|
FILGRASTIM-AAFI 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$295.93
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.44 |
| Max. Negotiated Rate |
$266.34 |
| Rate for Payer: Aetna Commercial |
$251.54
|
| Rate for Payer: Aetna Commercial |
$251.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.35
|
| Rate for Payer: Cash Price |
$236.74
|
| Rate for Payer: Cash Price |
$236.75
|
| Rate for Payer: Cofinity Commercial |
$207.16
|
| Rate for Payer: Cofinity Commercial |
$207.15
|
| Rate for Payer: Cofinity Commercial |
$254.50
|
| Rate for Payer: Cofinity Commercial |
$254.51
|
| Rate for Payer: Healthscope Commercial |
$266.34
|
| Rate for Payer: Healthscope Commercial |
$266.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.54
|
| Rate for Payer: PHP Commercial |
$251.54
|
| Rate for Payer: PHP Commercial |
$251.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.15
|
| Rate for Payer: Priority Health SBD |
$186.44
|
| Rate for Payer: Priority Health SBD |
$186.44
|
|
|
FILGRASTIM-AAFI 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$295.93
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$266.34 |
| Rate for Payer: Aetna Commercial |
$251.54
|
| Rate for Payer: Aetna Commercial |
$251.55
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.36
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS MAPPO |
$0.29
|
| Rate for Payer: BCBS MAPPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$0.67
|
| Rate for Payer: BCN Medicare Advantage |
$0.29
|
| Rate for Payer: BCN Medicare Advantage |
$0.29
|
| Rate for Payer: Cash Price |
$236.74
|
| Rate for Payer: Cash Price |
$236.75
|
| Rate for Payer: Cash Price |
$236.75
|
| Rate for Payer: Cash Price |
$236.74
|
| Rate for Payer: Cofinity Commercial |
$207.15
|
| Rate for Payer: Cofinity Commercial |
$254.51
|
| Rate for Payer: Cofinity Commercial |
$207.16
|
| Rate for Payer: Cofinity Commercial |
$254.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.29
|
| Rate for Payer: Healthscope Commercial |
$266.35
|
| Rate for Payer: Healthscope Commercial |
$266.34
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicare |
$0.29
|
| Rate for Payer: Mclaren Medicare |
$0.29
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.54
|
| Rate for Payer: PACE Medicare |
$0.28
|
| Rate for Payer: PACE Medicare |
$0.28
|
| Rate for Payer: PACE SWMI |
$0.29
|
| Rate for Payer: PACE SWMI |
$0.29
|
| Rate for Payer: PHP Commercial |
$251.54
|
| Rate for Payer: PHP Commercial |
$251.55
|
| Rate for Payer: PHP Medicare Advantage |
$0.29
|
| Rate for Payer: PHP Medicare Advantage |
$0.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.15
|
| Rate for Payer: Priority Health Medicare |
$0.29
|
| Rate for Payer: Priority Health Medicare |
$0.29
|
| Rate for Payer: Priority Health SBD |
$186.44
|
| Rate for Payer: Priority Health SBD |
$186.44
|
| Rate for Payer: Railroad Medicare Medicare |
$0.29
|
| Rate for Payer: Railroad Medicare Medicare |
$0.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.29
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: VA VA |
$0.29
|
| Rate for Payer: VA VA |
$0.29
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$473.50
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$298.30 |
| Max. Negotiated Rate |
$426.15 |
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.78
|
| Rate for Payer: Cash Price |
$378.80
|
| Rate for Payer: Cofinity Commercial |
$331.45
|
| Rate for Payer: Cofinity Commercial |
$407.21
|
| Rate for Payer: Healthscope Commercial |
$426.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.48
|
| Rate for Payer: PHP Commercial |
$402.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.45
|
| Rate for Payer: Priority Health SBD |
$298.30
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$473.50
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$426.15 |
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.36
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS MAPPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.67
|
| Rate for Payer: BCN Medicare Advantage |
$0.29
|
| Rate for Payer: Cash Price |
$378.80
|
| Rate for Payer: Cash Price |
$378.80
|
| Rate for Payer: Cofinity Commercial |
$407.21
|
| Rate for Payer: Cofinity Commercial |
$331.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.29
|
| Rate for Payer: Healthscope Commercial |
$426.15
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicare |
$0.29
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.48
|
| Rate for Payer: PACE Medicare |
$0.28
|
| Rate for Payer: PACE SWMI |
$0.29
|
| Rate for Payer: PHP Commercial |
$402.48
|
| Rate for Payer: PHP Medicare Advantage |
$0.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.45
|
| Rate for Payer: Priority Health Medicare |
$0.29
|
| Rate for Payer: Priority Health SBD |
$298.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.29
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: VA VA |
$0.29
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$493.82
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$444.44 |
| Rate for Payer: Aetna Commercial |
$419.75
|
| Rate for Payer: Aetna Commercial |
$419.74
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.40
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS MAPPO |
$0.32
|
| Rate for Payer: BCBS MAPPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.76
|
| Rate for Payer: BCBS Trust/PPO |
$0.76
|
| Rate for Payer: BCN Medicare Advantage |
$0.32
|
| Rate for Payer: BCN Medicare Advantage |
$0.32
|
| Rate for Payer: Cash Price |
$395.05
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Cash Price |
$395.05
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$424.68
|
| Rate for Payer: Cofinity Commercial |
$424.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.32
|
| Rate for Payer: Healthscope Commercial |
$444.44
|
| Rate for Payer: Healthscope Commercial |
$444.43
|
| Rate for Payer: Mclaren Medicaid |
$0.17
|
| Rate for Payer: Mclaren Medicaid |
$0.17
|
| Rate for Payer: Mclaren Medicare |
$0.32
|
| Rate for Payer: Mclaren Medicare |
$0.32
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$419.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$419.75
|
| Rate for Payer: PACE Medicare |
$0.30
|
| Rate for Payer: PACE Medicare |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.32
|
| Rate for Payer: PACE SWMI |
$0.32
|
| Rate for Payer: PHP Commercial |
$419.74
|
| Rate for Payer: PHP Commercial |
$419.75
|
| Rate for Payer: PHP Medicare Advantage |
$0.32
|
| Rate for Payer: PHP Medicare Advantage |
$0.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.67
|
| Rate for Payer: Priority Health Medicare |
$0.32
|
| Rate for Payer: Priority Health Medicare |
$0.32
|
| Rate for Payer: Priority Health SBD |
$311.10
|
| Rate for Payer: Priority Health SBD |
$311.11
|
| Rate for Payer: Railroad Medicare Medicare |
$0.32
|
| Rate for Payer: Railroad Medicare Medicare |
$0.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.32
|
| Rate for Payer: UHC Medicare Advantage |
$0.33
|
| Rate for Payer: UHC Medicare Advantage |
$0.33
|
| Rate for Payer: VA VA |
$0.32
|
| Rate for Payer: VA VA |
$0.32
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$493.81
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$311.10 |
| Max. Negotiated Rate |
$444.43 |
| Rate for Payer: Aetna Commercial |
$419.74
|
| Rate for Payer: Aetna Commercial |
$419.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Cash Price |
$395.05
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$424.69
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$424.68
|
| Rate for Payer: Healthscope Commercial |
$444.43
|
| Rate for Payer: Healthscope Commercial |
$444.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$419.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$419.75
|
| Rate for Payer: PHP Commercial |
$419.74
|
| Rate for Payer: PHP Commercial |
$419.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.67
|
| Rate for Payer: Priority Health SBD |
$311.10
|
| Rate for Payer: Priority Health SBD |
$311.11
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
IP
|
$790.09
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$497.76 |
| Max. Negotiated Rate |
$711.08 |
| Rate for Payer: Aetna Commercial |
$671.58
|
| Rate for Payer: Aetna Commercial |
$671.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.56
|
| Rate for Payer: Cash Price |
$632.07
|
| Rate for Payer: Cash Price |
$632.08
|
| Rate for Payer: Cofinity Commercial |
$553.07
|
| Rate for Payer: Cofinity Commercial |
$553.06
|
| Rate for Payer: Cofinity Commercial |
$679.48
|
| Rate for Payer: Cofinity Commercial |
$679.49
|
| Rate for Payer: Healthscope Commercial |
$711.08
|
| Rate for Payer: Healthscope Commercial |
$711.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$671.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$671.58
|
| Rate for Payer: PHP Commercial |
$671.58
|
| Rate for Payer: PHP Commercial |
$671.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.07
|
| Rate for Payer: Priority Health SBD |
$497.76
|
| Rate for Payer: Priority Health SBD |
$497.76
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
OP
|
$790.09
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$711.08 |
| Rate for Payer: Aetna Commercial |
$671.58
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.40
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS MAPPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.76
|
| Rate for Payer: BCN Medicare Advantage |
$0.32
|
| Rate for Payer: Cash Price |
$632.07
|
| Rate for Payer: Cash Price |
$632.07
|
| Rate for Payer: Cofinity Commercial |
$679.48
|
| Rate for Payer: Cofinity Commercial |
$553.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.32
|
| Rate for Payer: Healthscope Commercial |
$711.08
|
| Rate for Payer: Mclaren Medicaid |
$0.17
|
| Rate for Payer: Mclaren Medicare |
$0.32
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$671.58
|
| Rate for Payer: PACE Medicare |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.32
|
| Rate for Payer: PHP Commercial |
$671.58
|
| Rate for Payer: PHP Medicare Advantage |
$0.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.06
|
| Rate for Payer: Priority Health Medicare |
$0.32
|
| Rate for Payer: Priority Health SBD |
$497.76
|
| Rate for Payer: Railroad Medicare Medicare |
$0.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.32
|
| Rate for Payer: UHC Medicare Advantage |
$0.33
|
| Rate for Payer: VA VA |
$0.32
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$3.92
|
|
|
Service Code
|
NDC 50268-314-11
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.55
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$3.37
|
| Rate for Payer: Healthscope Commercial |
$3.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.33
|
| Rate for Payer: PHP Commercial |
$3.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.74
|
| Rate for Payer: Priority Health SBD |
$2.47
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$53.58
|
|
|
Service Code
|
NDC 16729-090-10
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.76 |
| Max. Negotiated Rate |
$48.22 |
| Rate for Payer: Aetna Commercial |
$45.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.83
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Commercial |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$46.08
|
| Rate for Payer: Healthscope Commercial |
$48.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.54
|
| Rate for Payer: PHP Commercial |
$45.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.51
|
| Rate for Payer: Priority Health SBD |
$33.76
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$193.80
|
|
|
Service Code
|
NDC 0904-6830-06
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.09 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Commercial |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.73
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.66
|
| Rate for Payer: Priority Health SBD |
$122.09
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 16729-090-01
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.27 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.84
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.64
|
| Rate for Payer: Priority Health SBD |
$93.27
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 50268-314-15
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.29 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.34
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.99
|
| Rate for Payer: Priority Health SBD |
$123.29
|
|
|
FINE NEEDLE ASPIRATION BIOPSY, INCLUDING ULTRASOUND GUIDANCE; FIRST LESION
|
Facility
|
OP
|
$1,463.00
|
|
|
Service Code
|
CPT 10005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.73 |
| Max. Negotiated Rate |
$1,463.00 |
| Rate for Payer: Aetna Medicare |
$651.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$782.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$782.55
|
| Rate for Payer: BCBS Complete |
$359.60
|
| Rate for Payer: BCBS MAPPO |
$626.04
|
| Rate for Payer: BCBS Trust/PPO |
$677.59
|
| Rate for Payer: BCCCP Commercial |
$141.12
|
| Rate for Payer: BCN Medicare Advantage |
$626.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.04
|
| Rate for Payer: Mclaren Medicaid |
$342.44
|
| Rate for Payer: Mclaren Medicare |
$626.04
|
| Rate for Payer: Meridian Medicaid |
$359.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$657.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.95
|
| Rate for Payer: PACE Medicare |
$594.74
|
| Rate for Payer: PACE SWMI |
$626.04
|
| Rate for Payer: PHP Medicare Advantage |
$626.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.44
|
| Rate for Payer: Priority Health Medicare |
$626.04
|
| Rate for Payer: Railroad Medicare Medicare |
$626.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.80
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.04
|
| Rate for Payer: UHC Exchange |
$70.73
|
| Rate for Payer: UHC Medicare Advantage |
$644.82
|
| Rate for Payer: VA VA |
$626.04
|
|
|
FISSURECTOMY, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 46200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$335.96 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,598.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,122.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,122.94
|
| Rate for Payer: BCBS Complete |
$1,435.05
|
| Rate for Payer: BCBS MAPPO |
$2,498.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,368.08
|
| Rate for Payer: BCN Medicare Advantage |
$2,498.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,498.35
|
| Rate for Payer: Mclaren Medicaid |
$1,366.60
|
| Rate for Payer: Mclaren Medicare |
$2,498.35
|
| Rate for Payer: Meridian Medicaid |
$1,435.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,623.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,873.10
|
| Rate for Payer: PACE Medicare |
$2,373.43
|
| Rate for Payer: PACE SWMI |
$2,498.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,498.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,366.60
|
| Rate for Payer: Priority Health Medicare |
$2,498.35
|
| Rate for Payer: Railroad Medicare Medicare |
$2,498.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.56
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,498.35
|
| Rate for Payer: UHC Exchange |
$335.96
|
| Rate for Payer: UHC Medicare Advantage |
$2,573.30
|
| Rate for Payer: VA VA |
$2,498.35
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$253.80
|
|
|
Service Code
|
NDC 53746-641-01
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.89 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.97
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$177.66
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.73
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.66
|
| Rate for Payer: Priority Health SBD |
$159.89
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$153.80
|
|
|
Service Code
|
NDC 0054-0010-21
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.89 |
| Max. Negotiated Rate |
$138.42 |
| Rate for Payer: Aetna Commercial |
$130.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.97
|
| Rate for Payer: Cash Price |
$123.04
|
| Rate for Payer: Cofinity Commercial |
$107.66
|
| Rate for Payer: Cofinity Commercial |
$132.27
|
| Rate for Payer: Healthscope Commercial |
$138.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.73
|
| Rate for Payer: PHP Commercial |
$130.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.66
|
| Rate for Payer: Priority Health SBD |
$96.89
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$250.08
|
|
|
Service Code
|
NDC 0054-0010-20
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.55 |
| Max. Negotiated Rate |
$225.07 |
| Rate for Payer: Aetna Commercial |
$212.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.55
|
| Rate for Payer: Cash Price |
$200.06
|
| Rate for Payer: Cofinity Commercial |
$175.06
|
| Rate for Payer: Cofinity Commercial |
$215.07
|
| Rate for Payer: Healthscope Commercial |
$225.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.57
|
| Rate for Payer: PHP Commercial |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.06
|
| Rate for Payer: Priority Health SBD |
$157.55
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$541.44
|
|
|
Service Code
|
NDC 0904-6500-61
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$341.11 |
| Max. Negotiated Rate |
$487.30 |
| Rate for Payer: Aetna Commercial |
$460.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.94
|
| Rate for Payer: Cash Price |
$433.15
|
| Rate for Payer: Cofinity Commercial |
$379.01
|
| Rate for Payer: Cofinity Commercial |
$465.64
|
| Rate for Payer: Healthscope Commercial |
$487.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.22
|
| Rate for Payer: PHP Commercial |
$460.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.01
|
| Rate for Payer: Priority Health SBD |
$341.11
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$115.71
|
|
|
Service Code
|
NDC 68462-102-30
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.90 |
| Max. Negotiated Rate |
$104.14 |
| Rate for Payer: Aetna Commercial |
$98.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.21
|
| Rate for Payer: Cash Price |
$92.57
|
| Rate for Payer: Cofinity Commercial |
$81.00
|
| Rate for Payer: Cofinity Commercial |
$99.51
|
| Rate for Payer: Healthscope Commercial |
$104.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.35
|
| Rate for Payer: PHP Commercial |
$98.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.00
|
| Rate for Payer: Priority Health SBD |
$72.90
|
|
|
FLUCONAZOLE 150 MG TABLET
|
Facility
|
IP
|
$60.25
|
|
|
Service Code
|
NDC 57237-005-11
|
| Hospital Charge Code |
13577
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$54.22 |
| Rate for Payer: Aetna Commercial |
$51.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.16
|
| Rate for Payer: Cash Price |
$48.20
|
| Rate for Payer: Cofinity Commercial |
$42.18
|
| Rate for Payer: Cofinity Commercial |
$51.82
|
| Rate for Payer: Healthscope Commercial |
$54.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.21
|
| Rate for Payer: PHP Commercial |
$51.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.18
|
| Rate for Payer: Priority Health SBD |
$37.96
|
|
|
FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$66.99
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
10049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$60.29 |
| Rate for Payer: Aetna Commercial |
$56.94
|
| Rate for Payer: Aetna Commercial |
$71.86
|
| Rate for Payer: Aetna Commercial |
$89.48
|
| Rate for Payer: Aetna Commercial |
$50.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.54
|
| Rate for Payer: Cash Price |
$53.59
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cash Price |
$47.22
|
| Rate for Payer: Cash Price |
$67.63
|
| Rate for Payer: Cofinity Commercial |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$73.69
|
| Rate for Payer: Cofinity Commercial |
$90.53
|
| Rate for Payer: Cofinity Commercial |
$41.31
|
| Rate for Payer: Cofinity Commercial |
$46.89
|
| Rate for Payer: Cofinity Commercial |
$57.61
|
| Rate for Payer: Cofinity Commercial |
$59.18
|
| Rate for Payer: Cofinity Commercial |
$72.70
|
| Rate for Payer: Healthscope Commercial |
$60.29
|
| Rate for Payer: Healthscope Commercial |
$76.09
|
| Rate for Payer: Healthscope Commercial |
$94.74
|
| Rate for Payer: Healthscope Commercial |
$53.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.17
|
| Rate for Payer: PHP Commercial |
$89.48
|
| Rate for Payer: PHP Commercial |
$71.86
|
| Rate for Payer: PHP Commercial |
$50.17
|
| Rate for Payer: PHP Commercial |
$56.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.31
|
| Rate for Payer: Priority Health SBD |
$37.18
|
| Rate for Payer: Priority Health SBD |
$66.32
|
| Rate for Payer: Priority Health SBD |
$42.20
|
| Rate for Payer: Priority Health SBD |
$53.26
|
|
|
FLUCONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$7.81
|
|
|
Service Code
|
NDC 68084-735-11
|
| Hospital Charge Code |
10045
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna Commercial |
$6.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.08
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Healthscope Commercial |
$7.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.64
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.47
|
| Rate for Payer: Priority Health SBD |
$4.92
|
|
|
FLUCONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$780.96
|
|
|
Service Code
|
NDC 68084-735-01
|
| Hospital Charge Code |
10045
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$492.00 |
| Max. Negotiated Rate |
$702.86 |
| Rate for Payer: Aetna Commercial |
$663.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.62
|
| Rate for Payer: Cash Price |
$624.77
|
| Rate for Payer: Cofinity Commercial |
$546.67
|
| Rate for Payer: Cofinity Commercial |
$671.63
|
| Rate for Payer: Healthscope Commercial |
$702.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$663.82
|
| Rate for Payer: PHP Commercial |
$663.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.67
|
| Rate for Payer: Priority Health SBD |
$492.00
|
|
|
FLUCONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$612.48
|
|
|
Service Code
|
NDC 55111-146-01
|
| Hospital Charge Code |
10045
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$385.86 |
| Max. Negotiated Rate |
$551.23 |
| Rate for Payer: Aetna Commercial |
$520.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.11
|
| Rate for Payer: Cash Price |
$489.98
|
| Rate for Payer: Cofinity Commercial |
$428.74
|
| Rate for Payer: Cofinity Commercial |
$526.73
|
| Rate for Payer: Healthscope Commercial |
$551.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$520.61
|
| Rate for Payer: PHP Commercial |
$520.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.74
|
| Rate for Payer: Priority Health SBD |
$385.86
|
|
