|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
OP
|
$12.62
|
|
|
Service Code
|
NDC 41100081163
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$12.62 |
| Rate for Payer: Aetna Commercial |
$11.36
|
| Rate for Payer: Aetna Medicare |
$6.31
|
| Rate for Payer: ASR ASR |
$12.24
|
| Rate for Payer: ASR Commercial |
$12.24
|
| Rate for Payer: BCBS Complete |
$5.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.33
|
| Rate for Payer: BCN Commercial |
$9.78
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$11.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.10
|
| Rate for Payer: Healthscope Commercial |
$12.62
|
| Rate for Payer: Healthscope Whirlpool |
$12.24
|
| Rate for Payer: Mclaren Commercial |
$11.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.73
|
| Rate for Payer: Nomi Health Commercial |
$10.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.06
|
| Rate for Payer: Priority Health Narrow Network |
$8.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.11
|
|
|
VIVONEX RTF BOLUS FEED
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
150771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR Commercial |
$14.36
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.12
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.97
|
| Rate for Payer: Priority Health Narrow Network |
$10.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
VIVONEX RTF BOLUS FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
150771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR Commercial |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.06
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
OP
|
$6,408.40
|
|
|
Service Code
|
NDC 09900000576
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,563.36 |
| Max. Negotiated Rate |
$6,408.40 |
| Rate for Payer: Aetna Commercial |
$5,767.56
|
| Rate for Payer: Aetna Medicare |
$3,204.20
|
| Rate for Payer: ASR ASR |
$6,216.15
|
| Rate for Payer: ASR Commercial |
$6,216.15
|
| Rate for Payer: BCBS Complete |
$2,563.36
|
| Rate for Payer: BCBS Trust/PPO |
$5,247.84
|
| Rate for Payer: BCN Commercial |
$4,968.43
|
| 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 |
$6,408.40
|
| Rate for Payer: Healthscope Whirlpool |
$6,216.15
|
| 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: Priority Health Cigna Priority Health |
$4,165.46
|
| Rate for Payer: 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 CONTINUOUS FEED
|
Facility
|
IP
|
$6,408.40
|
|
|
Service Code
|
NDC 09900000576
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,165.46 |
| 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: ASR Commercial |
$6,216.15
|
| Rate for Payer: BCBS Trust/PPO |
$5,222.21
|
| Rate for Payer: BCN Commercial |
$4,968.43
|
| 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 |
$6,408.40
|
| Rate for Payer: Healthscope Whirlpool |
$6,216.15
|
| 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: Priority Health Cigna Priority Health |
$4,165.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,639.39
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR Commercial |
$14.36
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.12
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.97
|
| Rate for Payer: Priority Health Narrow Network |
$10.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR Commercial |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.06
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
VIVONEX RTF CYCLIC FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
200089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR Commercial |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.06
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
VIVONEX RTF CYCLIC FEED
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
200089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR Commercial |
$14.36
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.12
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.97
|
| Rate for Payer: Priority Health Narrow Network |
$10.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
VIVONEX RTF CYCLIC FEED
|
Facility
|
IP
|
$6,408.40
|
|
|
Service Code
|
NDC 09900000576
|
| Hospital Charge Code |
200089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,165.46 |
| 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: ASR Commercial |
$6,216.15
|
| Rate for Payer: BCBS Trust/PPO |
$5,222.21
|
| Rate for Payer: BCN Commercial |
$4,968.43
|
| 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 |
$6,408.40
|
| Rate for Payer: Healthscope Whirlpool |
$6,216.15
|
| 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: Priority Health Cigna Priority Health |
$4,165.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,639.39
|
|
|
VIVONEX RTF CYCLIC FEED
|
Facility
|
OP
|
$6,408.40
|
|
|
Service Code
|
NDC 09900000576
|
| Hospital Charge Code |
200089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,563.36 |
| Max. Negotiated Rate |
$6,408.40 |
| Rate for Payer: Aetna Commercial |
$5,767.56
|
| Rate for Payer: Aetna Medicare |
$3,204.20
|
| Rate for Payer: ASR ASR |
$6,216.15
|
| Rate for Payer: ASR Commercial |
$6,216.15
|
| Rate for Payer: BCBS Complete |
$2,563.36
|
| Rate for Payer: BCBS Trust/PPO |
$5,247.84
|
| Rate for Payer: BCN Commercial |
$4,968.43
|
| 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 |
$6,408.40
|
| Rate for Payer: Healthscope Whirlpool |
$6,216.15
|
| 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: Priority Health Cigna Priority Health |
$4,165.46
|
| Rate for Payer: 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
|
$6,408.40
|
|
|
Service Code
|
NDC 09900000576
|
| Hospital Charge Code |
200088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,563.36 |
| Max. Negotiated Rate |
$6,408.40 |
| Rate for Payer: Aetna Commercial |
$5,767.56
|
| Rate for Payer: Aetna Medicare |
$3,204.20
|
| Rate for Payer: ASR ASR |
$6,216.15
|
| Rate for Payer: ASR Commercial |
$6,216.15
|
| Rate for Payer: BCBS Complete |
$2,563.36
|
| Rate for Payer: BCBS Trust/PPO |
$5,247.84
|
| Rate for Payer: BCN Commercial |
$4,968.43
|
| 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 |
$6,408.40
|
| Rate for Payer: Healthscope Whirlpool |
$6,216.15
|
| 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: Priority Health Cigna Priority Health |
$4,165.46
|
| Rate for Payer: 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
|
IP
|
$6,408.40
|
|
|
Service Code
|
NDC 09900000576
|
| Hospital Charge Code |
200088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,165.46 |
| 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: ASR Commercial |
$6,216.15
|
| Rate for Payer: BCBS Trust/PPO |
$5,222.21
|
| Rate for Payer: BCN Commercial |
$4,968.43
|
| 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 |
$6,408.40
|
| Rate for Payer: Healthscope Whirlpool |
$6,216.15
|
| 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: Priority Health Cigna Priority Health |
$4,165.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,639.39
|
|
|
VIVONEX RTF INTERMITTENT FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
200088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR Commercial |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.06
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
VIVONEX RTF INTERMITTENT FEED
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
200088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR Commercial |
$14.36
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.12
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.97
|
| Rate for Payer: Priority Health Narrow Network |
$10.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
OP
|
$371.30
|
|
|
Service Code
|
NDC 00832121101
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.52 |
| Max. Negotiated Rate |
$371.30 |
| Rate for Payer: Aetna Commercial |
$334.17
|
| Rate for Payer: Aetna Medicare |
$185.65
|
| Rate for Payer: ASR ASR |
$360.16
|
| Rate for Payer: ASR Commercial |
$360.16
|
| Rate for Payer: BCBS Complete |
$148.52
|
| Rate for Payer: BCBS Trust/PPO |
$304.06
|
| Rate for Payer: BCN Commercial |
$287.87
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$349.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$371.30
|
| Rate for Payer: Healthscope Whirlpool |
$360.16
|
| Rate for Payer: Mclaren Commercial |
$334.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.60
|
| Rate for Payer: Nomi Health Commercial |
$304.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$325.33
|
| Rate for Payer: Priority Health Narrow Network |
$260.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.74
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$371.30
|
|
|
Service Code
|
NDC 00832121101
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.34 |
| Max. Negotiated Rate |
$371.30 |
| Rate for Payer: Aetna Commercial |
$334.17
|
| Rate for Payer: ASR ASR |
$360.16
|
| Rate for Payer: ASR Commercial |
$360.16
|
| Rate for Payer: BCBS Trust/PPO |
$302.57
|
| Rate for Payer: BCN Commercial |
$287.87
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$349.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$371.30
|
| Rate for Payer: Healthscope Whirlpool |
$360.16
|
| Rate for Payer: Mclaren Commercial |
$334.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.60
|
| Rate for Payer: Nomi Health Commercial |
$304.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.74
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
OP
|
$3.71
|
|
|
Service Code
|
NDC 00832121189
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: ASR ASR |
$3.60
|
| Rate for Payer: ASR Commercial |
$3.60
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.04
|
| Rate for Payer: BCN Commercial |
$2.88
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$3.71
|
| Rate for Payer: Healthscope Whirlpool |
$3.60
|
| Rate for Payer: Mclaren Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Nomi Health Commercial |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.25
|
| Rate for Payer: Priority Health Narrow Network |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.26
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$3.71
|
|
|
Service Code
|
NDC 00832121189
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: ASR ASR |
$3.60
|
| Rate for Payer: ASR Commercial |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.02
|
| Rate for Payer: BCN Commercial |
$2.88
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$3.71
|
| Rate for Payer: Healthscope Whirlpool |
$3.60
|
| Rate for Payer: Mclaren Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Nomi Health Commercial |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.26
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
IP
|
$368.95
|
|
|
Service Code
|
NDC 00832121301
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.82 |
| Max. Negotiated Rate |
$368.95 |
| Rate for Payer: Aetna Commercial |
$332.06
|
| Rate for Payer: ASR ASR |
$357.88
|
| Rate for Payer: ASR Commercial |
$357.88
|
| Rate for Payer: BCBS Trust/PPO |
$300.66
|
| Rate for Payer: BCN Commercial |
$286.05
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Commercial |
$346.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$368.95
|
| Rate for Payer: Healthscope Whirlpool |
$357.88
|
| Rate for Payer: Mclaren Commercial |
$332.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Nomi Health Commercial |
$302.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.68
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 00832121389
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: ASR ASR |
$3.58
|
| Rate for Payer: ASR Commercial |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$3.01
|
| Rate for Payer: BCN Commercial |
$2.86
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.69
|
| Rate for Payer: Healthscope Whirlpool |
$3.58
|
| Rate for Payer: Mclaren Commercial |
$3.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Nomi Health Commercial |
$3.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.25
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 00832121389
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: ASR ASR |
$3.58
|
| Rate for Payer: ASR Commercial |
$3.58
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.02
|
| Rate for Payer: BCN Commercial |
$2.86
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.69
|
| Rate for Payer: Healthscope Whirlpool |
$3.58
|
| Rate for Payer: Mclaren Commercial |
$3.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Nomi Health Commercial |
$3.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.23
|
| Rate for Payer: Priority Health Narrow Network |
$2.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.25
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
OP
|
$368.95
|
|
|
Service Code
|
NDC 00832121301
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.58 |
| Max. Negotiated Rate |
$368.95 |
| Rate for Payer: Aetna Commercial |
$332.06
|
| Rate for Payer: Aetna Medicare |
$184.48
|
| Rate for Payer: ASR ASR |
$357.88
|
| Rate for Payer: ASR Commercial |
$357.88
|
| Rate for Payer: BCBS Complete |
$147.58
|
| Rate for Payer: BCBS Trust/PPO |
$302.13
|
| Rate for Payer: BCN Commercial |
$286.05
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Commercial |
$346.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$368.95
|
| Rate for Payer: Healthscope Whirlpool |
$357.88
|
| Rate for Payer: Mclaren Commercial |
$332.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Nomi Health Commercial |
$302.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.27
|
| Rate for Payer: Priority Health Narrow Network |
$258.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.68
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
OP
|
$46.50
|
|
|
Service Code
|
NDC 00409397703
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Aetna Commercial |
$41.85
|
| Rate for Payer: Aetna Medicare |
$23.25
|
| Rate for Payer: ASR ASR |
$45.10
|
| Rate for Payer: ASR Commercial |
$45.10
|
| Rate for Payer: BCBS Complete |
$18.60
|
| Rate for Payer: BCBS Trust/PPO |
$38.08
|
| Rate for Payer: BCN Commercial |
$36.05
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cofinity Commercial |
$43.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.20
|
| Rate for Payer: Healthscope Commercial |
$46.50
|
| Rate for Payer: Healthscope Whirlpool |
$45.10
|
| Rate for Payer: Mclaren Commercial |
$41.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.52
|
| Rate for Payer: Nomi Health Commercial |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.74
|
| Rate for Payer: Priority Health Narrow Network |
$32.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.92
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
IP
|
$46.50
|
|
|
Service Code
|
NDC 00409397703
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.22 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Aetna Commercial |
$41.85
|
| Rate for Payer: ASR ASR |
$45.10
|
| Rate for Payer: ASR Commercial |
$45.10
|
| Rate for Payer: BCBS Trust/PPO |
$37.89
|
| Rate for Payer: BCN Commercial |
$36.05
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cofinity Commercial |
$43.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.20
|
| Rate for Payer: Healthscope Commercial |
$46.50
|
| Rate for Payer: Healthscope Whirlpool |
$45.10
|
| Rate for Payer: Mclaren Commercial |
$41.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.52
|
| Rate for Payer: Nomi Health Commercial |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.92
|
|
