|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$288.80
|
|
|
Service Code
|
NDC 51079029420
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.50 |
| Max. Negotiated Rate |
$259.92 |
| Rate for Payer: Aetna Commercial |
$245.48
|
| Rate for Payer: Aetna Medicare |
$144.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.72
|
| Rate for Payer: BCBS Complete |
$115.52
|
| 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: MI Amish Medical Board Commercial |
$231.04
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.72
|
| Rate for Payer: UHC Core |
$150.46
|
| Rate for Payer: UHC Exchange |
$113.50
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$234.65
|
|
|
Service Code
|
NDC 00904738361
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.83 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.52
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Advantage |
$164.25
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health SBD |
$147.83
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$2.59
|
|
|
Service Code
|
NDC 68084029911
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Aetna Medicare |
$1.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.68
|
| Rate for Payer: BCBS Complete |
$1.04
|
| 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: MI Amish Medical Board Commercial |
$2.07
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.68
|
| Rate for Payer: UHC Core |
$1.35
|
| Rate for Payer: UHC Exchange |
$1.02
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$2.57
|
|
|
Service Code
|
NDC 50268074011
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.67
|
| Rate for Payer: BCBS Complete |
$1.03
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Advantage |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.93
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health SBD |
$1.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.67
|
| Rate for Payer: UHC Core |
$1.34
|
| Rate for Payer: UHC Exchange |
$1.01
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$166.85
|
|
|
Service Code
|
NDC 33342015911
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.57 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna Medicare |
$83.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.45
|
| Rate for Payer: BCBS Complete |
$66.74
|
| 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: MI Amish Medical Board Commercial |
$133.48
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.45
|
| Rate for Payer: UHC Core |
$86.93
|
| Rate for Payer: UHC Exchange |
$65.57
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$258.40
|
|
|
Service Code
|
NDC 68084029901
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.79 |
| Max. Negotiated Rate |
$232.56 |
| Rate for Payer: Aetna Commercial |
$219.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.96
|
| 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: 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
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 00904640161
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| 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: 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
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$169.20
|
|
|
Service Code
|
NDC 65862059801
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.60 |
| Max. Negotiated Rate |
$152.28 |
| Rate for Payer: Aetna Commercial |
$143.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.98
|
| Rate for Payer: Cash Price |
$135.36
|
| Rate for Payer: Cofinity Advantage |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$145.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.36
|
| Rate for Payer: Healthscope Commercial |
$152.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.90
|
| Rate for Payer: PHP Commercial |
$143.82
|
| Rate for Payer: Priority Health SBD |
$106.60
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$451.25
|
|
|
Service Code
|
NDC 00228299611
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.34 |
| Max. Negotiated Rate |
$406.12 |
| Rate for Payer: Aetna Commercial |
$383.56
|
| Rate for Payer: Aetna Medicare |
$225.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.31
|
| Rate for Payer: BCBS Complete |
$180.50
|
| 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: MI Amish Medical Board Commercial |
$361.00
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.31
|
| Rate for Payer: UHC Core |
$235.10
|
| Rate for Payer: UHC Exchange |
$177.34
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
NDC 63739056710
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.52 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.60
|
| 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: 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
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$128.25
|
|
|
Service Code
|
NDC 50268074015
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Advantage |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.60
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.19
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: Priority Health SBD |
$80.80
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$128.25
|
|
|
Service Code
|
NDC 50268074015
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: Aetna Medicare |
$64.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: BCBS Complete |
$51.30
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Advantage |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.60
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.19
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: Priority Health SBD |
$80.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.36
|
| Rate for Payer: UHC Core |
$66.82
|
| Rate for Payer: UHC Exchange |
$50.40
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$234.65
|
|
|
Service Code
|
NDC 00904738361
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.22 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna Medicare |
$117.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.52
|
| Rate for Payer: BCBS Complete |
$93.86
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Advantage |
$164.25
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health SBD |
$147.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.52
|
| Rate for Payer: UHC Core |
$122.25
|
| Rate for Payer: UHC Exchange |
$92.22
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$262.26
|
|
|
Service Code
|
NDC 62756016081
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.07 |
| Max. Negotiated Rate |
$236.03 |
| Rate for Payer: Aetna Commercial |
$222.92
|
| Rate for Payer: Aetna Medicare |
$131.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.47
|
| Rate for Payer: BCBS Complete |
$104.90
|
| 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: MI Amish Medical Board Commercial |
$209.81
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.47
|
| Rate for Payer: UHC Core |
$136.64
|
| Rate for Payer: UHC Exchange |
$103.07
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
NDC 50268074011
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.67
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Advantage |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.93
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health SBD |
$1.62
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$169.20
|
|
|
Service Code
|
NDC 65862059801
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$152.28 |
| Rate for Payer: Aetna Commercial |
$143.82
|
| Rate for Payer: Aetna Medicare |
$84.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.98
|
| Rate for Payer: BCBS Complete |
$67.68
|
| Rate for Payer: Cash Price |
$135.36
|
| Rate for Payer: Cofinity Advantage |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$145.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.36
|
| Rate for Payer: Healthscope Commercial |
$152.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.90
|
| Rate for Payer: PHP Commercial |
$143.82
|
| Rate for Payer: Priority Health SBD |
$106.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.98
|
| Rate for Payer: UHC Core |
$88.15
|
| Rate for Payer: UHC Exchange |
$66.50
|
|
|
TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69,370.50
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
207439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43,703.42 |
| Max. Negotiated Rate |
$62,433.45 |
| Rate for Payer: Aetna Commercial |
$58,964.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45,090.82
|
| Rate for Payer: Cash Price |
$55,496.40
|
| Rate for Payer: Cofinity Advantage |
$48,559.35
|
| Rate for Payer: Cofinity Commercial |
$59,658.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55,496.40
|
| Rate for Payer: Healthscope Commercial |
$62,433.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58,964.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52,027.88
|
| Rate for Payer: PHP Commercial |
$58,964.93
|
| Rate for Payer: Priority Health SBD |
$43,703.42
|
|
|
TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69,370.50
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
207439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$819.92 |
| Max. Negotiated Rate |
$62,433.45 |
| Rate for Payer: Aetna Commercial |
$58,964.93
|
| Rate for Payer: Aetna Medicare |
$1,630.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45,090.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,959.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,959.65
|
| Rate for Payer: BCBS Complete |
$860.99
|
| Rate for Payer: BCBS MAPPO |
$1,567.72
|
| Rate for Payer: BCBS Trust/PPO |
$3,930.34
|
| Rate for Payer: BCN Commercial |
$3,930.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,567.72
|
| Rate for Payer: Cash Price |
$55,496.40
|
| Rate for Payer: Cash Price |
$55,496.40
|
| Rate for Payer: Cofinity Advantage |
$48,559.35
|
| Rate for Payer: Cofinity Commercial |
$59,658.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55,496.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,567.72
|
| Rate for Payer: Healthscope Commercial |
$62,433.45
|
| Rate for Payer: Mclaren Medicaid |
$819.92
|
| Rate for Payer: Mclaren Medicare |
$1,567.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.11
|
| Rate for Payer: Meridian Medicaid |
$1,646.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,802.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,724.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58,964.93
|
| Rate for Payer: Nomi Health Commercial |
$4,703.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52,027.88
|
| Rate for Payer: PACE Medicare |
$1,489.33
|
| Rate for Payer: PACE SWMI |
$1,567.72
|
| Rate for Payer: PHP Commercial |
$58,964.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,567.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$819.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,934.80
|
| Rate for Payer: Priority Health Medicare |
$1,567.72
|
| Rate for Payer: Priority Health SBD |
$43,703.42
|
| Rate for Payer: Priority Health Tiered Network |
$3,947.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,567.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,584.87
|
| Rate for Payer: UHC Core |
$2,584.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,567.72
|
| Rate for Payer: UHC Exchange |
$2,584.87
|
| Rate for Payer: UHC Medicaid |
$819.92
|
| Rate for Payer: UHCCP Medicaid |
$819.92
|
| Rate for Payer: VA VA |
$1,567.72
|
|
|
TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$911.49
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$820.34 |
| Rate for Payer: Aetna Commercial |
$774.77
|
| Rate for Payer: Aetna Commercial |
$774.77
|
| Rate for Payer: Aetna Medicare |
$0.26
|
| Rate for Payer: Aetna Medicare |
$0.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.31
|
| Rate for Payer: BCBS Complete |
$0.14
|
| Rate for Payer: BCBS Complete |
$0.14
|
| Rate for Payer: BCBS MAPPO |
$0.25
|
| Rate for Payer: BCBS MAPPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.59
|
| Rate for Payer: BCBS Trust/PPO |
$0.59
|
| Rate for Payer: BCN Commercial |
$0.59
|
| Rate for Payer: BCN Commercial |
$0.59
|
| Rate for Payer: BCN Medicare Advantage |
$0.25
|
| Rate for Payer: BCN Medicare Advantage |
$0.25
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cash Price |
$729.20
|
| Rate for Payer: Cash Price |
$729.20
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cofinity Advantage |
$638.05
|
| Rate for Payer: Cofinity Advantage |
$638.04
|
| Rate for Payer: Cofinity Commercial |
$783.89
|
| Rate for Payer: Cofinity Commercial |
$783.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.25
|
| Rate for Payer: Healthscope Commercial |
$820.34
|
| Rate for Payer: Healthscope Commercial |
$820.35
|
| Rate for Payer: Mclaren Medicaid |
$0.13
|
| Rate for Payer: Mclaren Medicaid |
$0.13
|
| Rate for Payer: Mclaren Medicare |
$0.25
|
| Rate for Payer: Mclaren Medicare |
$0.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: Nomi Health Commercial |
$0.75
|
| Rate for Payer: Nomi Health Commercial |
$0.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.62
|
| Rate for Payer: PACE Medicare |
$0.24
|
| Rate for Payer: PACE Medicare |
$0.24
|
| Rate for Payer: PACE SWMI |
$0.25
|
| Rate for Payer: PACE SWMI |
$0.25
|
| Rate for Payer: PHP Commercial |
$774.77
|
| Rate for Payer: PHP Commercial |
$774.77
|
| Rate for Payer: PHP Medicare Advantage |
$0.25
|
| Rate for Payer: PHP Medicare Advantage |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.89
|
| Rate for Payer: Priority Health Medicare |
$0.25
|
| Rate for Payer: Priority Health Medicare |
$0.25
|
| Rate for Payer: Priority Health SBD |
$574.25
|
| Rate for Payer: Priority Health SBD |
$574.24
|
| Rate for Payer: Priority Health Tiered Network |
$0.71
|
| Rate for Payer: Priority Health Tiered Network |
$0.71
|
| Rate for Payer: Railroad Medicare Medicare |
$0.25
|
| Rate for Payer: Railroad Medicare Medicare |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Medicaid |
$0.13
|
| Rate for Payer: UHC Medicaid |
$0.13
|
| Rate for Payer: UHCCP Medicaid |
$0.13
|
| Rate for Payer: UHCCP Medicaid |
$0.13
|
| Rate for Payer: VA VA |
$0.25
|
| Rate for Payer: VA VA |
$0.25
|
|
|
TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$911.49
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$574.24 |
| Max. Negotiated Rate |
$820.34 |
| Rate for Payer: Aetna Commercial |
$774.77
|
| Rate for Payer: Aetna Commercial |
$774.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.48
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cash Price |
$729.20
|
| Rate for Payer: Cofinity Advantage |
$638.04
|
| Rate for Payer: Cofinity Advantage |
$638.05
|
| Rate for Payer: Cofinity Commercial |
$783.88
|
| Rate for Payer: Cofinity Commercial |
$783.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.19
|
| Rate for Payer: Healthscope Commercial |
$820.35
|
| Rate for Payer: Healthscope Commercial |
$820.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.62
|
| Rate for Payer: PHP Commercial |
$774.77
|
| Rate for Payer: PHP Commercial |
$774.77
|
| Rate for Payer: Priority Health SBD |
$574.24
|
| Rate for Payer: Priority Health SBD |
$574.25
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$338.95
|
|
|
Service Code
|
NDC 00904643604
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.21 |
| Max. Negotiated Rate |
$305.06 |
| Rate for Payer: Aetna Commercial |
$288.11
|
| Rate for Payer: Aetna Medicare |
$169.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.32
|
| Rate for Payer: BCBS Complete |
$135.58
|
| Rate for Payer: Cash Price |
$271.16
|
| Rate for Payer: Cofinity Advantage |
$237.26
|
| Rate for Payer: Cofinity Commercial |
$291.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.16
|
| Rate for Payer: Healthscope Commercial |
$305.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.21
|
| Rate for Payer: PHP Commercial |
$288.11
|
| Rate for Payer: Priority Health SBD |
$213.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.32
|
| Rate for Payer: UHC Core |
$176.59
|
| Rate for Payer: UHC Exchange |
$133.21
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$384.93
|
|
|
Service Code
|
NDC 63739000333
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.28 |
| Max. Negotiated Rate |
$346.44 |
| Rate for Payer: Aetna Commercial |
$327.19
|
| Rate for Payer: Aetna Medicare |
$192.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.20
|
| Rate for Payer: BCBS Complete |
$153.97
|
| Rate for Payer: Cash Price |
$307.94
|
| Rate for Payer: Cofinity Advantage |
$269.45
|
| Rate for Payer: Cofinity Commercial |
$331.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.94
|
| Rate for Payer: Healthscope Commercial |
$346.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$307.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.70
|
| Rate for Payer: PHP Commercial |
$327.19
|
| Rate for Payer: Priority Health SBD |
$242.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.20
|
| Rate for Payer: UHC Core |
$200.55
|
| Rate for Payer: UHC Exchange |
$151.28
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$384.93
|
|
|
Service Code
|
NDC 63739000333
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.51 |
| Max. Negotiated Rate |
$346.44 |
| Rate for Payer: Aetna Commercial |
$327.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.20
|
| Rate for Payer: Cash Price |
$307.94
|
| Rate for Payer: Cofinity Advantage |
$269.45
|
| Rate for Payer: Cofinity Commercial |
$331.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.94
|
| Rate for Payer: Healthscope Commercial |
$346.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.70
|
| Rate for Payer: PHP Commercial |
$327.19
|
| Rate for Payer: Priority Health SBD |
$242.51
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$2,127.84
|
|
|
Service Code
|
NDC 00378311001
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,340.54 |
| Max. Negotiated Rate |
$1,915.06 |
| Rate for Payer: Aetna Commercial |
$1,808.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,383.10
|
| Rate for Payer: Cash Price |
$1,702.27
|
| Rate for Payer: Cofinity Advantage |
$1,489.49
|
| Rate for Payer: Cofinity Commercial |
$1,829.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.27
|
| Rate for Payer: Healthscope Commercial |
$1,915.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,808.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,595.88
|
| Rate for Payer: PHP Commercial |
$1,808.66
|
| Rate for Payer: Priority Health SBD |
$1,340.54
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$2,127.84
|
|
|
Service Code
|
NDC 00378311001
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$836.24 |
| Max. Negotiated Rate |
$1,915.06 |
| Rate for Payer: Aetna Commercial |
$1,808.66
|
| Rate for Payer: Aetna Medicare |
$1,063.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,383.10
|
| Rate for Payer: BCBS Complete |
$851.14
|
| Rate for Payer: Cash Price |
$1,702.27
|
| Rate for Payer: Cofinity Advantage |
$1,489.49
|
| Rate for Payer: Cofinity Commercial |
$1,829.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.27
|
| Rate for Payer: Healthscope Commercial |
$1,915.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,702.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,808.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,595.88
|
| Rate for Payer: PHP Commercial |
$1,808.66
|
| Rate for Payer: Priority Health SBD |
$1,340.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,383.10
|
| Rate for Payer: UHC Core |
$1,108.60
|
| Rate for Payer: UHC Exchange |
$836.24
|
|
