|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$14.84
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$13.36 |
| Rate for Payer: Aetna American Axle |
$9.65
|
| Rate for Payer: Aetna American Axle |
$18.06
|
| Rate for Payer: Aetna American Axle |
$17.26
|
| Rate for Payer: Aetna American Axle |
$12.11
|
| Rate for Payer: Aetna American Axle |
$20.99
|
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Aetna Commercial |
$15.84
|
| Rate for Payer: Aetna Commercial |
$27.45
|
| Rate for Payer: Aetna Commercial |
$23.61
|
| Rate for Payer: Aetna Commercial |
$22.57
|
| Rate for Payer: Aetna Medicare |
$16.14
|
| Rate for Payer: Aetna Medicare |
$9.31
|
| Rate for Payer: Aetna Medicare |
$7.42
|
| Rate for Payer: Aetna Medicare |
$13.28
|
| Rate for Payer: Aetna Medicare |
$13.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.99
|
| Rate for Payer: BCBS Complete |
$11.11
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS Complete |
$7.45
|
| Rate for Payer: BCBS Complete |
$10.62
|
| Rate for Payer: BCBS Complete |
$12.92
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$22.22
|
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Cash Price |
$22.22
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Cofinity Advantage |
$19.45
|
| Rate for Payer: Cofinity Advantage |
$13.04
|
| Rate for Payer: Cofinity Advantage |
$18.59
|
| Rate for Payer: Cofinity Advantage |
$22.60
|
| Rate for Payer: Cofinity Advantage |
$10.39
|
| Rate for Payer: Cofinity Commercial |
$23.89
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$22.83
|
| Rate for Payer: Cofinity Commercial |
$27.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.24
|
| Rate for Payer: Healthscope Commercial |
$23.89
|
| Rate for Payer: Healthscope Commercial |
$29.06
|
| Rate for Payer: Healthscope Commercial |
$25.00
|
| Rate for Payer: Healthscope Commercial |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$16.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.22
|
| Rate for Payer: PHP Commercial |
$15.84
|
| Rate for Payer: PHP Commercial |
$22.57
|
| Rate for Payer: PHP Commercial |
$27.45
|
| Rate for Payer: PHP Commercial |
$23.61
|
| Rate for Payer: PHP Commercial |
$12.61
|
| Rate for Payer: Priority Health SBD |
$16.73
|
| Rate for Payer: Priority Health SBD |
$9.35
|
| Rate for Payer: Priority Health SBD |
$17.50
|
| Rate for Payer: Priority Health SBD |
$20.34
|
| Rate for Payer: Priority Health SBD |
$11.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UMR Bronson Commercial |
$5.49
|
| Rate for Payer: UMR Bronson Commercial |
$10.28
|
| Rate for Payer: UMR Bronson Commercial |
$9.82
|
| Rate for Payer: UMR Bronson Commercial |
$11.95
|
| Rate for Payer: UMR Bronson Commercial |
$6.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.13
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$27.78
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna American Axle |
$18.06
|
| Rate for Payer: Aetna American Axle |
$17.26
|
| Rate for Payer: Aetna American Axle |
$20.99
|
| Rate for Payer: Aetna American Axle |
$12.11
|
| Rate for Payer: Aetna American Axle |
$9.65
|
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Aetna Commercial |
$22.57
|
| Rate for Payer: Aetna Commercial |
$23.61
|
| Rate for Payer: Aetna Commercial |
$27.45
|
| Rate for Payer: Aetna Commercial |
$15.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.99
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Cash Price |
$22.22
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cofinity Advantage |
$10.39
|
| Rate for Payer: Cofinity Advantage |
$22.60
|
| Rate for Payer: Cofinity Advantage |
$13.04
|
| Rate for Payer: Cofinity Advantage |
$19.45
|
| Rate for Payer: Cofinity Advantage |
$18.59
|
| Rate for Payer: Cofinity Commercial |
$27.77
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$22.83
|
| Rate for Payer: Cofinity Commercial |
$23.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.83
|
| Rate for Payer: Healthscope Commercial |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$16.77
|
| Rate for Payer: Healthscope Commercial |
$23.89
|
| Rate for Payer: Healthscope Commercial |
$25.00
|
| Rate for Payer: Healthscope Commercial |
$29.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.84
|
| Rate for Payer: PHP Commercial |
$22.57
|
| Rate for Payer: PHP Commercial |
$12.61
|
| Rate for Payer: PHP Commercial |
$23.61
|
| Rate for Payer: PHP Commercial |
$27.45
|
| Rate for Payer: PHP Commercial |
$15.84
|
| Rate for Payer: Priority Health SBD |
$17.50
|
| Rate for Payer: Priority Health SBD |
$20.34
|
| Rate for Payer: Priority Health SBD |
$11.74
|
| Rate for Payer: Priority Health SBD |
$9.35
|
| Rate for Payer: Priority Health SBD |
$16.73
|
| Rate for Payer: UMR Bronson Commercial |
$8.20
|
| Rate for Payer: UMR Bronson Commercial |
$14.21
|
| Rate for Payer: UMR Bronson Commercial |
$11.68
|
| Rate for Payer: UMR Bronson Commercial |
$6.53
|
| Rate for Payer: UMR Bronson Commercial |
$12.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.97
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$25.37
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$22.83 |
| Rate for Payer: Aetna American Axle |
$16.49
|
| Rate for Payer: Aetna American Axle |
$16.17
|
| Rate for Payer: Aetna American Axle |
$10.97
|
| Rate for Payer: Aetna American Axle |
$16.11
|
| Rate for Payer: Aetna American Axle |
$16.15
|
| Rate for Payer: Aetna American Axle |
$10.25
|
| Rate for Payer: Aetna American Axle |
$10.34
|
| Rate for Payer: Aetna American Axle |
$27.99
|
| Rate for Payer: Aetna Commercial |
$14.34
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna Commercial |
$21.07
|
| Rate for Payer: Aetna Commercial |
$21.14
|
| Rate for Payer: Aetna Commercial |
$21.56
|
| Rate for Payer: Aetna Commercial |
$36.60
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: Aetna Medicare |
$7.95
|
| Rate for Payer: Aetna Medicare |
$12.69
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Aetna Medicare |
$12.42
|
| Rate for Payer: Aetna Medicare |
$12.39
|
| Rate for Payer: Aetna Medicare |
$21.53
|
| Rate for Payer: Aetna Medicare |
$12.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: BCBS Complete |
$17.22
|
| Rate for Payer: BCBS Complete |
$9.95
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS Complete |
$6.31
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS Complete |
$6.36
|
| Rate for Payer: BCBS Complete |
$10.15
|
| Rate for Payer: BCBS Complete |
$9.94
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cash Price |
$34.45
|
| Rate for Payer: Cash Price |
$34.45
|
| Rate for Payer: Cofinity Advantage |
$17.41
|
| Rate for Payer: Cofinity Advantage |
$30.14
|
| Rate for Payer: Cofinity Advantage |
$11.81
|
| Rate for Payer: Cofinity Advantage |
$17.39
|
| Rate for Payer: Cofinity Advantage |
$17.76
|
| Rate for Payer: Cofinity Advantage |
$17.35
|
| Rate for Payer: Cofinity Advantage |
$11.04
|
| Rate for Payer: Cofinity Advantage |
$11.13
|
| Rate for Payer: Cofinity Commercial |
$21.32
|
| Rate for Payer: Cofinity Commercial |
$21.39
|
| Rate for Payer: Cofinity Commercial |
$37.03
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Commercial |
$13.67
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| Rate for Payer: Cofinity Commercial |
$21.82
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.30
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Healthscope Commercial |
$38.75
|
| Rate for Payer: Healthscope Commercial |
$15.18
|
| Rate for Payer: Healthscope Commercial |
$22.31
|
| Rate for Payer: Healthscope Commercial |
$22.83
|
| Rate for Payer: Healthscope Commercial |
$22.38
|
| Rate for Payer: Healthscope Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.65
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: PHP Commercial |
$21.07
|
| Rate for Payer: PHP Commercial |
$21.14
|
| Rate for Payer: PHP Commercial |
$14.34
|
| Rate for Payer: PHP Commercial |
$36.60
|
| Rate for Payer: PHP Commercial |
$21.56
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: Priority Health SBD |
$10.02
|
| Rate for Payer: Priority Health SBD |
$27.13
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: Priority Health SBD |
$15.67
|
| Rate for Payer: Priority Health SBD |
$15.98
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: Priority Health SBD |
$15.62
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: UMR Bronson Commercial |
$15.93
|
| Rate for Payer: UMR Bronson Commercial |
$9.19
|
| Rate for Payer: UMR Bronson Commercial |
$6.24
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
| Rate for Payer: UMR Bronson Commercial |
$5.83
|
| Rate for Payer: UMR Bronson Commercial |
$5.88
|
| Rate for Payer: UMR Bronson Commercial |
$9.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.03
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$24.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$22.31 |
| Rate for Payer: Aetna American Axle |
$16.11
|
| Rate for Payer: Aetna American Axle |
$16.17
|
| Rate for Payer: Aetna American Axle |
$16.49
|
| Rate for Payer: Aetna American Axle |
$10.25
|
| Rate for Payer: Aetna American Axle |
$10.97
|
| Rate for Payer: Aetna American Axle |
$10.34
|
| Rate for Payer: Aetna American Axle |
$27.99
|
| Rate for Payer: Aetna American Axle |
$16.15
|
| Rate for Payer: Aetna Commercial |
$36.60
|
| Rate for Payer: Aetna Commercial |
$21.56
|
| Rate for Payer: Aetna Commercial |
$21.07
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Commercial |
$21.14
|
| Rate for Payer: Aetna Commercial |
$14.34
|
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.17
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$34.45
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cofinity Advantage |
$30.14
|
| Rate for Payer: Cofinity Advantage |
$11.13
|
| Rate for Payer: Cofinity Advantage |
$17.35
|
| Rate for Payer: Cofinity Advantage |
$11.81
|
| Rate for Payer: Cofinity Advantage |
$11.04
|
| Rate for Payer: Cofinity Advantage |
$17.41
|
| Rate for Payer: Cofinity Advantage |
$17.76
|
| Rate for Payer: Cofinity Advantage |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$13.67
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| Rate for Payer: Cofinity Commercial |
$21.32
|
| Rate for Payer: Cofinity Commercial |
$37.03
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Commercial |
$21.82
|
| Rate for Payer: Cofinity Commercial |
$21.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Healthscope Commercial |
$22.31
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Healthscope Commercial |
$38.75
|
| Rate for Payer: Healthscope Commercial |
$22.83
|
| Rate for Payer: Healthscope Commercial |
$15.18
|
| Rate for Payer: Healthscope Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$22.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.30
|
| Rate for Payer: PHP Commercial |
$21.07
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: PHP Commercial |
$36.60
|
| Rate for Payer: PHP Commercial |
$14.34
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: PHP Commercial |
$21.14
|
| Rate for Payer: PHP Commercial |
$21.56
|
| Rate for Payer: Priority Health SBD |
$15.67
|
| Rate for Payer: Priority Health SBD |
$15.98
|
| Rate for Payer: Priority Health SBD |
$27.13
|
| Rate for Payer: Priority Health SBD |
$10.02
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: Priority Health SBD |
$15.62
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: UMR Bronson Commercial |
$6.94
|
| Rate for Payer: UMR Bronson Commercial |
$10.93
|
| Rate for Payer: UMR Bronson Commercial |
$7.42
|
| Rate for Payer: UMR Bronson Commercial |
$18.95
|
| Rate for Payer: UMR Bronson Commercial |
$11.16
|
| Rate for Payer: UMR Bronson Commercial |
$10.91
|
| Rate for Payer: UMR Bronson Commercial |
$7.00
|
| Rate for Payer: UMR Bronson Commercial |
$10.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.03
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$18.75
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna American Axle |
$12.19
|
| Rate for Payer: Aetna American Axle |
$24.21
|
| Rate for Payer: Aetna American Axle |
$24.17
|
| Rate for Payer: Aetna American Axle |
$17.54
|
| Rate for Payer: Aetna American Axle |
$42.03
|
| Rate for Payer: Aetna Commercial |
$15.94
|
| Rate for Payer: Aetna Commercial |
$22.94
|
| Rate for Payer: Aetna Commercial |
$54.96
|
| Rate for Payer: Aetna Commercial |
$31.66
|
| Rate for Payer: Aetna Commercial |
$31.60
|
| Rate for Payer: Aetna Medicare |
$32.33
|
| Rate for Payer: Aetna Medicare |
$13.49
|
| Rate for Payer: Aetna Medicare |
$9.38
|
| Rate for Payer: Aetna Medicare |
$18.59
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.03
|
| Rate for Payer: BCBS Complete |
$14.90
|
| Rate for Payer: BCBS Complete |
$7.50
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS Complete |
$14.87
|
| Rate for Payer: BCBS Complete |
$25.86
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cash Price |
$51.73
|
| Rate for Payer: Cash Price |
$21.59
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cash Price |
$21.59
|
| Rate for Payer: Cash Price |
$51.73
|
| Rate for Payer: Cofinity Advantage |
$26.07
|
| Rate for Payer: Cofinity Advantage |
$18.89
|
| Rate for Payer: Cofinity Advantage |
$26.03
|
| Rate for Payer: Cofinity Advantage |
$45.26
|
| Rate for Payer: Cofinity Advantage |
$13.12
|
| Rate for Payer: Cofinity Commercial |
$32.03
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$23.21
|
| Rate for Payer: Cofinity Commercial |
$31.97
|
| Rate for Payer: Cofinity Commercial |
$55.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.74
|
| Rate for Payer: Healthscope Commercial |
$33.46
|
| Rate for Payer: Healthscope Commercial |
$58.19
|
| Rate for Payer: Healthscope Commercial |
$33.52
|
| Rate for Payer: Healthscope Commercial |
$16.88
|
| Rate for Payer: Healthscope Commercial |
$24.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.49
|
| Rate for Payer: PHP Commercial |
$22.94
|
| Rate for Payer: PHP Commercial |
$31.60
|
| Rate for Payer: PHP Commercial |
$54.96
|
| Rate for Payer: PHP Commercial |
$31.66
|
| Rate for Payer: PHP Commercial |
$15.94
|
| Rate for Payer: Priority Health SBD |
$23.42
|
| Rate for Payer: Priority Health SBD |
$11.81
|
| Rate for Payer: Priority Health SBD |
$23.47
|
| Rate for Payer: Priority Health SBD |
$40.74
|
| Rate for Payer: Priority Health SBD |
$17.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UMR Bronson Commercial |
$6.94
|
| Rate for Payer: UMR Bronson Commercial |
$13.78
|
| Rate for Payer: UMR Bronson Commercial |
$13.76
|
| Rate for Payer: UMR Bronson Commercial |
$23.92
|
| Rate for Payer: UMR Bronson Commercial |
$9.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.06
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$37.25
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$33.52 |
| Rate for Payer: Aetna American Axle |
$24.21
|
| Rate for Payer: Aetna American Axle |
$24.17
|
| Rate for Payer: Aetna American Axle |
$42.03
|
| Rate for Payer: Aetna American Axle |
$17.54
|
| Rate for Payer: Aetna American Axle |
$12.19
|
| Rate for Payer: Aetna Commercial |
$15.94
|
| Rate for Payer: Aetna Commercial |
$31.60
|
| Rate for Payer: Aetna Commercial |
$31.66
|
| Rate for Payer: Aetna Commercial |
$54.96
|
| Rate for Payer: Aetna Commercial |
$22.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.03
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cash Price |
$21.59
|
| Rate for Payer: Cash Price |
$51.73
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cofinity Advantage |
$13.12
|
| Rate for Payer: Cofinity Advantage |
$45.26
|
| Rate for Payer: Cofinity Advantage |
$18.89
|
| Rate for Payer: Cofinity Advantage |
$26.07
|
| Rate for Payer: Cofinity Advantage |
$26.03
|
| Rate for Payer: Cofinity Commercial |
$55.61
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$23.21
|
| Rate for Payer: Cofinity Commercial |
$31.97
|
| Rate for Payer: Cofinity Commercial |
$32.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.73
|
| Rate for Payer: Healthscope Commercial |
$16.88
|
| Rate for Payer: Healthscope Commercial |
$24.29
|
| Rate for Payer: Healthscope Commercial |
$33.46
|
| Rate for Payer: Healthscope Commercial |
$33.52
|
| Rate for Payer: Healthscope Commercial |
$58.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.94
|
| Rate for Payer: PHP Commercial |
$31.60
|
| Rate for Payer: PHP Commercial |
$15.94
|
| Rate for Payer: PHP Commercial |
$31.66
|
| Rate for Payer: PHP Commercial |
$54.96
|
| Rate for Payer: PHP Commercial |
$22.94
|
| Rate for Payer: Priority Health SBD |
$23.47
|
| Rate for Payer: Priority Health SBD |
$40.74
|
| Rate for Payer: Priority Health SBD |
$17.00
|
| Rate for Payer: Priority Health SBD |
$11.81
|
| Rate for Payer: Priority Health SBD |
$23.42
|
| Rate for Payer: UMR Bronson Commercial |
$11.88
|
| Rate for Payer: UMR Bronson Commercial |
$28.45
|
| Rate for Payer: UMR Bronson Commercial |
$16.36
|
| Rate for Payer: UMR Bronson Commercial |
$8.25
|
| Rate for Payer: UMR Bronson Commercial |
$16.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.24
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$70.74
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna American Axle |
$45.98
|
| Rate for Payer: Aetna American Axle |
$32.29
|
| Rate for Payer: Aetna American Axle |
$56.04
|
| Rate for Payer: Aetna American Axle |
$14.50
|
| Rate for Payer: Aetna Commercial |
$73.28
|
| Rate for Payer: Aetna Commercial |
$60.13
|
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.50
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cash Price |
$68.97
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$56.59
|
| Rate for Payer: Cofinity Advantage |
$34.77
|
| Rate for Payer: Cofinity Advantage |
$15.62
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Advantage |
$60.35
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$74.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Healthscope Commercial |
$77.59
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$20.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.73
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: PHP Commercial |
$60.13
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: PHP Commercial |
$73.28
|
| Rate for Payer: Priority Health SBD |
$54.31
|
| Rate for Payer: Priority Health SBD |
$14.06
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: UMR Bronson Commercial |
$21.85
|
| Rate for Payer: UMR Bronson Commercial |
$31.13
|
| Rate for Payer: UMR Bronson Commercial |
$9.82
|
| Rate for Payer: UMR Bronson Commercial |
$37.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.66
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$86.21
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$77.59 |
| Rate for Payer: Aetna American Axle |
$56.04
|
| Rate for Payer: Aetna American Axle |
$14.50
|
| Rate for Payer: Aetna American Axle |
$32.29
|
| Rate for Payer: Aetna American Axle |
$45.98
|
| Rate for Payer: Aetna Commercial |
$73.28
|
| Rate for Payer: Aetna Commercial |
$60.13
|
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna Medicare |
$35.37
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna Medicare |
$43.10
|
| Rate for Payer: Aetna Medicare |
$11.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.98
|
| Rate for Payer: BCBS Complete |
$8.92
|
| Rate for Payer: BCBS Complete |
$19.87
|
| Rate for Payer: BCBS Complete |
$28.30
|
| Rate for Payer: BCBS Complete |
$34.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$56.59
|
| Rate for Payer: Cash Price |
$68.97
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cash Price |
$68.97
|
| Rate for Payer: Cash Price |
$56.59
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cofinity Advantage |
$60.35
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Advantage |
$34.77
|
| Rate for Payer: Cofinity Advantage |
$15.62
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Commercial |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$20.08
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Healthscope Commercial |
$77.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.66
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: PHP Commercial |
$60.13
|
| Rate for Payer: PHP Commercial |
$73.28
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: Priority Health SBD |
$14.06
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: Priority Health SBD |
$54.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UMR Bronson Commercial |
$31.90
|
| Rate for Payer: UMR Bronson Commercial |
$8.25
|
| Rate for Payer: UMR Bronson Commercial |
$18.38
|
| Rate for Payer: UMR Bronson Commercial |
$26.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.66
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 27241004910
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Advantage |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UMR Bronson Commercial |
$117.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 27241004910
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.10 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna Medicare |
$133.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: BCBS Complete |
$107.14
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Advantage |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.10
|
| Rate for Payer: UHC Core |
$139.54
|
| Rate for Payer: UHC Exchange |
$105.26
|
| Rate for Payer: UMR Bronson Commercial |
$99.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$256.32
|
|
|
Service Code
|
NDC 65862065401
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.78 |
| Max. Negotiated Rate |
$230.69 |
| Rate for Payer: Aetna American Axle |
$166.61
|
| Rate for Payer: Aetna Commercial |
$217.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.61
|
| Rate for Payer: Cash Price |
$205.06
|
| Rate for Payer: Cofinity Advantage |
$179.42
|
| Rate for Payer: Cofinity Commercial |
$220.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.06
|
| Rate for Payer: Healthscope Commercial |
$230.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.24
|
| Rate for Payer: PHP Commercial |
$217.87
|
| Rate for Payer: Priority Health SBD |
$161.48
|
| Rate for Payer: UMR Bronson Commercial |
$112.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.24
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$1,308.69
|
|
|
Service Code
|
NDC 47335000788
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$575.82 |
| Max. Negotiated Rate |
$1,177.82 |
| Rate for Payer: Aetna American Axle |
$850.65
|
| Rate for Payer: Aetna Commercial |
$1,112.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.65
|
| Rate for Payer: Cash Price |
$1,046.95
|
| Rate for Payer: Cofinity Advantage |
$916.08
|
| Rate for Payer: Cofinity Commercial |
$1,125.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.95
|
| Rate for Payer: Healthscope Commercial |
$1,177.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$916.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$981.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,112.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$981.52
|
| Rate for Payer: PHP Commercial |
$1,112.39
|
| Rate for Payer: Priority Health SBD |
$824.47
|
| Rate for Payer: UMR Bronson Commercial |
$575.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$981.52
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
OP
|
$256.32
|
|
|
Service Code
|
NDC 65862065401
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.84 |
| Max. Negotiated Rate |
$230.69 |
| Rate for Payer: Aetna American Axle |
$166.61
|
| Rate for Payer: Aetna Commercial |
$217.87
|
| Rate for Payer: Aetna Medicare |
$128.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.61
|
| Rate for Payer: BCBS Complete |
$102.53
|
| Rate for Payer: Cash Price |
$205.06
|
| Rate for Payer: Cofinity Advantage |
$179.42
|
| Rate for Payer: Cofinity Commercial |
$220.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.06
|
| Rate for Payer: Healthscope Commercial |
$230.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.24
|
| Rate for Payer: PHP Commercial |
$217.87
|
| Rate for Payer: Priority Health SBD |
$161.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.61
|
| Rate for Payer: UHC Core |
$133.54
|
| Rate for Payer: UHC Exchange |
$100.73
|
| Rate for Payer: UMR Bronson Commercial |
$94.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.24
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
OP
|
$1,308.69
|
|
|
Service Code
|
NDC 47335000788
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$484.22 |
| Max. Negotiated Rate |
$1,177.82 |
| Rate for Payer: Aetna American Axle |
$850.65
|
| Rate for Payer: Aetna Commercial |
$1,112.39
|
| Rate for Payer: Aetna Medicare |
$654.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.65
|
| Rate for Payer: BCBS Complete |
$523.48
|
| Rate for Payer: Cash Price |
$1,046.95
|
| Rate for Payer: Cofinity Advantage |
$916.08
|
| Rate for Payer: Cofinity Commercial |
$1,125.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.95
|
| Rate for Payer: Healthscope Commercial |
$1,177.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$916.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$981.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,046.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,112.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$981.52
|
| Rate for Payer: PHP Commercial |
$1,112.39
|
| Rate for Payer: Priority Health SBD |
$824.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$850.65
|
| Rate for Payer: UHC Core |
$681.83
|
| Rate for Payer: UHC Exchange |
$514.32
|
| Rate for Payer: UMR Bronson Commercial |
$484.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$981.52
|
|
|
EPCORITAMAB-BYSP 0.16 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$2,371.17
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
301958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,043.31 |
| Max. Negotiated Rate |
$2,134.05 |
| Rate for Payer: Aetna American Axle |
$1,541.26
|
| Rate for Payer: Aetna Commercial |
$2,015.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,541.26
|
| Rate for Payer: Cash Price |
$1,896.94
|
| Rate for Payer: Cofinity Advantage |
$1,659.82
|
| Rate for Payer: Cofinity Commercial |
$2,039.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,896.94
|
| Rate for Payer: Healthscope Commercial |
$2,134.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,659.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,778.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,015.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,778.38
|
| Rate for Payer: PHP Commercial |
$2,015.49
|
| Rate for Payer: Priority Health SBD |
$1,493.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,043.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,778.38
|
|
|
EPCORITAMAB-BYSP 0.16 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$2,371.17
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
301958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$2,134.05 |
| Rate for Payer: Aetna American Axle |
$1,541.26
|
| Rate for Payer: Aetna Commercial |
$2,015.49
|
| Rate for Payer: Aetna Medicare |
$59.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,541.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.15
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$56.92
|
| Rate for Payer: BCBS Trust/PPO |
$184.18
|
| Rate for Payer: BCN Commercial |
$184.18
|
| Rate for Payer: BCN Medicare Advantage |
$56.92
|
| Rate for Payer: Cash Price |
$1,896.94
|
| Rate for Payer: Cash Price |
$1,896.94
|
| Rate for Payer: Cofinity Advantage |
$1,659.82
|
| Rate for Payer: Cofinity Commercial |
$2,039.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,896.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.92
|
| Rate for Payer: Healthscope Commercial |
$2,134.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,659.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,778.38
|
| Rate for Payer: Mclaren Medicaid |
$56.92
|
| Rate for Payer: Mclaren Medicare |
$56.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.77
|
| Rate for Payer: Meridian Medicaid |
$59.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,015.49
|
| Rate for Payer: Nomi Health Commercial |
$170.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,778.38
|
| Rate for Payer: PACE Medicare |
$54.07
|
| Rate for Payer: PACE SWMI |
$56.92
|
| Rate for Payer: PHP Commercial |
$2,015.49
|
| Rate for Payer: PHP Medicare Advantage |
$56.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$176.13
|
| Rate for Payer: Priority Health Medicare |
$56.92
|
| Rate for Payer: Priority Health SBD |
$1,493.84
|
| Rate for Payer: Priority Health Tiered Network |
$140.90
|
| Rate for Payer: Railroad Medicare Medicare |
$56.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.74
|
| Rate for Payer: UHC Core |
$93.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56.92
|
| Rate for Payer: UHC Exchange |
$93.74
|
| Rate for Payer: UHC Medicaid |
$29.77
|
| Rate for Payer: UHCCP Medicaid |
$29.77
|
| Rate for Payer: UMR Bronson Commercial |
$877.33
|
| Rate for Payer: VA VA |
$56.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,778.38
|
|
|
EPCORITAMAB-BYSP 0.8 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$5,927.03
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
301960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$5,334.33 |
| Rate for Payer: Aetna American Axle |
$3,852.57
|
| Rate for Payer: Aetna Commercial |
$5,037.98
|
| Rate for Payer: Aetna Medicare |
$59.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,852.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.15
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$56.92
|
| Rate for Payer: BCBS Trust/PPO |
$184.18
|
| Rate for Payer: BCN Commercial |
$184.18
|
| Rate for Payer: BCN Medicare Advantage |
$56.92
|
| Rate for Payer: Cash Price |
$4,741.62
|
| Rate for Payer: Cash Price |
$4,741.62
|
| Rate for Payer: Cofinity Advantage |
$4,148.92
|
| Rate for Payer: Cofinity Commercial |
$5,097.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,741.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.92
|
| Rate for Payer: Healthscope Commercial |
$5,334.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,148.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,445.27
|
| Rate for Payer: Mclaren Medicaid |
$56.92
|
| Rate for Payer: Mclaren Medicare |
$56.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.77
|
| Rate for Payer: Meridian Medicaid |
$59.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,037.98
|
| Rate for Payer: Nomi Health Commercial |
$170.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,445.27
|
| Rate for Payer: PACE Medicare |
$54.07
|
| Rate for Payer: PACE SWMI |
$56.92
|
| Rate for Payer: PHP Commercial |
$5,037.98
|
| Rate for Payer: PHP Medicare Advantage |
$56.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$176.13
|
| Rate for Payer: Priority Health Medicare |
$56.92
|
| Rate for Payer: Priority Health SBD |
$3,734.03
|
| Rate for Payer: Priority Health Tiered Network |
$140.90
|
| Rate for Payer: Railroad Medicare Medicare |
$56.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.74
|
| Rate for Payer: UHC Core |
$93.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56.92
|
| Rate for Payer: UHC Exchange |
$93.74
|
| Rate for Payer: UHC Medicaid |
$29.77
|
| Rate for Payer: UHCCP Medicaid |
$29.77
|
| Rate for Payer: UMR Bronson Commercial |
$2,193.00
|
| Rate for Payer: VA VA |
$56.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,445.27
|
|
|
EPCORITAMAB-BYSP 0.8 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$5,927.03
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
301960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,607.89 |
| Max. Negotiated Rate |
$5,334.33 |
| Rate for Payer: Aetna American Axle |
$3,852.57
|
| Rate for Payer: Aetna Commercial |
$5,037.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,852.57
|
| Rate for Payer: Cash Price |
$4,741.62
|
| Rate for Payer: Cofinity Advantage |
$4,148.92
|
| Rate for Payer: Cofinity Commercial |
$5,097.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,741.62
|
| Rate for Payer: Healthscope Commercial |
$5,334.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,148.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,445.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,037.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,445.27
|
| Rate for Payer: PHP Commercial |
$5,037.98
|
| Rate for Payer: Priority Health SBD |
$3,734.03
|
| Rate for Payer: UMR Bronson Commercial |
$2,607.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,445.27
|
|
|
EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$75,476.73
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
204020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33,209.76 |
| Max. Negotiated Rate |
$67,929.06 |
| Rate for Payer: Aetna American Axle |
$49,059.87
|
| Rate for Payer: Aetna Commercial |
$64,155.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49,059.87
|
| Rate for Payer: Cash Price |
$60,381.38
|
| Rate for Payer: Cofinity Advantage |
$52,833.71
|
| Rate for Payer: Cofinity Commercial |
$64,909.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60,381.38
|
| Rate for Payer: Healthscope Commercial |
$67,929.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52,833.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56,607.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64,155.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56,607.55
|
| Rate for Payer: PHP Commercial |
$64,155.22
|
| Rate for Payer: Priority Health SBD |
$47,550.34
|
| Rate for Payer: UMR Bronson Commercial |
$33,209.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56,607.55
|
|
|
EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$75,476.73
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
204020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$67,929.06 |
| Rate for Payer: Aetna American Axle |
$49,059.87
|
| Rate for Payer: Aetna Commercial |
$64,155.22
|
| Rate for Payer: Aetna Medicare |
$59.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49,059.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.15
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$56.92
|
| Rate for Payer: BCBS Trust/PPO |
$184.18
|
| Rate for Payer: BCN Commercial |
$184.18
|
| Rate for Payer: BCN Medicare Advantage |
$56.92
|
| Rate for Payer: Cash Price |
$60,381.38
|
| Rate for Payer: Cash Price |
$60,381.38
|
| Rate for Payer: Cofinity Advantage |
$52,833.71
|
| Rate for Payer: Cofinity Commercial |
$64,909.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60,381.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.92
|
| Rate for Payer: Healthscope Commercial |
$67,929.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52,833.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56,607.55
|
| Rate for Payer: Mclaren Medicaid |
$56.92
|
| Rate for Payer: Mclaren Medicare |
$56.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.77
|
| Rate for Payer: Meridian Medicaid |
$59.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64,155.22
|
| Rate for Payer: Nomi Health Commercial |
$170.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56,607.55
|
| Rate for Payer: PACE Medicare |
$54.07
|
| Rate for Payer: PACE SWMI |
$56.92
|
| Rate for Payer: PHP Commercial |
$64,155.22
|
| Rate for Payer: PHP Medicare Advantage |
$56.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$176.13
|
| Rate for Payer: Priority Health Medicare |
$56.92
|
| Rate for Payer: Priority Health SBD |
$47,550.34
|
| Rate for Payer: Priority Health Tiered Network |
$140.90
|
| Rate for Payer: Railroad Medicare Medicare |
$56.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.74
|
| Rate for Payer: UHC Core |
$93.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56.92
|
| Rate for Payer: UHC Exchange |
$93.74
|
| Rate for Payer: UHC Medicaid |
$29.77
|
| Rate for Payer: UHCCP Medicaid |
$29.77
|
| Rate for Payer: UMR Bronson Commercial |
$27,926.39
|
| Rate for Payer: VA VA |
$56.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56,607.55
|
|
|
EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$6,289.73
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
204021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$5,660.76 |
| Rate for Payer: Aetna American Axle |
$4,088.32
|
| Rate for Payer: Aetna Commercial |
$5,346.27
|
| Rate for Payer: Aetna Medicare |
$59.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,088.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.15
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$56.92
|
| Rate for Payer: BCBS Trust/PPO |
$184.18
|
| Rate for Payer: BCN Commercial |
$184.18
|
| Rate for Payer: BCN Medicare Advantage |
$56.92
|
| Rate for Payer: Cash Price |
$5,031.78
|
| Rate for Payer: Cash Price |
$5,031.78
|
| Rate for Payer: Cofinity Advantage |
$4,402.81
|
| Rate for Payer: Cofinity Commercial |
$5,409.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,031.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.92
|
| Rate for Payer: Healthscope Commercial |
$5,660.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,402.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,717.30
|
| Rate for Payer: Mclaren Medicaid |
$56.92
|
| Rate for Payer: Mclaren Medicare |
$56.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.77
|
| Rate for Payer: Meridian Medicaid |
$59.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,346.27
|
| Rate for Payer: Nomi Health Commercial |
$170.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,717.30
|
| Rate for Payer: PACE Medicare |
$54.07
|
| Rate for Payer: PACE SWMI |
$56.92
|
| Rate for Payer: PHP Commercial |
$5,346.27
|
| Rate for Payer: PHP Medicare Advantage |
$56.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$176.13
|
| Rate for Payer: Priority Health Medicare |
$56.92
|
| Rate for Payer: Priority Health SBD |
$3,962.53
|
| Rate for Payer: Priority Health Tiered Network |
$140.90
|
| Rate for Payer: Railroad Medicare Medicare |
$56.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.74
|
| Rate for Payer: UHC Core |
$93.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56.92
|
| Rate for Payer: UHC Exchange |
$93.74
|
| Rate for Payer: UHC Medicaid |
$29.77
|
| Rate for Payer: UHCCP Medicaid |
$29.77
|
| Rate for Payer: UMR Bronson Commercial |
$2,327.20
|
| Rate for Payer: VA VA |
$56.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,717.30
|
|
|
EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$6,289.73
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
204021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,767.48 |
| Max. Negotiated Rate |
$5,660.76 |
| Rate for Payer: Aetna American Axle |
$4,088.32
|
| Rate for Payer: Aetna Commercial |
$5,346.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,088.32
|
| Rate for Payer: Cash Price |
$5,031.78
|
| Rate for Payer: Cofinity Advantage |
$4,402.81
|
| Rate for Payer: Cofinity Commercial |
$5,409.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,031.78
|
| Rate for Payer: Healthscope Commercial |
$5,660.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,402.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,717.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,346.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,717.30
|
| Rate for Payer: PHP Commercial |
$5,346.27
|
| Rate for Payer: Priority Health SBD |
$3,962.53
|
| Rate for Payer: UMR Bronson Commercial |
$2,767.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,717.30
|
|
|
EPHEDRINE 10MG/2 ML SYRINGE
|
Facility
|
IP
|
$8.86
|
|
|
Service Code
|
NDC 09900000633
|
| Hospital Charge Code |
180020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: Aetna American Axle |
$5.76
|
| Rate for Payer: Aetna Commercial |
$7.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.76
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Cofinity Advantage |
$6.20
|
| Rate for Payer: Cofinity Commercial |
$7.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.09
|
| Rate for Payer: Healthscope Commercial |
$7.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.64
|
| Rate for Payer: PHP Commercial |
$7.53
|
| Rate for Payer: Priority Health SBD |
$5.58
|
| Rate for Payer: UMR Bronson Commercial |
$3.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
EPHEDRINE 10MG/2 ML SYRINGE
|
Facility
|
OP
|
$8.86
|
|
|
Service Code
|
NDC 09900000633
|
| Hospital Charge Code |
180020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: Aetna American Axle |
$5.76
|
| Rate for Payer: Aetna Commercial |
$7.53
|
| Rate for Payer: Aetna Medicare |
$4.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.76
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Cofinity Advantage |
$6.20
|
| Rate for Payer: Cofinity Commercial |
$7.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.09
|
| Rate for Payer: Healthscope Commercial |
$7.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.64
|
| Rate for Payer: PHP Commercial |
$7.53
|
| Rate for Payer: Priority Health SBD |
$5.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.76
|
| Rate for Payer: UHC Core |
$4.62
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UMR Bronson Commercial |
$3.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$144.85
|
|
|
Service Code
|
NDC 14789025110
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.59 |
| Max. Negotiated Rate |
$130.37 |
| Rate for Payer: Aetna American Axle |
$94.15
|
| Rate for Payer: Aetna Commercial |
$123.12
|
| Rate for Payer: Aetna Medicare |
$72.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.15
|
| Rate for Payer: BCBS Complete |
$57.94
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cofinity Advantage |
$101.39
|
| Rate for Payer: Cofinity Commercial |
$124.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.88
|
| Rate for Payer: Healthscope Commercial |
$130.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.64
|
| Rate for Payer: PHP Commercial |
$123.12
|
| Rate for Payer: Priority Health SBD |
$91.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.15
|
| Rate for Payer: UHC Core |
$75.47
|
| Rate for Payer: UHC Exchange |
$56.93
|
| Rate for Payer: UMR Bronson Commercial |
$53.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.64
|
|
