|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$200.45
|
|
|
Service Code
|
NDC 68462029201
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.29 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna Commercial |
$180.40
|
| Rate for Payer: ASR ASR |
$194.44
|
| Rate for Payer: ASR Commercial |
$194.44
|
| Rate for Payer: BCBS Trust/PPO |
$163.35
|
| Rate for Payer: BCN Commercial |
$155.41
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$188.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$200.45
|
| Rate for Payer: Healthscope Whirlpool |
$194.44
|
| Rate for Payer: Mclaren Commercial |
$180.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.40
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$524.64
|
|
|
Service Code
|
NDC 60687049301
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.86 |
| Max. Negotiated Rate |
$524.64 |
| Rate for Payer: Aetna Commercial |
$472.18
|
| Rate for Payer: Aetna Medicare |
$262.32
|
| Rate for Payer: ASR ASR |
$508.90
|
| Rate for Payer: ASR Commercial |
$508.90
|
| Rate for Payer: BCBS Complete |
$209.86
|
| Rate for Payer: BCBS Trust/PPO |
$429.63
|
| Rate for Payer: BCN Commercial |
$406.75
|
| Rate for Payer: Cash Price |
$419.71
|
| Rate for Payer: Cofinity Commercial |
$493.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.71
|
| Rate for Payer: Healthscope Commercial |
$524.64
|
| Rate for Payer: Healthscope Whirlpool |
$508.90
|
| Rate for Payer: Mclaren Commercial |
$472.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.94
|
| Rate for Payer: Nomi Health Commercial |
$430.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$459.69
|
| Rate for Payer: Priority Health Narrow Network |
$367.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.68
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$5.25
|
|
|
Service Code
|
NDC 60687049311
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna Commercial |
$4.72
|
| Rate for Payer: Aetna Medicare |
$2.62
|
| Rate for Payer: ASR ASR |
$5.09
|
| Rate for Payer: ASR Commercial |
$5.09
|
| Rate for Payer: BCBS Complete |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.07
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$5.25
|
| Rate for Payer: Healthscope Whirlpool |
$5.09
|
| Rate for Payer: Mclaren Commercial |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.46
|
| Rate for Payer: Nomi Health Commercial |
$4.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.60
|
| Rate for Payer: Priority Health Narrow Network |
$3.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.62
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$524.64
|
|
|
Service Code
|
NDC 60687049301
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$341.02 |
| Max. Negotiated Rate |
$524.64 |
| Rate for Payer: Aetna Commercial |
$472.18
|
| Rate for Payer: ASR ASR |
$508.90
|
| Rate for Payer: ASR Commercial |
$508.90
|
| Rate for Payer: BCBS Trust/PPO |
$427.53
|
| Rate for Payer: BCN Commercial |
$406.75
|
| Rate for Payer: Cash Price |
$419.71
|
| Rate for Payer: Cofinity Commercial |
$493.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.71
|
| Rate for Payer: Healthscope Commercial |
$524.64
|
| Rate for Payer: Healthscope Whirlpool |
$508.90
|
| Rate for Payer: Mclaren Commercial |
$472.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.94
|
| Rate for Payer: Nomi Health Commercial |
$430.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.68
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$5.25
|
|
|
Service Code
|
NDC 60687049311
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna Commercial |
$4.72
|
| Rate for Payer: ASR ASR |
$5.09
|
| Rate for Payer: ASR Commercial |
$5.09
|
| Rate for Payer: BCBS Trust/PPO |
$4.28
|
| Rate for Payer: BCN Commercial |
$4.07
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$5.25
|
| Rate for Payer: Healthscope Whirlpool |
$5.09
|
| Rate for Payer: Mclaren Commercial |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.46
|
| Rate for Payer: Nomi Health Commercial |
$4.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.62
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$200.45
|
|
|
Service Code
|
NDC 68462029201
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna Commercial |
$180.40
|
| Rate for Payer: Aetna Medicare |
$100.22
|
| Rate for Payer: ASR ASR |
$194.44
|
| Rate for Payer: ASR Commercial |
$194.44
|
| Rate for Payer: BCBS Complete |
$80.18
|
| Rate for Payer: BCBS Trust/PPO |
$164.15
|
| Rate for Payer: BCN Commercial |
$155.41
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$188.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$200.45
|
| Rate for Payer: Healthscope Whirlpool |
$194.44
|
| Rate for Payer: Mclaren Commercial |
$180.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.63
|
| Rate for Payer: Priority Health Narrow Network |
$140.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.40
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$5.62
|
|
|
Service Code
|
NDC 60687050411
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$5.06
|
| Rate for Payer: Aetna Medicare |
$2.81
|
| Rate for Payer: ASR ASR |
$5.45
|
| Rate for Payer: ASR Commercial |
$5.45
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: BCBS Trust/PPO |
$4.60
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cofinity Commercial |
$5.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Healthscope Whirlpool |
$5.45
|
| Rate for Payer: Mclaren Commercial |
$5.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.78
|
| Rate for Payer: Nomi Health Commercial |
$4.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.92
|
| Rate for Payer: Priority Health Narrow Network |
$3.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.95
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$432.40
|
|
|
Service Code
|
NDC 68462029301
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.96 |
| Max. Negotiated Rate |
$432.40 |
| Rate for Payer: Aetna Commercial |
$389.16
|
| Rate for Payer: Aetna Medicare |
$216.20
|
| Rate for Payer: ASR ASR |
$419.43
|
| Rate for Payer: ASR Commercial |
$419.43
|
| Rate for Payer: BCBS Complete |
$172.96
|
| Rate for Payer: BCBS Trust/PPO |
$354.09
|
| Rate for Payer: BCN Commercial |
$335.24
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Commercial |
$406.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$432.40
|
| Rate for Payer: Healthscope Whirlpool |
$419.43
|
| Rate for Payer: Mclaren Commercial |
$389.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Nomi Health Commercial |
$354.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$378.87
|
| Rate for Payer: Priority Health Narrow Network |
$303.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$380.51
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$5.62
|
|
|
Service Code
|
NDC 60687050411
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$5.06
|
| Rate for Payer: ASR ASR |
$5.45
|
| Rate for Payer: ASR Commercial |
$5.45
|
| Rate for Payer: BCBS Trust/PPO |
$4.58
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cofinity Commercial |
$5.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Healthscope Whirlpool |
$5.45
|
| Rate for Payer: Mclaren Commercial |
$5.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.78
|
| Rate for Payer: Nomi Health Commercial |
$4.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.95
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$561.60
|
|
|
Service Code
|
NDC 60687050401
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.64 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$505.44
|
| Rate for Payer: Aetna Medicare |
$280.80
|
| Rate for Payer: ASR ASR |
$544.75
|
| Rate for Payer: ASR Commercial |
$544.75
|
| Rate for Payer: BCBS Complete |
$224.64
|
| Rate for Payer: BCBS Trust/PPO |
$459.89
|
| Rate for Payer: BCN Commercial |
$435.41
|
| Rate for Payer: Cash Price |
$449.28
|
| Rate for Payer: Cofinity Commercial |
$527.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.28
|
| Rate for Payer: Healthscope Commercial |
$561.60
|
| Rate for Payer: Healthscope Whirlpool |
$544.75
|
| Rate for Payer: Mclaren Commercial |
$505.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.36
|
| Rate for Payer: Nomi Health Commercial |
$460.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$492.07
|
| Rate for Payer: Priority Health Narrow Network |
$393.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.21
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$561.60
|
|
|
Service Code
|
NDC 60687050401
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$365.04 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$505.44
|
| Rate for Payer: ASR ASR |
$544.75
|
| Rate for Payer: ASR Commercial |
$544.75
|
| Rate for Payer: BCBS Trust/PPO |
$457.65
|
| Rate for Payer: BCN Commercial |
$435.41
|
| Rate for Payer: Cash Price |
$449.28
|
| Rate for Payer: Cofinity Commercial |
$527.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.28
|
| Rate for Payer: Healthscope Commercial |
$561.60
|
| Rate for Payer: Healthscope Whirlpool |
$544.75
|
| Rate for Payer: Mclaren Commercial |
$505.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.36
|
| Rate for Payer: Nomi Health Commercial |
$460.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.21
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$432.40
|
|
|
Service Code
|
NDC 68462029301
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.06 |
| Max. Negotiated Rate |
$432.40 |
| Rate for Payer: Aetna Commercial |
$389.16
|
| Rate for Payer: ASR ASR |
$419.43
|
| Rate for Payer: ASR Commercial |
$419.43
|
| Rate for Payer: BCBS Trust/PPO |
$352.36
|
| Rate for Payer: BCN Commercial |
$335.24
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Commercial |
$406.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$432.40
|
| Rate for Payer: Healthscope Whirlpool |
$419.43
|
| Rate for Payer: Mclaren Commercial |
$389.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Nomi Health Commercial |
$354.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$380.51
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
OP
|
$1,254.74
|
|
|
Service Code
|
NDC 00456112030
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$501.90 |
| Max. Negotiated Rate |
$1,254.74 |
| Rate for Payer: Aetna Commercial |
$1,129.27
|
| Rate for Payer: Aetna Medicare |
$627.37
|
| Rate for Payer: ASR ASR |
$1,217.10
|
| Rate for Payer: ASR Commercial |
$1,217.10
|
| Rate for Payer: BCBS Complete |
$501.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,027.51
|
| Rate for Payer: BCN Commercial |
$972.80
|
| Rate for Payer: Cash Price |
$1,003.80
|
| Rate for Payer: Cofinity Commercial |
$1,179.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.79
|
| Rate for Payer: Healthscope Commercial |
$1,254.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,217.10
|
| Rate for Payer: Mclaren Commercial |
$1,129.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,066.53
|
| Rate for Payer: Nomi Health Commercial |
$1,028.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.40
|
| Rate for Payer: Priority Health Narrow Network |
$879.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,104.17
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
IP
|
$154.51
|
|
|
Service Code
|
NDC 60505437303
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.43 |
| Max. Negotiated Rate |
$154.51 |
| Rate for Payer: Aetna Commercial |
$139.06
|
| Rate for Payer: ASR ASR |
$149.87
|
| Rate for Payer: ASR Commercial |
$149.87
|
| Rate for Payer: BCBS Trust/PPO |
$125.91
|
| Rate for Payer: BCN Commercial |
$119.79
|
| Rate for Payer: Cash Price |
$123.61
|
| Rate for Payer: Cofinity Commercial |
$145.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.61
|
| Rate for Payer: Healthscope Commercial |
$154.51
|
| Rate for Payer: Healthscope Whirlpool |
$149.87
|
| Rate for Payer: Mclaren Commercial |
$139.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.33
|
| Rate for Payer: Nomi Health Commercial |
$126.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.97
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
OP
|
$527.03
|
|
|
Service Code
|
NDC 60505477303
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.81 |
| Max. Negotiated Rate |
$527.03 |
| Rate for Payer: Aetna Commercial |
$474.33
|
| Rate for Payer: Aetna Medicare |
$263.52
|
| Rate for Payer: ASR ASR |
$511.22
|
| Rate for Payer: ASR Commercial |
$511.22
|
| Rate for Payer: BCBS Complete |
$210.81
|
| Rate for Payer: BCBS Trust/PPO |
$431.58
|
| Rate for Payer: BCN Commercial |
$408.61
|
| Rate for Payer: Cash Price |
$421.62
|
| Rate for Payer: Cofinity Commercial |
$495.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.62
|
| Rate for Payer: Healthscope Commercial |
$527.03
|
| Rate for Payer: Healthscope Whirlpool |
$511.22
|
| Rate for Payer: Mclaren Commercial |
$474.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.98
|
| Rate for Payer: Nomi Health Commercial |
$432.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$461.78
|
| Rate for Payer: Priority Health Narrow Network |
$369.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$463.79
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
IP
|
$527.03
|
|
|
Service Code
|
NDC 60505477303
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$342.57 |
| Max. Negotiated Rate |
$527.03 |
| Rate for Payer: Aetna Commercial |
$474.33
|
| Rate for Payer: ASR ASR |
$511.22
|
| Rate for Payer: ASR Commercial |
$511.22
|
| Rate for Payer: BCBS Trust/PPO |
$429.48
|
| Rate for Payer: BCN Commercial |
$408.61
|
| Rate for Payer: Cash Price |
$421.62
|
| Rate for Payer: Cofinity Commercial |
$495.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.62
|
| Rate for Payer: Healthscope Commercial |
$527.03
|
| Rate for Payer: Healthscope Whirlpool |
$511.22
|
| Rate for Payer: Mclaren Commercial |
$474.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.98
|
| Rate for Payer: Nomi Health Commercial |
$432.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$463.79
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
IP
|
$1,254.74
|
|
|
Service Code
|
NDC 00456112030
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$815.58 |
| Max. Negotiated Rate |
$1,254.74 |
| Rate for Payer: Aetna Commercial |
$1,129.27
|
| Rate for Payer: ASR ASR |
$1,217.10
|
| Rate for Payer: ASR Commercial |
$1,217.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,022.49
|
| Rate for Payer: BCN Commercial |
$972.80
|
| Rate for Payer: Cash Price |
$1,003.80
|
| Rate for Payer: Cofinity Commercial |
$1,179.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.79
|
| Rate for Payer: Healthscope Commercial |
$1,254.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,217.10
|
| Rate for Payer: Mclaren Commercial |
$1,129.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,066.53
|
| Rate for Payer: Nomi Health Commercial |
$1,028.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,104.17
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
OP
|
$154.51
|
|
|
Service Code
|
NDC 60505437303
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.80 |
| Max. Negotiated Rate |
$154.51 |
| Rate for Payer: Aetna Commercial |
$139.06
|
| Rate for Payer: Aetna Medicare |
$77.26
|
| Rate for Payer: ASR ASR |
$149.87
|
| Rate for Payer: ASR Commercial |
$149.87
|
| Rate for Payer: BCBS Complete |
$61.80
|
| Rate for Payer: BCBS Trust/PPO |
$126.53
|
| Rate for Payer: BCN Commercial |
$119.79
|
| Rate for Payer: Cash Price |
$123.61
|
| Rate for Payer: Cofinity Commercial |
$145.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.61
|
| Rate for Payer: Healthscope Commercial |
$154.51
|
| Rate for Payer: Healthscope Whirlpool |
$149.87
|
| Rate for Payer: Mclaren Commercial |
$139.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.33
|
| Rate for Payer: Nomi Health Commercial |
$126.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.38
|
| Rate for Payer: Priority Health Narrow Network |
$108.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.97
|
|
|
VILAZODONE 40 MG TABLET
|
Facility
|
OP
|
$542.24
|
|
|
Service Code
|
NDC 62332023430
|
| Hospital Charge Code |
152701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.90 |
| Max. Negotiated Rate |
$542.24 |
| Rate for Payer: Aetna Commercial |
$488.02
|
| Rate for Payer: Aetna Medicare |
$271.12
|
| Rate for Payer: ASR ASR |
$525.97
|
| Rate for Payer: ASR Commercial |
$525.97
|
| Rate for Payer: BCBS Complete |
$216.90
|
| Rate for Payer: BCBS Trust/PPO |
$444.04
|
| Rate for Payer: BCN Commercial |
$420.40
|
| Rate for Payer: Cash Price |
$433.79
|
| Rate for Payer: Cofinity Commercial |
$509.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.79
|
| Rate for Payer: Healthscope Commercial |
$542.24
|
| Rate for Payer: Healthscope Whirlpool |
$525.97
|
| Rate for Payer: Mclaren Commercial |
$488.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.90
|
| Rate for Payer: Nomi Health Commercial |
$444.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$475.11
|
| Rate for Payer: Priority Health Narrow Network |
$380.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$477.17
|
|
|
VILAZODONE 40 MG TABLET
|
Facility
|
IP
|
$542.24
|
|
|
Service Code
|
NDC 62332023430
|
| Hospital Charge Code |
152701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$352.46 |
| Max. Negotiated Rate |
$542.24 |
| Rate for Payer: Aetna Commercial |
$488.02
|
| Rate for Payer: ASR ASR |
$525.97
|
| Rate for Payer: ASR Commercial |
$525.97
|
| Rate for Payer: BCBS Trust/PPO |
$441.87
|
| Rate for Payer: BCN Commercial |
$420.40
|
| Rate for Payer: Cash Price |
$433.79
|
| Rate for Payer: Cofinity Commercial |
$509.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.79
|
| Rate for Payer: Healthscope Commercial |
$542.24
|
| Rate for Payer: Healthscope Whirlpool |
$525.97
|
| Rate for Payer: Mclaren Commercial |
$488.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.90
|
| Rate for Payer: Nomi Health Commercial |
$444.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$477.17
|
|
|
VIT A-D3-E-ALOE VERA-ZINC TOPICAL OINTMENT
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
NDC 61924020404
|
| Hospital Charge Code |
115852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: ASR Commercial |
$14.84
|
| Rate for Payer: BCBS Trust/PPO |
$12.47
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Healthscope Whirlpool |
$14.84
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.00
|
| Rate for Payer: Nomi Health Commercial |
$12.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
|
|
VIT A-D3-E-ALOE VERA-ZINC TOPICAL OINTMENT
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
NDC 61924020404
|
| Hospital Charge Code |
115852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna Medicare |
$7.65
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: ASR Commercial |
$14.84
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: BCBS Trust/PPO |
$12.53
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Healthscope Whirlpool |
$14.84
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.00
|
| Rate for Payer: Nomi Health Commercial |
$12.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.41
|
| Rate for Payer: Priority Health Narrow Network |
$10.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
|
|
VITAMIN B COMPLEX CAPSULE
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 00536478701
|
| Hospital Charge Code |
804
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: ASR ASR |
$136.77
|
| Rate for Payer: ASR Commercial |
$136.77
|
| Rate for Payer: BCBS Trust/PPO |
$114.90
|
| Rate for Payer: BCN Commercial |
$109.32
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$141.00
|
| Rate for Payer: Healthscope Whirlpool |
$136.77
|
| Rate for Payer: Mclaren Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.08
|
|
|
VITAMIN B COMPLEX CAPSULE
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 00536478701
|
| Hospital Charge Code |
804
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: ASR ASR |
$136.77
|
| Rate for Payer: ASR Commercial |
$136.77
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS Trust/PPO |
$115.46
|
| Rate for Payer: BCN Commercial |
$109.32
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$141.00
|
| Rate for Payer: Healthscope Whirlpool |
$136.77
|
| Rate for Payer: Mclaren Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.54
|
| Rate for Payer: Priority Health Narrow Network |
$98.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.08
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
IP
|
$12.62
|
|
|
Service Code
|
NDC 41100081163
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$12.62 |
| Rate for Payer: Aetna Commercial |
$11.36
|
| Rate for Payer: ASR ASR |
$12.24
|
| Rate for Payer: ASR Commercial |
$12.24
|
| Rate for Payer: BCBS Trust/PPO |
$10.28
|
| Rate for Payer: BCN Commercial |
$9.78
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$11.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.10
|
| Rate for Payer: Healthscope Commercial |
$12.62
|
| Rate for Payer: Healthscope Whirlpool |
$12.24
|
| Rate for Payer: Mclaren Commercial |
$11.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.73
|
| Rate for Payer: Nomi Health Commercial |
$10.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.11
|
|
