Aetna Commercial |
$24.84
|
| Rate for Payer: Aetna Commercial |
$22.35
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Aetna Medicare |
$8.53
|
| Rate for Payer: Aetna Medicare |
$8.32
|
| Rate for Payer: Aetna Medicare |
$9.64
|
| Rate for Payer: Aetna Medicare |
$33.19
|
| Rate for Payer: Aetna Medicare |
$9.27
|
| Rate for Payer: Aetna Medicare |
$9.45
|
| Rate for Payer: Aetna Medicare |
$12.41
|
| Rate for Payer: Aetna Medicare |
$8.85
|
| Rate for Payer: Aetna Medicare |
$13.80
|
| Rate for Payer: Aetna Medicare |
$15.52
|
| Rate for Payer: ASR ASR |
$17.98
|
| Rate for Payer: ASR ASR |
$17.16
|
| Rate for Payer: ASR ASR |
$24.09
|
| Rate for Payer: ASR ASR |
$64.39
|
| Rate for Payer: ASR ASR |
$18.70
|
| Rate for Payer: ASR ASR |
$16.15
|
| Rate for Payer: ASR ASR |
$22.37
|
| Rate for Payer: ASR ASR |
$30.11
|
| Rate for Payer: ASR ASR |
$18.32
|
| Rate for Payer: ASR ASR |
$26.77
|
| Rate for Payer: ASR ASR |
$16.55
|
| Rate for Payer: ASR Commercial |
$18.70
|
| Rate for Payer: ASR Commercial |
$16.55
|
| Rate for Payer: ASR Commercial |
$17.16
|
| Rate for Payer: ASR Commercial |
$17.98
|
| Rate for Payer: ASR Commercial |
$16.15
|
| Rate for Payer: ASR Commercial |
$64.39
|
| Rate for Payer: ASR Commercial |
$30.11
|
| Rate for Payer: ASR Commercial |
$26.77
|
| Rate for Payer: ASR Commercial |
$24.09
|
| Rate for Payer: ASR Commercial |
$18.32
|
| Rate for Payer: ASR Commercial |
$22.37
|
| Rate for Payer: BCBS Complete |
$9.93
|
| Rate for Payer: BCBS Complete |
$11.04
|
| Rate for Payer: BCBS Complete |
$26.55
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS Complete |
$7.71
|
| Rate for Payer: BCBS Complete |
$9.22
|
| Rate for Payer: BCBS Complete |
$6.66
|
| Rate for Payer: BCBS Complete |
$12.42
|
| Rate for Payer: BCBS Complete |
$7.08
|
| Rate for Payer: BCBS Complete |
$7.56
|
| Rate for Payer: BCBS Complete |
$6.82
|
| Rate for Payer: BCBS Trust/PPO |
$15.18
|
| Rate for Payer: BCBS Trust/PPO |
$25.42
|
| Rate for Payer: BCBS Trust/PPO |
$22.60
|
| Rate for Payer: BCBS Trust/PPO |
$20.33
|
| Rate for Payer: BCBS Trust/PPO |
$14.49
|
| Rate for Payer: BCBS Trust/PPO |
$13.97
|
| Rate for Payer: BCBS Trust/PPO |
$13.63
|
| Rate for Payer: BCBS Trust/PPO |
$15.79
|
| Rate for Payer: BCBS Trust/PPO |
$15.47
|
| Rate for Payer: BCBS Trust/PPO |
$18.88
|
| Rate for Payer: BCBS Trust/PPO |
$54.36
|
| Rate for Payer: BCN Commercial |
$13.23
|
| Rate for Payer: BCN Commercial |
$19.25
|
| Rate for Payer: BCN Commercial |
$14.95
|
| Rate for Payer: BCN Commercial |
$14.37
|
| Rate for Payer: BCN Commercial |
$51.46
|
| Rate for Payer: BCN Commercial |
$14.65
|
| Rate for Payer: BCN Commercial |
$17.88
|
| Rate for Payer: BCN Commercial |
$21.40
|
| Rate for Payer: BCN Commercial |
$24.07
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: BCN Commercial |
$12.91
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cash Price |
$15.11
|
| Rate for Payer: Cash Price |
$18.44
|
| Rate for Payer: Cash Price |
$15.43
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$22.08
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cofinity Commercial |
$29.18
|
| Rate for Payer: Cofinity Commercial |
$23.34
|
| Rate for Payer: Cofinity Commercial |
$17.43
|
| Rate for Payer: Cofinity Commercial |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$25.94
|
| Rate for Payer: Cofinity Commercial |
$15.65
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$21.68
|
| Rate for Payer: Cofinity Commercial |
$16.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.10
|
| Rate for Payer: Healthscope Commercial |
$17.69
|
| Rate for Payer: Healthscope Commercial |
$18.89
|
| Rate for Payer: Healthscope Commercial |
$24.83
|
| Rate for Payer: Healthscope Commercial |
$23.06
|
| Rate for Payer: Healthscope Commercial |
$19.28
|
| Rate for Payer: Healthscope Commercial |
$27.60
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.54
|
| Rate for Payer: Healthscope Commercial |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$31.04
|
| Rate for Payer: Healthscope Commercial |
$66.38
|
| Rate for Payer: Healthscope Whirlpool |
$64.39
|
| Rate for Payer: Healthscope Whirlpool |
$30.11
|
| Rate for Payer: Healthscope Whirlpool |
$16.15
|
| Rate for Payer: Healthscope Whirlpool |
$16.55
|
| Rate for Payer: Healthscope Whirlpool |
$17.16
|
| Rate for Payer: Healthscope Whirlpool |
$24.09
|
| Rate for Payer: Healthscope Whirlpool |
$26.77
|
| Rate for Payer: Healthscope Whirlpool |
$18.32
|
| Rate for Payer: Healthscope Whirlpool |
$22.37
|
| Rate for Payer: Healthscope Whirlpool |
$18.70
|
| Rate for Payer: Healthscope Whirlpool |
$17.98
|
| Rate for Payer: Mclaren Commercial |
$24.84
|
| Rate for Payer: Mclaren Commercial |
$17.00
|
| Rate for Payer: Mclaren Commercial |
$20.75
|
| Rate for Payer: Mclaren Commercial |
$59.74
|
| Rate for Payer: Mclaren Commercial |
$17.35
|
| Rate for Payer: Mclaren Commercial |
$16.69
|
| Rate for Payer: Mclaren Commercial |
$22.35
|
| Rate for Payer: Mclaren Commercial |
$14.98
|
| Rate for Payer: Mclaren Commercial |
$15.35
|
| Rate for Payer: Mclaren Commercial |
$15.92
|
| Rate for Payer: Mclaren Commercial |
$27.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Nomi Health Commercial |
$22.63
|
| Rate for Payer: Nomi Health Commercial |
$14.51
|
| Rate for Payer: Nomi Health Commercial |
$20.36
|
| Rate for Payer: Nomi Health Commercial |
$15.49
|
| Rate for Payer: Nomi Health Commercial |
$15.81
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: Nomi Health Commercial |
$54.43
|
| Rate for Payer: Nomi Health Commercial |
$25.45
|
| Rate for Payer: Nomi Health Commercial |
$13.99
|
| Rate for Payer: Nomi Health Commercial |
$15.20
|
| Rate for Payer: Nomi Health Commercial |
$18.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.24
|
| Rate for Payer: Priority Health Narrow Network |
$17.41
|
| Rate for Payer: Priority Health Narrow Network |
$12.40
|
| Rate for Payer: Priority Health Narrow Network |
$11.67
|
| Rate for Payer: Priority Health Narrow Network |
$16.17
|
| Rate for Payer: Priority Health Narrow Network |
$21.76
|
| Rate for Payer: Priority Health Narrow Network |
$46.53
|
| Rate for Payer: Priority Health Narrow Network |
$13.24
|
| Rate for Payer: Priority Health Narrow Network |
$11.96
|
| Rate for Payer: Priority Health Narrow Network |
$13.00
|
| Rate for Payer: Priority Health Narrow Network |
$13.52
|
| Rate for Payer: Priority Health Narrow Network |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.97
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$117.79
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$117.79 |
| Rate for Payer: Aetna Commercial |
$106.01
|
| Rate for Payer: ASR ASR |
$114.26
|
| Rate for Payer: ASR Commercial |
$114.26
|
| Rate for Payer: BCBS Trust/PPO |
$95.99
|
| Rate for Payer: BCN Commercial |
$91.32
|
| Rate for Payer: Cash Price |
$94.23
|
| Rate for Payer: Cofinity Commercial |
$110.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.23
|
| Rate for Payer: Healthscope Commercial |
$117.79
|
| Rate for Payer: Healthscope Whirlpool |
$114.26
|
| Rate for Payer: Mclaren Commercial |
$106.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.12
|
| Rate for Payer: Nomi Health Commercial |
$96.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.66
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$117.79
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$117.79 |
| Rate for Payer: Aetna Commercial |
$106.01
|
| Rate for Payer: Aetna Medicare |
$58.90
|
| Rate for Payer: ASR ASR |
$114.26
|
| Rate for Payer: ASR Commercial |
$114.26
|
| Rate for Payer: BCBS Complete |
$47.12
|
| Rate for Payer: BCBS Trust/PPO |
$96.46
|
| Rate for Payer: BCN Commercial |
$91.32
|
| Rate for Payer: Cash Price |
$94.23
|
| Rate for Payer: Cofinity Commercial |
$110.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.23
|
| Rate for Payer: Healthscope Commercial |
$117.79
|
| Rate for Payer: Healthscope Whirlpool |
$114.26
|
| Rate for Payer: Mclaren Commercial |
$106.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.12
|
| Rate for Payer: Nomi Health Commercial |
$96.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.21
|
| Rate for Payer: Priority Health Narrow Network |
$82.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.66
|
|
|
VANCOMYCIN 1.25 GRAM/250 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$70.09
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.04 |
| Max. Negotiated Rate |
$70.09 |
| Rate for Payer: Aetna Commercial |
$63.08
|
| Rate for Payer: Aetna Medicare |
$35.05
|
| Rate for Payer: ASR ASR |
$67.99
|
| Rate for Payer: ASR Commercial |
$67.99
|
| Rate for Payer: BCBS Complete |
$28.04
|
| Rate for Payer: BCBS Trust/PPO |
$57.40
|
| Rate for Payer: BCN Commercial |
$54.34
|
| Rate for Payer: Cash Price |
$56.07
|
| Rate for Payer: Cofinity Commercial |
$65.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.07
|
| Rate for Payer: Healthscope Commercial |
$70.09
|
| Rate for Payer: Healthscope Whirlpool |
$67.99
|
| Rate for Payer: Mclaren Commercial |
$63.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.58
|
| Rate for Payer: Nomi Health Commercial |
$57.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.41
|
| Rate for Payer: Priority Health Narrow Network |
$49.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.68
|
|
|
VANCOMYCIN 1.25 GRAM/250 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$70.09
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.56 |
| Max. Negotiated Rate |
$70.09 |
| Rate for Payer: Aetna Commercial |
$63.08
|
| Rate for Payer: ASR ASR |
$67.99
|
| Rate for Payer: ASR Commercial |
$67.99
|
| Rate for Payer: BCBS Trust/PPO |
$57.12
|
| Rate for Payer: BCN Commercial |
$54.34
|
| Rate for Payer: Cash Price |
$56.07
|
| Rate for Payer: Cofinity Commercial |
$65.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.07
|
| Rate for Payer: Healthscope Commercial |
$70.09
|
| Rate for Payer: Healthscope Whirlpool |
$67.99
|
| Rate for Payer: Mclaren Commercial |
$63.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.58
|
| Rate for Payer: Nomi Health Commercial |
$57.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.68
|
|
|
VANCOMYCIN 1.5 GRAM/300 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$84.11
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
189877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.64 |
| Max. Negotiated Rate |
$84.11 |
| Rate for Payer: Aetna Commercial |
$75.70
|
| Rate for Payer: Aetna Medicare |
$42.05
|
| Rate for Payer: ASR ASR |
$81.59
|
| Rate for Payer: ASR Commercial |
$81.59
|
| Rate for Payer: BCBS Complete |
$33.64
|
| Rate for Payer: BCBS Trust/PPO |
$68.88
|
| Rate for Payer: BCN Commercial |
$65.21
|
| Rate for Payer: Cash Price |
$67.28
|
| Rate for Payer: Cofinity Commercial |
$79.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.29
|
| Rate for Payer: Healthscope Commercial |
$84.11
|
| Rate for Payer: Healthscope Whirlpool |
$81.59
|
| Rate for Payer: Mclaren Commercial |
$75.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.49
|
| Rate for Payer: Nomi Health Commercial |
$68.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.70
|
| Rate for Payer: Priority Health Narrow Network |
$58.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.02
|
|
|
VANCOMYCIN 1.5 GRAM/300 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$84.11
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
189877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.67 |
| Max. Negotiated Rate |
$84.11 |
| Rate for Payer: Aetna Commercial |
$75.70
|
| Rate for Payer: ASR ASR |
$81.59
|
| Rate for Payer: ASR Commercial |
$81.59
|
| Rate for Payer: BCBS Trust/PPO |
$68.54
|
| Rate for Payer: BCN Commercial |
$65.21
|
| Rate for Payer: Cash Price |
$67.28
|
| Rate for Payer: Cofinity Commercial |
$79.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.29
|
| Rate for Payer: Healthscope Commercial |
$84.11
|
| Rate for Payer: Healthscope Whirlpool |
$81.59
|
| Rate for Payer: Mclaren Commercial |
$75.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.49
|
| Rate for Payer: Nomi Health Commercial |
$68.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.02
|
|
|
VANCOMYCIN 1.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$41.38
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
189183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$41.38 |
| Rate for Payer: Aetna Commercial |
$37.24
|
| Rate for Payer: Aetna Commercial |
$44.69
|
| Rate for Payer: Aetna Commercial |
$46.94
|
| Rate for Payer: Aetna Medicare |
$24.83
|
| Rate for Payer: Aetna Medicare |
$26.07
|
| Rate for Payer: Aetna Medicare |
$20.69
|
| Rate for Payer: ASR ASR |
$48.17
|
| Rate for Payer: ASR ASR |
$40.14
|
| Rate for Payer: ASR ASR |
$50.59
|
| Rate for Payer: ASR Commercial |
$50.59
|
| Rate for Payer: ASR Commercial |
$48.17
|
| Rate for Payer: ASR Commercial |
$40.14
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS Complete |
$19.86
|
| Rate for Payer: BCBS Complete |
$20.86
|
| Rate for Payer: BCBS Trust/PPO |
$33.89
|
| Rate for Payer: BCBS Trust/PPO |
$40.67
|
| Rate for Payer: BCBS Trust/PPO |
$42.71
|
| Rate for Payer: BCN Commercial |
$40.43
|
| Rate for Payer: BCN Commercial |
$32.08
|
| Rate for Payer: BCN Commercial |
$38.50
|
| Rate for Payer: Cash Price |
$39.73
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: Cofinity Commercial |
$49.02
|
| Rate for Payer: Cofinity Commercial |
$38.90
|
| Rate for Payer: Cofinity Commercial |
$46.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.72
|
| Rate for Payer: Healthscope Commercial |
$41.38
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Healthscope Whirlpool |
$48.17
|
| Rate for Payer: Healthscope Whirlpool |
$40.14
|
| Rate for Payer: Healthscope Whirlpool |
$50.59
|
| Rate for Payer: Mclaren Commercial |
$37.24
|
| Rate for Payer: Mclaren Commercial |
$44.69
|
| Rate for Payer: Mclaren Commercial |
$46.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.33
|
| Rate for Payer: Nomi Health Commercial |
$33.93
|
| Rate for Payer: Nomi Health Commercial |
$40.72
|
| Rate for Payer: Nomi Health Commercial |
$42.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.69
|
| Rate for Payer: Priority Health Narrow Network |
$36.56
|
| Rate for Payer: Priority Health Narrow Network |
$29.01
|
| Rate for Payer: Priority Health Narrow Network |
$34.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.89
|
|
|
VANCOMYCIN 1.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$49.66
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
189183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.28 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna Commercial |
$44.69
|
| Rate for Payer: Aetna Commercial |
$37.24
|
| Rate for Payer: Aetna Commercial |
$46.94
|
| Rate for Payer: ASR ASR |
$40.14
|
| Rate for Payer: ASR ASR |
$48.17
|
| Rate for Payer: ASR ASR |
$50.59
|
| Rate for Payer: ASR Commercial |
$48.17
|
| Rate for Payer: ASR Commercial |
$40.14
|
| Rate for Payer: ASR Commercial |
$50.59
|
| Rate for Payer: BCBS Trust/PPO |
$42.50
|
| Rate for Payer: BCBS Trust/PPO |
$33.72
|
| Rate for Payer: BCBS Trust/PPO |
$40.47
|
| Rate for Payer: BCN Commercial |
$32.08
|
| Rate for Payer: BCN Commercial |
$40.43
|
| Rate for Payer: BCN Commercial |
$38.50
|
| Rate for Payer: Cash Price |
$39.73
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: Cofinity Commercial |
$49.02
|
| Rate for Payer: Cofinity Commercial |
$38.90
|
| Rate for Payer: Cofinity Commercial |
$46.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.72
|
| Rate for Payer: Healthscope Commercial |
$41.38
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Healthscope Whirlpool |
$48.17
|
| Rate for Payer: Healthscope Whirlpool |
$40.14
|
| Rate for Payer: Healthscope Whirlpool |
$50.59
|
| Rate for Payer: Mclaren Commercial |
$44.69
|
| Rate for Payer: Mclaren Commercial |
$37.24
|
| Rate for Payer: Mclaren Commercial |
$46.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.17
|
| Rate for Payer: Nomi Health Commercial |
$40.72
|
| Rate for Payer: Nomi Health Commercial |
$33.93
|
| Rate for Payer: Nomi Health Commercial |
$42.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.41
|
|
|
VANCOMYCIN 1.75 GRAM/350 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$98.12
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.78 |
| Max. Negotiated Rate |
$98.12 |
| Rate for Payer: Aetna Commercial |
$88.31
|
| Rate for Payer: ASR ASR |
$95.18
|
| Rate for Payer: ASR Commercial |
$95.18
|
| Rate for Payer: BCBS Trust/PPO |
$79.96
|
| Rate for Payer: BCN Commercial |
$76.07
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cofinity Commercial |
$92.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.50
|
| Rate for Payer: Healthscope Commercial |
$98.12
|
| Rate for Payer: Healthscope Whirlpool |
$95.18
|
| Rate for Payer: Mclaren Commercial |
$88.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.40
|
| Rate for Payer: Nomi Health Commercial |
$80.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.35
|
|
|
VANCOMYCIN 1.75 GRAM/350 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$98.12
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$98.12 |
| Rate for Payer: Aetna Commercial |
$88.31
|
| Rate for Payer: Aetna Medicare |
$49.06
|
| Rate for Payer: ASR ASR |
$95.18
|
| Rate for Payer: ASR Commercial |
$95.18
|
| Rate for Payer: BCBS Complete |
$39.25
|
| Rate for Payer: BCBS Trust/PPO |
$80.35
|
| Rate for Payer: BCN Commercial |
$76.07
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cofinity Commercial |
$92.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.50
|
| Rate for Payer: Healthscope Commercial |
$98.12
|
| Rate for Payer: Healthscope Whirlpool |
$95.18
|
| Rate for Payer: Mclaren Commercial |
$88.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.40
|
| Rate for Payer: Nomi Health Commercial |
$80.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.97
|
| Rate for Payer: Priority Health Narrow Network |
$68.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.35
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$56.07
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
189876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.43 |
| Max. Negotiated Rate |
$56.07 |
| Rate for Payer: Aetna Commercial |
$50.46
|
| Rate for Payer: Aetna Medicare |
$28.04
|
| Rate for Payer: ASR ASR |
$54.39
|
| Rate for Payer: ASR Commercial |
$54.39
|
| Rate for Payer: BCBS Complete |
$22.43
|
| Rate for Payer: BCBS Trust/PPO |
$45.92
|
| Rate for Payer: BCN Commercial |
$43.47
|
| Rate for Payer: Cash Price |
$44.86
|
| Rate for Payer: Cofinity Commercial |
$52.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.86
|
| Rate for Payer: Healthscope Commercial |
$56.07
|
| Rate for Payer: Healthscope Whirlpool |
$54.39
|
| Rate for Payer: Mclaren Commercial |
$50.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.66
|
| Rate for Payer: Nomi Health Commercial |
$45.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.13
|
| Rate for Payer: Priority Health Narrow Network |
$39.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.34
|
|
