|
PAROXETINE 10 MG TABLET
|
Facility
|
IP
|
$470.25
|
|
|
Service Code
|
NDC 68084004401
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$305.66 |
| Max. Negotiated Rate |
$470.25 |
| Rate for Payer: Aetna Commercial |
$423.22
|
| Rate for Payer: ASR ASR |
$456.14
|
| Rate for Payer: ASR Commercial |
$456.14
|
| Rate for Payer: BCBS Trust/PPO |
$383.21
|
| Rate for Payer: BCN Commercial |
$364.58
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cofinity Commercial |
$442.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.20
|
| Rate for Payer: Healthscope Commercial |
$470.25
|
| Rate for Payer: Healthscope Whirlpool |
$456.14
|
| Rate for Payer: Mclaren Commercial |
$423.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.71
|
| Rate for Payer: Nomi Health Commercial |
$385.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$413.82
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
IP
|
$470.25
|
|
|
Service Code
|
NDC 68084004411
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$305.66 |
| Max. Negotiated Rate |
$470.25 |
| Rate for Payer: Aetna Commercial |
$423.22
|
| Rate for Payer: ASR ASR |
$456.14
|
| Rate for Payer: ASR Commercial |
$456.14
|
| Rate for Payer: BCBS Trust/PPO |
$383.21
|
| Rate for Payer: BCN Commercial |
$364.58
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cofinity Commercial |
$442.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.20
|
| Rate for Payer: Healthscope Commercial |
$470.25
|
| Rate for Payer: Healthscope Whirlpool |
$456.14
|
| Rate for Payer: Mclaren Commercial |
$423.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.71
|
| Rate for Payer: Nomi Health Commercial |
$385.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$413.82
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
OP
|
$74.73
|
|
|
Service Code
|
NDC 00378700193
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$74.73 |
| Rate for Payer: Aetna Commercial |
$67.26
|
| Rate for Payer: Aetna Medicare |
$37.36
|
| Rate for Payer: ASR ASR |
$72.49
|
| Rate for Payer: ASR Commercial |
$72.49
|
| Rate for Payer: BCBS Complete |
$29.89
|
| Rate for Payer: BCBS Trust/PPO |
$61.20
|
| Rate for Payer: BCN Commercial |
$57.94
|
| Rate for Payer: Cash Price |
$59.78
|
| Rate for Payer: Cofinity Commercial |
$70.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.78
|
| Rate for Payer: Healthscope Commercial |
$74.73
|
| Rate for Payer: Healthscope Whirlpool |
$72.49
|
| Rate for Payer: Mclaren Commercial |
$67.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.52
|
| Rate for Payer: Nomi Health Commercial |
$61.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.48
|
| Rate for Payer: Priority Health Narrow Network |
$52.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.76
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
OP
|
$321.95
|
|
|
Service Code
|
NDC 63739096310
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.78 |
| Max. Negotiated Rate |
$321.95 |
| Rate for Payer: Aetna Commercial |
$289.76
|
| Rate for Payer: Aetna Medicare |
$160.98
|
| Rate for Payer: ASR ASR |
$312.29
|
| Rate for Payer: ASR Commercial |
$312.29
|
| Rate for Payer: BCBS Complete |
$128.78
|
| Rate for Payer: BCBS Trust/PPO |
$263.64
|
| Rate for Payer: BCN Commercial |
$249.61
|
| Rate for Payer: Cash Price |
$257.56
|
| Rate for Payer: Cofinity Commercial |
$302.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.56
|
| Rate for Payer: Healthscope Commercial |
$321.95
|
| Rate for Payer: Healthscope Whirlpool |
$312.29
|
| Rate for Payer: Mclaren Commercial |
$289.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.66
|
| Rate for Payer: Nomi Health Commercial |
$264.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.09
|
| Rate for Payer: Priority Health Narrow Network |
$225.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.32
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
IP
|
$397.15
|
|
|
Service Code
|
NDC 00904567761
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.15 |
| Max. Negotiated Rate |
$397.15 |
| Rate for Payer: Aetna Commercial |
$357.44
|
| Rate for Payer: ASR ASR |
$385.24
|
| Rate for Payer: ASR Commercial |
$385.24
|
| Rate for Payer: BCBS Trust/PPO |
$323.64
|
| Rate for Payer: BCN Commercial |
$307.91
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Cofinity Commercial |
$373.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.72
|
| Rate for Payer: Healthscope Commercial |
$397.15
|
| Rate for Payer: Healthscope Whirlpool |
$385.24
|
| Rate for Payer: Mclaren Commercial |
$357.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.58
|
| Rate for Payer: Nomi Health Commercial |
$325.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.49
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
IP
|
$321.95
|
|
|
Service Code
|
NDC 63739096310
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.27 |
| Max. Negotiated Rate |
$321.95 |
| Rate for Payer: Aetna Commercial |
$289.76
|
| Rate for Payer: ASR ASR |
$312.29
|
| Rate for Payer: ASR Commercial |
$312.29
|
| Rate for Payer: BCBS Trust/PPO |
$262.36
|
| Rate for Payer: BCN Commercial |
$249.61
|
| Rate for Payer: Cash Price |
$257.56
|
| Rate for Payer: Cofinity Commercial |
$302.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.56
|
| Rate for Payer: Healthscope Commercial |
$321.95
|
| Rate for Payer: Healthscope Whirlpool |
$312.29
|
| Rate for Payer: Mclaren Commercial |
$289.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.66
|
| Rate for Payer: Nomi Health Commercial |
$264.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.32
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
OP
|
$397.15
|
|
|
Service Code
|
NDC 00904567761
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.86 |
| Max. Negotiated Rate |
$397.15 |
| Rate for Payer: Aetna Commercial |
$357.44
|
| Rate for Payer: Aetna Medicare |
$198.58
|
| Rate for Payer: ASR ASR |
$385.24
|
| Rate for Payer: ASR Commercial |
$385.24
|
| Rate for Payer: BCBS Complete |
$158.86
|
| Rate for Payer: BCBS Trust/PPO |
$325.23
|
| Rate for Payer: BCN Commercial |
$307.91
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Cofinity Commercial |
$373.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.72
|
| Rate for Payer: Healthscope Commercial |
$397.15
|
| Rate for Payer: Healthscope Whirlpool |
$385.24
|
| Rate for Payer: Mclaren Commercial |
$357.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.58
|
| Rate for Payer: Nomi Health Commercial |
$325.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$347.98
|
| Rate for Payer: Priority Health Narrow Network |
$278.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.49
|
|
|
PEDS ECHO LIMITED W/DEFINITY
|
Facility
|
OP
|
$1,384.11
|
|
|
Service Code
|
HCPCS C8922
|
| Hospital Charge Code |
48000029
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$414.91 |
| Max. Negotiated Rate |
$1,384.11 |
| Rate for Payer: Aetna Commercial |
$1,245.70
|
| Rate for Payer: Aetna Medicare |
$774.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.60
|
| Rate for Payer: ASR ASR |
$1,342.59
|
| Rate for Payer: ASR Commercial |
$1,342.59
|
| Rate for Payer: BCBS Complete |
$435.65
|
| Rate for Payer: BCBS MAPPO |
$774.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,133.45
|
| Rate for Payer: BCN Commercial |
$1,073.10
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: Cash Price |
$1,107.29
|
| Rate for Payer: Cash Price |
$1,107.29
|
| Rate for Payer: Cofinity Commercial |
$1,301.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,107.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Healthscope Commercial |
$1,384.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,342.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$774.08
|
| Rate for Payer: Mclaren Commercial |
$1,245.70
|
| Rate for Payer: Mclaren Medicaid |
$414.91
|
| Rate for Payer: Mclaren Medicare |
$774.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.78
|
| Rate for Payer: Meridian Medicaid |
$435.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$890.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,176.49
|
| Rate for Payer: Nomi Health Commercial |
$1,134.97
|
| Rate for Payer: PACE Medicare |
$735.38
|
| Rate for Payer: PACE SWMI |
$774.08
|
| Rate for Payer: PHP Commercial |
$851.49
|
| Rate for Payer: PHP Medicaid |
$414.91
|
| Rate for Payer: PHP Medicare Advantage |
$774.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,212.76
|
| Rate for Payer: Priority Health Medicare |
$774.08
|
| Rate for Payer: Priority Health Narrow Network |
$970.26
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,218.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.08
|
| Rate for Payer: UHC Exchange |
$1,199.82
|
| Rate for Payer: UHC Medicare Advantage |
$774.08
|
| Rate for Payer: UHCCP DNSP |
$774.08
|
| Rate for Payer: UHCCP Medicaid |
$414.91
|
| Rate for Payer: VA VA |
$774.08
|
|
|
PEDS ECHO LIMITED W/DEFINITY
|
Facility
|
IP
|
$1,384.11
|
|
|
Service Code
|
HCPCS C8922
|
| Hospital Charge Code |
48000029
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$899.67 |
| Max. Negotiated Rate |
$1,384.11 |
| Rate for Payer: Aetna Commercial |
$1,245.70
|
| Rate for Payer: ASR ASR |
$1,342.59
|
| Rate for Payer: ASR Commercial |
$1,342.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,127.91
|
| Rate for Payer: BCN Commercial |
$1,073.10
|
| Rate for Payer: Cash Price |
$1,107.29
|
| Rate for Payer: Cofinity Commercial |
$1,301.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,107.29
|
| Rate for Payer: Healthscope Commercial |
$1,384.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,342.59
|
| Rate for Payer: Mclaren Commercial |
$1,245.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,176.49
|
| Rate for Payer: Nomi Health Commercial |
$1,134.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,218.02
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
NDC 43386009019
|
| Hospital Charge Code |
10839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: ASR ASR |
$54.32
|
| Rate for Payer: ASR Commercial |
$54.32
|
| Rate for Payer: BCBS Trust/PPO |
$45.63
|
| Rate for Payer: BCN Commercial |
$43.42
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Healthscope Whirlpool |
$54.32
|
| Rate for Payer: Mclaren Commercial |
$50.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.60
|
| Rate for Payer: Nomi Health Commercial |
$45.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.28
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
NDC 52268010001
|
| Hospital Charge Code |
10839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: ASR ASR |
$67.90
|
| Rate for Payer: ASR Commercial |
$67.90
|
| Rate for Payer: BCBS Trust/PPO |
$57.04
|
| Rate for Payer: BCN Commercial |
$54.27
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$65.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$70.00
|
| Rate for Payer: Healthscope Whirlpool |
$67.90
|
| Rate for Payer: Mclaren Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.50
|
| Rate for Payer: Nomi Health Commercial |
$57.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.60
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
NDC 52268010001
|
| Hospital Charge Code |
10839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Medicare |
$35.00
|
| Rate for Payer: ASR ASR |
$67.90
|
| Rate for Payer: ASR Commercial |
$67.90
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS Trust/PPO |
$57.32
|
| Rate for Payer: BCN Commercial |
$54.27
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$65.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$70.00
|
| Rate for Payer: Healthscope Whirlpool |
$67.90
|
| Rate for Payer: Mclaren Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.50
|
| Rate for Payer: Nomi Health Commercial |
$57.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.33
|
| Rate for Payer: Priority Health Narrow Network |
$49.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.60
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
NDC 43386009019
|
| Hospital Charge Code |
10839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: ASR ASR |
$54.32
|
| Rate for Payer: ASR Commercial |
$54.32
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$45.86
|
| Rate for Payer: BCN Commercial |
$43.42
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Healthscope Whirlpool |
$54.32
|
| Rate for Payer: Mclaren Commercial |
$50.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.60
|
| Rate for Payer: Nomi Health Commercial |
$45.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.07
|
| Rate for Payer: Priority Health Narrow Network |
$39.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.28
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
IP
|
$11.07
|
|
|
Service Code
|
NDC 96295013764
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Aetna Commercial |
$9.96
|
| Rate for Payer: ASR ASR |
$10.74
|
| Rate for Payer: ASR Commercial |
$10.74
|
| Rate for Payer: BCBS Trust/PPO |
$9.02
|
| Rate for Payer: BCN Commercial |
$8.58
|
| Rate for Payer: Cash Price |
$8.86
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.86
|
| Rate for Payer: Healthscope Commercial |
$11.07
|
| Rate for Payer: Healthscope Whirlpool |
$10.74
|
| Rate for Payer: Mclaren Commercial |
$9.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.41
|
| Rate for Payer: Nomi Health Commercial |
$9.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.74
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
OP
|
$9.52
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$9.52 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna Medicare |
$4.76
|
| Rate for Payer: ASR ASR |
$9.23
|
| Rate for Payer: ASR Commercial |
$9.23
|
| Rate for Payer: BCBS Complete |
$3.81
|
| Rate for Payer: BCBS Trust/PPO |
$7.80
|
| Rate for Payer: BCN Commercial |
$7.38
|
| Rate for Payer: Cash Price |
$7.61
|
| Rate for Payer: Cofinity Commercial |
$8.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.62
|
| Rate for Payer: Healthscope Commercial |
$9.52
|
| Rate for Payer: Healthscope Whirlpool |
$9.23
|
| Rate for Payer: Mclaren Commercial |
$8.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.09
|
| Rate for Payer: Nomi Health Commercial |
$7.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.34
|
| Rate for Payer: Priority Health Narrow Network |
$6.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.38
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
OP
|
$11.07
|
|
|
Service Code
|
NDC 96295013764
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Aetna Commercial |
$9.96
|
| Rate for Payer: Aetna Medicare |
$5.54
|
| Rate for Payer: ASR ASR |
$10.74
|
| Rate for Payer: ASR Commercial |
$10.74
|
| Rate for Payer: BCBS Complete |
$4.43
|
| Rate for Payer: BCBS Trust/PPO |
$9.07
|
| Rate for Payer: BCN Commercial |
$8.58
|
| Rate for Payer: Cash Price |
$8.86
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.86
|
| Rate for Payer: Healthscope Commercial |
$11.07
|
| Rate for Payer: Healthscope Whirlpool |
$10.74
|
| Rate for Payer: Mclaren Commercial |
$9.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.41
|
| Rate for Payer: Nomi Health Commercial |
$9.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.70
|
| Rate for Payer: Priority Health Narrow Network |
$7.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.74
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
IP
|
$9.52
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$9.52 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: ASR ASR |
$9.23
|
| Rate for Payer: ASR Commercial |
$9.23
|
| Rate for Payer: BCBS Trust/PPO |
$7.76
|
| Rate for Payer: BCN Commercial |
$7.38
|
| Rate for Payer: Cash Price |
$7.61
|
| Rate for Payer: Cofinity Commercial |
$8.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.62
|
| Rate for Payer: Healthscope Commercial |
$9.52
|
| Rate for Payer: Healthscope Whirlpool |
$9.23
|
| Rate for Payer: Mclaren Commercial |
$8.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.09
|
| Rate for Payer: Nomi Health Commercial |
$7.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.38
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$9,031.02
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
32267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,870.16 |
| Max. Negotiated Rate |
$9,031.02 |
| Rate for Payer: Aetna Commercial |
$8,127.92
|
| Rate for Payer: ASR ASR |
$8,760.09
|
| Rate for Payer: ASR Commercial |
$8,760.09
|
| Rate for Payer: BCBS Trust/PPO |
$7,359.38
|
| Rate for Payer: BCN Commercial |
$7,001.75
|
| Rate for Payer: Cash Price |
$7,224.82
|
| Rate for Payer: Cofinity Commercial |
$8,489.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,224.82
|
| Rate for Payer: Healthscope Commercial |
$9,031.02
|
| Rate for Payer: Healthscope Whirlpool |
$8,760.09
|
| Rate for Payer: Mclaren Commercial |
$8,127.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,676.37
|
| Rate for Payer: Nomi Health Commercial |
$7,405.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,870.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,947.30
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$9,031.02
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
32267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$9,031.02 |
| Rate for Payer: Aetna Commercial |
$8,127.92
|
| Rate for Payer: Aetna Medicare |
$19.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.98
|
| Rate for Payer: ASR ASR |
$8,760.09
|
| Rate for Payer: ASR Commercial |
$8,760.09
|
| Rate for Payer: BCBS Complete |
$11.24
|
| Rate for Payer: BCBS MAPPO |
$19.98
|
| Rate for Payer: BCBS Trust/PPO |
$7,395.50
|
| Rate for Payer: BCN Commercial |
$7,001.75
|
| Rate for Payer: BCN Medicare Advantage |
$19.98
|
| Rate for Payer: Cash Price |
$7,224.82
|
| Rate for Payer: Cash Price |
$7,224.82
|
| Rate for Payer: Cofinity Commercial |
$8,489.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,224.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$9,031.02
|
| Rate for Payer: Healthscope Whirlpool |
$8,760.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.98
|
| Rate for Payer: Mclaren Commercial |
$8,127.92
|
| Rate for Payer: Mclaren Medicaid |
$10.71
|
| Rate for Payer: Mclaren Medicare |
$19.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.98
|
| Rate for Payer: Meridian Medicaid |
$11.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,676.37
|
| Rate for Payer: Nomi Health Commercial |
$7,405.44
|
| Rate for Payer: PACE Medicare |
$18.98
|
| Rate for Payer: PACE SWMI |
$19.98
|
| Rate for Payer: PHP Commercial |
$21.98
|
| Rate for Payer: PHP Medicaid |
$10.71
|
| Rate for Payer: PHP Medicare Advantage |
$19.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,870.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.74
|
| Rate for Payer: Priority Health Medicare |
$19.98
|
| Rate for Payer: Priority Health Narrow Network |
$16.59
|
| Rate for Payer: Railroad Medicare Medicare |
$19.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,947.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.98
|
| Rate for Payer: UHC Exchange |
$30.97
|
| Rate for Payer: UHC Medicare Advantage |
$19.98
|
| Rate for Payer: UHCCP DNSP |
$19.98
|
| Rate for Payer: UHCCP Medicaid |
$10.71
|
| Rate for Payer: VA VA |
$19.98
|
|
|
PEGFILGRASTIM-BMEZ 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$9,951.21
|
|
|
Service Code
|
HCPCS Q5120
|
| Hospital Charge Code |
192102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$9,951.21 |
| Rate for Payer: Aetna Commercial |
$8,956.09
|
| Rate for Payer: Aetna Medicare |
$24.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.89
|
| Rate for Payer: ASR ASR |
$9,652.67
|
| Rate for Payer: ASR Commercial |
$9,652.67
|
| Rate for Payer: BCBS Complete |
$13.91
|
| Rate for Payer: BCBS MAPPO |
$24.71
|
| Rate for Payer: BCBS Trust/PPO |
$8,149.05
|
| Rate for Payer: BCN Commercial |
$7,715.17
|
| Rate for Payer: BCN Medicare Advantage |
$24.71
|
| Rate for Payer: Cash Price |
$7,960.97
|
| Rate for Payer: Cash Price |
$7,960.97
|
| Rate for Payer: Cofinity Commercial |
$9,354.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,960.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.71
|
| Rate for Payer: Healthscope Commercial |
$9,951.21
|
| Rate for Payer: Healthscope Whirlpool |
$9,652.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.71
|
| Rate for Payer: Mclaren Commercial |
$8,956.09
|
| Rate for Payer: Mclaren Medicaid |
$13.24
|
| Rate for Payer: Mclaren Medicare |
$24.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.95
|
| Rate for Payer: Meridian Medicaid |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,458.53
|
| Rate for Payer: Nomi Health Commercial |
$8,159.99
|
| Rate for Payer: PACE Medicare |
$23.47
|
| Rate for Payer: PACE SWMI |
$24.71
|
| Rate for Payer: PHP Commercial |
$27.18
|
| Rate for Payer: PHP Medicaid |
$13.24
|
| Rate for Payer: PHP Medicare Advantage |
$24.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,468.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.64
|
| Rate for Payer: Priority Health Medicare |
$24.71
|
| Rate for Payer: Priority Health Narrow Network |
$20.51
|
| Rate for Payer: Railroad Medicare Medicare |
$24.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,757.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.71
|
| Rate for Payer: UHC Exchange |
$38.30
|
| Rate for Payer: UHC Medicare Advantage |
$24.71
|
| Rate for Payer: UHCCP DNSP |
$24.71
|
| Rate for Payer: UHCCP Medicaid |
$13.24
|
| Rate for Payer: VA VA |
$24.71
|
|
|
PEGFILGRASTIM-BMEZ 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$9,951.21
|
|
|
Service Code
|
HCPCS Q5120
|
| Hospital Charge Code |
192102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,468.29 |
| Max. Negotiated Rate |
$9,951.21 |
| Rate for Payer: Aetna Commercial |
$8,956.09
|
| Rate for Payer: ASR ASR |
$9,652.67
|
| Rate for Payer: ASR Commercial |
$9,652.67
|
| Rate for Payer: BCBS Trust/PPO |
$8,109.24
|
| Rate for Payer: BCN Commercial |
$7,715.17
|
| Rate for Payer: Cash Price |
$7,960.97
|
| Rate for Payer: Cofinity Commercial |
$9,354.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,960.97
|
| Rate for Payer: Healthscope Commercial |
$9,951.21
|
| Rate for Payer: Healthscope Whirlpool |
$9,652.67
|
| Rate for Payer: Mclaren Commercial |
$8,956.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,458.53
|
| Rate for Payer: Nomi Health Commercial |
$8,159.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,468.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,757.06
|
|
|
PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$8,255.24
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
189200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,365.91 |
| Max. Negotiated Rate |
$8,255.24 |
| Rate for Payer: Aetna Commercial |
$7,429.72
|
| Rate for Payer: ASR ASR |
$8,007.58
|
| Rate for Payer: ASR Commercial |
$8,007.58
|
| Rate for Payer: BCBS Trust/PPO |
$6,727.20
|
| Rate for Payer: BCN Commercial |
$6,400.29
|
| Rate for Payer: Cash Price |
$6,604.19
|
| Rate for Payer: Cofinity Commercial |
$7,759.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,604.19
|
| Rate for Payer: Healthscope Commercial |
$8,255.24
|
| Rate for Payer: Healthscope Whirlpool |
$8,007.58
|
| Rate for Payer: Mclaren Commercial |
$7,429.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,016.95
|
| Rate for Payer: Nomi Health Commercial |
$6,769.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,365.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,264.61
|
|
|
PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$8,255.24
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
189200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.65 |
| Max. Negotiated Rate |
$8,255.24 |
| Rate for Payer: Aetna Commercial |
$7,429.72
|
| Rate for Payer: Aetna Medicare |
$135.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.44
|
| Rate for Payer: ASR ASR |
$8,007.58
|
| Rate for Payer: ASR Commercial |
$8,007.58
|
| Rate for Payer: BCBS Complete |
$76.29
|
| Rate for Payer: BCBS MAPPO |
$135.55
|
| Rate for Payer: BCBS Trust/PPO |
$6,760.22
|
| Rate for Payer: BCN Commercial |
$6,400.29
|
| Rate for Payer: BCN Medicare Advantage |
$135.55
|
| Rate for Payer: Cash Price |
$6,604.19
|
| Rate for Payer: Cash Price |
$6,604.19
|
| Rate for Payer: Cofinity Commercial |
$7,759.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,604.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.55
|
| Rate for Payer: Healthscope Commercial |
$8,255.24
|
| Rate for Payer: Healthscope Whirlpool |
$8,007.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$135.55
|
| Rate for Payer: Mclaren Commercial |
$7,429.72
|
| Rate for Payer: Mclaren Medicaid |
$72.65
|
| Rate for Payer: Mclaren Medicare |
$135.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.33
|
| Rate for Payer: Meridian Medicaid |
$76.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,016.95
|
| Rate for Payer: Nomi Health Commercial |
$6,769.30
|
| Rate for Payer: PACE Medicare |
$128.77
|
| Rate for Payer: PACE SWMI |
$135.55
|
| Rate for Payer: PHP Commercial |
$149.10
|
| Rate for Payer: PHP Medicaid |
$72.65
|
| Rate for Payer: PHP Medicare Advantage |
$135.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,365.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.78
|
| Rate for Payer: Priority Health Medicare |
$135.55
|
| Rate for Payer: Priority Health Narrow Network |
$135.82
|
| Rate for Payer: Railroad Medicare Medicare |
$135.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,264.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.55
|
| Rate for Payer: UHC Exchange |
$210.10
|
| Rate for Payer: UHC Medicare Advantage |
$135.55
|
| Rate for Payer: UHCCP DNSP |
$135.55
|
| Rate for Payer: UHCCP Medicaid |
$72.65
|
| Rate for Payer: VA VA |
$135.55
|
|
|
PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,616.00
|
|
|
Service Code
|
HCPCS Q5108
|
| Hospital Charge Code |
187520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.16 |
| Max. Negotiated Rate |
$5,616.00 |
| Rate for Payer: Aetna Commercial |
$5,054.40
|
| Rate for Payer: Aetna Medicare |
$125.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.62
|
| Rate for Payer: ASR ASR |
$5,447.52
|
| Rate for Payer: ASR Commercial |
$5,447.52
|
| Rate for Payer: BCBS Complete |
$70.52
|
| Rate for Payer: BCBS MAPPO |
$125.30
|
| Rate for Payer: BCBS Trust/PPO |
$4,598.94
|
| Rate for Payer: BCN Commercial |
$4,354.08
|
| Rate for Payer: BCN Medicare Advantage |
$125.30
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cofinity Commercial |
$5,279.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,492.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.30
|
| Rate for Payer: Healthscope Commercial |
$5,616.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,447.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.30
|
| Rate for Payer: Mclaren Commercial |
$5,054.40
|
| Rate for Payer: Mclaren Medicaid |
$67.16
|
| Rate for Payer: Mclaren Medicare |
$125.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.56
|
| Rate for Payer: Meridian Medicaid |
$70.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,773.60
|
| Rate for Payer: Nomi Health Commercial |
$4,605.12
|
| Rate for Payer: PACE Medicare |
$119.04
|
| Rate for Payer: PACE SWMI |
$125.30
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: PHP Medicaid |
$67.16
|
| Rate for Payer: PHP Medicare Advantage |
$125.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,650.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.16
|
| Rate for Payer: Priority Health Medicare |
$125.30
|
| Rate for Payer: Priority Health Narrow Network |
$93.73
|
| Rate for Payer: Railroad Medicare Medicare |
$125.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,942.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.30
|
| Rate for Payer: UHC Exchange |
$194.22
|
| Rate for Payer: UHC Medicare Advantage |
$125.30
|
| Rate for Payer: UHCCP DNSP |
$125.30
|
| Rate for Payer: UHCCP Medicaid |
$67.16
|
| Rate for Payer: VA VA |
$125.30
|
|
|
PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,616.00
|
|
|
Service Code
|
HCPCS Q5108
|
| Hospital Charge Code |
187520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,650.40 |
| Max. Negotiated Rate |
$5,616.00 |
| Rate for Payer: Aetna Commercial |
$5,054.40
|
| Rate for Payer: ASR ASR |
$5,447.52
|
| Rate for Payer: ASR Commercial |
$5,447.52
|
| Rate for Payer: BCBS Trust/PPO |
$4,576.48
|
| Rate for Payer: BCN Commercial |
$4,354.08
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cofinity Commercial |
$5,279.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,492.80
|
| Rate for Payer: Healthscope Commercial |
$5,616.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,447.52
|
| Rate for Payer: Mclaren Commercial |
$5,054.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,773.60
|
| Rate for Payer: Nomi Health Commercial |
$4,605.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,650.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,942.08
|
|
