|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.20
|
|
|
Service Code
|
NDC 55150022220
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$26.20 |
| Rate for Payer: Aetna Commercial |
$23.58
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: ASR ASR |
$25.41
|
| Rate for Payer: ASR Commercial |
$25.41
|
| Rate for Payer: BCBS Complete |
$10.48
|
| Rate for Payer: BCBS Trust/PPO |
$21.46
|
| Rate for Payer: BCN Commercial |
$20.31
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$24.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.96
|
| Rate for Payer: Healthscope Commercial |
$26.20
|
| Rate for Payer: Healthscope Whirlpool |
$25.41
|
| Rate for Payer: Mclaren Commercial |
$23.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.27
|
| Rate for Payer: Nomi Health Commercial |
$21.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.96
|
| Rate for Payer: Priority Health Narrow Network |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.06
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.57
|
|
|
Service Code
|
NDC 55150022110
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$18.57 |
| Rate for Payer: Aetna Commercial |
$16.71
|
| Rate for Payer: Aetna Medicare |
$9.28
|
| Rate for Payer: ASR ASR |
$18.01
|
| Rate for Payer: ASR Commercial |
$18.01
|
| Rate for Payer: BCBS Complete |
$7.43
|
| Rate for Payer: BCBS Trust/PPO |
$15.21
|
| Rate for Payer: BCN Commercial |
$14.40
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$18.57
|
| Rate for Payer: Healthscope Whirlpool |
$18.01
|
| Rate for Payer: Mclaren Commercial |
$16.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.78
|
| Rate for Payer: Nomi Health Commercial |
$15.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.27
|
| Rate for Payer: Priority Health Narrow Network |
$13.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.34
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.43
|
|
|
Service Code
|
NDC 65219044501
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.59
|
| Rate for Payer: Aetna Medicare |
$9.22
|
| Rate for Payer: ASR ASR |
$17.88
|
| Rate for Payer: ASR Commercial |
$17.88
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS Trust/PPO |
$15.09
|
| Rate for Payer: BCN Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$18.43
|
| Rate for Payer: Healthscope Whirlpool |
$17.88
|
| Rate for Payer: Mclaren Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.15
|
| Rate for Payer: Priority Health Narrow Network |
$12.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.22
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.23
|
|
|
Service Code
|
NDC 00143950601
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: ASR ASR |
$24.47
|
| Rate for Payer: ASR Commercial |
$24.47
|
| Rate for Payer: BCBS Trust/PPO |
$20.56
|
| Rate for Payer: BCN Commercial |
$19.56
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$23.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.18
|
| Rate for Payer: Healthscope Commercial |
$25.23
|
| Rate for Payer: Healthscope Whirlpool |
$24.47
|
| Rate for Payer: Mclaren Commercial |
$22.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$20.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.20
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.43
|
|
|
Service Code
|
NDC 65219044510
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.59
|
| Rate for Payer: Aetna Medicare |
$9.22
|
| Rate for Payer: ASR ASR |
$17.88
|
| Rate for Payer: ASR Commercial |
$17.88
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS Trust/PPO |
$15.09
|
| Rate for Payer: BCN Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$18.43
|
| Rate for Payer: Healthscope Whirlpool |
$17.88
|
| Rate for Payer: Mclaren Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.15
|
| Rate for Payer: Priority Health Narrow Network |
$12.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.22
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
NDC 65219044501
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.59
|
| Rate for Payer: ASR ASR |
$17.88
|
| Rate for Payer: ASR Commercial |
$17.88
|
| Rate for Payer: BCBS Trust/PPO |
$15.02
|
| Rate for Payer: BCN Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$18.43
|
| Rate for Payer: Healthscope Whirlpool |
$17.88
|
| Rate for Payer: Mclaren Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.22
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.24
|
|
|
Service Code
|
NDC 72266014601
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$17.24 |
| Rate for Payer: Aetna Commercial |
$15.52
|
| Rate for Payer: ASR ASR |
$16.72
|
| Rate for Payer: ASR Commercial |
$16.72
|
| Rate for Payer: BCBS Trust/PPO |
$14.05
|
| Rate for Payer: BCN Commercial |
$13.37
|
| Rate for Payer: Cash Price |
$13.79
|
| Rate for Payer: Cofinity Commercial |
$16.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.79
|
| Rate for Payer: Healthscope Commercial |
$17.24
|
| Rate for Payer: Healthscope Whirlpool |
$16.72
|
| Rate for Payer: Mclaren Commercial |
$15.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.65
|
| Rate for Payer: Nomi Health Commercial |
$14.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.17
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.23
|
|
|
Service Code
|
NDC 00143950610
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: ASR ASR |
$24.47
|
| Rate for Payer: ASR Commercial |
$24.47
|
| Rate for Payer: BCBS Trust/PPO |
$20.56
|
| Rate for Payer: BCN Commercial |
$19.56
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$23.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.18
|
| Rate for Payer: Healthscope Commercial |
$25.23
|
| Rate for Payer: Healthscope Whirlpool |
$24.47
|
| Rate for Payer: Mclaren Commercial |
$22.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$20.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.20
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
IP
|
$22.92
|
|
|
Service Code
|
NDC 00409669501
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$20.63
|
| Rate for Payer: ASR ASR |
$22.23
|
| Rate for Payer: ASR Commercial |
$22.23
|
| Rate for Payer: BCBS Trust/PPO |
$18.68
|
| Rate for Payer: BCN Commercial |
$17.77
|
| Rate for Payer: Cash Price |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Healthscope Whirlpool |
$22.23
|
| Rate for Payer: Mclaren Commercial |
$20.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: Nomi Health Commercial |
$18.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.17
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
OP
|
$22.92
|
|
|
Service Code
|
NDC 00409669501
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$20.63
|
| Rate for Payer: Aetna Medicare |
$11.46
|
| Rate for Payer: ASR ASR |
$22.23
|
| Rate for Payer: ASR Commercial |
$22.23
|
| Rate for Payer: BCBS Complete |
$9.17
|
| Rate for Payer: BCBS Trust/PPO |
$18.77
|
| Rate for Payer: BCN Commercial |
$17.77
|
| Rate for Payer: Cash Price |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Healthscope Whirlpool |
$22.23
|
| Rate for Payer: Mclaren Commercial |
$20.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: Nomi Health Commercial |
$18.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.08
|
| Rate for Payer: Priority Health Narrow Network |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.17
|
|
|
EUFLEXXA 10 MG/ML (MW 2.4-3.6 MILLION) INTRA-ARTICULAR SYRINGE
|
Facility
|
OP
|
$1,073.23
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
43247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$1,073.23 |
| Rate for Payer: Aetna Commercial |
$965.91
|
| Rate for Payer: Aetna Medicare |
$120.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.85
|
| Rate for Payer: ASR ASR |
$1,041.03
|
| Rate for Payer: ASR Commercial |
$1,041.03
|
| Rate for Payer: BCBS Complete |
$67.92
|
| Rate for Payer: BCBS MAPPO |
$120.68
|
| Rate for Payer: BCBS Trust/PPO |
$878.87
|
| Rate for Payer: BCN Commercial |
$832.08
|
| Rate for Payer: BCN Medicare Advantage |
$120.68
|
| Rate for Payer: Cash Price |
$858.58
|
| Rate for Payer: Cash Price |
$858.58
|
| Rate for Payer: Cofinity Commercial |
$1,008.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.68
|
| Rate for Payer: Healthscope Commercial |
$1,073.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$120.68
|
| Rate for Payer: Mclaren Commercial |
$965.91
|
| Rate for Payer: Mclaren Medicaid |
$64.68
|
| Rate for Payer: Mclaren Medicare |
$120.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.71
|
| Rate for Payer: Meridian Medicaid |
$67.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$912.25
|
| Rate for Payer: Nomi Health Commercial |
$880.05
|
| Rate for Payer: PACE Medicare |
$114.65
|
| Rate for Payer: PACE SWMI |
$120.68
|
| Rate for Payer: PHP Commercial |
$132.75
|
| Rate for Payer: PHP Medicaid |
$64.68
|
| Rate for Payer: PHP Medicare Advantage |
$120.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.57
|
| Rate for Payer: Priority Health Medicare |
$120.68
|
| Rate for Payer: Priority Health Narrow Network |
$106.86
|
| Rate for Payer: Railroad Medicare Medicare |
$120.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$944.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.68
|
| Rate for Payer: UHC Exchange |
$187.05
|
| Rate for Payer: UHC Medicare Advantage |
$120.68
|
| Rate for Payer: UHCCP DNSP |
$120.68
|
| Rate for Payer: UHCCP Medicaid |
$64.68
|
| Rate for Payer: VA VA |
$120.68
|
|
|
EUFLEXXA 10 MG/ML (MW 2.4-3.6 MILLION) INTRA-ARTICULAR SYRINGE
|
Facility
|
IP
|
$1,073.23
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
43247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$697.60 |
| Max. Negotiated Rate |
$1,073.23 |
| Rate for Payer: Aetna Commercial |
$965.91
|
| Rate for Payer: ASR ASR |
$1,041.03
|
| Rate for Payer: ASR Commercial |
$1,041.03
|
| Rate for Payer: BCBS Trust/PPO |
$874.58
|
| Rate for Payer: BCN Commercial |
$832.08
|
| Rate for Payer: Cash Price |
$858.58
|
| Rate for Payer: Cofinity Commercial |
$1,008.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.58
|
| Rate for Payer: Healthscope Commercial |
$1,073.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.03
|
| Rate for Payer: Mclaren Commercial |
$965.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$912.25
|
| Rate for Payer: Nomi Health Commercial |
$880.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$944.44
|
|
|
EVOLOCUMAB 140 MG/ML SUBCUTANEOUS PEN INJECTOR
|
Facility
|
OP
|
$926.89
|
|
|
Service Code
|
NDC 72511076002
|
| Hospital Charge Code |
175551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$370.76 |
| Max. Negotiated Rate |
$926.89 |
| Rate for Payer: Aetna Commercial |
$834.20
|
| Rate for Payer: Aetna Medicare |
$463.44
|
| Rate for Payer: ASR ASR |
$899.08
|
| Rate for Payer: ASR Commercial |
$899.08
|
| Rate for Payer: BCBS Complete |
$370.76
|
| Rate for Payer: BCBS Trust/PPO |
$759.03
|
| Rate for Payer: BCN Commercial |
$718.62
|
| Rate for Payer: Cash Price |
$741.51
|
| Rate for Payer: Cofinity Commercial |
$871.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.51
|
| Rate for Payer: Healthscope Commercial |
$926.89
|
| Rate for Payer: Healthscope Whirlpool |
$899.08
|
| Rate for Payer: Mclaren Commercial |
$834.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.86
|
| Rate for Payer: Nomi Health Commercial |
$760.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$812.14
|
| Rate for Payer: Priority Health Narrow Network |
$649.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$815.66
|
|
|
EVOLOCUMAB 140 MG/ML SUBCUTANEOUS PEN INJECTOR
|
Facility
|
OP
|
$926.89
|
|
|
Service Code
|
NDC 72511076001
|
| Hospital Charge Code |
175551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$370.76 |
| Max. Negotiated Rate |
$926.89 |
| Rate for Payer: Aetna Commercial |
$834.20
|
| Rate for Payer: Aetna Medicare |
$463.44
|
| Rate for Payer: ASR ASR |
$899.08
|
| Rate for Payer: ASR Commercial |
$899.08
|
| Rate for Payer: BCBS Complete |
$370.76
|
| Rate for Payer: BCBS Trust/PPO |
$759.03
|
| Rate for Payer: BCN Commercial |
$718.62
|
| Rate for Payer: Cash Price |
$741.51
|
| Rate for Payer: Cofinity Commercial |
$871.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.51
|
| Rate for Payer: Healthscope Commercial |
$926.89
|
| Rate for Payer: Healthscope Whirlpool |
$899.08
|
| Rate for Payer: Mclaren Commercial |
$834.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.86
|
| Rate for Payer: Nomi Health Commercial |
$760.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$812.14
|
| Rate for Payer: Priority Health Narrow Network |
$649.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$815.66
|
|
|
EVOLOCUMAB 140 MG/ML SUBCUTANEOUS PEN INJECTOR
|
Facility
|
IP
|
$926.89
|
|
|
Service Code
|
NDC 72511076001
|
| Hospital Charge Code |
175551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$602.48 |
| Max. Negotiated Rate |
$926.89 |
| Rate for Payer: Aetna Commercial |
$834.20
|
| Rate for Payer: ASR ASR |
$899.08
|
| Rate for Payer: ASR Commercial |
$899.08
|
| Rate for Payer: BCBS Trust/PPO |
$755.32
|
| Rate for Payer: BCN Commercial |
$718.62
|
| Rate for Payer: Cash Price |
$741.51
|
| Rate for Payer: Cofinity Commercial |
$871.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.51
|
| Rate for Payer: Healthscope Commercial |
$926.89
|
| Rate for Payer: Healthscope Whirlpool |
$899.08
|
| Rate for Payer: Mclaren Commercial |
$834.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.86
|
| Rate for Payer: Nomi Health Commercial |
$760.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$815.66
|
|
|
EVOLOCUMAB 140 MG/ML SUBCUTANEOUS PEN INJECTOR
|
Facility
|
IP
|
$926.89
|
|
|
Service Code
|
NDC 72511076002
|
| Hospital Charge Code |
175551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$602.48 |
| Max. Negotiated Rate |
$926.89 |
| Rate for Payer: Aetna Commercial |
$834.20
|
| Rate for Payer: ASR ASR |
$899.08
|
| Rate for Payer: ASR Commercial |
$899.08
|
| Rate for Payer: BCBS Trust/PPO |
$755.32
|
| Rate for Payer: BCN Commercial |
$718.62
|
| Rate for Payer: Cash Price |
$741.51
|
| Rate for Payer: Cofinity Commercial |
$871.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.51
|
| Rate for Payer: Healthscope Commercial |
$926.89
|
| Rate for Payer: Healthscope Whirlpool |
$899.08
|
| Rate for Payer: Mclaren Commercial |
$834.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.86
|
| Rate for Payer: Nomi Health Commercial |
$760.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$815.66
|
|
|
EYELASH TINTING
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 00176
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$81.80
|
|
|
Service Code
|
NDC 67877049030
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.17 |
| Max. Negotiated Rate |
$81.80 |
| Rate for Payer: Aetna Commercial |
$73.62
|
| Rate for Payer: ASR ASR |
$79.35
|
| Rate for Payer: ASR Commercial |
$79.35
|
| Rate for Payer: BCBS Trust/PPO |
$66.66
|
| Rate for Payer: BCN Commercial |
$63.42
|
| Rate for Payer: Cash Price |
$65.44
|
| Rate for Payer: Cofinity Commercial |
$76.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.44
|
| Rate for Payer: Healthscope Commercial |
$81.80
|
| Rate for Payer: Healthscope Whirlpool |
$79.35
|
| Rate for Payer: Mclaren Commercial |
$73.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.53
|
| Rate for Payer: Nomi Health Commercial |
$67.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.98
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$300.22
|
|
|
Service Code
|
NDC 00904710310
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.14 |
| Max. Negotiated Rate |
$300.22 |
| Rate for Payer: Aetna Commercial |
$270.20
|
| Rate for Payer: ASR ASR |
$291.21
|
| Rate for Payer: ASR Commercial |
$291.21
|
| Rate for Payer: BCBS Trust/PPO |
$244.65
|
| Rate for Payer: BCN Commercial |
$232.76
|
| Rate for Payer: Cash Price |
$240.17
|
| Rate for Payer: Cofinity Commercial |
$282.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.18
|
| Rate for Payer: Healthscope Commercial |
$300.22
|
| Rate for Payer: Healthscope Whirlpool |
$291.21
|
| Rate for Payer: Mclaren Commercial |
$270.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.19
|
| Rate for Payer: Nomi Health Commercial |
$246.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.19
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$66.27
|
|
|
Service Code
|
NDC 50228037930
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.08 |
| Max. Negotiated Rate |
$66.27 |
| Rate for Payer: Aetna Commercial |
$59.64
|
| Rate for Payer: ASR ASR |
$64.28
|
| Rate for Payer: ASR Commercial |
$64.28
|
| Rate for Payer: BCBS Trust/PPO |
$54.00
|
| Rate for Payer: BCN Commercial |
$51.38
|
| Rate for Payer: Cash Price |
$53.02
|
| Rate for Payer: Cofinity Commercial |
$62.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.02
|
| Rate for Payer: Healthscope Commercial |
$66.27
|
| Rate for Payer: Healthscope Whirlpool |
$64.28
|
| Rate for Payer: Mclaren Commercial |
$59.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.33
|
| Rate for Payer: Nomi Health Commercial |
$54.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.32
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
OP
|
$300.22
|
|
|
Service Code
|
NDC 00904710310
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.09 |
| Max. Negotiated Rate |
$300.22 |
| Rate for Payer: Aetna Commercial |
$270.20
|
| Rate for Payer: Aetna Medicare |
$150.11
|
| Rate for Payer: ASR ASR |
$291.21
|
| Rate for Payer: ASR Commercial |
$291.21
|
| Rate for Payer: BCBS Complete |
$120.09
|
| Rate for Payer: BCBS Trust/PPO |
$245.85
|
| Rate for Payer: BCN Commercial |
$232.76
|
| Rate for Payer: Cash Price |
$240.17
|
| Rate for Payer: Cofinity Commercial |
$282.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.18
|
| Rate for Payer: Healthscope Commercial |
$300.22
|
| Rate for Payer: Healthscope Whirlpool |
$291.21
|
| Rate for Payer: Mclaren Commercial |
$270.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.19
|
| Rate for Payer: Nomi Health Commercial |
$246.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.05
|
| Rate for Payer: Priority Health Narrow Network |
$210.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.19
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
OP
|
$66.27
|
|
|
Service Code
|
NDC 50228037930
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.51 |
| Max. Negotiated Rate |
$66.27 |
| Rate for Payer: Aetna Commercial |
$59.64
|
| Rate for Payer: Aetna Medicare |
$33.14
|
| Rate for Payer: ASR ASR |
$64.28
|
| Rate for Payer: ASR Commercial |
$64.28
|
| Rate for Payer: BCBS Complete |
$26.51
|
| Rate for Payer: BCBS Trust/PPO |
$54.27
|
| Rate for Payer: BCN Commercial |
$51.38
|
| Rate for Payer: Cash Price |
$53.02
|
| Rate for Payer: Cofinity Commercial |
$62.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.02
|
| Rate for Payer: Healthscope Commercial |
$66.27
|
| Rate for Payer: Healthscope Whirlpool |
$64.28
|
| Rate for Payer: Mclaren Commercial |
$59.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.33
|
| Rate for Payer: Nomi Health Commercial |
$54.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.07
|
| Rate for Payer: Priority Health Narrow Network |
$46.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.32
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
OP
|
$81.80
|
|
|
Service Code
|
NDC 67877049030
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.72 |
| Max. Negotiated Rate |
$81.80 |
| Rate for Payer: Aetna Commercial |
$73.62
|
| Rate for Payer: Aetna Medicare |
$40.90
|
| Rate for Payer: ASR ASR |
$79.35
|
| Rate for Payer: ASR Commercial |
$79.35
|
| Rate for Payer: BCBS Complete |
$32.72
|
| Rate for Payer: BCBS Trust/PPO |
$66.99
|
| Rate for Payer: BCN Commercial |
$63.42
|
| Rate for Payer: Cash Price |
$65.44
|
| Rate for Payer: Cofinity Commercial |
$76.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.44
|
| Rate for Payer: Healthscope Commercial |
$81.80
|
| Rate for Payer: Healthscope Whirlpool |
$79.35
|
| Rate for Payer: Mclaren Commercial |
$73.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.53
|
| Rate for Payer: Nomi Health Commercial |
$67.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.67
|
| Rate for Payer: Priority Health Narrow Network |
$57.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.98
|
|
|
FACIAL
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 00174
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$42.90 |
| Rate for Payer: Aetna Medicare |
$33.00
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$150.40
|
|
|
Service Code
|
NDC 61442012101
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.16 |
| Max. Negotiated Rate |
$150.40 |
| Rate for Payer: Aetna Commercial |
$135.36
|
| Rate for Payer: Aetna Medicare |
$75.20
|
| Rate for Payer: ASR ASR |
$145.89
|
| Rate for Payer: ASR Commercial |
$145.89
|
| Rate for Payer: BCBS Complete |
$60.16
|
| Rate for Payer: BCBS Trust/PPO |
$123.16
|
| Rate for Payer: BCN Commercial |
$116.61
|
| Rate for Payer: Cash Price |
$120.32
|
| Rate for Payer: Cofinity Commercial |
$141.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.32
|
| Rate for Payer: Healthscope Commercial |
$150.40
|
| Rate for Payer: Healthscope Whirlpool |
$145.89
|
| Rate for Payer: Mclaren Commercial |
$135.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.84
|
| Rate for Payer: Nomi Health Commercial |
$123.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.78
|
| Rate for Payer: Priority Health Narrow Network |
$105.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.35
|
|
