|
VIVONEX RTF CYCLIC FEED
|
Facility
|
OP
|
$6,408.40
|
|
|
Service Code
|
NDC 9900000576
|
| Hospital Charge Code |
200089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,371.11 |
| Max. Negotiated Rate |
$6,408.40 |
| Rate for Payer: Aetna Commercial |
$5,767.56
|
| Rate for Payer: Aetna Medicare |
$2,371.11
|
| Rate for Payer: ASR ASR |
$6,216.15
|
| Rate for Payer: BCBS Complete |
$2,563.36
|
| Rate for Payer: BCBS Trust/PPO |
$5,283.73
|
| Rate for Payer: BCN Commercial |
$5,283.73
|
| Rate for Payer: Cash Price |
$5,126.72
|
| Rate for Payer: Cofinity Commercial |
$6,023.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,126.72
|
| Rate for Payer: Healthscope Commercial |
$6,216.15
|
| Rate for Payer: Healthscope Whirlpool |
$6,408.40
|
| Rate for Payer: Mclaren Commercial |
$5,767.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,126.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,447.14
|
| Rate for Payer: Nomi Health Commercial |
$5,254.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,806.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,615.04
|
| Rate for Payer: Priority Health Narrow Network |
$4,492.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,639.39
|
|
|
VIVONEX RTF CYCLIC FEED
|
Facility
|
OP
|
$10.18
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
200089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Aetna Commercial |
$9.16
|
| Rate for Payer: Aetna Medicare |
$3.76
|
| Rate for Payer: ASR ASR |
$9.87
|
| Rate for Payer: BCBS Complete |
$4.07
|
| Rate for Payer: BCBS Trust/PPO |
$8.39
|
| Rate for Payer: BCN Commercial |
$8.39
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Whirlpool |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$9.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.65
|
| Rate for Payer: Nomi Health Commercial |
$8.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.92
|
| Rate for Payer: Priority Health Narrow Network |
$7.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.95
|
|
|
VIVONEX RTF CYCLIC FEED
|
Facility
|
IP
|
$10.18
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
200089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Aetna Commercial |
$9.16
|
| Rate for Payer: ASR ASR |
$9.87
|
| Rate for Payer: BCBS Trust/PPO |
$8.36
|
| Rate for Payer: BCN Commercial |
$8.36
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Whirlpool |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$9.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.65
|
| Rate for Payer: Nomi Health Commercial |
$8.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.95
|
|
|
VIVONEX RTF CYCLIC FEED
|
Facility
|
IP
|
$6,408.40
|
|
|
Service Code
|
NDC 9900000576
|
| Hospital Charge Code |
200089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,806.30 |
| Max. Negotiated Rate |
$6,408.40 |
| Rate for Payer: Aetna Commercial |
$5,767.56
|
| Rate for Payer: ASR ASR |
$6,216.15
|
| Rate for Payer: BCBS Trust/PPO |
$5,262.58
|
| Rate for Payer: BCN Commercial |
$5,262.58
|
| Rate for Payer: Cash Price |
$5,126.72
|
| Rate for Payer: Cofinity Commercial |
$6,023.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,126.72
|
| Rate for Payer: Healthscope Commercial |
$6,216.15
|
| Rate for Payer: Healthscope Whirlpool |
$6,408.40
|
| Rate for Payer: Mclaren Commercial |
$5,767.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,447.14
|
| Rate for Payer: Nomi Health Commercial |
$5,254.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,806.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,639.39
|
|
|
VIVONEX RTF INTERMITTENT FEED
|
Facility
|
IP
|
$10.18
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
200088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Aetna Commercial |
$9.16
|
| Rate for Payer: ASR ASR |
$9.87
|
| Rate for Payer: BCBS Trust/PPO |
$8.36
|
| Rate for Payer: BCN Commercial |
$8.36
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Whirlpool |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$9.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.65
|
| Rate for Payer: Nomi Health Commercial |
$8.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.95
|
|
|
VIVONEX RTF INTERMITTENT FEED
|
Facility
|
OP
|
$6,408.40
|
|
|
Service Code
|
NDC 9900000576
|
| Hospital Charge Code |
200088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,371.11 |
| Max. Negotiated Rate |
$6,408.40 |
| Rate for Payer: Aetna Commercial |
$5,767.56
|
| Rate for Payer: Aetna Medicare |
$2,371.11
|
| Rate for Payer: ASR ASR |
$6,216.15
|
| Rate for Payer: BCBS Complete |
$2,563.36
|
| Rate for Payer: BCBS Trust/PPO |
$5,283.73
|
| Rate for Payer: BCN Commercial |
$5,283.73
|
| Rate for Payer: Cash Price |
$5,126.72
|
| Rate for Payer: Cofinity Commercial |
$6,023.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,126.72
|
| Rate for Payer: Healthscope Commercial |
$6,216.15
|
| Rate for Payer: Healthscope Whirlpool |
$6,408.40
|
| Rate for Payer: Mclaren Commercial |
$5,767.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,126.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,447.14
|
| Rate for Payer: Nomi Health Commercial |
$5,254.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,806.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,615.04
|
| Rate for Payer: Priority Health Narrow Network |
$4,492.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,639.39
|
|
|
VIVONEX RTF INTERMITTENT FEED
|
Facility
|
OP
|
$10.18
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
200088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Aetna Commercial |
$9.16
|
| Rate for Payer: Aetna Medicare |
$3.76
|
| Rate for Payer: ASR ASR |
$9.87
|
| Rate for Payer: BCBS Complete |
$4.07
|
| Rate for Payer: BCBS Trust/PPO |
$8.39
|
| Rate for Payer: BCN Commercial |
$8.39
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Whirlpool |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$9.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.65
|
| Rate for Payer: Nomi Health Commercial |
$8.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.92
|
| Rate for Payer: Priority Health Narrow Network |
$7.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.95
|
|
|
VIVONEX RTF INTERMITTENT FEED
|
Facility
|
IP
|
$6,408.40
|
|
|
Service Code
|
NDC 9900000576
|
| Hospital Charge Code |
200088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,806.30 |
| Max. Negotiated Rate |
$6,408.40 |
| Rate for Payer: Aetna Commercial |
$5,767.56
|
| Rate for Payer: ASR ASR |
$6,216.15
|
| Rate for Payer: BCBS Trust/PPO |
$5,262.58
|
| Rate for Payer: BCN Commercial |
$5,262.58
|
| Rate for Payer: Cash Price |
$5,126.72
|
| Rate for Payer: Cofinity Commercial |
$6,023.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,126.72
|
| Rate for Payer: Healthscope Commercial |
$6,216.15
|
| Rate for Payer: Healthscope Whirlpool |
$6,408.40
|
| Rate for Payer: Mclaren Commercial |
$5,767.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,447.14
|
| Rate for Payer: Nomi Health Commercial |
$5,254.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,806.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,639.39
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
OP
|
$279.65
|
|
|
Service Code
|
NDC 832121101
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.47 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna Medicare |
$103.47
|
| Rate for Payer: ASR ASR |
$271.26
|
| Rate for Payer: BCBS Complete |
$111.86
|
| Rate for Payer: BCBS Trust/PPO |
$230.57
|
| Rate for Payer: BCN Commercial |
$230.57
|
| Rate for Payer: Cash Price |
$223.72
|
| Rate for Payer: Cofinity Commercial |
$262.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.72
|
| Rate for Payer: Healthscope Commercial |
$271.26
|
| Rate for Payer: Healthscope Whirlpool |
$279.65
|
| Rate for Payer: Mclaren Commercial |
$251.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.70
|
| Rate for Payer: Nomi Health Commercial |
$229.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$245.03
|
| Rate for Payer: Priority Health Narrow Network |
$196.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.09
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$279.65
|
|
|
Service Code
|
NDC 832121101
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.74 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: ASR ASR |
$271.26
|
| Rate for Payer: BCBS Trust/PPO |
$229.65
|
| Rate for Payer: BCN Commercial |
$229.65
|
| Rate for Payer: Cash Price |
$223.72
|
| Rate for Payer: Cofinity Commercial |
$262.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.72
|
| Rate for Payer: Healthscope Commercial |
$271.26
|
| Rate for Payer: Healthscope Whirlpool |
$279.65
|
| Rate for Payer: Mclaren Commercial |
$251.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.70
|
| Rate for Payer: Nomi Health Commercial |
$229.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.09
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$2.80
|
|
|
Service Code
|
NDC 832121189
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: ASR ASR |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cofinity Commercial |
$2.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.24
|
| Rate for Payer: Healthscope Commercial |
$2.71
|
| Rate for Payer: Healthscope Whirlpool |
$2.80
|
| Rate for Payer: Mclaren Commercial |
$2.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.38
|
| Rate for Payer: Nomi Health Commercial |
$2.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.46
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
OP
|
$2.80
|
|
|
Service Code
|
NDC 832121189
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: ASR ASR |
$2.71
|
| Rate for Payer: BCBS Complete |
$1.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.31
|
| Rate for Payer: BCN Commercial |
$2.31
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cofinity Commercial |
$2.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.24
|
| Rate for Payer: Healthscope Commercial |
$2.71
|
| Rate for Payer: Healthscope Whirlpool |
$2.80
|
| Rate for Payer: Mclaren Commercial |
$2.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.38
|
| Rate for Payer: Nomi Health Commercial |
$2.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.45
|
| Rate for Payer: Priority Health Narrow Network |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.46
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
OP
|
$2.80
|
|
|
Service Code
|
NDC 832121389
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: ASR ASR |
$2.71
|
| Rate for Payer: BCBS Complete |
$1.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.31
|
| Rate for Payer: BCN Commercial |
$2.31
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cofinity Commercial |
$2.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.24
|
| Rate for Payer: Healthscope Commercial |
$2.71
|
| Rate for Payer: Healthscope Whirlpool |
$2.80
|
| Rate for Payer: Mclaren Commercial |
$2.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.38
|
| Rate for Payer: Nomi Health Commercial |
$2.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.45
|
| Rate for Payer: Priority Health Narrow Network |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.46
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
OP
|
$278.35
|
|
|
Service Code
|
NDC 68084002711
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.99 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Aetna Commercial |
$250.51
|
| Rate for Payer: Aetna Medicare |
$102.99
|
| Rate for Payer: ASR ASR |
$270.00
|
| Rate for Payer: BCBS Complete |
$111.34
|
| Rate for Payer: BCBS Trust/PPO |
$229.50
|
| Rate for Payer: BCN Commercial |
$229.50
|
| Rate for Payer: Cash Price |
$222.68
|
| Rate for Payer: Cofinity Commercial |
$261.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.68
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Healthscope Whirlpool |
$278.35
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$228.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$243.89
|
| Rate for Payer: Priority Health Narrow Network |
$195.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.95
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
IP
|
$278.35
|
|
|
Service Code
|
NDC 68084002711
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.76 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Aetna Commercial |
$250.51
|
| Rate for Payer: ASR ASR |
$270.00
|
| Rate for Payer: BCBS Trust/PPO |
$228.58
|
| Rate for Payer: BCN Commercial |
$228.58
|
| Rate for Payer: Cash Price |
$222.68
|
| Rate for Payer: Cofinity Commercial |
$261.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.68
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Healthscope Whirlpool |
$278.35
|
| Rate for Payer: Mclaren Commercial |
$250.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.60
|
| Rate for Payer: Nomi Health Commercial |
$228.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.95
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
OP
|
$279.65
|
|
|
Service Code
|
NDC 832121301
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.47 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna Medicare |
$103.47
|
| Rate for Payer: ASR ASR |
$271.26
|
| Rate for Payer: BCBS Complete |
$111.86
|
| Rate for Payer: BCBS Trust/PPO |
$230.57
|
| Rate for Payer: BCN Commercial |
$230.57
|
| Rate for Payer: Cash Price |
$223.72
|
| Rate for Payer: Cofinity Commercial |
$262.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.72
|
| Rate for Payer: Healthscope Commercial |
$271.26
|
| Rate for Payer: Healthscope Whirlpool |
$279.65
|
| Rate for Payer: Mclaren Commercial |
$251.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.70
|
| Rate for Payer: Nomi Health Commercial |
$229.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$245.03
|
| Rate for Payer: Priority Health Narrow Network |
$196.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.09
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
IP
|
$279.65
|
|
|
Service Code
|
NDC 832121301
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.74 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: ASR ASR |
$271.26
|
| Rate for Payer: BCBS Trust/PPO |
$229.65
|
| Rate for Payer: BCN Commercial |
$229.65
|
| Rate for Payer: Cash Price |
$223.72
|
| Rate for Payer: Cofinity Commercial |
$262.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.72
|
| Rate for Payer: Healthscope Commercial |
$271.26
|
| Rate for Payer: Healthscope Whirlpool |
$279.65
|
| Rate for Payer: Mclaren Commercial |
$251.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.70
|
| Rate for Payer: Nomi Health Commercial |
$229.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.09
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
IP
|
$2.80
|
|
|
Service Code
|
NDC 832121389
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: ASR ASR |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cofinity Commercial |
$2.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.24
|
| Rate for Payer: Healthscope Commercial |
$2.71
|
| Rate for Payer: Healthscope Whirlpool |
$2.80
|
| Rate for Payer: Mclaren Commercial |
$2.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.38
|
| Rate for Payer: Nomi Health Commercial |
$2.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.46
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
NDC 409397703
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$18.87
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$42.05
|
| Rate for Payer: BCN Commercial |
$42.05
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$49.47
|
| Rate for Payer: Healthscope Whirlpool |
$51.00
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44.69
|
| Rate for Payer: Priority Health Narrow Network |
$35.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
NDC 409397703
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$41.88
|
| Rate for Payer: BCN Commercial |
$41.88
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$49.47
|
| Rate for Payer: Healthscope Whirlpool |
$51.00
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$26.97
|
|
|
Service Code
|
NDC 63323018520
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.23 |
| Max. Negotiated Rate |
$26.97 |
| Rate for Payer: Aetna Commercial |
$24.27
|
| Rate for Payer: ASR ASR |
$26.16
|
| Rate for Payer: BCBS Trust/PPO |
$22.15
|
| Rate for Payer: BCN Commercial |
$22.15
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cofinity Commercial |
$25.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.57
|
| Rate for Payer: Healthscope Commercial |
$26.16
|
| Rate for Payer: Healthscope Whirlpool |
$26.97
|
| Rate for Payer: Mclaren Commercial |
$24.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Nomi Health Commercial |
$22.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.73
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$19.14
|
|
|
Service Code
|
NDC 409488723
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$19.14 |
| Rate for Payer: Aetna Commercial |
$17.23
|
| Rate for Payer: Aetna Medicare |
$7.08
|
| Rate for Payer: ASR ASR |
$18.57
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: BCBS Trust/PPO |
$15.78
|
| Rate for Payer: BCN Commercial |
$15.78
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$17.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$18.57
|
| Rate for Payer: Healthscope Whirlpool |
$19.14
|
| Rate for Payer: Mclaren Commercial |
$17.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Nomi Health Commercial |
$15.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.77
|
| Rate for Payer: Priority Health Narrow Network |
$13.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.84
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$19.14
|
|
|
Service Code
|
NDC 409488720
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$19.14 |
| Rate for Payer: Aetna Commercial |
$17.23
|
| Rate for Payer: Aetna Medicare |
$7.08
|
| Rate for Payer: ASR ASR |
$18.57
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: BCBS Trust/PPO |
$15.78
|
| Rate for Payer: BCN Commercial |
$15.78
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$17.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$18.57
|
| Rate for Payer: Healthscope Whirlpool |
$19.14
|
| Rate for Payer: Mclaren Commercial |
$17.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Nomi Health Commercial |
$15.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.77
|
| Rate for Payer: Priority Health Narrow Network |
$13.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.84
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$23.05
|
|
|
Service Code
|
NDC 63323018504
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$23.05 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Medicare |
$8.53
|
| Rate for Payer: ASR ASR |
$22.36
|
| Rate for Payer: BCBS Complete |
$9.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.01
|
| Rate for Payer: BCN Commercial |
$19.01
|
| Rate for Payer: Cash Price |
$18.44
|
| Rate for Payer: Cofinity Commercial |
$21.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.44
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Healthscope Whirlpool |
$23.05
|
| Rate for Payer: Mclaren Commercial |
$20.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.59
|
| Rate for Payer: Nomi Health Commercial |
$18.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.20
|
| Rate for Payer: Priority Health Narrow Network |
$16.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.28
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$23.05
|
|
|
Service Code
|
NDC 63323018504
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.29 |
| Max. Negotiated Rate |
$23.05 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: ASR ASR |
$22.36
|
| Rate for Payer: BCBS Trust/PPO |
$18.93
|
| Rate for Payer: BCN Commercial |
$18.93
|
| Rate for Payer: Cash Price |
$18.44
|
| Rate for Payer: Cofinity Commercial |
$21.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.44
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Healthscope Whirlpool |
$23.05
|
| Rate for Payer: Mclaren Commercial |
$20.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.59
|
| Rate for Payer: Nomi Health Commercial |
$18.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.28
|
|
