|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$200.22
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
155384
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.09 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Aetna Commercial |
$170.19
|
| Rate for Payer: Aetna Medicare |
$100.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.14
|
| Rate for Payer: BCBS Complete |
$80.09
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cofinity Commercial |
$140.15
|
| Rate for Payer: Cofinity Commercial |
$172.19
|
| 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
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$271.91
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.76 |
| Max. Negotiated Rate |
$244.72 |
| Rate for Payer: Aetna Commercial |
$231.12
|
| Rate for Payer: Aetna Commercial |
$913.50
|
| Rate for Payer: Aetna Medicare |
$537.35
|
| Rate for Payer: Aetna Medicare |
$135.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$698.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.74
|
| Rate for Payer: BCBS Complete |
$429.88
|
| Rate for Payer: BCBS Complete |
$108.76
|
| Rate for Payer: Cash Price |
$217.53
|
| Rate for Payer: Cash Price |
$859.76
|
| Rate for Payer: Cofinity Commercial |
$924.24
|
| Rate for Payer: Cofinity Commercial |
$233.84
|
| Rate for Payer: Cofinity Commercial |
$190.34
|
| Rate for Payer: Cofinity Commercial |
$752.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$752.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$859.76
|
| Rate for Payer: Healthscope Commercial |
$244.72
|
| Rate for Payer: Healthscope Commercial |
$967.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$913.50
|
| Rate for Payer: PHP Commercial |
$231.12
|
| Rate for Payer: PHP Commercial |
$913.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$698.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.74
|
| Rate for Payer: Priority Health SBD |
$171.30
|
| Rate for Payer: Priority Health SBD |
$677.06
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,074.70
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$677.06 |
| Max. Negotiated Rate |
$967.23 |
| Rate for Payer: Aetna Commercial |
$913.50
|
| Rate for Payer: Aetna Commercial |
$231.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$698.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.74
|
| Rate for Payer: Cash Price |
$859.76
|
| Rate for Payer: Cash Price |
$217.53
|
| Rate for Payer: Cofinity Commercial |
$752.29
|
| Rate for Payer: Cofinity Commercial |
$190.34
|
| Rate for Payer: Cofinity Commercial |
$233.84
|
| Rate for Payer: Cofinity Commercial |
$924.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$752.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$859.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.53
|
| Rate for Payer: Healthscope Commercial |
$967.23
|
| Rate for Payer: Healthscope Commercial |
$244.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$913.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.12
|
| Rate for Payer: PHP Commercial |
$913.50
|
| Rate for Payer: PHP Commercial |
$231.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$698.55
|
| Rate for Payer: Priority Health SBD |
$171.30
|
| Rate for Payer: Priority Health SBD |
$677.06
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.19 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$73.12
|
| Rate for Payer: Aetna Commercial |
$68.28
|
| Rate for Payer: Aetna Commercial |
$70.32
|
| Rate for Payer: Aetna Commercial |
$252.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.21
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cash Price |
$237.71
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$73.98
|
| Rate for Payer: Cofinity Commercial |
$255.54
|
| Rate for Payer: Cofinity Commercial |
$56.23
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$57.91
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Cofinity Commercial |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$60.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.71
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Commercial |
$72.30
|
| Rate for Payer: Healthscope Commercial |
$267.43
|
| Rate for Payer: Healthscope Commercial |
$77.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.32
|
| Rate for Payer: PHP Commercial |
$252.57
|
| Rate for Payer: PHP Commercial |
$68.28
|
| Rate for Payer: PHP Commercial |
$73.12
|
| Rate for Payer: PHP Commercial |
$70.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health SBD |
$50.61
|
| Rate for Payer: Priority Health SBD |
$187.20
|
| Rate for Payer: Priority Health SBD |
$52.12
|
| Rate for Payer: Priority Health SBD |
$54.19
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$82.73
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.09 |
| Max. Negotiated Rate |
$74.46 |
| Rate for Payer: Aetna Commercial |
$70.32
|
| Rate for Payer: Aetna Commercial |
$68.28
|
| Rate for Payer: Aetna Commercial |
$73.12
|
| Rate for Payer: Aetna Commercial |
$252.57
|
| Rate for Payer: Aetna Medicare |
$43.01
|
| Rate for Payer: Aetna Medicare |
$41.37
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: Aetna Medicare |
$148.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.91
|
| Rate for Payer: BCBS Complete |
$118.86
|
| Rate for Payer: BCBS Complete |
$34.41
|
| Rate for Payer: BCBS Complete |
$32.13
|
| Rate for Payer: BCBS Complete |
$33.09
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$237.71
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$73.98
|
| Rate for Payer: Cofinity Commercial |
$57.91
|
| Rate for Payer: Cofinity Commercial |
$60.21
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Cofinity Commercial |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$255.54
|
| Rate for Payer: Cofinity Commercial |
$56.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Healthscope Commercial |
$267.43
|
| Rate for Payer: Healthscope Commercial |
$77.42
|
| Rate for Payer: Healthscope Commercial |
$72.30
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.57
|
| Rate for Payer: PHP Commercial |
$68.28
|
| Rate for Payer: PHP Commercial |
$73.12
|
| Rate for Payer: PHP Commercial |
$70.32
|
| Rate for Payer: PHP Commercial |
$252.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.91
|
| Rate for Payer: Priority Health SBD |
$187.20
|
| Rate for Payer: Priority Health SBD |
$52.12
|
| Rate for Payer: Priority Health SBD |
$50.61
|
| Rate for Payer: Priority Health SBD |
$54.19
|
|
|
EPTINEZUMAB-JJMR 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,042.08
|
|
|
Service Code
|
HCPCS J3032
|
| Hospital Charge Code |
193002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$5,437.87 |
| Rate for Payer: Aetna Commercial |
$5,135.77
|
| Rate for Payer: Aetna Medicare |
$20.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,927.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.96
|
| Rate for Payer: BCBS Complete |
$11.24
|
| Rate for Payer: BCBS MAPPO |
$19.97
|
| Rate for Payer: BCN Medicare Advantage |
$19.97
|
| Rate for Payer: Cash Price |
$4,833.66
|
| Rate for Payer: Cash Price |
$4,833.66
|
| Rate for Payer: Cofinity Commercial |
$5,196.19
|
| Rate for Payer: Cofinity Commercial |
$4,229.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,229.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,833.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.97
|
| Rate for Payer: Healthscope Commercial |
$5,437.87
|
| Rate for Payer: Mclaren Medicaid |
$10.70
|
| Rate for Payer: Mclaren Medicare |
$19.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.97
|
| Rate for Payer: Meridian Medicaid |
$11.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,135.77
|
| Rate for Payer: PACE Medicare |
$18.97
|
| Rate for Payer: PACE SWMI |
$19.97
|
| Rate for Payer: PHP Commercial |
$5,135.77
|
| Rate for Payer: PHP Medicare Advantage |
$19.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,927.35
|
| Rate for Payer: Priority Health Medicare |
$19.97
|
| Rate for Payer: Priority Health SBD |
$3,806.51
|
| Rate for Payer: Railroad Medicare Medicare |
$19.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.97
|
| Rate for Payer: UHC Medicare Advantage |
$19.97
|
| Rate for Payer: UHCCP Medicaid |
$11.24
|
| Rate for Payer: VA VA |
$19.97
|
|
|
EPTINEZUMAB-JJMR 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,042.08
|
|
|
Service Code
|
HCPCS J3032
|
| Hospital Charge Code |
193002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,806.51 |
| Max. Negotiated Rate |
$5,437.87 |
| Rate for Payer: Aetna Commercial |
$5,135.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,927.35
|
| Rate for Payer: Cash Price |
$4,833.66
|
| Rate for Payer: Cofinity Commercial |
$4,229.46
|
| Rate for Payer: Cofinity Commercial |
$5,196.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,229.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,833.66
|
| Rate for Payer: Healthscope Commercial |
$5,437.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,135.77
|
| Rate for Payer: PHP Commercial |
$5,135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,927.35
|
| Rate for Payer: Priority Health SBD |
$3,806.51
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$321.10
|
|
|
Service Code
|
NDC 62332046431
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.44 |
| Max. Negotiated Rate |
$288.99 |
| Rate for Payer: Aetna Commercial |
$272.94
|
| Rate for Payer: Aetna Medicare |
$160.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.72
|
| Rate for Payer: BCBS Complete |
$128.44
|
| Rate for Payer: Cash Price |
$256.88
|
| Rate for Payer: Cofinity Commercial |
$224.77
|
| Rate for Payer: Cofinity Commercial |
$276.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.88
|
| Rate for Payer: Healthscope Commercial |
$288.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.94
|
| Rate for Payer: PHP Commercial |
$272.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.72
|
| Rate for Payer: Priority Health SBD |
$202.29
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 60687050011
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna Medicare |
$2.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.79
|
| Rate for Payer: BCBS Complete |
$1.72
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$3.01
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$3.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.79
|
| Rate for Payer: Priority Health SBD |
$2.71
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
NDC 60687050011
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.79
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$3.01
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$3.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.79
|
| Rate for Payer: Priority Health SBD |
$2.71
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$321.10
|
|
|
Service Code
|
NDC 62332046431
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.29 |
| Max. Negotiated Rate |
$288.99 |
| Rate for Payer: Aetna Commercial |
$272.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.72
|
| Rate for Payer: Cash Price |
$256.88
|
| Rate for Payer: Cofinity Commercial |
$224.77
|
| Rate for Payer: Cofinity Commercial |
$276.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.88
|
| Rate for Payer: Healthscope Commercial |
$288.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.94
|
| Rate for Payer: PHP Commercial |
$272.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.72
|
| Rate for Payer: Priority Health SBD |
$202.29
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$429.60
|
|
|
Service Code
|
NDC 60687050001
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.65 |
| Max. Negotiated Rate |
$386.64 |
| Rate for Payer: Aetna Commercial |
$365.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.24
|
| Rate for Payer: Cash Price |
$343.68
|
| Rate for Payer: Cofinity Commercial |
$300.72
|
| Rate for Payer: Cofinity Commercial |
$369.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.68
|
| Rate for Payer: Healthscope Commercial |
$386.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.16
|
| Rate for Payer: PHP Commercial |
$365.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.24
|
| Rate for Payer: Priority Health SBD |
$270.65
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$222.72
|
|
|
Service Code
|
NDC 50268029715
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.31 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna Commercial |
$189.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.77
|
| Rate for Payer: Cash Price |
$178.18
|
| Rate for Payer: Cofinity Commercial |
$155.90
|
| Rate for Payer: Cofinity Commercial |
$191.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.18
|
| Rate for Payer: Healthscope Commercial |
$200.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.31
|
| Rate for Payer: PHP Commercial |
$189.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.77
|
| Rate for Payer: Priority Health SBD |
$140.31
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$4.46
|
|
|
Service Code
|
NDC 50268029711
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$4.01 |
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.90
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: PHP Commercial |
$3.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.90
|
| Rate for Payer: Priority Health SBD |
$2.81
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$4.46
|
|
|
Service Code
|
NDC 50268029711
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$4.01 |
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.90
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: PHP Commercial |
$3.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.90
|
| Rate for Payer: Priority Health SBD |
$2.81
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$429.60
|
|
|
Service Code
|
NDC 60687050001
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.84 |
| Max. Negotiated Rate |
$386.64 |
| Rate for Payer: Aetna Commercial |
$365.16
|
| Rate for Payer: Aetna Medicare |
$214.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.24
|
| Rate for Payer: BCBS Complete |
$171.84
|
| Rate for Payer: Cash Price |
$343.68
|
| Rate for Payer: Cofinity Commercial |
$300.72
|
| Rate for Payer: Cofinity Commercial |
$369.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.68
|
| Rate for Payer: Healthscope Commercial |
$386.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.16
|
| Rate for Payer: PHP Commercial |
$365.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.24
|
| Rate for Payer: Priority Health SBD |
$270.65
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$222.72
|
|
|
Service Code
|
NDC 50268029715
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.09 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna Commercial |
$189.31
|
| Rate for Payer: Aetna Medicare |
$111.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.77
|
| Rate for Payer: BCBS Complete |
$89.09
|
| Rate for Payer: Cash Price |
$178.18
|
| Rate for Payer: Cofinity Commercial |
$155.90
|
| Rate for Payer: Cofinity Commercial |
$191.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.18
|
| Rate for Payer: Healthscope Commercial |
$200.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.31
|
| Rate for Payer: PHP Commercial |
$189.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.77
|
| Rate for Payer: Priority Health SBD |
$140.31
|
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,330.90
|
|
|
Service Code
|
HCPCS J9179
|
| Hospital Charge Code |
106773
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$5,697.81 |
| Rate for Payer: Aetna Commercial |
$5,381.27
|
| Rate for Payer: Aetna Medicare |
$92.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,115.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.67
|
| Rate for Payer: BCBS Complete |
$50.28
|
| Rate for Payer: BCBS MAPPO |
$89.34
|
| Rate for Payer: BCN Medicare Advantage |
$89.34
|
| Rate for Payer: Cash Price |
$5,064.72
|
| Rate for Payer: Cash Price |
$5,064.72
|
| Rate for Payer: Cofinity Commercial |
$5,444.57
|
| Rate for Payer: Cofinity Commercial |
$4,431.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,431.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,064.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.34
|
| Rate for Payer: Healthscope Commercial |
$5,697.81
|
| Rate for Payer: Mclaren Medicaid |
$47.89
|
| Rate for Payer: Mclaren Medicare |
$89.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.81
|
| Rate for Payer: Meridian Medicaid |
$50.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,381.27
|
| Rate for Payer: PACE Medicare |
$84.87
|
| Rate for Payer: PACE SWMI |
$89.34
|
| Rate for Payer: PHP Commercial |
$5,381.27
|
| Rate for Payer: PHP Medicare Advantage |
$89.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,115.09
|
| Rate for Payer: Priority Health Medicare |
$89.34
|
| Rate for Payer: Priority Health SBD |
$3,988.47
|
| Rate for Payer: Railroad Medicare Medicare |
$89.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.34
|
| Rate for Payer: UHC Medicare Advantage |
$89.34
|
| Rate for Payer: UHCCP Medicaid |
$50.30
|
| Rate for Payer: VA VA |
$89.34
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
IP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.11 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Priority Health SBD |
$67.11
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.60 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Medicare |
$53.27
|
| Rate for Payer: Aetna Medicare |
$212.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Complete |
$42.61
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health SBD |
$67.11
|
| Rate for Payer: Priority Health SBD |
$267.12
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$134.69
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.88 |
| Max. Negotiated Rate |
$121.22 |
| Rate for Payer: Aetna Commercial |
$114.49
|
| Rate for Payer: Aetna Commercial |
$93.90
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Medicare |
$55.23
|
| Rate for Payer: Aetna Medicare |
$212.00
|
| Rate for Payer: Aetna Medicare |
$67.34
|
| Rate for Payer: Aetna Medicare |
$53.27
|
| Rate for Payer: Aetna Medicare |
$50.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.91
|
| Rate for Payer: BCBS Complete |
$42.61
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS Complete |
$44.19
|
| Rate for Payer: BCBS Complete |
$40.56
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$88.38
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$107.75
|
| Rate for Payer: Cofinity Commercial |
$94.28
|
| Rate for Payer: Cofinity Commercial |
$70.98
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$77.33
|
| Rate for Payer: Cofinity Commercial |
$95.00
|
| Rate for Payer: Cofinity Commercial |
$115.83
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Healthscope Commercial |
$121.22
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$99.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$114.49
|
| Rate for Payer: PHP Commercial |
$93.90
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.81
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Priority Health SBD |
$63.88
|
| Rate for Payer: Priority Health SBD |
$67.11
|
| Rate for Payer: Priority Health SBD |
$84.85
|
| Rate for Payer: Priority Health SBD |
$69.60
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$101.40
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.88 |
| Max. Negotiated Rate |
$91.26 |
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Commercial |
$93.90
|
| Rate for Payer: Aetna Commercial |
$114.49
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$107.75
|
| Rate for Payer: Cash Price |
$88.38
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$70.98
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$94.28
|
| Rate for Payer: Cofinity Commercial |
$115.83
|
| Rate for Payer: Cofinity Commercial |
$77.33
|
| Rate for Payer: Cofinity Commercial |
$95.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$99.42
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Healthscope Commercial |
$121.22
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.19
|
| Rate for Payer: PHP Commercial |
$114.49
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$93.90
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.55
|
| Rate for Payer: Priority Health SBD |
$84.85
|
| Rate for Payer: Priority Health SBD |
$67.11
|
| Rate for Payer: Priority Health SBD |
$69.60
|
| Rate for Payer: Priority Health SBD |
$63.88
|
| Rate for Payer: Priority Health SBD |
$267.12
|
|
|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.11 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health SBD |
$67.11
|
|
|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Medicare |
$53.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: BCBS Complete |
$42.61
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health SBD |
$67.11
|
|
|
ERTAPENEM IVPB (INTRA-OP)
|
Facility
|
IP
|
$4,550.67
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
167002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,866.92 |
| Max. Negotiated Rate |
$4,095.60 |
| Rate for Payer: Aetna Commercial |
$3,868.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,957.94
|
| Rate for Payer: Cash Price |
$3,640.54
|
| Rate for Payer: Cofinity Commercial |
$3,913.58
|
| Rate for Payer: Cofinity Commercial |
$3,185.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,185.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,640.54
|
| Rate for Payer: Healthscope Commercial |
$4,095.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,868.07
|
| Rate for Payer: PHP Commercial |
$3,868.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,957.94
|
| Rate for Payer: Priority Health SBD |
$2,866.92
|
|
