|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
IP
|
$29.27
|
|
|
Service Code
|
NDC 70069050101
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$26.34 |
| Rate for Payer: Aetna Commercial |
$24.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.03
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Cofinity Advantage |
$20.49
|
| Rate for Payer: Cofinity Commercial |
$25.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.42
|
| Rate for Payer: Healthscope Commercial |
$26.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.95
|
| Rate for Payer: PHP Commercial |
$24.88
|
| Rate for Payer: Priority Health SBD |
$18.44
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
OP
|
$36.63
|
|
|
Service Code
|
NDC 50383023210
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Aetna Commercial |
$31.14
|
| Rate for Payer: Aetna Medicare |
$18.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.81
|
| Rate for Payer: BCBS Complete |
$14.65
|
| Rate for Payer: Cash Price |
$29.30
|
| Rate for Payer: Cofinity Advantage |
$25.64
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.30
|
| Rate for Payer: Healthscope Commercial |
$32.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.47
|
| Rate for Payer: PHP Commercial |
$31.14
|
| Rate for Payer: Priority Health SBD |
$23.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.81
|
| Rate for Payer: UHC Core |
$19.08
|
| Rate for Payer: UHC Exchange |
$14.40
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
OP
|
$29.27
|
|
|
Service Code
|
NDC 70069050101
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$26.34 |
| Rate for Payer: Aetna Commercial |
$24.88
|
| Rate for Payer: Aetna Medicare |
$14.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.03
|
| Rate for Payer: BCBS Complete |
$11.71
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Cofinity Advantage |
$20.49
|
| Rate for Payer: Cofinity Commercial |
$25.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.42
|
| Rate for Payer: Healthscope Commercial |
$26.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.95
|
| Rate for Payer: PHP Commercial |
$24.88
|
| Rate for Payer: Priority Health SBD |
$18.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.03
|
| Rate for Payer: UHC Core |
$15.25
|
| Rate for Payer: UHC Exchange |
$11.50
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
OP
|
$116.96
|
|
|
Service Code
|
NDC 24208048510
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.97 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Aetna Commercial |
$99.42
|
| Rate for Payer: Aetna Medicare |
$58.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.02
|
| Rate for Payer: BCBS Complete |
$46.78
|
| Rate for Payer: Cash Price |
$93.57
|
| Rate for Payer: Cofinity Advantage |
$81.87
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.57
|
| Rate for Payer: Healthscope Commercial |
$105.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.72
|
| Rate for Payer: PHP Commercial |
$99.42
|
| Rate for Payer: Priority Health SBD |
$73.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.02
|
| Rate for Payer: UHC Core |
$60.94
|
| Rate for Payer: UHC Exchange |
$45.97
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
IP
|
$36.63
|
|
|
Service Code
|
NDC 50383023210
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.08 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Aetna Commercial |
$31.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.81
|
| Rate for Payer: Cash Price |
$29.30
|
| Rate for Payer: Cofinity Advantage |
$25.64
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.30
|
| Rate for Payer: Healthscope Commercial |
$32.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.47
|
| Rate for Payer: PHP Commercial |
$31.14
|
| Rate for Payer: Priority Health SBD |
$23.08
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
IP
|
$116.96
|
|
|
Service Code
|
NDC 24208048510
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.68 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Aetna Commercial |
$99.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.02
|
| Rate for Payer: Cash Price |
$93.57
|
| Rate for Payer: Cofinity Advantage |
$81.87
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.57
|
| Rate for Payer: Healthscope Commercial |
$105.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.72
|
| Rate for Payer: PHP Commercial |
$99.42
|
| Rate for Payer: Priority Health SBD |
$73.68
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
OP
|
$86.03
|
|
|
Service Code
|
NDC 61314001910
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$77.43 |
| Rate for Payer: Aetna Commercial |
$73.13
|
| Rate for Payer: Aetna Medicare |
$43.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.92
|
| Rate for Payer: BCBS Complete |
$34.41
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cofinity Advantage |
$60.22
|
| Rate for Payer: Cofinity Commercial |
$73.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.82
|
| Rate for Payer: Healthscope Commercial |
$77.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.52
|
| Rate for Payer: PHP Commercial |
$73.13
|
| Rate for Payer: Priority Health SBD |
$54.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.92
|
| Rate for Payer: UHC Core |
$44.82
|
| Rate for Payer: UHC Exchange |
$33.81
|
|
|
DOSTARLIMAB-GXLY 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$55,096.26
|
|
|
Service Code
|
HCPCS J9272
|
| Hospital Charge Code |
197057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.22 |
| Max. Negotiated Rate |
$49,586.63 |
| Rate for Payer: Aetna Commercial |
$46,831.82
|
| Rate for Payer: Aetna Medicare |
$256.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35,812.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$308.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$308.85
|
| Rate for Payer: BCBS Complete |
$135.70
|
| Rate for Payer: BCBS MAPPO |
$247.08
|
| Rate for Payer: BCBS Trust/PPO |
$620.77
|
| Rate for Payer: BCN Commercial |
$620.77
|
| Rate for Payer: BCN Medicare Advantage |
$247.08
|
| Rate for Payer: Cash Price |
$44,077.01
|
| Rate for Payer: Cash Price |
$44,077.01
|
| Rate for Payer: Cofinity Advantage |
$38,567.38
|
| Rate for Payer: Cofinity Commercial |
$47,382.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44,077.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.08
|
| Rate for Payer: Healthscope Commercial |
$49,586.63
|
| Rate for Payer: Mclaren Medicaid |
$129.22
|
| Rate for Payer: Mclaren Medicare |
$247.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$259.43
|
| Rate for Payer: Meridian Medicaid |
$259.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$284.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$271.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46,831.82
|
| Rate for Payer: Nomi Health Commercial |
$741.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41,322.19
|
| Rate for Payer: PACE Medicare |
$234.73
|
| Rate for Payer: PACE SWMI |
$247.08
|
| Rate for Payer: PHP Commercial |
$46,831.82
|
| Rate for Payer: PHP Medicare Advantage |
$247.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.66
|
| Rate for Payer: Priority Health Medicare |
$247.08
|
| Rate for Payer: Priority Health SBD |
$34,710.64
|
| Rate for Payer: Priority Health Tiered Network |
$614.93
|
| Rate for Payer: Railroad Medicare Medicare |
$247.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$408.28
|
| Rate for Payer: UHC Core |
$408.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$247.08
|
| Rate for Payer: UHC Exchange |
$408.28
|
| Rate for Payer: UHC Medicaid |
$129.22
|
| Rate for Payer: UHCCP Medicaid |
$129.22
|
| Rate for Payer: VA VA |
$247.08
|
|
|
DOXEPIN 10 MG CAPSULE
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
NDC 51079043620
|
| Hospital Charge Code |
2608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.23 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Advantage |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.08
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health SBD |
$167.23
|
|
|
DOXEPIN 10 MG CAPSULE
|
Facility
|
OP
|
$265.44
|
|
|
Service Code
|
NDC 51079043620
|
| Hospital Charge Code |
2608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna Medicare |
$132.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: BCBS Complete |
$106.18
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Advantage |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.08
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health SBD |
$167.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.54
|
| Rate for Payer: UHC Core |
$138.29
|
| Rate for Payer: UHC Exchange |
$104.32
|
|
|
DOXEPIN 10 MG CAPSULE
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
NDC 51079043601
|
| Hospital Charge Code |
2608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Advantage |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health SBD |
$1.68
|
|
|
DOXEPIN 10 MG CAPSULE
|
Facility
|
OP
|
$2.66
|
|
|
Service Code
|
NDC 51079043601
|
| Hospital Charge Code |
2608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Advantage |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.73
|
| Rate for Payer: UHC Core |
$1.39
|
| Rate for Payer: UHC Exchange |
$1.05
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 51079043701
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Advantage |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.55
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health SBD |
$2.14
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
IP
|
$339.84
|
|
|
Service Code
|
NDC 51079043720
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.10 |
| Max. Negotiated Rate |
$305.86 |
| Rate for Payer: Aetna Commercial |
$288.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.90
|
| Rate for Payer: Cash Price |
$271.87
|
| Rate for Payer: Cofinity Advantage |
$237.89
|
| Rate for Payer: Cofinity Commercial |
$292.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.87
|
| Rate for Payer: Healthscope Commercial |
$305.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.88
|
| Rate for Payer: PHP Commercial |
$288.86
|
| Rate for Payer: Priority Health SBD |
$214.10
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
OP
|
$339.84
|
|
|
Service Code
|
NDC 51079043720
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.56 |
| Max. Negotiated Rate |
$305.86 |
| Rate for Payer: Aetna Commercial |
$288.86
|
| Rate for Payer: Aetna Medicare |
$169.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.90
|
| Rate for Payer: BCBS Complete |
$135.94
|
| Rate for Payer: Cash Price |
$271.87
|
| Rate for Payer: Cofinity Advantage |
$237.89
|
| Rate for Payer: Cofinity Commercial |
$292.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.87
|
| Rate for Payer: Healthscope Commercial |
$305.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.88
|
| Rate for Payer: PHP Commercial |
$288.86
|
| Rate for Payer: Priority Health SBD |
$214.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.90
|
| Rate for Payer: UHC Core |
$177.06
|
| Rate for Payer: UHC Exchange |
$133.56
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 51079043701
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Advantage |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.55
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC Core |
$1.77
|
| Rate for Payer: UHC Exchange |
$1.34
|
|
|
DOXORUBICIN 20 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$305.04
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
118503
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$274.54 |
| Rate for Payer: Aetna Commercial |
$259.28
|
| Rate for Payer: Aetna Medicare |
$152.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.28
|
| Rate for Payer: BCBS Complete |
$122.02
|
| Rate for Payer: BCBS Trust/PPO |
$6.85
|
| Rate for Payer: BCN Commercial |
$6.85
|
| Rate for Payer: Cash Price |
$244.03
|
| Rate for Payer: Cash Price |
$244.03
|
| Rate for Payer: Cofinity Advantage |
$213.53
|
| Rate for Payer: Cofinity Commercial |
$262.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.03
|
| Rate for Payer: Healthscope Commercial |
$274.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.78
|
| Rate for Payer: PHP Commercial |
$259.28
|
| Rate for Payer: Priority Health SBD |
$192.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC Core |
$4.59
|
| Rate for Payer: UHC Exchange |
$4.59
|
|
|
DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$285.98
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
118501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.17 |
| Max. Negotiated Rate |
$257.38 |
| Rate for Payer: Aetna Commercial |
$243.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.89
|
| Rate for Payer: Cash Price |
$228.78
|
| Rate for Payer: Cofinity Advantage |
$200.19
|
| Rate for Payer: Cofinity Commercial |
$245.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.78
|
| Rate for Payer: Healthscope Commercial |
$257.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.49
|
| Rate for Payer: PHP Commercial |
$243.08
|
| Rate for Payer: Priority Health SBD |
$180.17
|
|
|
DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$181.43
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
118501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$163.29 |
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Aetna Commercial |
$243.08
|
| Rate for Payer: Aetna Commercial |
$141.58
|
| Rate for Payer: Aetna Commercial |
$235.35
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Medicare |
$83.28
|
| Rate for Payer: Aetna Medicare |
$138.44
|
| Rate for Payer: Aetna Medicare |
$142.99
|
| Rate for Payer: Aetna Medicare |
$90.72
|
| Rate for Payer: Aetna Medicare |
$166.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.89
|
| Rate for Payer: BCBS Complete |
$114.39
|
| Rate for Payer: BCBS Complete |
$72.57
|
| Rate for Payer: BCBS Complete |
$66.63
|
| Rate for Payer: BCBS Complete |
$110.75
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: BCBS Trust/PPO |
$6.85
|
| Rate for Payer: BCBS Trust/PPO |
$6.85
|
| Rate for Payer: BCBS Trust/PPO |
$6.85
|
| Rate for Payer: BCBS Trust/PPO |
$6.85
|
| Rate for Payer: BCBS Trust/PPO |
$6.85
|
| Rate for Payer: BCN Commercial |
$6.85
|
| Rate for Payer: BCN Commercial |
$6.85
|
| Rate for Payer: BCN Commercial |
$6.85
|
| Rate for Payer: BCN Commercial |
$6.85
|
| Rate for Payer: BCN Commercial |
$6.85
|
| Rate for Payer: Cash Price |
$133.26
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cash Price |
$145.14
|
| Rate for Payer: Cash Price |
$133.26
|
| Rate for Payer: Cash Price |
$228.78
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$145.14
|
| Rate for Payer: Cash Price |
$228.78
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cofinity Advantage |
$127.00
|
| Rate for Payer: Cofinity Advantage |
$193.82
|
| Rate for Payer: Cofinity Advantage |
$233.55
|
| Rate for Payer: Cofinity Advantage |
$200.19
|
| Rate for Payer: Cofinity Advantage |
$116.60
|
| Rate for Payer: Cofinity Commercial |
$238.12
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$245.94
|
| Rate for Payer: Cofinity Commercial |
$143.25
|
| Rate for Payer: Cofinity Commercial |
$156.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.14
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$257.38
|
| Rate for Payer: Healthscope Commercial |
$163.29
|
| Rate for Payer: Healthscope Commercial |
$149.91
|
| Rate for Payer: Healthscope Commercial |
$249.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.49
|
| Rate for Payer: PHP Commercial |
$154.22
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$243.08
|
| Rate for Payer: PHP Commercial |
$235.35
|
| Rate for Payer: PHP Commercial |
$141.58
|
| Rate for Payer: Priority Health SBD |
$180.17
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: Priority Health SBD |
$174.43
|
| Rate for Payer: Priority Health SBD |
$104.94
|
| Rate for Payer: Priority Health SBD |
$114.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC Core |
$4.59
|
| Rate for Payer: UHC Core |
$4.59
|
| Rate for Payer: UHC Core |
$4.59
|
| Rate for Payer: UHC Core |
$4.59
|
| Rate for Payer: UHC Core |
$4.59
|
| Rate for Payer: UHC Exchange |
$4.59
|
| Rate for Payer: UHC Exchange |
$4.59
|
| Rate for Payer: UHC Exchange |
$4.59
|
| Rate for Payer: UHC Exchange |
$4.59
|
| Rate for Payer: UHC Exchange |
$4.59
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION
|
Facility
|
OP
|
$1,589.50
|
|
|
Service Code
|
HCPCS Q2050
|
| Hospital Charge Code |
27431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.58 |
| Max. Negotiated Rate |
$1,430.55 |
| Rate for Payer: Aetna Commercial |
$1,351.08
|
| Rate for Payer: Aetna Commercial |
$1,269.70
|
| Rate for Payer: Aetna Commercial |
$834.87
|
| Rate for Payer: Aetna Commercial |
$561.08
|
| Rate for Payer: Aetna Commercial |
$859.93
|
| Rate for Payer: Aetna Medicare |
$74.73
|
| Rate for Payer: Aetna Medicare |
$74.73
|
| Rate for Payer: Aetna Medicare |
$74.73
|
| Rate for Payer: Aetna Medicare |
$74.73
|
| Rate for Payer: Aetna Medicare |
$74.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.83
|
| Rate for Payer: BCBS Complete |
$39.47
|
| Rate for Payer: BCBS Complete |
$39.47
|
| Rate for Payer: BCBS Complete |
$39.47
|
| Rate for Payer: BCBS Complete |
$39.47
|
| Rate for Payer: BCBS Complete |
$39.47
|
| Rate for Payer: BCBS MAPPO |
$71.86
|
| Rate for Payer: BCBS MAPPO |
$71.86
|
| Rate for Payer: BCBS MAPPO |
$71.86
|
| Rate for Payer: BCBS MAPPO |
$71.86
|
| Rate for Payer: BCBS MAPPO |
$71.86
|
| Rate for Payer: BCBS Trust/PPO |
$260.94
|
| Rate for Payer: BCBS Trust/PPO |
$260.94
|
| Rate for Payer: BCBS Trust/PPO |
$260.94
|
| Rate for Payer: BCBS Trust/PPO |
$260.94
|
| Rate for Payer: BCBS Trust/PPO |
$260.94
|
| Rate for Payer: BCN Commercial |
$260.94
|
| Rate for Payer: BCN Commercial |
$260.94
|
| Rate for Payer: BCN Commercial |
$260.94
|
| Rate for Payer: BCN Commercial |
$260.94
|
| Rate for Payer: BCN Commercial |
$260.94
|
| Rate for Payer: BCN Medicare Advantage |
$71.86
|
| Rate for Payer: BCN Medicare Advantage |
$71.86
|
| Rate for Payer: BCN Medicare Advantage |
$71.86
|
| Rate for Payer: BCN Medicare Advantage |
$71.86
|
| Rate for Payer: BCN Medicare Advantage |
$71.86
|
| Rate for Payer: Cash Price |
$1,195.01
|
| Rate for Payer: Cash Price |
$809.34
|
| Rate for Payer: Cash Price |
$809.34
|
| Rate for Payer: Cash Price |
$785.76
|
| Rate for Payer: Cash Price |
$785.76
|
| Rate for Payer: Cash Price |
$528.07
|
| Rate for Payer: Cash Price |
$528.07
|
| Rate for Payer: Cash Price |
$1,271.60
|
| Rate for Payer: Cash Price |
$1,271.60
|
| Rate for Payer: Cash Price |
$1,195.01
|
| Rate for Payer: Cofinity Advantage |
$708.18
|
| Rate for Payer: Cofinity Advantage |
$1,045.63
|
| Rate for Payer: Cofinity Advantage |
$462.06
|
| Rate for Payer: Cofinity Advantage |
$687.54
|
| Rate for Payer: Cofinity Advantage |
$1,112.65
|
| Rate for Payer: Cofinity Commercial |
$844.69
|
| Rate for Payer: Cofinity Commercial |
$870.04
|
| Rate for Payer: Cofinity Commercial |
$567.68
|
| Rate for Payer: Cofinity Commercial |
$1,366.97
|
| Rate for Payer: Cofinity Commercial |
$1,284.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,271.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,195.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.86
|
| Rate for Payer: Healthscope Commercial |
$910.51
|
| Rate for Payer: Healthscope Commercial |
$1,344.38
|
| Rate for Payer: Healthscope Commercial |
$1,430.55
|
| Rate for Payer: Healthscope Commercial |
$594.08
|
| Rate for Payer: Healthscope Commercial |
$883.98
|
| Rate for Payer: Mclaren Medicaid |
$37.58
|
| Rate for Payer: Mclaren Medicaid |
$37.58
|
| Rate for Payer: Mclaren Medicaid |
$37.58
|
| Rate for Payer: Mclaren Medicaid |
$37.58
|
| Rate for Payer: Mclaren Medicaid |
$37.58
|
| Rate for Payer: Mclaren Medicare |
$71.86
|
| Rate for Payer: Mclaren Medicare |
$71.86
|
| Rate for Payer: Mclaren Medicare |
$71.86
|
| Rate for Payer: Mclaren Medicare |
$71.86
|
| Rate for Payer: Mclaren Medicare |
$71.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.45
|
| Rate for Payer: Meridian Medicaid |
$75.45
|
| Rate for Payer: Meridian Medicaid |
$75.45
|
| Rate for Payer: Meridian Medicaid |
$75.45
|
| Rate for Payer: Meridian Medicaid |
$75.45
|
| Rate for Payer: Meridian Medicaid |
$75.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,269.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$834.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,351.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.93
|
| Rate for Payer: Nomi Health Commercial |
$215.58
|
| Rate for Payer: Nomi Health Commercial |
$215.58
|
| Rate for Payer: Nomi Health Commercial |
$215.58
|
| Rate for Payer: Nomi Health Commercial |
$215.58
|
| Rate for Payer: Nomi Health Commercial |
$215.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$736.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,192.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,120.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$758.76
|
| Rate for Payer: PACE Medicare |
$68.27
|
| Rate for Payer: PACE Medicare |
$68.27
|
| Rate for Payer: PACE Medicare |
$68.27
|
| Rate for Payer: PACE Medicare |
$68.27
|
| Rate for Payer: PACE Medicare |
$68.27
|
| Rate for Payer: PACE SWMI |
$71.86
|
| Rate for Payer: PACE SWMI |
$71.86
|
| Rate for Payer: PACE SWMI |
$71.86
|
| Rate for Payer: PACE SWMI |
$71.86
|
| Rate for Payer: PACE SWMI |
$71.86
|
| Rate for Payer: PHP Commercial |
$1,351.08
|
| Rate for Payer: PHP Commercial |
$834.87
|
| Rate for Payer: PHP Commercial |
$859.93
|
| Rate for Payer: PHP Commercial |
$1,269.70
|
| Rate for Payer: PHP Commercial |
$561.08
|
| Rate for Payer: PHP Medicare Advantage |
$71.86
|
| Rate for Payer: PHP Medicare Advantage |
$71.86
|
| Rate for Payer: PHP Medicare Advantage |
$71.86
|
| Rate for Payer: PHP Medicare Advantage |
$71.86
|
| Rate for Payer: PHP Medicare Advantage |
$71.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$342.09
|
| Rate for Payer: Priority Health Medicare |
$71.86
|
| Rate for Payer: Priority Health Medicare |
$71.86
|
| Rate for Payer: Priority Health Medicare |
$71.86
|
| Rate for Payer: Priority Health Medicare |
$71.86
|
| Rate for Payer: Priority Health Medicare |
$71.86
|
| Rate for Payer: Priority Health SBD |
$941.07
|
| Rate for Payer: Priority Health SBD |
$415.86
|
| Rate for Payer: Priority Health SBD |
$618.79
|
| Rate for Payer: Priority Health SBD |
$1,001.38
|
| Rate for Payer: Priority Health SBD |
$637.36
|
| Rate for Payer: Priority Health Tiered Network |
$273.67
|
| Rate for Payer: Priority Health Tiered Network |
$273.67
|
| Rate for Payer: Priority Health Tiered Network |
$273.67
|
| Rate for Payer: Priority Health Tiered Network |
$273.67
|
| Rate for Payer: Priority Health Tiered Network |
$273.67
|
| Rate for Payer: Railroad Medicare Medicare |
$71.86
|
| Rate for Payer: Railroad Medicare Medicare |
$71.86
|
| Rate for Payer: Railroad Medicare Medicare |
$71.86
|
| Rate for Payer: Railroad Medicare Medicare |
$71.86
|
| Rate for Payer: Railroad Medicare Medicare |
$71.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.62
|
| Rate for Payer: UHC Core |
$171.62
|
| Rate for Payer: UHC Core |
$171.62
|
| Rate for Payer: UHC Core |
$171.62
|
| Rate for Payer: UHC Core |
$171.62
|
| Rate for Payer: UHC Core |
$171.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.86
|
| Rate for Payer: UHC Exchange |
$171.62
|
| Rate for Payer: UHC Exchange |
$171.62
|
| Rate for Payer: UHC Exchange |
$171.62
|
| Rate for Payer: UHC Exchange |
$171.62
|
| Rate for Payer: UHC Exchange |
$171.62
|
| Rate for Payer: UHC Medicaid |
$37.58
|
| Rate for Payer: UHC Medicaid |
$37.58
|
| Rate for Payer: UHC Medicaid |
$37.58
|
| Rate for Payer: UHC Medicaid |
$37.58
|
| Rate for Payer: UHC Medicaid |
$37.58
|
| Rate for Payer: UHCCP Medicaid |
$37.58
|
| Rate for Payer: UHCCP Medicaid |
$37.58
|
| Rate for Payer: UHCCP Medicaid |
$37.58
|
| Rate for Payer: UHCCP Medicaid |
$37.58
|
| Rate for Payer: UHCCP Medicaid |
$37.58
|
| Rate for Payer: VA VA |
$71.86
|
| Rate for Payer: VA VA |
$71.86
|
| Rate for Payer: VA VA |
$71.86
|
| Rate for Payer: VA VA |
$71.86
|
| Rate for Payer: VA VA |
$71.86
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION
|
Facility
|
IP
|
$982.20
|
|
|
Service Code
|
HCPCS Q2050
|
| Hospital Charge Code |
27431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$618.79 |
| Max. Negotiated Rate |
$883.98 |
| Rate for Payer: Aetna Commercial |
$834.87
|
| Rate for Payer: Aetna Commercial |
$561.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.43
|
| Rate for Payer: Cash Price |
$528.07
|
| Rate for Payer: Cash Price |
$785.76
|
| Rate for Payer: Cofinity Advantage |
$462.06
|
| Rate for Payer: Cofinity Advantage |
$687.54
|
| Rate for Payer: Cofinity Commercial |
$844.69
|
| Rate for Payer: Cofinity Commercial |
$567.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.07
|
| Rate for Payer: Healthscope Commercial |
$883.98
|
| Rate for Payer: Healthscope Commercial |
$594.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$834.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$736.65
|
| Rate for Payer: PHP Commercial |
$561.08
|
| Rate for Payer: PHP Commercial |
$834.87
|
| Rate for Payer: Priority Health SBD |
$618.79
|
| Rate for Payer: Priority Health SBD |
$415.86
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.92 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Commercial |
$26.04
|
| Rate for Payer: Aetna Commercial |
$54.20
|
| Rate for Payer: Aetna Commercial |
$44.01
|
| Rate for Payer: Aetna Commercial |
$20.41
|
| Rate for Payer: Aetna Commercial |
$23.36
|
| Rate for Payer: Aetna Commercial |
$31.72
|
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.26
|
| Rate for Payer: Cash Price |
$51.02
|
| Rate for Payer: Cash Price |
$29.86
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Cofinity Advantage |
$36.25
|
| Rate for Payer: Cofinity Advantage |
$44.64
|
| Rate for Payer: Cofinity Advantage |
$26.12
|
| Rate for Payer: Cofinity Advantage |
$18.46
|
| Rate for Payer: Cofinity Advantage |
$32.13
|
| Rate for Payer: Cofinity Advantage |
$16.81
|
| Rate for Payer: Cofinity Advantage |
$21.44
|
| Rate for Payer: Cofinity Advantage |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$26.34
|
| Rate for Payer: Cofinity Commercial |
$44.53
|
| Rate for Payer: Cofinity Commercial |
$22.68
|
| Rate for Payer: Cofinity Commercial |
$20.65
|
| Rate for Payer: Cofinity Commercial |
$23.63
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Cofinity Commercial |
$32.10
|
| Rate for Payer: Cofinity Commercial |
$54.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.50
|
| Rate for Payer: Healthscope Commercial |
$27.57
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Healthscope Commercial |
$23.73
|
| Rate for Payer: Healthscope Commercial |
$33.59
|
| Rate for Payer: Healthscope Commercial |
$21.61
|
| Rate for Payer: Healthscope Commercial |
$57.39
|
| Rate for Payer: Healthscope Commercial |
$46.60
|
| Rate for Payer: Healthscope Commercial |
$24.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.61
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: PHP Commercial |
$54.20
|
| Rate for Payer: PHP Commercial |
$26.04
|
| Rate for Payer: PHP Commercial |
$44.01
|
| Rate for Payer: PHP Commercial |
$20.41
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: PHP Commercial |
$23.36
|
| Rate for Payer: PHP Commercial |
$31.72
|
| Rate for Payer: Priority Health SBD |
$15.13
|
| Rate for Payer: Priority Health SBD |
$28.92
|
| Rate for Payer: Priority Health SBD |
$19.30
|
| Rate for Payer: Priority Health SBD |
$17.31
|
| Rate for Payer: Priority Health SBD |
$32.62
|
| Rate for Payer: Priority Health SBD |
$40.18
|
| Rate for Payer: Priority Health SBD |
$23.51
|
| Rate for Payer: Priority Health SBD |
$16.61
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$26.37
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$23.73 |
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna Commercial |
$20.41
|
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Commercial |
$44.01
|
| Rate for Payer: Aetna Commercial |
$54.20
|
| Rate for Payer: Aetna Commercial |
$31.72
|
| Rate for Payer: Aetna Commercial |
$26.04
|
| Rate for Payer: Aetna Commercial |
$23.36
|
| Rate for Payer: Aetna Medicare |
$18.66
|
| Rate for Payer: Aetna Medicare |
$15.31
|
| Rate for Payer: Aetna Medicare |
$12.01
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: Aetna Medicare |
$13.74
|
| Rate for Payer: Aetna Medicare |
$31.89
|
| Rate for Payer: Aetna Medicare |
$25.89
|
| Rate for Payer: Aetna Medicare |
$22.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: BCBS Complete |
$12.25
|
| Rate for Payer: BCBS Complete |
$20.71
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS Complete |
$10.99
|
| Rate for Payer: BCBS Complete |
$18.36
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS Complete |
$25.51
|
| Rate for Payer: BCBS Complete |
$14.93
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$29.86
|
| Rate for Payer: Cash Price |
$29.86
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Cash Price |
$51.02
|
| Rate for Payer: Cash Price |
$51.02
|
| Rate for Payer: Cofinity Advantage |
$16.81
|
| Rate for Payer: Cofinity Advantage |
$32.13
|
| Rate for Payer: Cofinity Advantage |
$19.24
|
| Rate for Payer: Cofinity Advantage |
$44.64
|
| Rate for Payer: Cofinity Advantage |
$18.46
|
| Rate for Payer: Cofinity Advantage |
$21.44
|
| Rate for Payer: Cofinity Advantage |
$26.12
|
| Rate for Payer: Cofinity Advantage |
$36.25
|
| Rate for Payer: Cofinity Commercial |
$26.34
|
| Rate for Payer: Cofinity Commercial |
$44.53
|
| Rate for Payer: Cofinity Commercial |
$54.84
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Cofinity Commercial |
$20.65
|
| Rate for Payer: Cofinity Commercial |
$22.68
|
| Rate for Payer: Cofinity Commercial |
$32.10
|
| Rate for Payer: Cofinity Commercial |
$23.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$21.61
|
| Rate for Payer: Healthscope Commercial |
$24.73
|
| Rate for Payer: Healthscope Commercial |
$57.39
|
| Rate for Payer: Healthscope Commercial |
$33.59
|
| Rate for Payer: Healthscope Commercial |
$27.57
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Healthscope Commercial |
$46.60
|
| Rate for Payer: Healthscope Commercial |
$23.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.97
|
| Rate for Payer: PHP Commercial |
$23.36
|
| Rate for Payer: PHP Commercial |
$31.72
|
| Rate for Payer: PHP Commercial |
$20.41
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: PHP Commercial |
$44.01
|
| Rate for Payer: PHP Commercial |
$26.04
|
| Rate for Payer: PHP Commercial |
$54.20
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health SBD |
$16.61
|
| Rate for Payer: Priority Health SBD |
$40.18
|
| Rate for Payer: Priority Health SBD |
$28.92
|
| Rate for Payer: Priority Health SBD |
$17.31
|
| Rate for Payer: Priority Health SBD |
$23.51
|
| Rate for Payer: Priority Health SBD |
$32.62
|
| Rate for Payer: Priority Health SBD |
$15.13
|
| Rate for Payer: Priority Health SBD |
$19.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$37.32
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
301731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$33.59 |
| Rate for Payer: Aetna Commercial |
$31.72
|
| Rate for Payer: Aetna Medicare |
$18.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.26
|
| Rate for Payer: BCBS Complete |
$14.93
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$29.86
|
| Rate for Payer: Cash Price |
$29.86
|
| Rate for Payer: Cofinity Advantage |
$26.12
|
| Rate for Payer: Cofinity Commercial |
$32.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.86
|
| Rate for Payer: Healthscope Commercial |
$33.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.99
|
| Rate for Payer: PHP Commercial |
$31.72
|
| Rate for Payer: Priority Health SBD |
$23.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$37.32
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
301731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.51 |
| Max. Negotiated Rate |
$33.59 |
| Rate for Payer: Aetna Commercial |
$31.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.26
|
| Rate for Payer: Cash Price |
$29.86
|
| Rate for Payer: Cofinity Advantage |
$26.12
|
| Rate for Payer: Cofinity Commercial |
$32.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.86
|
| Rate for Payer: Healthscope Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.99
|
| Rate for Payer: PHP Commercial |
$31.72
|
| Rate for Payer: Priority Health SBD |
$23.51
|
|
