|
ABATACEPT INJECTION
|
Professional
|
$40.00
|
|
|
Service Code
|
HCPCS J0129
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$80.05 |
| Rate for Payer: Aetna Commercial |
$57.98
|
| Rate for Payer: Aetna Medicare |
$45.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.31
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$43.27
|
| Rate for Payer: BCBS Trust/PPO |
$52.16
|
| Rate for Payer: BCN Medicare Advantage |
$43.27
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$62.31
|
| Rate for Payer: Cofinity Commercial |
$57.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.27
|
| Rate for Payer: Healthscope Commercial |
$69.23
|
| Rate for Payer: Healthscope Commercial |
$80.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.43
|
| Rate for Payer: PACE SWMI |
$43.27
|
| Rate for Payer: PHP Medicare Advantage |
$43.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health Medicare |
$43.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.27
|
| Rate for Payer: UHC Medicare Advantage |
$44.57
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$4,456.00
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
70287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,807.28 |
| Max. Negotiated Rate |
$4,010.40 |
| Rate for Payer: Aetna Commercial |
$3,787.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,896.40
|
| Rate for Payer: Cash Price |
$3,564.80
|
| Rate for Payer: Cofinity Commercial |
$3,119.20
|
| Rate for Payer: Cofinity Commercial |
$3,832.16
|
| Rate for Payer: Healthscope Commercial |
$4,010.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,787.60
|
| Rate for Payer: PHP Commercial |
$3,787.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,119.20
|
| Rate for Payer: Priority Health SBD |
$2,807.28
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); INTRAMURAL (IE, SUBMUCOSAL)
|
Facility
OP
|
$4,162.38
|
|
|
Service Code
|
CPT 30802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$200.39 |
| Max. Negotiated Rate |
$4,162.38 |
| Rate for Payer: Aetna Medicare |
$1,411.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,696.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,696.21
|
| Rate for Payer: BCBS Complete |
$779.44
|
| Rate for Payer: BCBS MAPPO |
$1,356.97
|
| Rate for Payer: BCBS Trust/PPO |
$649.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,356.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,356.97
|
| Rate for Payer: Mclaren Medicaid |
$742.26
|
| Rate for Payer: Mclaren Medicare |
$1,356.97
|
| Rate for Payer: Meridian Medicaid |
$779.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,424.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,560.52
|
| Rate for Payer: PACE Medicare |
$1,289.12
|
| Rate for Payer: PACE SWMI |
$1,356.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,356.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$742.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,162.38
|
| Rate for Payer: Priority Health Medicare |
$1,356.97
|
| Rate for Payer: Priority Health Narrow Network |
$3,329.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,356.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.43
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,356.97
|
| Rate for Payer: UHC Exchange |
$200.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,397.68
|
| Rate for Payer: VA VA |
$1,356.97
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); SUPERFICIAL
|
Facility
OP
|
$4,162.38
|
|
|
Service Code
|
CPT 30801
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$150.62 |
| Max. Negotiated Rate |
$4,162.38 |
| Rate for Payer: Aetna Medicare |
$1,411.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,696.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,696.21
|
| Rate for Payer: BCBS Complete |
$779.44
|
| Rate for Payer: BCBS MAPPO |
$1,356.97
|
| Rate for Payer: BCBS Trust/PPO |
$487.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,356.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,356.97
|
| Rate for Payer: Mclaren Medicaid |
$742.26
|
| Rate for Payer: Mclaren Medicare |
$1,356.97
|
| Rate for Payer: Meridian Medicaid |
$779.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,424.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,560.52
|
| Rate for Payer: PACE Medicare |
$1,289.12
|
| Rate for Payer: PACE SWMI |
$1,356.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,356.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$742.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,162.38
|
| Rate for Payer: Priority Health Medicare |
$1,356.97
|
| Rate for Payer: Priority Health Narrow Network |
$3,329.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,356.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.68
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,356.97
|
| Rate for Payer: UHC Exchange |
$150.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,397.68
|
| Rate for Payer: VA VA |
$1,356.97
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$13,225.91
|
|
|
Service Code
|
MS-DRG 770
|
| Min. Negotiated Rate |
$5,932.57 |
| Max. Negotiated Rate |
$13,225.91 |
| Rate for Payer: Aetna Medicare |
$6,494.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,806.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,806.01
|
| Rate for Payer: BCBS MAPPO |
$6,244.81
|
| Rate for Payer: BCBS Trust/PPO |
$13,225.91
|
| Rate for Payer: BCN Medicare Advantage |
$6,244.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,244.81
|
| Rate for Payer: Mclaren Medicare |
$6,244.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,557.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,181.53
|
| Rate for Payer: PACE Medicare |
$5,932.57
|
| Rate for Payer: PACE SWMI |
$6,244.81
|
| Rate for Payer: PHP Medicare Advantage |
$6,244.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,461.28
|
| Rate for Payer: Priority Health Medicare |
$6,244.81
|
| Rate for Payer: Priority Health Narrow Network |
$9,169.02
|
| Rate for Payer: Railroad Medicare Medicare |
$6,244.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,183.37
|
| Rate for Payer: UHC Core |
$7,475.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,244.81
|
| Rate for Payer: UHC Exchange |
$8,006.97
|
| Rate for Payer: UHC Medicare Advantage |
$6,432.15
|
| Rate for Payer: VA VA |
$6,244.81
|
|
|
ABORTION WITHOUT D&C
|
Facility
IP
|
$15,089.26
|
|
|
Service Code
|
MS-DRG 779
|
| Min. Negotiated Rate |
$7,235.91 |
| Max. Negotiated Rate |
$15,089.26 |
| Rate for Payer: Aetna Medicare |
$7,921.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,520.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,520.94
|
| Rate for Payer: BCBS MAPPO |
$7,616.75
|
| Rate for Payer: BCBS Trust/PPO |
$8,471.78
|
| Rate for Payer: BCN Medicare Advantage |
$7,616.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,616.75
|
| Rate for Payer: Mclaren Medicare |
$7,616.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,997.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,759.26
|
| Rate for Payer: PACE Medicare |
$7,235.91
|
| Rate for Payer: PACE SWMI |
$7,616.75
|
| Rate for Payer: PHP Medicare Advantage |
$7,616.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,194.94
|
| Rate for Payer: Priority Health Medicare |
$7,616.75
|
| Rate for Payer: Priority Health Narrow Network |
$11,355.95
|
| Rate for Payer: Railroad Medicare Medicare |
$7,616.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,089.26
|
| Rate for Payer: UHC Core |
$9,258.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,616.75
|
| Rate for Payer: UHC Exchange |
$9,916.73
|
| Rate for Payer: UHC Medicare Advantage |
$7,845.25
|
| Rate for Payer: VA VA |
$7,616.75
|
|
|
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 Commercial |
$21.43
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Healthscope Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.18
|
| Rate for Payer: PHP Commercial |
$21.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.44
|
| Rate for Payer: Priority Health SBD |
$15.70
|
|
|
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 Commercial |
$27.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$23.05
|
| Rate for Payer: Cofinity Commercial |
$28.32
|
| Rate for Payer: Healthscope Commercial |
$29.64
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.99
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$27.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.05
|
| Rate for Payer: Priority Health SBD |
$14.58
|
| Rate for Payer: Priority Health SBD |
$20.75
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$2.34
|
|
|
Service Code
|
NDC 51672-2115-0
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.11 |
| Rate for Payer: Aetna Commercial |
$1.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.52
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: Cofinity Commercial |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$2.01
|
| Rate for Payer: Healthscope Commercial |
$2.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.99
|
| Rate for Payer: PHP Commercial |
$1.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health SBD |
$1.47
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$14.03
|
|
|
Service Code
|
NDC 51672-2115-2
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$12.63 |
| Rate for Payer: Aetna Commercial |
$11.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.12
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cofinity Commercial |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$9.82
|
| Rate for Payer: Healthscope Commercial |
$12.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.93
|
| Rate for Payer: PHP Commercial |
$11.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.82
|
| Rate for Payer: Priority Health SBD |
$8.84
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$18.57
|
|
|
Service Code
|
NDC 45802-732-30
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$16.71 |
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.07
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$13.00
|
| Rate for Payer: Cofinity Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$16.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.78
|
| Rate for Payer: PHP Commercial |
$15.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health SBD |
$11.70
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$5.19
|
|
|
Service Code
|
NDC 0121-1781-05
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial |
$4.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.37
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$3.63
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$4.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.41
|
| Rate for Payer: PHP Commercial |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.63
|
| Rate for Payer: Priority Health SBD |
$3.27
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$4.76
|
|
|
Service Code
|
NDC 68094-015-61
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.81
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.05
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.33
|
| Rate for Payer: Priority Health SBD |
$3.00
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$3.99
|
|
|
Service Code
|
NDC 68094-231-61
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.39
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.79
|
| Rate for Payer: Priority Health SBD |
$2.51
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$3.99
|
|
|
Service Code
|
NDC 68094-231-59
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.39
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.79
|
| Rate for Payer: Priority Health SBD |
$2.51
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$5.19
|
|
|
Service Code
|
NDC 0121-1781-00
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial |
$4.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.37
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Cofinity Commercial |
$3.63
|
| Rate for Payer: Healthscope Commercial |
$4.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.41
|
| Rate for Payer: PHP Commercial |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.63
|
| Rate for Payer: Priority Health SBD |
$3.27
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$87.36
|
|
|
Service Code
|
NDC 51672-2116-4
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$78.62 |
| Rate for Payer: Aetna Commercial |
$74.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.78
|
| Rate for Payer: Cash Price |
$69.89
|
| Rate for Payer: Cofinity Commercial |
$61.15
|
| Rate for Payer: Cofinity Commercial |
$75.13
|
| Rate for Payer: Healthscope Commercial |
$78.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.26
|
| Rate for Payer: PHP Commercial |
$74.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.15
|
| Rate for Payer: Priority Health SBD |
$55.04
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$1.69
|
|
|
Service Code
|
NDC 51672-2116-0
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna Commercial |
$1.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.10
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cofinity Commercial |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.45
|
| Rate for Payer: Healthscope Commercial |
$1.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.44
|
| Rate for Payer: PHP Commercial |
$1.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.18
|
| Rate for Payer: Priority Health SBD |
$1.06
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$10.12
|
|
|
Service Code
|
NDC 51672-2116-2
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$9.11 |
| Rate for Payer: Aetna Commercial |
$8.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.58
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cofinity Commercial |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$8.70
|
| Rate for Payer: Healthscope Commercial |
$9.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.60
|
| Rate for Payer: PHP Commercial |
$8.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.08
|
| Rate for Payer: Priority Health SBD |
$6.38
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
IP
|
$184.00
|
|
|
Service Code
|
NDC 0904-6773-61
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.92 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna Commercial |
$156.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.60
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$158.24
|
| Rate for Payer: Healthscope Commercial |
$165.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.40
|
| Rate for Payer: PHP Commercial |
$156.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
| Rate for Payer: Priority Health SBD |
$115.92
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
IP
|
$132.30
|
|
|
Service Code
|
NDC 49483-340-01
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.35 |
| Max. Negotiated Rate |
$119.07 |
| Rate for Payer: Aetna Commercial |
$112.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.00
|
| Rate for Payer: Cash Price |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$113.78
|
| Rate for Payer: Cofinity Commercial |
$92.61
|
| Rate for Payer: Healthscope Commercial |
$119.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.46
|
| Rate for Payer: PHP Commercial |
$112.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.61
|
| Rate for Payer: Priority Health SBD |
$83.35
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
IP
|
$992.25
|
|
|
Service Code
|
NDC 63739-440-01
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$625.12 |
| Max. Negotiated Rate |
$893.02 |
| Rate for Payer: Aetna Commercial |
$843.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.96
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cofinity Commercial |
$694.58
|
| Rate for Payer: Cofinity Commercial |
$853.34
|
| Rate for Payer: Healthscope Commercial |
$893.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$843.41
|
| Rate for Payer: PHP Commercial |
$843.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$694.58
|
| Rate for Payer: Priority Health SBD |
$625.12
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
OP
|
$992.25
|
|
|
Service Code
|
NDC 63739-440-01
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$396.90 |
| Max. Negotiated Rate |
$893.02 |
| Rate for Payer: Aetna Commercial |
$843.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.96
|
| Rate for Payer: BCBS Complete |
$396.90
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cofinity Commercial |
$694.58
|
| Rate for Payer: Cofinity Commercial |
$853.34
|
| Rate for Payer: Healthscope Commercial |
$893.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$843.41
|
| Rate for Payer: PHP Commercial |
$843.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$694.58
|
| Rate for Payer: Priority Health SBD |
$625.12
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
OP
|
$184.00
|
|
|
Service Code
|
NDC 0904-6773-61
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna Commercial |
$156.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.60
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$158.24
|
| Rate for Payer: Healthscope Commercial |
$165.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.40
|
| Rate for Payer: PHP Commercial |
$156.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
| Rate for Payer: Priority Health SBD |
$115.92
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
IP
|
$113.40
|
|
|
Service Code
|
NDC 69618-010-01
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.44 |
| Max. Negotiated Rate |
$102.06 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.71
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cofinity Commercial |
$79.38
|
| Rate for Payer: Cofinity Commercial |
$97.52
|
| Rate for Payer: Healthscope Commercial |
$102.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.39
|
| Rate for Payer: PHP Commercial |
$96.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.38
|
| Rate for Payer: Priority Health SBD |
$71.44
|
|
