|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
IP
|
$485.07
|
|
|
Service Code
|
NDC 60687012765
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$363.80 |
| Max. Negotiated Rate |
$485.07 |
| Rate for Payer: Aetna Commercial |
$436.56
|
| Rate for Payer: ASR ASR |
$470.52
|
| Rate for Payer: BCBS Trust/PPO |
$398.34
|
| Rate for Payer: BCN Commercial |
$398.34
|
| Rate for Payer: Cash Price |
$388.06
|
| Rate for Payer: Cofinity Commercial |
$455.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.06
|
| Rate for Payer: Healthscope Commercial |
$470.52
|
| Rate for Payer: Healthscope Whirlpool |
$485.07
|
| Rate for Payer: Mclaren Commercial |
$436.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.31
|
| Rate for Payer: Nomi Health Commercial |
$397.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.86
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
IP
|
$440.86
|
|
|
Service Code
|
NDC 904670606
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$330.64 |
| Max. Negotiated Rate |
$440.86 |
| Rate for Payer: Aetna Commercial |
$396.77
|
| Rate for Payer: ASR ASR |
$427.63
|
| Rate for Payer: BCBS Trust/PPO |
$362.03
|
| Rate for Payer: BCN Commercial |
$362.03
|
| Rate for Payer: Cash Price |
$352.68
|
| Rate for Payer: Cofinity Commercial |
$414.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.68
|
| Rate for Payer: Healthscope Commercial |
$427.63
|
| Rate for Payer: Healthscope Whirlpool |
$440.86
|
| Rate for Payer: Mclaren Commercial |
$396.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.73
|
| Rate for Payer: Nomi Health Commercial |
$361.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$387.95
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$495.43
|
|
|
Service Code
|
NDC 904749506
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.31 |
| Max. Negotiated Rate |
$495.43 |
| Rate for Payer: Aetna Commercial |
$445.89
|
| Rate for Payer: Aetna Medicare |
$183.31
|
| Rate for Payer: ASR ASR |
$480.57
|
| Rate for Payer: BCBS Complete |
$198.17
|
| Rate for Payer: BCBS Trust/PPO |
$408.48
|
| Rate for Payer: BCN Commercial |
$408.48
|
| Rate for Payer: Cash Price |
$396.34
|
| Rate for Payer: Cofinity Commercial |
$465.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.34
|
| Rate for Payer: Healthscope Commercial |
$480.57
|
| Rate for Payer: Healthscope Whirlpool |
$495.43
|
| Rate for Payer: Mclaren Commercial |
$445.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$396.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.12
|
| Rate for Payer: Nomi Health Commercial |
$406.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$434.10
|
| Rate for Payer: Priority Health Narrow Network |
$347.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.98
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$9.70
|
|
|
Service Code
|
NDC 60687012711
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: Aetna Commercial |
$8.73
|
| Rate for Payer: Aetna Medicare |
$3.59
|
| Rate for Payer: ASR ASR |
$9.41
|
| Rate for Payer: BCBS Complete |
$3.88
|
| Rate for Payer: BCBS Trust/PPO |
$8.00
|
| Rate for Payer: BCN Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$7.76
|
| Rate for Payer: Cofinity Commercial |
$9.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.76
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Healthscope Whirlpool |
$9.70
|
| Rate for Payer: Mclaren Commercial |
$8.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.25
|
| Rate for Payer: Nomi Health Commercial |
$7.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.50
|
| Rate for Payer: Priority Health Narrow Network |
$6.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.54
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$66.41
|
|
|
Service Code
|
NDC 57237007710
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna Medicare |
$24.57
|
| Rate for Payer: ASR ASR |
$64.41
|
| Rate for Payer: BCBS Complete |
$26.56
|
| Rate for Payer: BCBS Trust/PPO |
$54.75
|
| Rate for Payer: BCN Commercial |
$54.75
|
| Rate for Payer: Cash Price |
$53.12
|
| Rate for Payer: Cofinity Commercial |
$62.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.12
|
| Rate for Payer: Healthscope Commercial |
$64.41
|
| Rate for Payer: Healthscope Whirlpool |
$66.41
|
| Rate for Payer: Mclaren Commercial |
$59.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.44
|
| Rate for Payer: Nomi Health Commercial |
$54.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58.18
|
| Rate for Payer: Priority Health Narrow Network |
$46.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.44
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$139.59
|
|
|
Service Code
|
NDC 68462015713
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna Commercial |
$125.63
|
| Rate for Payer: ASR ASR |
$135.40
|
| Rate for Payer: BCBS Trust/PPO |
$114.63
|
| Rate for Payer: BCN Commercial |
$114.63
|
| Rate for Payer: Cash Price |
$111.67
|
| Rate for Payer: Cofinity Commercial |
$131.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.67
|
| Rate for Payer: Healthscope Commercial |
$135.40
|
| Rate for Payer: Healthscope Whirlpool |
$139.59
|
| Rate for Payer: Mclaren Commercial |
$125.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.65
|
| Rate for Payer: Nomi Health Commercial |
$114.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.84
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$4.65
|
|
|
Service Code
|
NDC 68462015740
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna Commercial |
$4.19
|
| Rate for Payer: Aetna Medicare |
$1.72
|
| Rate for Payer: ASR ASR |
$4.51
|
| Rate for Payer: BCBS Complete |
$1.86
|
| Rate for Payer: BCBS Trust/PPO |
$3.84
|
| Rate for Payer: BCN Commercial |
$3.84
|
| 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 |
$4.51
|
| Rate for Payer: Healthscope Whirlpool |
$4.65
|
| Rate for Payer: Mclaren Commercial |
$4.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: Nomi Health Commercial |
$3.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.08
|
| Rate for Payer: Priority Health Narrow Network |
$3.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.09
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$81.94
|
|
|
Service Code
|
NDC 65862039010
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.45 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$73.74
|
| Rate for Payer: ASR ASR |
$79.48
|
| Rate for Payer: BCBS Trust/PPO |
$67.29
|
| Rate for Payer: BCN Commercial |
$67.29
|
| Rate for Payer: Cash Price |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$77.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.55
|
| Rate for Payer: Healthscope Commercial |
$79.48
|
| Rate for Payer: Healthscope Whirlpool |
$81.94
|
| Rate for Payer: Mclaren Commercial |
$73.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.65
|
| Rate for Payer: Nomi Health Commercial |
$67.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.10
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$66.41
|
|
|
Service Code
|
NDC 57237007710
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: ASR ASR |
$64.41
|
| Rate for Payer: BCBS Trust/PPO |
$54.53
|
| Rate for Payer: BCN Commercial |
$54.53
|
| Rate for Payer: Cash Price |
$53.12
|
| Rate for Payer: Cofinity Commercial |
$62.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.12
|
| Rate for Payer: Healthscope Commercial |
$64.41
|
| Rate for Payer: Healthscope Whirlpool |
$66.41
|
| Rate for Payer: Mclaren Commercial |
$59.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.44
|
| Rate for Payer: Nomi Health Commercial |
$54.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.44
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$81.94
|
|
|
Service Code
|
NDC 65862039010
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$73.74
|
| Rate for Payer: Aetna Medicare |
$30.32
|
| Rate for Payer: ASR ASR |
$79.48
|
| Rate for Payer: BCBS Complete |
$32.77
|
| Rate for Payer: BCBS Trust/PPO |
$67.56
|
| Rate for Payer: BCN Commercial |
$67.56
|
| Rate for Payer: Cash Price |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$77.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.55
|
| Rate for Payer: Healthscope Commercial |
$79.48
|
| Rate for Payer: Healthscope Whirlpool |
$81.94
|
| Rate for Payer: Mclaren Commercial |
$73.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.65
|
| Rate for Payer: Nomi Health Commercial |
$67.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$71.79
|
| Rate for Payer: Priority Health Narrow Network |
$57.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.10
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$139.59
|
|
|
Service Code
|
NDC 68462015713
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.65 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna Commercial |
$125.63
|
| Rate for Payer: Aetna Medicare |
$51.65
|
| Rate for Payer: ASR ASR |
$135.40
|
| Rate for Payer: BCBS Complete |
$55.84
|
| Rate for Payer: BCBS Trust/PPO |
$115.09
|
| Rate for Payer: BCN Commercial |
$115.09
|
| Rate for Payer: Cash Price |
$111.67
|
| Rate for Payer: Cofinity Commercial |
$131.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.67
|
| Rate for Payer: Healthscope Commercial |
$135.40
|
| Rate for Payer: Healthscope Whirlpool |
$139.59
|
| Rate for Payer: Mclaren Commercial |
$125.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.65
|
| Rate for Payer: Nomi Health Commercial |
$114.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$122.31
|
| Rate for Payer: Priority Health Narrow Network |
$97.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.84
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.65
|
|
|
Service Code
|
NDC 68462015740
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna Commercial |
$4.19
|
| Rate for Payer: ASR ASR |
$4.51
|
| Rate for Payer: BCBS Trust/PPO |
$3.82
|
| Rate for Payer: BCN Commercial |
$3.82
|
| 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 |
$4.51
|
| Rate for Payer: Healthscope Whirlpool |
$4.65
|
| Rate for Payer: Mclaren Commercial |
$4.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: Nomi Health Commercial |
$3.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.09
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$47.81
|
|
|
Service Code
|
NDC 904707393
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$47.81 |
| Rate for Payer: Aetna Commercial |
$43.03
|
| Rate for Payer: Aetna Medicare |
$17.69
|
| Rate for Payer: ASR ASR |
$46.37
|
| Rate for Payer: BCBS Complete |
$19.12
|
| Rate for Payer: BCBS Trust/PPO |
$39.42
|
| Rate for Payer: BCN Commercial |
$39.42
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cofinity Commercial |
$44.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$46.37
|
| Rate for Payer: Healthscope Whirlpool |
$47.81
|
| Rate for Payer: Mclaren Commercial |
$43.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.64
|
| Rate for Payer: Nomi Health Commercial |
$39.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.89
|
| Rate for Payer: Priority Health Narrow Network |
$33.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.07
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$116.38
|
|
|
Service Code
|
NDC 65162069179
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.06 |
| Max. Negotiated Rate |
$116.38 |
| Rate for Payer: Aetna Commercial |
$104.74
|
| Rate for Payer: Aetna Medicare |
$43.06
|
| Rate for Payer: ASR ASR |
$112.88
|
| Rate for Payer: BCBS Complete |
$46.55
|
| Rate for Payer: BCBS Trust/PPO |
$95.95
|
| Rate for Payer: BCN Commercial |
$95.95
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: Cofinity Commercial |
$109.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.10
|
| Rate for Payer: Healthscope Commercial |
$112.88
|
| Rate for Payer: Healthscope Whirlpool |
$116.38
|
| Rate for Payer: Mclaren Commercial |
$104.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.92
|
| Rate for Payer: Nomi Health Commercial |
$95.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$101.97
|
| Rate for Payer: Priority Health Narrow Network |
$81.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.41
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$47.81
|
|
|
Service Code
|
NDC 904707393
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.86 |
| Max. Negotiated Rate |
$47.81 |
| Rate for Payer: Aetna Commercial |
$43.03
|
| Rate for Payer: ASR ASR |
$46.37
|
| Rate for Payer: BCBS Trust/PPO |
$39.26
|
| Rate for Payer: BCN Commercial |
$39.26
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cofinity Commercial |
$44.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$46.37
|
| Rate for Payer: Healthscope Whirlpool |
$47.81
|
| Rate for Payer: Mclaren Commercial |
$43.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.64
|
| Rate for Payer: Nomi Health Commercial |
$39.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.07
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$220.88
|
|
|
Service Code
|
NDC 54838055550
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.66 |
| Max. Negotiated Rate |
$220.88 |
| Rate for Payer: Aetna Commercial |
$198.79
|
| Rate for Payer: ASR ASR |
$214.25
|
| Rate for Payer: BCBS Trust/PPO |
$181.38
|
| Rate for Payer: BCN Commercial |
$181.38
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cofinity Commercial |
$207.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.70
|
| Rate for Payer: Healthscope Commercial |
$214.25
|
| Rate for Payer: Healthscope Whirlpool |
$220.88
|
| Rate for Payer: Mclaren Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.74
|
| Rate for Payer: Nomi Health Commercial |
$181.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.37
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$14.30
|
|
|
Service Code
|
NDC 9900000346
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Aetna Commercial |
$12.87
|
| Rate for Payer: Aetna Medicare |
$5.29
|
| Rate for Payer: ASR ASR |
$13.87
|
| Rate for Payer: BCBS Complete |
$5.72
|
| Rate for Payer: BCBS Trust/PPO |
$11.79
|
| Rate for Payer: BCN Commercial |
$11.79
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cofinity Commercial |
$13.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.44
|
| Rate for Payer: Healthscope Commercial |
$13.87
|
| Rate for Payer: Healthscope Whirlpool |
$14.30
|
| Rate for Payer: Mclaren Commercial |
$12.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.15
|
| Rate for Payer: Nomi Health Commercial |
$11.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.53
|
| Rate for Payer: Priority Health Narrow Network |
$10.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.58
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$41.70
|
|
|
Service Code
|
NDC 60687025240
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.27 |
| Max. Negotiated Rate |
$41.70 |
| Rate for Payer: Aetna Commercial |
$37.53
|
| Rate for Payer: ASR ASR |
$40.45
|
| Rate for Payer: BCBS Trust/PPO |
$34.24
|
| Rate for Payer: BCN Commercial |
$34.24
|
| Rate for Payer: Cash Price |
$33.36
|
| Rate for Payer: Cofinity Commercial |
$39.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.36
|
| Rate for Payer: Healthscope Commercial |
$40.45
|
| Rate for Payer: Healthscope Whirlpool |
$41.70
|
| Rate for Payer: Mclaren Commercial |
$37.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.44
|
| Rate for Payer: Nomi Health Commercial |
$34.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.70
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$41.70
|
|
|
Service Code
|
NDC 60687025286
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.27 |
| Max. Negotiated Rate |
$41.70 |
| Rate for Payer: Aetna Commercial |
$37.53
|
| Rate for Payer: ASR ASR |
$40.45
|
| Rate for Payer: BCBS Trust/PPO |
$34.24
|
| Rate for Payer: BCN Commercial |
$34.24
|
| Rate for Payer: Cash Price |
$33.36
|
| Rate for Payer: Cofinity Commercial |
$39.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.36
|
| Rate for Payer: Healthscope Commercial |
$40.45
|
| Rate for Payer: Healthscope Whirlpool |
$41.70
|
| Rate for Payer: Mclaren Commercial |
$37.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.44
|
| Rate for Payer: Nomi Health Commercial |
$34.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.70
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$41.70
|
|
|
Service Code
|
NDC 60687025240
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$41.70 |
| Rate for Payer: Aetna Commercial |
$37.53
|
| Rate for Payer: Aetna Medicare |
$15.43
|
| Rate for Payer: ASR ASR |
$40.45
|
| Rate for Payer: BCBS Complete |
$16.68
|
| Rate for Payer: BCBS Trust/PPO |
$34.38
|
| Rate for Payer: BCN Commercial |
$34.38
|
| Rate for Payer: Cash Price |
$33.36
|
| Rate for Payer: Cofinity Commercial |
$39.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.36
|
| Rate for Payer: Healthscope Commercial |
$40.45
|
| Rate for Payer: Healthscope Whirlpool |
$41.70
|
| Rate for Payer: Mclaren Commercial |
$37.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.44
|
| Rate for Payer: Nomi Health Commercial |
$34.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$36.54
|
| Rate for Payer: Priority Health Narrow Network |
$29.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.70
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$41.70
|
|
|
Service Code
|
NDC 60687025286
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$41.70 |
| Rate for Payer: Aetna Commercial |
$37.53
|
| Rate for Payer: Aetna Medicare |
$15.43
|
| Rate for Payer: ASR ASR |
$40.45
|
| Rate for Payer: BCBS Complete |
$16.68
|
| Rate for Payer: BCBS Trust/PPO |
$34.38
|
| Rate for Payer: BCN Commercial |
$34.38
|
| Rate for Payer: Cash Price |
$33.36
|
| Rate for Payer: Cofinity Commercial |
$39.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.36
|
| Rate for Payer: Healthscope Commercial |
$40.45
|
| Rate for Payer: Healthscope Whirlpool |
$41.70
|
| Rate for Payer: Mclaren Commercial |
$37.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.44
|
| Rate for Payer: Nomi Health Commercial |
$34.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$36.54
|
| Rate for Payer: Priority Health Narrow Network |
$29.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.70
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$14.30
|
|
|
Service Code
|
NDC 9900000346
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Aetna Commercial |
$12.87
|
| Rate for Payer: ASR ASR |
$13.87
|
| Rate for Payer: BCBS Trust/PPO |
$11.74
|
| Rate for Payer: BCN Commercial |
$11.74
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cofinity Commercial |
$13.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.44
|
| Rate for Payer: Healthscope Commercial |
$13.87
|
| Rate for Payer: Healthscope Whirlpool |
$14.30
|
| Rate for Payer: Mclaren Commercial |
$12.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.15
|
| Rate for Payer: Nomi Health Commercial |
$11.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.58
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$53.35
|
|
|
Service Code
|
NDC 68094076359
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.74 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Aetna Medicare |
$19.74
|
| Rate for Payer: ASR ASR |
$51.75
|
| Rate for Payer: BCBS Complete |
$21.34
|
| Rate for Payer: BCBS Trust/PPO |
$43.99
|
| Rate for Payer: BCN Commercial |
$43.99
|
| Rate for Payer: Cash Price |
$42.68
|
| Rate for Payer: Cofinity Commercial |
$50.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.68
|
| Rate for Payer: Healthscope Commercial |
$51.75
|
| Rate for Payer: Healthscope Whirlpool |
$53.35
|
| Rate for Payer: Mclaren Commercial |
$48.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.35
|
| Rate for Payer: Nomi Health Commercial |
$43.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.75
|
| Rate for Payer: Priority Health Narrow Network |
$37.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.95
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$53.35
|
|
|
Service Code
|
NDC 68094076362
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.74 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Aetna Medicare |
$19.74
|
| Rate for Payer: ASR ASR |
$51.75
|
| Rate for Payer: BCBS Complete |
$21.34
|
| Rate for Payer: BCBS Trust/PPO |
$43.99
|
| Rate for Payer: BCN Commercial |
$43.99
|
| Rate for Payer: Cash Price |
$42.68
|
| Rate for Payer: Cofinity Commercial |
$50.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.68
|
| Rate for Payer: Healthscope Commercial |
$51.75
|
| Rate for Payer: Healthscope Whirlpool |
$53.35
|
| Rate for Payer: Mclaren Commercial |
$48.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.35
|
| Rate for Payer: Nomi Health Commercial |
$43.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.75
|
| Rate for Payer: Priority Health Narrow Network |
$37.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.95
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$53.35
|
|
|
Service Code
|
NDC 68094076359
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.02 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: ASR ASR |
$51.75
|
| Rate for Payer: BCBS Trust/PPO |
$43.81
|
| Rate for Payer: BCN Commercial |
$43.81
|
| Rate for Payer: Cash Price |
$42.68
|
| Rate for Payer: Cofinity Commercial |
$50.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.68
|
| Rate for Payer: Healthscope Commercial |
$51.75
|
| Rate for Payer: Healthscope Whirlpool |
$53.35
|
| Rate for Payer: Mclaren Commercial |
$48.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.35
|
| Rate for Payer: Nomi Health Commercial |
$43.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.95
|
|
