|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$218.92
|
|
|
Service Code
|
NDC 27505000367
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.57 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$186.08
|
| Rate for Payer: Aetna Medicare |
$109.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.30
|
| Rate for Payer: BCBS Complete |
$87.57
|
| Rate for Payer: Cash Price |
$175.14
|
| Rate for Payer: Cofinity Commercial |
$153.24
|
| Rate for Payer: Cofinity Commercial |
$188.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.14
|
| Rate for Payer: Healthscope Commercial |
$197.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.08
|
| Rate for Payer: PHP Commercial |
$186.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.30
|
| Rate for Payer: Priority Health SBD |
$137.92
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$218.92
|
|
|
Service Code
|
NDC 27505000367
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$137.92 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$186.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.30
|
| Rate for Payer: Cash Price |
$175.14
|
| Rate for Payer: Cofinity Commercial |
$153.24
|
| Rate for Payer: Cofinity Commercial |
$188.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.14
|
| Rate for Payer: Healthscope Commercial |
$197.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.08
|
| Rate for Payer: PHP Commercial |
$186.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.30
|
| Rate for Payer: Priority Health SBD |
$137.92
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$218.92
|
|
|
Service Code
|
NDC 78670000367
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.57 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$186.08
|
| Rate for Payer: Aetna Medicare |
$109.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.30
|
| Rate for Payer: BCBS Complete |
$87.57
|
| Rate for Payer: Cash Price |
$175.14
|
| Rate for Payer: Cofinity Commercial |
$153.24
|
| Rate for Payer: Cofinity Commercial |
$188.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.14
|
| Rate for Payer: Healthscope Commercial |
$197.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.08
|
| Rate for Payer: PHP Commercial |
$186.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.30
|
| Rate for Payer: Priority Health SBD |
$137.92
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$218.92
|
|
|
Service Code
|
NDC 78670000367
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$137.92 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$186.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.30
|
| Rate for Payer: Cash Price |
$175.14
|
| Rate for Payer: Cofinity Commercial |
$153.24
|
| Rate for Payer: Cofinity Commercial |
$188.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.14
|
| Rate for Payer: Healthscope Commercial |
$197.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.08
|
| Rate for Payer: PHP Commercial |
$186.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.30
|
| Rate for Payer: Priority Health SBD |
$137.92
|
|
|
DANTROLENE IVPB
|
Facility
|
OP
|
$218.92
|
|
|
Service Code
|
NDC 27505000367
|
| Hospital Charge Code |
400129
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.57 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$186.08
|
| Rate for Payer: Aetna Medicare |
$109.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.30
|
| Rate for Payer: BCBS Complete |
$87.57
|
| Rate for Payer: Cash Price |
$175.14
|
| Rate for Payer: Cofinity Commercial |
$153.24
|
| Rate for Payer: Cofinity Commercial |
$188.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.14
|
| Rate for Payer: Healthscope Commercial |
$197.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.08
|
| Rate for Payer: PHP Commercial |
$186.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.30
|
| Rate for Payer: Priority Health SBD |
$137.92
|
|
|
DANTROLENE IVPB
|
Facility
|
IP
|
$218.92
|
|
|
Service Code
|
NDC 27505000367
|
| Hospital Charge Code |
400129
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$137.92 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$186.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.30
|
| Rate for Payer: Cash Price |
$175.14
|
| Rate for Payer: Cofinity Commercial |
$153.24
|
| Rate for Payer: Cofinity Commercial |
$188.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.14
|
| Rate for Payer: Healthscope Commercial |
$197.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.08
|
| Rate for Payer: PHP Commercial |
$186.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.30
|
| Rate for Payer: Priority Health SBD |
$137.92
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
IP
|
$1,400.16
|
|
|
Service Code
|
NDC 00310621039
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$882.10 |
| Max. Negotiated Rate |
$1,260.14 |
| Rate for Payer: Aetna Commercial |
$1,190.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.10
|
| Rate for Payer: Cash Price |
$1,120.13
|
| Rate for Payer: Cofinity Commercial |
$1,204.14
|
| Rate for Payer: Cofinity Commercial |
$980.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$980.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.13
|
| Rate for Payer: Healthscope Commercial |
$1,260.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,190.14
|
| Rate for Payer: PHP Commercial |
$1,190.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.10
|
| Rate for Payer: Priority Health SBD |
$882.10
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
OP
|
$1,400.16
|
|
|
Service Code
|
NDC 00310621039
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$560.06 |
| Max. Negotiated Rate |
$1,260.14 |
| Rate for Payer: Aetna Commercial |
$1,190.14
|
| Rate for Payer: Aetna Medicare |
$700.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.10
|
| Rate for Payer: BCBS Complete |
$560.06
|
| Rate for Payer: Cash Price |
$1,120.13
|
| Rate for Payer: Cofinity Commercial |
$1,204.14
|
| Rate for Payer: Cofinity Commercial |
$980.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$980.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.13
|
| Rate for Payer: Healthscope Commercial |
$1,260.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,190.14
|
| Rate for Payer: PHP Commercial |
$1,190.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.10
|
| Rate for Payer: Priority Health SBD |
$882.10
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
OP
|
$141.08
|
|
|
Service Code
|
NDC 70954013510
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.43 |
| Max. Negotiated Rate |
$126.97 |
| Rate for Payer: Aetna Commercial |
$119.92
|
| Rate for Payer: Aetna Medicare |
$70.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.70
|
| Rate for Payer: BCBS Complete |
$56.43
|
| Rate for Payer: Cash Price |
$112.86
|
| Rate for Payer: Cofinity Commercial |
$121.33
|
| Rate for Payer: Cofinity Commercial |
$98.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.86
|
| Rate for Payer: Healthscope Commercial |
$126.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.92
|
| Rate for Payer: PHP Commercial |
$119.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.70
|
| Rate for Payer: Priority Health SBD |
$88.88
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
OP
|
$235.55
|
|
|
Service Code
|
NDC 49938010230
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.22 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$200.22
|
| Rate for Payer: Aetna Medicare |
$117.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.11
|
| Rate for Payer: BCBS Complete |
$94.22
|
| Rate for Payer: Cash Price |
$188.44
|
| Rate for Payer: Cofinity Commercial |
$164.88
|
| Rate for Payer: Cofinity Commercial |
$202.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.44
|
| Rate for Payer: Healthscope Commercial |
$212.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.22
|
| Rate for Payer: PHP Commercial |
$200.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.11
|
| Rate for Payer: Priority Health SBD |
$148.40
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
IP
|
$141.08
|
|
|
Service Code
|
NDC 70954013510
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.88 |
| Max. Negotiated Rate |
$126.97 |
| Rate for Payer: Aetna Commercial |
$119.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.70
|
| Rate for Payer: Cash Price |
$112.86
|
| Rate for Payer: Cofinity Commercial |
$121.33
|
| Rate for Payer: Cofinity Commercial |
$98.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.86
|
| Rate for Payer: Healthscope Commercial |
$126.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.92
|
| Rate for Payer: PHP Commercial |
$119.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.70
|
| Rate for Payer: Priority Health SBD |
$88.88
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
IP
|
$235.55
|
|
|
Service Code
|
NDC 49938010230
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$200.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.11
|
| Rate for Payer: Cash Price |
$188.44
|
| Rate for Payer: Cofinity Commercial |
$164.88
|
| Rate for Payer: Cofinity Commercial |
$202.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.44
|
| Rate for Payer: Healthscope Commercial |
$212.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.22
|
| Rate for Payer: PHP Commercial |
$200.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.11
|
| Rate for Payer: Priority Health SBD |
$148.40
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$53.40
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$48.06 |
| Rate for Payer: Aetna Commercial |
$45.39
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Medicare |
$46.56
|
| Rate for Payer: Aetna Medicare |
$26.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: BCBS Complete |
$37.25
|
| Rate for Payer: BCBS Complete |
$21.36
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cofinity Commercial |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$37.38
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Healthscope Commercial |
$48.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.39
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$45.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.71
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: Priority Health SBD |
$33.64
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$93.12
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.67 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Commercial |
$45.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$37.38
|
| Rate for Payer: Cofinity Commercial |
$45.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Healthscope Commercial |
$48.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$45.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.53
|
| Rate for Payer: Priority Health SBD |
$33.64
|
| Rate for Payer: Priority Health SBD |
$58.67
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$144.63
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.12 |
| Max. Negotiated Rate |
$130.17 |
| Rate for Payer: Aetna Commercial |
$122.94
|
| Rate for Payer: Aetna Commercial |
$1,133.46
|
| Rate for Payer: Aetna Commercial |
$80.12
|
| Rate for Payer: Aetna Commercial |
$57.23
|
| Rate for Payer: Aetna Commercial |
$1,133.32
|
| Rate for Payer: Aetna Commercial |
$49.25
|
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Commercial |
$43.58
|
| Rate for Payer: Aetna Commercial |
$73.35
|
| Rate for Payer: Aetna Commercial |
$73.58
|
| Rate for Payer: Aetna Commercial |
$1,129.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.66
|
| Rate for Payer: Cash Price |
$1,066.66
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cash Price |
$1,063.48
|
| Rate for Payer: Cash Price |
$1,066.78
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cash Price |
$75.41
|
| Rate for Payer: Cash Price |
$69.25
|
| Rate for Payer: Cash Price |
$69.03
|
| Rate for Payer: Cash Price |
$41.02
|
| Rate for Payer: Cash Price |
$68.71
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$60.59
|
| Rate for Payer: Cofinity Commercial |
$44.09
|
| Rate for Payer: Cofinity Commercial |
$933.44
|
| Rate for Payer: Cofinity Commercial |
$60.12
|
| Rate for Payer: Cofinity Commercial |
$49.83
|
| Rate for Payer: Cofinity Commercial |
$930.54
|
| Rate for Payer: Cofinity Commercial |
$1,143.24
|
| Rate for Payer: Cofinity Commercial |
$47.13
|
| Rate for Payer: Cofinity Commercial |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$81.06
|
| Rate for Payer: Cofinity Commercial |
$74.44
|
| Rate for Payer: Cofinity Commercial |
$57.90
|
| Rate for Payer: Cofinity Commercial |
$74.21
|
| Rate for Payer: Cofinity Commercial |
$60.40
|
| Rate for Payer: Cofinity Commercial |
$101.24
|
| Rate for Payer: Cofinity Commercial |
$124.38
|
| Rate for Payer: Cofinity Commercial |
$1,146.79
|
| Rate for Payer: Cofinity Commercial |
$73.87
|
| Rate for Payer: Cofinity Commercial |
$933.32
|
| Rate for Payer: Cofinity Commercial |
$1,146.66
|
| Rate for Payer: Cofinity Commercial |
$40.56
|
| Rate for Payer: Cofinity Commercial |
$35.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$933.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$930.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$933.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,063.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.41
|
| Rate for Payer: Healthscope Commercial |
$77.66
|
| Rate for Payer: Healthscope Commercial |
$130.17
|
| Rate for Payer: Healthscope Commercial |
$84.83
|
| Rate for Payer: Healthscope Commercial |
$77.30
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Healthscope Commercial |
$1,200.13
|
| Rate for Payer: Healthscope Commercial |
$1,199.99
|
| Rate for Payer: Healthscope Commercial |
$1,196.42
|
| Rate for Payer: Healthscope Commercial |
$77.90
|
| Rate for Payer: Healthscope Commercial |
$60.60
|
| Rate for Payer: Healthscope Commercial |
$46.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,133.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,133.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| Rate for Payer: PHP Commercial |
$57.23
|
| Rate for Payer: PHP Commercial |
$1,133.46
|
| Rate for Payer: PHP Commercial |
$1,133.32
|
| Rate for Payer: PHP Commercial |
$1,129.95
|
| Rate for Payer: PHP Commercial |
$49.25
|
| Rate for Payer: PHP Commercial |
$43.58
|
| Rate for Payer: PHP Commercial |
$73.35
|
| Rate for Payer: PHP Commercial |
$122.94
|
| Rate for Payer: PHP Commercial |
$73.58
|
| Rate for Payer: PHP Commercial |
$73.01
|
| Rate for Payer: PHP Commercial |
$80.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.83
|
| Rate for Payer: Priority Health SBD |
$32.30
|
| Rate for Payer: Priority Health SBD |
$91.12
|
| Rate for Payer: Priority Health SBD |
$840.09
|
| Rate for Payer: Priority Health SBD |
$42.42
|
| Rate for Payer: Priority Health SBD |
$59.38
|
| Rate for Payer: Priority Health SBD |
$837.49
|
| Rate for Payer: Priority Health SBD |
$36.50
|
| Rate for Payer: Priority Health SBD |
$54.36
|
| Rate for Payer: Priority Health SBD |
$839.99
|
| Rate for Payer: Priority Health SBD |
$54.53
|
| Rate for Payer: Priority Health SBD |
$54.11
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,329.35
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$1,196.42 |
| Rate for Payer: Aetna Commercial |
$1,129.95
|
| Rate for Payer: Aetna Commercial |
$1,133.32
|
| Rate for Payer: Aetna Commercial |
$57.23
|
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Commercial |
$1,133.46
|
| Rate for Payer: Aetna Commercial |
$43.58
|
| Rate for Payer: Aetna Commercial |
$49.25
|
| Rate for Payer: Aetna Commercial |
$73.35
|
| Rate for Payer: Aetna Commercial |
$73.58
|
| Rate for Payer: Aetna Commercial |
$80.12
|
| Rate for Payer: Aetna Commercial |
$122.94
|
| Rate for Payer: Aetna Medicare |
$47.13
|
| Rate for Payer: Aetna Medicare |
$43.14
|
| Rate for Payer: Aetna Medicare |
$666.74
|
| Rate for Payer: Aetna Medicare |
$664.68
|
| Rate for Payer: Aetna Medicare |
$72.32
|
| Rate for Payer: Aetna Medicare |
$666.66
|
| Rate for Payer: Aetna Medicare |
$43.28
|
| Rate for Payer: Aetna Medicare |
$33.66
|
| Rate for Payer: Aetna Medicare |
$42.94
|
| Rate for Payer: Aetna Medicare |
$28.97
|
| Rate for Payer: Aetna Medicare |
$25.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.76
|
| Rate for Payer: BCBS Complete |
$34.36
|
| Rate for Payer: BCBS Complete |
$23.18
|
| Rate for Payer: BCBS Complete |
$533.39
|
| Rate for Payer: BCBS Complete |
$57.85
|
| Rate for Payer: BCBS Complete |
$533.33
|
| Rate for Payer: BCBS Complete |
$531.74
|
| Rate for Payer: BCBS Complete |
$37.70
|
| Rate for Payer: BCBS Complete |
$34.62
|
| Rate for Payer: BCBS Complete |
$34.52
|
| Rate for Payer: BCBS Complete |
$20.51
|
| Rate for Payer: BCBS Complete |
$26.93
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cash Price |
$75.41
|
| Rate for Payer: Cash Price |
$69.25
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$1,066.66
|
| Rate for Payer: Cash Price |
$1,066.78
|
| Rate for Payer: Cash Price |
$1,063.48
|
| Rate for Payer: Cash Price |
$69.25
|
| Rate for Payer: Cash Price |
$69.03
|
| Rate for Payer: Cash Price |
$1,066.66
|
| Rate for Payer: Cash Price |
$69.03
|
| Rate for Payer: Cash Price |
$68.71
|
| Rate for Payer: Cash Price |
$41.02
|
| Rate for Payer: Cash Price |
$41.02
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cash Price |
$68.71
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cash Price |
$1,063.48
|
| Rate for Payer: Cash Price |
$75.41
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cash Price |
$1,066.78
|
| Rate for Payer: Cofinity Commercial |
$40.56
|
| Rate for Payer: Cofinity Commercial |
$1,143.24
|
| Rate for Payer: Cofinity Commercial |
$930.54
|
| Rate for Payer: Cofinity Commercial |
$1,146.66
|
| Rate for Payer: Cofinity Commercial |
$933.32
|
| Rate for Payer: Cofinity Commercial |
$1,146.79
|
| Rate for Payer: Cofinity Commercial |
$933.44
|
| Rate for Payer: Cofinity Commercial |
$101.24
|
| Rate for Payer: Cofinity Commercial |
$124.38
|
| Rate for Payer: Cofinity Commercial |
$35.89
|
| Rate for Payer: Cofinity Commercial |
$44.09
|
| Rate for Payer: Cofinity Commercial |
$49.83
|
| Rate for Payer: Cofinity Commercial |
$47.13
|
| Rate for Payer: Cofinity Commercial |
$57.90
|
| Rate for Payer: Cofinity Commercial |
$60.12
|
| Rate for Payer: Cofinity Commercial |
$73.87
|
| Rate for Payer: Cofinity Commercial |
$60.40
|
| Rate for Payer: Cofinity Commercial |
$74.21
|
| Rate for Payer: Cofinity Commercial |
$60.59
|
| Rate for Payer: Cofinity Commercial |
$74.44
|
| Rate for Payer: Cofinity Commercial |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$81.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$930.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$933.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$933.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,063.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.71
|
| Rate for Payer: Healthscope Commercial |
$1,196.42
|
| Rate for Payer: Healthscope Commercial |
$60.60
|
| Rate for Payer: Healthscope Commercial |
$46.14
|
| Rate for Payer: Healthscope Commercial |
$77.30
|
| Rate for Payer: Healthscope Commercial |
$84.83
|
| Rate for Payer: Healthscope Commercial |
$77.66
|
| Rate for Payer: Healthscope Commercial |
$1,200.13
|
| Rate for Payer: Healthscope Commercial |
$130.17
|
| Rate for Payer: Healthscope Commercial |
$1,199.99
|
| Rate for Payer: Healthscope Commercial |
$77.90
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,133.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,133.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.94
|
| Rate for Payer: PHP Commercial |
$43.58
|
| Rate for Payer: PHP Commercial |
$73.01
|
| Rate for Payer: PHP Commercial |
$1,133.32
|
| Rate for Payer: PHP Commercial |
$73.35
|
| Rate for Payer: PHP Commercial |
$80.12
|
| Rate for Payer: PHP Commercial |
$73.58
|
| Rate for Payer: PHP Commercial |
$122.94
|
| Rate for Payer: PHP Commercial |
$57.23
|
| Rate for Payer: PHP Commercial |
$49.25
|
| Rate for Payer: PHP Commercial |
$1,129.95
|
| Rate for Payer: PHP Commercial |
$1,133.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.09
|
| Rate for Payer: Priority Health SBD |
$32.30
|
| Rate for Payer: Priority Health SBD |
$840.09
|
| Rate for Payer: Priority Health SBD |
$839.99
|
| Rate for Payer: Priority Health SBD |
$36.50
|
| Rate for Payer: Priority Health SBD |
$54.53
|
| Rate for Payer: Priority Health SBD |
$837.49
|
| Rate for Payer: Priority Health SBD |
$54.36
|
| Rate for Payer: Priority Health SBD |
$91.12
|
| Rate for Payer: Priority Health SBD |
$54.11
|
| Rate for Payer: Priority Health SBD |
$42.42
|
| Rate for Payer: Priority Health SBD |
$59.38
|
|
|
DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN
|
Facility
|
OP
|
$44,776.64
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
193506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$40,298.98 |
| Rate for Payer: Aetna Commercial |
$38,060.14
|
| Rate for Payer: Aetna Medicare |
$53.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29,104.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.24
|
| Rate for Payer: BCBS Complete |
$28.92
|
| Rate for Payer: BCBS MAPPO |
$51.39
|
| Rate for Payer: BCBS Trust/PPO |
$145.22
|
| Rate for Payer: BCN Commercial |
$145.22
|
| Rate for Payer: BCN Medicare Advantage |
$51.39
|
| Rate for Payer: Cash Price |
$35,821.31
|
| Rate for Payer: Cash Price |
$35,821.31
|
| Rate for Payer: Cofinity Commercial |
$38,507.91
|
| Rate for Payer: Cofinity Commercial |
$31,343.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$31,343.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35,821.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.39
|
| Rate for Payer: Healthscope Commercial |
$40,298.98
|
| Rate for Payer: Mclaren Medicaid |
$27.55
|
| Rate for Payer: Mclaren Medicare |
$51.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.96
|
| Rate for Payer: Meridian Medicaid |
$28.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38,060.14
|
| Rate for Payer: Nomi Health Commercial |
$154.17
|
| Rate for Payer: PACE Medicare |
$48.82
|
| Rate for Payer: PACE SWMI |
$51.39
|
| Rate for Payer: PHP Commercial |
$38,060.14
|
| Rate for Payer: PHP Medicare Advantage |
$51.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29,104.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.97
|
| Rate for Payer: Priority Health Medicare |
$51.39
|
| Rate for Payer: Priority Health Narrow Network |
$118.38
|
| Rate for Payer: Priority Health SBD |
$28,209.28
|
| Rate for Payer: Railroad Medicare Medicare |
$51.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.39
|
| Rate for Payer: UHC Medicare Advantage |
$51.39
|
| Rate for Payer: UHCCP Medicaid |
$28.93
|
| Rate for Payer: VA VA |
$51.39
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$7,647.38
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
176546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,817.85 |
| Max. Negotiated Rate |
$6,882.64 |
| Rate for Payer: Aetna Commercial |
$6,500.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,970.80
|
| Rate for Payer: Cash Price |
$6,117.90
|
| Rate for Payer: Cofinity Commercial |
$5,353.17
|
| Rate for Payer: Cofinity Commercial |
$6,576.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,353.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,117.90
|
| Rate for Payer: Healthscope Commercial |
$6,882.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,500.27
|
| Rate for Payer: PHP Commercial |
$6,500.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,970.80
|
| Rate for Payer: Priority Health SBD |
$4,817.85
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,353.06
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
176546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$2,117.75 |
| Rate for Payer: Aetna Commercial |
$2,000.10
|
| Rate for Payer: Aetna Commercial |
$6,500.27
|
| Rate for Payer: Aetna Medicare |
$67.93
|
| Rate for Payer: Aetna Medicare |
$67.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,970.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,529.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.65
|
| Rate for Payer: BCBS Complete |
$36.76
|
| Rate for Payer: BCBS Complete |
$36.76
|
| Rate for Payer: BCBS MAPPO |
$65.32
|
| Rate for Payer: BCBS MAPPO |
$65.32
|
| Rate for Payer: BCBS Trust/PPO |
$184.48
|
| Rate for Payer: BCBS Trust/PPO |
$184.48
|
| Rate for Payer: BCN Commercial |
$184.48
|
| Rate for Payer: BCN Commercial |
$184.48
|
| Rate for Payer: BCN Medicare Advantage |
$65.32
|
| Rate for Payer: BCN Medicare Advantage |
$65.32
|
| Rate for Payer: Cash Price |
$6,117.90
|
| Rate for Payer: Cash Price |
$6,117.90
|
| Rate for Payer: Cash Price |
$1,882.45
|
| Rate for Payer: Cash Price |
$1,882.45
|
| Rate for Payer: Cofinity Commercial |
$1,647.14
|
| Rate for Payer: Cofinity Commercial |
$6,576.75
|
| Rate for Payer: Cofinity Commercial |
$5,353.17
|
| Rate for Payer: Cofinity Commercial |
$2,023.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,647.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,353.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,882.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,117.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.32
|
| Rate for Payer: Healthscope Commercial |
$6,882.64
|
| Rate for Payer: Healthscope Commercial |
$2,117.75
|
| Rate for Payer: Mclaren Medicaid |
$35.01
|
| Rate for Payer: Mclaren Medicaid |
$35.01
|
| Rate for Payer: Mclaren Medicare |
$65.32
|
| Rate for Payer: Mclaren Medicare |
$65.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.59
|
| Rate for Payer: Meridian Medicaid |
$36.76
|
| Rate for Payer: Meridian Medicaid |
$36.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,500.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,000.10
|
| Rate for Payer: Nomi Health Commercial |
$195.96
|
| Rate for Payer: Nomi Health Commercial |
$195.96
|
| Rate for Payer: PACE Medicare |
$62.05
|
| Rate for Payer: PACE Medicare |
$62.05
|
| Rate for Payer: PACE SWMI |
$65.32
|
| Rate for Payer: PACE SWMI |
$65.32
|
| Rate for Payer: PHP Commercial |
$2,000.10
|
| Rate for Payer: PHP Commercial |
$6,500.27
|
| Rate for Payer: PHP Medicare Advantage |
$65.32
|
| Rate for Payer: PHP Medicare Advantage |
$65.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,529.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,970.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.42
|
| Rate for Payer: Priority Health Medicare |
$65.32
|
| Rate for Payer: Priority Health Medicare |
$65.32
|
| Rate for Payer: Priority Health Narrow Network |
$149.94
|
| Rate for Payer: Priority Health Narrow Network |
$149.94
|
| Rate for Payer: Priority Health SBD |
$4,817.85
|
| Rate for Payer: Priority Health SBD |
$1,482.43
|
| Rate for Payer: Railroad Medicare Medicare |
$65.32
|
| Rate for Payer: Railroad Medicare Medicare |
$65.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.32
|
| Rate for Payer: UHC Medicare Advantage |
$65.32
|
| Rate for Payer: UHC Medicare Advantage |
$65.32
|
| Rate for Payer: UHCCP Medicaid |
$36.78
|
| Rate for Payer: UHCCP Medicaid |
$36.78
|
| Rate for Payer: VA VA |
$65.32
|
| Rate for Payer: VA VA |
$65.32
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$2,412.47
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$2,171.22 |
| Rate for Payer: Aetna Commercial |
$2,050.60
|
| Rate for Payer: Aetna Medicare |
$3.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,568.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$8.40
|
| Rate for Payer: BCN Commercial |
$8.40
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cofinity Commercial |
$2,074.72
|
| Rate for Payer: Cofinity Commercial |
$1,688.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,688.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,929.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$2,171.22
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,050.60
|
| Rate for Payer: Nomi Health Commercial |
$8.91
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$2,050.60
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,568.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.73
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$6.98
|
| Rate for Payer: Priority Health SBD |
$1,519.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.67
|
| Rate for Payer: VA VA |
$2.97
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$2,412.47
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,519.86 |
| Max. Negotiated Rate |
$2,171.22 |
| Rate for Payer: Aetna Commercial |
$2,050.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,568.11
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cofinity Commercial |
$1,688.73
|
| Rate for Payer: Cofinity Commercial |
$2,074.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,688.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,929.98
|
| Rate for Payer: Healthscope Commercial |
$2,171.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,050.60
|
| Rate for Payer: PHP Commercial |
$2,050.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,568.11
|
| Rate for Payer: Priority Health SBD |
$1,519.86
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$3,618.71
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3,256.84 |
| Rate for Payer: Aetna Commercial |
$3,075.90
|
| Rate for Payer: Aetna Medicare |
$3.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,352.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$8.40
|
| Rate for Payer: BCN Commercial |
$8.40
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: Cash Price |
$2,894.97
|
| Rate for Payer: Cash Price |
$2,894.97
|
| Rate for Payer: Cofinity Commercial |
$3,112.09
|
| Rate for Payer: Cofinity Commercial |
$2,533.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,533.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,894.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$3,256.84
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,075.90
|
| Rate for Payer: Nomi Health Commercial |
$8.91
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$3,075.90
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,352.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.73
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$6.98
|
| Rate for Payer: Priority Health SBD |
$2,279.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.67
|
| Rate for Payer: VA VA |
$2.97
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$3,618.71
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,279.79 |
| Max. Negotiated Rate |
$3,256.84 |
| Rate for Payer: Aetna Commercial |
$3,075.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,352.16
|
| Rate for Payer: Cash Price |
$2,894.97
|
| Rate for Payer: Cofinity Commercial |
$2,533.10
|
| Rate for Payer: Cofinity Commercial |
$3,112.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,533.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,894.97
|
| Rate for Payer: Healthscope Commercial |
$3,256.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,075.90
|
| Rate for Payer: PHP Commercial |
$3,075.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,352.16
|
| Rate for Payer: Priority Health SBD |
$2,279.79
|
|
|
DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$4,824.93
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$4,342.44 |
| Rate for Payer: Aetna Commercial |
$4,101.19
|
| Rate for Payer: Aetna Medicare |
$3.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,136.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$8.40
|
| Rate for Payer: BCN Commercial |
$8.40
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: Cash Price |
$3,859.94
|
| Rate for Payer: Cash Price |
$3,859.94
|
| Rate for Payer: Cofinity Commercial |
$4,149.44
|
| Rate for Payer: Cofinity Commercial |
$3,377.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,377.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,859.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$4,342.44
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,101.19
|
| Rate for Payer: Nomi Health Commercial |
$8.91
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$4,101.19
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,136.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.73
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$6.98
|
| Rate for Payer: Priority Health SBD |
$3,039.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.67
|
| Rate for Payer: VA VA |
$2.97
|
|
|
DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$4,824.93
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,039.71 |
| Max. Negotiated Rate |
$4,342.44 |
| Rate for Payer: Aetna Commercial |
$4,101.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,136.20
|
| Rate for Payer: Cash Price |
$3,859.94
|
| Rate for Payer: Cofinity Commercial |
$3,377.45
|
| Rate for Payer: Cofinity Commercial |
$4,149.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,377.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,859.94
|
| Rate for Payer: Healthscope Commercial |
$4,342.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,101.19
|
| Rate for Payer: PHP Commercial |
$4,101.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,136.20
|
| Rate for Payer: Priority Health SBD |
$3,039.71
|
|
