|
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 |
$4.00 |
| Max. Negotiated Rate |
$556.63 |
| Rate for Payer: Aetna Commercial |
$525.71
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.34
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS MAPPO |
$7.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.10
|
| Rate for Payer: BCN Commercial |
$21.10
|
| Rate for Payer: BCN Medicare Advantage |
$7.47
|
| 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 |
$7.47
|
| Rate for Payer: Healthscope Commercial |
$556.63
|
| Rate for Payer: Mclaren Medicaid |
$4.00
|
| Rate for Payer: Mclaren Medicare |
$7.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.84
|
| Rate for Payer: Meridian Medicaid |
$4.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.71
|
| Rate for Payer: Nomi Health Commercial |
$22.41
|
| Rate for Payer: PACE Medicare |
$7.10
|
| Rate for Payer: PACE SWMI |
$7.47
|
| Rate for Payer: PHP Commercial |
$525.71
|
| Rate for Payer: PHP Medicare Advantage |
$7.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.92
|
| Rate for Payer: Priority Health Medicare |
$7.47
|
| Rate for Payer: Priority Health Narrow Network |
$17.54
|
| Rate for Payer: Priority Health SBD |
$389.64
|
| Rate for Payer: Railroad Medicare Medicare |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.47
|
| Rate for Payer: UHC Medicare Advantage |
$7.47
|
| Rate for Payer: UHCCP Medicaid |
$4.21
|
| Rate for Payer: VA VA |
$7.47
|
|
|
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 |
$4.00 |
| Max. Negotiated Rate |
$69.78 |
| Rate for Payer: Aetna Commercial |
$65.90
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.34
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS MAPPO |
$7.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.10
|
| Rate for Payer: BCN Commercial |
$21.10
|
| Rate for Payer: BCN Medicare Advantage |
$7.47
|
| 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 |
$7.47
|
| Rate for Payer: Healthscope Commercial |
$69.78
|
| Rate for Payer: Mclaren Medicaid |
$4.00
|
| Rate for Payer: Mclaren Medicare |
$7.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.84
|
| Rate for Payer: Meridian Medicaid |
$4.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.90
|
| Rate for Payer: Nomi Health Commercial |
$22.41
|
| Rate for Payer: PACE Medicare |
$7.10
|
| Rate for Payer: PACE SWMI |
$7.47
|
| Rate for Payer: PHP Commercial |
$65.90
|
| Rate for Payer: PHP Medicare Advantage |
$7.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.92
|
| Rate for Payer: Priority Health Medicare |
$7.47
|
| Rate for Payer: Priority Health Narrow Network |
$17.54
|
| Rate for Payer: Priority Health SBD |
$48.84
|
| Rate for Payer: Railroad Medicare Medicare |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.47
|
| Rate for Payer: UHC Medicare Advantage |
$7.47
|
| Rate for Payer: UHCCP Medicaid |
$4.21
|
| Rate for Payer: VA VA |
$7.47
|
|
|
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 |
$4.00 |
| Max. Negotiated Rate |
$1,003.51 |
| Rate for Payer: Aetna Commercial |
$947.76
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.34
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS MAPPO |
$7.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.10
|
| Rate for Payer: BCN Commercial |
$21.10
|
| Rate for Payer: BCN Medicare Advantage |
$7.47
|
| 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 |
$7.47
|
| Rate for Payer: Healthscope Commercial |
$1,003.51
|
| Rate for Payer: Mclaren Medicaid |
$4.00
|
| Rate for Payer: Mclaren Medicare |
$7.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.84
|
| Rate for Payer: Meridian Medicaid |
$4.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.76
|
| Rate for Payer: Nomi Health Commercial |
$22.41
|
| Rate for Payer: PACE Medicare |
$7.10
|
| Rate for Payer: PACE SWMI |
$7.47
|
| Rate for Payer: PHP Commercial |
$947.76
|
| Rate for Payer: PHP Medicare Advantage |
$7.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.92
|
| Rate for Payer: Priority Health Medicare |
$7.47
|
| Rate for Payer: Priority Health Narrow Network |
$17.54
|
| Rate for Payer: Priority Health SBD |
$702.46
|
| Rate for Payer: Railroad Medicare Medicare |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.47
|
| Rate for Payer: UHC Medicare Advantage |
$7.47
|
| Rate for Payer: UHCCP Medicaid |
$4.21
|
| Rate for Payer: VA VA |
$7.47
|
|
|
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 |
$4.00 |
| Max. Negotiated Rate |
$139.55 |
| Rate for Payer: Aetna Commercial |
$131.80
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.34
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS MAPPO |
$7.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.10
|
| Rate for Payer: BCN Commercial |
$21.10
|
| Rate for Payer: BCN Medicare Advantage |
$7.47
|
| 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 |
$7.47
|
| Rate for Payer: Healthscope Commercial |
$139.55
|
| Rate for Payer: Mclaren Medicaid |
$4.00
|
| Rate for Payer: Mclaren Medicare |
$7.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.84
|
| Rate for Payer: Meridian Medicaid |
$4.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.80
|
| Rate for Payer: Nomi Health Commercial |
$22.41
|
| Rate for Payer: PACE Medicare |
$7.10
|
| Rate for Payer: PACE SWMI |
$7.47
|
| Rate for Payer: PHP Commercial |
$131.80
|
| Rate for Payer: PHP Medicare Advantage |
$7.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.92
|
| Rate for Payer: Priority Health Medicare |
$7.47
|
| Rate for Payer: Priority Health Narrow Network |
$17.54
|
| Rate for Payer: Priority Health SBD |
$97.69
|
| Rate for Payer: Railroad Medicare Medicare |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.47
|
| Rate for Payer: UHC Medicare Advantage |
$7.47
|
| Rate for Payer: UHCCP Medicaid |
$4.21
|
| Rate for Payer: VA VA |
$7.47
|
|
|
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
|
|
|
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 |
$44.78 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$111.22
|
| Rate for Payer: Aetna Medicare |
$65.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.05
|
| Rate for Payer: BCBS Complete |
$52.34
|
| Rate for Payer: BCBS Trust/PPO |
$44.78
|
| Rate for Payer: BCN Commercial |
$44.78
|
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Cofinity Commercial |
$112.53
|
| Rate for Payer: Cofinity Commercial |
$91.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.68
|
| Rate for Payer: Healthscope Commercial |
$117.76
|
| 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
|
IP
|
$130.85
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
162203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.44 |
| Max. Negotiated Rate |
$117.76 |
| 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 |
$91.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.68
|
| Rate for Payer: Healthscope Commercial |
$117.76
|
| 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
|
OP
|
$200.22
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
155384
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Aetna Commercial |
$170.19
|
| Rate for Payer: Aetna Medicare |
$100.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.14
|
| Rate for Payer: BCBS Complete |
$80.09
|
| Rate for Payer: BCBS Trust/PPO |
$44.78
|
| Rate for Payer: BCN Commercial |
$44.78
|
| Rate for Payer: Cash Price |
$160.18
|
| 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
|
|
|
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 |
$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
|
$1,074.70
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.72 |
| Max. Negotiated Rate |
$967.23 |
| Rate for Payer: Aetna Commercial |
$913.50
|
| Rate for Payer: Aetna Commercial |
$231.12
|
| Rate for Payer: Aetna Medicare |
$135.96
|
| Rate for Payer: Aetna Medicare |
$537.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$698.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.74
|
| Rate for Payer: BCBS Complete |
$108.76
|
| Rate for Payer: BCBS Complete |
$429.88
|
| Rate for Payer: BCBS Trust/PPO |
$32.72
|
| Rate for Payer: BCBS Trust/PPO |
$32.72
|
| Rate for Payer: BCN Commercial |
$32.72
|
| Rate for Payer: BCN Commercial |
$32.72
|
| Rate for Payer: Cash Price |
$217.53
|
| Rate for Payer: Cash Price |
$859.76
|
| Rate for Payer: Cash Price |
$859.76
|
| Rate for Payer: Cash Price |
$217.53
|
| Rate for Payer: Cofinity Commercial |
$924.24
|
| 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 Medicare Advantage |
$752.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.34
|
| 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 |
$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 |
$176.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$698.56
|
| 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) |
$698.56
|
| 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 |
$698.56
|
| Rate for Payer: Priority Health SBD |
$171.30
|
| Rate for Payer: Priority Health SBD |
$677.06
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$82.73
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.12 |
| 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 New Business (MI Preferred) |
$52.21
|
| 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) |
$55.91
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cash Price |
$237.71
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cofinity Commercial |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$73.98
|
| Rate for Payer: Cofinity Commercial |
$60.21
|
| Rate for Payer: Cofinity Commercial |
$56.23
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Cofinity Commercial |
$57.91
|
| Rate for Payer: Cofinity Commercial |
$255.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.91
|
| 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 |
$237.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.82
|
| Rate for Payer: Healthscope Commercial |
$72.30
|
| Rate for Payer: Healthscope Commercial |
$267.43
|
| Rate for Payer: Healthscope Commercial |
$77.42
|
| 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 |
$252.57
|
| Rate for Payer: PHP Commercial |
$70.32
|
| Rate for Payer: PHP Commercial |
$68.28
|
| Rate for Payer: PHP Commercial |
$73.12
|
| 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
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.72 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$73.12
|
| Rate for Payer: Aetna Commercial |
$252.57
|
| Rate for Payer: Aetna Commercial |
$70.32
|
| Rate for Payer: Aetna Commercial |
$68.28
|
| Rate for Payer: Aetna Medicare |
$41.36
|
| Rate for Payer: Aetna Medicare |
$148.57
|
| Rate for Payer: Aetna Medicare |
$43.01
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.91
|
| 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: BCBS Complete |
$33.09
|
| Rate for Payer: BCBS Complete |
$34.41
|
| Rate for Payer: BCBS Complete |
$32.13
|
| Rate for Payer: BCBS Complete |
$118.86
|
| Rate for Payer: BCBS Trust/PPO |
$32.72
|
| Rate for Payer: BCBS Trust/PPO |
$32.72
|
| Rate for Payer: BCBS Trust/PPO |
$32.72
|
| Rate for Payer: BCBS Trust/PPO |
$32.72
|
| Rate for Payer: BCN Commercial |
$32.72
|
| Rate for Payer: BCN Commercial |
$32.72
|
| Rate for Payer: BCN Commercial |
$32.72
|
| Rate for Payer: BCN Commercial |
$32.72
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cash Price |
$237.71
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cash Price |
$237.71
|
| Rate for Payer: Cofinity Commercial |
$56.23
|
| Rate for Payer: Cofinity Commercial |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$255.54
|
| 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 |
$60.21
|
| Rate for Payer: Cofinity Commercial |
$73.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Healthscope Commercial |
$72.30
|
| Rate for Payer: Healthscope Commercial |
$77.42
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Commercial |
$267.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.12
|
| Rate for Payer: PHP Commercial |
$73.12
|
| Rate for Payer: PHP Commercial |
$68.28
|
| Rate for Payer: PHP Commercial |
$70.32
|
| Rate for Payer: PHP Commercial |
$252.57
|
| 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 |
$53.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health SBD |
$54.19
|
| Rate for Payer: Priority Health SBD |
$50.61
|
| Rate for Payer: Priority Health SBD |
$187.20
|
| Rate for Payer: Priority Health SBD |
$52.12
|
|
|
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
|
|
|
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 |
$10.36 |
| Max. Negotiated Rate |
$5,437.87 |
| Rate for Payer: Aetna Commercial |
$5,135.77
|
| Rate for Payer: Aetna Medicare |
$20.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,927.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.15
|
| Rate for Payer: BCBS Complete |
$10.87
|
| Rate for Payer: BCBS MAPPO |
$19.32
|
| Rate for Payer: BCBS Trust/PPO |
$54.56
|
| Rate for Payer: BCN Commercial |
$54.56
|
| Rate for Payer: BCN Medicare Advantage |
$19.32
|
| 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 |
$19.32
|
| Rate for Payer: Healthscope Commercial |
$5,437.87
|
| Rate for Payer: Mclaren Medicaid |
$10.36
|
| Rate for Payer: Mclaren Medicare |
$19.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.29
|
| Rate for Payer: Meridian Medicaid |
$10.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,135.77
|
| Rate for Payer: Nomi Health Commercial |
$57.96
|
| Rate for Payer: PACE Medicare |
$18.35
|
| Rate for Payer: PACE SWMI |
$19.32
|
| Rate for Payer: PHP Commercial |
$5,135.77
|
| Rate for Payer: PHP Medicare Advantage |
$19.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,927.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.79
|
| Rate for Payer: Priority Health Medicare |
$19.32
|
| Rate for Payer: Priority Health Narrow Network |
$43.03
|
| Rate for Payer: Priority Health SBD |
$3,806.51
|
| Rate for Payer: Railroad Medicare Medicare |
$19.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.32
|
| Rate for Payer: UHC Medicare Advantage |
$19.32
|
| Rate for Payer: UHCCP Medicaid |
$10.88
|
| Rate for Payer: VA VA |
$19.32
|
|
|
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 |
$3.66
|
| Rate for Payer: Aetna Medicare |
$2.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.80
|
| 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 |
$3.66
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health SBD |
$2.71
|
|
|
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
|
$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
|
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
|
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 |
$3.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.80
|
| 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 |
$3.66
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health SBD |
$2.71
|
|
|
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
|
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
|
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
|
|
