|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$260.30
|
|
|
Service Code
|
NDC 51862007901
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.99 |
| Max. Negotiated Rate |
$234.27 |
| Rate for Payer: Aetna Commercial |
$221.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.19
|
| Rate for Payer: Cash Price |
$208.24
|
| Rate for Payer: Cofinity Commercial |
$182.21
|
| Rate for Payer: Cofinity Commercial |
$223.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.24
|
| Rate for Payer: Healthscope Commercial |
$234.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.25
|
| Rate for Payer: PHP Commercial |
$221.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.19
|
| Rate for Payer: Priority Health SBD |
$163.99
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
OP
|
$200.45
|
|
|
Service Code
|
NDC 00904623861
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$180.41 |
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna Medicare |
$100.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.29
|
| Rate for Payer: BCBS Complete |
$80.18
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$140.31
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: Priority Health SBD |
$126.28
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
IP
|
$200.45
|
|
|
Service Code
|
NDC 00904623861
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.28 |
| Max. Negotiated Rate |
$180.41 |
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.29
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$140.31
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: Priority Health SBD |
$126.28
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$305.28
|
|
|
Service Code
|
NDC 68084028211
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.33 |
| Max. Negotiated Rate |
$274.75 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.43
|
| Rate for Payer: Cash Price |
$244.22
|
| Rate for Payer: Cofinity Commercial |
$213.70
|
| Rate for Payer: Cofinity Commercial |
$262.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.22
|
| Rate for Payer: Healthscope Commercial |
$274.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.49
|
| Rate for Payer: PHP Commercial |
$259.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.43
|
| Rate for Payer: Priority Health SBD |
$192.33
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$305.28
|
|
|
Service Code
|
NDC 68084028201
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.11 |
| Max. Negotiated Rate |
$274.75 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Aetna Medicare |
$152.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.43
|
| Rate for Payer: BCBS Complete |
$122.11
|
| Rate for Payer: Cash Price |
$244.22
|
| Rate for Payer: Cofinity Commercial |
$213.70
|
| Rate for Payer: Cofinity Commercial |
$262.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.22
|
| Rate for Payer: Healthscope Commercial |
$274.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.49
|
| Rate for Payer: PHP Commercial |
$259.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.43
|
| Rate for Payer: Priority Health SBD |
$192.33
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$305.28
|
|
|
Service Code
|
NDC 68084028201
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.33 |
| Max. Negotiated Rate |
$274.75 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.43
|
| Rate for Payer: Cash Price |
$244.22
|
| Rate for Payer: Cofinity Commercial |
$213.70
|
| Rate for Payer: Cofinity Commercial |
$262.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.22
|
| Rate for Payer: Healthscope Commercial |
$274.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.49
|
| Rate for Payer: PHP Commercial |
$259.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.43
|
| Rate for Payer: Priority Health SBD |
$192.33
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$627.36
|
|
|
Service Code
|
NDC 00378009401
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.94 |
| Max. Negotiated Rate |
$564.62 |
| Rate for Payer: Aetna Commercial |
$533.26
|
| Rate for Payer: Aetna Medicare |
$313.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$407.78
|
| Rate for Payer: BCBS Complete |
$250.94
|
| Rate for Payer: Cash Price |
$501.89
|
| Rate for Payer: Cofinity Commercial |
$439.15
|
| Rate for Payer: Cofinity Commercial |
$539.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$439.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.89
|
| Rate for Payer: Healthscope Commercial |
$564.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$533.26
|
| Rate for Payer: PHP Commercial |
$533.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$407.78
|
| Rate for Payer: Priority Health SBD |
$395.24
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$305.28
|
|
|
Service Code
|
NDC 68084028211
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.11 |
| Max. Negotiated Rate |
$274.75 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Aetna Medicare |
$152.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.43
|
| Rate for Payer: BCBS Complete |
$122.11
|
| Rate for Payer: Cash Price |
$244.22
|
| Rate for Payer: Cofinity Commercial |
$213.70
|
| Rate for Payer: Cofinity Commercial |
$262.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.22
|
| Rate for Payer: Healthscope Commercial |
$274.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.49
|
| Rate for Payer: PHP Commercial |
$259.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.43
|
| Rate for Payer: Priority Health SBD |
$192.33
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$627.36
|
|
|
Service Code
|
NDC 00378009401
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$395.24 |
| Max. Negotiated Rate |
$564.62 |
| Rate for Payer: Aetna Commercial |
$533.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$407.78
|
| Rate for Payer: Cash Price |
$501.89
|
| Rate for Payer: Cofinity Commercial |
$439.15
|
| Rate for Payer: Cofinity Commercial |
$539.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$439.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.89
|
| Rate for Payer: Healthscope Commercial |
$564.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$533.26
|
| Rate for Payer: PHP Commercial |
$533.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$407.78
|
| Rate for Payer: Priority Health SBD |
$395.24
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$346.25
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
39265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$138.50 |
| Max. Negotiated Rate |
$311.62 |
| Rate for Payer: Aetna Commercial |
$294.31
|
| Rate for Payer: Aetna Commercial |
$197.95
|
| Rate for Payer: Aetna Commercial |
$408.27
|
| Rate for Payer: Aetna Commercial |
$468.92
|
| Rate for Payer: Aetna Commercial |
$201.30
|
| Rate for Payer: Aetna Commercial |
$186.00
|
| Rate for Payer: Aetna Commercial |
$228.96
|
| Rate for Payer: Aetna Commercial |
$153.95
|
| Rate for Payer: Aetna Commercial |
$410.49
|
| Rate for Payer: Aetna Medicare |
$90.56
|
| Rate for Payer: Aetna Medicare |
$118.41
|
| Rate for Payer: Aetna Medicare |
$134.69
|
| Rate for Payer: Aetna Medicare |
$240.16
|
| Rate for Payer: Aetna Medicare |
$241.47
|
| Rate for Payer: Aetna Medicare |
$275.83
|
| Rate for Payer: Aetna Medicare |
$173.12
|
| Rate for Payer: Aetna Medicare |
$116.44
|
| Rate for Payer: Aetna Medicare |
$109.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.90
|
| Rate for Payer: BCBS Complete |
$72.45
|
| Rate for Payer: BCBS Complete |
$138.50
|
| Rate for Payer: BCBS Complete |
$193.17
|
| Rate for Payer: BCBS Complete |
$87.53
|
| Rate for Payer: BCBS Complete |
$220.67
|
| Rate for Payer: BCBS Complete |
$93.15
|
| Rate for Payer: BCBS Complete |
$107.75
|
| Rate for Payer: BCBS Complete |
$94.73
|
| Rate for Payer: BCBS Complete |
$192.13
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$441.34
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$386.34
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cash Price |
$175.06
|
| Rate for Payer: Cash Price |
$189.46
|
| Rate for Payer: Cash Price |
$384.26
|
| Rate for Payer: Cofinity Commercial |
$413.08
|
| Rate for Payer: Cofinity Commercial |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$126.78
|
| Rate for Payer: Cofinity Commercial |
$155.76
|
| Rate for Payer: Cofinity Commercial |
$153.17
|
| Rate for Payer: Cofinity Commercial |
$188.19
|
| Rate for Payer: Cofinity Commercial |
$163.02
|
| Rate for Payer: Cofinity Commercial |
$200.28
|
| Rate for Payer: Cofinity Commercial |
$165.77
|
| Rate for Payer: Cofinity Commercial |
$188.56
|
| Rate for Payer: Cofinity Commercial |
$231.66
|
| Rate for Payer: Cofinity Commercial |
$474.44
|
| Rate for Payer: Cofinity Commercial |
$386.17
|
| Rate for Payer: Cofinity Commercial |
$415.32
|
| Rate for Payer: Cofinity Commercial |
$338.05
|
| Rate for Payer: Cofinity Commercial |
$242.38
|
| Rate for Payer: Cofinity Commercial |
$297.77
|
| Rate for Payer: Cofinity Commercial |
$336.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$386.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$336.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$338.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$242.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.34
|
| Rate for Payer: Healthscope Commercial |
$163.01
|
| Rate for Payer: Healthscope Commercial |
$209.59
|
| Rate for Payer: Healthscope Commercial |
$213.14
|
| Rate for Payer: Healthscope Commercial |
$196.94
|
| Rate for Payer: Healthscope Commercial |
$242.43
|
| Rate for Payer: Healthscope Commercial |
$311.62
|
| Rate for Payer: Healthscope Commercial |
$432.29
|
| Rate for Payer: Healthscope Commercial |
$434.64
|
| Rate for Payer: Healthscope Commercial |
$496.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$468.92
|
| Rate for Payer: PHP Commercial |
$228.96
|
| Rate for Payer: PHP Commercial |
$410.49
|
| Rate for Payer: PHP Commercial |
$408.27
|
| Rate for Payer: PHP Commercial |
$197.95
|
| Rate for Payer: PHP Commercial |
$186.00
|
| Rate for Payer: PHP Commercial |
$153.95
|
| Rate for Payer: PHP Commercial |
$201.30
|
| Rate for Payer: PHP Commercial |
$294.31
|
| Rate for Payer: PHP Commercial |
$468.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.21
|
| Rate for Payer: Priority Health SBD |
$347.55
|
| Rate for Payer: Priority Health SBD |
$169.70
|
| Rate for Payer: Priority Health SBD |
$302.60
|
| Rate for Payer: Priority Health SBD |
$114.11
|
| Rate for Payer: Priority Health SBD |
$137.86
|
| Rate for Payer: Priority Health SBD |
$149.20
|
| Rate for Payer: Priority Health SBD |
$146.71
|
| Rate for Payer: Priority Health SBD |
$218.14
|
| Rate for Payer: Priority Health SBD |
$304.25
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$218.82
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
39265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.86 |
| Max. Negotiated Rate |
$196.94 |
| Rate for Payer: Aetna Commercial |
$186.00
|
| Rate for Payer: Aetna Commercial |
$153.95
|
| Rate for Payer: Aetna Commercial |
$468.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.59
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$441.34
|
| Rate for Payer: Cash Price |
$175.06
|
| Rate for Payer: Cofinity Commercial |
$126.78
|
| Rate for Payer: Cofinity Commercial |
$155.76
|
| Rate for Payer: Cofinity Commercial |
$153.17
|
| Rate for Payer: Cofinity Commercial |
$188.19
|
| Rate for Payer: Cofinity Commercial |
$386.17
|
| Rate for Payer: Cofinity Commercial |
$474.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$386.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.34
|
| Rate for Payer: Healthscope Commercial |
$163.01
|
| Rate for Payer: Healthscope Commercial |
$196.94
|
| Rate for Payer: Healthscope Commercial |
$496.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$468.92
|
| Rate for Payer: PHP Commercial |
$186.00
|
| Rate for Payer: PHP Commercial |
$468.92
|
| Rate for Payer: PHP Commercial |
$153.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.73
|
| Rate for Payer: Priority Health SBD |
$347.55
|
| Rate for Payer: Priority Health SBD |
$137.86
|
| Rate for Payer: Priority Health SBD |
$114.11
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$439.02
|
|
|
Service Code
|
NDC 00009085605
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$175.61 |
| Max. Negotiated Rate |
$395.12 |
| Rate for Payer: Aetna Commercial |
$373.17
|
| Rate for Payer: Aetna Medicare |
$219.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.36
|
| Rate for Payer: BCBS Complete |
$175.61
|
| Rate for Payer: Cash Price |
$351.22
|
| Rate for Payer: Cofinity Commercial |
$307.31
|
| Rate for Payer: Cofinity Commercial |
$377.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.22
|
| Rate for Payer: Healthscope Commercial |
$395.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.17
|
| Rate for Payer: PHP Commercial |
$373.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.36
|
| Rate for Payer: Priority Health SBD |
$276.58
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$550.67
|
|
|
Service Code
|
NDC 69784024001
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$220.27 |
| Max. Negotiated Rate |
$495.60 |
| Rate for Payer: Aetna Commercial |
$468.07
|
| Rate for Payer: Aetna Medicare |
$275.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.94
|
| Rate for Payer: BCBS Complete |
$220.27
|
| Rate for Payer: Cash Price |
$440.54
|
| Rate for Payer: Cofinity Commercial |
$385.47
|
| Rate for Payer: Cofinity Commercial |
$473.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$385.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.54
|
| Rate for Payer: Healthscope Commercial |
$495.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$468.07
|
| Rate for Payer: PHP Commercial |
$468.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.94
|
| Rate for Payer: Priority Health SBD |
$346.92
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$164.59
|
|
|
Service Code
|
NDC 43598069858
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.69 |
| Max. Negotiated Rate |
$148.13 |
| Rate for Payer: Aetna Commercial |
$139.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.98
|
| Rate for Payer: Cash Price |
$131.67
|
| Rate for Payer: Cofinity Commercial |
$115.21
|
| Rate for Payer: Cofinity Commercial |
$141.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.67
|
| Rate for Payer: Healthscope Commercial |
$148.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.90
|
| Rate for Payer: PHP Commercial |
$139.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.98
|
| Rate for Payer: Priority Health SBD |
$103.69
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$156.56
|
|
|
Service Code
|
NDC 43598069811
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$98.63 |
| Max. Negotiated Rate |
$140.90 |
| Rate for Payer: Aetna Commercial |
$133.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.76
|
| Rate for Payer: Cash Price |
$125.25
|
| Rate for Payer: Cofinity Commercial |
$109.59
|
| Rate for Payer: Cofinity Commercial |
$134.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.25
|
| Rate for Payer: Healthscope Commercial |
$140.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.08
|
| Rate for Payer: PHP Commercial |
$133.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.76
|
| Rate for Payer: Priority Health SBD |
$98.63
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$550.67
|
|
|
Service Code
|
NDC 69784024010
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$220.27 |
| Max. Negotiated Rate |
$495.60 |
| Rate for Payer: Aetna Commercial |
$468.07
|
| Rate for Payer: Aetna Medicare |
$275.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.94
|
| Rate for Payer: BCBS Complete |
$220.27
|
| Rate for Payer: Cash Price |
$440.54
|
| Rate for Payer: Cofinity Commercial |
$385.47
|
| Rate for Payer: Cofinity Commercial |
$473.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$385.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.54
|
| Rate for Payer: Healthscope Commercial |
$495.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$468.07
|
| Rate for Payer: PHP Commercial |
$468.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.94
|
| Rate for Payer: Priority Health SBD |
$346.92
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$164.59
|
|
|
Service Code
|
NDC 43598069858
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$148.13 |
| Rate for Payer: Aetna Commercial |
$139.90
|
| Rate for Payer: Aetna Medicare |
$82.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.98
|
| Rate for Payer: BCBS Complete |
$65.84
|
| Rate for Payer: Cash Price |
$131.67
|
| Rate for Payer: Cofinity Commercial |
$115.21
|
| Rate for Payer: Cofinity Commercial |
$141.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.67
|
| Rate for Payer: Healthscope Commercial |
$148.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.90
|
| Rate for Payer: PHP Commercial |
$139.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.98
|
| Rate for Payer: Priority Health SBD |
$103.69
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$550.67
|
|
|
Service Code
|
NDC 69784024001
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$346.92 |
| Max. Negotiated Rate |
$495.60 |
| Rate for Payer: Aetna Commercial |
$468.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.94
|
| Rate for Payer: Cash Price |
$440.54
|
| Rate for Payer: Cofinity Commercial |
$385.47
|
| Rate for Payer: Cofinity Commercial |
$473.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$385.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.54
|
| Rate for Payer: Healthscope Commercial |
$495.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$468.07
|
| Rate for Payer: PHP Commercial |
$468.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.94
|
| Rate for Payer: Priority Health SBD |
$346.92
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$439.02
|
|
|
Service Code
|
NDC 00009085608
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$276.58 |
| Max. Negotiated Rate |
$395.12 |
| Rate for Payer: Aetna Commercial |
$373.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.36
|
| Rate for Payer: Cash Price |
$351.22
|
| Rate for Payer: Cofinity Commercial |
$307.31
|
| Rate for Payer: Cofinity Commercial |
$377.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.22
|
| Rate for Payer: Healthscope Commercial |
$395.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.17
|
| Rate for Payer: PHP Commercial |
$373.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.36
|
| Rate for Payer: Priority Health SBD |
$276.58
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$156.56
|
|
|
Service Code
|
NDC 43598069811
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.62 |
| Max. Negotiated Rate |
$140.90 |
| Rate for Payer: Aetna Commercial |
$133.08
|
| Rate for Payer: Aetna Medicare |
$78.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.76
|
| Rate for Payer: BCBS Complete |
$62.62
|
| Rate for Payer: Cash Price |
$125.25
|
| Rate for Payer: Cofinity Commercial |
$109.59
|
| Rate for Payer: Cofinity Commercial |
$134.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.25
|
| Rate for Payer: Healthscope Commercial |
$140.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.08
|
| Rate for Payer: PHP Commercial |
$133.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.76
|
| Rate for Payer: Priority Health SBD |
$98.63
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$550.67
|
|
|
Service Code
|
NDC 69784024010
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$346.92 |
| Max. Negotiated Rate |
$495.60 |
| Rate for Payer: Aetna Commercial |
$468.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.94
|
| Rate for Payer: Cash Price |
$440.54
|
| Rate for Payer: Cofinity Commercial |
$385.47
|
| Rate for Payer: Cofinity Commercial |
$473.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$385.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.54
|
| Rate for Payer: Healthscope Commercial |
$495.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$468.07
|
| Rate for Payer: PHP Commercial |
$468.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.94
|
| Rate for Payer: Priority Health SBD |
$346.92
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$439.02
|
|
|
Service Code
|
NDC 00009085608
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$175.61 |
| Max. Negotiated Rate |
$395.12 |
| Rate for Payer: Aetna Commercial |
$373.17
|
| Rate for Payer: Aetna Medicare |
$219.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.36
|
| Rate for Payer: BCBS Complete |
$175.61
|
| Rate for Payer: Cash Price |
$351.22
|
| Rate for Payer: Cofinity Commercial |
$307.31
|
| Rate for Payer: Cofinity Commercial |
$377.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.22
|
| Rate for Payer: Healthscope Commercial |
$395.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.17
|
| Rate for Payer: PHP Commercial |
$373.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.36
|
| Rate for Payer: Priority Health SBD |
$276.58
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$439.02
|
|
|
Service Code
|
NDC 00009085605
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$276.58 |
| Max. Negotiated Rate |
$395.12 |
| Rate for Payer: Aetna Commercial |
$373.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.36
|
| Rate for Payer: Cash Price |
$351.22
|
| Rate for Payer: Cofinity Commercial |
$307.31
|
| Rate for Payer: Cofinity Commercial |
$377.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.22
|
| Rate for Payer: Healthscope Commercial |
$395.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.17
|
| Rate for Payer: PHP Commercial |
$373.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.36
|
| Rate for Payer: Priority Health SBD |
$276.58
|
|
|
CARFILZOMIB 30 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$7,940.21
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
179327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$7,146.19 |
| Rate for Payer: Aetna Commercial |
$6,749.18
|
| Rate for Payer: Aetna Medicare |
$57.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,161.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.56
|
| Rate for Payer: BCBS Complete |
$31.32
|
| Rate for Payer: BCBS MAPPO |
$55.65
|
| Rate for Payer: BCN Medicare Advantage |
$55.65
|
| Rate for Payer: Cash Price |
$6,352.17
|
| Rate for Payer: Cash Price |
$6,352.17
|
| Rate for Payer: Cofinity Commercial |
$5,558.15
|
| Rate for Payer: Cofinity Commercial |
$6,828.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,558.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,352.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.65
|
| Rate for Payer: Healthscope Commercial |
$7,146.19
|
| Rate for Payer: Mclaren Medicaid |
$29.83
|
| Rate for Payer: Mclaren Medicare |
$55.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.43
|
| Rate for Payer: Meridian Medicaid |
$31.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,749.18
|
| Rate for Payer: PACE Medicare |
$52.87
|
| Rate for Payer: PACE SWMI |
$55.65
|
| Rate for Payer: PHP Commercial |
$6,749.18
|
| Rate for Payer: PHP Medicare Advantage |
$55.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,161.14
|
| Rate for Payer: Priority Health Medicare |
$55.65
|
| Rate for Payer: Priority Health SBD |
$5,002.33
|
| Rate for Payer: Railroad Medicare Medicare |
$55.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.65
|
| Rate for Payer: UHC Medicare Advantage |
$55.65
|
| Rate for Payer: UHCCP Medicaid |
$31.33
|
| Rate for Payer: VA VA |
$55.65
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15,880.42
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
161768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,004.66 |
| Max. Negotiated Rate |
$14,292.38 |
| Rate for Payer: Aetna Commercial |
$13,498.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,322.27
|
| Rate for Payer: Cash Price |
$12,704.34
|
| Rate for Payer: Cofinity Commercial |
$11,116.29
|
| Rate for Payer: Cofinity Commercial |
$13,657.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,116.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,704.34
|
| Rate for Payer: Healthscope Commercial |
$14,292.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,498.36
|
| Rate for Payer: PHP Commercial |
$13,498.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,322.27
|
| Rate for Payer: Priority Health SBD |
$10,004.66
|
|
