|
WARFARIN SODIUM 2.5 MG PO TABS
|
Facility
|
OP
|
$0.66
|
|
|
Service Code
|
NDC 0832121389
|
| Hospital Charge Code |
0832121389
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.33
|
| Rate for Payer: Aetna Government |
$0.33
|
| Rate for Payer: Brighton Health Commercial |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.45
|
| Rate for Payer: EmblemHealth Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Medicare |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.43
|
|
|
WARFARIN SODIUM 2.5 MG PO TABS
|
Facility
|
OP
|
$0.66
|
|
|
Service Code
|
NDC 0832121301
|
| Hospital Charge Code |
0832121301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.33
|
| Rate for Payer: Aetna Government |
$0.33
|
| Rate for Payer: Brighton Health Commercial |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.45
|
| Rate for Payer: EmblemHealth Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Medicare |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.43
|
|
|
WARFARIN SODIUM 2.5 MG PO TABS
|
Facility
|
IP
|
$0.66
|
|
|
Service Code
|
NDC 0832121301
|
| Hospital Charge Code |
0832121301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
|
|
WARFARIN SODIUM 2 MG PO TABS
|
Facility
|
IP
|
$0.64
|
|
|
Service Code
|
NDC 5167240281
|
| Hospital Charge Code |
5167240281
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
|
|
WARFARIN SODIUM 2 MG PO TABS
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 6258498411
|
| Hospital Charge Code |
6258498411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.31
|
| Rate for Payer: Aetna Government |
$0.31
|
| Rate for Payer: Brighton Health Commercial |
$0.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.42
|
| Rate for Payer: EmblemHealth Commercial |
$0.31
|
| Rate for Payer: Group Health Inc Commercial |
$0.31
|
| Rate for Payer: Group Health Inc Medicare |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.40
|
|
|
WARFARIN SODIUM 2 MG PO TABS
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 0832121201
|
| Hospital Charge Code |
0832121201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna Government |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$0.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.44
|
| Rate for Payer: EmblemHealth Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Medicare |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.42
|
|
|
WARFARIN SODIUM 2 MG PO TABS
|
Facility
|
IP
|
$0.64
|
|
|
Service Code
|
NDC 0832121201
|
| Hospital Charge Code |
0832121201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
|
|
WARFARIN SODIUM 2 MG PO TABS
|
Facility
|
IP
|
$0.64
|
|
|
Service Code
|
NDC 0832121200
|
| Hospital Charge Code |
0832121200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
|
|
WARFARIN SODIUM 2 MG PO TABS
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 6258498411
|
| Hospital Charge Code |
6258498411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
|
|
WARFARIN SODIUM 2 MG PO TABS
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 0832121200
|
| Hospital Charge Code |
0832121200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna Government |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$0.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.44
|
| Rate for Payer: EmblemHealth Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Medicare |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.42
|
|
|
WARFARIN SODIUM 2 MG PO TABS
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 5167240281
|
| Hospital Charge Code |
5167240281
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna Government |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$0.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.43
|
| Rate for Payer: EmblemHealth Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Medicare |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.41
|
|
|
WARFARIN SODIUM 5 MG PO TABS
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
NDC 0832121601
|
| Hospital Charge Code |
0832121601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
| Rate for Payer: Aetna Government |
$0.34
|
| Rate for Payer: Brighton Health Commercial |
$0.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.47
|
| Rate for Payer: EmblemHealth Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.45
|
|
|
WARFARIN SODIUM 5 MG PO TABS
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 5167240321
|
| Hospital Charge Code |
5167240321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
|
|
WARFARIN SODIUM 5 MG PO TABS
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
NDC 0832121600
|
| Hospital Charge Code |
0832121600
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
| Rate for Payer: Aetna Government |
$0.34
|
| Rate for Payer: Brighton Health Commercial |
$0.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.47
|
| Rate for Payer: EmblemHealth Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.45
|
|
|
WARFARIN SODIUM 5 MG PO TABS
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 5167240321
|
| Hospital Charge Code |
5167240321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
| Rate for Payer: Aetna Government |
$0.34
|
| Rate for Payer: Brighton Health Commercial |
$0.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.46
|
| Rate for Payer: EmblemHealth Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.44
|
|
|
WARFARIN SODIUM 5 MG PO TABS
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 6258499411
|
| Hospital Charge Code |
6258499411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna Government |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$0.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.44
|
| Rate for Payer: EmblemHealth Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Medicare |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.42
|
|
|
WARFARIN SODIUM 5 MG PO TABS
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
NDC 0832121689
|
| Hospital Charge Code |
0832121689
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.35
|
|
|
WARFARIN SODIUM 5 MG PO TABS
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
NDC 0832121601
|
| Hospital Charge Code |
0832121601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
|
|
WARFARIN SODIUM 5 MG PO TABS
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
NDC 0832121600
|
| Hospital Charge Code |
0832121600
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
|
|
WARFARIN SODIUM 5 MG PO TABS
|
Facility
|
IP
|
$0.64
|
|
|
Service Code
|
NDC 6258499411
|
| Hospital Charge Code |
6258499411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
|
|
WARFARIN SODIUM 5 MG PO TABS
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
NDC 0832121689
|
| Hospital Charge Code |
0832121689
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.35
|
| Rate for Payer: Aetna Government |
$0.35
|
| Rate for Payer: Brighton Health Commercial |
$0.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.47
|
| Rate for Payer: EmblemHealth Commercial |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.35
|
| Rate for Payer: Group Health Inc Medicare |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.45
|
|
|
WARFARIN SODIUM 7.5 MG PO TABS
|
Facility
|
IP
|
$0.96
|
|
|
Service Code
|
NDC 5167240341
|
| Hospital Charge Code |
5167240341
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.48
|
|
|
WARFARIN SODIUM 7.5 MG PO TABS
|
Facility
|
OP
|
$0.92
|
|
|
Service Code
|
NDC 0832121801
|
| Hospital Charge Code |
0832121801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.46
|
| Rate for Payer: Aetna Government |
$0.46
|
| Rate for Payer: Brighton Health Commercial |
$0.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.63
|
| Rate for Payer: EmblemHealth Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.60
|
|
|
WARFARIN SODIUM 7.5 MG PO TABS
|
Facility
|
OP
|
$0.92
|
|
|
Service Code
|
NDC 0832121800
|
| Hospital Charge Code |
0832121800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.46
|
| Rate for Payer: Aetna Government |
$0.46
|
| Rate for Payer: Brighton Health Commercial |
$0.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.63
|
| Rate for Payer: EmblemHealth Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.60
|
|
|
WARFARIN SODIUM 7.5 MG PO TABS
|
Facility
|
OP
|
$0.92
|
|
|
Service Code
|
NDC 0832121889
|
| Hospital Charge Code |
0832121889
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.46
|
| Rate for Payer: Aetna Government |
$0.46
|
| Rate for Payer: Brighton Health Commercial |
$0.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.63
|
| Rate for Payer: EmblemHealth Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.60
|
|