|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.58
|
|
|
Service Code
|
NDC 68462015740
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: ASR ASR |
$4.44
|
| Rate for Payer: ASR Commercial |
$4.44
|
| Rate for Payer: BCBS Trust/PPO |
$3.73
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.66
|
| Rate for Payer: Healthscope Commercial |
$4.58
|
| Rate for Payer: Healthscope Whirlpool |
$4.44
|
| Rate for Payer: Mclaren Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.89
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.03
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$83.66
|
|
|
Service Code
|
NDC 65862039010
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.38 |
| Max. Negotiated Rate |
$83.66 |
| Rate for Payer: Aetna Commercial |
$75.29
|
| Rate for Payer: ASR ASR |
$81.15
|
| Rate for Payer: ASR Commercial |
$81.15
|
| Rate for Payer: BCBS Trust/PPO |
$68.17
|
| Rate for Payer: BCN Commercial |
$64.86
|
| Rate for Payer: Cash Price |
$66.93
|
| Rate for Payer: Cofinity Commercial |
$78.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.93
|
| Rate for Payer: Healthscope Commercial |
$83.66
|
| Rate for Payer: Healthscope Whirlpool |
$81.15
|
| Rate for Payer: Mclaren Commercial |
$75.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.11
|
| Rate for Payer: Nomi Health Commercial |
$68.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.62
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$137.48
|
|
|
Service Code
|
NDC 68462015713
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.99 |
| Max. Negotiated Rate |
$137.48 |
| Rate for Payer: Aetna Commercial |
$123.73
|
| Rate for Payer: Aetna Medicare |
$68.74
|
| Rate for Payer: ASR ASR |
$133.36
|
| Rate for Payer: ASR Commercial |
$133.36
|
| Rate for Payer: BCBS Complete |
$54.99
|
| Rate for Payer: BCBS Trust/PPO |
$112.58
|
| Rate for Payer: BCN Commercial |
$106.59
|
| Rate for Payer: Cash Price |
$109.98
|
| Rate for Payer: Cofinity Commercial |
$129.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.98
|
| Rate for Payer: Healthscope Commercial |
$137.48
|
| Rate for Payer: Healthscope Whirlpool |
$133.36
|
| Rate for Payer: Mclaren Commercial |
$123.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.86
|
| Rate for Payer: Nomi Health Commercial |
$112.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.46
|
| Rate for Payer: Priority Health Narrow Network |
$96.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.98
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$66.40
|
|
|
Service Code
|
NDC 57237007710
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.56 |
| Max. Negotiated Rate |
$66.40 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna Medicare |
$33.20
|
| Rate for Payer: ASR ASR |
$64.41
|
| Rate for Payer: ASR Commercial |
$64.41
|
| Rate for Payer: BCBS Complete |
$26.56
|
| Rate for Payer: BCBS Trust/PPO |
$54.37
|
| Rate for Payer: BCN Commercial |
$51.48
|
| 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 |
$66.40
|
| Rate for Payer: Healthscope Whirlpool |
$64.41
|
| 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: Priority Health Cigna Priority Health |
$43.16
|
| Rate for Payer: 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 |
$58.43
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$66.40
|
|
|
Service Code
|
NDC 57237007710
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$66.40 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: ASR ASR |
$64.41
|
| Rate for Payer: ASR Commercial |
$64.41
|
| Rate for Payer: BCBS Trust/PPO |
$54.11
|
| Rate for Payer: BCN Commercial |
$51.48
|
| 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 |
$66.40
|
| Rate for Payer: Healthscope Whirlpool |
$64.41
|
| 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: Priority Health Cigna Priority Health |
$43.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.43
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$137.48
|
|
|
Service Code
|
NDC 68462015713
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.36 |
| Max. Negotiated Rate |
$137.48 |
| Rate for Payer: Aetna Commercial |
$123.73
|
| Rate for Payer: ASR ASR |
$133.36
|
| Rate for Payer: ASR Commercial |
$133.36
|
| Rate for Payer: BCBS Trust/PPO |
$112.03
|
| Rate for Payer: BCN Commercial |
$106.59
|
| Rate for Payer: Cash Price |
$109.98
|
| Rate for Payer: Cofinity Commercial |
$129.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.98
|
| Rate for Payer: Healthscope Commercial |
$137.48
|
| Rate for Payer: Healthscope Whirlpool |
$133.36
|
| Rate for Payer: Mclaren Commercial |
$123.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.86
|
| Rate for Payer: Nomi Health Commercial |
$112.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.98
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$4.58
|
|
|
Service Code
|
NDC 68462015740
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: Aetna Medicare |
$2.29
|
| Rate for Payer: ASR ASR |
$4.44
|
| Rate for Payer: ASR Commercial |
$4.44
|
| Rate for Payer: BCBS Complete |
$1.83
|
| Rate for Payer: BCBS Trust/PPO |
$3.75
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.66
|
| Rate for Payer: Healthscope Commercial |
$4.58
|
| Rate for Payer: Healthscope Whirlpool |
$4.44
|
| Rate for Payer: Mclaren Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.89
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.01
|
| Rate for Payer: Priority Health Narrow Network |
$3.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.03
|
|
|
ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$116.50
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
10777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.72 |
| Max. Negotiated Rate |
$116.50 |
| Rate for Payer: Aetna Commercial |
$104.85
|
| Rate for Payer: ASR ASR |
$113.00
|
| Rate for Payer: ASR Commercial |
$113.00
|
| Rate for Payer: BCBS Trust/PPO |
$94.94
|
| Rate for Payer: BCN Commercial |
$90.32
|
| Rate for Payer: Cash Price |
$93.20
|
| Rate for Payer: Cofinity Commercial |
$109.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.20
|
| Rate for Payer: Healthscope Commercial |
$116.50
|
| Rate for Payer: Healthscope Whirlpool |
$113.00
|
| Rate for Payer: Mclaren Commercial |
$104.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.03
|
| Rate for Payer: Nomi Health Commercial |
$95.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.52
|
|
|
ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$116.50
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
10777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.60 |
| Max. Negotiated Rate |
$116.50 |
| Rate for Payer: Aetna Commercial |
$104.85
|
| Rate for Payer: Aetna Medicare |
$58.25
|
| Rate for Payer: ASR ASR |
$113.00
|
| Rate for Payer: ASR Commercial |
$113.00
|
| Rate for Payer: BCBS Complete |
$46.60
|
| Rate for Payer: BCBS Trust/PPO |
$95.40
|
| Rate for Payer: BCN Commercial |
$90.32
|
| Rate for Payer: Cash Price |
$93.20
|
| Rate for Payer: Cofinity Commercial |
$109.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.20
|
| Rate for Payer: Healthscope Commercial |
$116.50
|
| Rate for Payer: Healthscope Whirlpool |
$113.00
|
| Rate for Payer: Mclaren Commercial |
$104.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.03
|
| Rate for Payer: Nomi Health Commercial |
$95.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.08
|
| Rate for Payer: Priority Health Narrow Network |
$81.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.52
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$47.81
|
|
|
Service Code
|
NDC 00904707341
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.12 |
| Max. Negotiated Rate |
$47.81 |
| Rate for Payer: Aetna Commercial |
$43.03
|
| Rate for Payer: Aetna Medicare |
$23.91
|
| Rate for Payer: ASR ASR |
$46.38
|
| Rate for Payer: ASR Commercial |
$46.38
|
| Rate for Payer: BCBS Complete |
$19.12
|
| Rate for Payer: BCBS Trust/PPO |
$39.15
|
| Rate for Payer: BCN Commercial |
$37.07
|
| 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 |
$47.81
|
| Rate for Payer: Healthscope Whirlpool |
$46.38
|
| 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: Priority Health Cigna Priority Health |
$31.08
|
| Rate for Payer: 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
|
$46.66
|
|
|
Service Code
|
NDC 68094076359
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$46.66 |
| Rate for Payer: Aetna Commercial |
$41.99
|
| Rate for Payer: Aetna Medicare |
$23.33
|
| Rate for Payer: ASR ASR |
$45.26
|
| Rate for Payer: ASR Commercial |
$45.26
|
| Rate for Payer: BCBS Complete |
$18.66
|
| Rate for Payer: BCBS Trust/PPO |
$38.21
|
| Rate for Payer: BCN Commercial |
$36.18
|
| Rate for Payer: Cash Price |
$37.33
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.33
|
| Rate for Payer: Healthscope Commercial |
$46.66
|
| Rate for Payer: Healthscope Whirlpool |
$45.26
|
| Rate for Payer: Mclaren Commercial |
$41.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.66
|
| Rate for Payer: Nomi Health Commercial |
$38.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.88
|
| Rate for Payer: Priority Health Narrow Network |
$32.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.06
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$47.81
|
|
|
Service Code
|
NDC 00904707393
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.12 |
| Max. Negotiated Rate |
$47.81 |
| Rate for Payer: Aetna Commercial |
$43.03
|
| Rate for Payer: Aetna Medicare |
$23.91
|
| Rate for Payer: ASR ASR |
$46.38
|
| Rate for Payer: ASR Commercial |
$46.38
|
| Rate for Payer: BCBS Complete |
$19.12
|
| Rate for Payer: BCBS Trust/PPO |
$39.15
|
| Rate for Payer: BCN Commercial |
$37.07
|
| 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 |
$47.81
|
| Rate for Payer: Healthscope Whirlpool |
$46.38
|
| 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: Priority Health Cigna Priority Health |
$31.08
|
| Rate for Payer: 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
|
$40.48
|
|
|
Service Code
|
NDC 60687025286
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$36.43
|
| Rate for Payer: Aetna Medicare |
$20.24
|
| Rate for Payer: ASR ASR |
$39.27
|
| Rate for Payer: ASR Commercial |
$39.27
|
| Rate for Payer: BCBS Complete |
$16.19
|
| Rate for Payer: BCBS Trust/PPO |
$33.15
|
| Rate for Payer: BCN Commercial |
$31.38
|
| Rate for Payer: Cash Price |
$32.38
|
| Rate for Payer: Cofinity Commercial |
$38.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.38
|
| Rate for Payer: Healthscope Commercial |
$40.48
|
| Rate for Payer: Healthscope Whirlpool |
$39.27
|
| Rate for Payer: Mclaren Commercial |
$36.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.41
|
| Rate for Payer: Nomi Health Commercial |
$33.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.47
|
| Rate for Payer: Priority Health Narrow Network |
$28.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.62
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$46.66
|
|
|
Service Code
|
NDC 68094076362
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$46.66 |
| Rate for Payer: Aetna Commercial |
$41.99
|
| Rate for Payer: Aetna Medicare |
$23.33
|
| Rate for Payer: ASR ASR |
$45.26
|
| Rate for Payer: ASR Commercial |
$45.26
|
| Rate for Payer: BCBS Complete |
$18.66
|
| Rate for Payer: BCBS Trust/PPO |
$38.21
|
| Rate for Payer: BCN Commercial |
$36.18
|
| Rate for Payer: Cash Price |
$37.33
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.33
|
| Rate for Payer: Healthscope Commercial |
$46.66
|
| Rate for Payer: Healthscope Whirlpool |
$45.26
|
| Rate for Payer: Mclaren Commercial |
$41.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.66
|
| Rate for Payer: Nomi Health Commercial |
$38.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.88
|
| Rate for Payer: Priority Health Narrow Network |
$32.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.06
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$46.66
|
|
|
Service Code
|
NDC 68094076362
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.33 |
| Max. Negotiated Rate |
$46.66 |
| Rate for Payer: Aetna Commercial |
$41.99
|
| Rate for Payer: ASR ASR |
$45.26
|
| Rate for Payer: ASR Commercial |
$45.26
|
| Rate for Payer: BCBS Trust/PPO |
$38.02
|
| Rate for Payer: BCN Commercial |
$36.18
|
| Rate for Payer: Cash Price |
$37.33
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.33
|
| Rate for Payer: Healthscope Commercial |
$46.66
|
| Rate for Payer: Healthscope Whirlpool |
$45.26
|
| Rate for Payer: Mclaren Commercial |
$41.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.66
|
| Rate for Payer: Nomi Health Commercial |
$38.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.06
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$115.42
|
|
|
Service Code
|
NDC 65162069179
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.02 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna Commercial |
$103.88
|
| Rate for Payer: ASR ASR |
$111.96
|
| Rate for Payer: ASR Commercial |
$111.96
|
| Rate for Payer: BCBS Trust/PPO |
$94.06
|
| Rate for Payer: BCN Commercial |
$89.49
|
| Rate for Payer: Cash Price |
$92.34
|
| Rate for Payer: Cofinity Commercial |
$108.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.34
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Healthscope Whirlpool |
$111.96
|
| Rate for Payer: Mclaren Commercial |
$103.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.11
|
| Rate for Payer: Nomi Health Commercial |
$94.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.57
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$47.81
|
|
|
Service Code
|
NDC 00904707341
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$47.81 |
| Rate for Payer: Aetna Commercial |
$43.03
|
| Rate for Payer: ASR ASR |
$46.38
|
| Rate for Payer: ASR Commercial |
$46.38
|
| Rate for Payer: BCBS Trust/PPO |
$38.96
|
| Rate for Payer: BCN Commercial |
$37.07
|
| 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 |
$47.81
|
| Rate for Payer: Healthscope Whirlpool |
$46.38
|
| 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: Priority Health Cigna Priority Health |
$31.08
|
| 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 |
$143.57 |
| Max. Negotiated Rate |
$220.88 |
| Rate for Payer: Aetna Commercial |
$198.79
|
| Rate for Payer: ASR ASR |
$214.25
|
| Rate for Payer: ASR Commercial |
$214.25
|
| Rate for Payer: BCBS Trust/PPO |
$180.00
|
| Rate for Payer: BCN Commercial |
$171.25
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cofinity Commercial |
$207.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.70
|
| Rate for Payer: Healthscope Commercial |
$220.88
|
| Rate for Payer: Healthscope Whirlpool |
$214.25
|
| Rate for Payer: Mclaren Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.75
|
| Rate for Payer: Nomi Health Commercial |
$181.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.37
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$40.48
|
|
|
Service Code
|
NDC 60687025286
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$36.43
|
| Rate for Payer: ASR ASR |
$39.27
|
| Rate for Payer: ASR Commercial |
$39.27
|
| Rate for Payer: BCBS Trust/PPO |
$32.99
|
| Rate for Payer: BCN Commercial |
$31.38
|
| Rate for Payer: Cash Price |
$32.38
|
| Rate for Payer: Cofinity Commercial |
$38.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.38
|
| Rate for Payer: Healthscope Commercial |
$40.48
|
| Rate for Payer: Healthscope Whirlpool |
$39.27
|
| Rate for Payer: Mclaren Commercial |
$36.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.41
|
| Rate for Payer: Nomi Health Commercial |
$33.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.62
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$47.81
|
|
|
Service Code
|
NDC 00904707393
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$47.81 |
| Rate for Payer: Aetna Commercial |
$43.03
|
| Rate for Payer: ASR ASR |
$46.38
|
| Rate for Payer: ASR Commercial |
$46.38
|
| Rate for Payer: BCBS Trust/PPO |
$38.96
|
| Rate for Payer: BCN Commercial |
$37.07
|
| 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 |
$47.81
|
| Rate for Payer: Healthscope Whirlpool |
$46.38
|
| 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: Priority Health Cigna Priority Health |
$31.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.07
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$40.48
|
|
|
Service Code
|
NDC 60687025240
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$36.43
|
| Rate for Payer: ASR ASR |
$39.27
|
| Rate for Payer: ASR Commercial |
$39.27
|
| Rate for Payer: BCBS Trust/PPO |
$32.99
|
| Rate for Payer: BCN Commercial |
$31.38
|
| Rate for Payer: Cash Price |
$32.38
|
| Rate for Payer: Cofinity Commercial |
$38.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.38
|
| Rate for Payer: Healthscope Commercial |
$40.48
|
| Rate for Payer: Healthscope Whirlpool |
$39.27
|
| Rate for Payer: Mclaren Commercial |
$36.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.41
|
| Rate for Payer: Nomi Health Commercial |
$33.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.62
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$46.66
|
|
|
Service Code
|
NDC 68094076359
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.33 |
| Max. Negotiated Rate |
$46.66 |
| Rate for Payer: Aetna Commercial |
$41.99
|
| Rate for Payer: ASR ASR |
$45.26
|
| Rate for Payer: ASR Commercial |
$45.26
|
| Rate for Payer: BCBS Trust/PPO |
$38.02
|
| Rate for Payer: BCN Commercial |
$36.18
|
| Rate for Payer: Cash Price |
$37.33
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.33
|
| Rate for Payer: Healthscope Commercial |
$46.66
|
| Rate for Payer: Healthscope Whirlpool |
$45.26
|
| Rate for Payer: Mclaren Commercial |
$41.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.66
|
| Rate for Payer: Nomi Health Commercial |
$38.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.06
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$115.42
|
|
|
Service Code
|
NDC 65162069179
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.17 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna Commercial |
$103.88
|
| Rate for Payer: Aetna Medicare |
$57.71
|
| Rate for Payer: ASR ASR |
$111.96
|
| Rate for Payer: ASR Commercial |
$111.96
|
| Rate for Payer: BCBS Complete |
$46.17
|
| Rate for Payer: BCBS Trust/PPO |
$94.52
|
| Rate for Payer: BCN Commercial |
$89.49
|
| Rate for Payer: Cash Price |
$92.34
|
| Rate for Payer: Cofinity Commercial |
$108.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.34
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Healthscope Whirlpool |
$111.96
|
| Rate for Payer: Mclaren Commercial |
$103.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.11
|
| Rate for Payer: Nomi Health Commercial |
$94.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.13
|
| Rate for Payer: Priority Health Narrow Network |
$80.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.57
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$14.30
|
|
|
Service Code
|
NDC 09900000346
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Aetna Commercial |
$12.87
|
| Rate for Payer: Aetna Medicare |
$7.15
|
| Rate for Payer: ASR ASR |
$13.87
|
| Rate for Payer: ASR Commercial |
$13.87
|
| Rate for Payer: BCBS Complete |
$5.72
|
| Rate for Payer: BCBS Trust/PPO |
$11.71
|
| Rate for Payer: BCN Commercial |
$11.09
|
| 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 |
$14.30
|
| Rate for Payer: Healthscope Whirlpool |
$13.87
|
| Rate for Payer: Mclaren Commercial |
$12.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.15
|
| Rate for Payer: Nomi Health Commercial |
$11.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.29
|
| Rate for Payer: 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
|
OP
|
$220.88
|
|
|
Service Code
|
NDC 54838055550
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.35 |
| Max. Negotiated Rate |
$220.88 |
| Rate for Payer: Aetna Commercial |
$198.79
|
| Rate for Payer: Aetna Medicare |
$110.44
|
| Rate for Payer: ASR ASR |
$214.25
|
| Rate for Payer: ASR Commercial |
$214.25
|
| Rate for Payer: BCBS Complete |
$88.35
|
| Rate for Payer: BCBS Trust/PPO |
$180.88
|
| Rate for Payer: BCN Commercial |
$171.25
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cofinity Commercial |
$207.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.70
|
| Rate for Payer: Healthscope Commercial |
$220.88
|
| Rate for Payer: Healthscope Whirlpool |
$214.25
|
| Rate for Payer: Mclaren Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.75
|
| Rate for Payer: Nomi Health Commercial |
$181.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.54
|
| Rate for Payer: Priority Health Narrow Network |
$154.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.37
|
|
