|
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,000.30
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
98312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$650.20 |
| Max. Negotiated Rate |
$1,000.30 |
| Rate for Payer: Aetna Commercial |
$900.27
|
| Rate for Payer: ASR ASR |
$970.29
|
| Rate for Payer: ASR Commercial |
$970.29
|
| Rate for Payer: BCBS Trust/PPO |
$815.14
|
| Rate for Payer: BCN Commercial |
$775.53
|
| Rate for Payer: Cash Price |
$800.24
|
| Rate for Payer: Cofinity Commercial |
$940.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.24
|
| Rate for Payer: Healthscope Commercial |
$1,000.30
|
| Rate for Payer: Healthscope Whirlpool |
$970.29
|
| Rate for Payer: Mclaren Commercial |
$900.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$850.26
|
| Rate for Payer: Nomi Health Commercial |
$820.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.26
|
|
|
FIBERSOURCE HN BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018555
|
| Hospital Charge Code |
161567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.87
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
FIBERSOURCE HN BOLUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018555
|
| Hospital Charge Code |
161567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
FIBERSOURCE HN CONTINUOUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018555
|
| Hospital Charge Code |
168938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
FIBERSOURCE HN CONTINUOUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018555
|
| Hospital Charge Code |
168938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.87
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
FIBERSOURCE HN CYCLIC FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018555
|
| Hospital Charge Code |
200077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.87
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
FIBERSOURCE HN CYCLIC FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018555
|
| Hospital Charge Code |
200077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
FIBERSOURCE HN INTERMITTENT FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018555
|
| Hospital Charge Code |
200076
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.87
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
FIBERSOURCE HN INTERMITTENT FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018555
|
| Hospital Charge Code |
200076
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
FIDAXOMICIN 200 MG TABLET
|
Facility
|
IP
|
$17,910.22
|
|
|
Service Code
|
NDC 52015008001
|
| Hospital Charge Code |
152861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11,641.64 |
| Max. Negotiated Rate |
$17,910.22 |
| Rate for Payer: Aetna Commercial |
$16,119.20
|
| Rate for Payer: ASR ASR |
$17,372.91
|
| Rate for Payer: ASR Commercial |
$17,372.91
|
| Rate for Payer: BCBS Trust/PPO |
$14,595.04
|
| Rate for Payer: BCN Commercial |
$13,885.79
|
| Rate for Payer: Cash Price |
$14,328.18
|
| Rate for Payer: Cofinity Commercial |
$16,835.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,328.18
|
| Rate for Payer: Healthscope Commercial |
$17,910.22
|
| Rate for Payer: Healthscope Whirlpool |
$17,372.91
|
| Rate for Payer: Mclaren Commercial |
$16,119.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,223.69
|
| Rate for Payer: Nomi Health Commercial |
$14,686.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,641.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,760.99
|
|
|
FIDAXOMICIN 200 MG TABLET
|
Facility
|
OP
|
$17,910.22
|
|
|
Service Code
|
NDC 52015008001
|
| Hospital Charge Code |
152861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7,164.09 |
| Max. Negotiated Rate |
$17,910.22 |
| Rate for Payer: Aetna Commercial |
$16,119.20
|
| Rate for Payer: Aetna Medicare |
$8,955.11
|
| Rate for Payer: ASR ASR |
$17,372.91
|
| Rate for Payer: ASR Commercial |
$17,372.91
|
| Rate for Payer: BCBS Complete |
$7,164.09
|
| Rate for Payer: BCBS Trust/PPO |
$14,666.68
|
| Rate for Payer: BCN Commercial |
$13,885.79
|
| Rate for Payer: Cash Price |
$14,328.18
|
| Rate for Payer: Cofinity Commercial |
$16,835.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,328.18
|
| Rate for Payer: Healthscope Commercial |
$17,910.22
|
| Rate for Payer: Healthscope Whirlpool |
$17,372.91
|
| Rate for Payer: Mclaren Commercial |
$16,119.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,223.69
|
| Rate for Payer: Nomi Health Commercial |
$14,686.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,641.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,692.93
|
| Rate for Payer: Priority Health Narrow Network |
$12,555.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,760.99
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$787.14
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$511.64 |
| Max. Negotiated Rate |
$787.14 |
| Rate for Payer: Aetna Commercial |
$708.43
|
| Rate for Payer: ASR ASR |
$763.53
|
| Rate for Payer: ASR Commercial |
$763.53
|
| Rate for Payer: BCBS Trust/PPO |
$641.44
|
| Rate for Payer: BCN Commercial |
$610.27
|
| Rate for Payer: Cash Price |
$629.71
|
| Rate for Payer: Cofinity Commercial |
$739.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$629.71
|
| Rate for Payer: Healthscope Commercial |
$787.14
|
| Rate for Payer: Healthscope Whirlpool |
$763.53
|
| Rate for Payer: Mclaren Commercial |
$708.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.07
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$692.68
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$787.14
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$787.14 |
| Rate for Payer: Aetna Commercial |
$708.43
|
| Rate for Payer: Aetna Medicare |
$0.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.36
|
| Rate for Payer: ASR ASR |
$763.53
|
| Rate for Payer: ASR Commercial |
$763.53
|
| Rate for Payer: BCBS Complete |
$0.16
|
| Rate for Payer: BCBS MAPPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$644.59
|
| Rate for Payer: BCN Commercial |
$610.27
|
| Rate for Payer: BCN Medicare Advantage |
$0.29
|
| Rate for Payer: Cash Price |
$629.71
|
| Rate for Payer: Cash Price |
$629.71
|
| Rate for Payer: Cofinity Commercial |
$739.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$629.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.29
|
| Rate for Payer: Healthscope Commercial |
$787.14
|
| Rate for Payer: Healthscope Whirlpool |
$763.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.29
|
| Rate for Payer: Mclaren Commercial |
$708.43
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicare |
$0.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.30
|
| Rate for Payer: Meridian Medicaid |
$0.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.07
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: PACE Medicare |
$0.28
|
| Rate for Payer: PACE SWMI |
$0.29
|
| Rate for Payer: PHP Commercial |
$0.32
|
| Rate for Payer: PHP Medicaid |
$0.16
|
| Rate for Payer: PHP Medicare Advantage |
$0.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.23
|
| Rate for Payer: Priority Health Medicare |
$0.29
|
| Rate for Payer: Priority Health Narrow Network |
$0.18
|
| Rate for Payer: Railroad Medicare Medicare |
$0.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$692.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.29
|
| Rate for Payer: UHC Exchange |
$0.45
|
| Rate for Payer: UHC Medicare Advantage |
$0.29
|
| Rate for Payer: UHCCP DNSP |
$0.29
|
| Rate for Payer: UHCCP Medicaid |
$0.16
|
| Rate for Payer: VA VA |
$0.29
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$707.48
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$707.48 |
| Rate for Payer: Aetna Commercial |
$636.73
|
| Rate for Payer: Aetna Medicare |
$0.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.45
|
| Rate for Payer: ASR ASR |
$686.26
|
| Rate for Payer: ASR Commercial |
$686.26
|
| Rate for Payer: BCBS Complete |
$0.20
|
| Rate for Payer: BCBS MAPPO |
$0.36
|
| Rate for Payer: BCBS Trust/PPO |
$579.36
|
| Rate for Payer: BCN Commercial |
$548.51
|
| Rate for Payer: BCN Medicare Advantage |
$0.36
|
| Rate for Payer: Cash Price |
$565.98
|
| Rate for Payer: Cash Price |
$565.98
|
| Rate for Payer: Cofinity Commercial |
$665.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.36
|
| Rate for Payer: Healthscope Commercial |
$707.48
|
| Rate for Payer: Healthscope Whirlpool |
$686.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.36
|
| Rate for Payer: Mclaren Commercial |
$636.73
|
| Rate for Payer: Mclaren Medicaid |
$0.19
|
| Rate for Payer: Mclaren Medicare |
$0.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.38
|
| Rate for Payer: Meridian Medicaid |
$0.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.36
|
| Rate for Payer: Nomi Health Commercial |
$580.13
|
| Rate for Payer: PACE Medicare |
$0.34
|
| Rate for Payer: PACE SWMI |
$0.36
|
| Rate for Payer: PHP Commercial |
$0.40
|
| Rate for Payer: PHP Medicaid |
$0.19
|
| Rate for Payer: PHP Medicare Advantage |
$0.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.28
|
| Rate for Payer: Priority Health Medicare |
$0.36
|
| Rate for Payer: Priority Health Narrow Network |
$0.22
|
| Rate for Payer: Railroad Medicare Medicare |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$622.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.36
|
| Rate for Payer: UHC Exchange |
$0.56
|
| Rate for Payer: UHC Medicare Advantage |
$0.36
|
| Rate for Payer: UHCCP DNSP |
$0.36
|
| Rate for Payer: UHCCP Medicaid |
$0.19
|
| Rate for Payer: VA VA |
$0.36
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$707.48
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$459.86 |
| Max. Negotiated Rate |
$707.48 |
| Rate for Payer: Aetna Commercial |
$636.73
|
| Rate for Payer: ASR ASR |
$686.26
|
| Rate for Payer: ASR Commercial |
$686.26
|
| Rate for Payer: BCBS Trust/PPO |
$576.53
|
| Rate for Payer: BCN Commercial |
$548.51
|
| Rate for Payer: Cash Price |
$565.98
|
| Rate for Payer: Cofinity Commercial |
$665.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.98
|
| Rate for Payer: Healthscope Commercial |
$707.48
|
| Rate for Payer: Healthscope Whirlpool |
$686.26
|
| Rate for Payer: Mclaren Commercial |
$636.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.36
|
| Rate for Payer: Nomi Health Commercial |
$580.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$622.58
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
IP
|
$1,020.35
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$663.23 |
| Max. Negotiated Rate |
$1,020.35 |
| Rate for Payer: Aetna Commercial |
$918.32
|
| Rate for Payer: Aetna Commercial |
$918.32
|
| Rate for Payer: ASR ASR |
$989.75
|
| Rate for Payer: ASR ASR |
$989.74
|
| Rate for Payer: ASR Commercial |
$989.75
|
| Rate for Payer: ASR Commercial |
$989.74
|
| Rate for Payer: BCBS Trust/PPO |
$831.49
|
| Rate for Payer: BCBS Trust/PPO |
$831.48
|
| Rate for Payer: BCN Commercial |
$791.09
|
| Rate for Payer: BCN Commercial |
$791.08
|
| Rate for Payer: Cash Price |
$816.28
|
| Rate for Payer: Cash Price |
$816.29
|
| Rate for Payer: Cofinity Commercial |
$959.14
|
| Rate for Payer: Cofinity Commercial |
$959.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.29
|
| Rate for Payer: Healthscope Commercial |
$1,020.35
|
| Rate for Payer: Healthscope Commercial |
$1,020.36
|
| Rate for Payer: Healthscope Whirlpool |
$989.75
|
| Rate for Payer: Healthscope Whirlpool |
$989.74
|
| Rate for Payer: Mclaren Commercial |
$918.32
|
| Rate for Payer: Mclaren Commercial |
$918.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.30
|
| Rate for Payer: Nomi Health Commercial |
$836.70
|
| Rate for Payer: Nomi Health Commercial |
$836.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.92
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
OP
|
$1,020.36
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$1,020.36 |
| Rate for Payer: Aetna Commercial |
$918.32
|
| Rate for Payer: Aetna Commercial |
$918.32
|
| Rate for Payer: Aetna Medicare |
$0.36
|
| Rate for Payer: Aetna Medicare |
$0.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.45
|
| Rate for Payer: ASR ASR |
$989.75
|
| Rate for Payer: ASR ASR |
$989.74
|
| Rate for Payer: ASR Commercial |
$989.74
|
| Rate for Payer: ASR Commercial |
$989.75
|
| Rate for Payer: BCBS Complete |
$0.20
|
| Rate for Payer: BCBS Complete |
$0.20
|
| Rate for Payer: BCBS MAPPO |
$0.36
|
| Rate for Payer: BCBS MAPPO |
$0.36
|
| Rate for Payer: BCBS Trust/PPO |
$835.57
|
| Rate for Payer: BCBS Trust/PPO |
$835.56
|
| Rate for Payer: BCN Commercial |
$791.08
|
| Rate for Payer: BCN Commercial |
$791.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.36
|
| Rate for Payer: BCN Medicare Advantage |
$0.36
|
| Rate for Payer: Cash Price |
$816.29
|
| Rate for Payer: Cash Price |
$816.28
|
| Rate for Payer: Cash Price |
$816.29
|
| Rate for Payer: Cash Price |
$816.28
|
| Rate for Payer: Cofinity Commercial |
$959.13
|
| Rate for Payer: Cofinity Commercial |
$959.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.36
|
| Rate for Payer: Healthscope Commercial |
$1,020.35
|
| Rate for Payer: Healthscope Commercial |
$1,020.36
|
| Rate for Payer: Healthscope Whirlpool |
$989.74
|
| Rate for Payer: Healthscope Whirlpool |
$989.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.36
|
| Rate for Payer: Mclaren Commercial |
$918.32
|
| Rate for Payer: Mclaren Commercial |
$918.32
|
| Rate for Payer: Mclaren Medicaid |
$0.19
|
| Rate for Payer: Mclaren Medicaid |
$0.19
|
| Rate for Payer: Mclaren Medicare |
$0.36
|
| Rate for Payer: Mclaren Medicare |
$0.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.38
|
| Rate for Payer: Meridian Medicaid |
$0.20
|
| Rate for Payer: Meridian Medicaid |
$0.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.30
|
| Rate for Payer: Nomi Health Commercial |
$836.70
|
| Rate for Payer: Nomi Health Commercial |
$836.69
|
| Rate for Payer: PACE Medicare |
$0.34
|
| Rate for Payer: PACE Medicare |
$0.34
|
| Rate for Payer: PACE SWMI |
$0.36
|
| Rate for Payer: PACE SWMI |
$0.36
|
| Rate for Payer: PHP Commercial |
$0.40
|
| Rate for Payer: PHP Commercial |
$0.40
|
| Rate for Payer: PHP Medicaid |
$0.19
|
| Rate for Payer: PHP Medicaid |
$0.19
|
| Rate for Payer: PHP Medicare Advantage |
$0.36
|
| Rate for Payer: PHP Medicare Advantage |
$0.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.28
|
| Rate for Payer: Priority Health Medicare |
$0.36
|
| Rate for Payer: Priority Health Medicare |
$0.36
|
| Rate for Payer: Priority Health Narrow Network |
$0.22
|
| Rate for Payer: Priority Health Narrow Network |
$0.22
|
| Rate for Payer: Railroad Medicare Medicare |
$0.36
|
| Rate for Payer: Railroad Medicare Medicare |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.36
|
| Rate for Payer: UHC Exchange |
$0.56
|
| Rate for Payer: UHC Exchange |
$0.56
|
| Rate for Payer: UHC Medicare Advantage |
$0.36
|
| Rate for Payer: UHC Medicare Advantage |
$0.36
|
| Rate for Payer: UHCCP DNSP |
$0.36
|
| Rate for Payer: UHCCP DNSP |
$0.36
|
| Rate for Payer: UHCCP Medicaid |
$0.19
|
| Rate for Payer: UHCCP Medicaid |
$0.19
|
| Rate for Payer: VA VA |
$0.36
|
| Rate for Payer: VA VA |
$0.36
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$53.58
|
|
|
Service Code
|
NDC 16729009010
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.43 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$48.22
|
| Rate for Payer: Aetna Medicare |
$26.79
|
| Rate for Payer: ASR ASR |
$51.97
|
| Rate for Payer: ASR Commercial |
$51.97
|
| Rate for Payer: BCBS Complete |
$21.43
|
| Rate for Payer: BCBS Trust/PPO |
$43.88
|
| Rate for Payer: BCN Commercial |
$41.54
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Commercial |
$50.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Healthscope Commercial |
$53.58
|
| Rate for Payer: Healthscope Whirlpool |
$51.97
|
| Rate for Payer: Mclaren Commercial |
$48.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.54
|
| Rate for Payer: Nomi Health Commercial |
$43.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.95
|
| Rate for Payer: Priority Health Narrow Network |
$37.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.15
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$2.84
|
|
|
Service Code
|
NDC 60687042811
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: Aetna Medicare |
$1.42
|
| Rate for Payer: ASR ASR |
$2.75
|
| Rate for Payer: ASR Commercial |
$2.75
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.27
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Healthscope Whirlpool |
$2.75
|
| Rate for Payer: Mclaren Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: Nomi Health Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.49
|
| Rate for Payer: Priority Health Narrow Network |
$1.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.50
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$2.84
|
|
|
Service Code
|
NDC 60687042811
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: ASR ASR |
$2.75
|
| Rate for Payer: ASR Commercial |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.31
|
| Rate for Payer: BCN Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.27
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Healthscope Whirlpool |
$2.75
|
| Rate for Payer: Mclaren Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: Nomi Health Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.50
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$283.68
|
|
|
Service Code
|
NDC 60687042801
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.47 |
| Max. Negotiated Rate |
$283.68 |
| Rate for Payer: Aetna Commercial |
$255.31
|
| Rate for Payer: Aetna Medicare |
$141.84
|
| Rate for Payer: ASR ASR |
$275.17
|
| Rate for Payer: ASR Commercial |
$275.17
|
| Rate for Payer: BCBS Complete |
$113.47
|
| Rate for Payer: BCBS Trust/PPO |
$232.31
|
| Rate for Payer: BCN Commercial |
$219.94
|
| Rate for Payer: Cash Price |
$226.94
|
| Rate for Payer: Cofinity Commercial |
$266.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.94
|
| Rate for Payer: Healthscope Commercial |
$283.68
|
| Rate for Payer: Healthscope Whirlpool |
$275.17
|
| Rate for Payer: Mclaren Commercial |
$255.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.13
|
| Rate for Payer: Nomi Health Commercial |
$232.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.56
|
| Rate for Payer: Priority Health Narrow Network |
$198.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.64
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$53.58
|
|
|
Service Code
|
NDC 16729009010
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.83 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$48.22
|
| Rate for Payer: ASR ASR |
$51.97
|
| Rate for Payer: ASR Commercial |
$51.97
|
| Rate for Payer: BCBS Trust/PPO |
$43.66
|
| Rate for Payer: BCN Commercial |
$41.54
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Commercial |
$50.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Healthscope Commercial |
$53.58
|
| Rate for Payer: Healthscope Whirlpool |
$51.97
|
| Rate for Payer: Mclaren Commercial |
$48.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.54
|
| Rate for Payer: Nomi Health Commercial |
$43.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.15
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$283.68
|
|
|
Service Code
|
NDC 60687042801
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.39 |
| Max. Negotiated Rate |
$283.68 |
| Rate for Payer: Aetna Commercial |
$255.31
|
| Rate for Payer: ASR ASR |
$275.17
|
| Rate for Payer: ASR Commercial |
$275.17
|
| Rate for Payer: BCBS Trust/PPO |
$231.17
|
| Rate for Payer: BCN Commercial |
$219.94
|
| Rate for Payer: Cash Price |
$226.94
|
| Rate for Payer: Cofinity Commercial |
$266.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.94
|
| Rate for Payer: Healthscope Commercial |
$283.68
|
| Rate for Payer: Healthscope Whirlpool |
$275.17
|
| Rate for Payer: Mclaren Commercial |
$255.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.13
|
| Rate for Payer: Nomi Health Commercial |
$232.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.64
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$100.82
|
|
|
Service Code
|
NDC 57237006230
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.33 |
| Max. Negotiated Rate |
$100.82 |
| Rate for Payer: Aetna Commercial |
$90.74
|
| Rate for Payer: Aetna Medicare |
$50.41
|
| Rate for Payer: ASR ASR |
$97.80
|
| Rate for Payer: ASR Commercial |
$97.80
|
| Rate for Payer: BCBS Complete |
$40.33
|
| Rate for Payer: BCBS Trust/PPO |
$82.56
|
| Rate for Payer: BCN Commercial |
$78.17
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cofinity Commercial |
$94.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$100.82
|
| Rate for Payer: Healthscope Whirlpool |
$97.80
|
| Rate for Payer: Mclaren Commercial |
$90.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.34
|
| Rate for Payer: Priority Health Narrow Network |
$70.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.72
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$100.82
|
|
|
Service Code
|
NDC 57237006230
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.53 |
| Max. Negotiated Rate |
$100.82 |
| Rate for Payer: Aetna Commercial |
$90.74
|
| Rate for Payer: ASR ASR |
$97.80
|
| Rate for Payer: ASR Commercial |
$97.80
|
| Rate for Payer: BCBS Trust/PPO |
$82.16
|
| Rate for Payer: BCN Commercial |
$78.17
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cofinity Commercial |
$94.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$100.82
|
| Rate for Payer: Healthscope Whirlpool |
$97.80
|
| Rate for Payer: Mclaren Commercial |
$90.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.72
|
|
