|
1-STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH URETHROPLASTY BY LOCAL SKIN FLAPS AND MOBILIZATION OF URETHRA
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 54326
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$996.24 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.87
|
| Rate for Payer: BCN Commercial |
$1,814.87
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$996.24
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,902.51
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$4,722.66
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
70287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,975.28 |
| Max. Negotiated Rate |
$4,250.39 |
| Rate for Payer: Aetna Commercial |
$4,014.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,069.73
|
| Rate for Payer: Cash Price |
$3,778.13
|
| Rate for Payer: Cofinity Commercial |
$3,305.86
|
| Rate for Payer: Cofinity Commercial |
$4,061.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,305.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,778.13
|
| Rate for Payer: Healthscope Commercial |
$4,250.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,014.26
|
| Rate for Payer: PHP Commercial |
$4,014.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,069.73
|
| Rate for Payer: Priority Health SBD |
$2,975.28
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$4,722.66
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
70287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$4,250.39 |
| Rate for Payer: Aetna Commercial |
$4,014.26
|
| Rate for Payer: Aetna Medicare |
$45.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,069.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.75
|
| Rate for Payer: BCBS Complete |
$24.65
|
| Rate for Payer: BCBS MAPPO |
$43.80
|
| Rate for Payer: BCBS Trust/PPO |
$153.26
|
| Rate for Payer: BCN Commercial |
$153.26
|
| Rate for Payer: BCN Medicare Advantage |
$43.80
|
| Rate for Payer: Cash Price |
$3,778.13
|
| Rate for Payer: Cash Price |
$3,778.13
|
| Rate for Payer: Cofinity Commercial |
$4,061.49
|
| Rate for Payer: Cofinity Commercial |
$3,305.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,305.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,778.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.80
|
| Rate for Payer: Healthscope Commercial |
$4,250.39
|
| Rate for Payer: Mclaren Medicaid |
$23.48
|
| Rate for Payer: Mclaren Medicare |
$43.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.99
|
| Rate for Payer: Meridian Medicaid |
$24.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,014.26
|
| Rate for Payer: Nomi Health Commercial |
$131.40
|
| Rate for Payer: PACE Medicare |
$41.61
|
| Rate for Payer: PACE SWMI |
$43.80
|
| Rate for Payer: PHP Commercial |
$4,014.26
|
| Rate for Payer: PHP Medicare Advantage |
$43.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,069.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.00
|
| Rate for Payer: Priority Health Medicare |
$43.80
|
| Rate for Payer: Priority Health Narrow Network |
$100.00
|
| Rate for Payer: Priority Health SBD |
$2,975.28
|
| Rate for Payer: Railroad Medicare Medicare |
$43.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.80
|
| Rate for Payer: UHC Medicare Advantage |
$43.80
|
| Rate for Payer: UHCCP Medicaid |
$24.66
|
| Rate for Payer: VA VA |
$43.80
|
|
|
ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITHOUT IMAGING GUIDANCE
|
Facility
|
OP
|
$3,362.00
|
|
|
Service Code
|
CPT 49082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.30 |
| Max. Negotiated Rate |
$3,362.00 |
| Rate for Payer: Aetna Medicare |
$955.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$445.14
|
| Rate for Payer: BCN Commercial |
$445.14
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.60
|
| Rate for Payer: Mclaren Medicaid |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Nomi Health Commercial |
$1,929.06
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,887.15
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$2,309.72
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.30
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$517.17
|
| Rate for Payer: VA VA |
$918.60
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); INTRAMURAL (IE, SUBMUCOSAL)
|
Facility
|
OP
|
$4,561.52
|
|
|
Service Code
|
CPT 30802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$210.31 |
| Max. Negotiated Rate |
$4,561.52 |
| Rate for Payer: Aetna Medicare |
$1,509.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,814.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,814.16
|
| Rate for Payer: BCBS Complete |
$816.81
|
| Rate for Payer: BCBS MAPPO |
$1,451.33
|
| Rate for Payer: BCBS Trust/PPO |
$668.88
|
| Rate for Payer: BCN Commercial |
$668.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.33
|
| Rate for Payer: Mclaren Medicaid |
$777.91
|
| Rate for Payer: Mclaren Medicare |
$1,451.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,523.90
|
| Rate for Payer: Meridian Medicaid |
$816.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,669.03
|
| Rate for Payer: Nomi Health Commercial |
$3,047.79
|
| Rate for Payer: PACE Medicare |
$1,378.76
|
| Rate for Payer: PACE SWMI |
$1,451.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$777.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,561.52
|
| Rate for Payer: Priority Health Medicare |
$1,451.33
|
| Rate for Payer: Priority Health Narrow Network |
$3,649.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,451.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.31
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.33
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,451.33
|
| Rate for Payer: UHCCP Medicaid |
$817.10
|
| Rate for Payer: VA VA |
$1,451.33
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); SUPERFICIAL
|
Facility
|
OP
|
$4,561.52
|
|
|
Service Code
|
CPT 30801
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$156.20 |
| Max. Negotiated Rate |
$4,561.52 |
| Rate for Payer: Aetna Medicare |
$1,509.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,814.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,814.16
|
| Rate for Payer: BCBS Complete |
$816.81
|
| Rate for Payer: BCBS MAPPO |
$1,451.33
|
| Rate for Payer: BCBS Trust/PPO |
$501.66
|
| Rate for Payer: BCN Commercial |
$501.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.33
|
| Rate for Payer: Mclaren Medicaid |
$777.91
|
| Rate for Payer: Mclaren Medicare |
$1,451.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,523.90
|
| Rate for Payer: Meridian Medicaid |
$816.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,669.03
|
| Rate for Payer: Nomi Health Commercial |
$3,047.79
|
| Rate for Payer: PACE Medicare |
$1,378.76
|
| Rate for Payer: PACE SWMI |
$1,451.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$777.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,561.52
|
| Rate for Payer: Priority Health Medicare |
$1,451.33
|
| Rate for Payer: Priority Health Narrow Network |
$3,649.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,451.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.20
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.33
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,451.33
|
| Rate for Payer: UHCCP Medicaid |
$817.10
|
| Rate for Payer: VA VA |
$1,451.33
|
|
|
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) |
$15.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.40
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$23.05
|
| Rate for Payer: Cofinity Commercial |
$28.32
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.34
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Healthscope Commercial |
$29.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.99
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$27.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health SBD |
$20.75
|
| Rate for Payer: Priority Health SBD |
$14.58
|
|
|
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 |
$0.11 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: Aetna Medicare |
$16.46
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.40
|
| Rate for Payer: BCBS Complete |
$13.17
|
| Rate for Payer: BCBS Complete |
$9.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$28.32
|
| Rate for Payer: Cofinity Commercial |
$23.05
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.34
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Healthscope Commercial |
$29.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$27.99
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.40
|
| Rate for Payer: Priority Health SBD |
$20.75
|
| 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 Commercial |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.44
|
| 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: PHP Commercial |
$21.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.20
|
| Rate for Payer: Priority Health SBD |
$15.70
|
|
|
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 |
$0.11 |
| 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 |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.44
|
| 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: PHP Commercial |
$21.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.20
|
| Rate for Payer: Priority Health SBD |
$15.70
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 51672211500
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health SBD |
$1.97
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$18.70
|
|
|
Service Code
|
NDC 51672211502
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.78 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Aetna Commercial |
$15.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.16
|
| Rate for Payer: Cash Price |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$13.09
|
| Rate for Payer: Cofinity Commercial |
$16.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.96
|
| Rate for Payer: Healthscope Commercial |
$16.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.90
|
| Rate for Payer: PHP Commercial |
$15.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.16
|
| Rate for Payer: Priority Health SBD |
$11.78
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$18.99
|
|
|
Service Code
|
NDC 45802073230
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$17.09 |
| Rate for Payer: Aetna Commercial |
$16.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.34
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Cofinity Commercial |
$16.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$17.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.14
|
| Rate for Payer: PHP Commercial |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.34
|
| Rate for Payer: Priority Health SBD |
$11.96
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$18.70
|
|
|
Service Code
|
NDC 51672211502
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Aetna Commercial |
$15.90
|
| Rate for Payer: Aetna Medicare |
$9.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.16
|
| Rate for Payer: BCBS Complete |
$7.48
|
| Rate for Payer: Cash Price |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$13.09
|
| Rate for Payer: Cofinity Commercial |
$16.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.96
|
| Rate for Payer: Healthscope Commercial |
$16.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.90
|
| Rate for Payer: PHP Commercial |
$15.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.16
|
| Rate for Payer: Priority Health SBD |
$11.78
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$18.99
|
|
|
Service Code
|
NDC 45802073230
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$17.09 |
| Rate for Payer: Aetna Commercial |
$16.14
|
| Rate for Payer: Aetna Medicare |
$9.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.34
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Cofinity Commercial |
$16.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$17.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.14
|
| Rate for Payer: PHP Commercial |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.34
|
| Rate for Payer: Priority Health SBD |
$11.96
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 51672211500
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: Aetna Medicare |
$1.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health SBD |
$1.97
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$16.69
|
|
|
Service Code
|
NDC 39328003105
|
| Hospital Charge Code |
119321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna Commercial |
$14.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.85
|
| Rate for Payer: Cash Price |
$13.35
|
| Rate for Payer: Cofinity Commercial |
$11.68
|
| Rate for Payer: Cofinity Commercial |
$14.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.35
|
| Rate for Payer: Healthscope Commercial |
$15.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.19
|
| Rate for Payer: PHP Commercial |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.85
|
| Rate for Payer: Priority Health SBD |
$10.51
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$16.69
|
|
|
Service Code
|
NDC 39328003150
|
| Hospital Charge Code |
119321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna Commercial |
$14.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.85
|
| Rate for Payer: Cash Price |
$13.35
|
| Rate for Payer: Cofinity Commercial |
$11.68
|
| Rate for Payer: Cofinity Commercial |
$14.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.35
|
| Rate for Payer: Healthscope Commercial |
$15.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.19
|
| Rate for Payer: PHP Commercial |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.85
|
| Rate for Payer: Priority Health SBD |
$10.51
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$16.69
|
|
|
Service Code
|
NDC 39328003105
|
| Hospital Charge Code |
119321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna Commercial |
$14.19
|
| Rate for Payer: Aetna Medicare |
$8.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.85
|
| Rate for Payer: BCBS Complete |
$6.68
|
| Rate for Payer: Cash Price |
$13.35
|
| Rate for Payer: Cofinity Commercial |
$11.68
|
| Rate for Payer: Cofinity Commercial |
$14.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.35
|
| Rate for Payer: Healthscope Commercial |
$15.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.19
|
| Rate for Payer: PHP Commercial |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.85
|
| Rate for Payer: Priority Health SBD |
$10.51
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$16.69
|
|
|
Service Code
|
NDC 39328003150
|
| Hospital Charge Code |
119321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna Commercial |
$14.19
|
| Rate for Payer: Aetna Medicare |
$8.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.85
|
| Rate for Payer: BCBS Complete |
$6.68
|
| Rate for Payer: Cash Price |
$13.35
|
| Rate for Payer: Cofinity Commercial |
$11.68
|
| Rate for Payer: Cofinity Commercial |
$14.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.35
|
| Rate for Payer: Healthscope Commercial |
$15.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.19
|
| Rate for Payer: PHP Commercial |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.85
|
| Rate for Payer: Priority Health SBD |
$10.51
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.95
|
|
|
Service Code
|
NDC 00121178105
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: Aetna Medicare |
$2.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.22
|
| Rate for Payer: BCBS Complete |
$1.98
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cofinity Commercial |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$4.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.96
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.21
|
| Rate for Payer: PHP Commercial |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.22
|
| Rate for Payer: Priority Health SBD |
$3.12
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.76
|
|
|
Service Code
|
NDC 68094001561
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.81
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.81
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.05
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$3.00
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 68094023159
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.81
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.67
|
| Rate for Payer: PHP Commercial |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health SBD |
$2.72
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.95
|
|
|
Service Code
|
NDC 00121178105
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.22
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cofinity Commercial |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$4.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.96
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.21
|
| Rate for Payer: PHP Commercial |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.22
|
| Rate for Payer: Priority Health SBD |
$3.12
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
NDC 68094001561
|
| 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: Cofinity Medicare Advantage |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.81
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.05
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$3.00
|
|
