|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$37.18
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$33.46 |
| Rate for Payer: Aetna American Axle |
$24.17
|
| Rate for Payer: Aetna American Axle |
$17.54
|
| Rate for Payer: Aetna American Axle |
$12.19
|
| Rate for Payer: Aetna American Axle |
$24.21
|
| Rate for Payer: Aetna American Axle |
$23.98
|
| Rate for Payer: Aetna American Axle |
$42.03
|
| Rate for Payer: Aetna Commercial |
$54.96
|
| Rate for Payer: Aetna Commercial |
$31.60
|
| Rate for Payer: Aetna Commercial |
$22.94
|
| Rate for Payer: Aetna Commercial |
$15.94
|
| Rate for Payer: Aetna Commercial |
$31.66
|
| Rate for Payer: Aetna Commercial |
$31.36
|
| Rate for Payer: Aetna Medicare |
$18.45
|
| Rate for Payer: Aetna Medicare |
$9.38
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna Medicare |
$32.33
|
| Rate for Payer: Aetna Medicare |
$18.59
|
| Rate for Payer: Aetna Medicare |
$13.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.17
|
| 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 |
$25.86
|
| Rate for Payer: BCBS Complete |
$14.87
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS Complete |
$14.76
|
| Rate for Payer: BCBS Complete |
$14.90
|
| Rate for Payer: BCBS Complete |
$7.50
|
| Rate for Payer: Cash Price |
$21.59
|
| Rate for Payer: Cash Price |
$29.52
|
| Rate for Payer: Cash Price |
$29.74
|
| 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 Commercial |
$55.61
|
| Rate for Payer: Cofinity Commercial |
$31.97
|
| Rate for Payer: Cofinity Commercial |
$13.12
|
| Rate for Payer: Cofinity Commercial |
$31.73
|
| Rate for Payer: Cofinity Commercial |
$25.83
|
| Rate for Payer: Cofinity Commercial |
$26.03
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Cofinity Commercial |
$23.21
|
| Rate for Payer: Cofinity Commercial |
$45.26
|
| Rate for Payer: Cofinity Commercial |
$32.03
|
| Rate for Payer: Cofinity Commercial |
$26.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.26
|
| 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 |
$29.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.73
|
| Rate for Payer: Healthscope Commercial |
$24.29
|
| Rate for Payer: Healthscope Commercial |
$33.21
|
| Rate for Payer: Healthscope Commercial |
$16.88
|
| Rate for Payer: Healthscope Commercial |
$33.46
|
| Rate for Payer: Healthscope Commercial |
$58.19
|
| Rate for Payer: Healthscope Commercial |
$33.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.68
|
| 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: Multiplan/Beech St/PHCS Commercial |
$31.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.36
|
| Rate for Payer: PHP Commercial |
$15.94
|
| Rate for Payer: PHP Commercial |
$31.60
|
| Rate for Payer: PHP Commercial |
$31.36
|
| Rate for Payer: PHP Commercial |
$22.94
|
| Rate for Payer: PHP Commercial |
$31.66
|
| Rate for Payer: PHP Commercial |
$54.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.98
|
| Rate for Payer: Priority Health SBD |
$17.00
|
| Rate for Payer: Priority Health SBD |
$23.47
|
| Rate for Payer: Priority Health SBD |
$23.25
|
| Rate for Payer: Priority Health SBD |
$23.42
|
| Rate for Payer: Priority Health SBD |
$11.81
|
| Rate for Payer: Priority Health SBD |
$40.74
|
| Rate for Payer: UMR Bronson Commercial |
$23.92
|
| Rate for Payer: UMR Bronson Commercial |
$6.94
|
| Rate for Payer: UMR Bronson Commercial |
$9.99
|
| Rate for Payer: UMR Bronson Commercial |
$13.65
|
| Rate for Payer: UMR Bronson Commercial |
$13.76
|
| Rate for Payer: UMR Bronson Commercial |
$13.78
|
| 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 |
$27.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.24
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$49.67
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$44.70 |
| 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 American Axle |
$45.98
|
| Rate for Payer: Aetna Commercial |
$73.28
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna Commercial |
$60.13
|
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: Aetna Medicare |
$35.37
|
| Rate for Payer: Aetna Medicare |
$11.15
|
| Rate for Payer: Aetna Medicare |
$43.10
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.50
|
| Rate for Payer: BCBS Complete |
$8.92
|
| Rate for Payer: BCBS Complete |
$34.48
|
| Rate for Payer: BCBS Complete |
$28.30
|
| Rate for Payer: BCBS Complete |
$19.87
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$56.59
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cash Price |
$68.97
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$15.62
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Commercial |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.35
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$34.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.35
|
| 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 |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| 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 |
$60.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.52
|
| 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: 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 |
$53.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.66
|
| 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 |
$42.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.13
|
| Rate for Payer: PHP Commercial |
$60.13
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: PHP Commercial |
$73.28
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: Priority Health SBD |
$54.31
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: Priority Health SBD |
$14.06
|
| Rate for Payer: UMR Bronson Commercial |
$26.17
|
| Rate for Payer: UMR Bronson Commercial |
$18.38
|
| Rate for Payer: UMR Bronson Commercial |
$31.90
|
| Rate for Payer: UMR Bronson Commercial |
$8.25
|
| 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 |
$64.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.25
|
|
|
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 |
$14.50
|
| Rate for Payer: Aetna American Axle |
$56.04
|
| Rate for Payer: Aetna Commercial |
$60.13
|
| Rate for Payer: Aetna Commercial |
$73.28
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.98
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$56.59
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cash Price |
$68.97
|
| Rate for Payer: Cofinity Commercial |
$15.62
|
| Rate for Payer: Cofinity Commercial |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$60.35
|
| Rate for Payer: Cofinity Commercial |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$34.77
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.62
|
| 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 |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| 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 |
$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: Kalamazoo County Sherrif's Dept Commercial |
$49.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.66
|
| 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: PHP Commercial |
$60.13
|
| Rate for Payer: PHP Commercial |
$73.28
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health SBD |
$54.31
|
| Rate for Payer: Priority Health SBD |
$14.06
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: UMR Bronson Commercial |
$31.13
|
| Rate for Payer: UMR Bronson Commercial |
$37.93
|
| Rate for Payer: UMR Bronson Commercial |
$21.85
|
| Rate for Payer: UMR Bronson Commercial |
$9.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.05
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
NDC 27241004910
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.56 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna American Axle |
$187.20
|
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna Medicare |
$144.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.20
|
| Rate for Payer: BCBS Complete |
$115.20
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cofinity Commercial |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$247.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.40
|
| Rate for Payer: Healthscope Commercial |
$259.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.80
|
| Rate for Payer: PHP Commercial |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.20
|
| Rate for Payer: Priority Health SBD |
$181.44
|
| Rate for Payer: UMR Bronson Commercial |
$106.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.00
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
NDC 27241004910
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.72 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna American Axle |
$187.20
|
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.20
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cofinity Commercial |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$247.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.40
|
| Rate for Payer: Healthscope Commercial |
$259.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.80
|
| Rate for Payer: PHP Commercial |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.20
|
| Rate for Payer: Priority Health SBD |
$181.44
|
| Rate for Payer: UMR Bronson Commercial |
$126.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.00
|
|
|
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 Commercial |
$1,125.47
|
| Rate for Payer: Cofinity Commercial |
$916.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$916.08
|
| 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: PHP Commercial |
$1,112.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.65
|
| Rate for Payer: Priority Health SBD |
$824.47
|
| Rate for Payer: UMR Bronson Commercial |
$484.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$981.52
|
|
|
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 Commercial |
$1,125.47
|
| Rate for Payer: Cofinity Commercial |
$916.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$916.08
|
| 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: PHP Commercial |
$1,112.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.65
|
| 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
|
IP
|
$252.96
|
|
|
Service Code
|
NDC 65862065401
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$227.66 |
| Rate for Payer: Aetna American Axle |
$164.42
|
| Rate for Payer: Aetna Commercial |
$215.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.42
|
| Rate for Payer: Cash Price |
$202.37
|
| Rate for Payer: Cofinity Commercial |
$177.07
|
| Rate for Payer: Cofinity Commercial |
$217.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.37
|
| Rate for Payer: Healthscope Commercial |
$227.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.02
|
| Rate for Payer: PHP Commercial |
$215.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.42
|
| Rate for Payer: Priority Health SBD |
$159.36
|
| Rate for Payer: UMR Bronson Commercial |
$111.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.72
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
OP
|
$252.96
|
|
|
Service Code
|
NDC 65862065401
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$227.66 |
| Rate for Payer: Aetna American Axle |
$164.42
|
| Rate for Payer: Aetna Commercial |
$215.02
|
| Rate for Payer: Aetna Medicare |
$126.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.42
|
| Rate for Payer: BCBS Complete |
$101.18
|
| Rate for Payer: Cash Price |
$202.37
|
| Rate for Payer: Cofinity Commercial |
$177.07
|
| Rate for Payer: Cofinity Commercial |
$217.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.37
|
| Rate for Payer: Healthscope Commercial |
$227.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.02
|
| Rate for Payer: PHP Commercial |
$215.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.42
|
| Rate for Payer: Priority Health SBD |
$159.36
|
| Rate for Payer: UMR Bronson Commercial |
$93.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.72
|
|
|
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 Commercial |
$1,659.82
|
| Rate for Payer: Cofinity Commercial |
$2,039.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,659.82
|
| 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: PHP Commercial |
$2,015.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,541.26
|
| 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 |
$29.93 |
| 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 |
$58.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,541.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.80
|
| Rate for Payer: BCBS Complete |
$31.43
|
| Rate for Payer: BCBS MAPPO |
$55.84
|
| Rate for Payer: BCN Medicare Advantage |
$55.84
|
| Rate for Payer: Cash Price |
$1,896.94
|
| Rate for Payer: Cash Price |
$1,896.94
|
| Rate for Payer: Cofinity Commercial |
$2,039.21
|
| Rate for Payer: Cofinity Commercial |
$1,659.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,659.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,896.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.84
|
| 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 |
$29.93
|
| Rate for Payer: Mclaren Medicare |
$55.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.63
|
| Rate for Payer: Meridian Medicaid |
$31.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,015.49
|
| Rate for Payer: PACE Medicare |
$53.05
|
| Rate for Payer: PACE SWMI |
$55.84
|
| Rate for Payer: PHP Commercial |
$2,015.49
|
| Rate for Payer: PHP Medicare Advantage |
$55.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,541.26
|
| Rate for Payer: Priority Health Medicare |
$55.84
|
| Rate for Payer: Priority Health SBD |
$1,493.84
|
| Rate for Payer: Railroad Medicare Medicare |
$55.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.84
|
| Rate for Payer: UHC Exchange |
$106.72
|
| Rate for Payer: UHC Medicare Advantage |
$55.84
|
| Rate for Payer: UHCCP Medicaid |
$29.93
|
| Rate for Payer: UMR Bronson Commercial |
$877.33
|
| Rate for Payer: VA VA |
$55.84
|
| 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 |
$29.93 |
| 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 |
$58.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,852.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.80
|
| Rate for Payer: BCBS Complete |
$31.43
|
| Rate for Payer: BCBS MAPPO |
$55.84
|
| Rate for Payer: BCN Medicare Advantage |
$55.84
|
| Rate for Payer: Cash Price |
$4,741.62
|
| Rate for Payer: Cash Price |
$4,741.62
|
| Rate for Payer: Cofinity Commercial |
$5,097.25
|
| Rate for Payer: Cofinity Commercial |
$4,148.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,148.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,741.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.84
|
| 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 |
$29.93
|
| Rate for Payer: Mclaren Medicare |
$55.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.63
|
| Rate for Payer: Meridian Medicaid |
$31.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,037.98
|
| Rate for Payer: PACE Medicare |
$53.05
|
| Rate for Payer: PACE SWMI |
$55.84
|
| Rate for Payer: PHP Commercial |
$5,037.98
|
| Rate for Payer: PHP Medicare Advantage |
$55.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,852.57
|
| Rate for Payer: Priority Health Medicare |
$55.84
|
| Rate for Payer: Priority Health SBD |
$3,734.03
|
| Rate for Payer: Railroad Medicare Medicare |
$55.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.84
|
| Rate for Payer: UHC Exchange |
$106.72
|
| Rate for Payer: UHC Medicare Advantage |
$55.84
|
| Rate for Payer: UHCCP Medicaid |
$29.93
|
| Rate for Payer: UMR Bronson Commercial |
$2,193.00
|
| Rate for Payer: VA VA |
$55.84
|
| 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 Commercial |
$4,148.92
|
| Rate for Payer: Cofinity Commercial |
$5,097.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,148.92
|
| 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: PHP Commercial |
$5,037.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,852.57
|
| 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
|
$71,123.22
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
204020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31,294.22 |
| Max. Negotiated Rate |
$64,010.90 |
| Rate for Payer: Aetna American Axle |
$46,230.09
|
| Rate for Payer: Aetna Commercial |
$60,454.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46,230.09
|
| Rate for Payer: Cash Price |
$56,898.58
|
| Rate for Payer: Cofinity Commercial |
$49,786.25
|
| Rate for Payer: Cofinity Commercial |
$61,165.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$49,786.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56,898.58
|
| Rate for Payer: Healthscope Commercial |
$64,010.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49,786.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53,342.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60,454.74
|
| Rate for Payer: PHP Commercial |
$60,454.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46,230.09
|
| Rate for Payer: Priority Health SBD |
$44,807.63
|
| Rate for Payer: UMR Bronson Commercial |
$31,294.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53,342.42
|
|
|
EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$71,123.22
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
204020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.93 |
| Max. Negotiated Rate |
$64,010.90 |
| Rate for Payer: Aetna American Axle |
$46,230.09
|
| Rate for Payer: Aetna Commercial |
$60,454.74
|
| Rate for Payer: Aetna Medicare |
$58.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46,230.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.80
|
| Rate for Payer: BCBS Complete |
$31.43
|
| Rate for Payer: BCBS MAPPO |
$55.84
|
| Rate for Payer: BCN Medicare Advantage |
$55.84
|
| Rate for Payer: Cash Price |
$56,898.58
|
| Rate for Payer: Cash Price |
$56,898.58
|
| Rate for Payer: Cofinity Commercial |
$49,786.25
|
| Rate for Payer: Cofinity Commercial |
$61,165.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$49,786.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56,898.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.84
|
| Rate for Payer: Healthscope Commercial |
$64,010.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49,786.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53,342.42
|
| Rate for Payer: Mclaren Medicaid |
$29.93
|
| Rate for Payer: Mclaren Medicare |
$55.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.63
|
| Rate for Payer: Meridian Medicaid |
$31.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60,454.74
|
| Rate for Payer: PACE Medicare |
$53.05
|
| Rate for Payer: PACE SWMI |
$55.84
|
| Rate for Payer: PHP Commercial |
$60,454.74
|
| Rate for Payer: PHP Medicare Advantage |
$55.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46,230.09
|
| Rate for Payer: Priority Health Medicare |
$55.84
|
| Rate for Payer: Priority Health SBD |
$44,807.63
|
| Rate for Payer: Railroad Medicare Medicare |
$55.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.84
|
| Rate for Payer: UHC Exchange |
$106.72
|
| Rate for Payer: UHC Medicare Advantage |
$55.84
|
| Rate for Payer: UHCCP Medicaid |
$29.93
|
| Rate for Payer: UMR Bronson Commercial |
$26,315.59
|
| Rate for Payer: VA VA |
$55.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53,342.42
|
|
|
EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$5,926.94
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
204021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.93 |
| Max. Negotiated Rate |
$5,334.25 |
| Rate for Payer: Aetna American Axle |
$3,852.51
|
| Rate for Payer: Aetna Commercial |
$5,037.90
|
| Rate for Payer: Aetna Medicare |
$58.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,852.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.80
|
| Rate for Payer: BCBS Complete |
$31.43
|
| Rate for Payer: BCBS MAPPO |
$55.84
|
| Rate for Payer: BCN Medicare Advantage |
$55.84
|
| Rate for Payer: Cash Price |
$4,741.55
|
| Rate for Payer: Cash Price |
$4,741.55
|
| Rate for Payer: Cofinity Commercial |
$5,097.17
|
| Rate for Payer: Cofinity Commercial |
$4,148.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,148.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,741.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.84
|
| Rate for Payer: Healthscope Commercial |
$5,334.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,148.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,445.20
|
| Rate for Payer: Mclaren Medicaid |
$29.93
|
| Rate for Payer: Mclaren Medicare |
$55.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.63
|
| Rate for Payer: Meridian Medicaid |
$31.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,037.90
|
| Rate for Payer: PACE Medicare |
$53.05
|
| Rate for Payer: PACE SWMI |
$55.84
|
| Rate for Payer: PHP Commercial |
$5,037.90
|
| Rate for Payer: PHP Medicare Advantage |
$55.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,852.51
|
| Rate for Payer: Priority Health Medicare |
$55.84
|
| Rate for Payer: Priority Health SBD |
$3,733.97
|
| Rate for Payer: Railroad Medicare Medicare |
$55.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.84
|
| Rate for Payer: UHC Exchange |
$106.72
|
| Rate for Payer: UHC Medicare Advantage |
$55.84
|
| Rate for Payer: UHCCP Medicaid |
$29.93
|
| Rate for Payer: UMR Bronson Commercial |
$2,192.97
|
| Rate for Payer: VA VA |
$55.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,445.20
|
|
|
EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$5,926.94
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
204021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,607.85 |
| Max. Negotiated Rate |
$5,334.25 |
| Rate for Payer: Aetna American Axle |
$3,852.51
|
| Rate for Payer: Aetna Commercial |
$5,037.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,852.51
|
| Rate for Payer: Cash Price |
$4,741.55
|
| Rate for Payer: Cofinity Commercial |
$4,148.86
|
| Rate for Payer: Cofinity Commercial |
$5,097.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,148.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,741.55
|
| Rate for Payer: Healthscope Commercial |
$5,334.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,148.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,445.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,037.90
|
| Rate for Payer: PHP Commercial |
$5,037.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,852.51
|
| Rate for Payer: Priority Health SBD |
$3,733.97
|
| Rate for Payer: UMR Bronson Commercial |
$2,607.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,445.20
|
|
|
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 Commercial |
$6.20
|
| Rate for Payer: Cofinity Commercial |
$7.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.20
|
| 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: PHP Commercial |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.76
|
| Rate for Payer: Priority Health SBD |
$5.58
|
| Rate for Payer: UMR Bronson Commercial |
$3.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
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 Commercial |
$6.20
|
| Rate for Payer: Cofinity Commercial |
$7.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.20
|
| 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: PHP Commercial |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.76
|
| 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 SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$48.64
|
|
|
Service Code
|
NDC 51754425003
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna American Axle |
$31.62
|
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.62
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$34.05
|
| Rate for Payer: Cofinity Commercial |
$41.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.62
|
| Rate for Payer: Priority Health SBD |
$30.64
|
| Rate for Payer: UMR Bronson Commercial |
$21.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.48
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$48.64
|
|
|
Service Code
|
NDC 51754425001
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna American Axle |
$31.62
|
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.62
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$34.05
|
| Rate for Payer: Cofinity Commercial |
$41.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.62
|
| Rate for Payer: Priority Health SBD |
$30.64
|
| Rate for Payer: UMR Bronson Commercial |
$21.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.48
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$48.64
|
|
|
Service Code
|
NDC 51754425003
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna American Axle |
$31.62
|
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna Medicare |
$24.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.62
|
| Rate for Payer: BCBS Complete |
$19.46
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$34.05
|
| Rate for Payer: Cofinity Commercial |
$41.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.62
|
| Rate for Payer: Priority Health SBD |
$30.64
|
| Rate for Payer: UMR Bronson Commercial |
$18.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.48
|
|
|
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 Commercial |
$101.39
|
| Rate for Payer: Cofinity Commercial |
$124.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.39
|
| 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: Multiplan/Beech St/PHCS Commercial |
$123.12
|
| Rate for Payer: PHP Commercial |
$123.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.15
|
| Rate for Payer: Priority Health SBD |
$91.26
|
| Rate for Payer: UMR Bronson Commercial |
$53.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.64
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$144.85
|
|
|
Service Code
|
NDC 14789025110
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.73 |
| Max. Negotiated Rate |
$130.37 |
| Rate for Payer: Aetna American Axle |
$94.15
|
| Rate for Payer: Aetna Commercial |
$123.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.15
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cofinity Commercial |
$101.39
|
| Rate for Payer: Cofinity Commercial |
$124.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.39
|
| 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: Multiplan/Beech St/PHCS Commercial |
$123.12
|
| Rate for Payer: PHP Commercial |
$123.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.15
|
| Rate for Payer: Priority Health SBD |
$91.26
|
| Rate for Payer: UMR Bronson Commercial |
$63.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.64
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$144.85
|
|
|
Service Code
|
NDC 14789025109
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.73 |
| Max. Negotiated Rate |
$130.37 |
| Rate for Payer: Aetna American Axle |
$94.15
|
| Rate for Payer: Aetna Commercial |
$123.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.15
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cofinity Commercial |
$101.39
|
| Rate for Payer: Cofinity Commercial |
$124.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.39
|
| 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: Multiplan/Beech St/PHCS Commercial |
$123.12
|
| Rate for Payer: PHP Commercial |
$123.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.15
|
| Rate for Payer: Priority Health SBD |
$91.26
|
| Rate for Payer: UMR Bronson Commercial |
$63.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.64
|
|
