|
VASOPRESSIN INJ 5U/ML
|
Facility
|
OP
|
$70.40
|
|
| Hospital Charge Code |
6005623
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$35.20 |
| Rate for Payer: Aetna Commercial |
$21.12
|
| Rate for Payer: Aetna Medicare Advantage |
$21.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.95
|
| Rate for Payer: Cigna Commercial |
$35.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.15
|
| Rate for Payer: Oxford Commercial |
$35.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$35.20
|
|
|
VASOPRESSIN INJ 5U/ML
|
Facility
|
IP
|
$70.40
|
|
| Hospital Charge Code |
6005623
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.56
|
|
|
VASOPRESSIN VL 20U
|
Facility
|
OP
|
$15.40
|
|
| Hospital Charge Code |
6013288
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$7.70 |
| Rate for Payer: Aetna Commercial |
$4.62
|
| Rate for Payer: Aetna Medicare Advantage |
$4.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.93
|
| Rate for Payer: Cigna Commercial |
$7.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.00
|
| Rate for Payer: Oxford Commercial |
$7.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.70
|
|
|
VASOPRESSIN VL 20U
|
Facility
|
IP
|
$15.40
|
|
| Hospital Charge Code |
6013288
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.31
|
|
|
VASOSULF/5ML
|
Facility
|
OP
|
$43.00
|
|
| Hospital Charge Code |
60634548
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Aetna Commercial |
$12.90
|
| Rate for Payer: Aetna Medicare Advantage |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.96
|
| Rate for Payer: Cigna Commercial |
$21.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.59
|
| Rate for Payer: Oxford Commercial |
$21.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.50
|
|
|
VASOSULF/5ML
|
Facility
|
IP
|
$43.00
|
|
| Hospital Charge Code |
60634548
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$6.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.45
|
|
|
VASOSULF OPHTH/5ML
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
60634132
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.70
|
|
|
VASOSULF OPHTH/5ML
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
60634132
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna Commercial |
$11.40
|
| Rate for Payer: Aetna Medicare Advantage |
$11.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.69
|
| Rate for Payer: Cigna Commercial |
$19.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.94
|
| Rate for Payer: Oxford Commercial |
$19.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.00
|
|
|
VASOTEC/10MG/TAB
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
60634138
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.75
|
|
|
VASOTEC/10MG/TAB
|
Facility
|
IP
|
$7.00
|
|
| Hospital Charge Code |
60634137
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.05
|
|
|
VASOTEC/10MG/TAB
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
60634138
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.27
|
| Rate for Payer: Cigna Commercial |
$2.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.65
|
| Rate for Payer: Oxford Commercial |
$2.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.50
|
|
|
VASOTEC/10MG/TAB
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
60634137
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.78
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.91
|
| Rate for Payer: Oxford Commercial |
$3.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.50
|
|
|
VASOTEC/20MG/TAB
|
Facility
|
IP
|
$18.56
|
|
|
Service Code
|
NDC 93002901
|
| Hospital Charge Code |
60634139
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$2.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.78
|
|
|
VASOTEC/20MG/TAB
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
60634140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.20
|
|
|
VASOTEC/20MG/TAB
|
Facility
|
OP
|
$18.56
|
|
|
Service Code
|
NDC 93002901
|
| Hospital Charge Code |
60634139
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: Aetna Commercial |
$5.57
|
| Rate for Payer: Aetna Medicare Advantage |
$5.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.73
|
| Rate for Payer: Cigna Commercial |
$9.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.41
|
| Rate for Payer: Oxford Commercial |
$9.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.28
|
|
|
VASOTEC/20MG/TAB
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
60634140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna Medicare Advantage |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.04
|
| Rate for Payer: Cigna Commercial |
$4.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.04
|
| Rate for Payer: Oxford Commercial |
$4.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.00
|
|
|
VASOTEC/2.5MG/TAB
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
60634135
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.27
|
| Rate for Payer: Cigna Commercial |
$2.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.65
|
| Rate for Payer: Oxford Commercial |
$2.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.50
|
|
|
VASOTEC/2.5MG/TAB
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
60634134
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.75
|
|
|
VASOTEC/2.5MG/TAB
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
60634134
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.27
|
| Rate for Payer: Cigna Commercial |
$2.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.65
|
| Rate for Payer: Oxford Commercial |
$2.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.50
|
|
|
VASOTEC/2.5MG/TAB
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
60634135
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.75
|
|
|
VASOTEC/5MG/TAB
|
Facility
|
OP
|
$10.32
|
|
|
Service Code
|
NDC 904550261
|
| Hospital Charge Code |
60634133
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Aetna Commercial |
$3.10
|
| Rate for Payer: Aetna Medicare Advantage |
$3.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.63
|
| Rate for Payer: Cigna Commercial |
$5.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.34
|
| Rate for Payer: Oxford Commercial |
$5.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.16
|
|
|
VASOTEC/5MG/TAB
|
Facility
|
IP
|
$10.32
|
|
|
Service Code
|
NDC 904550261
|
| Hospital Charge Code |
60634133
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.55
|
|
|
VASOTEC/5MG/TAB
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
60634136
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.90
|
|
|
VASOTEC/5MG/TAB
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
60634136
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.53
|
| Rate for Payer: Cigna Commercial |
$3.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.78
|
| Rate for Payer: Oxford Commercial |
$3.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.00
|
|
|
VASOTEC I.V./1.25MG/1ML
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
60634141
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.60
|
|