|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,024.25
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
14643
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$921.82 |
| Rate for Payer: Aetna Commercial |
$870.61
|
| Rate for Payer: Aetna Medicare |
$9.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$665.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.11
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS MAPPO |
$8.89
|
| Rate for Payer: BCBS Trust/PPO |
$26.30
|
| Rate for Payer: BCN Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$819.40
|
| Rate for Payer: Cash Price |
$819.40
|
| Rate for Payer: Cofinity Commercial |
$880.86
|
| Rate for Payer: Cofinity Commercial |
$716.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.89
|
| Rate for Payer: Healthscope Commercial |
$921.82
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicare |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$5.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$870.61
|
| Rate for Payer: PACE Medicare |
$8.44
|
| Rate for Payer: PACE SWMI |
$8.89
|
| Rate for Payer: PHP Commercial |
$870.61
|
| Rate for Payer: PHP Medicare Advantage |
$8.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.98
|
| Rate for Payer: Priority Health Medicare |
$8.89
|
| Rate for Payer: Priority Health SBD |
$645.28
|
| Rate for Payer: Railroad Medicare Medicare |
$8.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.89
|
| Rate for Payer: UHC Medicare Advantage |
$9.15
|
| Rate for Payer: VA VA |
$8.89
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$181.34
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.24 |
| Max. Negotiated Rate |
$163.21 |
| Rate for Payer: Aetna Commercial |
$154.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.87
|
| Rate for Payer: Cash Price |
$145.07
|
| Rate for Payer: Cofinity Commercial |
$126.94
|
| Rate for Payer: Cofinity Commercial |
$155.95
|
| Rate for Payer: Healthscope Commercial |
$163.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.14
|
| Rate for Payer: PHP Commercial |
$154.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.94
|
| Rate for Payer: Priority Health SBD |
$114.24
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,801.05
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
24513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$1,620.94 |
| Rate for Payer: Aetna Commercial |
$1,530.89
|
| Rate for Payer: Aetna Medicare |
$9.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.11
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS MAPPO |
$8.89
|
| Rate for Payer: BCBS Trust/PPO |
$26.30
|
| Rate for Payer: BCN Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$1,440.84
|
| Rate for Payer: Cash Price |
$1,440.84
|
| Rate for Payer: Cofinity Commercial |
$1,548.90
|
| Rate for Payer: Cofinity Commercial |
$1,260.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.89
|
| Rate for Payer: Healthscope Commercial |
$1,620.94
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicare |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$5.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,530.89
|
| Rate for Payer: PACE Medicare |
$8.44
|
| Rate for Payer: PACE SWMI |
$8.89
|
| Rate for Payer: PHP Commercial |
$1,530.89
|
| Rate for Payer: PHP Medicare Advantage |
$8.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,260.74
|
| Rate for Payer: Priority Health Medicare |
$8.89
|
| Rate for Payer: Priority Health SBD |
$1,134.66
|
| Rate for Payer: Railroad Medicare Medicare |
$8.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.89
|
| Rate for Payer: UHC Medicare Advantage |
$9.15
|
| Rate for Payer: VA VA |
$8.89
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,801.05
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
24513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,134.66 |
| Max. Negotiated Rate |
$1,620.94 |
| Rate for Payer: Aetna Commercial |
$1,530.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.68
|
| Rate for Payer: Cash Price |
$1,440.84
|
| Rate for Payer: Cofinity Commercial |
$1,260.74
|
| Rate for Payer: Cofinity Commercial |
$1,548.90
|
| Rate for Payer: Healthscope Commercial |
$1,620.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,530.89
|
| Rate for Payer: PHP Commercial |
$1,530.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,260.74
|
| Rate for Payer: Priority Health SBD |
$1,134.66
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$362.61
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$228.44 |
| Max. Negotiated Rate |
$326.35 |
| Rate for Payer: Aetna Commercial |
$308.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.70
|
| Rate for Payer: Cash Price |
$290.09
|
| Rate for Payer: Cofinity Commercial |
$253.83
|
| Rate for Payer: Cofinity Commercial |
$311.84
|
| Rate for Payer: Healthscope Commercial |
$326.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$308.22
|
| Rate for Payer: PHP Commercial |
$308.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.83
|
| Rate for Payer: Priority Health SBD |
$228.44
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$362.61
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$326.35 |
| Rate for Payer: Aetna Commercial |
$308.22
|
| Rate for Payer: Aetna Medicare |
$9.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.11
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS MAPPO |
$8.89
|
| Rate for Payer: BCBS Trust/PPO |
$26.30
|
| Rate for Payer: BCN Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$290.09
|
| Rate for Payer: Cash Price |
$290.09
|
| Rate for Payer: Cofinity Commercial |
$253.83
|
| Rate for Payer: Cofinity Commercial |
$311.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.89
|
| Rate for Payer: Healthscope Commercial |
$326.35
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicare |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$5.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$308.22
|
| Rate for Payer: PACE Medicare |
$8.44
|
| Rate for Payer: PACE SWMI |
$8.89
|
| Rate for Payer: PHP Commercial |
$308.22
|
| Rate for Payer: PHP Medicare Advantage |
$8.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.83
|
| Rate for Payer: Priority Health Medicare |
$8.89
|
| Rate for Payer: Priority Health SBD |
$228.44
|
| Rate for Payer: Railroad Medicare Medicare |
$8.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.89
|
| Rate for Payer: UHC Medicare Advantage |
$9.15
|
| Rate for Payer: VA VA |
$8.89
|
|
|
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: Healthscope Commercial |
$117.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.22
|
| Rate for Payer: PHP Commercial |
$111.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.60
|
| Rate for Payer: Priority Health SBD |
$82.44
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$200.22
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
155384
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.14 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Aetna Commercial |
$170.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.14
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cofinity Commercial |
$140.15
|
| Rate for Payer: Cofinity Commercial |
$172.19
|
| Rate for Payer: Healthscope Commercial |
$180.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.19
|
| Rate for Payer: PHP Commercial |
$170.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.15
|
| Rate for Payer: Priority Health SBD |
$126.14
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$271.91
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.30 |
| Max. Negotiated Rate |
$244.72 |
| Rate for Payer: Aetna Commercial |
$231.12
|
| Rate for Payer: Aetna Commercial |
$1,631.66
|
| Rate for Payer: Aetna Commercial |
$908.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$694.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,247.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.74
|
| Rate for Payer: Cash Price |
$854.86
|
| Rate for Payer: Cash Price |
$217.53
|
| Rate for Payer: Cash Price |
$1,535.68
|
| Rate for Payer: Cofinity Commercial |
$1,343.72
|
| Rate for Payer: Cofinity Commercial |
$748.00
|
| Rate for Payer: Cofinity Commercial |
$918.97
|
| Rate for Payer: Cofinity Commercial |
$1,650.86
|
| Rate for Payer: Cofinity Commercial |
$190.34
|
| Rate for Payer: Cofinity Commercial |
$233.84
|
| Rate for Payer: Healthscope Commercial |
$1,727.64
|
| Rate for Payer: Healthscope Commercial |
$961.71
|
| Rate for Payer: Healthscope Commercial |
$244.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$908.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,631.66
|
| Rate for Payer: PHP Commercial |
$908.28
|
| Rate for Payer: PHP Commercial |
$1,631.66
|
| Rate for Payer: PHP Commercial |
$231.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,343.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$748.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.34
|
| Rate for Payer: Priority Health SBD |
$171.30
|
| Rate for Payer: Priority Health SBD |
$673.20
|
| Rate for Payer: Priority Health SBD |
$1,209.35
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$297.14
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$267.43 |
| Rate for Payer: Aetna Commercial |
$252.57
|
| Rate for Payer: Aetna Commercial |
$70.32
|
| Rate for Payer: Aetna Commercial |
$72.93
|
| Rate for Payer: Aetna Commercial |
$73.12
|
| Rate for Payer: Aetna Commercial |
$483.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.14
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cash Price |
$68.64
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$454.86
|
| Rate for Payer: Cash Price |
$237.71
|
| Rate for Payer: Cofinity Commercial |
$60.21
|
| Rate for Payer: Cofinity Commercial |
$73.98
|
| Rate for Payer: Cofinity Commercial |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$255.54
|
| Rate for Payer: Cofinity Commercial |
$398.00
|
| Rate for Payer: Cofinity Commercial |
$488.97
|
| Rate for Payer: Cofinity Commercial |
$57.91
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Cofinity Commercial |
$60.06
|
| Rate for Payer: Cofinity Commercial |
$73.79
|
| Rate for Payer: Healthscope Commercial |
$511.71
|
| Rate for Payer: Healthscope Commercial |
$77.22
|
| Rate for Payer: Healthscope Commercial |
$267.43
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Commercial |
$77.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$252.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$483.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.93
|
| Rate for Payer: PHP Commercial |
$73.12
|
| Rate for Payer: PHP Commercial |
$70.32
|
| Rate for Payer: PHP Commercial |
$483.28
|
| Rate for Payer: PHP Commercial |
$252.57
|
| Rate for Payer: PHP Commercial |
$72.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.21
|
| Rate for Payer: Priority Health SBD |
$358.20
|
| Rate for Payer: Priority Health SBD |
$52.12
|
| Rate for Payer: Priority Health SBD |
$187.20
|
| Rate for Payer: Priority Health SBD |
$54.05
|
| Rate for Payer: Priority Health SBD |
$54.19
|
|
|
EPTINEZUMAB-JJMR 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,656.74
|
|
|
Service Code
|
HCPCS J3032
|
| Hospital Charge Code |
193002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,563.75 |
| Max. Negotiated Rate |
$5,091.07 |
| Rate for Payer: Aetna Commercial |
$4,808.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,676.88
|
| Rate for Payer: Cash Price |
$4,525.39
|
| Rate for Payer: Cofinity Commercial |
$3,959.72
|
| Rate for Payer: Cofinity Commercial |
$4,864.80
|
| Rate for Payer: Healthscope Commercial |
$5,091.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,808.23
|
| Rate for Payer: PHP Commercial |
$4,808.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,959.72
|
| Rate for Payer: Priority Health SBD |
$3,563.75
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
NDC 50268-297-11
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.84
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$3.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.71
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: Priority Health SBD |
$2.75
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$321.10
|
|
|
Service Code
|
NDC 62332-464-31
|
| 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 |
$276.15
|
| Rate for Payer: Cofinity Commercial |
$224.77
|
| Rate for Payer: Healthscope Commercial |
$288.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$272.94
|
| Rate for Payer: PHP Commercial |
$272.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.77
|
| Rate for Payer: Priority Health SBD |
$202.29
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$429.60
|
|
|
Service Code
|
NDC 60687-500-01
|
| 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: Healthscope Commercial |
$386.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.16
|
| Rate for Payer: PHP Commercial |
$365.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.72
|
| Rate for Payer: Priority Health SBD |
$270.65
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
NDC 60687-500-11
|
| 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: Healthscope Commercial |
$3.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.66
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.01
|
| Rate for Payer: Priority Health SBD |
$2.71
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$218.16
|
|
|
Service Code
|
NDC 50268-297-15
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.44 |
| Max. Negotiated Rate |
$196.34 |
| Rate for Payer: Aetna Commercial |
$185.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.80
|
| Rate for Payer: Cash Price |
$174.53
|
| Rate for Payer: Cofinity Commercial |
$152.71
|
| Rate for Payer: Cofinity Commercial |
$187.62
|
| Rate for Payer: Healthscope Commercial |
$196.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.44
|
| Rate for Payer: PHP Commercial |
$185.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.71
|
| Rate for Payer: Priority Health SBD |
$137.44
|
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,142.32
|
|
|
Service Code
|
HCPCS J9179
|
| Hospital Charge Code |
106773
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.31 |
| Max. Negotiated Rate |
$5,528.09 |
| Rate for Payer: Aetna Commercial |
$5,220.97
|
| Rate for Payer: Aetna Medicare |
$139.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,992.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.52
|
| Rate for Payer: BCBS Complete |
$76.98
|
| Rate for Payer: BCBS MAPPO |
$134.02
|
| Rate for Payer: BCBS Trust/PPO |
$396.74
|
| Rate for Payer: BCN Medicare Advantage |
$134.02
|
| Rate for Payer: Cash Price |
$4,913.86
|
| Rate for Payer: Cash Price |
$4,913.86
|
| Rate for Payer: Cofinity Commercial |
$4,299.62
|
| Rate for Payer: Cofinity Commercial |
$5,282.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.02
|
| Rate for Payer: Healthscope Commercial |
$5,528.09
|
| Rate for Payer: Mclaren Medicaid |
$73.31
|
| Rate for Payer: Mclaren Medicare |
$134.02
|
| Rate for Payer: Meridian Medicaid |
$76.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$140.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,220.97
|
| Rate for Payer: PACE Medicare |
$127.32
|
| Rate for Payer: PACE SWMI |
$134.02
|
| Rate for Payer: PHP Commercial |
$5,220.97
|
| Rate for Payer: PHP Medicare Advantage |
$134.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,299.62
|
| Rate for Payer: Priority Health Medicare |
$134.02
|
| Rate for Payer: Priority Health SBD |
$3,869.66
|
| Rate for Payer: Railroad Medicare Medicare |
$134.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.02
|
| Rate for Payer: UHC Medicare Advantage |
$138.04
|
| Rate for Payer: VA VA |
$134.02
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$267.12 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$360.40
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.80
|
| Rate for Payer: Priority Health SBD |
$67.11
|
| Rate for Payer: Priority Health SBD |
$267.12
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.36 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Trust/PPO |
$38.36
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$360.40
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.80
|
| Rate for Payer: Priority Health SBD |
$267.12
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.11 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Commercial |
$117.37
|
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Commercial |
$112.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.91
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$110.46
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$105.42
|
| Rate for Payer: Cofinity Commercial |
$118.75
|
| Rate for Payer: Cofinity Commercial |
$70.98
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$113.32
|
| Rate for Payer: Cofinity Commercial |
$92.24
|
| Rate for Payer: Cofinity Commercial |
$96.66
|
| Rate for Payer: Healthscope Commercial |
$118.59
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$124.27
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$360.40
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: PHP Commercial |
$117.37
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$112.00
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.80
|
| Rate for Payer: Priority Health SBD |
$67.11
|
| Rate for Payer: Priority Health SBD |
$86.99
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Priority Health SBD |
$63.88
|
| Rate for Payer: Priority Health SBD |
$83.02
|
|
|
ERTAPENEM IVPB (INTRA-OP)
|
Facility
|
IP
|
$4,550.67
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
167002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,866.92 |
| Max. Negotiated Rate |
$4,095.60 |
| Rate for Payer: Aetna Commercial |
$3,868.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,957.94
|
| Rate for Payer: Cash Price |
$3,640.54
|
| Rate for Payer: Cofinity Commercial |
$3,185.47
|
| Rate for Payer: Cofinity Commercial |
$3,913.58
|
| Rate for Payer: Healthscope Commercial |
$4,095.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,868.07
|
| Rate for Payer: PHP Commercial |
$3,868.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,185.47
|
| Rate for Payer: Priority Health SBD |
$2,866.92
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$531.69
|
|
|
Service Code
|
NDC 24338-122-03
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$334.96 |
| Max. Negotiated Rate |
$478.52 |
| Rate for Payer: Aetna Commercial |
$451.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.60
|
| Rate for Payer: Cash Price |
$425.35
|
| Rate for Payer: Cofinity Commercial |
$372.18
|
| Rate for Payer: Cofinity Commercial |
$457.25
|
| Rate for Payer: Healthscope Commercial |
$478.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$451.94
|
| Rate for Payer: PHP Commercial |
$451.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.18
|
| Rate for Payer: Priority Health SBD |
$334.96
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$514.93
|
|
|
Service Code
|
NDC 52536-180-03
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$324.41 |
| Max. Negotiated Rate |
$463.44 |
| Rate for Payer: Aetna Commercial |
$437.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.70
|
| Rate for Payer: Cash Price |
$411.94
|
| Rate for Payer: Cofinity Commercial |
$360.45
|
| Rate for Payer: Cofinity Commercial |
$442.84
|
| Rate for Payer: Healthscope Commercial |
$463.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$437.69
|
| Rate for Payer: PHP Commercial |
$437.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.45
|
| Rate for Payer: Priority Health SBD |
$324.41
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$2,418.69
|
|
|
Service Code
|
NDC 24338-122-13
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,523.77 |
| Max. Negotiated Rate |
$2,176.82 |
| Rate for Payer: Aetna Commercial |
$2,055.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,572.15
|
| Rate for Payer: Cash Price |
$1,934.95
|
| Rate for Payer: Cofinity Commercial |
$1,693.08
|
| Rate for Payer: Cofinity Commercial |
$2,080.07
|
| Rate for Payer: Healthscope Commercial |
$2,176.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,055.89
|
| Rate for Payer: PHP Commercial |
$2,055.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,693.08
|
| Rate for Payer: Priority Health SBD |
$1,523.77
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
NDC 0574-4024-50
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.86 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.05
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.51
|
| Rate for Payer: Priority Health SBD |
$14.86
|
|
