|
TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$4.74
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
24914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$4.03
|
| Rate for Payer: Aetna Commercial |
$311.61
|
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna Commercial |
$345.58
|
| Rate for Payer: Aetna Commercial |
$402.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.08
|
| Rate for Payer: Cash Price |
$325.25
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Cash Price |
$293.28
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cash Price |
$378.62
|
| Rate for Payer: Cofinity Advantage |
$331.30
|
| Rate for Payer: Cofinity Advantage |
$284.59
|
| Rate for Payer: Cofinity Advantage |
$3.32
|
| Rate for Payer: Cofinity Advantage |
$191.52
|
| Rate for Payer: Cofinity Advantage |
$256.62
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$349.64
|
| Rate for Payer: Cofinity Commercial |
$407.02
|
| Rate for Payer: Cofinity Commercial |
$315.28
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.79
|
| Rate for Payer: Healthscope Commercial |
$365.90
|
| Rate for Payer: Healthscope Commercial |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$329.94
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Healthscope Commercial |
$425.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: PHP Commercial |
$402.29
|
| Rate for Payer: PHP Commercial |
$4.03
|
| Rate for Payer: PHP Commercial |
$311.61
|
| Rate for Payer: PHP Commercial |
$345.58
|
| Rate for Payer: Priority Health SBD |
$298.17
|
| Rate for Payer: Priority Health SBD |
$256.13
|
| Rate for Payer: Priority Health SBD |
$230.96
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: Priority Health SBD |
$2.99
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
OP
|
$572.64
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$515.38 |
| Rate for Payer: Aetna Commercial |
$486.74
|
| Rate for Payer: Aetna Commercial |
$485.52
|
| Rate for Payer: Aetna Commercial |
$441.46
|
| Rate for Payer: Aetna Commercial |
$4.86
|
| Rate for Payer: Aetna Commercial |
$242.35
|
| Rate for Payer: Aetna Medicare |
$142.56
|
| Rate for Payer: Aetna Medicare |
$259.68
|
| Rate for Payer: Aetna Medicare |
$285.60
|
| Rate for Payer: Aetna Medicare |
$286.32
|
| Rate for Payer: Aetna Medicare |
$2.86
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.33
|
| Rate for Payer: BCBS Complete |
$229.06
|
| Rate for Payer: BCBS Complete |
$207.74
|
| Rate for Payer: BCBS Complete |
$228.48
|
| Rate for Payer: BCBS Complete |
$114.05
|
| Rate for Payer: BCBS Complete |
$2.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.49
|
| Rate for Payer: BCBS Trust/PPO |
$0.49
|
| Rate for Payer: BCBS Trust/PPO |
$0.49
|
| Rate for Payer: BCBS Trust/PPO |
$0.49
|
| Rate for Payer: BCBS Trust/PPO |
$0.49
|
| Rate for Payer: BCN Commercial |
$0.49
|
| Rate for Payer: BCN Commercial |
$0.49
|
| Rate for Payer: BCN Commercial |
$0.49
|
| Rate for Payer: BCN Commercial |
$0.49
|
| Rate for Payer: BCN Commercial |
$0.49
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cash Price |
$415.49
|
| Rate for Payer: Cash Price |
$228.10
|
| Rate for Payer: Cash Price |
$228.10
|
| Rate for Payer: Cash Price |
$456.96
|
| Rate for Payer: Cash Price |
$415.49
|
| Rate for Payer: Cash Price |
$456.96
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cash Price |
$458.11
|
| Rate for Payer: Cash Price |
$458.11
|
| Rate for Payer: Cofinity Advantage |
$400.85
|
| Rate for Payer: Cofinity Advantage |
$4.00
|
| Rate for Payer: Cofinity Advantage |
$363.55
|
| Rate for Payer: Cofinity Advantage |
$199.58
|
| Rate for Payer: Cofinity Advantage |
$399.84
|
| Rate for Payer: Cofinity Commercial |
$491.23
|
| Rate for Payer: Cofinity Commercial |
$446.65
|
| Rate for Payer: Cofinity Commercial |
$4.92
|
| Rate for Payer: Cofinity Commercial |
$492.47
|
| Rate for Payer: Cofinity Commercial |
$245.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.49
|
| Rate for Payer: Healthscope Commercial |
$467.42
|
| Rate for Payer: Healthscope Commercial |
$515.38
|
| Rate for Payer: Healthscope Commercial |
$5.15
|
| Rate for Payer: Healthscope Commercial |
$514.08
|
| Rate for Payer: Healthscope Commercial |
$256.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$415.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$456.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$485.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$428.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$389.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.29
|
| Rate for Payer: PHP Commercial |
$485.52
|
| Rate for Payer: PHP Commercial |
$441.46
|
| Rate for Payer: PHP Commercial |
$242.35
|
| Rate for Payer: PHP Commercial |
$486.74
|
| Rate for Payer: PHP Commercial |
$4.86
|
| Rate for Payer: Priority Health SBD |
$359.86
|
| Rate for Payer: Priority Health SBD |
$3.60
|
| Rate for Payer: Priority Health SBD |
$360.76
|
| Rate for Payer: Priority Health SBD |
$327.20
|
| Rate for Payer: Priority Health SBD |
$179.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$519.36
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$327.20 |
| Max. Negotiated Rate |
$467.42 |
| Rate for Payer: Aetna Commercial |
$441.46
|
| Rate for Payer: Aetna Commercial |
$485.52
|
| Rate for Payer: Aetna Commercial |
$486.74
|
| Rate for Payer: Aetna Commercial |
$242.35
|
| Rate for Payer: Aetna Commercial |
$4.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.72
|
| Rate for Payer: Cash Price |
$458.11
|
| Rate for Payer: Cash Price |
$228.10
|
| Rate for Payer: Cash Price |
$415.49
|
| Rate for Payer: Cash Price |
$456.96
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cofinity Advantage |
$199.58
|
| Rate for Payer: Cofinity Advantage |
$363.55
|
| Rate for Payer: Cofinity Advantage |
$4.00
|
| Rate for Payer: Cofinity Advantage |
$399.84
|
| Rate for Payer: Cofinity Advantage |
$400.85
|
| Rate for Payer: Cofinity Commercial |
$446.65
|
| Rate for Payer: Cofinity Commercial |
$4.92
|
| Rate for Payer: Cofinity Commercial |
$245.20
|
| Rate for Payer: Cofinity Commercial |
$491.23
|
| Rate for Payer: Cofinity Commercial |
$492.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.11
|
| Rate for Payer: Healthscope Commercial |
$467.42
|
| Rate for Payer: Healthscope Commercial |
$256.61
|
| Rate for Payer: Healthscope Commercial |
$515.38
|
| Rate for Payer: Healthscope Commercial |
$5.15
|
| Rate for Payer: Healthscope Commercial |
$514.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$485.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$428.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$389.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.84
|
| Rate for Payer: PHP Commercial |
$486.74
|
| Rate for Payer: PHP Commercial |
$4.86
|
| Rate for Payer: PHP Commercial |
$485.52
|
| Rate for Payer: PHP Commercial |
$441.46
|
| Rate for Payer: PHP Commercial |
$242.35
|
| Rate for Payer: Priority Health SBD |
$327.20
|
| Rate for Payer: Priority Health SBD |
$360.76
|
| Rate for Payer: Priority Health SBD |
$3.60
|
| Rate for Payer: Priority Health SBD |
$179.63
|
| Rate for Payer: Priority Health SBD |
$359.86
|
|
|
TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$257.28
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$162.09 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Advantage |
$180.10
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.96
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health SBD |
$162.09
|
|
|
TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$257.28
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna Medicare |
$128.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: BCBS Complete |
$102.91
|
| Rate for Payer: BCBS Trust/PPO |
$4.68
|
| Rate for Payer: BCN Commercial |
$4.68
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Advantage |
$180.10
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.96
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health SBD |
$162.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.09
|
| Rate for Payer: UHC Core |
$3.09
|
| Rate for Payer: UHC Exchange |
$3.09
|
|
|
TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$102.82
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175522
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$92.54 |
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Commercial |
$291.72
|
| Rate for Payer: Aetna Medicare |
$171.60
|
| Rate for Payer: Aetna Medicare |
$51.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.08
|
| Rate for Payer: BCBS Complete |
$137.28
|
| Rate for Payer: BCBS Complete |
$41.13
|
| Rate for Payer: BCBS Trust/PPO |
$4.68
|
| Rate for Payer: BCBS Trust/PPO |
$4.68
|
| Rate for Payer: BCN Commercial |
$4.68
|
| Rate for Payer: BCN Commercial |
$4.68
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cash Price |
$274.56
|
| Rate for Payer: Cash Price |
$274.56
|
| Rate for Payer: Cofinity Advantage |
$71.97
|
| Rate for Payer: Cofinity Advantage |
$240.24
|
| Rate for Payer: Cofinity Commercial |
$88.43
|
| Rate for Payer: Cofinity Commercial |
$295.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.26
|
| Rate for Payer: Healthscope Commercial |
$308.88
|
| Rate for Payer: Healthscope Commercial |
$92.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.40
|
| Rate for Payer: PHP Commercial |
$87.40
|
| Rate for Payer: PHP Commercial |
$291.72
|
| Rate for Payer: Priority Health SBD |
$64.78
|
| Rate for Payer: Priority Health SBD |
$216.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.83
|
| Rate for Payer: UHC Core |
$53.57
|
| Rate for Payer: UHC Core |
$178.81
|
| Rate for Payer: UHC Exchange |
$40.41
|
| Rate for Payer: UHC Exchange |
$134.88
|
|
|
TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$343.20
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175522
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.22 |
| Max. Negotiated Rate |
$308.88 |
| Rate for Payer: Aetna Commercial |
$291.72
|
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.08
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cash Price |
$274.56
|
| Rate for Payer: Cofinity Advantage |
$71.97
|
| Rate for Payer: Cofinity Advantage |
$240.24
|
| Rate for Payer: Cofinity Commercial |
$295.15
|
| Rate for Payer: Cofinity Commercial |
$88.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.26
|
| Rate for Payer: Healthscope Commercial |
$308.88
|
| Rate for Payer: Healthscope Commercial |
$92.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.40
|
| Rate for Payer: PHP Commercial |
$87.40
|
| Rate for Payer: PHP Commercial |
$291.72
|
| Rate for Payer: Priority Health SBD |
$216.22
|
| Rate for Payer: Priority Health SBD |
$64.78
|
|
|
TACROLIMUS XR 4 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$317.24
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$199.86 |
| Max. Negotiated Rate |
$285.52 |
| Rate for Payer: Aetna Commercial |
$269.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.21
|
| Rate for Payer: Cash Price |
$253.79
|
| Rate for Payer: Cofinity Advantage |
$222.07
|
| Rate for Payer: Cofinity Commercial |
$272.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.79
|
| Rate for Payer: Healthscope Commercial |
$285.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.93
|
| Rate for Payer: PHP Commercial |
$269.65
|
| Rate for Payer: Priority Health SBD |
$199.86
|
|
|
TACROLIMUS XR 4 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$317.24
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$285.52 |
| Rate for Payer: Aetna Commercial |
$269.65
|
| Rate for Payer: Aetna Medicare |
$158.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.21
|
| Rate for Payer: BCBS Complete |
$126.90
|
| Rate for Payer: BCBS Trust/PPO |
$4.68
|
| Rate for Payer: BCN Commercial |
$4.68
|
| Rate for Payer: Cash Price |
$253.79
|
| Rate for Payer: Cash Price |
$253.79
|
| Rate for Payer: Cofinity Advantage |
$222.07
|
| Rate for Payer: Cofinity Commercial |
$272.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.79
|
| Rate for Payer: Healthscope Commercial |
$285.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.93
|
| Rate for Payer: PHP Commercial |
$269.65
|
| Rate for Payer: Priority Health SBD |
$199.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.09
|
| Rate for Payer: UHC Core |
$3.09
|
| Rate for Payer: UHC Exchange |
$3.09
|
|
|
TALQUETAMAB-TGVS 2 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$2,722.78
|
|
|
Service Code
|
HCPCS J3055
|
| Hospital Charge Code |
204984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.16 |
| Max. Negotiated Rate |
$2,450.50 |
| Rate for Payer: Aetna Commercial |
$2,314.36
|
| Rate for Payer: Aetna Medicare |
$77.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,769.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.60
|
| Rate for Payer: BCBS Complete |
$41.12
|
| Rate for Payer: BCBS MAPPO |
$74.88
|
| Rate for Payer: BCBS Trust/PPO |
$187.93
|
| Rate for Payer: BCN Commercial |
$187.93
|
| Rate for Payer: BCN Medicare Advantage |
$74.88
|
| Rate for Payer: Cash Price |
$2,178.22
|
| Rate for Payer: Cash Price |
$2,178.22
|
| Rate for Payer: Cofinity Advantage |
$1,905.95
|
| Rate for Payer: Cofinity Commercial |
$2,341.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,178.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.88
|
| Rate for Payer: Healthscope Commercial |
$2,450.50
|
| Rate for Payer: Mclaren Medicaid |
$39.16
|
| Rate for Payer: Mclaren Medicare |
$74.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.62
|
| Rate for Payer: Meridian Medicaid |
$78.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,314.36
|
| Rate for Payer: Nomi Health Commercial |
$224.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,042.09
|
| Rate for Payer: PACE Medicare |
$71.14
|
| Rate for Payer: PACE SWMI |
$74.88
|
| Rate for Payer: PHP Commercial |
$2,314.36
|
| Rate for Payer: PHP Medicare Advantage |
$74.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$229.04
|
| Rate for Payer: Priority Health Medicare |
$74.88
|
| Rate for Payer: Priority Health SBD |
$1,715.35
|
| Rate for Payer: Priority Health Tiered Network |
$183.23
|
| Rate for Payer: Railroad Medicare Medicare |
$74.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.62
|
| Rate for Payer: UHC Core |
$123.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.88
|
| Rate for Payer: UHC Exchange |
$123.62
|
| Rate for Payer: UHC Medicaid |
$39.16
|
| Rate for Payer: UHCCP Medicaid |
$39.16
|
| Rate for Payer: VA VA |
$74.88
|
|
|
TALQUETAMAB-TGVS 40 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$36,384.63
|
|
|
Service Code
|
HCPCS J3055
|
| Hospital Charge Code |
204983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.16 |
| Max. Negotiated Rate |
$32,746.17 |
| Rate for Payer: Aetna Commercial |
$30,926.94
|
| Rate for Payer: Aetna Medicare |
$77.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23,650.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.60
|
| Rate for Payer: BCBS Complete |
$41.12
|
| Rate for Payer: BCBS MAPPO |
$74.88
|
| Rate for Payer: BCBS Trust/PPO |
$187.93
|
| Rate for Payer: BCN Commercial |
$187.93
|
| Rate for Payer: BCN Medicare Advantage |
$74.88
|
| Rate for Payer: Cash Price |
$29,107.70
|
| Rate for Payer: Cash Price |
$29,107.70
|
| Rate for Payer: Cofinity Advantage |
$25,469.24
|
| Rate for Payer: Cofinity Commercial |
$31,290.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29,107.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.88
|
| Rate for Payer: Healthscope Commercial |
$32,746.17
|
| Rate for Payer: Mclaren Medicaid |
$39.16
|
| Rate for Payer: Mclaren Medicare |
$74.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.62
|
| Rate for Payer: Meridian Medicaid |
$78.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30,926.94
|
| Rate for Payer: Nomi Health Commercial |
$224.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27,288.47
|
| Rate for Payer: PACE Medicare |
$71.14
|
| Rate for Payer: PACE SWMI |
$74.88
|
| Rate for Payer: PHP Commercial |
$30,926.94
|
| Rate for Payer: PHP Medicare Advantage |
$74.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$229.04
|
| Rate for Payer: Priority Health Medicare |
$74.88
|
| Rate for Payer: Priority Health SBD |
$22,922.32
|
| Rate for Payer: Priority Health Tiered Network |
$183.23
|
| Rate for Payer: Railroad Medicare Medicare |
$74.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.62
|
| Rate for Payer: UHC Core |
$123.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.88
|
| Rate for Payer: UHC Exchange |
$123.62
|
| Rate for Payer: UHC Medicaid |
$39.16
|
| Rate for Payer: UHCCP Medicaid |
$39.16
|
| Rate for Payer: VA VA |
$74.88
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
OP
|
$249.57
|
|
|
Service Code
|
NDC 59651029960
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.08 |
| Max. Negotiated Rate |
$224.61 |
| Rate for Payer: Aetna Commercial |
$212.13
|
| Rate for Payer: Aetna Medicare |
$124.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.22
|
| Rate for Payer: BCBS Complete |
$99.83
|
| Rate for Payer: Cash Price |
$199.66
|
| Rate for Payer: Cofinity Advantage |
$174.70
|
| Rate for Payer: Cofinity Commercial |
$214.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.66
|
| Rate for Payer: Healthscope Commercial |
$224.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.18
|
| Rate for Payer: PHP Commercial |
$212.13
|
| Rate for Payer: Priority Health SBD |
$157.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.22
|
| Rate for Payer: UHC Core |
$130.03
|
| Rate for Payer: UHC Exchange |
$98.08
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
OP
|
$387.60
|
|
|
Service Code
|
NDC 63739014310
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.33 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: Aetna Medicare |
$193.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.94
|
| Rate for Payer: BCBS Complete |
$155.04
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Advantage |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$310.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.70
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: Priority Health SBD |
$244.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.94
|
| Rate for Payer: UHC Core |
$201.94
|
| Rate for Payer: UHC Exchange |
$152.33
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
IP
|
$249.57
|
|
|
Service Code
|
NDC 59651029960
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.23 |
| Max. Negotiated Rate |
$224.61 |
| Rate for Payer: Aetna Commercial |
$212.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.22
|
| Rate for Payer: Cash Price |
$199.66
|
| Rate for Payer: Cofinity Advantage |
$174.70
|
| Rate for Payer: Cofinity Commercial |
$214.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.66
|
| Rate for Payer: Healthscope Commercial |
$224.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.18
|
| Rate for Payer: PHP Commercial |
$212.13
|
| Rate for Payer: Priority Health SBD |
$157.23
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
IP
|
$201.78
|
|
|
Service Code
|
NDC 00378014491
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.12 |
| Max. Negotiated Rate |
$181.60 |
| Rate for Payer: Aetna Commercial |
$171.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.16
|
| Rate for Payer: Cash Price |
$161.42
|
| Rate for Payer: Cofinity Advantage |
$141.25
|
| Rate for Payer: Cofinity Commercial |
$173.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.42
|
| Rate for Payer: Healthscope Commercial |
$181.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.34
|
| Rate for Payer: PHP Commercial |
$171.51
|
| Rate for Payer: Priority Health SBD |
$127.12
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
IP
|
$387.60
|
|
|
Service Code
|
NDC 63739014310
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.19 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.94
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Advantage |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.70
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: Priority Health SBD |
$244.19
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
OP
|
$201.78
|
|
|
Service Code
|
NDC 00378014491
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$181.60 |
| Rate for Payer: Aetna Commercial |
$171.51
|
| Rate for Payer: Aetna Medicare |
$100.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.16
|
| Rate for Payer: BCBS Complete |
$80.71
|
| Rate for Payer: Cash Price |
$161.42
|
| Rate for Payer: Cofinity Advantage |
$141.25
|
| Rate for Payer: Cofinity Commercial |
$173.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.42
|
| Rate for Payer: Healthscope Commercial |
$181.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.34
|
| Rate for Payer: PHP Commercial |
$171.51
|
| Rate for Payer: Priority Health SBD |
$127.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.16
|
| Rate for Payer: UHC Core |
$105.13
|
| Rate for Payer: UHC Exchange |
$79.30
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$192.85
|
|
|
Service Code
|
NDC 00904640161
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.79 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna Medicare |
$96.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: BCBS Complete |
$77.14
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Advantage |
$135.00
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.64
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health SBD |
$121.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.35
|
| Rate for Payer: UHC Core |
$100.47
|
| Rate for Payer: UHC Exchange |
$75.79
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$166.85
|
|
|
Service Code
|
NDC 33342015911
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.12 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.45
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Advantage |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$143.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$150.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.14
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: Priority Health SBD |
$105.12
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$2.59
|
|
|
Service Code
|
NDC 68084029911
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.68
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Advantage |
$1.81
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$2.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.94
|
| Rate for Payer: PHP Commercial |
$2.20
|
| Rate for Payer: Priority Health SBD |
$1.63
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$262.26
|
|
|
Service Code
|
NDC 62756016081
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.22 |
| Max. Negotiated Rate |
$236.03 |
| Rate for Payer: Aetna Commercial |
$222.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.47
|
| Rate for Payer: Cash Price |
$209.81
|
| Rate for Payer: Cofinity Advantage |
$183.58
|
| Rate for Payer: Cofinity Commercial |
$225.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.81
|
| Rate for Payer: Healthscope Commercial |
$236.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.69
|
| Rate for Payer: PHP Commercial |
$222.92
|
| Rate for Payer: Priority Health SBD |
$165.22
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$451.25
|
|
|
Service Code
|
NDC 00228299611
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.29 |
| Max. Negotiated Rate |
$406.12 |
| Rate for Payer: Aetna Commercial |
$383.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.31
|
| Rate for Payer: Cash Price |
$361.00
|
| Rate for Payer: Cofinity Advantage |
$315.88
|
| Rate for Payer: Cofinity Commercial |
$388.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.00
|
| Rate for Payer: Healthscope Commercial |
$406.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$338.44
|
| Rate for Payer: PHP Commercial |
$383.56
|
| Rate for Payer: Priority Health SBD |
$284.29
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
NDC 63739056710
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.47 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: Aetna Medicare |
$152.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.60
|
| Rate for Payer: BCBS Complete |
$121.60
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cofinity Advantage |
$212.80
|
| Rate for Payer: Cofinity Commercial |
$261.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.20
|
| Rate for Payer: Healthscope Commercial |
$273.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.00
|
| Rate for Payer: PHP Commercial |
$258.40
|
| Rate for Payer: Priority Health SBD |
$191.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.60
|
| Rate for Payer: UHC Core |
$158.38
|
| Rate for Payer: UHC Exchange |
$119.47
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$258.40
|
|
|
Service Code
|
NDC 68084029901
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.55 |
| Max. Negotiated Rate |
$232.56 |
| Rate for Payer: Aetna Commercial |
$219.64
|
| Rate for Payer: Aetna Medicare |
$129.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.96
|
| Rate for Payer: BCBS Complete |
$103.36
|
| Rate for Payer: Cash Price |
$206.72
|
| Rate for Payer: Cofinity Advantage |
$180.88
|
| Rate for Payer: Cofinity Commercial |
$222.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.72
|
| Rate for Payer: Healthscope Commercial |
$232.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.80
|
| Rate for Payer: PHP Commercial |
$219.64
|
| Rate for Payer: Priority Health SBD |
$162.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.96
|
| Rate for Payer: UHC Core |
$134.63
|
| Rate for Payer: UHC Exchange |
$101.55
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$288.80
|
|
|
Service Code
|
NDC 51079029420
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.94 |
| Max. Negotiated Rate |
$259.92 |
| Rate for Payer: Aetna Commercial |
$245.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.72
|
| Rate for Payer: Cash Price |
$231.04
|
| Rate for Payer: Cofinity Advantage |
$202.16
|
| Rate for Payer: Cofinity Commercial |
$248.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.04
|
| Rate for Payer: Healthscope Commercial |
$259.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.60
|
| Rate for Payer: PHP Commercial |
$245.48
|
| Rate for Payer: Priority Health SBD |
$181.94
|
|
