|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$499.51
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$314.69 |
| Max. Negotiated Rate |
$449.56 |
| Rate for Payer: Aetna Commercial |
$424.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.68
|
| Rate for Payer: Cash Price |
$399.61
|
| Rate for Payer: Cofinity Commercial |
$349.66
|
| Rate for Payer: Cofinity Commercial |
$429.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.61
|
| Rate for Payer: Healthscope Commercial |
$449.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.58
|
| Rate for Payer: PHP Commercial |
$424.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.68
|
| Rate for Payer: Priority Health SBD |
$314.69
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$499.51
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$449.56 |
| Rate for Payer: Aetna Commercial |
$424.58
|
| Rate for Payer: Aetna Medicare |
$8.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.68
|
| Rate for Payer: BCBS Complete |
$4.81
|
| Rate for Payer: BCBS MAPPO |
$8.54
|
| Rate for Payer: BCN Medicare Advantage |
$8.54
|
| Rate for Payer: Cash Price |
$399.61
|
| Rate for Payer: Cash Price |
$399.61
|
| Rate for Payer: Cofinity Commercial |
$429.58
|
| Rate for Payer: Cofinity Commercial |
$349.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$449.56
|
| Rate for Payer: Mclaren Medicaid |
$4.58
|
| Rate for Payer: Mclaren Medicare |
$8.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.97
|
| Rate for Payer: Meridian Medicaid |
$4.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.58
|
| Rate for Payer: PACE Medicare |
$8.11
|
| Rate for Payer: PACE SWMI |
$8.54
|
| Rate for Payer: PHP Commercial |
$424.58
|
| Rate for Payer: PHP Medicare Advantage |
$8.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.68
|
| Rate for Payer: Priority Health Medicare |
$8.54
|
| Rate for Payer: Priority Health SBD |
$314.69
|
| Rate for Payer: Railroad Medicare Medicare |
$8.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.54
|
| Rate for Payer: UHC Medicare Advantage |
$8.54
|
| Rate for Payer: UHCCP Medicaid |
$4.81
|
| Rate for Payer: VA VA |
$8.54
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,634.30
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
115705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$1,470.87 |
| Rate for Payer: Aetna Commercial |
$1,389.15
|
| Rate for Payer: Aetna Medicare |
$8.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,062.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.68
|
| Rate for Payer: BCBS Complete |
$4.81
|
| Rate for Payer: BCBS MAPPO |
$8.54
|
| Rate for Payer: BCN Medicare Advantage |
$8.54
|
| Rate for Payer: Cash Price |
$1,307.44
|
| Rate for Payer: Cash Price |
$1,307.44
|
| Rate for Payer: Cofinity Commercial |
$1,144.01
|
| Rate for Payer: Cofinity Commercial |
$1,405.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,144.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,307.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$1,470.87
|
| Rate for Payer: Mclaren Medicaid |
$4.58
|
| Rate for Payer: Mclaren Medicare |
$8.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.97
|
| Rate for Payer: Meridian Medicaid |
$4.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,389.15
|
| Rate for Payer: PACE Medicare |
$8.11
|
| Rate for Payer: PACE SWMI |
$8.54
|
| Rate for Payer: PHP Commercial |
$1,389.15
|
| Rate for Payer: PHP Medicare Advantage |
$8.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,062.30
|
| Rate for Payer: Priority Health Medicare |
$8.54
|
| Rate for Payer: Priority Health SBD |
$1,029.61
|
| Rate for Payer: Railroad Medicare Medicare |
$8.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.54
|
| Rate for Payer: UHC Medicare Advantage |
$8.54
|
| Rate for Payer: UHCCP Medicaid |
$4.81
|
| Rate for Payer: VA VA |
$8.54
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,634.30
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
115705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,029.61 |
| Max. Negotiated Rate |
$1,470.87 |
| Rate for Payer: Aetna Commercial |
$1,389.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,062.30
|
| Rate for Payer: Cash Price |
$1,307.44
|
| Rate for Payer: Cofinity Commercial |
$1,144.01
|
| Rate for Payer: Cofinity Commercial |
$1,405.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,144.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,307.44
|
| Rate for Payer: Healthscope Commercial |
$1,470.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,389.15
|
| Rate for Payer: PHP Commercial |
$1,389.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,062.30
|
| Rate for Payer: Priority Health SBD |
$1,029.61
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$999.03
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
14643
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$899.13 |
| Rate for Payer: Aetna Commercial |
$849.18
|
| Rate for Payer: Aetna Medicare |
$8.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$649.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.68
|
| Rate for Payer: BCBS Complete |
$4.81
|
| Rate for Payer: BCBS MAPPO |
$8.54
|
| Rate for Payer: BCN Medicare Advantage |
$8.54
|
| Rate for Payer: Cash Price |
$799.22
|
| Rate for Payer: Cash Price |
$799.22
|
| Rate for Payer: Cofinity Commercial |
$699.32
|
| Rate for Payer: Cofinity Commercial |
$859.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$699.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$799.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$899.13
|
| Rate for Payer: Mclaren Medicaid |
$4.58
|
| Rate for Payer: Mclaren Medicare |
$8.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.97
|
| Rate for Payer: Meridian Medicaid |
$4.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$849.18
|
| Rate for Payer: PACE Medicare |
$8.11
|
| Rate for Payer: PACE SWMI |
$8.54
|
| Rate for Payer: PHP Commercial |
$849.18
|
| Rate for Payer: PHP Medicare Advantage |
$8.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.37
|
| Rate for Payer: Priority Health Medicare |
$8.54
|
| Rate for Payer: Priority Health SBD |
$629.39
|
| Rate for Payer: Railroad Medicare Medicare |
$8.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.54
|
| Rate for Payer: UHC Medicare Advantage |
$8.54
|
| Rate for Payer: UHCCP Medicaid |
$4.81
|
| Rate for Payer: VA VA |
$8.54
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$999.03
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
14643
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$629.39 |
| Max. Negotiated Rate |
$899.13 |
| Rate for Payer: Aetna Commercial |
$849.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$649.37
|
| Rate for Payer: Cash Price |
$799.22
|
| Rate for Payer: Cofinity Commercial |
$699.32
|
| Rate for Payer: Cofinity Commercial |
$859.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$699.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$799.22
|
| Rate for Payer: Healthscope Commercial |
$899.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$849.18
|
| Rate for Payer: PHP Commercial |
$849.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.37
|
| Rate for Payer: Priority Health SBD |
$629.39
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$181.34
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$163.21 |
| Rate for Payer: Aetna Commercial |
$154.14
|
| Rate for Payer: Aetna Medicare |
$8.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.68
|
| Rate for Payer: BCBS Complete |
$4.81
|
| Rate for Payer: BCBS MAPPO |
$8.54
|
| Rate for Payer: BCN Medicare Advantage |
$8.54
|
| Rate for Payer: Cash Price |
$145.07
|
| Rate for Payer: Cash Price |
$145.07
|
| Rate for Payer: Cofinity Commercial |
$155.95
|
| Rate for Payer: Cofinity Commercial |
$126.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$163.21
|
| Rate for Payer: Mclaren Medicaid |
$4.58
|
| Rate for Payer: Mclaren Medicare |
$8.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.97
|
| Rate for Payer: Meridian Medicaid |
$4.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.14
|
| Rate for Payer: PACE Medicare |
$8.11
|
| Rate for Payer: PACE SWMI |
$8.54
|
| Rate for Payer: PHP Commercial |
$154.14
|
| Rate for Payer: PHP Medicare Advantage |
$8.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.87
|
| Rate for Payer: Priority Health Medicare |
$8.54
|
| Rate for Payer: Priority Health SBD |
$114.24
|
| Rate for Payer: Railroad Medicare Medicare |
$8.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.54
|
| Rate for Payer: UHC Medicare Advantage |
$8.54
|
| Rate for Payer: UHCCP Medicaid |
$4.81
|
| Rate for Payer: VA VA |
$8.54
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$181.34
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.24 |
| Max. Negotiated Rate |
$163.21 |
| Rate for Payer: Aetna Commercial |
$154.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.87
|
| Rate for Payer: Cash Price |
$145.07
|
| Rate for Payer: Cofinity Commercial |
$126.94
|
| Rate for Payer: Cofinity Commercial |
$155.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.07
|
| Rate for Payer: Healthscope Commercial |
$163.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.14
|
| Rate for Payer: PHP Commercial |
$154.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.87
|
| Rate for Payer: Priority Health SBD |
$114.24
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,801.05
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
24513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$1,620.94 |
| Rate for Payer: Aetna Commercial |
$1,530.89
|
| Rate for Payer: Aetna Medicare |
$8.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.68
|
| Rate for Payer: BCBS Complete |
$4.81
|
| Rate for Payer: BCBS MAPPO |
$8.54
|
| Rate for Payer: BCN Medicare Advantage |
$8.54
|
| Rate for Payer: Cash Price |
$1,440.84
|
| Rate for Payer: Cash Price |
$1,440.84
|
| Rate for Payer: Cofinity Commercial |
$1,548.90
|
| Rate for Payer: Cofinity Commercial |
$1,260.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,260.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,440.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$1,620.94
|
| Rate for Payer: Mclaren Medicaid |
$4.58
|
| Rate for Payer: Mclaren Medicare |
$8.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.97
|
| Rate for Payer: Meridian Medicaid |
$4.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,530.89
|
| Rate for Payer: PACE Medicare |
$8.11
|
| Rate for Payer: PACE SWMI |
$8.54
|
| Rate for Payer: PHP Commercial |
$1,530.89
|
| Rate for Payer: PHP Medicare Advantage |
$8.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,170.68
|
| Rate for Payer: Priority Health Medicare |
$8.54
|
| Rate for Payer: Priority Health SBD |
$1,134.66
|
| Rate for Payer: Railroad Medicare Medicare |
$8.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.54
|
| Rate for Payer: UHC Medicare Advantage |
$8.54
|
| Rate for Payer: UHCCP Medicaid |
$4.81
|
| Rate for Payer: VA VA |
$8.54
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,801.05
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
24513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,134.66 |
| Max. Negotiated Rate |
$1,620.94 |
| Rate for Payer: Aetna Commercial |
$1,530.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.68
|
| Rate for Payer: Cash Price |
$1,440.84
|
| Rate for Payer: Cofinity Commercial |
$1,260.73
|
| Rate for Payer: Cofinity Commercial |
$1,548.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,260.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,440.84
|
| Rate for Payer: Healthscope Commercial |
$1,620.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,530.89
|
| Rate for Payer: PHP Commercial |
$1,530.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,170.68
|
| Rate for Payer: Priority Health SBD |
$1,134.66
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$362.61
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$326.35 |
| Rate for Payer: Aetna Commercial |
$308.22
|
| Rate for Payer: Aetna Medicare |
$8.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.68
|
| Rate for Payer: BCBS Complete |
$4.81
|
| Rate for Payer: BCBS MAPPO |
$8.54
|
| Rate for Payer: BCN Medicare Advantage |
$8.54
|
| Rate for Payer: Cash Price |
$290.09
|
| Rate for Payer: Cash Price |
$290.09
|
| Rate for Payer: Cofinity Commercial |
$311.84
|
| Rate for Payer: Cofinity Commercial |
$253.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$253.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$326.35
|
| Rate for Payer: Mclaren Medicaid |
$4.58
|
| Rate for Payer: Mclaren Medicare |
$8.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.97
|
| Rate for Payer: Meridian Medicaid |
$4.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.22
|
| Rate for Payer: PACE Medicare |
$8.11
|
| Rate for Payer: PACE SWMI |
$8.54
|
| Rate for Payer: PHP Commercial |
$308.22
|
| Rate for Payer: PHP Medicare Advantage |
$8.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.70
|
| Rate for Payer: Priority Health Medicare |
$8.54
|
| Rate for Payer: Priority Health SBD |
$228.44
|
| Rate for Payer: Railroad Medicare Medicare |
$8.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.54
|
| Rate for Payer: UHC Medicare Advantage |
$8.54
|
| Rate for Payer: UHCCP Medicaid |
$4.81
|
| Rate for Payer: VA VA |
$8.54
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$362.61
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$228.44 |
| Max. Negotiated Rate |
$326.35 |
| Rate for Payer: Aetna Commercial |
$308.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.70
|
| Rate for Payer: Cash Price |
$290.09
|
| Rate for Payer: Cofinity Commercial |
$253.83
|
| Rate for Payer: Cofinity Commercial |
$311.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$253.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.09
|
| Rate for Payer: Healthscope Commercial |
$326.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.22
|
| Rate for Payer: PHP Commercial |
$308.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.70
|
| Rate for Payer: Priority Health SBD |
$228.44
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$309.24
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$194.82 |
| Max. Negotiated Rate |
$278.32 |
| Rate for Payer: Aetna Commercial |
$262.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.01
|
| Rate for Payer: Cash Price |
$247.39
|
| Rate for Payer: Cofinity Commercial |
$216.47
|
| Rate for Payer: Cofinity Commercial |
$265.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.39
|
| Rate for Payer: Healthscope Commercial |
$278.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.85
|
| Rate for Payer: PHP Commercial |
$262.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.01
|
| Rate for Payer: Priority Health SBD |
$194.82
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$309.24
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$278.32 |
| Rate for Payer: Aetna Commercial |
$262.85
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.81
|
| Rate for Payer: BCBS Complete |
$4.42
|
| Rate for Payer: BCBS MAPPO |
$7.85
|
| Rate for Payer: BCN Medicare Advantage |
$7.85
|
| Rate for Payer: Cash Price |
$247.39
|
| Rate for Payer: Cash Price |
$247.39
|
| Rate for Payer: Cofinity Commercial |
$265.95
|
| Rate for Payer: Cofinity Commercial |
$216.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.85
|
| Rate for Payer: Healthscope Commercial |
$278.32
|
| Rate for Payer: Mclaren Medicaid |
$4.21
|
| Rate for Payer: Mclaren Medicare |
$7.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.24
|
| Rate for Payer: Meridian Medicaid |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.85
|
| Rate for Payer: PACE Medicare |
$7.46
|
| Rate for Payer: PACE SWMI |
$7.85
|
| Rate for Payer: PHP Commercial |
$262.85
|
| Rate for Payer: PHP Medicare Advantage |
$7.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.01
|
| Rate for Payer: Priority Health Medicare |
$7.85
|
| Rate for Payer: Priority Health SBD |
$194.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.85
|
| Rate for Payer: UHC Medicare Advantage |
$7.85
|
| Rate for Payer: UHCCP Medicaid |
$4.42
|
| Rate for Payer: VA VA |
$7.85
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$618.48
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
195677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$556.63 |
| Rate for Payer: Aetna Commercial |
$525.71
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.81
|
| Rate for Payer: BCBS Complete |
$4.42
|
| Rate for Payer: BCBS MAPPO |
$7.85
|
| Rate for Payer: BCN Medicare Advantage |
$7.85
|
| Rate for Payer: Cash Price |
$494.78
|
| Rate for Payer: Cash Price |
$494.78
|
| Rate for Payer: Cofinity Commercial |
$531.89
|
| Rate for Payer: Cofinity Commercial |
$432.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.85
|
| Rate for Payer: Healthscope Commercial |
$556.63
|
| Rate for Payer: Mclaren Medicaid |
$4.21
|
| Rate for Payer: Mclaren Medicare |
$7.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.24
|
| Rate for Payer: Meridian Medicaid |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.71
|
| Rate for Payer: PACE Medicare |
$7.46
|
| Rate for Payer: PACE SWMI |
$7.85
|
| Rate for Payer: PHP Commercial |
$525.71
|
| Rate for Payer: PHP Medicare Advantage |
$7.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.01
|
| Rate for Payer: Priority Health Medicare |
$7.85
|
| Rate for Payer: Priority Health SBD |
$389.64
|
| Rate for Payer: Railroad Medicare Medicare |
$7.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.85
|
| Rate for Payer: UHC Medicare Advantage |
$7.85
|
| Rate for Payer: UHCCP Medicaid |
$4.42
|
| Rate for Payer: VA VA |
$7.85
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$618.48
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
195677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$389.64 |
| Max. Negotiated Rate |
$556.63 |
| Rate for Payer: Aetna Commercial |
$525.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.01
|
| Rate for Payer: Cash Price |
$494.78
|
| Rate for Payer: Cofinity Commercial |
$432.94
|
| Rate for Payer: Cofinity Commercial |
$531.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.78
|
| Rate for Payer: Healthscope Commercial |
$556.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.71
|
| Rate for Payer: PHP Commercial |
$525.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.01
|
| Rate for Payer: Priority Health SBD |
$389.64
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$77.53
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.84 |
| Max. Negotiated Rate |
$69.78 |
| Rate for Payer: Aetna Commercial |
$65.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.39
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$54.27
|
| Rate for Payer: Cofinity Commercial |
$66.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.02
|
| Rate for Payer: Healthscope Commercial |
$69.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.90
|
| Rate for Payer: PHP Commercial |
$65.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.39
|
| Rate for Payer: Priority Health SBD |
$48.84
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$77.53
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$69.78 |
| Rate for Payer: Aetna Commercial |
$65.90
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.81
|
| Rate for Payer: BCBS Complete |
$4.42
|
| Rate for Payer: BCBS MAPPO |
$7.85
|
| Rate for Payer: BCN Medicare Advantage |
$7.85
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$66.68
|
| Rate for Payer: Cofinity Commercial |
$54.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.85
|
| Rate for Payer: Healthscope Commercial |
$69.78
|
| Rate for Payer: Mclaren Medicaid |
$4.21
|
| Rate for Payer: Mclaren Medicare |
$7.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.24
|
| Rate for Payer: Meridian Medicaid |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.90
|
| Rate for Payer: PACE Medicare |
$7.46
|
| Rate for Payer: PACE SWMI |
$7.85
|
| Rate for Payer: PHP Commercial |
$65.90
|
| Rate for Payer: PHP Medicare Advantage |
$7.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.39
|
| Rate for Payer: Priority Health Medicare |
$7.85
|
| Rate for Payer: Priority Health SBD |
$48.84
|
| Rate for Payer: Railroad Medicare Medicare |
$7.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.85
|
| Rate for Payer: UHC Medicare Advantage |
$7.85
|
| Rate for Payer: UHCCP Medicaid |
$4.42
|
| Rate for Payer: VA VA |
$7.85
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,115.01
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$702.46 |
| Max. Negotiated Rate |
$1,003.51 |
| Rate for Payer: Aetna Commercial |
$947.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.76
|
| Rate for Payer: Cash Price |
$892.01
|
| Rate for Payer: Cofinity Commercial |
$780.51
|
| Rate for Payer: Cofinity Commercial |
$958.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$780.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$892.01
|
| Rate for Payer: Healthscope Commercial |
$1,003.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.76
|
| Rate for Payer: PHP Commercial |
$947.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.76
|
| Rate for Payer: Priority Health SBD |
$702.46
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,115.01
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$1,003.51 |
| Rate for Payer: Aetna Commercial |
$947.76
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.81
|
| Rate for Payer: BCBS Complete |
$4.42
|
| Rate for Payer: BCBS MAPPO |
$7.85
|
| Rate for Payer: BCN Medicare Advantage |
$7.85
|
| Rate for Payer: Cash Price |
$892.01
|
| Rate for Payer: Cash Price |
$892.01
|
| Rate for Payer: Cofinity Commercial |
$958.91
|
| Rate for Payer: Cofinity Commercial |
$780.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$780.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$892.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.85
|
| Rate for Payer: Healthscope Commercial |
$1,003.51
|
| Rate for Payer: Mclaren Medicaid |
$4.21
|
| Rate for Payer: Mclaren Medicare |
$7.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.24
|
| Rate for Payer: Meridian Medicaid |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.76
|
| Rate for Payer: PACE Medicare |
$7.46
|
| Rate for Payer: PACE SWMI |
$7.85
|
| Rate for Payer: PHP Commercial |
$947.76
|
| Rate for Payer: PHP Medicare Advantage |
$7.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.76
|
| Rate for Payer: Priority Health Medicare |
$7.85
|
| Rate for Payer: Priority Health SBD |
$702.46
|
| Rate for Payer: Railroad Medicare Medicare |
$7.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.85
|
| Rate for Payer: UHC Medicare Advantage |
$7.85
|
| Rate for Payer: UHCCP Medicaid |
$4.42
|
| Rate for Payer: VA VA |
$7.85
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$155.06
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.69 |
| Max. Negotiated Rate |
$139.55 |
| Rate for Payer: Aetna Commercial |
$131.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.79
|
| Rate for Payer: Cash Price |
$124.05
|
| Rate for Payer: Cofinity Commercial |
$108.54
|
| Rate for Payer: Cofinity Commercial |
$133.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.05
|
| Rate for Payer: Healthscope Commercial |
$139.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.80
|
| Rate for Payer: PHP Commercial |
$131.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.79
|
| Rate for Payer: Priority Health SBD |
$97.69
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$155.06
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$139.55 |
| Rate for Payer: Aetna Commercial |
$131.80
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.81
|
| Rate for Payer: BCBS Complete |
$4.42
|
| Rate for Payer: BCBS MAPPO |
$7.85
|
| Rate for Payer: BCN Medicare Advantage |
$7.85
|
| Rate for Payer: Cash Price |
$124.05
|
| Rate for Payer: Cash Price |
$124.05
|
| Rate for Payer: Cofinity Commercial |
$133.35
|
| Rate for Payer: Cofinity Commercial |
$108.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.85
|
| Rate for Payer: Healthscope Commercial |
$139.55
|
| Rate for Payer: Mclaren Medicaid |
$4.21
|
| Rate for Payer: Mclaren Medicare |
$7.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.24
|
| Rate for Payer: Meridian Medicaid |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.80
|
| Rate for Payer: PACE Medicare |
$7.46
|
| Rate for Payer: PACE SWMI |
$7.85
|
| Rate for Payer: PHP Commercial |
$131.80
|
| Rate for Payer: PHP Medicare Advantage |
$7.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.79
|
| Rate for Payer: Priority Health Medicare |
$7.85
|
| Rate for Payer: Priority Health SBD |
$97.69
|
| Rate for Payer: Railroad Medicare Medicare |
$7.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.85
|
| Rate for Payer: UHC Medicare Advantage |
$7.85
|
| Rate for Payer: UHCCP Medicaid |
$4.42
|
| Rate for Payer: VA VA |
$7.85
|
|
|
EPOPROSTENOL 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$130.85
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
162203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.44 |
| Max. Negotiated Rate |
$117.77 |
| Rate for Payer: Aetna Commercial |
$111.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.05
|
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Cofinity Commercial |
$112.53
|
| Rate for Payer: Cofinity Commercial |
$91.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.68
|
| Rate for Payer: Healthscope Commercial |
$117.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.22
|
| Rate for Payer: PHP Commercial |
$111.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.05
|
| Rate for Payer: Priority Health SBD |
$82.44
|
|
|
EPOPROSTENOL 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$130.85
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
162203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.34 |
| Max. Negotiated Rate |
$117.77 |
| Rate for Payer: Aetna Commercial |
$111.22
|
| Rate for Payer: Aetna Medicare |
$65.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.05
|
| Rate for Payer: BCBS Complete |
$52.34
|
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Cofinity Commercial |
$112.53
|
| Rate for Payer: Cofinity Commercial |
$91.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.68
|
| Rate for Payer: Healthscope Commercial |
$117.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.22
|
| Rate for Payer: PHP Commercial |
$111.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.05
|
| Rate for Payer: Priority Health SBD |
$82.44
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$200.22
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
155384
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.14 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Aetna Commercial |
$170.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.14
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cofinity Commercial |
$172.19
|
| Rate for Payer: Cofinity Commercial |
$140.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.18
|
| Rate for Payer: Healthscope Commercial |
$180.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.19
|
| Rate for Payer: PHP Commercial |
$170.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.14
|
| Rate for Payer: Priority Health SBD |
$126.14
|
|
