|
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 |
$7.94 |
| 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: 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 |
$17.40
|
| Rate for Payer: Priority Health Narrow Network |
$13.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.48
|
|
|
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 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 |
$4.58 |
| Max. Negotiated Rate |
$366.31 |
| Rate for Payer: Aetna Commercial |
$329.68
|
| Rate for Payer: Aetna Medicare |
$8.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.68
|
| Rate for Payer: ASR ASR |
$355.32
|
| Rate for Payer: ASR Commercial |
$355.32
|
| Rate for Payer: BCBS Complete |
$4.81
|
| Rate for Payer: BCBS MAPPO |
$8.54
|
| Rate for Payer: BCBS Trust/PPO |
$299.97
|
| Rate for Payer: BCN Commercial |
$284.00
|
| Rate for Payer: BCN Medicare Advantage |
$8.54
|
| 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 |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$366.31
|
| Rate for Payer: Healthscope Whirlpool |
$355.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.54
|
| Rate for Payer: Mclaren Commercial |
$329.68
|
| Rate for Payer: Mclaren Medicaid |
$4.58
|
| Rate for Payer: Mclaren Medicare |
$8.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.97
|
| Rate for Payer: Meridian Medicaid |
$4.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.36
|
| Rate for Payer: Nomi Health Commercial |
$300.37
|
| Rate for Payer: PACE Medicare |
$8.11
|
| Rate for Payer: PACE SWMI |
$8.54
|
| Rate for Payer: PHP Commercial |
$9.39
|
| Rate for Payer: PHP Medicaid |
$4.58
|
| Rate for Payer: PHP Medicare Advantage |
$8.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.96
|
| Rate for Payer: Priority Health Medicare |
$8.54
|
| Rate for Payer: Priority Health Narrow Network |
$256.78
|
| Rate for Payer: Railroad Medicare Medicare |
$8.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.54
|
| Rate for Payer: UHC Exchange |
$13.24
|
| Rate for Payer: UHC Medicare Advantage |
$8.54
|
| Rate for Payer: UHCCP DNSP |
$8.54
|
| Rate for Payer: UHCCP Medicaid |
$4.58
|
| Rate for Payer: VA VA |
$8.54
|
|
|
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 |
$4.21 |
| Max. Negotiated Rate |
$309.24 |
| Rate for Payer: Aetna Commercial |
$278.32
|
| Rate for Payer: Aetna Medicare |
$7.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.81
|
| Rate for Payer: ASR ASR |
$299.96
|
| Rate for Payer: ASR Commercial |
$299.96
|
| Rate for Payer: BCBS Complete |
$4.42
|
| Rate for Payer: BCBS MAPPO |
$7.85
|
| Rate for Payer: BCBS Trust/PPO |
$253.24
|
| Rate for Payer: BCN Commercial |
$239.75
|
| Rate for Payer: BCN Medicare Advantage |
$7.85
|
| 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 |
$7.85
|
| Rate for Payer: Healthscope Commercial |
$309.24
|
| Rate for Payer: Healthscope Whirlpool |
$299.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.85
|
| Rate for Payer: Mclaren Commercial |
$278.32
|
| Rate for Payer: Mclaren Medicaid |
$4.21
|
| Rate for Payer: Mclaren Medicare |
$7.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.24
|
| Rate for Payer: Meridian Medicaid |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.85
|
| Rate for Payer: Nomi Health Commercial |
$253.58
|
| Rate for Payer: PACE Medicare |
$7.46
|
| Rate for Payer: PACE SWMI |
$7.85
|
| Rate for Payer: PHP Commercial |
$8.63
|
| Rate for Payer: PHP Medicaid |
$4.21
|
| Rate for Payer: PHP Medicare Advantage |
$7.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.96
|
| Rate for Payer: Priority Health Medicare |
$7.85
|
| Rate for Payer: Priority Health Narrow Network |
$216.78
|
| Rate for Payer: Railroad Medicare Medicare |
$7.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.85
|
| Rate for Payer: UHC Exchange |
$12.17
|
| Rate for Payer: UHC Medicare Advantage |
$7.85
|
| Rate for Payer: UHCCP DNSP |
$7.85
|
| Rate for Payer: UHCCP Medicaid |
$4.21
|
| Rate for Payer: VA VA |
$7.85
|
|
|
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 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 |
$4.21 |
| Max. Negotiated Rate |
$618.48 |
| Rate for Payer: Aetna Commercial |
$556.63
|
| Rate for Payer: Aetna Medicare |
$7.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.81
|
| Rate for Payer: ASR ASR |
$599.93
|
| Rate for Payer: ASR Commercial |
$599.93
|
| Rate for Payer: BCBS Complete |
$4.42
|
| Rate for Payer: BCBS MAPPO |
$7.85
|
| Rate for Payer: BCBS Trust/PPO |
$506.47
|
| Rate for Payer: BCN Commercial |
$479.51
|
| Rate for Payer: BCN Medicare Advantage |
$7.85
|
| 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 |
$7.85
|
| Rate for Payer: Healthscope Commercial |
$618.48
|
| Rate for Payer: Healthscope Whirlpool |
$599.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.85
|
| Rate for Payer: Mclaren Commercial |
$556.63
|
| Rate for Payer: Mclaren Medicaid |
$4.21
|
| Rate for Payer: Mclaren Medicare |
$7.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.24
|
| Rate for Payer: Meridian Medicaid |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.71
|
| Rate for Payer: Nomi Health Commercial |
$507.15
|
| Rate for Payer: PACE Medicare |
$7.46
|
| Rate for Payer: PACE SWMI |
$7.85
|
| Rate for Payer: PHP Commercial |
$8.63
|
| Rate for Payer: PHP Medicaid |
$4.21
|
| Rate for Payer: PHP Medicare Advantage |
$7.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.91
|
| Rate for Payer: Priority Health Medicare |
$7.85
|
| Rate for Payer: Priority Health Narrow Network |
$433.55
|
| Rate for Payer: Railroad Medicare Medicare |
$7.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$544.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.85
|
| Rate for Payer: UHC Exchange |
$12.17
|
| Rate for Payer: UHC Medicare Advantage |
$7.85
|
| Rate for Payer: UHCCP DNSP |
$7.85
|
| Rate for Payer: UHCCP Medicaid |
$4.21
|
| Rate for Payer: VA VA |
$7.85
|
|
|
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 |
$4.21 |
| Max. Negotiated Rate |
$77.53 |
| Rate for Payer: Aetna Commercial |
$69.78
|
| Rate for Payer: Aetna Medicare |
$7.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.81
|
| Rate for Payer: ASR ASR |
$75.20
|
| Rate for Payer: ASR Commercial |
$75.20
|
| Rate for Payer: BCBS Complete |
$4.42
|
| Rate for Payer: BCBS MAPPO |
$7.85
|
| Rate for Payer: BCBS Trust/PPO |
$63.49
|
| Rate for Payer: BCN Commercial |
$60.11
|
| Rate for Payer: BCN Medicare Advantage |
$7.85
|
| 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 |
$7.85
|
| Rate for Payer: Healthscope Commercial |
$77.53
|
| Rate for Payer: Healthscope Whirlpool |
$75.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.85
|
| Rate for Payer: Mclaren Commercial |
$69.78
|
| Rate for Payer: Mclaren Medicaid |
$4.21
|
| Rate for Payer: Mclaren Medicare |
$7.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.24
|
| Rate for Payer: Meridian Medicaid |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.90
|
| Rate for Payer: Nomi Health Commercial |
$63.57
|
| Rate for Payer: PACE Medicare |
$7.46
|
| Rate for Payer: PACE SWMI |
$7.85
|
| Rate for Payer: PHP Commercial |
$8.63
|
| Rate for Payer: PHP Medicaid |
$4.21
|
| Rate for Payer: PHP Medicare Advantage |
$7.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.93
|
| Rate for Payer: Priority Health Medicare |
$7.85
|
| Rate for Payer: Priority Health Narrow Network |
$54.35
|
| Rate for Payer: Railroad Medicare Medicare |
$7.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.85
|
| Rate for Payer: UHC Exchange |
$12.17
|
| Rate for Payer: UHC Medicare Advantage |
$7.85
|
| Rate for Payer: UHCCP DNSP |
$7.85
|
| Rate for Payer: UHCCP Medicaid |
$4.21
|
| Rate for Payer: VA VA |
$7.85
|
|
|
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 |
$4.21 |
| Max. Negotiated Rate |
$1,115.00 |
| Rate for Payer: Aetna Commercial |
$1,003.50
|
| Rate for Payer: Aetna Medicare |
$7.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.81
|
| Rate for Payer: ASR ASR |
$1,081.55
|
| Rate for Payer: ASR Commercial |
$1,081.55
|
| Rate for Payer: BCBS Complete |
$4.42
|
| Rate for Payer: BCBS MAPPO |
$7.85
|
| Rate for Payer: BCBS Trust/PPO |
$913.07
|
| Rate for Payer: BCN Commercial |
$864.46
|
| Rate for Payer: BCN Medicare Advantage |
$7.85
|
| 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 |
$7.85
|
| Rate for Payer: Healthscope Commercial |
$1,115.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,081.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.85
|
| Rate for Payer: Mclaren Commercial |
$1,003.50
|
| Rate for Payer: Mclaren Medicaid |
$4.21
|
| Rate for Payer: Mclaren Medicare |
$7.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.24
|
| Rate for Payer: Meridian Medicaid |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.75
|
| Rate for Payer: Nomi Health Commercial |
$914.30
|
| Rate for Payer: PACE Medicare |
$7.46
|
| Rate for Payer: PACE SWMI |
$7.85
|
| Rate for Payer: PHP Commercial |
$8.63
|
| Rate for Payer: PHP Medicaid |
$4.21
|
| Rate for Payer: PHP Medicare Advantage |
$7.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$976.96
|
| Rate for Payer: Priority Health Medicare |
$7.85
|
| Rate for Payer: Priority Health Narrow Network |
$781.62
|
| Rate for Payer: Railroad Medicare Medicare |
$7.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$981.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.85
|
| Rate for Payer: UHC Exchange |
$12.17
|
| Rate for Payer: UHC Medicare Advantage |
$7.85
|
| Rate for Payer: UHCCP DNSP |
$7.85
|
| Rate for Payer: UHCCP Medicaid |
$4.21
|
| Rate for Payer: VA VA |
$7.85
|
|
|
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 |
$4.21 |
| Max. Negotiated Rate |
$155.06 |
| Rate for Payer: Aetna Commercial |
$139.55
|
| Rate for Payer: Aetna Medicare |
$7.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.81
|
| Rate for Payer: ASR ASR |
$150.41
|
| Rate for Payer: ASR Commercial |
$150.41
|
| Rate for Payer: BCBS Complete |
$4.42
|
| Rate for Payer: BCBS MAPPO |
$7.85
|
| Rate for Payer: BCBS Trust/PPO |
$126.98
|
| Rate for Payer: BCN Commercial |
$120.22
|
| Rate for Payer: BCN Medicare Advantage |
$7.85
|
| 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 |
$7.85
|
| Rate for Payer: Healthscope Commercial |
$155.06
|
| Rate for Payer: Healthscope Whirlpool |
$150.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.85
|
| Rate for Payer: Mclaren Commercial |
$139.55
|
| Rate for Payer: Mclaren Medicaid |
$4.21
|
| Rate for Payer: Mclaren Medicare |
$7.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.24
|
| Rate for Payer: Meridian Medicaid |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.80
|
| Rate for Payer: Nomi Health Commercial |
$127.15
|
| Rate for Payer: PACE Medicare |
$7.46
|
| Rate for Payer: PACE SWMI |
$7.85
|
| Rate for Payer: PHP Commercial |
$8.63
|
| Rate for Payer: PHP Medicaid |
$4.21
|
| Rate for Payer: PHP Medicare Advantage |
$7.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.86
|
| Rate for Payer: Priority Health Medicare |
$7.85
|
| Rate for Payer: Priority Health Narrow Network |
$108.70
|
| Rate for Payer: Railroad Medicare Medicare |
$7.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.85
|
| Rate for Payer: UHC Exchange |
$12.17
|
| Rate for Payer: UHC Medicare Advantage |
$7.85
|
| Rate for Payer: UHCCP DNSP |
$7.85
|
| Rate for Payer: UHCCP Medicaid |
$4.21
|
| Rate for Payer: VA VA |
$7.85
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$271.90
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.76 |
| Max. Negotiated Rate |
$271.90 |
| Rate for Payer: Aetna Commercial |
$244.71
|
| Rate for Payer: Aetna Commercial |
$263.09
|
| Rate for Payer: Aetna Medicare |
$135.95
|
| Rate for Payer: Aetna Medicare |
$146.16
|
| Rate for Payer: ASR ASR |
$263.74
|
| Rate for Payer: ASR ASR |
$283.55
|
| Rate for Payer: ASR Commercial |
$283.55
|
| Rate for Payer: ASR Commercial |
$263.74
|
| Rate for Payer: BCBS Complete |
$108.76
|
| Rate for Payer: BCBS Complete |
$116.93
|
| Rate for Payer: BCBS Trust/PPO |
$222.66
|
| Rate for Payer: BCBS Trust/PPO |
$239.38
|
| Rate for Payer: BCN Commercial |
$226.64
|
| Rate for Payer: BCN Commercial |
$210.80
|
| Rate for Payer: Cash Price |
$217.52
|
| 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 |
$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 |
$248.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.12
|
| 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: Priority Health HMO/PPO/Tiered Network |
$238.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$256.13
|
| Rate for Payer: Priority Health Narrow Network |
$204.92
|
| Rate for Payer: Priority Health Narrow Network |
$190.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.27
|
|
|
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 |
$263.74
|
| Rate for Payer: ASR ASR |
$283.55
|
| 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 |
$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 |
$176.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.24
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$86.91
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.49 |
| Max. Negotiated Rate |
$86.91 |
| Rate for Payer: Aetna Commercial |
$78.22
|
| Rate for Payer: Aetna Commercial |
$298.86
|
| Rate for Payer: ASR ASR |
$322.11
|
| Rate for Payer: ASR ASR |
$84.30
|
| Rate for Payer: ASR Commercial |
$322.11
|
| Rate for Payer: ASR Commercial |
$84.30
|
| Rate for Payer: BCBS Trust/PPO |
$270.60
|
| Rate for Payer: BCBS Trust/PPO |
$70.82
|
| Rate for Payer: BCN Commercial |
$67.38
|
| Rate for Payer: BCN Commercial |
$257.45
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Cofinity Commercial |
$312.15
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Healthscope Commercial |
$332.07
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: Healthscope Whirlpool |
$84.30
|
| Rate for Payer: Healthscope Whirlpool |
$322.11
|
| Rate for Payer: Mclaren Commercial |
$298.86
|
| Rate for Payer: Mclaren Commercial |
$78.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.26
|
| Rate for Payer: Nomi Health Commercial |
$71.27
|
| Rate for Payer: Nomi Health Commercial |
$272.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.48
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$332.07
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.83 |
| Max. Negotiated Rate |
$332.07 |
| Rate for Payer: Aetna Commercial |
$298.86
|
| Rate for Payer: Aetna Commercial |
$78.22
|
| Rate for Payer: Aetna Medicare |
$166.03
|
| Rate for Payer: Aetna Medicare |
$43.45
|
| Rate for Payer: ASR ASR |
$322.11
|
| Rate for Payer: ASR ASR |
$84.30
|
| Rate for Payer: ASR Commercial |
$84.30
|
| Rate for Payer: ASR Commercial |
$322.11
|
| Rate for Payer: BCBS Complete |
$132.83
|
| Rate for Payer: BCBS Complete |
$34.76
|
| Rate for Payer: BCBS Trust/PPO |
$271.93
|
| Rate for Payer: BCBS Trust/PPO |
$71.17
|
| Rate for Payer: BCN Commercial |
$67.38
|
| Rate for Payer: BCN Commercial |
$257.45
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$312.15
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Healthscope Commercial |
$332.07
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: Healthscope Whirlpool |
$322.11
|
| Rate for Payer: Healthscope Whirlpool |
$84.30
|
| Rate for Payer: Mclaren Commercial |
$298.86
|
| Rate for Payer: Mclaren Commercial |
$78.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.26
|
| Rate for Payer: Nomi Health Commercial |
$272.30
|
| Rate for Payer: Nomi Health Commercial |
$71.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.15
|
| Rate for Payer: Priority Health Narrow Network |
$60.92
|
| Rate for Payer: Priority Health Narrow Network |
$232.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.22
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$298.45
|
|
|
Service Code
|
NDC 64380073706
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.38 |
| Max. Negotiated Rate |
$298.45 |
| Rate for Payer: Aetna Commercial |
$268.61
|
| Rate for Payer: Aetna Medicare |
$149.22
|
| Rate for Payer: ASR ASR |
$289.50
|
| Rate for Payer: ASR Commercial |
$289.50
|
| Rate for Payer: BCBS Complete |
$119.38
|
| Rate for Payer: BCBS Trust/PPO |
$244.40
|
| Rate for Payer: BCN Commercial |
$231.39
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$280.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$298.45
|
| Rate for Payer: Healthscope Whirlpool |
$289.50
|
| Rate for Payer: Mclaren Commercial |
$268.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Nomi Health Commercial |
$244.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.50
|
| Rate for Payer: Priority Health Narrow Network |
$209.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.64
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$298.45
|
|
|
Service Code
|
NDC 64380073706
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.99 |
| Max. Negotiated Rate |
$298.45 |
| Rate for Payer: Aetna Commercial |
$268.61
|
| Rate for Payer: ASR ASR |
$289.50
|
| Rate for Payer: ASR Commercial |
$289.50
|
| Rate for Payer: BCBS Trust/PPO |
$243.21
|
| Rate for Payer: BCN Commercial |
$231.39
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$280.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$298.45
|
| Rate for Payer: Healthscope Whirlpool |
$289.50
|
| Rate for Payer: Mclaren Commercial |
$268.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Nomi Health Commercial |
$244.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.64
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
IP
|
$107.60
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.94 |
| Max. Negotiated Rate |
$107.60 |
| Rate for Payer: Aetna Commercial |
$96.84
|
| Rate for Payer: Aetna Commercial |
$95.88
|
| Rate for Payer: Aetna Commercial |
$381.60
|
| Rate for Payer: ASR ASR |
$103.33
|
| Rate for Payer: ASR ASR |
$104.37
|
| Rate for Payer: ASR ASR |
$411.28
|
| Rate for Payer: ASR Commercial |
$104.37
|
| Rate for Payer: ASR Commercial |
$103.33
|
| Rate for Payer: ASR Commercial |
$411.28
|
| Rate for Payer: BCBS Trust/PPO |
$345.52
|
| Rate for Payer: BCBS Trust/PPO |
$86.81
|
| Rate for Payer: BCBS Trust/PPO |
$87.68
|
| Rate for Payer: BCN Commercial |
$82.59
|
| Rate for Payer: BCN Commercial |
$328.73
|
| Rate for Payer: BCN Commercial |
$83.42
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$398.56
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$101.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$106.53
|
| Rate for Payer: Healthscope Commercial |
$107.60
|
| Rate for Payer: Healthscope Commercial |
$424.00
|
| Rate for Payer: Healthscope Whirlpool |
$104.37
|
| Rate for Payer: Healthscope Whirlpool |
$103.33
|
| Rate for Payer: Healthscope Whirlpool |
$411.28
|
| Rate for Payer: Mclaren Commercial |
$96.84
|
| Rate for Payer: Mclaren Commercial |
$95.88
|
| Rate for Payer: Mclaren Commercial |
$381.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Nomi Health Commercial |
$88.23
|
| Rate for Payer: Nomi Health Commercial |
$87.35
|
| Rate for Payer: Nomi Health Commercial |
$347.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.75
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
OP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$106.53 |
| Rate for Payer: Aetna Commercial |
$95.88
|
| Rate for Payer: Aetna Commercial |
$96.84
|
| Rate for Payer: Aetna Commercial |
$381.60
|
| Rate for Payer: Aetna Medicare |
$53.80
|
| Rate for Payer: Aetna Medicare |
$212.00
|
| Rate for Payer: Aetna Medicare |
$53.27
|
| Rate for Payer: ASR ASR |
$104.37
|
| Rate for Payer: ASR ASR |
$103.33
|
| Rate for Payer: ASR ASR |
$411.28
|
| Rate for Payer: ASR Commercial |
$411.28
|
| Rate for Payer: ASR Commercial |
$104.37
|
| Rate for Payer: ASR Commercial |
$103.33
|
| Rate for Payer: BCBS Complete |
$42.61
|
| Rate for Payer: BCBS Complete |
$43.04
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Trust/PPO |
$87.24
|
| Rate for Payer: BCBS Trust/PPO |
$88.11
|
| Rate for Payer: BCBS Trust/PPO |
$347.21
|
| Rate for Payer: BCN Commercial |
$328.73
|
| Rate for Payer: BCN Commercial |
$82.59
|
| Rate for Payer: BCN Commercial |
$83.42
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$398.56
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$101.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$106.53
|
| Rate for Payer: Healthscope Commercial |
$107.60
|
| Rate for Payer: Healthscope Commercial |
$424.00
|
| Rate for Payer: Healthscope Whirlpool |
$104.37
|
| Rate for Payer: Healthscope Whirlpool |
$103.33
|
| Rate for Payer: Healthscope Whirlpool |
$411.28
|
| Rate for Payer: Mclaren Commercial |
$95.88
|
| Rate for Payer: Mclaren Commercial |
$96.84
|
| Rate for Payer: Mclaren Commercial |
$381.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Nomi Health Commercial |
$87.35
|
| Rate for Payer: Nomi Health Commercial |
$88.23
|
| Rate for Payer: Nomi Health Commercial |
$347.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$371.51
|
| Rate for Payer: Priority Health Narrow Network |
$297.22
|
| Rate for Payer: Priority Health Narrow Network |
$74.68
|
| Rate for Payer: Priority Health Narrow Network |
$75.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.12
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.24 |
| Max. Negotiated Rate |
$106.53 |
| Rate for Payer: Aetna Commercial |
$95.88
|
| Rate for Payer: Aetna Commercial |
$99.41
|
| Rate for Payer: Aetna Commercial |
$96.84
|
| Rate for Payer: Aetna Commercial |
$111.74
|
| Rate for Payer: Aetna Commercial |
$81.94
|
| Rate for Payer: Aetna Commercial |
$91.25
|
| Rate for Payer: Aetna Commercial |
$381.60
|
| Rate for Payer: ASR ASR |
$107.15
|
| Rate for Payer: ASR ASR |
$104.37
|
| Rate for Payer: ASR ASR |
$88.32
|
| Rate for Payer: ASR ASR |
$120.44
|
| Rate for Payer: ASR ASR |
$103.33
|
| Rate for Payer: ASR ASR |
$98.35
|
| Rate for Payer: ASR ASR |
$411.28
|
| Rate for Payer: ASR Commercial |
$88.32
|
| Rate for Payer: ASR Commercial |
$411.28
|
| Rate for Payer: ASR Commercial |
$104.37
|
| Rate for Payer: ASR Commercial |
$120.44
|
| Rate for Payer: ASR Commercial |
$107.15
|
| Rate for Payer: ASR Commercial |
$103.33
|
| Rate for Payer: ASR Commercial |
$98.35
|
| Rate for Payer: BCBS Trust/PPO |
$345.52
|
| Rate for Payer: BCBS Trust/PPO |
$101.18
|
| Rate for Payer: BCBS Trust/PPO |
$82.62
|
| Rate for Payer: BCBS Trust/PPO |
$86.81
|
| Rate for Payer: BCBS Trust/PPO |
$90.01
|
| Rate for Payer: BCBS Trust/PPO |
$87.68
|
| Rate for Payer: BCBS Trust/PPO |
$74.20
|
| Rate for Payer: BCN Commercial |
$83.42
|
| Rate for Payer: BCN Commercial |
$70.59
|
| Rate for Payer: BCN Commercial |
$96.26
|
| Rate for Payer: BCN Commercial |
$78.61
|
| Rate for Payer: BCN Commercial |
$82.59
|
| Rate for Payer: BCN Commercial |
$328.73
|
| Rate for Payer: BCN Commercial |
$85.64
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$88.37
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cash Price |
$99.32
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$72.84
|
| Rate for Payer: Cofinity Commercial |
$116.71
|
| Rate for Payer: Cofinity Commercial |
$101.14
|
| Rate for Payer: Cofinity Commercial |
$95.31
|
| Rate for Payer: Cofinity Commercial |
$103.83
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$398.56
|
| Rate for Payer: Cofinity Commercial |
$85.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Healthscope Commercial |
$124.16
|
| Rate for Payer: Healthscope Commercial |
$91.05
|
| Rate for Payer: Healthscope Commercial |
$107.60
|
| Rate for Payer: Healthscope Commercial |
$110.46
|
| Rate for Payer: Healthscope Commercial |
$424.00
|
| Rate for Payer: Healthscope Commercial |
$106.53
|
| Rate for Payer: Healthscope Commercial |
$101.39
|
| Rate for Payer: Healthscope Whirlpool |
$411.28
|
| Rate for Payer: Healthscope Whirlpool |
$120.44
|
| Rate for Payer: Healthscope Whirlpool |
$107.15
|
| Rate for Payer: Healthscope Whirlpool |
$103.33
|
| Rate for Payer: Healthscope Whirlpool |
$104.37
|
| Rate for Payer: Healthscope Whirlpool |
$98.35
|
| Rate for Payer: Healthscope Whirlpool |
$88.32
|
| Rate for Payer: Mclaren Commercial |
$111.74
|
| Rate for Payer: Mclaren Commercial |
$81.94
|
| Rate for Payer: Mclaren Commercial |
$91.25
|
| Rate for Payer: Mclaren Commercial |
$381.60
|
| Rate for Payer: Mclaren Commercial |
$96.84
|
| Rate for Payer: Mclaren Commercial |
$95.88
|
| Rate for Payer: Mclaren Commercial |
$99.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Nomi Health Commercial |
$83.14
|
| Rate for Payer: Nomi Health Commercial |
$347.68
|
| Rate for Payer: Nomi Health Commercial |
$74.66
|
| Rate for Payer: Nomi Health Commercial |
$90.58
|
| Rate for Payer: Nomi Health Commercial |
$88.23
|
| Rate for Payer: Nomi Health Commercial |
$87.35
|
| Rate for Payer: Nomi Health Commercial |
$101.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.69
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$91.05
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$91.05 |
| Rate for Payer: Aetna Commercial |
$81.94
|
| Rate for Payer: Aetna Commercial |
$95.88
|
| Rate for Payer: Aetna Commercial |
$96.84
|
| Rate for Payer: Aetna Commercial |
$111.74
|
| Rate for Payer: Aetna Commercial |
$99.41
|
| Rate for Payer: Aetna Commercial |
$91.25
|
| Rate for Payer: Aetna Commercial |
$381.60
|
| Rate for Payer: Aetna Medicare |
$45.52
|
| Rate for Payer: Aetna Medicare |
$53.27
|
| Rate for Payer: Aetna Medicare |
$212.00
|
| Rate for Payer: Aetna Medicare |
$50.70
|
| Rate for Payer: Aetna Medicare |
$62.08
|
| Rate for Payer: Aetna Medicare |
$53.80
|
| Rate for Payer: Aetna Medicare |
$55.23
|
| Rate for Payer: ASR ASR |
$104.37
|
| Rate for Payer: ASR ASR |
$411.28
|
| Rate for Payer: ASR ASR |
$88.32
|
| Rate for Payer: ASR ASR |
$120.44
|
| Rate for Payer: ASR ASR |
$103.33
|
| Rate for Payer: ASR ASR |
$107.15
|
| Rate for Payer: ASR ASR |
$98.35
|
| Rate for Payer: ASR Commercial |
$104.37
|
| Rate for Payer: ASR Commercial |
$98.35
|
| Rate for Payer: ASR Commercial |
$120.44
|
| Rate for Payer: ASR Commercial |
$88.32
|
| Rate for Payer: ASR Commercial |
$411.28
|
| Rate for Payer: ASR Commercial |
$103.33
|
| Rate for Payer: ASR Commercial |
$107.15
|
| Rate for Payer: BCBS Complete |
$44.18
|
| Rate for Payer: BCBS Complete |
$40.56
|
| Rate for Payer: BCBS Complete |
$49.66
|
| Rate for Payer: BCBS Complete |
$43.04
|
| Rate for Payer: BCBS Complete |
$42.61
|
| Rate for Payer: BCBS Complete |
$36.42
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Trust/PPO |
$347.21
|
| Rate for Payer: BCBS Trust/PPO |
$90.46
|
| Rate for Payer: BCBS Trust/PPO |
$83.03
|
| Rate for Payer: BCBS Trust/PPO |
$87.24
|
| Rate for Payer: BCBS Trust/PPO |
$88.11
|
| Rate for Payer: BCBS Trust/PPO |
$101.67
|
| Rate for Payer: BCBS Trust/PPO |
$74.56
|
| Rate for Payer: BCN Commercial |
$328.73
|
| Rate for Payer: BCN Commercial |
$96.26
|
| Rate for Payer: BCN Commercial |
$70.59
|
| Rate for Payer: BCN Commercial |
$85.64
|
| Rate for Payer: BCN Commercial |
$82.59
|
| Rate for Payer: BCN Commercial |
$78.61
|
| Rate for Payer: BCN Commercial |
$83.42
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$88.37
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$99.32
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cash Price |
$72.84
|
| Rate for Payer: Cofinity Commercial |
$85.59
|
| Rate for Payer: Cofinity Commercial |
$116.71
|
| Rate for Payer: Cofinity Commercial |
$398.56
|
| Rate for Payer: Cofinity Commercial |
$95.31
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$103.83
|
| Rate for Payer: Cofinity Commercial |
$101.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Healthscope Commercial |
$101.39
|
| Rate for Payer: Healthscope Commercial |
$91.05
|
| Rate for Payer: Healthscope Commercial |
$424.00
|
| Rate for Payer: Healthscope Commercial |
$110.46
|
| Rate for Payer: Healthscope Commercial |
$106.53
|
| Rate for Payer: Healthscope Commercial |
$124.16
|
| Rate for Payer: Healthscope Commercial |
$107.60
|
| Rate for Payer: Healthscope Whirlpool |
$104.37
|
| Rate for Payer: Healthscope Whirlpool |
$98.35
|
| Rate for Payer: Healthscope Whirlpool |
$107.15
|
| Rate for Payer: Healthscope Whirlpool |
$120.44
|
| Rate for Payer: Healthscope Whirlpool |
$411.28
|
| Rate for Payer: Healthscope Whirlpool |
$88.32
|
| Rate for Payer: Healthscope Whirlpool |
$103.33
|
| Rate for Payer: Mclaren Commercial |
$96.84
|
| Rate for Payer: Mclaren Commercial |
$111.74
|
| Rate for Payer: Mclaren Commercial |
$381.60
|
| Rate for Payer: Mclaren Commercial |
$81.94
|
| Rate for Payer: Mclaren Commercial |
$99.41
|
| Rate for Payer: Mclaren Commercial |
$91.25
|
| Rate for Payer: Mclaren Commercial |
$95.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.39
|
| Rate for Payer: Nomi Health Commercial |
$88.23
|
| Rate for Payer: Nomi Health Commercial |
$347.68
|
| Rate for Payer: Nomi Health Commercial |
$101.81
|
| Rate for Payer: Nomi Health Commercial |
$74.66
|
| Rate for Payer: Nomi Health Commercial |
$87.35
|
| Rate for Payer: Nomi Health Commercial |
$83.14
|
| Rate for Payer: Nomi Health Commercial |
$90.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$371.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.34
|
| Rate for Payer: Priority Health Narrow Network |
$74.68
|
| Rate for Payer: Priority Health Narrow Network |
$77.43
|
| Rate for Payer: Priority Health Narrow Network |
$75.43
|
| Rate for Payer: Priority Health Narrow Network |
$71.07
|
| Rate for Payer: Priority Health Narrow Network |
$297.22
|
| Rate for Payer: Priority Health Narrow Network |
$87.04
|
| Rate for Payer: Priority Health Narrow Network |
$63.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.22
|
|
|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$91.05
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.18 |
| Max. Negotiated Rate |
$91.05 |
| Rate for Payer: Aetna Commercial |
$81.94
|
| Rate for Payer: ASR ASR |
$88.32
|
| Rate for Payer: ASR Commercial |
$88.32
|
| Rate for Payer: BCBS Trust/PPO |
$74.20
|
| Rate for Payer: BCN Commercial |
$70.59
|
| Rate for Payer: Cash Price |
$72.84
|
| Rate for Payer: Cofinity Commercial |
$85.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.84
|
| Rate for Payer: Healthscope Commercial |
$91.05
|
| Rate for Payer: Healthscope Whirlpool |
$88.32
|
| Rate for Payer: Mclaren Commercial |
$81.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.39
|
| Rate for Payer: Nomi Health Commercial |
$74.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.12
|
|
