|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$37.18
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$33.46 |
| 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 |
$32.34
|
| Rate for Payer: Aetna Commercial |
$22.94
|
| Rate for Payer: Aetna Medicare |
$19.02
|
| Rate for Payer: Aetna Medicare |
$18.59
|
| Rate for Payer: Aetna Medicare |
$10.88
|
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: Aetna Medicare |
$32.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.54
|
| 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) |
$24.17
|
| Rate for Payer: BCBS Complete |
$8.71
|
| Rate for Payer: BCBS Complete |
$25.86
|
| Rate for Payer: BCBS Complete |
$14.87
|
| Rate for Payer: BCBS Complete |
$15.22
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$1.61
|
| Rate for Payer: BCBS Trust/PPO |
$1.61
|
| Rate for Payer: BCBS Trust/PPO |
$1.61
|
| Rate for Payer: BCBS Trust/PPO |
$1.61
|
| Rate for Payer: BCBS Trust/PPO |
$1.61
|
| Rate for Payer: BCN Commercial |
$1.61
|
| Rate for Payer: BCN Commercial |
$1.61
|
| Rate for Payer: BCN Commercial |
$1.61
|
| Rate for Payer: BCN Commercial |
$1.61
|
| Rate for Payer: BCN Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Cash Price |
$51.73
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cash Price |
$21.59
|
| Rate for Payer: Cash Price |
$51.73
|
| Rate for Payer: Cash Price |
$21.59
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$55.61
|
| Rate for Payer: Cofinity Commercial |
$45.26
|
| 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 |
$32.72
|
| 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: Cofinity Medicare Advantage |
$45.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.44
|
| Rate for Payer: Healthscope Commercial |
$33.46
|
| Rate for Payer: Healthscope Commercial |
$58.19
|
| Rate for Payer: Healthscope Commercial |
$24.29
|
| Rate for Payer: Healthscope Commercial |
$34.24
|
| Rate for Payer: Healthscope Commercial |
$19.59
|
| 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 |
$22.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.34
|
| Rate for Payer: PHP Commercial |
$54.96
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: PHP Commercial |
$31.60
|
| Rate for Payer: PHP Commercial |
$22.94
|
| Rate for Payer: PHP Commercial |
$32.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.54
|
| 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 Cigna Priority Health |
$42.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.15
|
| 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
|
| Rate for Payer: Priority Health SBD |
$23.97
|
|
|
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
|
$86.21
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$77.59 |
| Rate for Payer: Aetna Commercial |
$73.28
|
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: Aetna Commercial |
$60.13
|
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Aetna Medicare |
$35.37
|
| Rate for Payer: Aetna Medicare |
$11.16
|
| Rate for Payer: Aetna Medicare |
$43.10
|
| Rate for Payer: Aetna Medicare |
$25.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.04
|
| 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: BCBS Complete |
$28.30
|
| Rate for Payer: BCBS Complete |
$34.48
|
| Rate for Payer: BCBS Complete |
$20.29
|
| Rate for Payer: BCBS Complete |
$8.92
|
| Rate for Payer: BCBS Trust/PPO |
$1.61
|
| Rate for Payer: BCBS Trust/PPO |
$1.61
|
| Rate for Payer: BCBS Trust/PPO |
$1.61
|
| Rate for Payer: BCBS Trust/PPO |
$1.61
|
| Rate for Payer: BCN Commercial |
$1.61
|
| Rate for Payer: BCN Commercial |
$1.61
|
| Rate for Payer: BCN Commercial |
$1.61
|
| Rate for Payer: BCN Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$40.58
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cash Price |
$56.59
|
| Rate for Payer: Cash Price |
$40.58
|
| Rate for Payer: Cash Price |
$56.59
|
| Rate for Payer: Cash Price |
$68.97
|
| Rate for Payer: Cash Price |
$68.97
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$35.51
|
| Rate for Payer: Cofinity Commercial |
$15.62
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$43.63
|
| Rate for Payer: Cofinity Commercial |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Commercial |
$60.35
|
| Rate for Payer: Cofinity Commercial |
$74.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.58
|
| Rate for Payer: Healthscope Commercial |
$45.66
|
| Rate for Payer: Healthscope Commercial |
$77.59
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$20.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.28
|
| Rate for Payer: PHP Commercial |
$73.28
|
| Rate for Payer: PHP Commercial |
$43.12
|
| Rate for Payer: PHP Commercial |
$60.13
|
| Rate for Payer: PHP Commercial |
$18.96
|
| 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 Cigna Priority Health |
$45.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.97
|
| Rate for Payer: Priority Health SBD |
$54.31
|
| Rate for Payer: Priority Health SBD |
$31.96
|
| Rate for Payer: Priority Health SBD |
$14.06
|
| Rate for Payer: Priority Health SBD |
$44.57
|
|
|
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
|
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
|
$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
|
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 |
$210.40
|
| 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
|
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 |
$7.02
|
| 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
|
|
|
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
|
|
|
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 |
$29.58 |
| Max. Negotiated Rate |
$2,134.05 |
| Rate for Payer: Aetna Commercial |
$2,015.49
|
| Rate for Payer: Aetna Medicare |
$57.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,541.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.99
|
| Rate for Payer: BCBS Complete |
$31.06
|
| Rate for Payer: BCBS MAPPO |
$55.19
|
| Rate for Payer: BCBS Trust/PPO |
$155.87
|
| Rate for Payer: BCN Commercial |
$155.87
|
| Rate for Payer: BCN Medicare Advantage |
$55.19
|
| 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 |
$55.19
|
| Rate for Payer: Healthscope Commercial |
$2,134.05
|
| Rate for Payer: Mclaren Medicaid |
$29.58
|
| Rate for Payer: Mclaren Medicare |
$55.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.95
|
| Rate for Payer: Meridian Medicaid |
$31.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,015.49
|
| Rate for Payer: Nomi Health Commercial |
$165.57
|
| Rate for Payer: PACE Medicare |
$52.43
|
| Rate for Payer: PACE SWMI |
$55.19
|
| Rate for Payer: PHP Commercial |
$2,015.49
|
| Rate for Payer: PHP Medicare Advantage |
$55.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,541.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.90
|
| Rate for Payer: Priority Health Medicare |
$55.19
|
| Rate for Payer: Priority Health Narrow Network |
$124.72
|
| Rate for Payer: Priority Health SBD |
$1,493.84
|
| Rate for Payer: Railroad Medicare Medicare |
$55.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.19
|
| Rate for Payer: UHC Medicare Advantage |
$55.19
|
| Rate for Payer: UHCCP Medicaid |
$31.07
|
| Rate for Payer: VA VA |
$55.19
|
|
|
EPCORITAMAB-BYSP 0.8 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$5,927.03
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
301960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$5,334.33 |
| Rate for Payer: Aetna Commercial |
$5,037.98
|
| Rate for Payer: Aetna Medicare |
$57.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,852.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.99
|
| Rate for Payer: BCBS Complete |
$31.06
|
| Rate for Payer: BCBS MAPPO |
$55.19
|
| Rate for Payer: BCBS Trust/PPO |
$155.87
|
| Rate for Payer: BCN Commercial |
$155.87
|
| Rate for Payer: BCN Medicare Advantage |
$55.19
|
| Rate for Payer: Cash Price |
$4,741.62
|
| Rate for Payer: Cash Price |
$4,741.62
|
| Rate for Payer: Cofinity Commercial |
$5,097.25
|
| Rate for Payer: Cofinity Commercial |
$4,148.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,148.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,741.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.19
|
| Rate for Payer: Healthscope Commercial |
$5,334.33
|
| Rate for Payer: Mclaren Medicaid |
$29.58
|
| Rate for Payer: Mclaren Medicare |
$55.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.95
|
| Rate for Payer: Meridian Medicaid |
$31.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,037.98
|
| Rate for Payer: Nomi Health Commercial |
$165.57
|
| Rate for Payer: PACE Medicare |
$52.43
|
| Rate for Payer: PACE SWMI |
$55.19
|
| Rate for Payer: PHP Commercial |
$5,037.98
|
| Rate for Payer: PHP Medicare Advantage |
$55.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,852.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.90
|
| Rate for Payer: Priority Health Medicare |
$55.19
|
| Rate for Payer: Priority Health Narrow Network |
$124.72
|
| Rate for Payer: Priority Health SBD |
$3,734.03
|
| Rate for Payer: Railroad Medicare Medicare |
$55.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.19
|
| Rate for Payer: UHC Medicare Advantage |
$55.19
|
| Rate for Payer: UHCCP Medicaid |
$31.07
|
| Rate for Payer: VA VA |
$55.19
|
|
|
EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$71,123.22
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
204020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$64,010.90 |
| Rate for Payer: Aetna Commercial |
$60,454.74
|
| Rate for Payer: Aetna Medicare |
$57.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46,230.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.99
|
| Rate for Payer: BCBS Complete |
$31.06
|
| Rate for Payer: BCBS MAPPO |
$55.19
|
| Rate for Payer: BCBS Trust/PPO |
$155.87
|
| Rate for Payer: BCN Commercial |
$155.87
|
| Rate for Payer: BCN Medicare Advantage |
$55.19
|
| Rate for Payer: Cash Price |
$56,898.58
|
| Rate for Payer: Cash Price |
$56,898.58
|
| Rate for Payer: Cofinity Commercial |
$61,165.97
|
| Rate for Payer: Cofinity Commercial |
$49,786.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$49,786.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56,898.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.19
|
| Rate for Payer: Healthscope Commercial |
$64,010.90
|
| Rate for Payer: Mclaren Medicaid |
$29.58
|
| Rate for Payer: Mclaren Medicare |
$55.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.95
|
| Rate for Payer: Meridian Medicaid |
$31.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60,454.74
|
| Rate for Payer: Nomi Health Commercial |
$165.57
|
| Rate for Payer: PACE Medicare |
$52.43
|
| Rate for Payer: PACE SWMI |
$55.19
|
| Rate for Payer: PHP Commercial |
$60,454.74
|
| Rate for Payer: PHP Medicare Advantage |
$55.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46,230.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.90
|
| Rate for Payer: Priority Health Medicare |
$55.19
|
| Rate for Payer: Priority Health Narrow Network |
$124.72
|
| Rate for Payer: Priority Health SBD |
$44,807.63
|
| Rate for Payer: Railroad Medicare Medicare |
$55.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.19
|
| Rate for Payer: UHC Medicare Advantage |
$55.19
|
| Rate for Payer: UHCCP Medicaid |
$31.07
|
| Rate for Payer: VA VA |
$55.19
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$48.64
|
|
|
Service Code
|
NDC 51754425001
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.64 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.62
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$34.05
|
| Rate for Payer: Cofinity Commercial |
$41.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.62
|
| Rate for Payer: Priority Health SBD |
$30.64
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$48.64
|
|
|
Service Code
|
NDC 51754425003
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.46 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna Medicare |
$24.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.62
|
| Rate for Payer: BCBS Complete |
$19.46
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$34.05
|
| Rate for Payer: Cofinity Commercial |
$41.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.62
|
| Rate for Payer: Priority Health SBD |
$30.64
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$48.64
|
|
|
Service Code
|
NDC 51754425001
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.46 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna Medicare |
$24.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.62
|
| Rate for Payer: BCBS Complete |
$19.46
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$34.05
|
| Rate for Payer: Cofinity Commercial |
$41.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.62
|
| Rate for Payer: Priority Health SBD |
$30.64
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$48.64
|
|
|
Service Code
|
NDC 51754425003
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.64 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.62
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$34.05
|
| Rate for Payer: Cofinity Commercial |
$41.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.62
|
| Rate for Payer: Priority Health SBD |
$30.64
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$31.11
|
|
|
Service Code
|
NDC 70121163701
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.22
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cofinity Commercial |
$21.78
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.22
|
| Rate for Payer: Priority Health SBD |
$19.60
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$28.97
|
|
|
Service Code
|
NDC 65219025700
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$26.07 |
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna Medicare |
$14.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.83
|
| Rate for Payer: BCBS Complete |
$11.59
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$24.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$26.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.62
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.83
|
| Rate for Payer: Priority Health SBD |
$18.25
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$18.07
|
|
|
Service Code
|
NDC 55150037325
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$16.26 |
| Rate for Payer: Aetna Commercial |
$15.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.75
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$12.65
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$16.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.36
|
| Rate for Payer: PHP Commercial |
$15.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health SBD |
$11.38
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$28.97
|
|
|
Service Code
|
NDC 65219025701
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$26.07 |
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.83
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$24.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$26.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.62
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.83
|
| Rate for Payer: Priority Health SBD |
$18.25
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$28.97
|
|
|
Service Code
|
NDC 65219025701
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$26.07 |
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna Medicare |
$14.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.83
|
| Rate for Payer: BCBS Complete |
$11.59
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$24.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$26.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.62
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.83
|
| Rate for Payer: Priority Health SBD |
$18.25
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 00641623801
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: Priority Health SBD |
$15.65
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 00641623825
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: Priority Health SBD |
$15.65
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$31.11
|
|
|
Service Code
|
NDC 70121163701
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna Medicare |
$15.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.22
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cofinity Commercial |
$21.78
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.22
|
| Rate for Payer: Priority Health SBD |
$19.60
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$24.84
|
|
|
Service Code
|
NDC 00641623801
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna Medicare |
$12.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: BCBS Complete |
$9.94
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: Priority Health SBD |
$15.65
|
|
