|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,005.25
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
70287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,153.31 |
| Max. Negotiated Rate |
$4,504.73 |
| Rate for Payer: Aetna Commercial |
$4,254.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,253.41
|
| Rate for Payer: Cash Price |
$4,004.20
|
| Rate for Payer: Cofinity Advantage |
$3,503.68
|
| Rate for Payer: Cofinity Commercial |
$4,304.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,004.20
|
| Rate for Payer: Healthscope Commercial |
$4,504.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,254.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,753.94
|
| Rate for Payer: PHP Commercial |
$4,254.46
|
| Rate for Payer: Priority Health SBD |
$3,153.31
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,005.25
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
70287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$4,504.73 |
| Rate for Payer: Aetna Commercial |
$4,254.46
|
| Rate for Payer: Aetna Medicare |
$46.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,253.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.90
|
| Rate for Payer: BCBS Complete |
$24.56
|
| Rate for Payer: BCBS MAPPO |
$44.72
|
| Rate for Payer: BCBS Trust/PPO |
$144.12
|
| Rate for Payer: BCN Commercial |
$144.12
|
| Rate for Payer: BCN Medicare Advantage |
$44.72
|
| Rate for Payer: Cash Price |
$4,004.20
|
| Rate for Payer: Cash Price |
$4,004.20
|
| Rate for Payer: Cofinity Advantage |
$3,503.68
|
| Rate for Payer: Cofinity Commercial |
$4,304.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,004.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.72
|
| Rate for Payer: Healthscope Commercial |
$4,504.73
|
| Rate for Payer: Mclaren Medicaid |
$23.39
|
| Rate for Payer: Mclaren Medicare |
$44.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.96
|
| Rate for Payer: Meridian Medicaid |
$46.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,254.46
|
| Rate for Payer: Nomi Health Commercial |
$134.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,753.94
|
| Rate for Payer: PACE Medicare |
$42.48
|
| Rate for Payer: PACE SWMI |
$44.72
|
| Rate for Payer: PHP Commercial |
$4,254.46
|
| Rate for Payer: PHP Medicare Advantage |
$44.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$139.11
|
| Rate for Payer: Priority Health Medicare |
$44.72
|
| Rate for Payer: Priority Health SBD |
$3,153.31
|
| Rate for Payer: Priority Health Tiered Network |
$111.29
|
| Rate for Payer: Railroad Medicare Medicare |
$44.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.87
|
| Rate for Payer: UHC Core |
$73.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.72
|
| Rate for Payer: UHC Exchange |
$73.87
|
| Rate for Payer: UHC Medicaid |
$23.39
|
| Rate for Payer: UHCCP Medicaid |
$23.39
|
| Rate for Payer: VA VA |
$44.72
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$3,950.04
|
|
|
Service Code
|
APR-DRG 2511
|
| Min. Negotiated Rate |
$3,761.94 |
| Max. Negotiated Rate |
$3,950.04 |
| Rate for Payer: BCBS Complete |
$3,950.04
|
| Rate for Payer: Mclaren Medicaid |
$3,761.94
|
| Rate for Payer: Meridian Medicaid |
$3,950.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,761.94
|
| Rate for Payer: UHC Medicaid |
$3,761.94
|
| Rate for Payer: UHCCP Medicaid |
$3,761.94
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$9,003.10
|
|
|
Service Code
|
APR-DRG 2514
|
| Min. Negotiated Rate |
$8,574.38 |
| Max. Negotiated Rate |
$9,003.10 |
| Rate for Payer: BCBS Complete |
$9,003.10
|
| Rate for Payer: Mclaren Medicaid |
$8,574.38
|
| Rate for Payer: Meridian Medicaid |
$9,003.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,574.38
|
| Rate for Payer: UHC Medicaid |
$8,574.38
|
| Rate for Payer: UHCCP Medicaid |
$8,574.38
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$4,726.29
|
|
|
Service Code
|
APR-DRG 2512
|
| Min. Negotiated Rate |
$4,501.22 |
| Max. Negotiated Rate |
$4,726.29 |
| Rate for Payer: BCBS Complete |
$4,726.29
|
| Rate for Payer: Mclaren Medicaid |
$4,501.22
|
| Rate for Payer: Meridian Medicaid |
$4,726.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,501.22
|
| Rate for Payer: UHC Medicaid |
$4,501.22
|
| Rate for Payer: UHCCP Medicaid |
$4,501.22
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$5,848.81
|
|
|
Service Code
|
APR-DRG 2513
|
| Min. Negotiated Rate |
$5,570.29 |
| Max. Negotiated Rate |
$5,848.81 |
| Rate for Payer: BCBS Complete |
$5,848.81
|
| Rate for Payer: Mclaren Medicaid |
$5,570.29
|
| Rate for Payer: Meridian Medicaid |
$5,848.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,570.29
|
| Rate for Payer: UHC Medicaid |
$5,570.29
|
| Rate for Payer: UHCCP Medicaid |
$5,570.29
|
|
|
ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITHOUT IMAGING GUIDANCE
|
Facility
|
OP
|
$2,922.56
|
|
|
Service Code
|
CPT 49082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$570.17
|
| Rate for Payer: BCN Commercial |
$570.17
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); INTRAMURAL (IE, SUBMUCOSAL)
|
Facility
|
OP
|
$4,999.64
|
|
|
Service Code
|
CPT 30802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$808.56 |
| Max. Negotiated Rate |
$4,999.64 |
| Rate for Payer: Aetna Medicare |
$1,607.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,932.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,932.50
|
| Rate for Payer: BCBS Complete |
$849.06
|
| Rate for Payer: BCBS MAPPO |
$1,546.00
|
| Rate for Payer: BCBS Trust/PPO |
$856.75
|
| Rate for Payer: BCN Commercial |
$856.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,546.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,546.00
|
| Rate for Payer: Mclaren Medicaid |
$808.56
|
| Rate for Payer: Mclaren Medicare |
$1,546.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.30
|
| Rate for Payer: Meridian Medicaid |
$1,623.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,777.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,700.60
|
| Rate for Payer: Nomi Health Commercial |
$4,638.00
|
| Rate for Payer: PACE Medicare |
$1,468.70
|
| Rate for Payer: PACE SWMI |
$1,546.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,546.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,999.64
|
| Rate for Payer: Priority Health Medicare |
$1,546.00
|
| Rate for Payer: Priority Health Tiered Network |
$3,999.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.00
|
| Rate for Payer: UHC Medicaid |
$808.56
|
| Rate for Payer: UHCCP Medicaid |
$808.56
|
| Rate for Payer: VA VA |
$1,546.00
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$3,685.75
|
|
|
Service Code
|
APR-DRG 5432
|
| Min. Negotiated Rate |
$3,510.23 |
| Max. Negotiated Rate |
$3,685.75 |
| Rate for Payer: BCBS Complete |
$3,685.75
|
| Rate for Payer: Mclaren Medicaid |
$3,510.23
|
| Rate for Payer: Meridian Medicaid |
$3,685.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,510.23
|
| Rate for Payer: UHC Medicaid |
$3,510.23
|
| Rate for Payer: UHCCP Medicaid |
$3,510.23
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$2,936.44
|
|
|
Service Code
|
APR-DRG 5431
|
| Min. Negotiated Rate |
$2,796.61 |
| Max. Negotiated Rate |
$2,936.44 |
| Rate for Payer: BCBS Complete |
$2,936.44
|
| Rate for Payer: Mclaren Medicaid |
$2,796.61
|
| Rate for Payer: Meridian Medicaid |
$2,936.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,796.61
|
| Rate for Payer: UHC Medicaid |
$2,796.61
|
| Rate for Payer: UHCCP Medicaid |
$2,796.61
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$13,709.32
|
|
|
Service Code
|
APR-DRG 5434
|
| Min. Negotiated Rate |
$13,056.50 |
| Max. Negotiated Rate |
$13,709.32 |
| Rate for Payer: BCBS Complete |
$13,709.32
|
| Rate for Payer: Mclaren Medicaid |
$13,056.50
|
| Rate for Payer: Meridian Medicaid |
$13,709.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,056.50
|
| Rate for Payer: UHC Medicaid |
$13,056.50
|
| Rate for Payer: UHCCP Medicaid |
$13,056.50
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$16,344.01
|
|
|
Service Code
|
MSDRG 770
|
| Min. Negotiated Rate |
$7,089.87 |
| Max. Negotiated Rate |
$16,344.01 |
| Rate for Payer: Aetna Medicare |
$8,661.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,410.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,410.11
|
| Rate for Payer: BCBS MAPPO |
$8,328.09
|
| Rate for Payer: BCBS Trust/PPO |
$14,098.64
|
| Rate for Payer: BCN Commercial |
$14,098.64
|
| Rate for Payer: BCN Medicare Advantage |
$8,328.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,328.09
|
| Rate for Payer: Mclaren Medicare |
$8,328.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,744.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,577.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,160.90
|
| Rate for Payer: Nomi Health Commercial |
$12,934.83
|
| Rate for Payer: PACE Medicare |
$7,911.69
|
| Rate for Payer: PACE SWMI |
$8,328.09
|
| Rate for Payer: PHP Medicare Advantage |
$8,328.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,862.34
|
| Rate for Payer: Priority Health Medicare |
$8,328.09
|
| Rate for Payer: Priority Health Tiered Network |
$7,089.87
|
| Rate for Payer: Railroad Medicare Medicare |
$8,328.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,344.01
|
| Rate for Payer: UHC Core |
$13,673.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,328.09
|
| Rate for Payer: UHC Exchange |
$11,167.07
|
| Rate for Payer: VA VA |
$8,328.09
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$5,727.84
|
|
|
Service Code
|
APR-DRG 5433
|
| Min. Negotiated Rate |
$5,455.09 |
| Max. Negotiated Rate |
$5,727.84 |
| Rate for Payer: BCBS Complete |
$5,727.84
|
| Rate for Payer: Mclaren Medicaid |
$5,455.09
|
| Rate for Payer: Meridian Medicaid |
$5,727.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,455.09
|
| Rate for Payer: UHC Medicaid |
$5,455.09
|
| Rate for Payer: UHCCP Medicaid |
$5,455.09
|
|
|
ABORTION WITHOUT D&C
|
Facility
|
IP
|
$11,623.53
|
|
|
Service Code
|
MSDRG 779
|
| Min. Negotiated Rate |
$5,702.08 |
| Max. Negotiated Rate |
$11,623.53 |
| Rate for Payer: Aetna Medicare |
$7,363.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,850.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,850.94
|
| Rate for Payer: BCBS MAPPO |
$7,080.75
|
| Rate for Payer: BCBS Trust/PPO |
$9,030.81
|
| Rate for Payer: BCN Commercial |
$9,030.81
|
| Rate for Payer: BCN Medicare Advantage |
$7,080.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,080.75
|
| Rate for Payer: Mclaren Medicare |
$7,080.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,434.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,142.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,788.82
|
| Rate for Payer: Nomi Health Commercial |
$9,198.99
|
| Rate for Payer: PACE Medicare |
$6,726.71
|
| Rate for Payer: PACE SWMI |
$7,080.75
|
| Rate for Payer: PHP Medicare Advantage |
$7,080.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7,127.60
|
| Rate for Payer: Priority Health Medicare |
$7,080.75
|
| Rate for Payer: Priority Health Tiered Network |
$5,702.08
|
| Rate for Payer: Railroad Medicare Medicare |
$7,080.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,623.53
|
| Rate for Payer: UHC Core |
$9,724.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,080.75
|
| Rate for Payer: UHC Exchange |
$7,941.79
|
| Rate for Payer: VA VA |
$7,080.75
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$3,268.96
|
|
|
Service Code
|
APR-DRG 5642
|
| Min. Negotiated Rate |
$3,113.29 |
| Max. Negotiated Rate |
$3,268.96 |
| Rate for Payer: BCBS Complete |
$3,268.96
|
| Rate for Payer: Mclaren Medicaid |
$3,113.29
|
| Rate for Payer: Meridian Medicaid |
$3,268.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,113.29
|
| Rate for Payer: UHC Medicaid |
$3,113.29
|
| Rate for Payer: UHCCP Medicaid |
$3,113.29
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$2,247.91
|
|
|
Service Code
|
APR-DRG 5641
|
| Min. Negotiated Rate |
$2,140.87 |
| Max. Negotiated Rate |
$2,247.91 |
| Rate for Payer: BCBS Complete |
$2,247.91
|
| Rate for Payer: Mclaren Medicaid |
$2,140.87
|
| Rate for Payer: Meridian Medicaid |
$2,247.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,140.87
|
| Rate for Payer: UHC Medicaid |
$2,140.87
|
| Rate for Payer: UHCCP Medicaid |
$2,140.87
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$4,737.18
|
|
|
Service Code
|
APR-DRG 5643
|
| Min. Negotiated Rate |
$4,511.60 |
| Max. Negotiated Rate |
$4,737.18 |
| Rate for Payer: BCBS Complete |
$4,737.18
|
| Rate for Payer: Mclaren Medicaid |
$4,511.60
|
| Rate for Payer: Meridian Medicaid |
$4,737.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,511.60
|
| Rate for Payer: UHC Medicaid |
$4,511.60
|
| Rate for Payer: UHCCP Medicaid |
$4,511.60
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$9,147.00
|
|
|
Service Code
|
APR-DRG 5644
|
| Min. Negotiated Rate |
$8,711.43 |
| Max. Negotiated Rate |
$9,147.00 |
| Rate for Payer: BCBS Complete |
$9,147.00
|
| Rate for Payer: Mclaren Medicaid |
$8,711.43
|
| Rate for Payer: Meridian Medicaid |
$9,147.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,711.43
|
| Rate for Payer: UHC Medicaid |
$8,711.43
|
| Rate for Payer: UHCCP Medicaid |
$8,711.43
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.14
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
151854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: BCBS Complete |
$9.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Advantage |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.36
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health SBD |
$14.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.92
|
|
|
Service Code
|
HCPCS J0134
|
| Hospital Charge Code |
151854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$22.43 |
| Rate for Payer: Aetna Commercial |
$21.18
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.20
|
| Rate for Payer: BCBS Complete |
$9.97
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cofinity Advantage |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.94
|
| Rate for Payer: Healthscope Commercial |
$22.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.69
|
| Rate for Payer: PHP Commercial |
$21.18
|
| Rate for Payer: Priority Health SBD |
$15.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.14
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
151854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.58 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Advantage |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.36
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health SBD |
$14.58
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.92
|
|
|
Service Code
|
HCPCS J0134
|
| Hospital Charge Code |
151854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.70 |
| Max. Negotiated Rate |
$22.43 |
| Rate for Payer: Aetna Commercial |
$21.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.20
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cofinity Advantage |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.94
|
| Rate for Payer: Healthscope Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.69
|
| Rate for Payer: PHP Commercial |
$21.18
|
| Rate for Payer: Priority Health SBD |
$15.70
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$19.88
|
|
|
Service Code
|
NDC 51672211502
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.52 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Aetna Commercial |
$16.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.92
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cofinity Advantage |
$13.92
|
| Rate for Payer: Cofinity Commercial |
$17.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.90
|
| Rate for Payer: Healthscope Commercial |
$17.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.91
|
| Rate for Payer: PHP Commercial |
$16.90
|
| Rate for Payer: Priority Health SBD |
$12.52
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$19.88
|
|
|
Service Code
|
NDC 51672211502
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Aetna Commercial |
$16.90
|
| Rate for Payer: Aetna Medicare |
$9.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.92
|
| Rate for Payer: BCBS Complete |
$7.95
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cofinity Advantage |
$13.92
|
| Rate for Payer: Cofinity Commercial |
$17.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.90
|
| Rate for Payer: Healthscope Commercial |
$17.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.91
|
| Rate for Payer: PHP Commercial |
$16.90
|
| Rate for Payer: Priority Health SBD |
$12.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.92
|
| Rate for Payer: UHC Core |
$10.36
|
| Rate for Payer: UHC Exchange |
$7.81
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$3.32
|
|
|
Service Code
|
NDC 51672211500
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna Medicare |
$1.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.16
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Advantage |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.49
|
| Rate for Payer: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.16
|
| Rate for Payer: UHC Core |
$1.73
|
| Rate for Payer: UHC Exchange |
$1.30
|
|
