|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$302.10
|
|
|
Service Code
|
NDC 00904707761
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.36 |
| Max. Negotiated Rate |
$302.10 |
| Rate for Payer: Aetna Commercial |
$271.89
|
| Rate for Payer: ASR ASR |
$293.04
|
| Rate for Payer: ASR Commercial |
$293.04
|
| Rate for Payer: BCBS Trust/PPO |
$246.18
|
| Rate for Payer: BCN Commercial |
$234.22
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$283.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Healthscope Commercial |
$302.10
|
| Rate for Payer: Healthscope Whirlpool |
$293.04
|
| Rate for Payer: Mclaren Commercial |
$271.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.78
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.85
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$66.78
|
|
|
Service Code
|
NDC 00173068224
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.71 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Aetna Commercial |
$60.10
|
| Rate for Payer: Aetna Medicare |
$33.39
|
| Rate for Payer: ASR ASR |
$64.78
|
| Rate for Payer: ASR Commercial |
$64.78
|
| Rate for Payer: BCBS Complete |
$26.71
|
| Rate for Payer: BCBS Trust/PPO |
$54.69
|
| Rate for Payer: BCN Commercial |
$51.77
|
| Rate for Payer: Cash Price |
$53.42
|
| Rate for Payer: Cofinity Commercial |
$62.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.42
|
| Rate for Payer: Healthscope Commercial |
$66.78
|
| Rate for Payer: Healthscope Whirlpool |
$64.78
|
| Rate for Payer: Mclaren Commercial |
$60.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.76
|
| Rate for Payer: Nomi Health Commercial |
$54.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.51
|
| Rate for Payer: Priority Health Narrow Network |
$46.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.77
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$47.60
|
|
|
Service Code
|
NDC 00054074287
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.94 |
| Max. Negotiated Rate |
$47.60 |
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: ASR ASR |
$46.17
|
| Rate for Payer: ASR Commercial |
$46.17
|
| Rate for Payer: BCBS Trust/PPO |
$38.79
|
| Rate for Payer: BCN Commercial |
$36.90
|
| Rate for Payer: Cash Price |
$38.08
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.08
|
| Rate for Payer: Healthscope Commercial |
$47.60
|
| Rate for Payer: Healthscope Whirlpool |
$46.17
|
| Rate for Payer: Mclaren Commercial |
$42.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.46
|
| Rate for Payer: Nomi Health Commercial |
$39.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.89
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$47.60
|
|
|
Service Code
|
NDC 00054074287
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$47.60 |
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Aetna Medicare |
$23.80
|
| Rate for Payer: ASR ASR |
$46.17
|
| Rate for Payer: ASR Commercial |
$46.17
|
| Rate for Payer: BCBS Complete |
$19.04
|
| Rate for Payer: BCBS Trust/PPO |
$38.98
|
| Rate for Payer: BCN Commercial |
$36.90
|
| Rate for Payer: Cash Price |
$38.08
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.08
|
| Rate for Payer: Healthscope Commercial |
$47.60
|
| Rate for Payer: Healthscope Whirlpool |
$46.17
|
| Rate for Payer: Mclaren Commercial |
$42.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.46
|
| Rate for Payer: Nomi Health Commercial |
$39.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.71
|
| Rate for Payer: Priority Health Narrow Network |
$33.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.89
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$174.30
|
|
|
Service Code
|
NDC 00173068220
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.72 |
| Max. Negotiated Rate |
$174.30 |
| Rate for Payer: Aetna Commercial |
$156.87
|
| Rate for Payer: Aetna Medicare |
$87.15
|
| Rate for Payer: ASR ASR |
$169.07
|
| Rate for Payer: ASR Commercial |
$169.07
|
| Rate for Payer: BCBS Complete |
$69.72
|
| Rate for Payer: BCBS Trust/PPO |
$142.73
|
| Rate for Payer: BCN Commercial |
$135.13
|
| Rate for Payer: Cash Price |
$139.44
|
| Rate for Payer: Cofinity Commercial |
$163.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.44
|
| Rate for Payer: Healthscope Commercial |
$174.30
|
| Rate for Payer: Healthscope Whirlpool |
$169.07
|
| Rate for Payer: Mclaren Commercial |
$156.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.16
|
| Rate for Payer: Nomi Health Commercial |
$142.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.72
|
| Rate for Payer: Priority Health Narrow Network |
$122.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.38
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$66.78
|
|
|
Service Code
|
NDC 00173068224
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.41 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Aetna Commercial |
$60.10
|
| Rate for Payer: ASR ASR |
$64.78
|
| Rate for Payer: ASR Commercial |
$64.78
|
| Rate for Payer: BCBS Trust/PPO |
$54.42
|
| Rate for Payer: BCN Commercial |
$51.77
|
| Rate for Payer: Cash Price |
$53.42
|
| Rate for Payer: Cofinity Commercial |
$62.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.42
|
| Rate for Payer: Healthscope Commercial |
$66.78
|
| Rate for Payer: Healthscope Whirlpool |
$64.78
|
| Rate for Payer: Mclaren Commercial |
$60.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.76
|
| Rate for Payer: Nomi Health Commercial |
$54.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.77
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$174.30
|
|
|
Service Code
|
NDC 00173068220
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.30 |
| Max. Negotiated Rate |
$174.30 |
| Rate for Payer: Aetna Commercial |
$156.87
|
| Rate for Payer: ASR ASR |
$169.07
|
| Rate for Payer: ASR Commercial |
$169.07
|
| Rate for Payer: BCBS Trust/PPO |
$142.04
|
| Rate for Payer: BCN Commercial |
$135.13
|
| Rate for Payer: Cash Price |
$139.44
|
| Rate for Payer: Cofinity Commercial |
$163.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.44
|
| Rate for Payer: Healthscope Commercial |
$174.30
|
| Rate for Payer: Healthscope Whirlpool |
$169.07
|
| Rate for Payer: Mclaren Commercial |
$156.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.16
|
| Rate for Payer: Nomi Health Commercial |
$142.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.38
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17.66
|
|
|
Service Code
|
NDC 70756060525
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$17.66 |
| Rate for Payer: Aetna Commercial |
$15.89
|
| Rate for Payer: Aetna Medicare |
$8.83
|
| Rate for Payer: ASR ASR |
$17.13
|
| Rate for Payer: ASR Commercial |
$17.13
|
| Rate for Payer: BCBS Complete |
$7.06
|
| Rate for Payer: BCBS Trust/PPO |
$14.46
|
| Rate for Payer: BCN Commercial |
$13.69
|
| Rate for Payer: Cash Price |
$14.13
|
| Rate for Payer: Cofinity Commercial |
$16.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.13
|
| Rate for Payer: Healthscope Commercial |
$17.66
|
| Rate for Payer: Healthscope Whirlpool |
$17.13
|
| Rate for Payer: Mclaren Commercial |
$15.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.01
|
| Rate for Payer: Nomi Health Commercial |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.47
|
| Rate for Payer: Priority Health Narrow Network |
$12.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.54
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.65
|
|
|
Service Code
|
NDC 67850007100
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$21.65 |
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna Medicare |
$10.82
|
| Rate for Payer: ASR ASR |
$21.00
|
| Rate for Payer: ASR Commercial |
$21.00
|
| Rate for Payer: BCBS Complete |
$8.66
|
| Rate for Payer: BCBS Trust/PPO |
$17.73
|
| Rate for Payer: BCN Commercial |
$16.79
|
| Rate for Payer: Cash Price |
$17.32
|
| Rate for Payer: Cofinity Commercial |
$20.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$21.65
|
| Rate for Payer: Healthscope Whirlpool |
$21.00
|
| Rate for Payer: Mclaren Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.40
|
| Rate for Payer: Nomi Health Commercial |
$17.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.97
|
| Rate for Payer: Priority Health Narrow Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.05
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.65
|
|
|
Service Code
|
NDC 67850007100
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.07 |
| Max. Negotiated Rate |
$21.65 |
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: ASR ASR |
$21.00
|
| Rate for Payer: ASR Commercial |
$21.00
|
| Rate for Payer: BCBS Trust/PPO |
$17.64
|
| Rate for Payer: BCN Commercial |
$16.79
|
| Rate for Payer: Cash Price |
$17.32
|
| Rate for Payer: Cofinity Commercial |
$20.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$21.65
|
| Rate for Payer: Healthscope Whirlpool |
$21.00
|
| Rate for Payer: Mclaren Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.40
|
| Rate for Payer: Nomi Health Commercial |
$17.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.05
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.26
|
|
|
Service Code
|
NDC 70756060582
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$18.26 |
| Rate for Payer: Aetna Commercial |
$16.43
|
| Rate for Payer: ASR ASR |
$17.71
|
| Rate for Payer: ASR Commercial |
$17.71
|
| Rate for Payer: BCBS Trust/PPO |
$14.88
|
| Rate for Payer: BCN Commercial |
$14.16
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Cofinity Commercial |
$17.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.61
|
| Rate for Payer: Healthscope Commercial |
$18.26
|
| Rate for Payer: Healthscope Whirlpool |
$17.71
|
| Rate for Payer: Mclaren Commercial |
$16.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.52
|
| Rate for Payer: Nomi Health Commercial |
$14.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.07
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.66
|
|
|
Service Code
|
NDC 70756060525
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$17.66 |
| Rate for Payer: Aetna Commercial |
$15.89
|
| Rate for Payer: ASR ASR |
$17.13
|
| Rate for Payer: ASR Commercial |
$17.13
|
| Rate for Payer: BCBS Trust/PPO |
$14.39
|
| Rate for Payer: BCN Commercial |
$13.69
|
| Rate for Payer: Cash Price |
$14.13
|
| Rate for Payer: Cofinity Commercial |
$16.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.13
|
| Rate for Payer: Healthscope Commercial |
$17.66
|
| Rate for Payer: Healthscope Whirlpool |
$17.13
|
| Rate for Payer: Mclaren Commercial |
$15.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.01
|
| Rate for Payer: Nomi Health Commercial |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.54
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.48
|
|
|
Service Code
|
NDC 70710164301
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$19.33
|
| Rate for Payer: ASR ASR |
$20.84
|
| Rate for Payer: ASR Commercial |
$20.84
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Healthscope Whirlpool |
$20.84
|
| Rate for Payer: Mclaren Commercial |
$19.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.26
|
| Rate for Payer: Nomi Health Commercial |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.90
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.48
|
|
|
Service Code
|
NDC 70710164307
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$19.33
|
| Rate for Payer: ASR ASR |
$20.84
|
| Rate for Payer: ASR Commercial |
$20.84
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Healthscope Whirlpool |
$20.84
|
| Rate for Payer: Mclaren Commercial |
$19.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.26
|
| Rate for Payer: Nomi Health Commercial |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.90
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.58
|
|
|
Service Code
|
NDC 67850007125
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$26.58 |
| Rate for Payer: Aetna Commercial |
$23.92
|
| Rate for Payer: Aetna Medicare |
$13.29
|
| Rate for Payer: ASR ASR |
$25.78
|
| Rate for Payer: ASR Commercial |
$25.78
|
| Rate for Payer: BCBS Complete |
$10.63
|
| Rate for Payer: BCBS Trust/PPO |
$21.77
|
| Rate for Payer: BCN Commercial |
$20.61
|
| Rate for Payer: Cash Price |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.26
|
| Rate for Payer: Healthscope Commercial |
$26.58
|
| Rate for Payer: Healthscope Whirlpool |
$25.78
|
| Rate for Payer: Mclaren Commercial |
$23.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.59
|
| Rate for Payer: Nomi Health Commercial |
$21.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.29
|
| Rate for Payer: Priority Health Narrow Network |
$18.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.39
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$113.39
|
|
|
Service Code
|
NDC 00409114405
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.36 |
| Max. Negotiated Rate |
$113.39 |
| Rate for Payer: Aetna Commercial |
$102.05
|
| Rate for Payer: Aetna Medicare |
$56.70
|
| Rate for Payer: ASR ASR |
$109.99
|
| Rate for Payer: ASR Commercial |
$109.99
|
| Rate for Payer: BCBS Complete |
$45.36
|
| Rate for Payer: BCBS Trust/PPO |
$92.86
|
| Rate for Payer: BCN Commercial |
$87.91
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cofinity Commercial |
$106.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.71
|
| Rate for Payer: Healthscope Commercial |
$113.39
|
| Rate for Payer: Healthscope Whirlpool |
$109.99
|
| Rate for Payer: Mclaren Commercial |
$102.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.38
|
| Rate for Payer: Nomi Health Commercial |
$92.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.35
|
| Rate for Payer: Priority Health Narrow Network |
$79.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.78
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.48
|
|
|
Service Code
|
NDC 70710164301
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$19.33
|
| Rate for Payer: Aetna Medicare |
$10.74
|
| Rate for Payer: ASR ASR |
$20.84
|
| Rate for Payer: ASR Commercial |
$20.84
|
| Rate for Payer: BCBS Complete |
$8.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.59
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Healthscope Whirlpool |
$20.84
|
| Rate for Payer: Mclaren Commercial |
$19.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.26
|
| Rate for Payer: Nomi Health Commercial |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.82
|
| Rate for Payer: Priority Health Narrow Network |
$15.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.90
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$37.25
|
|
|
Service Code
|
NDC 00409401101
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.21 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: ASR ASR |
$36.13
|
| Rate for Payer: ASR Commercial |
$36.13
|
| Rate for Payer: BCBS Trust/PPO |
$30.36
|
| Rate for Payer: BCN Commercial |
$28.88
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cofinity Commercial |
$35.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Healthscope Whirlpool |
$36.13
|
| Rate for Payer: Mclaren Commercial |
$33.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.66
|
| Rate for Payer: Nomi Health Commercial |
$30.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.78
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$37.25
|
|
|
Service Code
|
NDC 00409401101
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: ASR ASR |
$36.13
|
| Rate for Payer: ASR Commercial |
$36.13
|
| Rate for Payer: BCBS Complete |
$14.90
|
| Rate for Payer: BCBS Trust/PPO |
$30.50
|
| Rate for Payer: BCN Commercial |
$28.88
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cofinity Commercial |
$35.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Healthscope Whirlpool |
$36.13
|
| Rate for Payer: Mclaren Commercial |
$33.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.66
|
| Rate for Payer: Nomi Health Commercial |
$30.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.64
|
| Rate for Payer: Priority Health Narrow Network |
$26.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.78
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.26
|
|
|
Service Code
|
NDC 70756060582
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$18.26 |
| Rate for Payer: Aetna Commercial |
$16.43
|
| Rate for Payer: Aetna Medicare |
$9.13
|
| Rate for Payer: ASR ASR |
$17.71
|
| Rate for Payer: ASR Commercial |
$17.71
|
| Rate for Payer: BCBS Complete |
$7.30
|
| Rate for Payer: BCBS Trust/PPO |
$14.95
|
| Rate for Payer: BCN Commercial |
$14.16
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Cofinity Commercial |
$17.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.61
|
| Rate for Payer: Healthscope Commercial |
$18.26
|
| Rate for Payer: Healthscope Whirlpool |
$17.71
|
| Rate for Payer: Mclaren Commercial |
$16.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.52
|
| Rate for Payer: Nomi Health Commercial |
$14.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.00
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.07
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$113.39
|
|
|
Service Code
|
NDC 00409114405
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.70 |
| Max. Negotiated Rate |
$113.39 |
| Rate for Payer: Aetna Commercial |
$102.05
|
| Rate for Payer: ASR ASR |
$109.99
|
| Rate for Payer: ASR Commercial |
$109.99
|
| Rate for Payer: BCBS Trust/PPO |
$92.40
|
| Rate for Payer: BCN Commercial |
$87.91
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cofinity Commercial |
$106.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.71
|
| Rate for Payer: Healthscope Commercial |
$113.39
|
| Rate for Payer: Healthscope Whirlpool |
$109.99
|
| Rate for Payer: Mclaren Commercial |
$102.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.38
|
| Rate for Payer: Nomi Health Commercial |
$92.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.78
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.58
|
|
|
Service Code
|
NDC 67850007125
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$26.58 |
| Rate for Payer: Aetna Commercial |
$23.92
|
| Rate for Payer: ASR ASR |
$25.78
|
| Rate for Payer: ASR Commercial |
$25.78
|
| Rate for Payer: BCBS Trust/PPO |
$21.66
|
| Rate for Payer: BCN Commercial |
$20.61
|
| Rate for Payer: Cash Price |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.26
|
| Rate for Payer: Healthscope Commercial |
$26.58
|
| Rate for Payer: Healthscope Whirlpool |
$25.78
|
| Rate for Payer: Mclaren Commercial |
$23.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.59
|
| Rate for Payer: Nomi Health Commercial |
$21.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.39
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.48
|
|
|
Service Code
|
NDC 70710164307
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$19.33
|
| Rate for Payer: Aetna Medicare |
$10.74
|
| Rate for Payer: ASR ASR |
$20.84
|
| Rate for Payer: ASR Commercial |
$20.84
|
| Rate for Payer: BCBS Complete |
$8.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.59
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Healthscope Whirlpool |
$20.84
|
| Rate for Payer: Mclaren Commercial |
$19.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.26
|
| Rate for Payer: Nomi Health Commercial |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.82
|
| Rate for Payer: Priority Health Narrow Network |
$15.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.90
|
|
|
VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$12.16
|
|
|
Service Code
|
NDC 51079091701
|
| Hospital Charge Code |
25238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$12.16 |
| Rate for Payer: Aetna Commercial |
$10.94
|
| Rate for Payer: ASR ASR |
$11.80
|
| Rate for Payer: ASR Commercial |
$11.80
|
| Rate for Payer: BCBS Trust/PPO |
$9.91
|
| Rate for Payer: BCN Commercial |
$9.43
|
| Rate for Payer: Cash Price |
$9.73
|
| Rate for Payer: Cofinity Commercial |
$11.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.73
|
| Rate for Payer: Healthscope Commercial |
$12.16
|
| Rate for Payer: Healthscope Whirlpool |
$11.80
|
| Rate for Payer: Mclaren Commercial |
$10.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.34
|
| Rate for Payer: Nomi Health Commercial |
$9.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.70
|
|
|
VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
OP
|
$12.16
|
|
|
Service Code
|
NDC 51079091701
|
| Hospital Charge Code |
25238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$12.16 |
| Rate for Payer: Aetna Commercial |
$10.94
|
| Rate for Payer: Aetna Medicare |
$6.08
|
| Rate for Payer: ASR ASR |
$11.80
|
| Rate for Payer: ASR Commercial |
$11.80
|
| Rate for Payer: BCBS Complete |
$4.86
|
| Rate for Payer: BCBS Trust/PPO |
$9.96
|
| Rate for Payer: BCN Commercial |
$9.43
|
| Rate for Payer: Cash Price |
$9.73
|
| Rate for Payer: Cofinity Commercial |
$11.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.73
|
| Rate for Payer: Healthscope Commercial |
$12.16
|
| Rate for Payer: Healthscope Whirlpool |
$11.80
|
| Rate for Payer: Mclaren Commercial |
$10.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.34
|
| Rate for Payer: Nomi Health Commercial |
$9.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.65
|
| Rate for Payer: Priority Health Narrow Network |
$8.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.70
|
|
