|
VIVONEX RTF INTERMITTENT FEED
|
Facility
|
IP
|
$40.70
|
|
|
Service Code
|
NDC 43900036280
|
| Hospital Charge Code |
200088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: Aetna Commercial |
$34.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.45
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cofinity Advantage |
$28.49
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.56
|
| Rate for Payer: Healthscope Commercial |
$36.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.52
|
| Rate for Payer: PHP Commercial |
$34.59
|
| Rate for Payer: Priority Health SBD |
$25.64
|
|
|
VIVONEX RTF INTERMITTENT FEED
|
Facility
|
IP
|
$44.40
|
|
|
Service Code
|
NDC 00212362814
|
| Hospital Charge Code |
200088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$39.96 |
| Rate for Payer: Aetna Commercial |
$37.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.86
|
| Rate for Payer: Cash Price |
$35.52
|
| Rate for Payer: Cofinity Advantage |
$31.08
|
| Rate for Payer: Cofinity Commercial |
$38.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.52
|
| Rate for Payer: Healthscope Commercial |
$39.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.30
|
| Rate for Payer: PHP Commercial |
$37.74
|
| Rate for Payer: Priority Health SBD |
$27.97
|
|
|
VORICONAZOLE 200 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$70.45
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
33010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.38 |
| Max. Negotiated Rate |
$63.41 |
| Rate for Payer: Aetna Commercial |
$59.88
|
| Rate for Payer: Aetna Commercial |
$168.32
|
| Rate for Payer: Aetna Commercial |
$140.71
|
| Rate for Payer: Aetna Commercial |
$49.82
|
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.79
|
| Rate for Payer: Cash Price |
$46.89
|
| Rate for Payer: Cash Price |
$56.36
|
| Rate for Payer: Cash Price |
$158.42
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Advantage |
$44.27
|
| Rate for Payer: Cofinity Advantage |
$41.03
|
| Rate for Payer: Cofinity Advantage |
$49.31
|
| Rate for Payer: Cofinity Advantage |
$115.88
|
| Rate for Payer: Cofinity Advantage |
$138.61
|
| Rate for Payer: Cofinity Commercial |
$60.59
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Commercial |
$170.30
|
| Rate for Payer: Cofinity Commercial |
$142.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.36
|
| Rate for Payer: Healthscope Commercial |
$52.75
|
| Rate for Payer: Healthscope Commercial |
$63.41
|
| Rate for Payer: Healthscope Commercial |
$178.22
|
| Rate for Payer: Healthscope Commercial |
$148.99
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.84
|
| Rate for Payer: PHP Commercial |
$140.71
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: PHP Commercial |
$59.88
|
| Rate for Payer: PHP Commercial |
$168.32
|
| Rate for Payer: PHP Commercial |
$49.82
|
| Rate for Payer: Priority Health SBD |
$39.84
|
| Rate for Payer: Priority Health SBD |
$36.92
|
| Rate for Payer: Priority Health SBD |
$124.75
|
| Rate for Payer: Priority Health SBD |
$104.29
|
| Rate for Payer: Priority Health SBD |
$44.38
|
|
|
VORICONAZOLE 200 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$70.45
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
33010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$63.41 |
| Rate for Payer: Aetna Commercial |
$59.88
|
| Rate for Payer: Aetna Commercial |
$49.82
|
| Rate for Payer: Aetna Commercial |
$168.32
|
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna Commercial |
$140.71
|
| Rate for Payer: Aetna Medicare |
$82.77
|
| Rate for Payer: Aetna Medicare |
$99.01
|
| Rate for Payer: Aetna Medicare |
$29.30
|
| Rate for Payer: Aetna Medicare |
$35.23
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.60
|
| Rate for Payer: BCBS Complete |
$28.18
|
| Rate for Payer: BCBS Complete |
$79.21
|
| Rate for Payer: BCBS Complete |
$23.44
|
| Rate for Payer: BCBS Complete |
$66.22
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.87
|
| Rate for Payer: BCBS Trust/PPO |
$1.87
|
| Rate for Payer: BCBS Trust/PPO |
$1.87
|
| Rate for Payer: BCBS Trust/PPO |
$1.87
|
| Rate for Payer: BCBS Trust/PPO |
$1.87
|
| Rate for Payer: BCN Commercial |
$1.87
|
| Rate for Payer: BCN Commercial |
$1.87
|
| Rate for Payer: BCN Commercial |
$1.87
|
| Rate for Payer: BCN Commercial |
$1.87
|
| Rate for Payer: BCN Commercial |
$1.87
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cash Price |
$158.42
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$46.89
|
| Rate for Payer: Cash Price |
$158.42
|
| Rate for Payer: Cash Price |
$46.89
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cash Price |
$56.36
|
| Rate for Payer: Cash Price |
$56.36
|
| Rate for Payer: Cofinity Advantage |
$49.31
|
| Rate for Payer: Cofinity Advantage |
$44.27
|
| Rate for Payer: Cofinity Advantage |
$138.61
|
| Rate for Payer: Cofinity Advantage |
$115.88
|
| Rate for Payer: Cofinity Advantage |
$41.03
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$170.30
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Commercial |
$60.59
|
| Rate for Payer: Cofinity Commercial |
$142.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.42
|
| Rate for Payer: Healthscope Commercial |
$178.22
|
| Rate for Payer: Healthscope Commercial |
$63.41
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Healthscope Commercial |
$52.75
|
| Rate for Payer: Healthscope Commercial |
$148.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.43
|
| Rate for Payer: PHP Commercial |
$49.82
|
| Rate for Payer: PHP Commercial |
$168.32
|
| Rate for Payer: PHP Commercial |
$140.71
|
| Rate for Payer: PHP Commercial |
$59.88
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health SBD |
$36.92
|
| Rate for Payer: Priority Health SBD |
$39.84
|
| Rate for Payer: Priority Health SBD |
$44.38
|
| Rate for Payer: Priority Health SBD |
$124.75
|
| Rate for Payer: Priority Health SBD |
$104.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.24
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: UHC Exchange |
$1.24
|
| Rate for Payer: UHC Exchange |
$1.24
|
| Rate for Payer: UHC Exchange |
$1.24
|
| Rate for Payer: UHC Exchange |
$1.24
|
| Rate for Payer: UHC Exchange |
$1.24
|
|
|
VORICONAZOLE 200 MG TABLET
|
Facility
|
OP
|
$385.40
|
|
|
Service Code
|
NDC 00049318030
|
| Hospital Charge Code |
33009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.46 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna Medicare |
$192.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: BCBS Complete |
$154.16
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Advantage |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$308.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.05
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health SBD |
$242.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.51
|
| Rate for Payer: UHC Core |
$200.79
|
| Rate for Payer: UHC Exchange |
$151.46
|
|
|
VORICONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$180.15
|
|
|
Service Code
|
NDC 27241006303
|
| Hospital Charge Code |
33009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.49 |
| Max. Negotiated Rate |
$162.13 |
| Rate for Payer: Aetna Commercial |
$153.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.10
|
| Rate for Payer: Cash Price |
$144.12
|
| Rate for Payer: Cofinity Advantage |
$126.11
|
| Rate for Payer: Cofinity Commercial |
$154.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.12
|
| Rate for Payer: Healthscope Commercial |
$162.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.11
|
| Rate for Payer: PHP Commercial |
$153.13
|
| Rate for Payer: Priority Health SBD |
$113.49
|
|
|
VORICONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$385.40
|
|
|
Service Code
|
NDC 00049318030
|
| Hospital Charge Code |
33009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.80 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Advantage |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.05
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health SBD |
$242.80
|
|
|
VORICONAZOLE 200 MG TABLET
|
Facility
|
OP
|
$180.15
|
|
|
Service Code
|
NDC 27241006303
|
| Hospital Charge Code |
33009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$162.13 |
| Rate for Payer: Aetna Commercial |
$153.13
|
| Rate for Payer: Aetna Medicare |
$90.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.10
|
| Rate for Payer: BCBS Complete |
$72.06
|
| Rate for Payer: Cash Price |
$144.12
|
| Rate for Payer: Cofinity Advantage |
$126.11
|
| Rate for Payer: Cofinity Commercial |
$154.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.12
|
| Rate for Payer: Healthscope Commercial |
$162.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.11
|
| Rate for Payer: PHP Commercial |
$153.13
|
| Rate for Payer: Priority Health SBD |
$113.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.10
|
| Rate for Payer: UHC Core |
$93.86
|
| Rate for Payer: UHC Exchange |
$70.80
|
|
|
VORTIOXETINE 10 MG TABLET
|
Facility
|
OP
|
$1,857.70
|
|
|
Service Code
|
NDC 64764073030
|
| Hospital Charge Code |
168416
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$730.08 |
| Max. Negotiated Rate |
$1,671.93 |
| Rate for Payer: Aetna Commercial |
$1,579.05
|
| Rate for Payer: Aetna Medicare |
$928.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,207.51
|
| Rate for Payer: BCBS Complete |
$743.08
|
| Rate for Payer: Cash Price |
$1,486.16
|
| Rate for Payer: Cofinity Advantage |
$1,300.39
|
| Rate for Payer: Cofinity Commercial |
$1,597.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,486.16
|
| Rate for Payer: Healthscope Commercial |
$1,671.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,486.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,579.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,393.28
|
| Rate for Payer: PHP Commercial |
$1,579.05
|
| Rate for Payer: Priority Health SBD |
$1,170.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,207.51
|
| Rate for Payer: UHC Core |
$967.86
|
| Rate for Payer: UHC Exchange |
$730.08
|
|
|
VORTIOXETINE 10 MG TABLET
|
Facility
|
IP
|
$1,857.70
|
|
|
Service Code
|
NDC 64764073030
|
| Hospital Charge Code |
168416
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,170.35 |
| Max. Negotiated Rate |
$1,671.93 |
| Rate for Payer: Aetna Commercial |
$1,579.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,207.51
|
| Rate for Payer: Cash Price |
$1,486.16
|
| Rate for Payer: Cofinity Advantage |
$1,300.39
|
| Rate for Payer: Cofinity Commercial |
$1,597.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,486.16
|
| Rate for Payer: Healthscope Commercial |
$1,671.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,579.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,393.28
|
| Rate for Payer: PHP Commercial |
$1,579.05
|
| Rate for Payer: Priority Health SBD |
$1,170.35
|
|
|
VORTIOXETINE 5 MG TABLET
|
Facility
|
OP
|
$1,857.70
|
|
|
Service Code
|
NDC 64764072030
|
| Hospital Charge Code |
168415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$730.08 |
| Max. Negotiated Rate |
$1,671.93 |
| Rate for Payer: Aetna Commercial |
$1,579.05
|
| Rate for Payer: Aetna Medicare |
$928.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,207.51
|
| Rate for Payer: BCBS Complete |
$743.08
|
| Rate for Payer: Cash Price |
$1,486.16
|
| Rate for Payer: Cofinity Advantage |
$1,300.39
|
| Rate for Payer: Cofinity Commercial |
$1,597.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,486.16
|
| Rate for Payer: Healthscope Commercial |
$1,671.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,486.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,579.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,393.28
|
| Rate for Payer: PHP Commercial |
$1,579.05
|
| Rate for Payer: Priority Health SBD |
$1,170.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,207.51
|
| Rate for Payer: UHC Core |
$967.86
|
| Rate for Payer: UHC Exchange |
$730.08
|
|
|
VORTIOXETINE 5 MG TABLET
|
Facility
|
IP
|
$1,857.70
|
|
|
Service Code
|
NDC 64764072030
|
| Hospital Charge Code |
168415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,170.35 |
| Max. Negotiated Rate |
$1,671.93 |
| Rate for Payer: Aetna Commercial |
$1,579.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,207.51
|
| Rate for Payer: Cash Price |
$1,486.16
|
| Rate for Payer: Cofinity Advantage |
$1,300.39
|
| Rate for Payer: Cofinity Commercial |
$1,597.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,486.16
|
| Rate for Payer: Healthscope Commercial |
$1,671.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,579.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,393.28
|
| Rate for Payer: PHP Commercial |
$1,579.05
|
| Rate for Payer: Priority Health SBD |
$1,170.35
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
OP
|
$272.60
|
|
|
Service Code
|
NDC 00832121101
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.13 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna Medicare |
$136.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.19
|
| Rate for Payer: BCBS Complete |
$109.04
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Advantage |
$190.82
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.45
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health SBD |
$171.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.19
|
| Rate for Payer: UHC Core |
$142.02
|
| Rate for Payer: UHC Exchange |
$107.13
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 51672402701
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Advantage |
$135.00
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.64
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health SBD |
$121.50
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
OP
|
$258.50
|
|
|
Service Code
|
NDC 00093171201
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: Aetna Medicare |
$129.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.03
|
| Rate for Payer: BCBS Complete |
$103.40
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Advantage |
$180.95
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.88
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health SBD |
$162.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.03
|
| Rate for Payer: UHC Core |
$134.68
|
| Rate for Payer: UHC Exchange |
$101.59
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$272.60
|
|
|
Service Code
|
NDC 00832121101
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.74 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.19
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Advantage |
$190.82
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.45
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health SBD |
$171.74
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
NDC 00832121189
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna Medicare |
$1.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: BCBS Complete |
$1.09
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Advantage |
$1.91
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: Priority Health SBD |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.77
|
| Rate for Payer: UHC Core |
$1.42
|
| Rate for Payer: UHC Exchange |
$1.07
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
NDC 00832121189
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Advantage |
$1.91
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: Priority Health SBD |
$1.72
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$258.50
|
|
|
Service Code
|
NDC 00093171201
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.85 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.03
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Advantage |
$180.95
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.88
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health SBD |
$162.85
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
OP
|
$192.85
|
|
|
Service Code
|
NDC 51672402701
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.79 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna Medicare |
$96.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: BCBS Complete |
$77.14
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Advantage |
$135.00
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.64
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health SBD |
$121.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.35
|
| Rate for Payer: UHC Core |
$100.47
|
| Rate for Payer: UHC Exchange |
$75.79
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
IP
|
$278.35
|
|
|
Service Code
|
NDC 68084002711
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.36 |
| Max. Negotiated Rate |
$250.51 |
| Rate for Payer: Aetna Commercial |
$236.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.93
|
| Rate for Payer: Cash Price |
$222.68
|
| Rate for Payer: Cofinity Advantage |
$194.84
|
| Rate for Payer: Cofinity Commercial |
$239.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.68
|
| Rate for Payer: Healthscope Commercial |
$250.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.76
|
| Rate for Payer: PHP Commercial |
$236.60
|
| Rate for Payer: Priority Health SBD |
$175.36
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
NDC 00832121389
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Advantage |
$1.91
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: Priority Health SBD |
$1.72
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
IP
|
$272.60
|
|
|
Service Code
|
NDC 00832121301
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.74 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.19
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Advantage |
$190.82
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.45
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health SBD |
$171.74
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
OP
|
$272.60
|
|
|
Service Code
|
NDC 00832121301
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.13 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna Medicare |
$136.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.19
|
| Rate for Payer: BCBS Complete |
$109.04
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Advantage |
$190.82
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.45
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health SBD |
$171.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.19
|
| Rate for Payer: UHC Core |
$142.02
|
| Rate for Payer: UHC Exchange |
$107.13
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
OP
|
$278.35
|
|
|
Service Code
|
NDC 68084002701
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.39 |
| Max. Negotiated Rate |
$250.51 |
| Rate for Payer: Aetna Commercial |
$236.60
|
| Rate for Payer: Aetna Medicare |
$139.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.93
|
| Rate for Payer: BCBS Complete |
$111.34
|
| Rate for Payer: Cash Price |
$222.68
|
| Rate for Payer: Cofinity Advantage |
$194.84
|
| Rate for Payer: Cofinity Commercial |
$239.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.68
|
| Rate for Payer: Healthscope Commercial |
$250.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.76
|
| Rate for Payer: PHP Commercial |
$236.60
|
| Rate for Payer: Priority Health SBD |
$175.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.93
|
| Rate for Payer: UHC Core |
$145.02
|
| Rate for Payer: UHC Exchange |
$109.39
|
|
