|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,201.67
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$757.05 |
| Max. Negotiated Rate |
$1,081.50 |
| Rate for Payer: Aetna Commercial |
$1,021.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.09
|
| Rate for Payer: Cash Price |
$961.34
|
| Rate for Payer: Cofinity Advantage |
$841.17
|
| Rate for Payer: Cofinity Commercial |
$1,033.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.34
|
| Rate for Payer: Healthscope Commercial |
$1,081.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$901.25
|
| Rate for Payer: PHP Commercial |
$1,021.42
|
| Rate for Payer: Priority Health SBD |
$757.05
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,201.67
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$1,081.50 |
| Rate for Payer: Aetna Commercial |
$1,021.42
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$18.22
|
| Rate for Payer: BCN Commercial |
$18.22
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$961.34
|
| Rate for Payer: Cash Price |
$961.34
|
| Rate for Payer: Cofinity Advantage |
$841.17
|
| Rate for Payer: Cofinity Commercial |
$1,033.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$1,081.50
|
| Rate for Payer: Mclaren Medicaid |
$4.12
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.42
|
| Rate for Payer: Nomi Health Commercial |
$23.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$901.25
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$1,021.42
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.77
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health SBD |
$757.05
|
| Rate for Payer: Priority Health Tiered Network |
$19.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.49
|
| Rate for Payer: UHC Core |
$12.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.49
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: VA VA |
$7.88
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$167.11
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.28 |
| Max. Negotiated Rate |
$150.40 |
| Rate for Payer: Aetna Commercial |
$142.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.62
|
| Rate for Payer: Cash Price |
$133.69
|
| Rate for Payer: Cofinity Advantage |
$116.98
|
| Rate for Payer: Cofinity Commercial |
$143.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.69
|
| Rate for Payer: Healthscope Commercial |
$150.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.33
|
| Rate for Payer: PHP Commercial |
$142.04
|
| Rate for Payer: Priority Health SBD |
$105.28
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$167.11
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$150.40 |
| Rate for Payer: Aetna Commercial |
$142.04
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$18.22
|
| Rate for Payer: BCN Commercial |
$18.22
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$133.69
|
| Rate for Payer: Cash Price |
$133.69
|
| Rate for Payer: Cofinity Advantage |
$116.98
|
| Rate for Payer: Cofinity Commercial |
$143.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$150.40
|
| Rate for Payer: Mclaren Medicaid |
$4.12
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.04
|
| Rate for Payer: Nomi Health Commercial |
$23.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.33
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$142.04
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.77
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health SBD |
$105.28
|
| Rate for Payer: Priority Health Tiered Network |
$19.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.49
|
| Rate for Payer: UHC Core |
$12.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.49
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: VA VA |
$7.88
|
|
|
EPOPROSTENOL 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$130.85
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
162203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.44 |
| Max. Negotiated Rate |
$117.77 |
| Rate for Payer: Aetna Commercial |
$111.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.05
|
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Cofinity Advantage |
$91.59
|
| Rate for Payer: Cofinity Commercial |
$112.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.68
|
| Rate for Payer: Healthscope Commercial |
$117.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.14
|
| Rate for Payer: PHP Commercial |
$111.22
|
| Rate for Payer: Priority Health SBD |
$82.44
|
|
|
EPOPROSTENOL 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$130.85
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
162203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.82 |
| Max. Negotiated Rate |
$117.77 |
| Rate for Payer: Aetna Commercial |
$111.22
|
| Rate for Payer: Aetna Medicare |
$65.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.05
|
| Rate for Payer: BCBS Complete |
$52.34
|
| Rate for Payer: BCBS Trust/PPO |
$39.25
|
| Rate for Payer: BCN Commercial |
$39.25
|
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Cofinity Advantage |
$91.59
|
| Rate for Payer: Cofinity Commercial |
$112.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.68
|
| Rate for Payer: Healthscope Commercial |
$117.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.14
|
| Rate for Payer: PHP Commercial |
$111.22
|
| Rate for Payer: Priority Health SBD |
$82.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.82
|
| Rate for Payer: UHC Core |
$25.82
|
| Rate for Payer: UHC Exchange |
$25.82
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$200.22
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
155384
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.14 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Aetna Commercial |
$170.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.14
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cofinity Advantage |
$140.15
|
| Rate for Payer: Cofinity Commercial |
$172.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.18
|
| Rate for Payer: Healthscope Commercial |
$180.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.16
|
| Rate for Payer: PHP Commercial |
$170.19
|
| Rate for Payer: Priority Health SBD |
$126.14
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$200.22
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
155384
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.82 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Aetna Commercial |
$170.19
|
| Rate for Payer: Aetna Medicare |
$100.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.14
|
| Rate for Payer: BCBS Complete |
$80.09
|
| Rate for Payer: BCBS Trust/PPO |
$39.25
|
| Rate for Payer: BCN Commercial |
$39.25
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cofinity Advantage |
$140.15
|
| Rate for Payer: Cofinity Commercial |
$172.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.18
|
| Rate for Payer: Healthscope Commercial |
$180.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.16
|
| Rate for Payer: PHP Commercial |
$170.19
|
| Rate for Payer: Priority Health SBD |
$126.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.82
|
| Rate for Payer: UHC Core |
$25.82
|
| Rate for Payer: UHC Exchange |
$25.82
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$271.91
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.30 |
| Max. Negotiated Rate |
$244.72 |
| Rate for Payer: Aetna Commercial |
$231.12
|
| Rate for Payer: Aetna Commercial |
$913.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$698.55
|
| Rate for Payer: Cash Price |
$859.76
|
| Rate for Payer: Cash Price |
$217.53
|
| Rate for Payer: Cofinity Advantage |
$190.34
|
| Rate for Payer: Cofinity Advantage |
$752.29
|
| Rate for Payer: Cofinity Commercial |
$924.24
|
| Rate for Payer: Cofinity Commercial |
$233.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$859.76
|
| Rate for Payer: Healthscope Commercial |
$244.72
|
| Rate for Payer: Healthscope Commercial |
$967.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$913.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$806.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.93
|
| Rate for Payer: PHP Commercial |
$913.50
|
| Rate for Payer: PHP Commercial |
$231.12
|
| Rate for Payer: Priority Health SBD |
$171.30
|
| Rate for Payer: Priority Health SBD |
$677.06
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$271.91
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$244.72 |
| Rate for Payer: Aetna Commercial |
$231.12
|
| Rate for Payer: Aetna Commercial |
$913.50
|
| Rate for Payer: Aetna Medicare |
$3.39
|
| Rate for Payer: Aetna Medicare |
$3.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$698.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$43.83
|
| Rate for Payer: BCBS Trust/PPO |
$43.83
|
| Rate for Payer: BCN Commercial |
$43.83
|
| Rate for Payer: BCN Commercial |
$43.83
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: Cash Price |
$859.76
|
| Rate for Payer: Cash Price |
$859.76
|
| Rate for Payer: Cash Price |
$217.53
|
| Rate for Payer: Cash Price |
$217.53
|
| Rate for Payer: Cofinity Advantage |
$190.34
|
| Rate for Payer: Cofinity Advantage |
$752.29
|
| Rate for Payer: Cofinity Commercial |
$233.84
|
| Rate for Payer: Cofinity Commercial |
$924.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$859.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$967.23
|
| Rate for Payer: Healthscope Commercial |
$244.72
|
| Rate for Payer: Mclaren Medicaid |
$1.70
|
| Rate for Payer: Mclaren Medicaid |
$1.70
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$913.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.12
|
| Rate for Payer: Nomi Health Commercial |
$9.78
|
| Rate for Payer: Nomi Health Commercial |
$9.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$806.02
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PHP Commercial |
$913.50
|
| Rate for Payer: PHP Commercial |
$231.12
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.43
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health SBD |
$171.30
|
| Rate for Payer: Priority Health SBD |
$677.06
|
| Rate for Payer: Priority Health Tiered Network |
$7.54
|
| Rate for Payer: Priority Health Tiered Network |
$7.54
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.81
|
| Rate for Payer: UHC Core |
$5.81
|
| Rate for Payer: UHC Core |
$5.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Exchange |
$5.81
|
| Rate for Payer: UHC Exchange |
$5.81
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: VA VA |
$3.26
|
| Rate for Payer: VA VA |
$3.26
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$80.68
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$72.61 |
| Rate for Payer: PHP Commercial |
$68.58
|
| Rate for Payer: Aetna Commercial |
$68.58
|
| Rate for Payer: Aetna Commercial |
$70.32
|
| Rate for Payer: Aetna Commercial |
$158.30
|
| Rate for Payer: Aetna Commercial |
$252.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.06
|
| Rate for Payer: Cash Price |
$64.54
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$237.71
|
| Rate for Payer: Cash Price |
$148.99
|
| Rate for Payer: Cofinity Advantage |
$56.48
|
| Rate for Payer: Cofinity Advantage |
$130.37
|
| Rate for Payer: Cofinity Advantage |
$57.91
|
| Rate for Payer: Cofinity Advantage |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Cofinity Commercial |
$69.38
|
| Rate for Payer: Cofinity Commercial |
$255.54
|
| Rate for Payer: Cofinity Commercial |
$160.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.54
|
| Rate for Payer: Healthscope Commercial |
$72.61
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Commercial |
$167.62
|
| Rate for Payer: Healthscope Commercial |
$267.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.85
|
| Rate for Payer: PHP Commercial |
$252.57
|
| Rate for Payer: PHP Commercial |
$158.30
|
| Rate for Payer: PHP Commercial |
$70.32
|
| Rate for Payer: Priority Health SBD |
$187.20
|
| Rate for Payer: Priority Health SBD |
$52.12
|
| Rate for Payer: Priority Health SBD |
$50.83
|
| Rate for Payer: Priority Health SBD |
$117.33
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$186.24
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$167.62 |
| Rate for Payer: Aetna Commercial |
$158.30
|
| Rate for Payer: Aetna Commercial |
$70.32
|
| Rate for Payer: Aetna Commercial |
$252.57
|
| Rate for Payer: Aetna Commercial |
$68.58
|
| Rate for Payer: Aetna Medicare |
$3.39
|
| Rate for Payer: Aetna Medicare |
$3.39
|
| Rate for Payer: Aetna Medicare |
$3.39
|
| Rate for Payer: Aetna Medicare |
$3.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$43.83
|
| Rate for Payer: BCBS Trust/PPO |
$43.83
|
| Rate for Payer: BCBS Trust/PPO |
$43.83
|
| Rate for Payer: BCBS Trust/PPO |
$43.83
|
| Rate for Payer: BCN Commercial |
$43.83
|
| Rate for Payer: BCN Commercial |
$43.83
|
| Rate for Payer: BCN Commercial |
$43.83
|
| Rate for Payer: BCN Commercial |
$43.83
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: Cash Price |
$64.54
|
| Rate for Payer: Cash Price |
$64.54
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$237.71
|
| Rate for Payer: Cash Price |
$237.71
|
| Rate for Payer: Cash Price |
$148.99
|
| Rate for Payer: Cash Price |
$148.99
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cofinity Advantage |
$56.48
|
| Rate for Payer: Cofinity Advantage |
$130.37
|
| Rate for Payer: Cofinity Advantage |
$208.00
|
| Rate for Payer: Cofinity Advantage |
$57.91
|
| Rate for Payer: Cofinity Commercial |
$69.38
|
| Rate for Payer: Cofinity Commercial |
$255.54
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Cofinity Commercial |
$160.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$267.43
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Commercial |
$167.62
|
| Rate for Payer: Healthscope Commercial |
$72.61
|
| Rate for Payer: Mclaren Medicaid |
$1.70
|
| Rate for Payer: Mclaren Medicaid |
$1.70
|
| Rate for Payer: Mclaren Medicaid |
$1.70
|
| Rate for Payer: Mclaren Medicaid |
$1.70
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.30
|
| Rate for Payer: Nomi Health Commercial |
$9.78
|
| Rate for Payer: Nomi Health Commercial |
$9.78
|
| Rate for Payer: Nomi Health Commercial |
$9.78
|
| Rate for Payer: Nomi Health Commercial |
$9.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.85
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PHP Commercial |
$70.32
|
| Rate for Payer: PHP Commercial |
$158.30
|
| Rate for Payer: PHP Commercial |
$252.57
|
| Rate for Payer: PHP Commercial |
$68.58
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.43
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health SBD |
$52.12
|
| Rate for Payer: Priority Health SBD |
$117.33
|
| Rate for Payer: Priority Health SBD |
$50.83
|
| Rate for Payer: Priority Health SBD |
$187.20
|
| Rate for Payer: Priority Health Tiered Network |
$7.54
|
| Rate for Payer: Priority Health Tiered Network |
$7.54
|
| Rate for Payer: Priority Health Tiered Network |
$7.54
|
| Rate for Payer: Priority Health Tiered Network |
$7.54
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.81
|
| Rate for Payer: UHC Core |
$5.81
|
| Rate for Payer: UHC Core |
$5.81
|
| Rate for Payer: UHC Core |
$5.81
|
| Rate for Payer: UHC Core |
$5.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Exchange |
$5.81
|
| Rate for Payer: UHC Exchange |
$5.81
|
| Rate for Payer: UHC Exchange |
$5.81
|
| Rate for Payer: UHC Exchange |
$5.81
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: VA VA |
$3.26
|
| Rate for Payer: VA VA |
$3.26
|
| Rate for Payer: VA VA |
$3.26
|
| Rate for Payer: VA VA |
$3.26
|
|
|
EPTINEZUMAB-JJMR 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$8,609.07
|
|
|
Service Code
|
HCPCS J3032
|
| Hospital Charge Code |
193002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,423.71 |
| Max. Negotiated Rate |
$7,748.16 |
| Rate for Payer: Aetna Commercial |
$7,317.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,595.90
|
| Rate for Payer: Cash Price |
$6,887.26
|
| Rate for Payer: Cofinity Advantage |
$6,026.35
|
| Rate for Payer: Cofinity Commercial |
$7,403.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,887.26
|
| Rate for Payer: Healthscope Commercial |
$7,748.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,317.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,456.80
|
| Rate for Payer: PHP Commercial |
$7,317.71
|
| Rate for Payer: Priority Health SBD |
$5,423.71
|
|
|
EPTINEZUMAB-JJMR 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$8,609.07
|
|
|
Service Code
|
HCPCS J3032
|
| Hospital Charge Code |
193002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$7,748.16 |
| Rate for Payer: Aetna Commercial |
$7,317.71
|
| Rate for Payer: Aetna Medicare |
$21.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,595.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.69
|
| Rate for Payer: BCBS Complete |
$11.29
|
| Rate for Payer: BCBS MAPPO |
$20.55
|
| Rate for Payer: BCBS Trust/PPO |
$51.41
|
| Rate for Payer: BCN Commercial |
$51.41
|
| Rate for Payer: BCN Medicare Advantage |
$20.55
|
| Rate for Payer: Cash Price |
$6,887.26
|
| Rate for Payer: Cash Price |
$6,887.26
|
| Rate for Payer: Cofinity Advantage |
$6,026.35
|
| Rate for Payer: Cofinity Commercial |
$7,403.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,887.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.55
|
| Rate for Payer: Healthscope Commercial |
$7,748.16
|
| Rate for Payer: Mclaren Medicaid |
$10.75
|
| Rate for Payer: Mclaren Medicare |
$20.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.58
|
| Rate for Payer: Meridian Medicaid |
$21.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,317.71
|
| Rate for Payer: Nomi Health Commercial |
$61.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,456.80
|
| Rate for Payer: PACE Medicare |
$19.52
|
| Rate for Payer: PACE SWMI |
$20.55
|
| Rate for Payer: PHP Commercial |
$7,317.71
|
| Rate for Payer: PHP Medicare Advantage |
$20.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$63.00
|
| Rate for Payer: Priority Health Medicare |
$20.55
|
| Rate for Payer: Priority Health SBD |
$5,423.71
|
| Rate for Payer: Priority Health Tiered Network |
$50.40
|
| Rate for Payer: Railroad Medicare Medicare |
$20.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.83
|
| Rate for Payer: UHC Core |
$33.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.55
|
| Rate for Payer: UHC Exchange |
$33.83
|
| Rate for Payer: UHC Medicaid |
$10.75
|
| Rate for Payer: UHCCP Medicaid |
$10.75
|
| Rate for Payer: VA VA |
$20.55
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$429.60
|
|
|
Service Code
|
NDC 60687050001
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.83 |
| Max. Negotiated Rate |
$386.64 |
| Rate for Payer: Aetna Commercial |
$365.16
|
| Rate for Payer: Aetna Medicare |
$214.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.24
|
| Rate for Payer: BCBS Complete |
$171.84
|
| Rate for Payer: Cash Price |
$343.68
|
| Rate for Payer: Cofinity Advantage |
$300.72
|
| Rate for Payer: Cofinity Commercial |
$369.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.68
|
| Rate for Payer: Healthscope Commercial |
$386.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$343.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.20
|
| Rate for Payer: PHP Commercial |
$365.16
|
| Rate for Payer: Priority Health SBD |
$270.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.24
|
| Rate for Payer: UHC Core |
$223.82
|
| Rate for Payer: UHC Exchange |
$168.83
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$321.10
|
|
|
Service Code
|
NDC 62332046431
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.19 |
| Max. Negotiated Rate |
$288.99 |
| Rate for Payer: Aetna Commercial |
$272.94
|
| Rate for Payer: Aetna Medicare |
$160.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.72
|
| Rate for Payer: BCBS Complete |
$128.44
|
| Rate for Payer: Cash Price |
$256.88
|
| Rate for Payer: Cofinity Advantage |
$224.77
|
| Rate for Payer: Cofinity Commercial |
$276.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.88
|
| Rate for Payer: Healthscope Commercial |
$288.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.82
|
| Rate for Payer: PHP Commercial |
$272.94
|
| Rate for Payer: Priority Health SBD |
$202.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.72
|
| Rate for Payer: UHC Core |
$167.29
|
| Rate for Payer: UHC Exchange |
$126.19
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$429.60
|
|
|
Service Code
|
NDC 60687050001
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.65 |
| Max. Negotiated Rate |
$386.64 |
| Rate for Payer: Aetna Commercial |
$365.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.24
|
| Rate for Payer: Cash Price |
$343.68
|
| Rate for Payer: Cofinity Advantage |
$300.72
|
| Rate for Payer: Cofinity Commercial |
$369.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.68
|
| Rate for Payer: Healthscope Commercial |
$386.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.20
|
| Rate for Payer: PHP Commercial |
$365.16
|
| Rate for Payer: Priority Health SBD |
$270.65
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$5.99
|
|
|
Service Code
|
NDC 50268029711
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna Commercial |
$5.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.89
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cofinity Advantage |
$4.19
|
| Rate for Payer: Cofinity Commercial |
$5.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.79
|
| Rate for Payer: Healthscope Commercial |
$5.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.49
|
| Rate for Payer: PHP Commercial |
$5.09
|
| Rate for Payer: Priority Health SBD |
$3.77
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
NDC 60687050011
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.79
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Advantage |
$3.01
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$3.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.23
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: Priority Health SBD |
$2.71
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$299.04
|
|
|
Service Code
|
NDC 50268029715
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.40 |
| Max. Negotiated Rate |
$269.14 |
| Rate for Payer: Aetna Commercial |
$254.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.38
|
| Rate for Payer: Cash Price |
$239.23
|
| Rate for Payer: Cofinity Advantage |
$209.33
|
| Rate for Payer: Cofinity Commercial |
$257.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.23
|
| Rate for Payer: Healthscope Commercial |
$269.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.28
|
| Rate for Payer: PHP Commercial |
$254.18
|
| Rate for Payer: Priority Health SBD |
$188.40
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$299.04
|
|
|
Service Code
|
NDC 50268029715
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.52 |
| Max. Negotiated Rate |
$269.14 |
| Rate for Payer: Aetna Commercial |
$254.18
|
| Rate for Payer: Aetna Medicare |
$149.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.38
|
| Rate for Payer: BCBS Complete |
$119.62
|
| Rate for Payer: Cash Price |
$239.23
|
| Rate for Payer: Cofinity Advantage |
$209.33
|
| Rate for Payer: Cofinity Commercial |
$257.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.23
|
| Rate for Payer: Healthscope Commercial |
$269.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$239.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.28
|
| Rate for Payer: PHP Commercial |
$254.18
|
| Rate for Payer: Priority Health SBD |
$188.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.38
|
| Rate for Payer: UHC Core |
$155.80
|
| Rate for Payer: UHC Exchange |
$117.52
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$5.99
|
|
|
Service Code
|
NDC 50268029711
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna Commercial |
$5.09
|
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.89
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cofinity Advantage |
$4.19
|
| Rate for Payer: Cofinity Commercial |
$5.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.79
|
| Rate for Payer: Healthscope Commercial |
$5.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.49
|
| Rate for Payer: PHP Commercial |
$5.09
|
| Rate for Payer: Priority Health SBD |
$3.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.89
|
| Rate for Payer: UHC Core |
$3.12
|
| Rate for Payer: UHC Exchange |
$2.35
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$321.10
|
|
|
Service Code
|
NDC 62332046431
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.29 |
| Max. Negotiated Rate |
$288.99 |
| Rate for Payer: Aetna Commercial |
$272.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.72
|
| Rate for Payer: Cash Price |
$256.88
|
| Rate for Payer: Cofinity Advantage |
$224.77
|
| Rate for Payer: Cofinity Commercial |
$276.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.88
|
| Rate for Payer: Healthscope Commercial |
$288.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.82
|
| Rate for Payer: PHP Commercial |
$272.94
|
| Rate for Payer: Priority Health SBD |
$202.29
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 60687050011
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna Medicare |
$2.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.79
|
| Rate for Payer: BCBS Complete |
$1.72
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Advantage |
$3.01
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$3.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.23
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: Priority Health SBD |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.79
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: UHC Exchange |
$1.69
|
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,330.90
|
|
|
Service Code
|
HCPCS J9179
|
| Hospital Charge Code |
106773
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.15 |
| Max. Negotiated Rate |
$5,697.81 |
| Rate for Payer: Aetna Commercial |
$5,381.27
|
| Rate for Payer: Aetna Medicare |
$79.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,115.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.95
|
| Rate for Payer: BCBS Complete |
$42.16
|
| Rate for Payer: BCBS MAPPO |
$76.76
|
| Rate for Payer: BCBS Trust/PPO |
$178.77
|
| Rate for Payer: BCN Commercial |
$178.77
|
| Rate for Payer: BCN Medicare Advantage |
$76.76
|
| Rate for Payer: Cash Price |
$5,064.72
|
| Rate for Payer: Cash Price |
$5,064.72
|
| Rate for Payer: Cofinity Advantage |
$4,431.63
|
| Rate for Payer: Cofinity Commercial |
$5,444.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,064.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.76
|
| Rate for Payer: Healthscope Commercial |
$5,697.81
|
| Rate for Payer: Mclaren Medicaid |
$40.15
|
| Rate for Payer: Mclaren Medicare |
$76.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.60
|
| Rate for Payer: Meridian Medicaid |
$80.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,381.27
|
| Rate for Payer: Nomi Health Commercial |
$230.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,748.18
|
| Rate for Payer: PACE Medicare |
$72.92
|
| Rate for Payer: PACE SWMI |
$76.76
|
| Rate for Payer: PHP Commercial |
$5,381.27
|
| Rate for Payer: PHP Medicare Advantage |
$76.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$281.78
|
| Rate for Payer: Priority Health Medicare |
$76.76
|
| Rate for Payer: Priority Health SBD |
$3,988.47
|
| Rate for Payer: Priority Health Tiered Network |
$225.42
|
| Rate for Payer: Railroad Medicare Medicare |
$76.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.81
|
| Rate for Payer: UHC Core |
$119.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$76.76
|
| Rate for Payer: UHC Exchange |
$119.81
|
| Rate for Payer: UHC Medicaid |
$40.15
|
| Rate for Payer: UHCCP Medicaid |
$40.15
|
| Rate for Payer: VA VA |
$76.76
|
|
