|
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$30.43
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$27.39 |
| Rate for Payer: Aetna Commercial |
$25.87
|
| Rate for Payer: Aetna Commercial |
$91.60
|
| Rate for Payer: Aetna Commercial |
$32.59
|
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: Aetna Commercial |
$75.17
|
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Medicare |
$19.06
|
| Rate for Payer: Aetna Medicare |
$19.25
|
| Rate for Payer: Aetna Medicare |
$19.17
|
| Rate for Payer: Aetna Medicare |
$15.21
|
| Rate for Payer: Aetna Medicare |
$53.88
|
| Rate for Payer: Aetna Medicare |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.78
|
| Rate for Payer: BCBS Complete |
$43.10
|
| Rate for Payer: BCBS Complete |
$15.40
|
| Rate for Payer: BCBS Complete |
$35.38
|
| Rate for Payer: BCBS Complete |
$12.17
|
| Rate for Payer: BCBS Complete |
$15.34
|
| Rate for Payer: BCBS Complete |
$15.25
|
| Rate for Payer: Cash Price |
$30.67
|
| Rate for Payer: Cash Price |
$86.21
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cash Price |
$24.34
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cofinity Commercial |
$26.68
|
| Rate for Payer: Cofinity Commercial |
$32.78
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Commercial |
$26.94
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Cofinity Commercial |
$21.30
|
| Rate for Payer: Cofinity Commercial |
$92.67
|
| Rate for Payer: Cofinity Commercial |
$75.43
|
| Rate for Payer: Cofinity Commercial |
$32.97
|
| Rate for Payer: Cofinity Commercial |
$76.06
|
| Rate for Payer: Cofinity Commercial |
$61.91
|
| Rate for Payer: Cofinity Commercial |
$26.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.75
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Healthscope Commercial |
$79.60
|
| Rate for Payer: Healthscope Commercial |
$34.31
|
| Rate for Payer: Healthscope Commercial |
$34.51
|
| Rate for Payer: Healthscope Commercial |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$96.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: PHP Commercial |
$25.87
|
| Rate for Payer: PHP Commercial |
$32.59
|
| Rate for Payer: PHP Commercial |
$91.60
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: PHP Commercial |
$75.17
|
| Rate for Payer: PHP Commercial |
$32.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: Priority Health SBD |
$55.72
|
| Rate for Payer: Priority Health SBD |
$24.15
|
| Rate for Payer: Priority Health SBD |
$19.17
|
| Rate for Payer: Priority Health SBD |
$67.89
|
| Rate for Payer: Priority Health SBD |
$24.02
|
| Rate for Payer: Priority Health SBD |
$24.25
|
|
|
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$38.49
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: Aetna Commercial |
$91.60
|
| Rate for Payer: Aetna Commercial |
$32.59
|
| Rate for Payer: Aetna Commercial |
$75.17
|
| Rate for Payer: Aetna Commercial |
$25.87
|
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.92
|
| Rate for Payer: Cash Price |
$30.67
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cash Price |
$24.34
|
| Rate for Payer: Cash Price |
$86.21
|
| Rate for Payer: Cofinity Commercial |
$76.06
|
| Rate for Payer: Cofinity Commercial |
$75.43
|
| Rate for Payer: Cofinity Commercial |
$92.67
|
| Rate for Payer: Cofinity Commercial |
$21.30
|
| Rate for Payer: Cofinity Commercial |
$26.17
|
| Rate for Payer: Cofinity Commercial |
$26.68
|
| Rate for Payer: Cofinity Commercial |
$32.78
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Commercial |
$32.97
|
| Rate for Payer: Cofinity Commercial |
$26.94
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Cofinity Commercial |
$61.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.75
|
| Rate for Payer: Healthscope Commercial |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$34.51
|
| Rate for Payer: Healthscope Commercial |
$96.98
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Healthscope Commercial |
$79.60
|
| Rate for Payer: Healthscope Commercial |
$34.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.40
|
| Rate for Payer: PHP Commercial |
$25.87
|
| Rate for Payer: PHP Commercial |
$75.17
|
| Rate for Payer: PHP Commercial |
$91.60
|
| Rate for Payer: PHP Commercial |
$32.40
|
| Rate for Payer: PHP Commercial |
$32.59
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.78
|
| Rate for Payer: Priority Health SBD |
$55.72
|
| Rate for Payer: Priority Health SBD |
$24.02
|
| Rate for Payer: Priority Health SBD |
$67.89
|
| Rate for Payer: Priority Health SBD |
$19.17
|
| Rate for Payer: Priority Health SBD |
$24.25
|
| Rate for Payer: Priority Health SBD |
$24.15
|
|
|
ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$45.61
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105904
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$41.05 |
| Rate for Payer: Aetna Commercial |
$38.77
|
| Rate for Payer: Aetna Commercial |
$109.96
|
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna Commercial |
$64.69
|
| Rate for Payer: Aetna Commercial |
$30.00
|
| Rate for Payer: Aetna Commercial |
$31.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.48
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Cash Price |
$60.88
|
| Rate for Payer: Cash Price |
$36.49
|
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Cash Price |
$103.49
|
| Rate for Payer: Cofinity Commercial |
$65.45
|
| Rate for Payer: Cofinity Commercial |
$111.25
|
| Rate for Payer: Cofinity Commercial |
$90.55
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$30.35
|
| Rate for Payer: Cofinity Commercial |
$26.17
|
| Rate for Payer: Cofinity Commercial |
$32.15
|
| Rate for Payer: Cofinity Commercial |
$31.75
|
| Rate for Payer: Cofinity Commercial |
$39.01
|
| Rate for Payer: Cofinity Commercial |
$31.93
|
| Rate for Payer: Cofinity Commercial |
$39.22
|
| Rate for Payer: Cofinity Commercial |
$53.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.88
|
| Rate for Payer: Healthscope Commercial |
$31.76
|
| Rate for Payer: Healthscope Commercial |
$40.82
|
| Rate for Payer: Healthscope Commercial |
$116.42
|
| Rate for Payer: Healthscope Commercial |
$41.05
|
| Rate for Payer: Healthscope Commercial |
$68.49
|
| Rate for Payer: Healthscope Commercial |
$33.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.77
|
| Rate for Payer: PHP Commercial |
$30.00
|
| Rate for Payer: PHP Commercial |
$64.69
|
| Rate for Payer: PHP Commercial |
$109.96
|
| Rate for Payer: PHP Commercial |
$31.77
|
| Rate for Payer: PHP Commercial |
$38.56
|
| Rate for Payer: PHP Commercial |
$38.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.30
|
| Rate for Payer: Priority Health SBD |
$47.94
|
| Rate for Payer: Priority Health SBD |
$23.55
|
| Rate for Payer: Priority Health SBD |
$81.50
|
| Rate for Payer: Priority Health SBD |
$22.23
|
| Rate for Payer: Priority Health SBD |
$28.73
|
| Rate for Payer: Priority Health SBD |
$28.58
|
|
|
ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$35.29
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105904
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$31.76 |
| Rate for Payer: Aetna Commercial |
$30.00
|
| Rate for Payer: Aetna Commercial |
$109.96
|
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna Commercial |
$38.77
|
| Rate for Payer: Aetna Commercial |
$64.69
|
| Rate for Payer: Aetna Commercial |
$31.77
|
| Rate for Payer: Aetna Medicare |
$18.69
|
| Rate for Payer: Aetna Medicare |
$22.80
|
| Rate for Payer: Aetna Medicare |
$22.68
|
| Rate for Payer: Aetna Medicare |
$17.64
|
| Rate for Payer: Aetna Medicare |
$64.68
|
| Rate for Payer: Aetna Medicare |
$38.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.94
|
| Rate for Payer: BCBS Complete |
$51.74
|
| Rate for Payer: BCBS Complete |
$18.24
|
| Rate for Payer: BCBS Complete |
$30.44
|
| Rate for Payer: BCBS Complete |
$14.12
|
| Rate for Payer: BCBS Complete |
$18.14
|
| Rate for Payer: BCBS Complete |
$14.95
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cash Price |
$103.49
|
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Cash Price |
$36.49
|
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Cash Price |
$60.88
|
| Rate for Payer: Cofinity Commercial |
$26.17
|
| Rate for Payer: Cofinity Commercial |
$32.15
|
| Rate for Payer: Cofinity Commercial |
$31.75
|
| Rate for Payer: Cofinity Commercial |
$31.93
|
| Rate for Payer: Cofinity Commercial |
$39.22
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$90.55
|
| Rate for Payer: Cofinity Commercial |
$111.25
|
| Rate for Payer: Cofinity Commercial |
$39.01
|
| Rate for Payer: Cofinity Commercial |
$65.45
|
| Rate for Payer: Cofinity Commercial |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$30.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.88
|
| Rate for Payer: Healthscope Commercial |
$41.05
|
| Rate for Payer: Healthscope Commercial |
$68.49
|
| Rate for Payer: Healthscope Commercial |
$33.64
|
| Rate for Payer: Healthscope Commercial |
$40.82
|
| Rate for Payer: Healthscope Commercial |
$31.76
|
| Rate for Payer: Healthscope Commercial |
$116.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.77
|
| Rate for Payer: PHP Commercial |
$30.00
|
| Rate for Payer: PHP Commercial |
$38.56
|
| Rate for Payer: PHP Commercial |
$109.96
|
| Rate for Payer: PHP Commercial |
$38.77
|
| Rate for Payer: PHP Commercial |
$64.69
|
| Rate for Payer: PHP Commercial |
$31.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.65
|
| Rate for Payer: Priority Health SBD |
$47.94
|
| Rate for Payer: Priority Health SBD |
$28.58
|
| Rate for Payer: Priority Health SBD |
$22.23
|
| Rate for Payer: Priority Health SBD |
$81.50
|
| Rate for Payer: Priority Health SBD |
$23.55
|
| Rate for Payer: Priority Health SBD |
$28.73
|
|
|
ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$57.10
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
31921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$51.39 |
| Rate for Payer: Aetna Commercial |
$48.53
|
| Rate for Payer: Aetna Commercial |
$137.44
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Commercial |
$117.97
|
| Rate for Payer: Aetna Medicare |
$46.56
|
| Rate for Payer: Aetna Medicare |
$28.55
|
| Rate for Payer: Aetna Medicare |
$80.85
|
| Rate for Payer: Aetna Medicare |
$69.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: BCBS Complete |
$55.52
|
| Rate for Payer: BCBS Complete |
$37.25
|
| Rate for Payer: BCBS Complete |
$64.68
|
| Rate for Payer: BCBS Complete |
$22.84
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$129.36
|
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: Cash Price |
$111.03
|
| Rate for Payer: Cofinity Commercial |
$139.06
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Commercial |
$39.97
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Cofinity Commercial |
$119.36
|
| Rate for Payer: Cofinity Commercial |
$97.15
|
| Rate for Payer: Cofinity Commercial |
$113.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.36
|
| Rate for Payer: Healthscope Commercial |
$124.91
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Healthscope Commercial |
$145.53
|
| Rate for Payer: Healthscope Commercial |
$51.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.97
|
| Rate for Payer: PHP Commercial |
$137.44
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$48.53
|
| Rate for Payer: PHP Commercial |
$117.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.53
|
| Rate for Payer: Priority Health SBD |
$87.44
|
| Rate for Payer: Priority Health SBD |
$35.97
|
| Rate for Payer: Priority Health SBD |
$101.87
|
| Rate for Payer: Priority Health SBD |
$58.67
|
|
|
ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$57.10
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
31921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.97 |
| Max. Negotiated Rate |
$51.39 |
| Rate for Payer: Aetna Commercial |
$48.53
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Commercial |
$117.97
|
| Rate for Payer: Aetna Commercial |
$137.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: Cash Price |
$129.36
|
| Rate for Payer: Cash Price |
$111.03
|
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cofinity Commercial |
$119.36
|
| Rate for Payer: Cofinity Commercial |
$97.15
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Cofinity Commercial |
$113.19
|
| Rate for Payer: Cofinity Commercial |
$139.06
|
| Rate for Payer: Cofinity Commercial |
$39.97
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$51.39
|
| Rate for Payer: Healthscope Commercial |
$145.53
|
| Rate for Payer: Healthscope Commercial |
$124.91
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.44
|
| Rate for Payer: PHP Commercial |
$137.44
|
| Rate for Payer: PHP Commercial |
$117.97
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$48.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.12
|
| Rate for Payer: Priority Health SBD |
$87.44
|
| Rate for Payer: Priority Health SBD |
$35.97
|
| Rate for Payer: Priority Health SBD |
$101.87
|
| Rate for Payer: Priority Health SBD |
$58.67
|
|
|
ENOXAPARIN 300 MG/3 ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$821.23
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105940
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$517.37 |
| Max. Negotiated Rate |
$739.11 |
| Rate for Payer: Aetna Commercial |
$698.05
|
| Rate for Payer: Aetna Commercial |
$121.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.80
|
| Rate for Payer: Cash Price |
$113.89
|
| Rate for Payer: Cash Price |
$656.98
|
| Rate for Payer: Cofinity Commercial |
$122.43
|
| Rate for Payer: Cofinity Commercial |
$574.86
|
| Rate for Payer: Cofinity Commercial |
$706.26
|
| Rate for Payer: Cofinity Commercial |
$99.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$574.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$656.98
|
| Rate for Payer: Healthscope Commercial |
$128.12
|
| Rate for Payer: Healthscope Commercial |
$739.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.05
|
| Rate for Payer: PHP Commercial |
$121.01
|
| Rate for Payer: PHP Commercial |
$698.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.53
|
| Rate for Payer: Priority Health SBD |
$517.37
|
| Rate for Payer: Priority Health SBD |
$89.69
|
|
|
ENOXAPARIN 300 MG/3 ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$821.23
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105940
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$328.49 |
| Max. Negotiated Rate |
$739.11 |
| Rate for Payer: Aetna Commercial |
$698.05
|
| Rate for Payer: Aetna Commercial |
$121.01
|
| Rate for Payer: Aetna Medicare |
$71.18
|
| Rate for Payer: Aetna Medicare |
$410.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.80
|
| Rate for Payer: BCBS Complete |
$328.49
|
| Rate for Payer: BCBS Complete |
$56.94
|
| Rate for Payer: Cash Price |
$113.89
|
| Rate for Payer: Cash Price |
$656.98
|
| Rate for Payer: Cofinity Commercial |
$122.43
|
| Rate for Payer: Cofinity Commercial |
$574.86
|
| Rate for Payer: Cofinity Commercial |
$706.26
|
| Rate for Payer: Cofinity Commercial |
$99.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$574.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$656.98
|
| Rate for Payer: Healthscope Commercial |
$128.12
|
| Rate for Payer: Healthscope Commercial |
$739.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.05
|
| Rate for Payer: PHP Commercial |
$698.05
|
| Rate for Payer: PHP Commercial |
$121.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.80
|
| Rate for Payer: Priority Health SBD |
$517.37
|
| Rate for Payer: Priority Health SBD |
$89.69
|
|
|
ENOXAPARIN 300 MG/3 ML SUBCUTANEOUS SOLUTION (CUSTOM)
|
Facility
|
OP
|
$821.23
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
301239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$328.49 |
| Max. Negotiated Rate |
$739.11 |
| Rate for Payer: Aetna Commercial |
$698.05
|
| Rate for Payer: Aetna Commercial |
$121.01
|
| Rate for Payer: Aetna Medicare |
$71.18
|
| Rate for Payer: Aetna Medicare |
$410.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.80
|
| Rate for Payer: BCBS Complete |
$328.49
|
| Rate for Payer: BCBS Complete |
$56.94
|
| Rate for Payer: Cash Price |
$113.89
|
| Rate for Payer: Cash Price |
$656.98
|
| Rate for Payer: Cofinity Commercial |
$122.43
|
| Rate for Payer: Cofinity Commercial |
$574.86
|
| Rate for Payer: Cofinity Commercial |
$706.26
|
| Rate for Payer: Cofinity Commercial |
$99.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$574.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$656.98
|
| Rate for Payer: Healthscope Commercial |
$128.12
|
| Rate for Payer: Healthscope Commercial |
$739.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.05
|
| Rate for Payer: PHP Commercial |
$698.05
|
| Rate for Payer: PHP Commercial |
$121.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.80
|
| Rate for Payer: Priority Health SBD |
$517.37
|
| Rate for Payer: Priority Health SBD |
$89.69
|
|
|
ENOXAPARIN 300 MG/3 ML SUBCUTANEOUS SOLUTION (CUSTOM)
|
Facility
|
IP
|
$821.23
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
301239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$517.37 |
| Max. Negotiated Rate |
$739.11 |
| Rate for Payer: Aetna Commercial |
$698.05
|
| Rate for Payer: Aetna Commercial |
$121.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.80
|
| Rate for Payer: Cash Price |
$113.89
|
| Rate for Payer: Cash Price |
$656.98
|
| Rate for Payer: Cofinity Commercial |
$122.43
|
| Rate for Payer: Cofinity Commercial |
$574.86
|
| Rate for Payer: Cofinity Commercial |
$706.26
|
| Rate for Payer: Cofinity Commercial |
$99.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$574.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$656.98
|
| Rate for Payer: Healthscope Commercial |
$128.12
|
| Rate for Payer: Healthscope Commercial |
$739.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.05
|
| Rate for Payer: PHP Commercial |
$121.01
|
| Rate for Payer: PHP Commercial |
$698.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.53
|
| Rate for Payer: Priority Health SBD |
$517.37
|
| Rate for Payer: Priority Health SBD |
$89.69
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$14.84
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$13.36 |
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Aetna Commercial |
$27.45
|
| Rate for Payer: Aetna Commercial |
$15.54
|
| Rate for Payer: Aetna Medicare |
$16.14
|
| Rate for Payer: Aetna Medicare |
$7.42
|
| Rate for Payer: Aetna Medicare |
$9.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.88
|
| Rate for Payer: BCBS Complete |
$7.31
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS Complete |
$12.92
|
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cofinity Commercial |
$27.77
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$10.39
|
| Rate for Payer: Cofinity Commercial |
$15.72
|
| Rate for Payer: Cofinity Commercial |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$22.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.87
|
| Rate for Payer: Healthscope Commercial |
$16.45
|
| Rate for Payer: Healthscope Commercial |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$29.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.61
|
| Rate for Payer: PHP Commercial |
$15.54
|
| Rate for Payer: PHP Commercial |
$12.61
|
| Rate for Payer: PHP Commercial |
$27.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.88
|
| Rate for Payer: Priority Health SBD |
$20.34
|
| Rate for Payer: Priority Health SBD |
$11.52
|
| Rate for Payer: Priority Health SBD |
$9.35
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$14.84
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$13.36 |
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Aetna Commercial |
$15.54
|
| Rate for Payer: Aetna Commercial |
$27.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.99
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Cofinity Commercial |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$10.39
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$27.77
|
| Rate for Payer: Cofinity Commercial |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$15.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.83
|
| Rate for Payer: Healthscope Commercial |
$16.45
|
| Rate for Payer: Healthscope Commercial |
$29.06
|
| Rate for Payer: Healthscope Commercial |
$13.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.45
|
| Rate for Payer: PHP Commercial |
$27.45
|
| Rate for Payer: PHP Commercial |
$12.61
|
| Rate for Payer: PHP Commercial |
$15.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.88
|
| Rate for Payer: Priority Health SBD |
$20.34
|
| Rate for Payer: Priority Health SBD |
$9.35
|
| Rate for Payer: Priority Health SBD |
$11.52
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$25.37
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$22.83 |
| Rate for Payer: Aetna Commercial |
$21.56
|
| Rate for Payer: Aetna Commercial |
$14.34
|
| Rate for Payer: Aetna Commercial |
$21.07
|
| Rate for Payer: Aetna Commercial |
$21.14
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Commercial |
$17.32
|
| Rate for Payer: Aetna Commercial |
$36.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.17
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Cash Price |
$34.45
|
| Rate for Payer: Cash Price |
$16.30
|
| Rate for Payer: Cofinity Commercial |
$30.14
|
| Rate for Payer: Cofinity Commercial |
$21.82
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Commercial |
$11.81
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| Rate for Payer: Cofinity Commercial |
$14.27
|
| Rate for Payer: Cofinity Commercial |
$17.53
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$21.32
|
| Rate for Payer: Cofinity Commercial |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$21.39
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$37.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.30
|
| Rate for Payer: Healthscope Commercial |
$15.18
|
| Rate for Payer: Healthscope Commercial |
$22.38
|
| Rate for Payer: Healthscope Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$22.31
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Healthscope Commercial |
$22.83
|
| Rate for Payer: Healthscope Commercial |
$38.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.60
|
| Rate for Payer: PHP Commercial |
$21.56
|
| Rate for Payer: PHP Commercial |
$17.32
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: PHP Commercial |
$21.14
|
| Rate for Payer: PHP Commercial |
$21.07
|
| Rate for Payer: PHP Commercial |
$14.34
|
| Rate for Payer: PHP Commercial |
$36.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.97
|
| Rate for Payer: Priority Health SBD |
$15.67
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: Priority Health SBD |
$27.13
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: Priority Health SBD |
$12.84
|
| Rate for Payer: Priority Health SBD |
$15.62
|
| Rate for Payer: Priority Health SBD |
$15.98
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$15.77
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$14.19 |
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Commercial |
$14.34
|
| Rate for Payer: Aetna Commercial |
$17.32
|
| Rate for Payer: Aetna Commercial |
$21.07
|
| Rate for Payer: Aetna Commercial |
$36.60
|
| Rate for Payer: Aetna Commercial |
$21.14
|
| Rate for Payer: Aetna Commercial |
$21.56
|
| Rate for Payer: Aetna Medicare |
$12.39
|
| Rate for Payer: Aetna Medicare |
$10.19
|
| Rate for Payer: Aetna Medicare |
$21.53
|
| Rate for Payer: Aetna Medicare |
$12.44
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Aetna Medicare |
$12.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: BCBS Complete |
$10.15
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS Complete |
$8.15
|
| Rate for Payer: BCBS Complete |
$6.31
|
| Rate for Payer: BCBS Complete |
$9.95
|
| Rate for Payer: BCBS Complete |
$17.22
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$34.45
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$16.30
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cofinity Commercial |
$14.27
|
| Rate for Payer: Cofinity Commercial |
$17.53
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Commercial |
$37.03
|
| Rate for Payer: Cofinity Commercial |
$30.14
|
| Rate for Payer: Cofinity Commercial |
$21.82
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$21.32
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$21.39
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| Rate for Payer: Cofinity Commercial |
$11.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Healthscope Commercial |
$22.31
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Healthscope Commercial |
$15.18
|
| Rate for Payer: Healthscope Commercial |
$22.38
|
| Rate for Payer: Healthscope Commercial |
$22.83
|
| Rate for Payer: Healthscope Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$38.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.07
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: PHP Commercial |
$21.14
|
| Rate for Payer: PHP Commercial |
$17.32
|
| Rate for Payer: PHP Commercial |
$21.56
|
| Rate for Payer: PHP Commercial |
$36.60
|
| Rate for Payer: PHP Commercial |
$14.34
|
| Rate for Payer: PHP Commercial |
$21.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.17
|
| Rate for Payer: Priority Health SBD |
$15.98
|
| Rate for Payer: Priority Health SBD |
$12.84
|
| Rate for Payer: Priority Health SBD |
$27.13
|
| Rate for Payer: Priority Health SBD |
$15.62
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: Priority Health SBD |
$15.67
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$21.77
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$19.59 |
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna Commercial |
$22.94
|
| Rate for Payer: Aetna Commercial |
$31.60
|
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Aetna Commercial |
$54.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.54
|
| Rate for Payer: Cash Price |
$51.73
|
| Rate for Payer: Cash Price |
$21.59
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Cofinity Commercial |
$18.72
|
| Rate for Payer: Cofinity Commercial |
$55.61
|
| Rate for Payer: Cofinity Commercial |
$45.26
|
| Rate for Payer: Cofinity Commercial |
$23.21
|
| Rate for Payer: Cofinity Commercial |
$32.72
|
| Rate for Payer: Cofinity Commercial |
$26.64
|
| Rate for Payer: Cofinity Commercial |
$26.03
|
| Rate for Payer: Cofinity Commercial |
$31.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.73
|
| Rate for Payer: Healthscope Commercial |
$33.46
|
| Rate for Payer: Healthscope Commercial |
$24.29
|
| Rate for Payer: Healthscope Commercial |
$19.59
|
| Rate for Payer: Healthscope Commercial |
$34.24
|
| Rate for Payer: Healthscope Commercial |
$58.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: PHP Commercial |
$32.34
|
| Rate for Payer: PHP Commercial |
$54.96
|
| Rate for Payer: PHP Commercial |
$31.60
|
| Rate for Payer: PHP Commercial |
$22.94
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.73
|
| Rate for Payer: Priority Health SBD |
$23.97
|
| Rate for Payer: Priority Health SBD |
$17.00
|
| Rate for Payer: Priority Health SBD |
$23.42
|
| Rate for Payer: Priority Health SBD |
$13.72
|
| Rate for Payer: Priority Health SBD |
$40.74
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$38.05
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$34.24 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Aetna Commercial |
$31.60
|
| Rate for Payer: Aetna Commercial |
$54.96
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna Commercial |
$22.94
|
| Rate for Payer: Aetna Medicare |
$18.59
|
| Rate for Payer: Aetna Medicare |
$32.33
|
| Rate for Payer: Aetna Medicare |
$19.02
|
| Rate for Payer: Aetna Medicare |
$13.49
|
| Rate for Payer: Aetna Medicare |
$10.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.15
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS Complete |
$15.22
|
| Rate for Payer: BCBS Complete |
$14.87
|
| Rate for Payer: BCBS Complete |
$8.71
|
| Rate for Payer: BCBS Complete |
$25.86
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cash Price |
$51.73
|
| Rate for Payer: Cash Price |
$21.59
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$32.72
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Cofinity Commercial |
$18.72
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Cofinity Commercial |
$23.21
|
| Rate for Payer: Cofinity Commercial |
$26.03
|
| Rate for Payer: Cofinity Commercial |
$31.97
|
| Rate for Payer: Cofinity Commercial |
$26.64
|
| Rate for Payer: Cofinity Commercial |
$45.26
|
| Rate for Payer: Cofinity Commercial |
$55.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.59
|
| Rate for Payer: Healthscope Commercial |
$24.29
|
| Rate for Payer: Healthscope Commercial |
$19.59
|
| Rate for Payer: Healthscope Commercial |
$34.24
|
| Rate for Payer: Healthscope Commercial |
$58.19
|
| Rate for Payer: Healthscope Commercial |
$33.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.96
|
| Rate for Payer: PHP Commercial |
$32.34
|
| Rate for Payer: PHP Commercial |
$31.60
|
| Rate for Payer: PHP Commercial |
$22.94
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: PHP Commercial |
$54.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.17
|
| Rate for Payer: Priority Health SBD |
$40.74
|
| Rate for Payer: Priority Health SBD |
$13.72
|
| Rate for Payer: Priority Health SBD |
$17.00
|
| Rate for Payer: Priority Health SBD |
$23.97
|
| Rate for Payer: Priority Health SBD |
$23.42
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$70.74
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.57 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.13
|
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Aetna Commercial |
$73.28
|
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.04
|
| Rate for Payer: Cash Price |
$56.59
|
| Rate for Payer: Cash Price |
$40.58
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cash Price |
$68.97
|
| Rate for Payer: Cofinity Commercial |
$15.62
|
| Rate for Payer: Cofinity Commercial |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$60.35
|
| Rate for Payer: Cofinity Commercial |
$35.51
|
| Rate for Payer: Cofinity Commercial |
$43.63
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Commercial |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.97
|
| Rate for Payer: Healthscope Commercial |
$45.66
|
| Rate for Payer: Healthscope Commercial |
$20.08
|
| Rate for Payer: Healthscope Commercial |
$77.59
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: PHP Commercial |
$60.13
|
| Rate for Payer: PHP Commercial |
$43.12
|
| Rate for Payer: PHP Commercial |
$73.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.04
|
| Rate for Payer: Priority Health SBD |
$14.06
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: Priority Health SBD |
$31.96
|
| Rate for Payer: Priority Health SBD |
$54.31
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$70.74
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.30 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.13
|
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Aetna Commercial |
$73.28
|
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: Aetna Medicare |
$43.10
|
| Rate for Payer: Aetna Medicare |
$35.37
|
| Rate for Payer: Aetna Medicare |
$25.36
|
| Rate for Payer: Aetna Medicare |
$11.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.04
|
| Rate for Payer: BCBS Complete |
$8.92
|
| Rate for Payer: BCBS Complete |
$34.48
|
| Rate for Payer: BCBS Complete |
$20.29
|
| Rate for Payer: BCBS Complete |
$28.30
|
| Rate for Payer: Cash Price |
$68.97
|
| Rate for Payer: Cash Price |
$40.58
|
| Rate for Payer: Cash Price |
$56.59
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$43.63
|
| Rate for Payer: Cofinity Commercial |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.35
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Commercial |
$15.62
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$35.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.58
|
| Rate for Payer: Healthscope Commercial |
$20.08
|
| Rate for Payer: Healthscope Commercial |
$77.59
|
| Rate for Payer: Healthscope Commercial |
$45.66
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: PHP Commercial |
$43.12
|
| Rate for Payer: PHP Commercial |
$73.28
|
| Rate for Payer: PHP Commercial |
$60.13
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.04
|
| Rate for Payer: Priority Health SBD |
$14.06
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: Priority Health SBD |
$31.96
|
| Rate for Payer: Priority Health SBD |
$54.31
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$420.81
|
|
|
Service Code
|
NDC 60687018821
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$265.11 |
| Max. Negotiated Rate |
$378.73 |
| Rate for Payer: Aetna Commercial |
$357.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.53
|
| Rate for Payer: Cash Price |
$336.65
|
| Rate for Payer: Cofinity Commercial |
$294.57
|
| Rate for Payer: Cofinity Commercial |
$361.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.65
|
| Rate for Payer: Healthscope Commercial |
$378.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.69
|
| Rate for Payer: PHP Commercial |
$357.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.53
|
| Rate for Payer: Priority Health SBD |
$265.11
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
OP
|
$420.81
|
|
|
Service Code
|
NDC 60687018821
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.32 |
| Max. Negotiated Rate |
$378.73 |
| Rate for Payer: Aetna Commercial |
$357.69
|
| Rate for Payer: Aetna Medicare |
$210.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.53
|
| Rate for Payer: BCBS Complete |
$168.32
|
| Rate for Payer: Cash Price |
$336.65
|
| Rate for Payer: Cofinity Commercial |
$294.57
|
| Rate for Payer: Cofinity Commercial |
$361.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.65
|
| Rate for Payer: Healthscope Commercial |
$378.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.69
|
| Rate for Payer: PHP Commercial |
$357.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.53
|
| Rate for Payer: Priority Health SBD |
$265.11
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$14.03
|
|
|
Service Code
|
NDC 60687018811
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$12.63 |
| Rate for Payer: Aetna Commercial |
$11.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.12
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cofinity Commercial |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$9.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.22
|
| Rate for Payer: Healthscope Commercial |
$12.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.93
|
| Rate for Payer: PHP Commercial |
$11.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.12
|
| Rate for Payer: Priority Health SBD |
$8.84
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
OP
|
$252.96
|
|
|
Service Code
|
NDC 65862065401
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$227.66 |
| Rate for Payer: Aetna Commercial |
$215.02
|
| Rate for Payer: Aetna Medicare |
$126.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.42
|
| Rate for Payer: BCBS Complete |
$101.18
|
| Rate for Payer: Cash Price |
$202.37
|
| Rate for Payer: Cofinity Commercial |
$177.07
|
| Rate for Payer: Cofinity Commercial |
$217.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.37
|
| Rate for Payer: Healthscope Commercial |
$227.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.02
|
| Rate for Payer: PHP Commercial |
$215.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.42
|
| Rate for Payer: Priority Health SBD |
$159.36
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$252.96
|
|
|
Service Code
|
NDC 65862065401
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.36 |
| Max. Negotiated Rate |
$227.66 |
| Rate for Payer: Aetna Commercial |
$215.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.42
|
| Rate for Payer: Cash Price |
$202.37
|
| Rate for Payer: Cofinity Commercial |
$177.07
|
| Rate for Payer: Cofinity Commercial |
$217.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.37
|
| Rate for Payer: Healthscope Commercial |
$227.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.02
|
| Rate for Payer: PHP Commercial |
$215.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.42
|
| Rate for Payer: Priority Health SBD |
$159.36
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
OP
|
$14.03
|
|
|
Service Code
|
NDC 60687018811
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$12.63 |
| Rate for Payer: Aetna Commercial |
$11.93
|
| Rate for Payer: Aetna Medicare |
$7.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.12
|
| Rate for Payer: BCBS Complete |
$5.61
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cofinity Commercial |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$9.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.22
|
| Rate for Payer: Healthscope Commercial |
$12.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.93
|
| Rate for Payer: PHP Commercial |
$11.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.12
|
| Rate for Payer: Priority Health SBD |
$8.84
|
|
|
EPCORITAMAB-BYSP 0.16 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$2,371.17
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
301958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.93 |
| Max. Negotiated Rate |
$2,134.05 |
| Rate for Payer: Aetna Commercial |
$2,015.49
|
| Rate for Payer: Aetna Medicare |
$58.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,541.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.80
|
| Rate for Payer: BCBS Complete |
$31.43
|
| Rate for Payer: BCBS MAPPO |
$55.84
|
| Rate for Payer: BCN Medicare Advantage |
$55.84
|
| Rate for Payer: Cash Price |
$1,896.94
|
| Rate for Payer: Cash Price |
$1,896.94
|
| Rate for Payer: Cofinity Commercial |
$1,659.82
|
| Rate for Payer: Cofinity Commercial |
$2,039.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,659.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,896.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.84
|
| Rate for Payer: Healthscope Commercial |
$2,134.05
|
| Rate for Payer: Mclaren Medicaid |
$29.93
|
| Rate for Payer: Mclaren Medicare |
$55.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.63
|
| Rate for Payer: Meridian Medicaid |
$31.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,015.49
|
| Rate for Payer: PACE Medicare |
$53.05
|
| Rate for Payer: PACE SWMI |
$55.84
|
| Rate for Payer: PHP Commercial |
$2,015.49
|
| Rate for Payer: PHP Medicare Advantage |
$55.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,541.26
|
| Rate for Payer: Priority Health Medicare |
$55.84
|
| Rate for Payer: Priority Health SBD |
$1,493.84
|
| Rate for Payer: Railroad Medicare Medicare |
$55.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.84
|
| Rate for Payer: UHC Medicare Advantage |
$55.84
|
| Rate for Payer: UHCCP Medicaid |
$31.44
|
| Rate for Payer: VA VA |
$55.84
|
|
