|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR
|
Facility
|
IP
|
$1,793.09
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,165.51 |
| Max. Negotiated Rate |
$1,793.09 |
| Rate for Payer: Aetna Commercial |
$1,613.78
|
| Rate for Payer: ASR ASR |
$1,739.30
|
| Rate for Payer: ASR Commercial |
$1,739.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,461.19
|
| Rate for Payer: BCN Commercial |
$1,390.18
|
| Rate for Payer: Cash Price |
$1,434.47
|
| Rate for Payer: Cofinity Commercial |
$1,685.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,434.47
|
| Rate for Payer: Healthscope Commercial |
$1,793.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,739.30
|
| Rate for Payer: Mclaren Commercial |
$1,613.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,524.13
|
| Rate for Payer: Nomi Health Commercial |
$1,470.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,577.92
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$57.94
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$57.94 |
| Rate for Payer: Aetna Commercial |
$52.15
|
| Rate for Payer: Aetna Commercial |
$43.90
|
| Rate for Payer: Aetna Medicare |
$24.39
|
| Rate for Payer: Aetna Medicare |
$28.97
|
| Rate for Payer: ASR ASR |
$56.20
|
| Rate for Payer: ASR ASR |
$47.32
|
| Rate for Payer: ASR Commercial |
$56.20
|
| Rate for Payer: ASR Commercial |
$47.32
|
| Rate for Payer: BCBS Complete |
$23.18
|
| Rate for Payer: BCBS Complete |
$19.51
|
| Rate for Payer: BCBS Trust/PPO |
$47.45
|
| Rate for Payer: BCBS Trust/PPO |
$39.95
|
| Rate for Payer: BCN Commercial |
$44.92
|
| Rate for Payer: BCN Commercial |
$37.82
|
| Rate for Payer: Cash Price |
$39.02
|
| Rate for Payer: Cash Price |
$39.02
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$45.85
|
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.02
|
| Rate for Payer: Healthscope Commercial |
$57.94
|
| Rate for Payer: Healthscope Commercial |
$48.78
|
| Rate for Payer: Healthscope Whirlpool |
$56.20
|
| Rate for Payer: Healthscope Whirlpool |
$47.32
|
| Rate for Payer: Mclaren Commercial |
$43.90
|
| Rate for Payer: Mclaren Commercial |
$52.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| Rate for Payer: Nomi Health Commercial |
$40.00
|
| Rate for Payer: Nomi Health Commercial |
$47.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.76
|
| Rate for Payer: Priority Health Narrow Network |
$0.61
|
| Rate for Payer: Priority Health Narrow Network |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.93
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$57.94
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$57.94 |
| Rate for Payer: Aetna Commercial |
$52.15
|
| Rate for Payer: Aetna Commercial |
$43.90
|
| Rate for Payer: ASR ASR |
$47.32
|
| Rate for Payer: ASR ASR |
$56.20
|
| Rate for Payer: ASR Commercial |
$47.32
|
| Rate for Payer: ASR Commercial |
$56.20
|
| Rate for Payer: BCBS Trust/PPO |
$47.22
|
| Rate for Payer: BCBS Trust/PPO |
$39.75
|
| Rate for Payer: BCN Commercial |
$44.92
|
| Rate for Payer: BCN Commercial |
$37.82
|
| Rate for Payer: Cash Price |
$39.02
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Cofinity Commercial |
$45.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Healthscope Commercial |
$48.78
|
| Rate for Payer: Healthscope Commercial |
$57.94
|
| Rate for Payer: Healthscope Whirlpool |
$47.32
|
| Rate for Payer: Healthscope Whirlpool |
$56.20
|
| Rate for Payer: Mclaren Commercial |
$52.15
|
| Rate for Payer: Mclaren Commercial |
$43.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| Rate for Payer: Nomi Health Commercial |
$47.51
|
| Rate for Payer: Nomi Health Commercial |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.99
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$590.01
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$383.51 |
| Max. Negotiated Rate |
$590.01 |
| Rate for Payer: Aetna Commercial |
$531.01
|
| Rate for Payer: Aetna Commercial |
$367.68
|
| Rate for Payer: ASR ASR |
$396.27
|
| Rate for Payer: ASR ASR |
$572.31
|
| Rate for Payer: ASR Commercial |
$396.27
|
| Rate for Payer: ASR Commercial |
$572.31
|
| Rate for Payer: BCBS Trust/PPO |
$480.80
|
| Rate for Payer: BCBS Trust/PPO |
$332.91
|
| Rate for Payer: BCN Commercial |
$457.43
|
| Rate for Payer: BCN Commercial |
$316.73
|
| Rate for Payer: Cash Price |
$326.83
|
| Rate for Payer: Cash Price |
$472.01
|
| Rate for Payer: Cofinity Commercial |
$554.61
|
| Rate for Payer: Cofinity Commercial |
$384.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.01
|
| Rate for Payer: Healthscope Commercial |
$408.53
|
| Rate for Payer: Healthscope Commercial |
$590.01
|
| Rate for Payer: Healthscope Whirlpool |
$396.27
|
| Rate for Payer: Healthscope Whirlpool |
$572.31
|
| Rate for Payer: Mclaren Commercial |
$531.01
|
| Rate for Payer: Mclaren Commercial |
$367.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.51
|
| Rate for Payer: Nomi Health Commercial |
$483.81
|
| Rate for Payer: Nomi Health Commercial |
$334.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$519.21
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$206.93
|
|
|
Service Code
|
HCPCS J0173
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$206.93 |
| Rate for Payer: Aetna Commercial |
$186.24
|
| Rate for Payer: Aetna Medicare |
$103.46
|
| Rate for Payer: ASR ASR |
$200.72
|
| Rate for Payer: ASR Commercial |
$200.72
|
| Rate for Payer: BCBS Complete |
$82.77
|
| Rate for Payer: BCBS Trust/PPO |
$169.45
|
| Rate for Payer: BCN Commercial |
$160.43
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cofinity Commercial |
$194.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Healthscope Commercial |
$206.93
|
| Rate for Payer: Healthscope Whirlpool |
$200.72
|
| Rate for Payer: Mclaren Commercial |
$186.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: Nomi Health Commercial |
$169.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.34
|
| Rate for Payer: Priority Health Narrow Network |
$1.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.10
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$206.93
|
|
|
Service Code
|
HCPCS J0173
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.50 |
| Max. Negotiated Rate |
$206.93 |
| Rate for Payer: Aetna Commercial |
$186.24
|
| Rate for Payer: ASR ASR |
$200.72
|
| Rate for Payer: ASR Commercial |
$200.72
|
| Rate for Payer: BCBS Trust/PPO |
$168.63
|
| Rate for Payer: BCN Commercial |
$160.43
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cofinity Commercial |
$194.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Healthscope Commercial |
$206.93
|
| Rate for Payer: Healthscope Whirlpool |
$200.72
|
| Rate for Payer: Mclaren Commercial |
$186.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: Nomi Health Commercial |
$169.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.10
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$590.01
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$590.01 |
| Rate for Payer: Aetna Commercial |
$531.01
|
| Rate for Payer: Aetna Commercial |
$367.68
|
| Rate for Payer: Aetna Medicare |
$204.26
|
| Rate for Payer: Aetna Medicare |
$295.00
|
| Rate for Payer: ASR ASR |
$572.31
|
| Rate for Payer: ASR ASR |
$396.27
|
| Rate for Payer: ASR Commercial |
$572.31
|
| Rate for Payer: ASR Commercial |
$396.27
|
| Rate for Payer: BCBS Complete |
$236.00
|
| Rate for Payer: BCBS Complete |
$163.41
|
| Rate for Payer: BCBS Trust/PPO |
$483.16
|
| Rate for Payer: BCBS Trust/PPO |
$334.55
|
| Rate for Payer: BCN Commercial |
$457.43
|
| Rate for Payer: BCN Commercial |
$316.73
|
| Rate for Payer: Cash Price |
$326.83
|
| Rate for Payer: Cash Price |
$326.83
|
| Rate for Payer: Cash Price |
$472.01
|
| Rate for Payer: Cash Price |
$472.01
|
| Rate for Payer: Cofinity Commercial |
$384.02
|
| Rate for Payer: Cofinity Commercial |
$554.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.82
|
| Rate for Payer: Healthscope Commercial |
$590.01
|
| Rate for Payer: Healthscope Commercial |
$408.53
|
| Rate for Payer: Healthscope Whirlpool |
$572.31
|
| Rate for Payer: Healthscope Whirlpool |
$396.27
|
| Rate for Payer: Mclaren Commercial |
$367.68
|
| Rate for Payer: Mclaren Commercial |
$531.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.51
|
| Rate for Payer: Nomi Health Commercial |
$334.99
|
| Rate for Payer: Nomi Health Commercial |
$483.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.76
|
| Rate for Payer: Priority Health Narrow Network |
$0.61
|
| Rate for Payer: Priority Health Narrow Network |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$519.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.51
|
|
|
EPINEPHRINE 1 MG/ML NASAL SOLUTION
|
Facility
|
OP
|
$812.49
|
|
|
Service Code
|
NDC 42023010301
|
| Hospital Charge Code |
19604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$812.49 |
| Rate for Payer: Aetna Commercial |
$731.24
|
| Rate for Payer: Aetna Medicare |
$406.24
|
| Rate for Payer: ASR ASR |
$788.12
|
| Rate for Payer: ASR Commercial |
$788.12
|
| Rate for Payer: BCBS Complete |
$325.00
|
| Rate for Payer: BCBS Trust/PPO |
$665.35
|
| Rate for Payer: BCN Commercial |
$629.92
|
| Rate for Payer: Cash Price |
$649.99
|
| Rate for Payer: Cofinity Commercial |
$763.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.99
|
| Rate for Payer: Healthscope Commercial |
$812.49
|
| Rate for Payer: Healthscope Whirlpool |
$788.12
|
| Rate for Payer: Mclaren Commercial |
$731.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.62
|
| Rate for Payer: Nomi Health Commercial |
$666.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$711.90
|
| Rate for Payer: Priority Health Narrow Network |
$569.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$714.99
|
|
|
EPINEPHRINE 1 MG/ML NASAL SOLUTION
|
Facility
|
IP
|
$812.49
|
|
|
Service Code
|
NDC 42023010301
|
| Hospital Charge Code |
19604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$528.12 |
| Max. Negotiated Rate |
$812.49 |
| Rate for Payer: Aetna Commercial |
$731.24
|
| Rate for Payer: ASR ASR |
$788.12
|
| Rate for Payer: ASR Commercial |
$788.12
|
| Rate for Payer: BCBS Trust/PPO |
$662.10
|
| Rate for Payer: BCN Commercial |
$629.92
|
| Rate for Payer: Cash Price |
$649.99
|
| Rate for Payer: Cofinity Commercial |
$763.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.99
|
| Rate for Payer: Healthscope Commercial |
$812.49
|
| Rate for Payer: Healthscope Whirlpool |
$788.12
|
| Rate for Payer: Mclaren Commercial |
$731.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.62
|
| Rate for Payer: Nomi Health Commercial |
$666.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$714.99
|
|
|
EPINEPHRINE ANAPHYLAXIS KIT
|
Facility
|
IP
|
$19.86
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
181607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$19.86 |
| Rate for Payer: Aetna Commercial |
$17.87
|
| Rate for Payer: ASR ASR |
$19.26
|
| Rate for Payer: ASR Commercial |
$19.26
|
| Rate for Payer: BCBS Trust/PPO |
$16.18
|
| Rate for Payer: BCN Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.89
|
| Rate for Payer: Healthscope Commercial |
$19.86
|
| Rate for Payer: Healthscope Whirlpool |
$19.26
|
| Rate for Payer: Mclaren Commercial |
$17.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.88
|
| Rate for Payer: Nomi Health Commercial |
$16.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.48
|
|
|
EPINEPHRINE ANAPHYLAXIS KIT
|
Facility
|
OP
|
$19.86
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
181607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$19.86 |
| Rate for Payer: Aetna Commercial |
$17.87
|
| Rate for Payer: Aetna Medicare |
$9.93
|
| Rate for Payer: ASR ASR |
$19.26
|
| Rate for Payer: ASR Commercial |
$19.26
|
| Rate for Payer: BCBS Complete |
$7.94
|
| Rate for Payer: BCBS Trust/PPO |
$16.26
|
| Rate for Payer: BCN Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.89
|
| Rate for Payer: Healthscope Commercial |
$19.86
|
| Rate for Payer: Healthscope Whirlpool |
$19.26
|
| Rate for Payer: Mclaren Commercial |
$17.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.88
|
| Rate for Payer: Nomi Health Commercial |
$16.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.76
|
| Rate for Payer: Priority Health Narrow Network |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.48
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$366.31
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$366.31 |
| Rate for Payer: Aetna Commercial |
$329.68
|
| Rate for Payer: Aetna Medicare |
$6.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.08
|
| Rate for Payer: ASR ASR |
$355.32
|
| Rate for Payer: ASR Commercial |
$355.32
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$6.46
|
| Rate for Payer: BCBS Trust/PPO |
$299.97
|
| Rate for Payer: BCN Commercial |
$284.00
|
| Rate for Payer: BCN Medicare Advantage |
$6.46
|
| Rate for Payer: Cash Price |
$293.05
|
| Rate for Payer: Cash Price |
$293.05
|
| Rate for Payer: Cofinity Commercial |
$344.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.46
|
| Rate for Payer: Healthscope Commercial |
$366.31
|
| Rate for Payer: Healthscope Whirlpool |
$355.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.46
|
| Rate for Payer: Mclaren Commercial |
$329.68
|
| Rate for Payer: Mclaren Medicaid |
$3.46
|
| Rate for Payer: Mclaren Medicare |
$6.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.78
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.36
|
| Rate for Payer: Nomi Health Commercial |
$300.37
|
| Rate for Payer: PACE Medicare |
$6.14
|
| Rate for Payer: PACE SWMI |
$6.46
|
| Rate for Payer: PHP Commercial |
$7.11
|
| Rate for Payer: PHP Medicaid |
$3.46
|
| Rate for Payer: PHP Medicare Advantage |
$6.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.35
|
| Rate for Payer: Priority Health Medicare |
$6.46
|
| Rate for Payer: Priority Health Narrow Network |
$5.88
|
| Rate for Payer: Railroad Medicare Medicare |
$6.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.46
|
| Rate for Payer: UHC Exchange |
$10.01
|
| Rate for Payer: UHC Medicare Advantage |
$6.46
|
| Rate for Payer: UHCCP DNSP |
$6.46
|
| Rate for Payer: UHCCP Medicaid |
$3.46
|
| Rate for Payer: VA VA |
$6.46
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$366.31
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$238.10 |
| Max. Negotiated Rate |
$366.31 |
| Rate for Payer: Aetna Commercial |
$329.68
|
| Rate for Payer: ASR ASR |
$355.32
|
| Rate for Payer: ASR Commercial |
$355.32
|
| Rate for Payer: BCBS Trust/PPO |
$298.51
|
| Rate for Payer: BCN Commercial |
$284.00
|
| Rate for Payer: Cash Price |
$293.05
|
| Rate for Payer: Cofinity Commercial |
$344.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.05
|
| Rate for Payer: Healthscope Commercial |
$366.31
|
| Rate for Payer: Healthscope Whirlpool |
$355.32
|
| Rate for Payer: Mclaren Commercial |
$329.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.36
|
| Rate for Payer: Nomi Health Commercial |
$300.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.35
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$309.24
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$201.01 |
| Max. Negotiated Rate |
$309.24 |
| Rate for Payer: Aetna Commercial |
$278.32
|
| Rate for Payer: ASR ASR |
$299.96
|
| Rate for Payer: ASR Commercial |
$299.96
|
| Rate for Payer: BCBS Trust/PPO |
$252.00
|
| Rate for Payer: BCN Commercial |
$239.75
|
| Rate for Payer: Cash Price |
$247.39
|
| Rate for Payer: Cofinity Commercial |
$290.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.39
|
| Rate for Payer: Healthscope Commercial |
$309.24
|
| Rate for Payer: Healthscope Whirlpool |
$299.96
|
| Rate for Payer: Mclaren Commercial |
$278.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.85
|
| Rate for Payer: Nomi Health Commercial |
$253.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.13
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$309.24
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$309.24 |
| Rate for Payer: Aetna Commercial |
$278.32
|
| Rate for Payer: Aetna Medicare |
$7.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.34
|
| Rate for Payer: ASR ASR |
$299.96
|
| Rate for Payer: ASR Commercial |
$299.96
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS MAPPO |
$7.47
|
| Rate for Payer: BCBS Trust/PPO |
$253.24
|
| Rate for Payer: BCN Commercial |
$239.75
|
| Rate for Payer: BCN Medicare Advantage |
$7.47
|
| Rate for Payer: Cash Price |
$247.39
|
| Rate for Payer: Cash Price |
$247.39
|
| Rate for Payer: Cofinity Commercial |
$290.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.47
|
| Rate for Payer: Healthscope Commercial |
$309.24
|
| Rate for Payer: Healthscope Whirlpool |
$299.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.47
|
| Rate for Payer: Mclaren Commercial |
$278.32
|
| Rate for Payer: Mclaren Medicaid |
$4.00
|
| Rate for Payer: Mclaren Medicare |
$7.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.84
|
| Rate for Payer: Meridian Medicaid |
$4.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.85
|
| Rate for Payer: Nomi Health Commercial |
$253.58
|
| Rate for Payer: PACE Medicare |
$7.10
|
| Rate for Payer: PACE SWMI |
$7.47
|
| Rate for Payer: PHP Commercial |
$8.22
|
| Rate for Payer: PHP Medicaid |
$4.00
|
| Rate for Payer: PHP Medicare Advantage |
$7.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.19
|
| Rate for Payer: Priority Health Medicare |
$7.47
|
| Rate for Payer: Priority Health Narrow Network |
$5.75
|
| Rate for Payer: Railroad Medicare Medicare |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.47
|
| Rate for Payer: UHC Exchange |
$11.58
|
| Rate for Payer: UHC Medicare Advantage |
$7.47
|
| Rate for Payer: UHCCP DNSP |
$7.47
|
| Rate for Payer: UHCCP Medicaid |
$4.00
|
| Rate for Payer: VA VA |
$7.47
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$618.48
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
195677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$618.48 |
| Rate for Payer: Aetna Commercial |
$556.63
|
| Rate for Payer: Aetna Medicare |
$7.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.34
|
| Rate for Payer: ASR ASR |
$599.93
|
| Rate for Payer: ASR Commercial |
$599.93
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS MAPPO |
$7.47
|
| Rate for Payer: BCBS Trust/PPO |
$506.47
|
| Rate for Payer: BCN Commercial |
$479.51
|
| Rate for Payer: BCN Medicare Advantage |
$7.47
|
| Rate for Payer: Cash Price |
$494.78
|
| Rate for Payer: Cash Price |
$494.78
|
| Rate for Payer: Cofinity Commercial |
$581.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.47
|
| Rate for Payer: Healthscope Commercial |
$618.48
|
| Rate for Payer: Healthscope Whirlpool |
$599.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.47
|
| Rate for Payer: Mclaren Commercial |
$556.63
|
| Rate for Payer: Mclaren Medicaid |
$4.00
|
| Rate for Payer: Mclaren Medicare |
$7.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.84
|
| Rate for Payer: Meridian Medicaid |
$4.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.71
|
| Rate for Payer: Nomi Health Commercial |
$507.15
|
| Rate for Payer: PACE Medicare |
$7.10
|
| Rate for Payer: PACE SWMI |
$7.47
|
| Rate for Payer: PHP Commercial |
$8.22
|
| Rate for Payer: PHP Medicaid |
$4.00
|
| Rate for Payer: PHP Medicare Advantage |
$7.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.19
|
| Rate for Payer: Priority Health Medicare |
$7.47
|
| Rate for Payer: Priority Health Narrow Network |
$5.75
|
| Rate for Payer: Railroad Medicare Medicare |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$544.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.47
|
| Rate for Payer: UHC Exchange |
$11.58
|
| Rate for Payer: UHC Medicare Advantage |
$7.47
|
| Rate for Payer: UHCCP DNSP |
$7.47
|
| Rate for Payer: UHCCP Medicaid |
$4.00
|
| Rate for Payer: VA VA |
$7.47
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$618.48
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
195677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$402.01 |
| Max. Negotiated Rate |
$618.48 |
| Rate for Payer: Aetna Commercial |
$556.63
|
| Rate for Payer: ASR ASR |
$599.93
|
| Rate for Payer: ASR Commercial |
$599.93
|
| Rate for Payer: BCBS Trust/PPO |
$504.00
|
| Rate for Payer: BCN Commercial |
$479.51
|
| Rate for Payer: Cash Price |
$494.78
|
| Rate for Payer: Cofinity Commercial |
$581.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.78
|
| Rate for Payer: Healthscope Commercial |
$618.48
|
| Rate for Payer: Healthscope Whirlpool |
$599.93
|
| Rate for Payer: Mclaren Commercial |
$556.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.71
|
| Rate for Payer: Nomi Health Commercial |
$507.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$544.26
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$77.53
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$77.53 |
| Rate for Payer: Aetna Commercial |
$69.78
|
| Rate for Payer: ASR ASR |
$75.20
|
| Rate for Payer: ASR Commercial |
$75.20
|
| Rate for Payer: BCBS Trust/PPO |
$63.18
|
| Rate for Payer: BCN Commercial |
$60.11
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$72.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.02
|
| Rate for Payer: Healthscope Commercial |
$77.53
|
| Rate for Payer: Healthscope Whirlpool |
$75.20
|
| Rate for Payer: Mclaren Commercial |
$69.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.90
|
| Rate for Payer: Nomi Health Commercial |
$63.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.23
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$77.53
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$77.53 |
| Rate for Payer: Aetna Commercial |
$69.78
|
| Rate for Payer: Aetna Medicare |
$7.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.34
|
| Rate for Payer: ASR ASR |
$75.20
|
| Rate for Payer: ASR Commercial |
$75.20
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS MAPPO |
$7.47
|
| Rate for Payer: BCBS Trust/PPO |
$63.49
|
| Rate for Payer: BCN Commercial |
$60.11
|
| Rate for Payer: BCN Medicare Advantage |
$7.47
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$72.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.47
|
| Rate for Payer: Healthscope Commercial |
$77.53
|
| Rate for Payer: Healthscope Whirlpool |
$75.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.47
|
| Rate for Payer: Mclaren Commercial |
$69.78
|
| Rate for Payer: Mclaren Medicaid |
$4.00
|
| Rate for Payer: Mclaren Medicare |
$7.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.84
|
| Rate for Payer: Meridian Medicaid |
$4.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.90
|
| Rate for Payer: Nomi Health Commercial |
$63.57
|
| Rate for Payer: PACE Medicare |
$7.10
|
| Rate for Payer: PACE SWMI |
$7.47
|
| Rate for Payer: PHP Commercial |
$8.22
|
| Rate for Payer: PHP Medicaid |
$4.00
|
| Rate for Payer: PHP Medicare Advantage |
$7.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.19
|
| Rate for Payer: Priority Health Medicare |
$7.47
|
| Rate for Payer: Priority Health Narrow Network |
$5.75
|
| Rate for Payer: Railroad Medicare Medicare |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.47
|
| Rate for Payer: UHC Exchange |
$11.58
|
| Rate for Payer: UHC Medicare Advantage |
$7.47
|
| Rate for Payer: UHCCP DNSP |
$7.47
|
| Rate for Payer: UHCCP Medicaid |
$4.00
|
| Rate for Payer: VA VA |
$7.47
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$1,115.00 |
| Rate for Payer: Aetna Commercial |
$1,003.50
|
| Rate for Payer: Aetna Medicare |
$7.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.34
|
| Rate for Payer: ASR ASR |
$1,081.55
|
| Rate for Payer: ASR Commercial |
$1,081.55
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS MAPPO |
$7.47
|
| Rate for Payer: BCBS Trust/PPO |
$913.07
|
| Rate for Payer: BCN Commercial |
$864.46
|
| Rate for Payer: BCN Medicare Advantage |
$7.47
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cofinity Commercial |
$1,048.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$892.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.47
|
| Rate for Payer: Healthscope Commercial |
$1,115.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,081.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.47
|
| Rate for Payer: Mclaren Commercial |
$1,003.50
|
| Rate for Payer: Mclaren Medicaid |
$4.00
|
| Rate for Payer: Mclaren Medicare |
$7.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.84
|
| Rate for Payer: Meridian Medicaid |
$4.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.75
|
| Rate for Payer: Nomi Health Commercial |
$914.30
|
| Rate for Payer: PACE Medicare |
$7.10
|
| Rate for Payer: PACE SWMI |
$7.47
|
| Rate for Payer: PHP Commercial |
$8.22
|
| Rate for Payer: PHP Medicaid |
$4.00
|
| Rate for Payer: PHP Medicare Advantage |
$7.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.19
|
| Rate for Payer: Priority Health Medicare |
$7.47
|
| Rate for Payer: Priority Health Narrow Network |
$5.75
|
| Rate for Payer: Railroad Medicare Medicare |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$981.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.47
|
| Rate for Payer: UHC Exchange |
$11.58
|
| Rate for Payer: UHC Medicare Advantage |
$7.47
|
| Rate for Payer: UHCCP DNSP |
$7.47
|
| Rate for Payer: UHCCP Medicaid |
$4.00
|
| Rate for Payer: VA VA |
$7.47
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$724.75 |
| Max. Negotiated Rate |
$1,115.00 |
| Rate for Payer: Aetna Commercial |
$1,003.50
|
| Rate for Payer: ASR ASR |
$1,081.55
|
| Rate for Payer: ASR Commercial |
$1,081.55
|
| Rate for Payer: BCBS Trust/PPO |
$908.61
|
| Rate for Payer: BCN Commercial |
$864.46
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cofinity Commercial |
$1,048.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$892.00
|
| Rate for Payer: Healthscope Commercial |
$1,115.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,081.55
|
| Rate for Payer: Mclaren Commercial |
$1,003.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.75
|
| Rate for Payer: Nomi Health Commercial |
$914.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$981.20
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$155.06
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.79 |
| Max. Negotiated Rate |
$155.06 |
| Rate for Payer: Aetna Commercial |
$139.55
|
| Rate for Payer: ASR ASR |
$150.41
|
| Rate for Payer: ASR Commercial |
$150.41
|
| Rate for Payer: BCBS Trust/PPO |
$126.36
|
| Rate for Payer: BCN Commercial |
$120.22
|
| Rate for Payer: Cash Price |
$124.04
|
| Rate for Payer: Cofinity Commercial |
$145.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.05
|
| Rate for Payer: Healthscope Commercial |
$155.06
|
| Rate for Payer: Healthscope Whirlpool |
$150.41
|
| Rate for Payer: Mclaren Commercial |
$139.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.80
|
| Rate for Payer: Nomi Health Commercial |
$127.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.45
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$155.06
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$155.06 |
| Rate for Payer: Aetna Commercial |
$139.55
|
| Rate for Payer: Aetna Medicare |
$7.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.34
|
| Rate for Payer: ASR ASR |
$150.41
|
| Rate for Payer: ASR Commercial |
$150.41
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS MAPPO |
$7.47
|
| Rate for Payer: BCBS Trust/PPO |
$126.98
|
| Rate for Payer: BCN Commercial |
$120.22
|
| Rate for Payer: BCN Medicare Advantage |
$7.47
|
| Rate for Payer: Cash Price |
$124.04
|
| Rate for Payer: Cash Price |
$124.04
|
| Rate for Payer: Cofinity Commercial |
$145.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.47
|
| Rate for Payer: Healthscope Commercial |
$155.06
|
| Rate for Payer: Healthscope Whirlpool |
$150.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.47
|
| Rate for Payer: Mclaren Commercial |
$139.55
|
| Rate for Payer: Mclaren Medicaid |
$4.00
|
| Rate for Payer: Mclaren Medicare |
$7.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.84
|
| Rate for Payer: Meridian Medicaid |
$4.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.80
|
| Rate for Payer: Nomi Health Commercial |
$127.15
|
| Rate for Payer: PACE Medicare |
$7.10
|
| Rate for Payer: PACE SWMI |
$7.47
|
| Rate for Payer: PHP Commercial |
$8.22
|
| Rate for Payer: PHP Medicaid |
$4.00
|
| Rate for Payer: PHP Medicare Advantage |
$7.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.19
|
| Rate for Payer: Priority Health Medicare |
$7.47
|
| Rate for Payer: Priority Health Narrow Network |
$5.75
|
| Rate for Payer: Railroad Medicare Medicare |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.47
|
| Rate for Payer: UHC Exchange |
$11.58
|
| Rate for Payer: UHC Medicare Advantage |
$7.47
|
| Rate for Payer: UHCCP DNSP |
$7.47
|
| Rate for Payer: UHCCP Medicaid |
$4.00
|
| Rate for Payer: VA VA |
$7.47
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$292.32
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$292.32 |
| Rate for Payer: Aetna Commercial |
$263.09
|
| Rate for Payer: Aetna Commercial |
$244.71
|
| Rate for Payer: Aetna Medicare |
$135.95
|
| Rate for Payer: Aetna Medicare |
$146.16
|
| Rate for Payer: ASR ASR |
$283.55
|
| Rate for Payer: ASR ASR |
$263.74
|
| Rate for Payer: ASR Commercial |
$263.74
|
| Rate for Payer: ASR Commercial |
$283.55
|
| Rate for Payer: BCBS Complete |
$116.93
|
| Rate for Payer: BCBS Complete |
$108.76
|
| Rate for Payer: BCBS Trust/PPO |
$239.38
|
| Rate for Payer: BCBS Trust/PPO |
$222.66
|
| Rate for Payer: BCN Commercial |
$210.80
|
| Rate for Payer: BCN Commercial |
$226.64
|
| Rate for Payer: Cash Price |
$217.52
|
| Rate for Payer: Cash Price |
$217.52
|
| Rate for Payer: Cash Price |
$233.86
|
| Rate for Payer: Cash Price |
$233.86
|
| Rate for Payer: Cofinity Commercial |
$255.59
|
| Rate for Payer: Cofinity Commercial |
$274.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.52
|
| Rate for Payer: Healthscope Commercial |
$292.32
|
| Rate for Payer: Healthscope Commercial |
$271.90
|
| Rate for Payer: Healthscope Whirlpool |
$283.55
|
| Rate for Payer: Healthscope Whirlpool |
$263.74
|
| Rate for Payer: Mclaren Commercial |
$244.71
|
| Rate for Payer: Mclaren Commercial |
$263.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.12
|
| Rate for Payer: Nomi Health Commercial |
$239.70
|
| Rate for Payer: Nomi Health Commercial |
$222.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.84
|
| Rate for Payer: Priority Health Narrow Network |
$8.67
|
| Rate for Payer: Priority Health Narrow Network |
$8.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.24
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$292.32
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$190.01 |
| Max. Negotiated Rate |
$292.32 |
| Rate for Payer: Aetna Commercial |
$263.09
|
| Rate for Payer: Aetna Commercial |
$244.71
|
| Rate for Payer: ASR ASR |
$283.55
|
| Rate for Payer: ASR ASR |
$263.74
|
| Rate for Payer: ASR Commercial |
$263.74
|
| Rate for Payer: ASR Commercial |
$283.55
|
| Rate for Payer: BCBS Trust/PPO |
$221.57
|
| Rate for Payer: BCBS Trust/PPO |
$238.21
|
| Rate for Payer: BCN Commercial |
$226.64
|
| Rate for Payer: BCN Commercial |
$210.80
|
| Rate for Payer: Cash Price |
$233.86
|
| Rate for Payer: Cash Price |
$217.52
|
| Rate for Payer: Cofinity Commercial |
$255.59
|
| Rate for Payer: Cofinity Commercial |
$274.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.86
|
| Rate for Payer: Healthscope Commercial |
$271.90
|
| Rate for Payer: Healthscope Commercial |
$292.32
|
| Rate for Payer: Healthscope Whirlpool |
$263.74
|
| Rate for Payer: Healthscope Whirlpool |
$283.55
|
| Rate for Payer: Mclaren Commercial |
$244.71
|
| Rate for Payer: Mclaren Commercial |
$263.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.47
|
| Rate for Payer: Nomi Health Commercial |
$222.96
|
| Rate for Payer: Nomi Health Commercial |
$239.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.24
|
|
