|
FENTANYL (PF) 50 MCG/ML INJECTION (CODE)
|
Facility
|
IP
|
$21.87
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
163724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.22 |
| Max. Negotiated Rate |
$21.87 |
| Rate for Payer: Aetna Commercial |
$19.68
|
| Rate for Payer: Aetna Commercial |
$38.46
|
| Rate for Payer: Aetna Commercial |
$62.69
|
| Rate for Payer: Aetna Commercial |
$25.64
|
| Rate for Payer: Aetna Commercial |
$19.21
|
| Rate for Payer: ASR ASR |
$67.57
|
| Rate for Payer: ASR ASR |
$41.45
|
| Rate for Payer: ASR ASR |
$27.64
|
| Rate for Payer: ASR ASR |
$21.21
|
| Rate for Payer: ASR ASR |
$20.71
|
| Rate for Payer: ASR Commercial |
$27.64
|
| Rate for Payer: ASR Commercial |
$67.57
|
| Rate for Payer: ASR Commercial |
$41.45
|
| Rate for Payer: ASR Commercial |
$21.21
|
| Rate for Payer: ASR Commercial |
$20.71
|
| Rate for Payer: BCBS Trust/PPO |
$56.77
|
| Rate for Payer: BCBS Trust/PPO |
$17.40
|
| Rate for Payer: BCBS Trust/PPO |
$17.82
|
| Rate for Payer: BCBS Trust/PPO |
$34.82
|
| Rate for Payer: BCBS Trust/PPO |
$23.22
|
| Rate for Payer: BCN Commercial |
$16.96
|
| Rate for Payer: BCN Commercial |
$54.01
|
| Rate for Payer: BCN Commercial |
$16.55
|
| Rate for Payer: BCN Commercial |
$22.09
|
| Rate for Payer: BCN Commercial |
$33.13
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$22.79
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cash Price |
$55.73
|
| Rate for Payer: Cash Price |
$17.08
|
| Rate for Payer: Cofinity Commercial |
$20.56
|
| Rate for Payer: Cofinity Commercial |
$26.78
|
| Rate for Payer: Cofinity Commercial |
$20.07
|
| Rate for Payer: Cofinity Commercial |
$40.17
|
| Rate for Payer: Cofinity Commercial |
$65.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$28.49
|
| Rate for Payer: Healthscope Commercial |
$42.73
|
| Rate for Payer: Healthscope Commercial |
$21.87
|
| Rate for Payer: Healthscope Commercial |
$21.35
|
| Rate for Payer: Healthscope Commercial |
$69.66
|
| Rate for Payer: Healthscope Whirlpool |
$67.57
|
| Rate for Payer: Healthscope Whirlpool |
$20.71
|
| Rate for Payer: Healthscope Whirlpool |
$27.64
|
| Rate for Payer: Healthscope Whirlpool |
$21.21
|
| Rate for Payer: Healthscope Whirlpool |
$41.45
|
| Rate for Payer: Mclaren Commercial |
$19.68
|
| Rate for Payer: Mclaren Commercial |
$25.64
|
| Rate for Payer: Mclaren Commercial |
$19.21
|
| Rate for Payer: Mclaren Commercial |
$38.46
|
| Rate for Payer: Mclaren Commercial |
$62.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.22
|
| Rate for Payer: Nomi Health Commercial |
$23.36
|
| Rate for Payer: Nomi Health Commercial |
$17.51
|
| Rate for Payer: Nomi Health Commercial |
$17.93
|
| Rate for Payer: Nomi Health Commercial |
$57.12
|
| Rate for Payer: Nomi Health Commercial |
$35.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.60
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION (CODE)
|
Facility
|
OP
|
$21.35
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
163724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$21.35 |
| Rate for Payer: Aetna Commercial |
$19.21
|
| Rate for Payer: Aetna Commercial |
$38.46
|
| Rate for Payer: Aetna Commercial |
$62.69
|
| Rate for Payer: Aetna Commercial |
$19.68
|
| Rate for Payer: Aetna Commercial |
$25.64
|
| Rate for Payer: Aetna Medicare |
$10.94
|
| Rate for Payer: Aetna Medicare |
$14.24
|
| Rate for Payer: Aetna Medicare |
$10.68
|
| Rate for Payer: Aetna Medicare |
$34.83
|
| Rate for Payer: Aetna Medicare |
$21.36
|
| Rate for Payer: ASR ASR |
$67.57
|
| Rate for Payer: ASR ASR |
$27.64
|
| Rate for Payer: ASR ASR |
$20.71
|
| Rate for Payer: ASR ASR |
$41.45
|
| Rate for Payer: ASR ASR |
$21.21
|
| Rate for Payer: ASR Commercial |
$67.57
|
| Rate for Payer: ASR Commercial |
$21.21
|
| Rate for Payer: ASR Commercial |
$27.64
|
| Rate for Payer: ASR Commercial |
$41.45
|
| Rate for Payer: ASR Commercial |
$20.71
|
| Rate for Payer: BCBS Complete |
$27.86
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS Complete |
$11.40
|
| Rate for Payer: BCBS Complete |
$17.09
|
| Rate for Payer: BCBS Complete |
$8.54
|
| Rate for Payer: BCBS Trust/PPO |
$34.99
|
| Rate for Payer: BCBS Trust/PPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$17.91
|
| Rate for Payer: BCBS Trust/PPO |
$23.33
|
| Rate for Payer: BCBS Trust/PPO |
$57.04
|
| Rate for Payer: BCN Commercial |
$54.01
|
| Rate for Payer: BCN Commercial |
$33.13
|
| Rate for Payer: BCN Commercial |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.55
|
| Rate for Payer: BCN Commercial |
$22.09
|
| Rate for Payer: Cash Price |
$55.73
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cash Price |
$22.79
|
| Rate for Payer: Cash Price |
$17.08
|
| Rate for Payer: Cofinity Commercial |
$65.48
|
| Rate for Payer: Cofinity Commercial |
$40.17
|
| Rate for Payer: Cofinity Commercial |
$26.78
|
| Rate for Payer: Cofinity Commercial |
$20.56
|
| Rate for Payer: Cofinity Commercial |
$20.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.18
|
| Rate for Payer: Healthscope Commercial |
$28.49
|
| Rate for Payer: Healthscope Commercial |
$42.73
|
| Rate for Payer: Healthscope Commercial |
$69.66
|
| Rate for Payer: Healthscope Commercial |
$21.35
|
| Rate for Payer: Healthscope Commercial |
$21.87
|
| Rate for Payer: Healthscope Whirlpool |
$41.45
|
| Rate for Payer: Healthscope Whirlpool |
$27.64
|
| Rate for Payer: Healthscope Whirlpool |
$21.21
|
| Rate for Payer: Healthscope Whirlpool |
$20.71
|
| Rate for Payer: Healthscope Whirlpool |
$67.57
|
| Rate for Payer: Mclaren Commercial |
$62.69
|
| Rate for Payer: Mclaren Commercial |
$25.64
|
| Rate for Payer: Mclaren Commercial |
$19.68
|
| Rate for Payer: Mclaren Commercial |
$38.46
|
| Rate for Payer: Mclaren Commercial |
$19.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.21
|
| Rate for Payer: Nomi Health Commercial |
$35.04
|
| Rate for Payer: Nomi Health Commercial |
$23.36
|
| Rate for Payer: Nomi Health Commercial |
$17.51
|
| Rate for Payer: Nomi Health Commercial |
$17.93
|
| Rate for Payer: Nomi Health Commercial |
$57.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.04
|
| Rate for Payer: Priority Health Narrow Network |
$48.83
|
| Rate for Payer: Priority Health Narrow Network |
$29.95
|
| Rate for Payer: Priority Health Narrow Network |
$15.33
|
| Rate for Payer: Priority Health Narrow Network |
$14.97
|
| Rate for Payer: Priority Health Narrow Network |
$19.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.07
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$9.99
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
3037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$9.99 |
| Rate for Payer: Aetna Commercial |
$8.99
|
| Rate for Payer: Aetna Commercial |
$16.10
|
| Rate for Payer: Aetna Commercial |
$17.57
|
| Rate for Payer: Aetna Commercial |
$25.64
|
| Rate for Payer: Aetna Commercial |
$19.21
|
| Rate for Payer: Aetna Commercial |
$12.94
|
| Rate for Payer: Aetna Commercial |
$28.64
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Aetna Medicare |
$7.19
|
| Rate for Payer: Aetna Medicare |
$14.24
|
| Rate for Payer: Aetna Medicare |
$9.76
|
| Rate for Payer: Aetna Medicare |
$10.68
|
| Rate for Payer: ASR ASR |
$18.93
|
| Rate for Payer: ASR ASR |
$30.87
|
| Rate for Payer: ASR ASR |
$9.69
|
| Rate for Payer: ASR ASR |
$27.64
|
| Rate for Payer: ASR ASR |
$17.35
|
| Rate for Payer: ASR ASR |
$20.71
|
| Rate for Payer: ASR ASR |
$13.95
|
| Rate for Payer: ASR Commercial |
$18.93
|
| Rate for Payer: ASR Commercial |
$13.95
|
| Rate for Payer: ASR Commercial |
$27.64
|
| Rate for Payer: ASR Commercial |
$9.69
|
| Rate for Payer: ASR Commercial |
$30.87
|
| Rate for Payer: ASR Commercial |
$17.35
|
| Rate for Payer: ASR Commercial |
$20.71
|
| Rate for Payer: BCBS Complete |
$8.54
|
| Rate for Payer: BCBS Complete |
$5.75
|
| Rate for Payer: BCBS Complete |
$11.40
|
| Rate for Payer: BCBS Complete |
$7.81
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS Complete |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$26.06
|
| Rate for Payer: BCBS Trust/PPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$11.78
|
| Rate for Payer: BCBS Trust/PPO |
$14.65
|
| Rate for Payer: BCBS Trust/PPO |
$15.98
|
| Rate for Payer: BCBS Trust/PPO |
$23.33
|
| Rate for Payer: BCBS Trust/PPO |
$8.18
|
| Rate for Payer: BCN Commercial |
$24.67
|
| Rate for Payer: BCN Commercial |
$22.09
|
| Rate for Payer: BCN Commercial |
$7.75
|
| Rate for Payer: BCN Commercial |
$16.55
|
| Rate for Payer: BCN Commercial |
$13.87
|
| Rate for Payer: BCN Commercial |
$11.15
|
| Rate for Payer: BCN Commercial |
$15.13
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$17.08
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$22.79
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cash Price |
$7.99
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Cofinity Commercial |
$26.78
|
| Rate for Payer: Cofinity Commercial |
$29.91
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| Rate for Payer: Cofinity Commercial |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$20.07
|
| Rate for Payer: Cofinity Commercial |
$18.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.79
|
| Rate for Payer: Healthscope Commercial |
$14.38
|
| Rate for Payer: Healthscope Commercial |
$9.99
|
| Rate for Payer: Healthscope Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$21.35
|
| Rate for Payer: Healthscope Commercial |
$17.89
|
| Rate for Payer: Healthscope Commercial |
$28.49
|
| Rate for Payer: Healthscope Commercial |
$19.52
|
| Rate for Payer: Healthscope Whirlpool |
$18.93
|
| Rate for Payer: Healthscope Whirlpool |
$13.95
|
| Rate for Payer: Healthscope Whirlpool |
$20.71
|
| Rate for Payer: Healthscope Whirlpool |
$27.64
|
| Rate for Payer: Healthscope Whirlpool |
$30.87
|
| Rate for Payer: Healthscope Whirlpool |
$9.69
|
| Rate for Payer: Healthscope Whirlpool |
$17.35
|
| Rate for Payer: Mclaren Commercial |
$17.57
|
| Rate for Payer: Mclaren Commercial |
$25.64
|
| Rate for Payer: Mclaren Commercial |
$28.64
|
| Rate for Payer: Mclaren Commercial |
$8.99
|
| Rate for Payer: Mclaren Commercial |
$19.21
|
| Rate for Payer: Mclaren Commercial |
$12.94
|
| Rate for Payer: Mclaren Commercial |
$16.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.49
|
| Rate for Payer: Nomi Health Commercial |
$16.01
|
| Rate for Payer: Nomi Health Commercial |
$26.09
|
| Rate for Payer: Nomi Health Commercial |
$23.36
|
| Rate for Payer: Nomi Health Commercial |
$8.19
|
| Rate for Payer: Nomi Health Commercial |
$14.67
|
| Rate for Payer: Nomi Health Commercial |
$11.79
|
| Rate for Payer: Nomi Health Commercial |
$17.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.68
|
| Rate for Payer: Priority Health Narrow Network |
$12.54
|
| Rate for Payer: Priority Health Narrow Network |
$14.97
|
| Rate for Payer: Priority Health Narrow Network |
$13.68
|
| Rate for Payer: Priority Health Narrow Network |
$10.08
|
| Rate for Payer: Priority Health Narrow Network |
$22.31
|
| Rate for Payer: Priority Health Narrow Network |
$19.97
|
| Rate for Payer: Priority Health Narrow Network |
$7.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.65
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$17.89
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
3037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Aetna Commercial |
$16.10
|
| Rate for Payer: Aetna Commercial |
$19.21
|
| Rate for Payer: Aetna Commercial |
$17.57
|
| Rate for Payer: Aetna Commercial |
$25.64
|
| Rate for Payer: Aetna Commercial |
$8.99
|
| Rate for Payer: Aetna Commercial |
$12.94
|
| Rate for Payer: Aetna Commercial |
$28.64
|
| Rate for Payer: ASR ASR |
$20.71
|
| Rate for Payer: ASR ASR |
$18.93
|
| Rate for Payer: ASR ASR |
$9.69
|
| Rate for Payer: ASR ASR |
$27.64
|
| Rate for Payer: ASR ASR |
$17.35
|
| Rate for Payer: ASR ASR |
$13.95
|
| Rate for Payer: ASR ASR |
$30.87
|
| Rate for Payer: ASR Commercial |
$9.69
|
| Rate for Payer: ASR Commercial |
$30.87
|
| Rate for Payer: ASR Commercial |
$18.93
|
| Rate for Payer: ASR Commercial |
$27.64
|
| Rate for Payer: ASR Commercial |
$20.71
|
| Rate for Payer: ASR Commercial |
$17.35
|
| Rate for Payer: ASR Commercial |
$13.95
|
| Rate for Payer: BCBS Trust/PPO |
$25.93
|
| Rate for Payer: BCBS Trust/PPO |
$23.22
|
| Rate for Payer: BCBS Trust/PPO |
$11.72
|
| Rate for Payer: BCBS Trust/PPO |
$14.58
|
| Rate for Payer: BCBS Trust/PPO |
$17.40
|
| Rate for Payer: BCBS Trust/PPO |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$8.14
|
| Rate for Payer: BCN Commercial |
$15.13
|
| Rate for Payer: BCN Commercial |
$7.75
|
| Rate for Payer: BCN Commercial |
$22.09
|
| Rate for Payer: BCN Commercial |
$11.15
|
| Rate for Payer: BCN Commercial |
$13.87
|
| Rate for Payer: BCN Commercial |
$24.67
|
| Rate for Payer: BCN Commercial |
$16.55
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$17.08
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cash Price |
$22.79
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cash Price |
$7.99
|
| Rate for Payer: Cofinity Commercial |
$26.78
|
| Rate for Payer: Cofinity Commercial |
$18.35
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| Rate for Payer: Cofinity Commercial |
$20.07
|
| Rate for Payer: Cofinity Commercial |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$29.91
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.79
|
| Rate for Payer: Healthscope Commercial |
$28.49
|
| Rate for Payer: Healthscope Commercial |
$9.99
|
| Rate for Payer: Healthscope Commercial |
$19.52
|
| Rate for Payer: Healthscope Commercial |
$21.35
|
| Rate for Payer: Healthscope Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$17.89
|
| Rate for Payer: Healthscope Commercial |
$14.38
|
| Rate for Payer: Healthscope Whirlpool |
$30.87
|
| Rate for Payer: Healthscope Whirlpool |
$27.64
|
| Rate for Payer: Healthscope Whirlpool |
$20.71
|
| Rate for Payer: Healthscope Whirlpool |
$17.35
|
| Rate for Payer: Healthscope Whirlpool |
$18.93
|
| Rate for Payer: Healthscope Whirlpool |
$13.95
|
| Rate for Payer: Healthscope Whirlpool |
$9.69
|
| Rate for Payer: Mclaren Commercial |
$25.64
|
| Rate for Payer: Mclaren Commercial |
$8.99
|
| Rate for Payer: Mclaren Commercial |
$12.94
|
| Rate for Payer: Mclaren Commercial |
$28.64
|
| Rate for Payer: Mclaren Commercial |
$17.57
|
| Rate for Payer: Mclaren Commercial |
$16.10
|
| Rate for Payer: Mclaren Commercial |
$19.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.05
|
| Rate for Payer: Nomi Health Commercial |
$11.79
|
| Rate for Payer: Nomi Health Commercial |
$26.09
|
| Rate for Payer: Nomi Health Commercial |
$8.19
|
| Rate for Payer: Nomi Health Commercial |
$17.51
|
| Rate for Payer: Nomi Health Commercial |
$16.01
|
| Rate for Payer: Nomi Health Commercial |
$14.67
|
| Rate for Payer: Nomi Health Commercial |
$23.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.18
|
|
|
FERRIC CARBOXYMALTOSE 100 MG IRON/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$659.80
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
200735
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$428.87 |
| Max. Negotiated Rate |
$659.80 |
| Rate for Payer: Aetna Commercial |
$593.82
|
| Rate for Payer: ASR ASR |
$640.01
|
| Rate for Payer: ASR Commercial |
$640.01
|
| Rate for Payer: BCBS Trust/PPO |
$537.67
|
| Rate for Payer: BCN Commercial |
$511.54
|
| Rate for Payer: Cash Price |
$527.84
|
| Rate for Payer: Cofinity Commercial |
$620.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$527.84
|
| Rate for Payer: Healthscope Commercial |
$659.80
|
| Rate for Payer: Healthscope Whirlpool |
$640.01
|
| Rate for Payer: Mclaren Commercial |
$593.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$560.83
|
| Rate for Payer: Nomi Health Commercial |
$541.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$580.62
|
|
|
FERRIC CARBOXYMALTOSE 100 MG IRON/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$659.80
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
200735
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$659.80 |
| Rate for Payer: Aetna Commercial |
$593.82
|
| Rate for Payer: Aetna Medicare |
$1.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.39
|
| Rate for Payer: ASR ASR |
$640.01
|
| Rate for Payer: ASR Commercial |
$640.01
|
| Rate for Payer: BCBS Complete |
$0.62
|
| Rate for Payer: BCBS MAPPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$540.31
|
| Rate for Payer: BCN Commercial |
$511.54
|
| Rate for Payer: BCN Medicare Advantage |
$1.11
|
| Rate for Payer: Cash Price |
$527.84
|
| Rate for Payer: Cash Price |
$527.84
|
| Rate for Payer: Cofinity Commercial |
$620.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$527.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.11
|
| Rate for Payer: Healthscope Commercial |
$659.80
|
| Rate for Payer: Healthscope Whirlpool |
$640.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$1.11
|
| Rate for Payer: Mclaren Commercial |
$593.82
|
| Rate for Payer: Mclaren Medicaid |
$0.59
|
| Rate for Payer: Mclaren Medicare |
$1.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.17
|
| Rate for Payer: Meridian Medicaid |
$0.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$560.83
|
| Rate for Payer: Nomi Health Commercial |
$541.04
|
| Rate for Payer: PACE Medicare |
$1.05
|
| Rate for Payer: PACE SWMI |
$1.11
|
| Rate for Payer: PHP Commercial |
$1.22
|
| Rate for Payer: PHP Medicaid |
$0.59
|
| Rate for Payer: PHP Medicare Advantage |
$1.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$578.12
|
| Rate for Payer: Priority Health Medicare |
$1.11
|
| Rate for Payer: Priority Health Narrow Network |
$462.52
|
| Rate for Payer: Railroad Medicare Medicare |
$1.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$580.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.11
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UHC Medicare Advantage |
$1.11
|
| Rate for Payer: UHCCP DNSP |
$1.11
|
| Rate for Payer: UHCCP Medicaid |
$0.59
|
| Rate for Payer: VA VA |
$1.11
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,185.42
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
167398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$3,185.42 |
| Rate for Payer: Aetna Commercial |
$2,866.88
|
| Rate for Payer: Aetna Medicare |
$1.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.39
|
| Rate for Payer: ASR ASR |
$3,089.86
|
| Rate for Payer: ASR Commercial |
$3,089.86
|
| Rate for Payer: BCBS Complete |
$0.62
|
| Rate for Payer: BCBS MAPPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,608.54
|
| Rate for Payer: BCN Commercial |
$2,469.66
|
| Rate for Payer: BCN Medicare Advantage |
$1.11
|
| Rate for Payer: Cash Price |
$2,548.34
|
| Rate for Payer: Cash Price |
$2,548.34
|
| Rate for Payer: Cofinity Commercial |
$2,994.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,548.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.11
|
| Rate for Payer: Healthscope Commercial |
$3,185.42
|
| Rate for Payer: Healthscope Whirlpool |
$3,089.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$1.11
|
| Rate for Payer: Mclaren Commercial |
$2,866.88
|
| Rate for Payer: Mclaren Medicaid |
$0.59
|
| Rate for Payer: Mclaren Medicare |
$1.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.17
|
| Rate for Payer: Meridian Medicaid |
$0.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,707.61
|
| Rate for Payer: Nomi Health Commercial |
$2,612.04
|
| Rate for Payer: PACE Medicare |
$1.05
|
| Rate for Payer: PACE SWMI |
$1.11
|
| Rate for Payer: PHP Commercial |
$1.22
|
| Rate for Payer: PHP Medicaid |
$0.59
|
| Rate for Payer: PHP Medicare Advantage |
$1.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,070.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,791.07
|
| Rate for Payer: Priority Health Medicare |
$1.11
|
| Rate for Payer: Priority Health Narrow Network |
$2,232.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,803.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.11
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UHC Medicare Advantage |
$1.11
|
| Rate for Payer: UHCCP DNSP |
$1.11
|
| Rate for Payer: UHCCP Medicaid |
$0.59
|
| Rate for Payer: VA VA |
$1.11
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,185.42
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
167398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,070.52 |
| Max. Negotiated Rate |
$3,185.42 |
| Rate for Payer: Aetna Commercial |
$2,866.88
|
| Rate for Payer: ASR ASR |
$3,089.86
|
| Rate for Payer: ASR Commercial |
$3,089.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,595.80
|
| Rate for Payer: BCN Commercial |
$2,469.66
|
| Rate for Payer: Cash Price |
$2,548.34
|
| Rate for Payer: Cofinity Commercial |
$2,994.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,548.34
|
| Rate for Payer: Healthscope Commercial |
$3,185.42
|
| Rate for Payer: Healthscope Whirlpool |
$3,089.86
|
| Rate for Payer: Mclaren Commercial |
$2,866.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,707.61
|
| Rate for Payer: Nomi Health Commercial |
$2,612.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,070.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,803.17
|
|
|
FERRIC DERISOMALTOSE 100 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,271.33
|
|
|
Service Code
|
HCPCS J1437
|
| Hospital Charge Code |
194928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$6,271.33 |
| Rate for Payer: Aetna Commercial |
$5,644.20
|
| Rate for Payer: Aetna Medicare |
$22.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.52
|
| Rate for Payer: ASR ASR |
$6,083.19
|
| Rate for Payer: ASR Commercial |
$6,083.19
|
| Rate for Payer: BCBS Complete |
$12.39
|
| Rate for Payer: BCBS MAPPO |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$5,135.59
|
| Rate for Payer: BCN Commercial |
$4,862.16
|
| Rate for Payer: BCN Medicare Advantage |
$22.02
|
| Rate for Payer: Cash Price |
$5,017.06
|
| Rate for Payer: Cash Price |
$5,017.06
|
| Rate for Payer: Cofinity Commercial |
$5,895.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,017.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.02
|
| Rate for Payer: Healthscope Commercial |
$6,271.33
|
| Rate for Payer: Healthscope Whirlpool |
$6,083.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.02
|
| Rate for Payer: Mclaren Commercial |
$5,644.20
|
| Rate for Payer: Mclaren Medicaid |
$11.80
|
| Rate for Payer: Mclaren Medicare |
$22.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.12
|
| Rate for Payer: Meridian Medicaid |
$12.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,330.63
|
| Rate for Payer: Nomi Health Commercial |
$5,142.49
|
| Rate for Payer: PACE Medicare |
$20.92
|
| Rate for Payer: PACE SWMI |
$22.02
|
| Rate for Payer: PHP Commercial |
$24.22
|
| Rate for Payer: PHP Medicaid |
$11.80
|
| Rate for Payer: PHP Medicare Advantage |
$22.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,076.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,494.94
|
| Rate for Payer: Priority Health Medicare |
$22.02
|
| Rate for Payer: Priority Health Narrow Network |
$4,396.20
|
| Rate for Payer: Railroad Medicare Medicare |
$22.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,518.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.02
|
| Rate for Payer: UHC Exchange |
$34.13
|
| Rate for Payer: UHC Medicare Advantage |
$22.02
|
| Rate for Payer: UHCCP DNSP |
$22.02
|
| Rate for Payer: UHCCP Medicaid |
$11.80
|
| Rate for Payer: VA VA |
$22.02
|
|
|
FERRIC DERISOMALTOSE 100 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,271.33
|
|
|
Service Code
|
HCPCS J1437
|
| Hospital Charge Code |
194928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,076.36 |
| Max. Negotiated Rate |
$6,271.33 |
| Rate for Payer: Aetna Commercial |
$5,644.20
|
| Rate for Payer: ASR ASR |
$6,083.19
|
| Rate for Payer: ASR Commercial |
$6,083.19
|
| Rate for Payer: BCBS Trust/PPO |
$5,110.51
|
| Rate for Payer: BCN Commercial |
$4,862.16
|
| Rate for Payer: Cash Price |
$5,017.06
|
| Rate for Payer: Cofinity Commercial |
$5,895.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,017.06
|
| Rate for Payer: Healthscope Commercial |
$6,271.33
|
| Rate for Payer: Healthscope Whirlpool |
$6,083.19
|
| Rate for Payer: Mclaren Commercial |
$5,644.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,330.63
|
| Rate for Payer: Nomi Health Commercial |
$5,142.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,076.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,518.77
|
|
|
FERRIC SUBSULFATE 0.2 GRAM TO 0.22 GRAM/ML TOPICAL SOLN AND APPLICATOR
|
Facility
|
OP
|
$58.94
|
|
|
Service Code
|
NDC 10481011208
|
| Hospital Charge Code |
167585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.58 |
| Max. Negotiated Rate |
$58.94 |
| Rate for Payer: Aetna Commercial |
$53.05
|
| Rate for Payer: Aetna Medicare |
$29.47
|
| Rate for Payer: ASR ASR |
$57.17
|
| Rate for Payer: ASR Commercial |
$57.17
|
| Rate for Payer: BCBS Complete |
$23.58
|
| Rate for Payer: BCBS Trust/PPO |
$48.27
|
| Rate for Payer: BCN Commercial |
$45.70
|
| Rate for Payer: Cash Price |
$47.15
|
| Rate for Payer: Cofinity Commercial |
$55.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.15
|
| Rate for Payer: Healthscope Commercial |
$58.94
|
| Rate for Payer: Healthscope Whirlpool |
$57.17
|
| Rate for Payer: Mclaren Commercial |
$53.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.10
|
| Rate for Payer: Nomi Health Commercial |
$48.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.64
|
| Rate for Payer: Priority Health Narrow Network |
$41.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.87
|
|
|
FERRIC SUBSULFATE 0.2 GRAM TO 0.22 GRAM/ML TOPICAL SOLN AND APPLICATOR
|
Facility
|
IP
|
$58.94
|
|
|
Service Code
|
NDC 10481011208
|
| Hospital Charge Code |
167585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.31 |
| Max. Negotiated Rate |
$58.94 |
| Rate for Payer: Aetna Commercial |
$53.05
|
| Rate for Payer: ASR ASR |
$57.17
|
| Rate for Payer: ASR Commercial |
$57.17
|
| Rate for Payer: BCBS Trust/PPO |
$48.03
|
| Rate for Payer: BCN Commercial |
$45.70
|
| Rate for Payer: Cash Price |
$47.15
|
| Rate for Payer: Cofinity Commercial |
$55.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.15
|
| Rate for Payer: Healthscope Commercial |
$58.94
|
| Rate for Payer: Healthscope Whirlpool |
$57.17
|
| Rate for Payer: Mclaren Commercial |
$53.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.10
|
| Rate for Payer: Nomi Health Commercial |
$48.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.87
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
OP
|
$63.45
|
|
|
Service Code
|
NDC 00904759161
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.38 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Medicare |
$31.73
|
| Rate for Payer: ASR ASR |
$61.55
|
| Rate for Payer: ASR Commercial |
$61.55
|
| Rate for Payer: BCBS Complete |
$25.38
|
| Rate for Payer: BCBS Trust/PPO |
$51.96
|
| Rate for Payer: BCN Commercial |
$49.19
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$59.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Healthscope Whirlpool |
$61.55
|
| Rate for Payer: Mclaren Commercial |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: Nomi Health Commercial |
$52.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.59
|
| Rate for Payer: Priority Health Narrow Network |
$44.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
IP
|
$63.45
|
|
|
Service Code
|
NDC 00904759161
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.24 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: ASR ASR |
$61.55
|
| Rate for Payer: ASR Commercial |
$61.55
|
| Rate for Payer: BCBS Trust/PPO |
$51.71
|
| Rate for Payer: BCN Commercial |
$49.19
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$59.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Healthscope Whirlpool |
$61.55
|
| Rate for Payer: Mclaren Commercial |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: Nomi Health Commercial |
$52.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
|
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,000.30
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
98312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$1,000.30 |
| Rate for Payer: Aetna Commercial |
$900.27
|
| Rate for Payer: Aetna Medicare |
$0.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.40
|
| Rate for Payer: ASR ASR |
$970.29
|
| Rate for Payer: ASR Commercial |
$970.29
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS MAPPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$819.15
|
| Rate for Payer: BCN Commercial |
$775.53
|
| Rate for Payer: BCN Medicare Advantage |
$0.32
|
| Rate for Payer: Cash Price |
$800.24
|
| 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: Health Alliance Plan Medicare Advantage |
$0.32
|
| Rate for Payer: Healthscope Commercial |
$1,000.30
|
| Rate for Payer: Healthscope Whirlpool |
$970.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.32
|
| Rate for Payer: Mclaren Commercial |
$900.27
|
| Rate for Payer: Mclaren Medicaid |
$0.17
|
| Rate for Payer: Mclaren Medicare |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.34
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$850.25
|
| Rate for Payer: Nomi Health Commercial |
$820.25
|
| Rate for Payer: PACE Medicare |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.32
|
| Rate for Payer: PHP Commercial |
$0.35
|
| Rate for Payer: PHP Medicaid |
$0.17
|
| Rate for Payer: PHP Medicare Advantage |
$0.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$876.46
|
| Rate for Payer: Priority Health Medicare |
$0.32
|
| Rate for Payer: Priority Health Narrow Network |
$701.21
|
| Rate for Payer: Railroad Medicare Medicare |
$0.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.32
|
| Rate for Payer: UHC Exchange |
$0.50
|
| Rate for Payer: UHC Medicare Advantage |
$0.32
|
| Rate for Payer: UHCCP DNSP |
$0.32
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: VA VA |
$0.32
|
|
|
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 |
$850.25
|
| 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
|
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 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 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 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 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 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 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
|
|
|
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
|
|
|
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
|
|
