|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
OP
|
$329.28
|
|
|
Service Code
|
NDC 68084008301
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.71 |
| Max. Negotiated Rate |
$329.28 |
| Rate for Payer: Aetna Commercial |
$296.35
|
| Rate for Payer: Aetna Medicare |
$164.64
|
| Rate for Payer: ASR ASR |
$319.40
|
| Rate for Payer: ASR Commercial |
$319.40
|
| Rate for Payer: BCBS Complete |
$131.71
|
| Rate for Payer: BCBS Trust/PPO |
$269.65
|
| Rate for Payer: BCN Commercial |
$255.29
|
| Rate for Payer: Cash Price |
$263.42
|
| Rate for Payer: Cofinity Commercial |
$309.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.42
|
| Rate for Payer: Healthscope Commercial |
$329.28
|
| Rate for Payer: Healthscope Whirlpool |
$319.40
|
| Rate for Payer: Mclaren Commercial |
$296.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.89
|
| Rate for Payer: Nomi Health Commercial |
$270.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.52
|
| Rate for Payer: Priority Health Narrow Network |
$230.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.77
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
OP
|
$242.88
|
|
|
Service Code
|
NDC 00904662061
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.15 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$218.59
|
| Rate for Payer: Aetna Medicare |
$121.44
|
| Rate for Payer: ASR ASR |
$235.59
|
| Rate for Payer: ASR Commercial |
$235.59
|
| Rate for Payer: BCBS Complete |
$97.15
|
| Rate for Payer: BCBS Trust/PPO |
$198.89
|
| Rate for Payer: BCN Commercial |
$188.30
|
| Rate for Payer: Cash Price |
$194.30
|
| Rate for Payer: Cofinity Commercial |
$228.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.30
|
| Rate for Payer: Healthscope Commercial |
$242.88
|
| Rate for Payer: Healthscope Whirlpool |
$235.59
|
| Rate for Payer: Mclaren Commercial |
$218.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.45
|
| Rate for Payer: Nomi Health Commercial |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.81
|
| Rate for Payer: Priority Health Narrow Network |
$170.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.73
|
|
|
ISOSORBIDE MONONITRATE 20 MG TABLET
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 00228262011
|
| Hospital Charge Code |
10357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.09 |
| Max. Negotiated Rate |
$392.45 |
| Rate for Payer: Aetna Commercial |
$353.20
|
| Rate for Payer: ASR ASR |
$380.68
|
| Rate for Payer: ASR Commercial |
$380.68
|
| Rate for Payer: BCBS Trust/PPO |
$319.81
|
| Rate for Payer: BCN Commercial |
$304.27
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$368.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$392.45
|
| Rate for Payer: Healthscope Whirlpool |
$380.68
|
| Rate for Payer: Mclaren Commercial |
$353.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Nomi Health Commercial |
$321.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$345.36
|
|
|
ISOSORBIDE MONONITRATE 20 MG TABLET
|
Facility
|
OP
|
$392.45
|
|
|
Service Code
|
NDC 00228262011
|
| Hospital Charge Code |
10357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.98 |
| Max. Negotiated Rate |
$392.45 |
| Rate for Payer: Aetna Commercial |
$353.20
|
| Rate for Payer: Aetna Medicare |
$196.22
|
| Rate for Payer: ASR ASR |
$380.68
|
| Rate for Payer: ASR Commercial |
$380.68
|
| Rate for Payer: BCBS Complete |
$156.98
|
| Rate for Payer: BCBS Trust/PPO |
$321.38
|
| Rate for Payer: BCN Commercial |
$304.27
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$368.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$392.45
|
| Rate for Payer: Healthscope Whirlpool |
$380.68
|
| Rate for Payer: Mclaren Commercial |
$353.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Nomi Health Commercial |
$321.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.86
|
| Rate for Payer: Priority Health Narrow Network |
$275.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$345.36
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$464.55
|
|
|
Service Code
|
NDC 68084059101
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.82 |
| Max. Negotiated Rate |
$464.55 |
| Rate for Payer: Aetna Commercial |
$418.10
|
| Rate for Payer: Aetna Medicare |
$232.28
|
| Rate for Payer: ASR ASR |
$450.61
|
| Rate for Payer: ASR Commercial |
$450.61
|
| Rate for Payer: BCBS Complete |
$185.82
|
| Rate for Payer: BCBS Trust/PPO |
$380.42
|
| Rate for Payer: BCN Commercial |
$360.17
|
| Rate for Payer: Cash Price |
$371.64
|
| Rate for Payer: Cofinity Commercial |
$436.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.64
|
| Rate for Payer: Healthscope Commercial |
$464.55
|
| Rate for Payer: Healthscope Whirlpool |
$450.61
|
| Rate for Payer: Mclaren Commercial |
$418.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.87
|
| Rate for Payer: Nomi Health Commercial |
$380.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$407.04
|
| Rate for Payer: Priority Health Narrow Network |
$325.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$408.80
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$464.55
|
|
|
Service Code
|
NDC 68084059101
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$301.96 |
| Max. Negotiated Rate |
$464.55 |
| Rate for Payer: Aetna Commercial |
$418.10
|
| Rate for Payer: ASR ASR |
$450.61
|
| Rate for Payer: ASR Commercial |
$450.61
|
| Rate for Payer: BCBS Trust/PPO |
$378.56
|
| Rate for Payer: BCN Commercial |
$360.17
|
| Rate for Payer: Cash Price |
$371.64
|
| Rate for Payer: Cofinity Commercial |
$436.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.64
|
| Rate for Payer: Healthscope Commercial |
$464.55
|
| Rate for Payer: Healthscope Whirlpool |
$450.61
|
| Rate for Payer: Mclaren Commercial |
$418.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.87
|
| Rate for Payer: Nomi Health Commercial |
$380.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$408.80
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$248.90
|
|
|
Service Code
|
NDC 00904644961
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.78 |
| Max. Negotiated Rate |
$248.90 |
| Rate for Payer: Aetna Commercial |
$224.01
|
| Rate for Payer: ASR ASR |
$241.43
|
| Rate for Payer: ASR Commercial |
$241.43
|
| Rate for Payer: BCBS Trust/PPO |
$202.83
|
| Rate for Payer: BCN Commercial |
$192.97
|
| Rate for Payer: Cash Price |
$199.12
|
| Rate for Payer: Cofinity Commercial |
$233.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.12
|
| Rate for Payer: Healthscope Commercial |
$248.90
|
| Rate for Payer: Healthscope Whirlpool |
$241.43
|
| Rate for Payer: Mclaren Commercial |
$224.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.56
|
| Rate for Payer: Nomi Health Commercial |
$204.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.03
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4.65
|
|
|
Service Code
|
NDC 68084059111
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: ASR ASR |
$4.51
|
| Rate for Payer: ASR Commercial |
$4.51
|
| Rate for Payer: BCBS Trust/PPO |
$3.79
|
| Rate for Payer: BCN Commercial |
$3.61
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cofinity Commercial |
$4.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.72
|
| Rate for Payer: Healthscope Commercial |
$4.65
|
| Rate for Payer: Healthscope Whirlpool |
$4.51
|
| Rate for Payer: Mclaren Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.95
|
| Rate for Payer: Nomi Health Commercial |
$3.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.09
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4.65
|
|
|
Service Code
|
NDC 68084059111
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna Medicare |
$2.32
|
| Rate for Payer: ASR ASR |
$4.51
|
| Rate for Payer: ASR Commercial |
$4.51
|
| Rate for Payer: BCBS Complete |
$1.86
|
| Rate for Payer: BCBS Trust/PPO |
$3.81
|
| Rate for Payer: BCN Commercial |
$3.61
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cofinity Commercial |
$4.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.72
|
| Rate for Payer: Healthscope Commercial |
$4.65
|
| Rate for Payer: Healthscope Whirlpool |
$4.51
|
| Rate for Payer: Mclaren Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.95
|
| Rate for Payer: Nomi Health Commercial |
$3.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.07
|
| Rate for Payer: Priority Health Narrow Network |
$3.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.09
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$248.90
|
|
|
Service Code
|
NDC 00904644961
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.56 |
| Max. Negotiated Rate |
$248.90 |
| Rate for Payer: Aetna Commercial |
$224.01
|
| Rate for Payer: Aetna Medicare |
$124.45
|
| Rate for Payer: ASR ASR |
$241.43
|
| Rate for Payer: ASR Commercial |
$241.43
|
| Rate for Payer: BCBS Complete |
$99.56
|
| Rate for Payer: BCBS Trust/PPO |
$203.82
|
| Rate for Payer: BCN Commercial |
$192.97
|
| Rate for Payer: Cash Price |
$199.12
|
| Rate for Payer: Cofinity Commercial |
$233.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.12
|
| Rate for Payer: Healthscope Commercial |
$248.90
|
| Rate for Payer: Healthscope Whirlpool |
$241.43
|
| Rate for Payer: Mclaren Commercial |
$224.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.56
|
| Rate for Payer: Nomi Health Commercial |
$204.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.09
|
| Rate for Payer: Priority Health Narrow Network |
$174.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.03
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$294.50
|
|
|
Service Code
|
NDC 00904645061
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.42 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Aetna Commercial |
$265.05
|
| Rate for Payer: ASR ASR |
$285.66
|
| Rate for Payer: ASR Commercial |
$285.66
|
| Rate for Payer: BCBS Trust/PPO |
$239.99
|
| Rate for Payer: BCN Commercial |
$228.33
|
| Rate for Payer: Cash Price |
$235.60
|
| Rate for Payer: Cofinity Commercial |
$276.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.60
|
| Rate for Payer: Healthscope Commercial |
$294.50
|
| Rate for Payer: Healthscope Whirlpool |
$285.66
|
| Rate for Payer: Mclaren Commercial |
$265.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.32
|
| Rate for Payer: Nomi Health Commercial |
$241.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.16
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
NDC 50268045211
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna Commercial |
$3.04
|
| Rate for Payer: Aetna Medicare |
$1.69
|
| Rate for Payer: ASR ASR |
$3.28
|
| Rate for Payer: ASR Commercial |
$3.28
|
| Rate for Payer: BCBS Complete |
$1.35
|
| Rate for Payer: BCBS Trust/PPO |
$2.77
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Healthscope Whirlpool |
$3.28
|
| Rate for Payer: Mclaren Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.87
|
| Rate for Payer: Nomi Health Commercial |
$2.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.96
|
| Rate for Payer: Priority Health Narrow Network |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.97
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.38
|
|
|
Service Code
|
NDC 50268045211
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna Commercial |
$3.04
|
| Rate for Payer: ASR ASR |
$3.28
|
| Rate for Payer: ASR Commercial |
$3.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.75
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Healthscope Whirlpool |
$3.28
|
| Rate for Payer: Mclaren Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.87
|
| Rate for Payer: Nomi Health Commercial |
$2.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.97
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$168.72
|
|
|
Service Code
|
NDC 50268045215
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.67 |
| Max. Negotiated Rate |
$168.72 |
| Rate for Payer: Aetna Commercial |
$151.85
|
| Rate for Payer: ASR ASR |
$163.66
|
| Rate for Payer: ASR Commercial |
$163.66
|
| Rate for Payer: BCBS Trust/PPO |
$137.49
|
| Rate for Payer: BCN Commercial |
$130.81
|
| Rate for Payer: Cash Price |
$134.98
|
| Rate for Payer: Cofinity Commercial |
$158.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.98
|
| Rate for Payer: Healthscope Commercial |
$168.72
|
| Rate for Payer: Healthscope Whirlpool |
$163.66
|
| Rate for Payer: Mclaren Commercial |
$151.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.41
|
| Rate for Payer: Nomi Health Commercial |
$138.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.47
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$168.72
|
|
|
Service Code
|
NDC 50268045215
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.49 |
| Max. Negotiated Rate |
$168.72 |
| Rate for Payer: Aetna Commercial |
$151.85
|
| Rate for Payer: Aetna Medicare |
$84.36
|
| Rate for Payer: ASR ASR |
$163.66
|
| Rate for Payer: ASR Commercial |
$163.66
|
| Rate for Payer: BCBS Complete |
$67.49
|
| Rate for Payer: BCBS Trust/PPO |
$138.16
|
| Rate for Payer: BCN Commercial |
$130.81
|
| Rate for Payer: Cash Price |
$134.98
|
| Rate for Payer: Cofinity Commercial |
$158.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.98
|
| Rate for Payer: Healthscope Commercial |
$168.72
|
| Rate for Payer: Healthscope Whirlpool |
$163.66
|
| Rate for Payer: Mclaren Commercial |
$151.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.41
|
| Rate for Payer: Nomi Health Commercial |
$138.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.83
|
| Rate for Payer: Priority Health Narrow Network |
$118.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.47
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$294.50
|
|
|
Service Code
|
NDC 00904645061
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.80 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Aetna Commercial |
$265.05
|
| Rate for Payer: Aetna Medicare |
$147.25
|
| Rate for Payer: ASR ASR |
$285.66
|
| Rate for Payer: ASR Commercial |
$285.66
|
| Rate for Payer: BCBS Complete |
$117.80
|
| Rate for Payer: BCBS Trust/PPO |
$241.17
|
| Rate for Payer: BCN Commercial |
$228.33
|
| Rate for Payer: Cash Price |
$235.60
|
| Rate for Payer: Cofinity Commercial |
$276.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.60
|
| Rate for Payer: Healthscope Commercial |
$294.50
|
| Rate for Payer: Healthscope Whirlpool |
$285.66
|
| Rate for Payer: Mclaren Commercial |
$265.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.32
|
| Rate for Payer: Nomi Health Commercial |
$241.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$258.04
|
| Rate for Payer: Priority Health Narrow Network |
$206.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.16
|
|
|
ISOSOURCE 1.5 BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018150
|
| Hospital Charge Code |
150768
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.87
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
ISOSOURCE 1.5 BOLUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018150
|
| Hospital Charge Code |
150768
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
ISOSOURCE 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018150
|
| Hospital Charge Code |
168943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
ISOSOURCE 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 43900018181
|
| Hospital Charge Code |
168943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna Commercial |
$8.64
|
| Rate for Payer: ASR ASR |
$9.31
|
| Rate for Payer: ASR Commercial |
$9.31
|
| Rate for Payer: BCBS Trust/PPO |
$7.82
|
| Rate for Payer: BCN Commercial |
$7.44
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$9.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$9.60
|
| Rate for Payer: Healthscope Whirlpool |
$9.31
|
| Rate for Payer: Mclaren Commercial |
$8.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Nomi Health Commercial |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.45
|
|
|
ISOSOURCE 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018150
|
| Hospital Charge Code |
168943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.87
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
ISOSOURCE 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 43900018181
|
| Hospital Charge Code |
168943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna Commercial |
$8.64
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: ASR ASR |
$9.31
|
| Rate for Payer: ASR Commercial |
$9.31
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: BCBS Trust/PPO |
$7.86
|
| Rate for Payer: BCN Commercial |
$7.44
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$9.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$9.60
|
| Rate for Payer: Healthscope Whirlpool |
$9.31
|
| Rate for Payer: Mclaren Commercial |
$8.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Nomi Health Commercial |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.41
|
| Rate for Payer: Priority Health Narrow Network |
$6.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.45
|
|
|
ISOSOURCE 1.5 CYCLIC FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018150
|
| Hospital Charge Code |
200081
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
ISOSOURCE 1.5 CYCLIC FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018150
|
| Hospital Charge Code |
200081
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.87
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
ISOSOURCE 1.5 INTERMITTENT FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018150
|
| Hospital Charge Code |
200080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
