|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$289.72
|
|
|
Service Code
|
NDC 60432053716
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.86 |
| Max. Negotiated Rate |
$260.75 |
| Rate for Payer: Aetna Commercial |
$246.26
|
| Rate for Payer: Aetna Medicare |
$144.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.32
|
| Rate for Payer: BCBS Complete |
$115.89
|
| Rate for Payer: Cash Price |
$231.78
|
| Rate for Payer: Cofinity Advantage |
$202.80
|
| Rate for Payer: Cofinity Commercial |
$249.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.78
|
| Rate for Payer: Healthscope Commercial |
$260.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.29
|
| Rate for Payer: PHP Commercial |
$246.26
|
| Rate for Payer: Priority Health SBD |
$182.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.32
|
| Rate for Payer: UHC Core |
$150.94
|
| Rate for Payer: UHC Exchange |
$113.86
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$18.03
|
|
|
Service Code
|
NDC 68462031417
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$16.23 |
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna Medicare |
$9.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.72
|
| Rate for Payer: BCBS Complete |
$7.21
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cofinity Advantage |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.52
|
| Rate for Payer: PHP Commercial |
$15.33
|
| Rate for Payer: Priority Health SBD |
$11.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.72
|
| Rate for Payer: UHC Core |
$9.39
|
| Rate for Payer: UHC Exchange |
$7.09
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$68.20
|
|
|
Service Code
|
NDC 51672126301
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.97 |
| Max. Negotiated Rate |
$61.38 |
| Rate for Payer: Aetna Commercial |
$57.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.33
|
| Rate for Payer: Cash Price |
$54.56
|
| Rate for Payer: Cofinity Advantage |
$47.74
|
| Rate for Payer: Cofinity Commercial |
$58.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.56
|
| Rate for Payer: Healthscope Commercial |
$61.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.15
|
| Rate for Payer: PHP Commercial |
$57.97
|
| Rate for Payer: Priority Health SBD |
$42.97
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$18.03
|
|
|
Service Code
|
NDC 68462031417
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$16.23 |
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.72
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cofinity Advantage |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.52
|
| Rate for Payer: PHP Commercial |
$15.33
|
| Rate for Payer: Priority Health SBD |
$11.36
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$68.20
|
|
|
Service Code
|
NDC 51672126301
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$61.38 |
| Rate for Payer: Aetna Commercial |
$57.97
|
| Rate for Payer: Aetna Medicare |
$34.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.33
|
| Rate for Payer: BCBS Complete |
$27.28
|
| Rate for Payer: Cash Price |
$54.56
|
| Rate for Payer: Cofinity Advantage |
$47.74
|
| Rate for Payer: Cofinity Commercial |
$58.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.56
|
| Rate for Payer: Healthscope Commercial |
$61.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.15
|
| Rate for Payer: PHP Commercial |
$57.97
|
| Rate for Payer: Priority Health SBD |
$42.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.33
|
| Rate for Payer: UHC Core |
$35.53
|
| Rate for Payer: UHC Exchange |
$26.80
|
|
|
OB/GYN SPEC KZOO ONLY - NITROUS OXIDE ADMIN
|
Professional
|
Both
|
$63.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Aetna Medicare |
$31.50
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.25
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$42,431.94
|
|
|
Service Code
|
HCPCS J9301
|
| Hospital Charge Code |
168805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.79 |
| Max. Negotiated Rate |
$38,188.75 |
| Rate for Payer: Aetna Commercial |
$36,067.15
|
| Rate for Payer: Aetna Medicare |
$85.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,580.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.26
|
| Rate for Payer: BCBS Complete |
$44.93
|
| Rate for Payer: BCBS MAPPO |
$81.81
|
| Rate for Payer: BCBS Trust/PPO |
$204.77
|
| Rate for Payer: BCN Commercial |
$204.77
|
| Rate for Payer: BCN Medicare Advantage |
$81.81
|
| Rate for Payer: Cash Price |
$33,945.55
|
| Rate for Payer: Cash Price |
$33,945.55
|
| Rate for Payer: Cofinity Advantage |
$29,702.36
|
| Rate for Payer: Cofinity Commercial |
$36,491.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,945.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.81
|
| Rate for Payer: Healthscope Commercial |
$38,188.75
|
| Rate for Payer: Mclaren Medicaid |
$42.79
|
| Rate for Payer: Mclaren Medicare |
$81.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.90
|
| Rate for Payer: Meridian Medicaid |
$85.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$89.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,067.15
|
| Rate for Payer: Nomi Health Commercial |
$245.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31,823.96
|
| Rate for Payer: PACE Medicare |
$77.72
|
| Rate for Payer: PACE SWMI |
$81.81
|
| Rate for Payer: PHP Commercial |
$36,067.15
|
| Rate for Payer: PHP Medicare Advantage |
$81.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$249.14
|
| Rate for Payer: Priority Health Medicare |
$81.81
|
| Rate for Payer: Priority Health SBD |
$26,732.12
|
| Rate for Payer: Priority Health Tiered Network |
$199.31
|
| Rate for Payer: Railroad Medicare Medicare |
$81.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.69
|
| Rate for Payer: UHC Core |
$134.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$81.81
|
| Rate for Payer: UHC Exchange |
$134.69
|
| Rate for Payer: UHC Medicaid |
$42.79
|
| Rate for Payer: UHCCP Medicaid |
$42.79
|
| Rate for Payer: VA VA |
$81.81
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$42,431.94
|
|
|
Service Code
|
HCPCS J9301
|
| Hospital Charge Code |
168805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26,732.12 |
| Max. Negotiated Rate |
$38,188.75 |
| Rate for Payer: Aetna Commercial |
$36,067.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,580.76
|
| Rate for Payer: Cash Price |
$33,945.55
|
| Rate for Payer: Cofinity Advantage |
$29,702.36
|
| Rate for Payer: Cofinity Commercial |
$36,491.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,945.55
|
| Rate for Payer: Healthscope Commercial |
$38,188.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,067.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31,823.96
|
| Rate for Payer: PHP Commercial |
$36,067.15
|
| Rate for Payer: Priority Health SBD |
$26,732.12
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$2,994.35
|
|
|
Service Code
|
APR-DRG 7621
|
| Min. Negotiated Rate |
$2,851.76 |
| Max. Negotiated Rate |
$2,994.35 |
| Rate for Payer: BCBS Complete |
$2,994.35
|
| Rate for Payer: Mclaren Medicaid |
$2,851.76
|
| Rate for Payer: Meridian Medicaid |
$2,994.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,851.76
|
| Rate for Payer: UHC Medicaid |
$2,851.76
|
| Rate for Payer: UHCCP Medicaid |
$2,851.76
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$5,509.99
|
|
|
Service Code
|
APR-DRG 7623
|
| Min. Negotiated Rate |
$5,247.61 |
| Max. Negotiated Rate |
$5,509.99 |
| Rate for Payer: BCBS Complete |
$5,509.99
|
| Rate for Payer: Mclaren Medicaid |
$5,247.61
|
| Rate for Payer: Meridian Medicaid |
$5,509.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,247.61
|
| Rate for Payer: UHC Medicaid |
$5,247.61
|
| Rate for Payer: UHCCP Medicaid |
$5,247.61
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$3,745.37
|
|
|
Service Code
|
APR-DRG 7622
|
| Min. Negotiated Rate |
$3,567.02 |
| Max. Negotiated Rate |
$3,745.37 |
| Rate for Payer: BCBS Complete |
$3,745.37
|
| Rate for Payer: Mclaren Medicaid |
$3,567.02
|
| Rate for Payer: Meridian Medicaid |
$3,745.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,567.02
|
| Rate for Payer: UHC Medicaid |
$3,567.02
|
| Rate for Payer: UHCCP Medicaid |
$3,567.02
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$6,889.92
|
|
|
Service Code
|
APR-DRG 7624
|
| Min. Negotiated Rate |
$6,561.83 |
| Max. Negotiated Rate |
$6,889.92 |
| Rate for Payer: BCBS Complete |
$6,889.92
|
| Rate for Payer: Mclaren Medicaid |
$6,561.83
|
| Rate for Payer: Meridian Medicaid |
$6,889.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,561.83
|
| Rate for Payer: UHC Medicaid |
$6,561.83
|
| Rate for Payer: UHCCP Medicaid |
$6,561.83
|
|
|
OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$91,205.39
|
|
|
Service Code
|
HCPCS J2350
|
| Hospital Charge Code |
182454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.17 |
| Max. Negotiated Rate |
$82,084.85 |
| Rate for Payer: Aetna Commercial |
$77,524.58
|
| Rate for Payer: Aetna Medicare |
$61.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59,283.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.50
|
| Rate for Payer: BCBS Complete |
$32.73
|
| Rate for Payer: BCBS MAPPO |
$59.60
|
| Rate for Payer: BCBS Trust/PPO |
$148.83
|
| Rate for Payer: BCN Commercial |
$148.83
|
| Rate for Payer: BCN Medicare Advantage |
$59.60
|
| Rate for Payer: Cash Price |
$72,964.31
|
| Rate for Payer: Cash Price |
$72,964.31
|
| Rate for Payer: Cofinity Advantage |
$63,843.77
|
| Rate for Payer: Cofinity Commercial |
$78,436.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72,964.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.60
|
| Rate for Payer: Healthscope Commercial |
$82,084.85
|
| Rate for Payer: Mclaren Medicaid |
$31.17
|
| Rate for Payer: Mclaren Medicare |
$59.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.58
|
| Rate for Payer: Meridian Medicaid |
$62.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77,524.58
|
| Rate for Payer: Nomi Health Commercial |
$178.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68,404.04
|
| Rate for Payer: PACE Medicare |
$56.62
|
| Rate for Payer: PACE SWMI |
$59.60
|
| Rate for Payer: PHP Commercial |
$77,524.58
|
| Rate for Payer: PHP Medicare Advantage |
$59.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$187.38
|
| Rate for Payer: Priority Health Medicare |
$59.60
|
| Rate for Payer: Priority Health SBD |
$57,459.40
|
| Rate for Payer: Priority Health Tiered Network |
$149.90
|
| Rate for Payer: Railroad Medicare Medicare |
$59.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.88
|
| Rate for Payer: UHC Core |
$97.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$59.60
|
| Rate for Payer: UHC Exchange |
$97.88
|
| Rate for Payer: UHC Medicaid |
$31.17
|
| Rate for Payer: UHCCP Medicaid |
$31.17
|
| Rate for Payer: VA VA |
$59.60
|
|
|
OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$91,205.39
|
|
|
Service Code
|
HCPCS J2350
|
| Hospital Charge Code |
182454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57,459.40 |
| Max. Negotiated Rate |
$82,084.85 |
| Rate for Payer: Aetna Commercial |
$77,524.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59,283.50
|
| Rate for Payer: Cash Price |
$72,964.31
|
| Rate for Payer: Cofinity Advantage |
$63,843.77
|
| Rate for Payer: Cofinity Commercial |
$78,436.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72,964.31
|
| Rate for Payer: Healthscope Commercial |
$82,084.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77,524.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68,404.04
|
| Rate for Payer: PHP Commercial |
$77,524.58
|
| Rate for Payer: Priority Health SBD |
$57,459.40
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$17.21
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Advantage |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: Priority Health SBD |
$10.84
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$17.21
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Trust/PPO |
$1.65
|
| Rate for Payer: BCN Commercial |
$1.65
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Advantage |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
|
|
OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$48.59
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.61 |
| Max. Negotiated Rate |
$43.73 |
| Rate for Payer: Aetna Commercial |
$41.30
|
| Rate for Payer: Aetna Commercial |
$123.12
|
| Rate for Payer: Aetna Commercial |
$26.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.58
|
| Rate for Payer: Cash Price |
$38.87
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cofinity Advantage |
$34.01
|
| Rate for Payer: Cofinity Advantage |
$101.39
|
| Rate for Payer: Cofinity Advantage |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$124.57
|
| Rate for Payer: Cofinity Commercial |
$26.69
|
| Rate for Payer: Cofinity Commercial |
$41.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Healthscope Commercial |
$130.37
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$43.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.44
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Commercial |
$41.30
|
| Rate for Payer: PHP Commercial |
$123.12
|
| Rate for Payer: Priority Health SBD |
$91.26
|
| Rate for Payer: Priority Health SBD |
$30.61
|
| Rate for Payer: Priority Health SBD |
$19.56
|
|
|
OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$144.85
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$130.37 |
| Rate for Payer: Aetna Commercial |
$123.12
|
| Rate for Payer: Aetna Commercial |
$26.38
|
| Rate for Payer: Aetna Commercial |
$41.30
|
| Rate for Payer: Aetna Medicare |
$72.42
|
| Rate for Payer: Aetna Medicare |
$15.52
|
| Rate for Payer: Aetna Medicare |
$24.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.58
|
| Rate for Payer: BCBS Complete |
$19.44
|
| Rate for Payer: BCBS Complete |
$57.94
|
| Rate for Payer: BCBS Complete |
$12.42
|
| Rate for Payer: BCBS Trust/PPO |
$1.65
|
| Rate for Payer: BCBS Trust/PPO |
$1.65
|
| Rate for Payer: BCBS Trust/PPO |
$1.65
|
| Rate for Payer: BCN Commercial |
$1.65
|
| Rate for Payer: BCN Commercial |
$1.65
|
| Rate for Payer: BCN Commercial |
$1.65
|
| Rate for Payer: Cash Price |
$38.87
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cash Price |
$38.87
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cofinity Advantage |
$21.73
|
| Rate for Payer: Cofinity Advantage |
$101.39
|
| Rate for Payer: Cofinity Advantage |
$34.01
|
| Rate for Payer: Cofinity Commercial |
$124.57
|
| Rate for Payer: Cofinity Commercial |
$26.69
|
| Rate for Payer: Cofinity Commercial |
$41.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.88
|
| Rate for Payer: Healthscope Commercial |
$43.73
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$130.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.44
|
| Rate for Payer: PHP Commercial |
$123.12
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Commercial |
$41.30
|
| Rate for Payer: Priority Health SBD |
$91.26
|
| Rate for Payer: Priority Health SBD |
$30.61
|
| Rate for Payer: Priority Health SBD |
$19.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
|
|
OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
OP
|
$11,585.32
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.51 |
| Max. Negotiated Rate |
$10,426.79 |
| Rate for Payer: Aetna Commercial |
$9,847.52
|
| Rate for Payer: Aetna Medicare |
$195.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,530.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$235.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$235.44
|
| Rate for Payer: BCBS Complete |
$103.44
|
| Rate for Payer: BCBS MAPPO |
$188.35
|
| Rate for Payer: BCBS Trust/PPO |
$499.67
|
| Rate for Payer: BCN Commercial |
$499.67
|
| Rate for Payer: BCN Medicare Advantage |
$188.35
|
| Rate for Payer: Cash Price |
$9,268.26
|
| Rate for Payer: Cash Price |
$9,268.26
|
| Rate for Payer: Cofinity Advantage |
$8,109.72
|
| Rate for Payer: Cofinity Commercial |
$9,963.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,268.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.35
|
| Rate for Payer: Healthscope Commercial |
$10,426.79
|
| Rate for Payer: Mclaren Medicaid |
$98.51
|
| Rate for Payer: Mclaren Medicare |
$188.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.77
|
| Rate for Payer: Meridian Medicaid |
$197.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$207.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,847.52
|
| Rate for Payer: Nomi Health Commercial |
$565.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,688.99
|
| Rate for Payer: PACE Medicare |
$178.93
|
| Rate for Payer: PACE SWMI |
$188.35
|
| Rate for Payer: PHP Commercial |
$9,847.52
|
| Rate for Payer: PHP Medicare Advantage |
$188.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$642.09
|
| Rate for Payer: Priority Health Medicare |
$188.35
|
| Rate for Payer: Priority Health SBD |
$7,298.75
|
| Rate for Payer: Priority Health Tiered Network |
$513.67
|
| Rate for Payer: Railroad Medicare Medicare |
$188.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.63
|
| Rate for Payer: UHC Core |
$328.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$188.35
|
| Rate for Payer: UHC Exchange |
$328.63
|
| Rate for Payer: UHC Medicaid |
$98.51
|
| Rate for Payer: UHCCP Medicaid |
$98.51
|
| Rate for Payer: VA VA |
$188.35
|
|
|
OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
IP
|
$11,585.32
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,298.75 |
| Max. Negotiated Rate |
$10,426.79 |
| Rate for Payer: Aetna Commercial |
$9,847.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,530.46
|
| Rate for Payer: Cash Price |
$9,268.26
|
| Rate for Payer: Cofinity Advantage |
$8,109.72
|
| Rate for Payer: Cofinity Commercial |
$9,963.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,268.26
|
| Rate for Payer: Healthscope Commercial |
$10,426.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,847.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,688.99
|
| Rate for Payer: PHP Commercial |
$9,847.52
|
| Rate for Payer: Priority Health SBD |
$7,298.75
|
|
|
OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
IP
|
$17,348.09
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,929.30 |
| Max. Negotiated Rate |
$15,613.28 |
| Rate for Payer: Aetna Commercial |
$14,745.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,276.26
|
| Rate for Payer: Cash Price |
$13,878.47
|
| Rate for Payer: Cofinity Advantage |
$12,143.66
|
| Rate for Payer: Cofinity Commercial |
$14,919.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,878.47
|
| Rate for Payer: Healthscope Commercial |
$15,613.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,745.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,011.07
|
| Rate for Payer: PHP Commercial |
$14,745.88
|
| Rate for Payer: Priority Health SBD |
$10,929.30
|
|
|
OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
OP
|
$17,348.09
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.51 |
| Max. Negotiated Rate |
$15,613.28 |
| Rate for Payer: Aetna Commercial |
$14,745.88
|
| Rate for Payer: Aetna Medicare |
$195.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,276.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$235.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$235.44
|
| Rate for Payer: BCBS Complete |
$103.44
|
| Rate for Payer: BCBS MAPPO |
$188.35
|
| Rate for Payer: BCBS Trust/PPO |
$499.67
|
| Rate for Payer: BCN Commercial |
$499.67
|
| Rate for Payer: BCN Medicare Advantage |
$188.35
|
| Rate for Payer: Cash Price |
$13,878.47
|
| Rate for Payer: Cash Price |
$13,878.47
|
| Rate for Payer: Cofinity Advantage |
$12,143.66
|
| Rate for Payer: Cofinity Commercial |
$14,919.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,878.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.35
|
| Rate for Payer: Healthscope Commercial |
$15,613.28
|
| Rate for Payer: Mclaren Medicaid |
$98.51
|
| Rate for Payer: Mclaren Medicare |
$188.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.77
|
| Rate for Payer: Meridian Medicaid |
$197.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$207.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,745.88
|
| Rate for Payer: Nomi Health Commercial |
$565.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,011.07
|
| Rate for Payer: PACE Medicare |
$178.93
|
| Rate for Payer: PACE SWMI |
$188.35
|
| Rate for Payer: PHP Commercial |
$14,745.88
|
| Rate for Payer: PHP Medicare Advantage |
$188.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$642.09
|
| Rate for Payer: Priority Health Medicare |
$188.35
|
| Rate for Payer: Priority Health SBD |
$10,929.30
|
| Rate for Payer: Priority Health Tiered Network |
$513.67
|
| Rate for Payer: Railroad Medicare Medicare |
$188.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.63
|
| Rate for Payer: UHC Core |
$328.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$188.35
|
| Rate for Payer: UHC Exchange |
$328.63
|
| Rate for Payer: UHC Medicaid |
$98.51
|
| Rate for Payer: UHCCP Medicaid |
$98.51
|
| Rate for Payer: VA VA |
$188.35
|
|
|
OFATUMUMAB 1,000 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26,414.00
|
|
|
Service Code
|
HCPCS J9302
|
| Hospital Charge Code |
153045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.55 |
| Max. Negotiated Rate |
$23,772.60 |
| Rate for Payer: Aetna Commercial |
$22,451.90
|
| Rate for Payer: Aetna Medicare |
$64.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,169.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.79
|
| Rate for Payer: BCBS Complete |
$34.18
|
| Rate for Payer: BCBS MAPPO |
$62.23
|
| Rate for Payer: BCBS Trust/PPO |
$151.12
|
| Rate for Payer: BCN Commercial |
$151.12
|
| Rate for Payer: BCN Medicare Advantage |
$62.23
|
| Rate for Payer: Cash Price |
$21,131.20
|
| Rate for Payer: Cash Price |
$21,131.20
|
| Rate for Payer: Cofinity Advantage |
$18,489.80
|
| Rate for Payer: Cofinity Commercial |
$22,716.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,131.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.23
|
| Rate for Payer: Healthscope Commercial |
$23,772.60
|
| Rate for Payer: Mclaren Medicaid |
$32.55
|
| Rate for Payer: Mclaren Medicare |
$62.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.34
|
| Rate for Payer: Meridian Medicaid |
$65.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,451.90
|
| Rate for Payer: Nomi Health Commercial |
$186.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19,810.50
|
| Rate for Payer: PACE Medicare |
$59.12
|
| Rate for Payer: PACE SWMI |
$62.23
|
| Rate for Payer: PHP Commercial |
$22,451.90
|
| Rate for Payer: PHP Medicare Advantage |
$62.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$196.29
|
| Rate for Payer: Priority Health Medicare |
$62.23
|
| Rate for Payer: Priority Health SBD |
$16,640.82
|
| Rate for Payer: Priority Health Tiered Network |
$157.03
|
| Rate for Payer: Railroad Medicare Medicare |
$62.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.68
|
| Rate for Payer: UHC Core |
$102.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.23
|
| Rate for Payer: UHC Exchange |
$102.68
|
| Rate for Payer: UHC Medicaid |
$32.55
|
| Rate for Payer: UHCCP Medicaid |
$32.55
|
| Rate for Payer: VA VA |
$62.23
|
|
|
OFATUMUMAB 100 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,641.40
|
|
|
Service Code
|
HCPCS J9302
|
| Hospital Charge Code |
100265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,664.08 |
| Max. Negotiated Rate |
$2,377.26 |
| Rate for Payer: Aetna Commercial |
$2,245.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,716.91
|
| Rate for Payer: Cash Price |
$2,113.12
|
| Rate for Payer: Cofinity Advantage |
$1,848.98
|
| Rate for Payer: Cofinity Commercial |
$2,271.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,113.12
|
| Rate for Payer: Healthscope Commercial |
$2,377.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,245.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,981.05
|
| Rate for Payer: PHP Commercial |
$2,245.19
|
| Rate for Payer: Priority Health SBD |
$1,664.08
|
|
|
OFATUMUMAB 100 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,641.40
|
|
|
Service Code
|
HCPCS J9302
|
| Hospital Charge Code |
100265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.55 |
| Max. Negotiated Rate |
$2,377.26 |
| Rate for Payer: Aetna Commercial |
$2,245.19
|
| Rate for Payer: Aetna Medicare |
$64.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,716.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.79
|
| Rate for Payer: BCBS Complete |
$34.18
|
| Rate for Payer: BCBS MAPPO |
$62.23
|
| Rate for Payer: BCBS Trust/PPO |
$151.12
|
| Rate for Payer: BCN Commercial |
$151.12
|
| Rate for Payer: BCN Medicare Advantage |
$62.23
|
| Rate for Payer: Cash Price |
$2,113.12
|
| Rate for Payer: Cash Price |
$2,113.12
|
| Rate for Payer: Cofinity Advantage |
$1,848.98
|
| Rate for Payer: Cofinity Commercial |
$2,271.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,113.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.23
|
| Rate for Payer: Healthscope Commercial |
$2,377.26
|
| Rate for Payer: Mclaren Medicaid |
$32.55
|
| Rate for Payer: Mclaren Medicare |
$62.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.34
|
| Rate for Payer: Meridian Medicaid |
$65.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,245.19
|
| Rate for Payer: Nomi Health Commercial |
$186.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,981.05
|
| Rate for Payer: PACE Medicare |
$59.12
|
| Rate for Payer: PACE SWMI |
$62.23
|
| Rate for Payer: PHP Commercial |
$2,245.19
|
| Rate for Payer: PHP Medicare Advantage |
$62.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$196.29
|
| Rate for Payer: Priority Health Medicare |
$62.23
|
| Rate for Payer: Priority Health SBD |
$1,664.08
|
| Rate for Payer: Priority Health Tiered Network |
$157.03
|
| Rate for Payer: Railroad Medicare Medicare |
$62.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.68
|
| Rate for Payer: UHC Core |
$102.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.23
|
| Rate for Payer: UHC Exchange |
$102.68
|
| Rate for Payer: UHC Medicaid |
$32.55
|
| Rate for Payer: UHCCP Medicaid |
$32.55
|
| Rate for Payer: VA VA |
$62.23
|
|
