|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$268.85
|
|
|
Service Code
|
NDC 00904650661
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.75 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Aetna Commercial |
$241.97
|
| Rate for Payer: ASR ASR |
$260.78
|
| Rate for Payer: ASR Commercial |
$260.78
|
| Rate for Payer: BCBS Trust/PPO |
$219.09
|
| Rate for Payer: BCN Commercial |
$208.44
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$252.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$268.85
|
| Rate for Payer: Healthscope Whirlpool |
$260.78
|
| Rate for Payer: Mclaren Commercial |
$241.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: Nomi Health Commercial |
$220.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.59
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$268.85
|
|
|
Service Code
|
NDC 00904650661
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Aetna Commercial |
$241.97
|
| Rate for Payer: Aetna Medicare |
$134.43
|
| Rate for Payer: ASR ASR |
$260.78
|
| Rate for Payer: ASR Commercial |
$260.78
|
| Rate for Payer: BCBS Complete |
$107.54
|
| Rate for Payer: BCBS Trust/PPO |
$220.16
|
| Rate for Payer: BCN Commercial |
$208.44
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$252.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$268.85
|
| Rate for Payer: Healthscope Whirlpool |
$260.78
|
| Rate for Payer: Mclaren Commercial |
$241.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: Nomi Health Commercial |
$220.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.57
|
| Rate for Payer: Priority Health Narrow Network |
$188.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.59
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$2.96
|
|
|
Service Code
|
NDC 00591387545
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna Commercial |
$2.66
|
| Rate for Payer: ASR ASR |
$2.87
|
| Rate for Payer: ASR Commercial |
$2.87
|
| Rate for Payer: BCBS Trust/PPO |
$2.41
|
| Rate for Payer: BCN Commercial |
$2.29
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.37
|
| Rate for Payer: Healthscope Commercial |
$2.96
|
| Rate for Payer: Healthscope Whirlpool |
$2.87
|
| Rate for Payer: Mclaren Commercial |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.52
|
| Rate for Payer: Nomi Health Commercial |
$2.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.60
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
NDC 00456321011
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$12.75
|
| Rate for Payer: ASR ASR |
$24.73
|
| Rate for Payer: ASR Commercial |
$24.73
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$20.88
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.73
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.34
|
| Rate for Payer: Priority Health Narrow Network |
$17.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION
|
Facility
|
OP
|
$380.36
|
|
|
Service Code
|
HCPCS 90619
|
| Hospital Charge Code |
194943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$152.14 |
| Max. Negotiated Rate |
$380.36 |
| Rate for Payer: Aetna Commercial |
$342.32
|
| Rate for Payer: Aetna Commercial |
$350.50
|
| Rate for Payer: Aetna Medicare |
$190.18
|
| Rate for Payer: Aetna Medicare |
$194.72
|
| Rate for Payer: ASR ASR |
$368.95
|
| Rate for Payer: ASR ASR |
$377.76
|
| Rate for Payer: ASR Commercial |
$377.76
|
| Rate for Payer: ASR Commercial |
$368.95
|
| Rate for Payer: BCBS Complete |
$152.14
|
| Rate for Payer: BCBS Complete |
$155.78
|
| Rate for Payer: BCBS Trust/PPO |
$311.48
|
| Rate for Payer: BCBS Trust/PPO |
$318.91
|
| Rate for Payer: BCN Commercial |
$301.93
|
| Rate for Payer: BCN Commercial |
$294.89
|
| Rate for Payer: Cash Price |
$304.28
|
| Rate for Payer: Cash Price |
$311.55
|
| Rate for Payer: Cofinity Commercial |
$357.54
|
| Rate for Payer: Cofinity Commercial |
$366.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.55
|
| Rate for Payer: Healthscope Commercial |
$380.36
|
| Rate for Payer: Healthscope Commercial |
$389.44
|
| Rate for Payer: Healthscope Whirlpool |
$368.95
|
| Rate for Payer: Healthscope Whirlpool |
$377.76
|
| Rate for Payer: Mclaren Commercial |
$342.32
|
| Rate for Payer: Mclaren Commercial |
$350.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.31
|
| Rate for Payer: Nomi Health Commercial |
$311.90
|
| Rate for Payer: Nomi Health Commercial |
$319.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$333.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$341.23
|
| Rate for Payer: Priority Health Narrow Network |
$273.00
|
| Rate for Payer: Priority Health Narrow Network |
$266.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.72
|
|
|
MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION
|
Facility
|
IP
|
$389.44
|
|
|
Service Code
|
HCPCS 90619
|
| Hospital Charge Code |
194943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$253.14 |
| Max. Negotiated Rate |
$389.44 |
| Rate for Payer: Aetna Commercial |
$350.50
|
| Rate for Payer: Aetna Commercial |
$342.32
|
| Rate for Payer: ASR ASR |
$368.95
|
| Rate for Payer: ASR ASR |
$377.76
|
| Rate for Payer: ASR Commercial |
$368.95
|
| Rate for Payer: ASR Commercial |
$377.76
|
| Rate for Payer: BCBS Trust/PPO |
$309.96
|
| Rate for Payer: BCBS Trust/PPO |
$317.35
|
| Rate for Payer: BCN Commercial |
$301.93
|
| Rate for Payer: BCN Commercial |
$294.89
|
| Rate for Payer: Cash Price |
$311.55
|
| Rate for Payer: Cash Price |
$304.28
|
| Rate for Payer: Cofinity Commercial |
$357.54
|
| Rate for Payer: Cofinity Commercial |
$366.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.55
|
| Rate for Payer: Healthscope Commercial |
$380.36
|
| Rate for Payer: Healthscope Commercial |
$389.44
|
| Rate for Payer: Healthscope Whirlpool |
$377.76
|
| Rate for Payer: Healthscope Whirlpool |
$368.95
|
| Rate for Payer: Mclaren Commercial |
$342.32
|
| Rate for Payer: Mclaren Commercial |
$350.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.31
|
| Rate for Payer: Nomi Health Commercial |
$319.34
|
| Rate for Payer: Nomi Health Commercial |
$311.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.71
|
|
|
MENTHOL 5 % TOPICAL GEL
|
Facility
|
OP
|
$30.96
|
|
|
Service Code
|
NDC 58980061840
|
| Hospital Charge Code |
152031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$30.96 |
| Rate for Payer: Aetna Commercial |
$27.86
|
| Rate for Payer: Aetna Medicare |
$15.48
|
| Rate for Payer: ASR ASR |
$30.03
|
| Rate for Payer: ASR Commercial |
$30.03
|
| Rate for Payer: BCBS Complete |
$12.38
|
| Rate for Payer: BCBS Trust/PPO |
$25.35
|
| Rate for Payer: BCN Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$29.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.77
|
| Rate for Payer: Healthscope Commercial |
$30.96
|
| Rate for Payer: Healthscope Whirlpool |
$30.03
|
| Rate for Payer: Mclaren Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.32
|
| Rate for Payer: Nomi Health Commercial |
$25.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.13
|
| Rate for Payer: Priority Health Narrow Network |
$21.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.24
|
|
|
MENTHOL 5 % TOPICAL GEL
|
Facility
|
IP
|
$30.96
|
|
|
Service Code
|
NDC 58980061840
|
| Hospital Charge Code |
152031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$30.96 |
| Rate for Payer: Aetna Commercial |
$27.86
|
| Rate for Payer: ASR ASR |
$30.03
|
| Rate for Payer: ASR Commercial |
$30.03
|
| Rate for Payer: BCBS Trust/PPO |
$25.23
|
| Rate for Payer: BCN Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$29.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.77
|
| Rate for Payer: Healthscope Commercial |
$30.96
|
| Rate for Payer: Healthscope Whirlpool |
$30.03
|
| Rate for Payer: Mclaren Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.32
|
| Rate for Payer: Nomi Health Commercial |
$25.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.24
|
|
|
MEPOLIZUMAB 100 MG/ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
|
OP
|
$9,878.67
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
190682
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.76 |
| Max. Negotiated Rate |
$9,878.67 |
| Rate for Payer: Aetna Commercial |
$8,890.80
|
| Rate for Payer: Aetna Medicare |
$31.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.09
|
| Rate for Payer: ASR ASR |
$9,582.31
|
| Rate for Payer: ASR Commercial |
$9,582.31
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS MAPPO |
$31.27
|
| Rate for Payer: BCBS Trust/PPO |
$8,089.64
|
| Rate for Payer: BCN Commercial |
$7,658.93
|
| Rate for Payer: BCN Medicare Advantage |
$31.27
|
| Rate for Payer: Cash Price |
$7,902.94
|
| Rate for Payer: Cash Price |
$7,902.94
|
| Rate for Payer: Cofinity Commercial |
$9,285.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,902.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.27
|
| Rate for Payer: Healthscope Commercial |
$9,878.67
|
| Rate for Payer: Healthscope Whirlpool |
$9,582.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$31.27
|
| Rate for Payer: Mclaren Commercial |
$8,890.80
|
| Rate for Payer: Mclaren Medicaid |
$16.76
|
| Rate for Payer: Mclaren Medicare |
$31.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.83
|
| Rate for Payer: Meridian Medicaid |
$17.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,396.87
|
| Rate for Payer: Nomi Health Commercial |
$8,100.51
|
| Rate for Payer: PACE Medicare |
$29.71
|
| Rate for Payer: PACE SWMI |
$31.27
|
| Rate for Payer: PHP Commercial |
$34.40
|
| Rate for Payer: PHP Medicaid |
$16.76
|
| Rate for Payer: PHP Medicare Advantage |
$31.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,421.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,655.69
|
| Rate for Payer: Priority Health Medicare |
$31.27
|
| Rate for Payer: Priority Health Narrow Network |
$6,924.95
|
| Rate for Payer: Railroad Medicare Medicare |
$31.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,693.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.27
|
| Rate for Payer: UHC Exchange |
$48.47
|
| Rate for Payer: UHC Medicare Advantage |
$31.27
|
| Rate for Payer: UHCCP DNSP |
$31.27
|
| Rate for Payer: UHCCP Medicaid |
$16.76
|
| Rate for Payer: VA VA |
$31.27
|
|
|
MEPOLIZUMAB 100 MG/ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
|
IP
|
$9,878.67
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
190682
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,421.14 |
| Max. Negotiated Rate |
$9,878.67 |
| Rate for Payer: Aetna Commercial |
$8,890.80
|
| Rate for Payer: ASR ASR |
$9,582.31
|
| Rate for Payer: ASR Commercial |
$9,582.31
|
| Rate for Payer: BCBS Trust/PPO |
$8,050.13
|
| Rate for Payer: BCN Commercial |
$7,658.93
|
| Rate for Payer: Cash Price |
$7,902.94
|
| Rate for Payer: Cofinity Commercial |
$9,285.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,902.94
|
| Rate for Payer: Healthscope Commercial |
$9,878.67
|
| Rate for Payer: Healthscope Whirlpool |
$9,582.31
|
| Rate for Payer: Mclaren Commercial |
$8,890.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,396.87
|
| Rate for Payer: Nomi Health Commercial |
$8,100.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,421.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,693.23
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$7,943.88
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
176478
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.76 |
| Max. Negotiated Rate |
$7,943.88 |
| Rate for Payer: Aetna Commercial |
$7,149.49
|
| Rate for Payer: Aetna Medicare |
$31.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.09
|
| Rate for Payer: ASR ASR |
$7,705.56
|
| Rate for Payer: ASR Commercial |
$7,705.56
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS MAPPO |
$31.27
|
| Rate for Payer: BCBS Trust/PPO |
$6,505.24
|
| Rate for Payer: BCN Commercial |
$6,158.89
|
| Rate for Payer: BCN Medicare Advantage |
$31.27
|
| Rate for Payer: Cash Price |
$6,355.11
|
| Rate for Payer: Cash Price |
$6,355.11
|
| Rate for Payer: Cofinity Commercial |
$7,467.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,355.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.27
|
| Rate for Payer: Healthscope Commercial |
$7,943.88
|
| Rate for Payer: Healthscope Whirlpool |
$7,705.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$31.27
|
| Rate for Payer: Mclaren Commercial |
$7,149.49
|
| Rate for Payer: Mclaren Medicaid |
$16.76
|
| Rate for Payer: Mclaren Medicare |
$31.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.83
|
| Rate for Payer: Meridian Medicaid |
$17.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,752.30
|
| Rate for Payer: Nomi Health Commercial |
$6,513.98
|
| Rate for Payer: PACE Medicare |
$29.71
|
| Rate for Payer: PACE SWMI |
$31.27
|
| Rate for Payer: PHP Commercial |
$34.40
|
| Rate for Payer: PHP Medicaid |
$16.76
|
| Rate for Payer: PHP Medicare Advantage |
$31.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,163.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,960.43
|
| Rate for Payer: Priority Health Medicare |
$31.27
|
| Rate for Payer: Priority Health Narrow Network |
$5,568.66
|
| Rate for Payer: Railroad Medicare Medicare |
$31.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,990.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.27
|
| Rate for Payer: UHC Exchange |
$48.47
|
| Rate for Payer: UHC Medicare Advantage |
$31.27
|
| Rate for Payer: UHCCP DNSP |
$31.27
|
| Rate for Payer: UHCCP Medicaid |
$16.76
|
| Rate for Payer: VA VA |
$31.27
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$7,943.88
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
176478
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,163.52 |
| Max. Negotiated Rate |
$7,943.88 |
| Rate for Payer: Aetna Commercial |
$7,149.49
|
| Rate for Payer: ASR ASR |
$7,705.56
|
| Rate for Payer: ASR Commercial |
$7,705.56
|
| Rate for Payer: BCBS Trust/PPO |
$6,473.47
|
| Rate for Payer: BCN Commercial |
$6,158.89
|
| Rate for Payer: Cash Price |
$6,355.11
|
| Rate for Payer: Cofinity Commercial |
$7,467.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,355.10
|
| Rate for Payer: Healthscope Commercial |
$7,943.88
|
| Rate for Payer: Healthscope Whirlpool |
$7,705.56
|
| Rate for Payer: Mclaren Commercial |
$7,149.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,752.30
|
| Rate for Payer: Nomi Health Commercial |
$6,513.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,163.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,990.61
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
301713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Medicare |
$14.50
|
| Rate for Payer: ASR ASR |
$28.13
|
| Rate for Payer: ASR Commercial |
$28.13
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Trust/PPO |
$23.75
|
| Rate for Payer: BCN Commercial |
$22.48
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Healthscope Commercial |
$29.00
|
| Rate for Payer: Healthscope Whirlpool |
$28.13
|
| Rate for Payer: Mclaren Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Nomi Health Commercial |
$23.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.41
|
| Rate for Payer: Priority Health Narrow Network |
$20.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.52
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
301713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: ASR ASR |
$28.13
|
| Rate for Payer: ASR Commercial |
$28.13
|
| Rate for Payer: BCBS Trust/PPO |
$23.63
|
| Rate for Payer: BCN Commercial |
$22.48
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Healthscope Commercial |
$29.00
|
| Rate for Payer: Healthscope Whirlpool |
$28.13
|
| Rate for Payer: Mclaren Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Nomi Health Commercial |
$23.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.52
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.24
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$26.24 |
| Rate for Payer: Aetna Commercial |
$23.62
|
| Rate for Payer: Aetna Commercial |
$26.32
|
| Rate for Payer: Aetna Commercial |
$23.17
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Medicare |
$14.62
|
| Rate for Payer: Aetna Medicare |
$13.12
|
| Rate for Payer: Aetna Medicare |
$14.50
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: ASR ASR |
$28.13
|
| Rate for Payer: ASR ASR |
$24.97
|
| Rate for Payer: ASR ASR |
$28.37
|
| Rate for Payer: ASR ASR |
$25.45
|
| Rate for Payer: ASR Commercial |
$25.45
|
| Rate for Payer: ASR Commercial |
$28.13
|
| Rate for Payer: ASR Commercial |
$28.37
|
| Rate for Payer: ASR Commercial |
$24.97
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS Complete |
$11.70
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Complete |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.49
|
| Rate for Payer: BCBS Trust/PPO |
$23.95
|
| Rate for Payer: BCBS Trust/PPO |
$21.08
|
| Rate for Payer: BCBS Trust/PPO |
$23.75
|
| Rate for Payer: BCN Commercial |
$22.68
|
| Rate for Payer: BCN Commercial |
$20.34
|
| Rate for Payer: BCN Commercial |
$19.96
|
| Rate for Payer: BCN Commercial |
$22.48
|
| Rate for Payer: Cash Price |
$20.99
|
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cofinity Commercial |
$24.20
|
| Rate for Payer: Cofinity Commercial |
$24.67
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Cofinity Commercial |
$27.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.99
|
| Rate for Payer: Healthscope Commercial |
$29.00
|
| Rate for Payer: Healthscope Commercial |
$25.74
|
| Rate for Payer: Healthscope Commercial |
$26.24
|
| Rate for Payer: Healthscope Commercial |
$29.25
|
| Rate for Payer: Healthscope Whirlpool |
$28.37
|
| Rate for Payer: Healthscope Whirlpool |
$28.13
|
| Rate for Payer: Healthscope Whirlpool |
$25.45
|
| Rate for Payer: Healthscope Whirlpool |
$24.97
|
| Rate for Payer: Mclaren Commercial |
$23.17
|
| Rate for Payer: Mclaren Commercial |
$23.62
|
| Rate for Payer: Mclaren Commercial |
$26.10
|
| Rate for Payer: Mclaren Commercial |
$26.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Nomi Health Commercial |
$23.78
|
| Rate for Payer: Nomi Health Commercial |
$21.52
|
| Rate for Payer: Nomi Health Commercial |
$23.98
|
| Rate for Payer: Nomi Health Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.55
|
| Rate for Payer: Priority Health Narrow Network |
$20.33
|
| Rate for Payer: Priority Health Narrow Network |
$18.39
|
| Rate for Payer: Priority Health Narrow Network |
$20.50
|
| Rate for Payer: Priority Health Narrow Network |
$18.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.09
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$23.62
|
| Rate for Payer: Aetna Commercial |
$26.32
|
| Rate for Payer: Aetna Commercial |
$23.17
|
| Rate for Payer: ASR ASR |
$24.97
|
| Rate for Payer: ASR ASR |
$28.13
|
| Rate for Payer: ASR ASR |
$25.45
|
| Rate for Payer: ASR ASR |
$28.37
|
| Rate for Payer: ASR Commercial |
$28.13
|
| Rate for Payer: ASR Commercial |
$28.37
|
| Rate for Payer: ASR Commercial |
$25.45
|
| Rate for Payer: ASR Commercial |
$24.97
|
| Rate for Payer: BCBS Trust/PPO |
$23.84
|
| Rate for Payer: BCBS Trust/PPO |
$20.98
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCBS Trust/PPO |
$23.63
|
| Rate for Payer: BCN Commercial |
$22.68
|
| Rate for Payer: BCN Commercial |
$19.96
|
| Rate for Payer: BCN Commercial |
$22.48
|
| Rate for Payer: BCN Commercial |
$20.34
|
| Rate for Payer: Cash Price |
$20.99
|
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Cofinity Commercial |
$24.67
|
| Rate for Payer: Cofinity Commercial |
$27.50
|
| Rate for Payer: Cofinity Commercial |
$24.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Healthscope Commercial |
$26.24
|
| Rate for Payer: Healthscope Commercial |
$25.74
|
| Rate for Payer: Healthscope Commercial |
$29.00
|
| Rate for Payer: Healthscope Commercial |
$29.25
|
| Rate for Payer: Healthscope Whirlpool |
$28.37
|
| Rate for Payer: Healthscope Whirlpool |
$25.45
|
| Rate for Payer: Healthscope Whirlpool |
$28.13
|
| Rate for Payer: Healthscope Whirlpool |
$24.97
|
| Rate for Payer: Mclaren Commercial |
$26.10
|
| Rate for Payer: Mclaren Commercial |
$26.32
|
| Rate for Payer: Mclaren Commercial |
$23.62
|
| Rate for Payer: Mclaren Commercial |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.88
|
| Rate for Payer: Nomi Health Commercial |
$21.11
|
| Rate for Payer: Nomi Health Commercial |
$23.98
|
| Rate for Payer: Nomi Health Commercial |
$23.78
|
| Rate for Payer: Nomi Health Commercial |
$21.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.65
|
|
|
MEROPENEM 500 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$19.96
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
301712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$19.96 |
| Rate for Payer: Aetna Commercial |
$17.96
|
| Rate for Payer: Aetna Medicare |
$9.98
|
| Rate for Payer: ASR ASR |
$19.36
|
| Rate for Payer: ASR Commercial |
$19.36
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS Trust/PPO |
$16.35
|
| Rate for Payer: BCN Commercial |
$15.47
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Commercial |
$18.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$19.96
|
| Rate for Payer: Healthscope Whirlpool |
$19.36
|
| Rate for Payer: Mclaren Commercial |
$17.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$16.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.49
|
| Rate for Payer: Priority Health Narrow Network |
$13.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.56
|
|
|
MEROPENEM 500 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$19.96
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
301712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.97 |
| Max. Negotiated Rate |
$19.96 |
| Rate for Payer: Aetna Commercial |
$17.96
|
| Rate for Payer: ASR ASR |
$19.36
|
| Rate for Payer: ASR Commercial |
$19.36
|
| Rate for Payer: BCBS Trust/PPO |
$16.27
|
| Rate for Payer: BCN Commercial |
$15.47
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Commercial |
$18.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$19.96
|
| Rate for Payer: Healthscope Whirlpool |
$19.36
|
| Rate for Payer: Mclaren Commercial |
$17.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$16.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.56
|
|
|
MEROPENEM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.96
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17379
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$19.96 |
| Rate for Payer: Aetna Commercial |
$17.96
|
| Rate for Payer: Aetna Medicare |
$9.98
|
| Rate for Payer: ASR ASR |
$19.36
|
| Rate for Payer: ASR Commercial |
$19.36
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS Trust/PPO |
$16.35
|
| Rate for Payer: BCN Commercial |
$15.47
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Commercial |
$18.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$19.96
|
| Rate for Payer: Healthscope Whirlpool |
$19.36
|
| Rate for Payer: Mclaren Commercial |
$17.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$16.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.49
|
| Rate for Payer: Priority Health Narrow Network |
$13.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.56
|
|
|
MEROPENEM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.96
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17379
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.97 |
| Max. Negotiated Rate |
$19.96 |
| Rate for Payer: Aetna Commercial |
$17.96
|
| Rate for Payer: ASR ASR |
$19.36
|
| Rate for Payer: ASR Commercial |
$19.36
|
| Rate for Payer: BCBS Trust/PPO |
$16.27
|
| Rate for Payer: BCN Commercial |
$15.47
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Commercial |
$18.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$19.96
|
| Rate for Payer: Healthscope Whirlpool |
$19.36
|
| Rate for Payer: Mclaren Commercial |
$17.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$16.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.56
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
IP
|
$246.75
|
|
|
Service Code
|
NDC 60687015501
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.39 |
| Max. Negotiated Rate |
$246.75 |
| Rate for Payer: Aetna Commercial |
$222.07
|
| Rate for Payer: ASR ASR |
$239.35
|
| Rate for Payer: ASR Commercial |
$239.35
|
| Rate for Payer: BCBS Trust/PPO |
$201.08
|
| Rate for Payer: BCN Commercial |
$191.31
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$231.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$246.75
|
| Rate for Payer: Healthscope Whirlpool |
$239.35
|
| Rate for Payer: Mclaren Commercial |
$222.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: Nomi Health Commercial |
$202.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.14
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 60687015511
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: ASR ASR |
$2.40
|
| Rate for Payer: ASR Commercial |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$2.01
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Healthscope Whirlpool |
$2.40
|
| Rate for Payer: Mclaren Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Nomi Health Commercial |
$2.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.17
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
OP
|
$246.75
|
|
|
Service Code
|
NDC 60687015501
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$246.75 |
| Rate for Payer: Aetna Commercial |
$222.07
|
| Rate for Payer: Aetna Medicare |
$123.38
|
| Rate for Payer: ASR ASR |
$239.35
|
| Rate for Payer: ASR Commercial |
$239.35
|
| Rate for Payer: BCBS Complete |
$98.70
|
| Rate for Payer: BCBS Trust/PPO |
$202.06
|
| Rate for Payer: BCN Commercial |
$191.31
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$231.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$246.75
|
| Rate for Payer: Healthscope Whirlpool |
$239.35
|
| Rate for Payer: Mclaren Commercial |
$222.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: Nomi Health Commercial |
$202.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.20
|
| Rate for Payer: Priority Health Narrow Network |
$172.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.14
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 60687015511
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: ASR ASR |
$2.40
|
| Rate for Payer: ASR Commercial |
$2.40
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Healthscope Whirlpool |
$2.40
|
| Rate for Payer: Mclaren Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Nomi Health Commercial |
$2.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.16
|
| Rate for Payer: Priority Health Narrow Network |
$1.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.17
|
|
|
METHACHOLINE 0.0625 MG/ML (VIAL E) SOLUTION FOR INHALATION
|
Facility
|
OP
|
$170.19
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
180308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.08 |
| Max. Negotiated Rate |
$170.19 |
| Rate for Payer: Aetna Commercial |
$153.17
|
| Rate for Payer: Aetna Medicare |
$85.09
|
| Rate for Payer: ASR ASR |
$165.08
|
| Rate for Payer: ASR Commercial |
$165.08
|
| Rate for Payer: BCBS Complete |
$68.08
|
| Rate for Payer: BCBS Trust/PPO |
$139.37
|
| Rate for Payer: BCN Commercial |
$131.95
|
| Rate for Payer: Cash Price |
$136.15
|
| Rate for Payer: Cofinity Commercial |
$159.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.15
|
| Rate for Payer: Healthscope Commercial |
$170.19
|
| Rate for Payer: Healthscope Whirlpool |
$165.08
|
| Rate for Payer: Mclaren Commercial |
$153.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.66
|
| Rate for Payer: Nomi Health Commercial |
$139.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.12
|
| Rate for Payer: Priority Health Narrow Network |
$119.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.77
|
|
