|
OMALIZUMAB 150 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$4,431.87
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
36151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,102.31 |
| Max. Negotiated Rate |
$4,431.87 |
| Rate for Payer: Aetna Commercial |
$3,988.68
|
| Rate for Payer: ASR ASR |
$4,298.91
|
| Rate for Payer: BCBS Trust/PPO |
$3,436.03
|
| Rate for Payer: BCN Commercial |
$3,436.03
|
| Rate for Payer: Cash Price |
$3,545.50
|
| Rate for Payer: Cofinity Commercial |
$4,165.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,545.50
|
| Rate for Payer: Healthscope Commercial |
$4,431.87
|
| Rate for Payer: Healthscope Whirlpool |
$4,298.91
|
| Rate for Payer: Mclaren Commercial |
$3,988.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,767.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,102.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,900.05
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$2,215.94
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
188926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,551.16 |
| Max. Negotiated Rate |
$2,215.94 |
| Rate for Payer: Aetna Commercial |
$1,994.35
|
| Rate for Payer: ASR ASR |
$2,149.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,718.02
|
| Rate for Payer: BCN Commercial |
$1,718.02
|
| Rate for Payer: Cash Price |
$1,772.75
|
| Rate for Payer: Cofinity Commercial |
$2,082.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,772.75
|
| Rate for Payer: Healthscope Commercial |
$2,215.94
|
| Rate for Payer: Healthscope Whirlpool |
$2,149.46
|
| Rate for Payer: Mclaren Commercial |
$1,994.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,883.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,551.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,950.03
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
IP
|
$493.50
|
|
|
Service Code
|
NDC 60505-3170-7
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$345.45 |
| Max. Negotiated Rate |
$493.50 |
| Rate for Payer: Aetna Commercial |
$444.15
|
| Rate for Payer: ASR ASR |
$478.70
|
| Rate for Payer: BCBS Trust/PPO |
$382.61
|
| Rate for Payer: BCN Commercial |
$382.61
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cofinity Commercial |
$463.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.80
|
| Rate for Payer: Healthscope Commercial |
$493.50
|
| Rate for Payer: Healthscope Whirlpool |
$478.70
|
| Rate for Payer: Mclaren Commercial |
$444.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$419.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$434.28
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$83.66
|
|
|
Service Code
|
NDC 65862-390-10
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.56 |
| Max. Negotiated Rate |
$83.66 |
| Rate for Payer: Aetna Commercial |
$75.29
|
| Rate for Payer: ASR ASR |
$81.15
|
| Rate for Payer: BCBS Trust/PPO |
$64.86
|
| Rate for Payer: BCN Commercial |
$64.86
|
| Rate for Payer: Cash Price |
$66.93
|
| Rate for Payer: Cofinity Commercial |
$78.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.93
|
| Rate for Payer: Healthscope Commercial |
$83.66
|
| Rate for Payer: Healthscope Whirlpool |
$81.15
|
| Rate for Payer: Mclaren Commercial |
$75.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.62
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$66.40
|
|
|
Service Code
|
NDC 57237-077-10
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$66.40 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: ASR ASR |
$64.41
|
| Rate for Payer: BCBS Trust/PPO |
$51.48
|
| Rate for Payer: BCN Commercial |
$51.48
|
| Rate for Payer: Cash Price |
$53.12
|
| Rate for Payer: Cofinity Commercial |
$62.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.12
|
| Rate for Payer: Healthscope Commercial |
$66.40
|
| Rate for Payer: Healthscope Whirlpool |
$64.41
|
| Rate for Payer: Mclaren Commercial |
$59.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.43
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
NDC 68462-157-40
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna Commercial |
$4.06
|
| Rate for Payer: ASR ASR |
$4.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.50
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cofinity Commercial |
$4.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.61
|
| Rate for Payer: Healthscope Commercial |
$4.51
|
| Rate for Payer: Healthscope Whirlpool |
$4.37
|
| Rate for Payer: Mclaren Commercial |
$4.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.97
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$135.36
|
|
|
Service Code
|
NDC 68462-157-13
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.75 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$121.82
|
| Rate for Payer: ASR ASR |
$131.30
|
| Rate for Payer: BCBS Trust/PPO |
$104.94
|
| Rate for Payer: BCN Commercial |
$104.94
|
| Rate for Payer: Cash Price |
$108.29
|
| Rate for Payer: Cofinity Commercial |
$127.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.29
|
| Rate for Payer: Healthscope Commercial |
$135.36
|
| Rate for Payer: Healthscope Whirlpool |
$131.30
|
| Rate for Payer: Mclaren Commercial |
$121.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.12
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 0781-5238-06
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: ASR ASR |
$2.77
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$2.86
|
| Rate for Payer: Healthscope Whirlpool |
$2.77
|
| Rate for Payer: Mclaren Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.52
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$85.68
|
|
|
Service Code
|
NDC 0781-5238-64
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.98 |
| Max. Negotiated Rate |
$85.68 |
| Rate for Payer: Aetna Commercial |
$77.11
|
| Rate for Payer: ASR ASR |
$83.11
|
| Rate for Payer: BCBS Trust/PPO |
$66.43
|
| Rate for Payer: BCN Commercial |
$66.43
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$80.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$85.68
|
| Rate for Payer: Healthscope Whirlpool |
$83.11
|
| Rate for Payer: Mclaren Commercial |
$77.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.40
|
|
|
ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$116.50
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
10777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$116.50 |
| Rate for Payer: Aetna Commercial |
$104.85
|
| Rate for Payer: Aetna Commercial |
$162.90
|
| Rate for Payer: ASR ASR |
$113.00
|
| Rate for Payer: ASR ASR |
$175.57
|
| Rate for Payer: BCBS Trust/PPO |
$90.32
|
| Rate for Payer: BCBS Trust/PPO |
$140.33
|
| Rate for Payer: BCN Commercial |
$140.33
|
| Rate for Payer: BCN Commercial |
$90.32
|
| Rate for Payer: Cash Price |
$93.20
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$170.14
|
| Rate for Payer: Cofinity Commercial |
$109.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.80
|
| Rate for Payer: Healthscope Commercial |
$116.50
|
| Rate for Payer: Healthscope Commercial |
$181.00
|
| Rate for Payer: Healthscope Whirlpool |
$175.57
|
| Rate for Payer: Healthscope Whirlpool |
$113.00
|
| Rate for Payer: Mclaren Commercial |
$104.85
|
| Rate for Payer: Mclaren Commercial |
$162.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.28
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$14.30
|
|
|
Service Code
|
NDC 9900-0003-46
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Aetna Commercial |
$12.87
|
| Rate for Payer: ASR ASR |
$13.87
|
| Rate for Payer: BCBS Trust/PPO |
$11.09
|
| Rate for Payer: BCN Commercial |
$11.09
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cofinity Commercial |
$13.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.44
|
| Rate for Payer: Healthscope Commercial |
$14.30
|
| Rate for Payer: Healthscope Whirlpool |
$13.87
|
| Rate for Payer: Mclaren Commercial |
$12.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.58
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$43.73
|
|
|
Service Code
|
NDC 68094-763-59
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.61 |
| Max. Negotiated Rate |
$43.73 |
| Rate for Payer: Aetna Commercial |
$39.36
|
| Rate for Payer: ASR ASR |
$42.42
|
| Rate for Payer: BCBS Trust/PPO |
$33.90
|
| Rate for Payer: BCN Commercial |
$33.90
|
| Rate for Payer: Cash Price |
$34.99
|
| Rate for Payer: Cofinity Commercial |
$41.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.98
|
| Rate for Payer: Healthscope Commercial |
$43.73
|
| Rate for Payer: Healthscope Whirlpool |
$42.42
|
| Rate for Payer: Mclaren Commercial |
$39.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.48
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$43.73
|
|
|
Service Code
|
NDC 68094-763-62
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.61 |
| Max. Negotiated Rate |
$43.73 |
| Rate for Payer: Aetna Commercial |
$39.36
|
| Rate for Payer: ASR ASR |
$42.42
|
| Rate for Payer: BCBS Trust/PPO |
$33.90
|
| Rate for Payer: BCN Commercial |
$33.90
|
| Rate for Payer: Cash Price |
$34.99
|
| Rate for Payer: Cofinity Commercial |
$41.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.98
|
| Rate for Payer: Healthscope Commercial |
$43.73
|
| Rate for Payer: Healthscope Whirlpool |
$42.42
|
| Rate for Payer: Mclaren Commercial |
$39.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.48
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$220.88
|
|
|
Service Code
|
NDC 54838-555-50
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.62 |
| Max. Negotiated Rate |
$220.88 |
| Rate for Payer: Aetna Commercial |
$198.79
|
| Rate for Payer: ASR ASR |
$214.25
|
| Rate for Payer: BCBS Trust/PPO |
$171.25
|
| Rate for Payer: BCN Commercial |
$171.25
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cofinity Commercial |
$207.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.70
|
| Rate for Payer: Healthscope Commercial |
$220.88
|
| Rate for Payer: Healthscope Whirlpool |
$214.25
|
| Rate for Payer: Mclaren Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.37
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$38.63
|
|
|
Service Code
|
NDC 60687-252-40
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.04 |
| Max. Negotiated Rate |
$38.63 |
| Rate for Payer: Aetna Commercial |
$34.77
|
| Rate for Payer: ASR ASR |
$37.47
|
| Rate for Payer: BCBS Trust/PPO |
$29.95
|
| Rate for Payer: BCN Commercial |
$29.95
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cofinity Commercial |
$36.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.90
|
| Rate for Payer: Healthscope Commercial |
$38.63
|
| Rate for Payer: Healthscope Whirlpool |
$37.47
|
| Rate for Payer: Mclaren Commercial |
$34.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.99
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$47.74
|
|
|
Service Code
|
NDC 0904-7073-41
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.42 |
| Max. Negotiated Rate |
$47.74 |
| Rate for Payer: Aetna Commercial |
$42.97
|
| Rate for Payer: ASR ASR |
$46.31
|
| Rate for Payer: BCBS Trust/PPO |
$37.01
|
| Rate for Payer: BCN Commercial |
$37.01
|
| Rate for Payer: Cash Price |
$38.19
|
| Rate for Payer: Cofinity Commercial |
$44.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.19
|
| Rate for Payer: Healthscope Commercial |
$47.74
|
| Rate for Payer: Healthscope Whirlpool |
$46.31
|
| Rate for Payer: Mclaren Commercial |
$42.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.01
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$47.74
|
|
|
Service Code
|
NDC 0904-7073-93
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.42 |
| Max. Negotiated Rate |
$47.74 |
| Rate for Payer: Aetna Commercial |
$42.97
|
| Rate for Payer: ASR ASR |
$46.31
|
| Rate for Payer: BCBS Trust/PPO |
$37.01
|
| Rate for Payer: BCN Commercial |
$37.01
|
| Rate for Payer: Cash Price |
$38.19
|
| Rate for Payer: Cofinity Commercial |
$44.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.19
|
| Rate for Payer: Healthscope Commercial |
$47.74
|
| Rate for Payer: Healthscope Whirlpool |
$46.31
|
| Rate for Payer: Mclaren Commercial |
$42.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.01
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$38.63
|
|
|
Service Code
|
NDC 60687-252-86
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.04 |
| Max. Negotiated Rate |
$38.63 |
| Rate for Payer: Aetna Commercial |
$34.77
|
| Rate for Payer: ASR ASR |
$37.47
|
| Rate for Payer: BCBS Trust/PPO |
$29.95
|
| Rate for Payer: BCN Commercial |
$29.95
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cofinity Commercial |
$36.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.90
|
| Rate for Payer: Healthscope Commercial |
$38.63
|
| Rate for Payer: Healthscope Whirlpool |
$37.47
|
| Rate for Payer: Mclaren Commercial |
$34.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.99
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$112.10
|
|
|
Service Code
|
NDC 65162-691-79
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.47 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Aetna Commercial |
$100.89
|
| Rate for Payer: ASR ASR |
$108.74
|
| Rate for Payer: BCBS Trust/PPO |
$86.91
|
| Rate for Payer: BCN Commercial |
$86.91
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$105.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$112.10
|
| Rate for Payer: Healthscope Whirlpool |
$108.74
|
| Rate for Payer: Mclaren Commercial |
$100.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.65
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION (CODE)
|
Facility
|
IP
|
$17.50
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
163708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$15.75
|
| Rate for Payer: Aetna Commercial |
$9.40
|
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna Commercial |
$20.38
|
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: ASR ASR |
$9.02
|
| Rate for Payer: ASR ASR |
$10.18
|
| Rate for Payer: ASR ASR |
$10.14
|
| Rate for Payer: ASR ASR |
$14.96
|
| Rate for Payer: ASR ASR |
$16.98
|
| Rate for Payer: ASR ASR |
$21.97
|
| Rate for Payer: BCBS Trust/PPO |
$13.57
|
| Rate for Payer: BCBS Trust/PPO |
$8.10
|
| Rate for Payer: BCBS Trust/PPO |
$8.14
|
| Rate for Payer: BCBS Trust/PPO |
$7.21
|
| Rate for Payer: BCBS Trust/PPO |
$17.56
|
| Rate for Payer: BCBS Trust/PPO |
$11.96
|
| Rate for Payer: BCN Commercial |
$17.56
|
| Rate for Payer: BCN Commercial |
$8.14
|
| Rate for Payer: BCN Commercial |
$13.57
|
| Rate for Payer: BCN Commercial |
$8.10
|
| Rate for Payer: BCN Commercial |
$11.96
|
| Rate for Payer: BCN Commercial |
$7.21
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$7.44
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cash Price |
$8.36
|
| Rate for Payer: Cofinity Commercial |
$9.82
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$9.87
|
| Rate for Payer: Cofinity Commercial |
$8.74
|
| Rate for Payer: Cofinity Commercial |
$21.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.44
|
| Rate for Payer: Healthscope Commercial |
$15.42
|
| Rate for Payer: Healthscope Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$10.45
|
| Rate for Payer: Healthscope Commercial |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Healthscope Whirlpool |
$10.18
|
| Rate for Payer: Healthscope Whirlpool |
$10.14
|
| Rate for Payer: Healthscope Whirlpool |
$14.96
|
| Rate for Payer: Healthscope Whirlpool |
$16.98
|
| Rate for Payer: Healthscope Whirlpool |
$9.02
|
| Rate for Payer: Healthscope Whirlpool |
$21.97
|
| Rate for Payer: Mclaren Commercial |
$13.88
|
| Rate for Payer: Mclaren Commercial |
$9.40
|
| Rate for Payer: Mclaren Commercial |
$15.75
|
| Rate for Payer: Mclaren Commercial |
$9.45
|
| Rate for Payer: Mclaren Commercial |
$20.38
|
| Rate for Payer: Mclaren Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.57
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$9.30
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
105614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$9.30 |
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: Aetna Commercial |
$9.40
|
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna Commercial |
$9.63
|
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Aetna Commercial |
$10.30
|
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna Commercial |
$13.68
|
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Aetna Commercial |
$15.75
|
| Rate for Payer: Aetna Commercial |
$20.38
|
| Rate for Payer: ASR ASR |
$16.98
|
| Rate for Payer: ASR ASR |
$9.02
|
| Rate for Payer: ASR ASR |
$10.48
|
| Rate for Payer: ASR ASR |
$10.38
|
| Rate for Payer: ASR ASR |
$16.76
|
| Rate for Payer: ASR ASR |
$21.97
|
| Rate for Payer: ASR ASR |
$10.14
|
| Rate for Payer: ASR ASR |
$11.11
|
| Rate for Payer: ASR ASR |
$12.03
|
| Rate for Payer: ASR ASR |
$14.96
|
| Rate for Payer: ASR ASR |
$14.74
|
| Rate for Payer: ASR ASR |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$8.14
|
| Rate for Payer: BCBS Trust/PPO |
$9.61
|
| Rate for Payer: BCBS Trust/PPO |
$8.37
|
| Rate for Payer: BCBS Trust/PPO |
$13.57
|
| Rate for Payer: BCBS Trust/PPO |
$8.88
|
| Rate for Payer: BCBS Trust/PPO |
$7.21
|
| Rate for Payer: BCBS Trust/PPO |
$8.10
|
| Rate for Payer: BCBS Trust/PPO |
$11.78
|
| Rate for Payer: BCBS Trust/PPO |
$17.56
|
| Rate for Payer: BCBS Trust/PPO |
$8.30
|
| Rate for Payer: BCBS Trust/PPO |
$13.40
|
| Rate for Payer: BCBS Trust/PPO |
$11.96
|
| Rate for Payer: BCN Commercial |
$9.61
|
| Rate for Payer: BCN Commercial |
$11.96
|
| Rate for Payer: BCN Commercial |
$13.40
|
| Rate for Payer: BCN Commercial |
$8.30
|
| Rate for Payer: BCN Commercial |
$8.10
|
| Rate for Payer: BCN Commercial |
$11.78
|
| Rate for Payer: BCN Commercial |
$8.37
|
| Rate for Payer: BCN Commercial |
$17.56
|
| Rate for Payer: BCN Commercial |
$8.14
|
| Rate for Payer: BCN Commercial |
$7.21
|
| Rate for Payer: BCN Commercial |
$8.88
|
| Rate for Payer: BCN Commercial |
$13.57
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: Cash Price |
$9.92
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$7.44
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cash Price |
$8.36
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$12.16
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cofinity Commercial |
$9.82
|
| Rate for Payer: Cofinity Commercial |
$16.24
|
| Rate for Payer: Cofinity Commercial |
$21.29
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Cofinity Commercial |
$10.15
|
| Rate for Payer: Cofinity Commercial |
$10.76
|
| Rate for Payer: Cofinity Commercial |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$9.87
|
| Rate for Payer: Cofinity Commercial |
$14.29
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$8.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.34
|
| Rate for Payer: Healthscope Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$10.70
|
| Rate for Payer: Healthscope Commercial |
$12.40
|
| Rate for Payer: Healthscope Commercial |
$15.42
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Healthscope Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$11.45
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$15.20
|
| Rate for Payer: Healthscope Commercial |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$10.45
|
| Rate for Payer: Healthscope Commercial |
$17.28
|
| Rate for Payer: Healthscope Whirlpool |
$10.18
|
| Rate for Payer: Healthscope Whirlpool |
$14.74
|
| Rate for Payer: Healthscope Whirlpool |
$21.97
|
| Rate for Payer: Healthscope Whirlpool |
$16.98
|
| Rate for Payer: Healthscope Whirlpool |
$9.02
|
| Rate for Payer: Healthscope Whirlpool |
$11.11
|
| Rate for Payer: Healthscope Whirlpool |
$10.14
|
| Rate for Payer: Healthscope Whirlpool |
$16.76
|
| Rate for Payer: Healthscope Whirlpool |
$12.03
|
| Rate for Payer: Healthscope Whirlpool |
$10.48
|
| Rate for Payer: Healthscope Whirlpool |
$14.96
|
| Rate for Payer: Healthscope Whirlpool |
$10.38
|
| Rate for Payer: Mclaren Commercial |
$20.38
|
| Rate for Payer: Mclaren Commercial |
$9.45
|
| Rate for Payer: Mclaren Commercial |
$9.63
|
| Rate for Payer: Mclaren Commercial |
$9.72
|
| Rate for Payer: Mclaren Commercial |
$8.37
|
| Rate for Payer: Mclaren Commercial |
$10.30
|
| Rate for Payer: Mclaren Commercial |
$11.16
|
| Rate for Payer: Mclaren Commercial |
$13.68
|
| Rate for Payer: Mclaren Commercial |
$13.88
|
| Rate for Payer: Mclaren Commercial |
$15.55
|
| Rate for Payer: Mclaren Commercial |
$15.75
|
| Rate for Payer: Mclaren Commercial |
$9.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.18
|
|
|
ORBITAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$32,193.73
|
|
|
Service Code
|
MS-DRG 113
|
| Min. Negotiated Rate |
$21,763.30 |
| Max. Negotiated Rate |
$32,193.73 |
| Rate for Payer: Aetna Medicare |
$22,908.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,635.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,635.92
|
| Rate for Payer: BCBS MAPPO |
$22,908.74
|
| Rate for Payer: BCN Medicare Advantage |
$22,908.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,908.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$22,908.74
|
| Rate for Payer: Mclaren Medicare |
$22,908.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,054.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,345.05
|
| Rate for Payer: PACE Medicare |
$21,763.30
|
| Rate for Payer: PACE SWMI |
$22,908.74
|
| Rate for Payer: PHP Commercial |
$25,199.61
|
| Rate for Payer: PHP Medicare Advantage |
$22,908.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,193.73
|
| Rate for Payer: Priority Health Medicare |
$22,908.74
|
| Rate for Payer: Priority Health Narrow Network |
$25,754.98
|
| Rate for Payer: Railroad Medicare Medicare |
$22,908.74
|
| Rate for Payer: UHC Medicare Advantage |
$23,596.00
|
| Rate for Payer: VA VA |
$22,908.74
|
|
|
ORBITAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$15,816.31
|
|
|
Service Code
|
MS-DRG 114
|
| Min. Negotiated Rate |
$11,504.36 |
| Max. Negotiated Rate |
$15,816.31 |
| Rate for Payer: Aetna Medicare |
$12,109.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,137.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,137.31
|
| Rate for Payer: BCBS MAPPO |
$12,109.85
|
| Rate for Payer: BCN Medicare Advantage |
$12,109.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,109.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,109.85
|
| Rate for Payer: Mclaren Medicare |
$12,109.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,715.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,926.33
|
| Rate for Payer: PACE Medicare |
$11,504.36
|
| Rate for Payer: PACE SWMI |
$12,109.85
|
| Rate for Payer: PHP Commercial |
$13,320.84
|
| Rate for Payer: PHP Medicare Advantage |
$12,109.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,816.31
|
| Rate for Payer: Priority Health Medicare |
$12,109.85
|
| Rate for Payer: Priority Health Narrow Network |
$12,653.05
|
| Rate for Payer: Railroad Medicare Medicare |
$12,109.85
|
| Rate for Payer: UHC Medicare Advantage |
$12,473.15
|
| Rate for Payer: VA VA |
$12,109.85
|
|
|
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY
|
Facility
|
IP
|
$22,558.60
|
|
|
Service Code
|
MS-DRG 884
|
| Min. Negotiated Rate |
$15,727.77 |
| Max. Negotiated Rate |
$22,558.60 |
| Rate for Payer: Aetna Medicare |
$16,555.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,694.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,694.44
|
| Rate for Payer: BCBS MAPPO |
$16,555.55
|
| Rate for Payer: BCN Medicare Advantage |
$16,555.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,555.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,555.55
|
| Rate for Payer: Mclaren Medicare |
$16,555.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,383.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,038.88
|
| Rate for Payer: PACE Medicare |
$15,727.77
|
| Rate for Payer: PACE SWMI |
$16,555.55
|
| Rate for Payer: PHP Commercial |
$18,211.10
|
| Rate for Payer: PHP Medicare Advantage |
$16,555.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,558.60
|
| Rate for Payer: Priority Health Medicare |
$16,555.55
|
| Rate for Payer: Priority Health Narrow Network |
$18,046.88
|
| Rate for Payer: Railroad Medicare Medicare |
$16,555.55
|
| Rate for Payer: UHC Medicare Advantage |
$17,052.22
|
| Rate for Payer: VA VA |
$16,555.55
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,511.80
|
|
|
Service Code
|
HCPCS J2406
|
| Hospital Charge Code |
197251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,758.26 |
| Max. Negotiated Rate |
$12,511.80 |
| Rate for Payer: Aetna Commercial |
$11,260.62
|
| Rate for Payer: ASR ASR |
$12,136.45
|
| Rate for Payer: BCBS Trust/PPO |
$9,700.40
|
| Rate for Payer: BCN Commercial |
$9,700.40
|
| Rate for Payer: Cash Price |
$10,009.44
|
| Rate for Payer: Cofinity Commercial |
$11,761.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,009.44
|
| Rate for Payer: Healthscope Commercial |
$12,511.80
|
| Rate for Payer: Healthscope Whirlpool |
$12,136.45
|
| Rate for Payer: Mclaren Commercial |
$11,260.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,635.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,758.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,010.38
|
|
