|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$396.15
|
|
|
Service Code
|
NDC 68084038801
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.69 |
| Max. Negotiated Rate |
$356.54 |
| Rate for Payer: Aetna Commercial |
$336.73
|
| Rate for Payer: Aetna Medicare |
$198.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.50
|
| Rate for Payer: BCBS Complete |
$158.46
|
| Rate for Payer: Cash Price |
$316.92
|
| Rate for Payer: Cofinity Advantage |
$277.31
|
| Rate for Payer: Cofinity Commercial |
$340.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.92
|
| Rate for Payer: Healthscope Commercial |
$356.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.11
|
| Rate for Payer: PHP Commercial |
$336.73
|
| Rate for Payer: Priority Health SBD |
$249.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.50
|
| Rate for Payer: UHC Core |
$206.39
|
| Rate for Payer: UHC Exchange |
$155.69
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$396.15
|
|
|
Service Code
|
NDC 68084038801
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.57 |
| Max. Negotiated Rate |
$356.54 |
| Rate for Payer: Aetna Commercial |
$336.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.50
|
| Rate for Payer: Cash Price |
$316.92
|
| Rate for Payer: Cofinity Advantage |
$277.31
|
| Rate for Payer: Cofinity Commercial |
$340.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.92
|
| Rate for Payer: Healthscope Commercial |
$356.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.11
|
| Rate for Payer: PHP Commercial |
$336.73
|
| Rate for Payer: Priority Health SBD |
$249.57
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$350.15
|
|
|
Service Code
|
NDC 00603243821
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.59 |
| Max. Negotiated Rate |
$315.13 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Advantage |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.61
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health SBD |
$220.59
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$433.20
|
|
|
Service Code
|
NDC 60687036801
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.92 |
| Max. Negotiated Rate |
$389.88 |
| Rate for Payer: Aetna Commercial |
$368.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.58
|
| Rate for Payer: Cash Price |
$346.56
|
| Rate for Payer: Cofinity Advantage |
$303.24
|
| Rate for Payer: Cofinity Commercial |
$372.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.56
|
| Rate for Payer: Healthscope Commercial |
$389.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.90
|
| Rate for Payer: PHP Commercial |
$368.22
|
| Rate for Payer: Priority Health SBD |
$272.92
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$350.15
|
|
|
Service Code
|
NDC 00603243821
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.61 |
| Max. Negotiated Rate |
$315.13 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna Medicare |
$175.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: BCBS Complete |
$140.06
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Advantage |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$280.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.61
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health SBD |
$220.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.60
|
| Rate for Payer: UHC Core |
$182.43
|
| Rate for Payer: UHC Exchange |
$137.61
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$155.53
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$139.98 |
| Rate for Payer: Aetna Commercial |
$132.20
|
| Rate for Payer: Aetna Commercial |
$134.44
|
| Rate for Payer: Aetna Commercial |
$168.90
|
| Rate for Payer: Aetna Medicare |
$77.77
|
| Rate for Payer: Aetna Medicare |
$79.08
|
| Rate for Payer: Aetna Medicare |
$99.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.16
|
| Rate for Payer: BCBS Complete |
$79.48
|
| Rate for Payer: BCBS Complete |
$62.21
|
| Rate for Payer: BCBS Complete |
$63.26
|
| Rate for Payer: BCBS Trust/PPO |
$17.31
|
| Rate for Payer: BCBS Trust/PPO |
$17.31
|
| Rate for Payer: BCBS Trust/PPO |
$17.31
|
| Rate for Payer: BCN Commercial |
$17.31
|
| Rate for Payer: BCN Commercial |
$17.31
|
| Rate for Payer: BCN Commercial |
$17.31
|
| Rate for Payer: Cash Price |
$158.96
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cash Price |
$126.53
|
| Rate for Payer: Cash Price |
$158.96
|
| Rate for Payer: Cash Price |
$126.53
|
| Rate for Payer: Cofinity Advantage |
$110.71
|
| Rate for Payer: Cofinity Advantage |
$108.87
|
| Rate for Payer: Cofinity Advantage |
$139.09
|
| Rate for Payer: Cofinity Commercial |
$133.76
|
| Rate for Payer: Cofinity Commercial |
$136.02
|
| Rate for Payer: Cofinity Commercial |
$170.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.42
|
| Rate for Payer: Healthscope Commercial |
$178.83
|
| Rate for Payer: Healthscope Commercial |
$142.34
|
| Rate for Payer: Healthscope Commercial |
$139.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.03
|
| Rate for Payer: PHP Commercial |
$132.20
|
| Rate for Payer: PHP Commercial |
$134.44
|
| Rate for Payer: PHP Commercial |
$168.90
|
| Rate for Payer: Priority Health SBD |
$97.98
|
| Rate for Payer: Priority Health SBD |
$125.18
|
| Rate for Payer: Priority Health SBD |
$99.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.40
|
| Rate for Payer: UHC Core |
$11.40
|
| Rate for Payer: UHC Core |
$11.40
|
| Rate for Payer: UHC Core |
$11.40
|
| Rate for Payer: UHC Exchange |
$11.40
|
| Rate for Payer: UHC Exchange |
$11.40
|
| Rate for Payer: UHC Exchange |
$11.40
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$158.16
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.64 |
| Max. Negotiated Rate |
$142.34 |
| Rate for Payer: Aetna Commercial |
$134.44
|
| Rate for Payer: Aetna Commercial |
$132.20
|
| Rate for Payer: Aetna Commercial |
$168.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.09
|
| Rate for Payer: Cash Price |
$158.96
|
| Rate for Payer: Cash Price |
$126.53
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cofinity Advantage |
$110.71
|
| Rate for Payer: Cofinity Advantage |
$108.87
|
| Rate for Payer: Cofinity Advantage |
$139.09
|
| Rate for Payer: Cofinity Commercial |
$170.88
|
| Rate for Payer: Cofinity Commercial |
$133.76
|
| Rate for Payer: Cofinity Commercial |
$136.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.96
|
| Rate for Payer: Healthscope Commercial |
$139.98
|
| Rate for Payer: Healthscope Commercial |
$142.34
|
| Rate for Payer: Healthscope Commercial |
$178.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.62
|
| Rate for Payer: PHP Commercial |
$132.20
|
| Rate for Payer: PHP Commercial |
$168.90
|
| Rate for Payer: PHP Commercial |
$134.44
|
| Rate for Payer: Priority Health SBD |
$125.18
|
| Rate for Payer: Priority Health SBD |
$97.98
|
| Rate for Payer: Priority Health SBD |
$99.64
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,578.27
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
38022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,254.31 |
| Max. Negotiated Rate |
$3,220.44 |
| Rate for Payer: Aetna Commercial |
$3,041.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,325.88
|
| Rate for Payer: Cash Price |
$2,862.62
|
| Rate for Payer: Cofinity Advantage |
$2,504.79
|
| Rate for Payer: Cofinity Commercial |
$3,077.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,862.62
|
| Rate for Payer: Healthscope Commercial |
$3,220.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,041.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,683.70
|
| Rate for Payer: PHP Commercial |
$3,041.53
|
| Rate for Payer: Priority Health SBD |
$2,254.31
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,578.27
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
38022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.89 |
| Max. Negotiated Rate |
$3,220.44 |
| Rate for Payer: Aetna Commercial |
$3,041.53
|
| Rate for Payer: Aetna Commercial |
$12,166.09
|
| Rate for Payer: Aetna Medicare |
$77.33
|
| Rate for Payer: Aetna Medicare |
$77.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,325.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,303.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.95
|
| Rate for Payer: BCBS Complete |
$40.84
|
| Rate for Payer: BCBS Complete |
$40.84
|
| Rate for Payer: BCBS MAPPO |
$74.36
|
| Rate for Payer: BCBS MAPPO |
$74.36
|
| Rate for Payer: BCBS Trust/PPO |
$184.73
|
| Rate for Payer: BCBS Trust/PPO |
$184.73
|
| Rate for Payer: BCN Commercial |
$184.73
|
| Rate for Payer: BCN Commercial |
$184.73
|
| Rate for Payer: BCN Medicare Advantage |
$74.36
|
| Rate for Payer: BCN Medicare Advantage |
$74.36
|
| Rate for Payer: Cash Price |
$11,450.44
|
| Rate for Payer: Cash Price |
$2,862.62
|
| Rate for Payer: Cash Price |
$2,862.62
|
| Rate for Payer: Cash Price |
$11,450.44
|
| Rate for Payer: Cofinity Advantage |
$10,019.14
|
| Rate for Payer: Cofinity Advantage |
$2,504.79
|
| Rate for Payer: Cofinity Commercial |
$3,077.31
|
| Rate for Payer: Cofinity Commercial |
$12,309.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,862.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,450.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.36
|
| Rate for Payer: Healthscope Commercial |
$3,220.44
|
| Rate for Payer: Healthscope Commercial |
$12,881.75
|
| Rate for Payer: Mclaren Medicaid |
$38.89
|
| Rate for Payer: Mclaren Medicaid |
$38.89
|
| Rate for Payer: Mclaren Medicare |
$74.36
|
| Rate for Payer: Mclaren Medicare |
$74.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.08
|
| Rate for Payer: Meridian Medicaid |
$78.08
|
| Rate for Payer: Meridian Medicaid |
$78.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,166.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,041.53
|
| Rate for Payer: Nomi Health Commercial |
$223.08
|
| Rate for Payer: Nomi Health Commercial |
$223.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,683.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,734.79
|
| Rate for Payer: PACE Medicare |
$70.64
|
| Rate for Payer: PACE Medicare |
$70.64
|
| Rate for Payer: PACE SWMI |
$74.36
|
| Rate for Payer: PACE SWMI |
$74.36
|
| Rate for Payer: PHP Commercial |
$3,041.53
|
| Rate for Payer: PHP Commercial |
$12,166.09
|
| Rate for Payer: PHP Medicare Advantage |
$74.36
|
| Rate for Payer: PHP Medicare Advantage |
$74.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$230.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$230.89
|
| Rate for Payer: Priority Health Medicare |
$74.36
|
| Rate for Payer: Priority Health Medicare |
$74.36
|
| Rate for Payer: Priority Health SBD |
$9,017.22
|
| Rate for Payer: Priority Health SBD |
$2,254.31
|
| Rate for Payer: Priority Health Tiered Network |
$184.71
|
| Rate for Payer: Priority Health Tiered Network |
$184.71
|
| Rate for Payer: Railroad Medicare Medicare |
$74.36
|
| Rate for Payer: Railroad Medicare Medicare |
$74.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.49
|
| Rate for Payer: UHC Core |
$121.49
|
| Rate for Payer: UHC Core |
$121.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.36
|
| Rate for Payer: UHC Exchange |
$121.49
|
| Rate for Payer: UHC Exchange |
$121.49
|
| Rate for Payer: UHC Medicaid |
$38.89
|
| Rate for Payer: UHC Medicaid |
$38.89
|
| Rate for Payer: UHCCP Medicaid |
$38.89
|
| Rate for Payer: UHCCP Medicaid |
$38.89
|
| Rate for Payer: VA VA |
$74.36
|
| Rate for Payer: VA VA |
$74.36
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,054.52
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
190598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.42 |
| Max. Negotiated Rate |
$2,749.07 |
| Rate for Payer: Aetna Commercial |
$2,596.34
|
| Rate for Payer: Aetna Commercial |
$10,385.16
|
| Rate for Payer: Aetna Medicare |
$24.69
|
| Rate for Payer: Aetna Medicare |
$24.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,941.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,985.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.68
|
| Rate for Payer: BCBS Complete |
$13.04
|
| Rate for Payer: BCBS Complete |
$13.04
|
| Rate for Payer: BCBS MAPPO |
$23.74
|
| Rate for Payer: BCBS MAPPO |
$23.74
|
| Rate for Payer: BCBS Trust/PPO |
$72.15
|
| Rate for Payer: BCBS Trust/PPO |
$72.15
|
| Rate for Payer: BCN Commercial |
$72.15
|
| Rate for Payer: BCN Commercial |
$72.15
|
| Rate for Payer: BCN Medicare Advantage |
$23.74
|
| Rate for Payer: BCN Medicare Advantage |
$23.74
|
| Rate for Payer: Cash Price |
$9,774.26
|
| Rate for Payer: Cash Price |
$9,774.26
|
| Rate for Payer: Cash Price |
$2,443.62
|
| Rate for Payer: Cash Price |
$2,443.62
|
| Rate for Payer: Cofinity Advantage |
$2,138.16
|
| Rate for Payer: Cofinity Advantage |
$8,552.48
|
| Rate for Payer: Cofinity Commercial |
$2,626.89
|
| Rate for Payer: Cofinity Commercial |
$10,507.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,774.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,443.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.74
|
| Rate for Payer: Healthscope Commercial |
$10,996.05
|
| Rate for Payer: Healthscope Commercial |
$2,749.07
|
| Rate for Payer: Mclaren Medicaid |
$12.42
|
| Rate for Payer: Mclaren Medicaid |
$12.42
|
| Rate for Payer: Mclaren Medicare |
$23.74
|
| Rate for Payer: Mclaren Medicare |
$23.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.93
|
| Rate for Payer: Meridian Medicaid |
$24.93
|
| Rate for Payer: Meridian Medicaid |
$24.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,385.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,596.34
|
| Rate for Payer: Nomi Health Commercial |
$71.22
|
| Rate for Payer: Nomi Health Commercial |
$71.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,290.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,163.37
|
| Rate for Payer: PACE Medicare |
$22.55
|
| Rate for Payer: PACE Medicare |
$22.55
|
| Rate for Payer: PACE SWMI |
$23.74
|
| Rate for Payer: PACE SWMI |
$23.74
|
| Rate for Payer: PHP Commercial |
$10,385.16
|
| Rate for Payer: PHP Commercial |
$2,596.34
|
| Rate for Payer: PHP Medicare Advantage |
$23.74
|
| Rate for Payer: PHP Medicare Advantage |
$23.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$87.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$87.88
|
| Rate for Payer: Priority Health Medicare |
$23.74
|
| Rate for Payer: Priority Health Medicare |
$23.74
|
| Rate for Payer: Priority Health SBD |
$1,924.35
|
| Rate for Payer: Priority Health SBD |
$7,697.23
|
| Rate for Payer: Priority Health Tiered Network |
$70.30
|
| Rate for Payer: Priority Health Tiered Network |
$70.30
|
| Rate for Payer: Railroad Medicare Medicare |
$23.74
|
| Rate for Payer: Railroad Medicare Medicare |
$23.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.34
|
| Rate for Payer: UHC Core |
$39.34
|
| Rate for Payer: UHC Core |
$39.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.74
|
| Rate for Payer: UHC Exchange |
$39.34
|
| Rate for Payer: UHC Exchange |
$39.34
|
| Rate for Payer: UHC Medicaid |
$12.42
|
| Rate for Payer: UHC Medicaid |
$12.42
|
| Rate for Payer: UHCCP Medicaid |
$12.42
|
| Rate for Payer: UHCCP Medicaid |
$12.42
|
| Rate for Payer: VA VA |
$23.74
|
| Rate for Payer: VA VA |
$23.74
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,054.52
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
190598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,924.35 |
| Max. Negotiated Rate |
$2,749.07 |
| Rate for Payer: Aetna Commercial |
$2,596.34
|
| Rate for Payer: Aetna Commercial |
$10,385.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,941.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,985.44
|
| Rate for Payer: Cash Price |
$9,774.26
|
| Rate for Payer: Cash Price |
$2,443.62
|
| Rate for Payer: Cofinity Advantage |
$8,552.48
|
| Rate for Payer: Cofinity Advantage |
$2,138.16
|
| Rate for Payer: Cofinity Commercial |
$2,626.89
|
| Rate for Payer: Cofinity Commercial |
$10,507.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,443.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,774.26
|
| Rate for Payer: Healthscope Commercial |
$2,749.07
|
| Rate for Payer: Healthscope Commercial |
$10,996.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,385.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,596.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,163.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,290.89
|
| Rate for Payer: PHP Commercial |
$10,385.16
|
| Rate for Payer: PHP Commercial |
$2,596.34
|
| Rate for Payer: Priority Health SBD |
$1,924.35
|
| Rate for Payer: Priority Health SBD |
$7,697.23
|
|
|
BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,427.53
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
192559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$2,184.78 |
| Rate for Payer: Aetna Commercial |
$2,063.40
|
| Rate for Payer: Aetna Commercial |
$8,253.59
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,311.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,577.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.31
|
| Rate for Payer: BCBS Complete |
$14.20
|
| Rate for Payer: BCBS Complete |
$14.20
|
| Rate for Payer: BCBS MAPPO |
$25.85
|
| Rate for Payer: BCBS MAPPO |
$25.85
|
| Rate for Payer: BCBS Trust/PPO |
$53.83
|
| Rate for Payer: BCBS Trust/PPO |
$53.83
|
| Rate for Payer: BCN Commercial |
$53.83
|
| Rate for Payer: BCN Commercial |
$53.83
|
| Rate for Payer: BCN Medicare Advantage |
$25.85
|
| Rate for Payer: BCN Medicare Advantage |
$25.85
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cofinity Advantage |
$6,797.08
|
| Rate for Payer: Cofinity Advantage |
$1,699.27
|
| Rate for Payer: Cofinity Commercial |
$8,350.69
|
| Rate for Payer: Cofinity Commercial |
$2,087.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,942.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,768.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.85
|
| Rate for Payer: Healthscope Commercial |
$2,184.78
|
| Rate for Payer: Healthscope Commercial |
$8,739.10
|
| Rate for Payer: Mclaren Medicaid |
$13.52
|
| Rate for Payer: Mclaren Medicaid |
$13.52
|
| Rate for Payer: Mclaren Medicare |
$25.85
|
| Rate for Payer: Mclaren Medicare |
$25.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.14
|
| Rate for Payer: Meridian Medicaid |
$27.14
|
| Rate for Payer: Meridian Medicaid |
$27.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,063.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,253.59
|
| Rate for Payer: Nomi Health Commercial |
$77.55
|
| Rate for Payer: Nomi Health Commercial |
$77.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,820.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,282.58
|
| Rate for Payer: PACE Medicare |
$24.56
|
| Rate for Payer: PACE Medicare |
$24.56
|
| Rate for Payer: PACE SWMI |
$25.85
|
| Rate for Payer: PACE SWMI |
$25.85
|
| Rate for Payer: PHP Commercial |
$8,253.59
|
| Rate for Payer: PHP Commercial |
$2,063.40
|
| Rate for Payer: PHP Medicare Advantage |
$25.85
|
| Rate for Payer: PHP Medicare Advantage |
$25.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$81.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$81.28
|
| Rate for Payer: Priority Health Medicare |
$25.85
|
| Rate for Payer: Priority Health Medicare |
$25.85
|
| Rate for Payer: Priority Health SBD |
$6,117.37
|
| Rate for Payer: Priority Health SBD |
$1,529.34
|
| Rate for Payer: Priority Health Tiered Network |
$65.02
|
| Rate for Payer: Priority Health Tiered Network |
$65.02
|
| Rate for Payer: Railroad Medicare Medicare |
$25.85
|
| Rate for Payer: Railroad Medicare Medicare |
$25.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.57
|
| Rate for Payer: UHC Core |
$42.57
|
| Rate for Payer: UHC Core |
$42.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.85
|
| Rate for Payer: UHC Exchange |
$42.57
|
| Rate for Payer: UHC Exchange |
$42.57
|
| Rate for Payer: UHC Medicaid |
$13.52
|
| Rate for Payer: UHC Medicaid |
$13.52
|
| Rate for Payer: UHCCP Medicaid |
$13.52
|
| Rate for Payer: UHCCP Medicaid |
$13.52
|
| Rate for Payer: VA VA |
$25.85
|
| Rate for Payer: VA VA |
$25.85
|
|
|
BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,427.53
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
192559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,529.34 |
| Max. Negotiated Rate |
$2,184.78 |
| Rate for Payer: Aetna Commercial |
$2,063.40
|
| Rate for Payer: Aetna Commercial |
$8,253.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,577.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,311.57
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cofinity Advantage |
$1,699.27
|
| Rate for Payer: Cofinity Advantage |
$6,797.08
|
| Rate for Payer: Cofinity Commercial |
$2,087.68
|
| Rate for Payer: Cofinity Commercial |
$8,350.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,768.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,942.02
|
| Rate for Payer: Healthscope Commercial |
$8,739.10
|
| Rate for Payer: Healthscope Commercial |
$2,184.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,063.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,253.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,820.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,282.58
|
| Rate for Payer: PHP Commercial |
$2,063.40
|
| Rate for Payer: PHP Commercial |
$8,253.59
|
| Rate for Payer: Priority Health SBD |
$1,529.34
|
| Rate for Payer: Priority Health SBD |
$6,117.37
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$129.11
|
|
|
Service Code
|
NDC 47335048583
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.34 |
| Max. Negotiated Rate |
$116.20 |
| Rate for Payer: Aetna Commercial |
$109.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.92
|
| Rate for Payer: Cash Price |
$103.29
|
| Rate for Payer: Cofinity Advantage |
$90.38
|
| Rate for Payer: Cofinity Commercial |
$111.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.29
|
| Rate for Payer: Healthscope Commercial |
$116.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.83
|
| Rate for Payer: PHP Commercial |
$109.74
|
| Rate for Payer: Priority Health SBD |
$81.34
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$76.38
|
|
|
Service Code
|
NDC 00904601946
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.12 |
| Max. Negotiated Rate |
$68.74 |
| Rate for Payer: Aetna Commercial |
$64.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.65
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cofinity Advantage |
$53.47
|
| Rate for Payer: Cofinity Commercial |
$65.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.10
|
| Rate for Payer: Healthscope Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.28
|
| Rate for Payer: PHP Commercial |
$64.92
|
| Rate for Payer: Priority Health SBD |
$48.12
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
OP
|
$129.11
|
|
|
Service Code
|
NDC 47335048583
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.74 |
| Max. Negotiated Rate |
$116.20 |
| Rate for Payer: Aetna Commercial |
$109.74
|
| Rate for Payer: Aetna Medicare |
$64.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.92
|
| Rate for Payer: BCBS Complete |
$51.64
|
| Rate for Payer: Cash Price |
$103.29
|
| Rate for Payer: Cofinity Advantage |
$90.38
|
| Rate for Payer: Cofinity Commercial |
$111.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.29
|
| Rate for Payer: Healthscope Commercial |
$116.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.83
|
| Rate for Payer: PHP Commercial |
$109.74
|
| Rate for Payer: Priority Health SBD |
$81.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.92
|
| Rate for Payer: UHC Core |
$67.27
|
| Rate for Payer: UHC Exchange |
$50.74
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$101.52
|
|
|
Service Code
|
NDC 16729002310
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.96 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Advantage |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.14
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health SBD |
$63.96
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
OP
|
$76.38
|
|
|
Service Code
|
NDC 00904601946
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.02 |
| Max. Negotiated Rate |
$68.74 |
| Rate for Payer: Aetna Commercial |
$64.92
|
| Rate for Payer: Aetna Medicare |
$38.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.65
|
| Rate for Payer: BCBS Complete |
$30.55
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cofinity Advantage |
$53.47
|
| Rate for Payer: Cofinity Commercial |
$65.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.10
|
| Rate for Payer: Healthscope Commercial |
$68.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.28
|
| Rate for Payer: PHP Commercial |
$64.92
|
| Rate for Payer: Priority Health SBD |
$48.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.65
|
| Rate for Payer: UHC Core |
$39.79
|
| Rate for Payer: UHC Exchange |
$30.02
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
OP
|
$101.52
|
|
|
Service Code
|
NDC 16729002310
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna Medicare |
$50.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: BCBS Complete |
$40.61
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Advantage |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.14
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.99
|
| Rate for Payer: UHC Core |
$52.89
|
| Rate for Payer: UHC Exchange |
$39.90
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.9 K 4 MEQ-CA 2.5 MEQ-MG 1.5 MEQ/L
|
Facility
|
OP
|
$394.40
|
|
|
Service Code
|
NDC 24571010506
|
| Hospital Charge Code |
100176
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$155.00 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna Commercial |
$335.24
|
| Rate for Payer: Aetna Medicare |
$197.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.36
|
| Rate for Payer: BCBS Complete |
$157.76
|
| Rate for Payer: Cash Price |
$315.52
|
| Rate for Payer: Cofinity Advantage |
$276.08
|
| Rate for Payer: Cofinity Commercial |
$339.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.52
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$315.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.80
|
| Rate for Payer: PHP Commercial |
$335.24
|
| Rate for Payer: Priority Health SBD |
$248.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.36
|
| Rate for Payer: UHC Core |
$205.48
|
| Rate for Payer: UHC Exchange |
$155.00
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.9 K 4 MEQ-CA 2.5 MEQ-MG 1.5 MEQ/L
|
Facility
|
IP
|
$394.40
|
|
|
Service Code
|
NDC 24571010506
|
| Hospital Charge Code |
100176
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$248.47 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna Commercial |
$335.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.36
|
| Rate for Payer: Cash Price |
$315.52
|
| Rate for Payer: Cofinity Advantage |
$276.08
|
| Rate for Payer: Cofinity Commercial |
$339.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.52
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.80
|
| Rate for Payer: PHP Commercial |
$335.24
|
| Rate for Payer: Priority Health SBD |
$248.47
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET
|
Facility
|
IP
|
$15,209.56
|
|
|
Service Code
|
NDC 61958250101
|
| Hospital Charge Code |
185933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9,582.02 |
| Max. Negotiated Rate |
$13,688.60 |
| Rate for Payer: Aetna Commercial |
$12,928.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,886.21
|
| Rate for Payer: Cash Price |
$12,167.65
|
| Rate for Payer: Cofinity Advantage |
$10,646.69
|
| Rate for Payer: Cofinity Commercial |
$13,080.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,167.65
|
| Rate for Payer: Healthscope Commercial |
$13,688.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,928.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,407.17
|
| Rate for Payer: PHP Commercial |
$12,928.13
|
| Rate for Payer: Priority Health SBD |
$9,582.02
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET
|
Facility
|
OP
|
$15,209.56
|
|
|
Service Code
|
NDC 61958250103
|
| Hospital Charge Code |
185933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,977.36 |
| Max. Negotiated Rate |
$13,688.60 |
| Rate for Payer: Aetna Commercial |
$12,928.13
|
| Rate for Payer: Aetna Medicare |
$7,604.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,886.21
|
| Rate for Payer: BCBS Complete |
$6,083.82
|
| Rate for Payer: Cash Price |
$12,167.65
|
| Rate for Payer: Cofinity Advantage |
$10,646.69
|
| Rate for Payer: Cofinity Commercial |
$13,080.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,167.65
|
| Rate for Payer: Healthscope Commercial |
$13,688.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,167.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,928.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,407.17
|
| Rate for Payer: PHP Commercial |
$12,928.13
|
| Rate for Payer: Priority Health SBD |
$9,582.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,886.21
|
| Rate for Payer: UHC Core |
$7,924.18
|
| Rate for Payer: UHC Exchange |
$5,977.36
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET
|
Facility
|
OP
|
$15,209.56
|
|
|
Service Code
|
NDC 61958250101
|
| Hospital Charge Code |
185933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,977.36 |
| Max. Negotiated Rate |
$13,688.60 |
| Rate for Payer: Aetna Commercial |
$12,928.13
|
| Rate for Payer: Aetna Medicare |
$7,604.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,886.21
|
| Rate for Payer: BCBS Complete |
$6,083.82
|
| Rate for Payer: Cash Price |
$12,167.65
|
| Rate for Payer: Cofinity Advantage |
$10,646.69
|
| Rate for Payer: Cofinity Commercial |
$13,080.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,167.65
|
| Rate for Payer: Healthscope Commercial |
$13,688.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,167.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,928.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,407.17
|
| Rate for Payer: PHP Commercial |
$12,928.13
|
| Rate for Payer: Priority Health SBD |
$9,582.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,886.21
|
| Rate for Payer: UHC Core |
$7,924.18
|
| Rate for Payer: UHC Exchange |
$5,977.36
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET
|
Facility
|
IP
|
$15,209.56
|
|
|
Service Code
|
NDC 61958250103
|
| Hospital Charge Code |
185933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9,582.02 |
| Max. Negotiated Rate |
$13,688.60 |
| Rate for Payer: Aetna Commercial |
$12,928.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,886.21
|
| Rate for Payer: Cash Price |
$12,167.65
|
| Rate for Payer: Cofinity Advantage |
$10,646.69
|
| Rate for Payer: Cofinity Commercial |
$13,080.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,167.65
|
| Rate for Payer: Healthscope Commercial |
$13,688.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,928.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,407.17
|
| Rate for Payer: PHP Commercial |
$12,928.13
|
| Rate for Payer: Priority Health SBD |
$9,582.02
|
|
