|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$176.55
|
|
|
Service Code
|
NDC 60687054921
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.23 |
| Max. Negotiated Rate |
$158.90 |
| Rate for Payer: Aetna Commercial |
$150.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.76
|
| Rate for Payer: Cash Price |
$141.24
|
| Rate for Payer: Cofinity Advantage |
$123.58
|
| Rate for Payer: Cofinity Commercial |
$151.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.24
|
| Rate for Payer: Healthscope Commercial |
$158.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.41
|
| Rate for Payer: PHP Commercial |
$150.07
|
| Rate for Payer: Priority Health SBD |
$111.23
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$176.55
|
|
|
Service Code
|
NDC 60687054921
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.38 |
| Max. Negotiated Rate |
$158.90 |
| Rate for Payer: Aetna Commercial |
$150.07
|
| Rate for Payer: Aetna Medicare |
$88.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.76
|
| Rate for Payer: BCBS Complete |
$70.62
|
| Rate for Payer: Cash Price |
$141.24
|
| Rate for Payer: Cofinity Advantage |
$123.58
|
| Rate for Payer: Cofinity Commercial |
$151.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.24
|
| Rate for Payer: Healthscope Commercial |
$158.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.41
|
| Rate for Payer: PHP Commercial |
$150.07
|
| Rate for Payer: Priority Health SBD |
$111.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.76
|
| Rate for Payer: UHC Core |
$91.98
|
| Rate for Payer: UHC Exchange |
$69.38
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$5.89
|
|
|
Service Code
|
NDC 60687054911
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Aetna Commercial |
$5.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.83
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cofinity Advantage |
$4.12
|
| Rate for Payer: Cofinity Commercial |
$5.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.71
|
| Rate for Payer: Healthscope Commercial |
$5.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.42
|
| Rate for Payer: PHP Commercial |
$5.01
|
| Rate for Payer: Priority Health SBD |
$3.71
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$381.03
|
|
|
Service Code
|
NDC 45963041806
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.05 |
| Max. Negotiated Rate |
$342.93 |
| Rate for Payer: Aetna Commercial |
$323.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.67
|
| Rate for Payer: Cash Price |
$304.82
|
| Rate for Payer: Cofinity Advantage |
$266.72
|
| Rate for Payer: Cofinity Commercial |
$327.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.82
|
| Rate for Payer: Healthscope Commercial |
$342.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.77
|
| Rate for Payer: PHP Commercial |
$323.88
|
| Rate for Payer: Priority Health SBD |
$240.05
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$1,414.81
|
|
|
Service Code
|
NDC 61958100301
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$891.33 |
| Max. Negotiated Rate |
$1,273.33 |
| Rate for Payer: Aetna Commercial |
$1,202.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.63
|
| Rate for Payer: Cash Price |
$1,131.85
|
| Rate for Payer: Cofinity Advantage |
$990.37
|
| Rate for Payer: Cofinity Commercial |
$1,216.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.85
|
| Rate for Payer: Healthscope Commercial |
$1,273.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,202.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,061.11
|
| Rate for Payer: PHP Commercial |
$1,202.59
|
| Rate for Payer: Priority Health SBD |
$891.33
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$381.03
|
|
|
Service Code
|
NDC 45963041806
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.74 |
| Max. Negotiated Rate |
$342.93 |
| Rate for Payer: Aetna Commercial |
$323.88
|
| Rate for Payer: Aetna Medicare |
$190.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.67
|
| Rate for Payer: BCBS Complete |
$152.41
|
| Rate for Payer: Cash Price |
$304.82
|
| Rate for Payer: Cofinity Advantage |
$266.72
|
| Rate for Payer: Cofinity Commercial |
$327.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.82
|
| Rate for Payer: Healthscope Commercial |
$342.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.77
|
| Rate for Payer: PHP Commercial |
$323.88
|
| Rate for Payer: Priority Health SBD |
$240.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.67
|
| Rate for Payer: UHC Core |
$198.52
|
| Rate for Payer: UHC Exchange |
$149.74
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$5.89
|
|
|
Service Code
|
NDC 60687054911
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Aetna Commercial |
$5.01
|
| Rate for Payer: Aetna Medicare |
$2.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.83
|
| Rate for Payer: BCBS Complete |
$2.36
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cofinity Advantage |
$4.12
|
| Rate for Payer: Cofinity Commercial |
$5.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.71
|
| Rate for Payer: Healthscope Commercial |
$5.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.42
|
| Rate for Payer: PHP Commercial |
$5.01
|
| Rate for Payer: Priority Health SBD |
$3.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.83
|
| Rate for Payer: UHC Core |
$3.07
|
| Rate for Payer: UHC Exchange |
$2.31
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$1,414.81
|
|
|
Service Code
|
NDC 61958100301
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$556.02 |
| Max. Negotiated Rate |
$1,273.33 |
| Rate for Payer: Aetna Commercial |
$1,202.59
|
| Rate for Payer: Aetna Medicare |
$707.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.63
|
| Rate for Payer: BCBS Complete |
$565.92
|
| Rate for Payer: Cash Price |
$1,131.85
|
| Rate for Payer: Cofinity Advantage |
$990.37
|
| Rate for Payer: Cofinity Commercial |
$1,216.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.85
|
| Rate for Payer: Healthscope Commercial |
$1,273.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,131.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,202.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,061.11
|
| Rate for Payer: PHP Commercial |
$1,202.59
|
| Rate for Payer: Priority Health SBD |
$891.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$919.63
|
| Rate for Payer: UHC Core |
$737.12
|
| Rate for Payer: UHC Exchange |
$556.02
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
IP
|
$203.19
|
|
|
Service Code
|
NDC 67877025930
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.01 |
| Max. Negotiated Rate |
$182.87 |
| Rate for Payer: Aetna Commercial |
$172.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.07
|
| Rate for Payer: Cash Price |
$162.55
|
| Rate for Payer: Cofinity Advantage |
$142.23
|
| Rate for Payer: Cofinity Commercial |
$174.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.55
|
| Rate for Payer: Healthscope Commercial |
$182.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.39
|
| Rate for Payer: PHP Commercial |
$172.71
|
| Rate for Payer: Priority Health SBD |
$128.01
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
OP
|
$203.19
|
|
|
Service Code
|
NDC 67877025930
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.85 |
| Max. Negotiated Rate |
$182.87 |
| Rate for Payer: Aetna Commercial |
$172.71
|
| Rate for Payer: Aetna Medicare |
$101.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.07
|
| Rate for Payer: BCBS Complete |
$81.28
|
| Rate for Payer: Cash Price |
$162.55
|
| Rate for Payer: Cofinity Advantage |
$142.23
|
| Rate for Payer: Cofinity Commercial |
$174.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.55
|
| Rate for Payer: Healthscope Commercial |
$182.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.39
|
| Rate for Payer: PHP Commercial |
$172.71
|
| Rate for Payer: Priority Health SBD |
$128.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.07
|
| Rate for Payer: UHC Core |
$105.86
|
| Rate for Payer: UHC Exchange |
$79.85
|
|
|
RASAGILINE 1 MG TABLET
|
Facility
|
IP
|
$4,709.73
|
|
|
Service Code
|
NDC 68546022956
|
| Hospital Charge Code |
76481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,967.13 |
| Max. Negotiated Rate |
$4,238.76 |
| Rate for Payer: Aetna Commercial |
$4,003.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,061.32
|
| Rate for Payer: Cash Price |
$3,767.78
|
| Rate for Payer: Cofinity Advantage |
$3,296.81
|
| Rate for Payer: Cofinity Commercial |
$4,050.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,767.78
|
| Rate for Payer: Healthscope Commercial |
$4,238.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,003.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,532.30
|
| Rate for Payer: PHP Commercial |
$4,003.27
|
| Rate for Payer: Priority Health SBD |
$2,967.13
|
|
|
RASAGILINE 1 MG TABLET
|
Facility
|
OP
|
$4,709.73
|
|
|
Service Code
|
NDC 68546022956
|
| Hospital Charge Code |
76481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,850.92 |
| Max. Negotiated Rate |
$4,238.76 |
| Rate for Payer: Aetna Commercial |
$4,003.27
|
| Rate for Payer: Aetna Medicare |
$2,354.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,061.32
|
| Rate for Payer: BCBS Complete |
$1,883.89
|
| Rate for Payer: Cash Price |
$3,767.78
|
| Rate for Payer: Cofinity Advantage |
$3,296.81
|
| Rate for Payer: Cofinity Commercial |
$4,050.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,767.78
|
| Rate for Payer: Healthscope Commercial |
$4,238.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,767.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,003.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,532.30
|
| Rate for Payer: PHP Commercial |
$4,003.27
|
| Rate for Payer: Priority Health SBD |
$2,967.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,061.32
|
| Rate for Payer: UHC Core |
$2,453.77
|
| Rate for Payer: UHC Exchange |
$1,850.92
|
|
|
RASAGILINE 1 MG TABLET
|
Facility
|
IP
|
$709.63
|
|
|
Service Code
|
NDC 00093306156
|
| Hospital Charge Code |
76481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$638.67 |
| Rate for Payer: Aetna Commercial |
$603.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.26
|
| Rate for Payer: Cash Price |
$567.70
|
| Rate for Payer: Cofinity Advantage |
$496.74
|
| Rate for Payer: Cofinity Commercial |
$610.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.70
|
| Rate for Payer: Healthscope Commercial |
$638.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.22
|
| Rate for Payer: PHP Commercial |
$603.19
|
| Rate for Payer: Priority Health SBD |
$447.07
|
|
|
RASAGILINE 1 MG TABLET
|
Facility
|
OP
|
$709.63
|
|
|
Service Code
|
NDC 00093306156
|
| Hospital Charge Code |
76481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.88 |
| Max. Negotiated Rate |
$638.67 |
| Rate for Payer: Aetna Commercial |
$603.19
|
| Rate for Payer: Aetna Medicare |
$354.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.26
|
| Rate for Payer: BCBS Complete |
$283.85
|
| Rate for Payer: Cash Price |
$567.70
|
| Rate for Payer: Cofinity Advantage |
$496.74
|
| Rate for Payer: Cofinity Commercial |
$610.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.70
|
| Rate for Payer: Healthscope Commercial |
$638.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$567.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.22
|
| Rate for Payer: PHP Commercial |
$603.19
|
| Rate for Payer: Priority Health SBD |
$447.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.26
|
| Rate for Payer: UHC Core |
$369.72
|
| Rate for Payer: UHC Exchange |
$278.88
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,577.81
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
33591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$199.89 |
| Max. Negotiated Rate |
$3,220.03 |
| Rate for Payer: Aetna Commercial |
$3,041.14
|
| Rate for Payer: Aetna Medicare |
$397.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,325.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$477.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$477.74
|
| Rate for Payer: BCBS Complete |
$209.90
|
| Rate for Payer: BCBS MAPPO |
$382.19
|
| Rate for Payer: BCBS Trust/PPO |
$961.81
|
| Rate for Payer: BCN Commercial |
$961.81
|
| Rate for Payer: BCN Medicare Advantage |
$382.19
|
| Rate for Payer: Cash Price |
$2,862.25
|
| Rate for Payer: Cash Price |
$2,862.25
|
| Rate for Payer: Cofinity Advantage |
$2,504.47
|
| Rate for Payer: Cofinity Commercial |
$3,076.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,862.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$382.19
|
| Rate for Payer: Healthscope Commercial |
$3,220.03
|
| Rate for Payer: Mclaren Medicaid |
$199.89
|
| Rate for Payer: Mclaren Medicare |
$382.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$401.30
|
| Rate for Payer: Meridian Medicaid |
$401.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$439.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$420.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,041.14
|
| Rate for Payer: Nomi Health Commercial |
$1,146.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,683.36
|
| Rate for Payer: PACE Medicare |
$363.08
|
| Rate for Payer: PACE SWMI |
$382.19
|
| Rate for Payer: PHP Commercial |
$3,041.14
|
| Rate for Payer: PHP Medicare Advantage |
$382.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,190.68
|
| Rate for Payer: Priority Health Medicare |
$382.19
|
| Rate for Payer: Priority Health SBD |
$2,254.02
|
| Rate for Payer: Priority Health Tiered Network |
$952.54
|
| Rate for Payer: Railroad Medicare Medicare |
$382.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$632.56
|
| Rate for Payer: UHC Core |
$632.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$382.19
|
| Rate for Payer: UHC Exchange |
$632.56
|
| Rate for Payer: UHC Medicaid |
$199.89
|
| Rate for Payer: UHCCP Medicaid |
$199.89
|
| Rate for Payer: VA VA |
$382.19
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,577.81
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
33591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,254.02 |
| Max. Negotiated Rate |
$3,220.03 |
| Rate for Payer: Aetna Commercial |
$3,041.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,325.58
|
| Rate for Payer: Cash Price |
$2,862.25
|
| Rate for Payer: Cofinity Advantage |
$2,504.47
|
| Rate for Payer: Cofinity Commercial |
$3,076.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,862.25
|
| Rate for Payer: Healthscope Commercial |
$3,220.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,041.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,683.36
|
| Rate for Payer: PHP Commercial |
$3,041.14
|
| Rate for Payer: Priority Health SBD |
$2,254.02
|
|
|
RASBURICASE 7.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,534.81
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
76868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$199.89 |
| Max. Negotiated Rate |
$13,081.33 |
| Rate for Payer: Aetna Commercial |
$12,354.59
|
| Rate for Payer: Aetna Medicare |
$397.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,447.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$477.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$477.74
|
| Rate for Payer: BCBS Complete |
$209.90
|
| Rate for Payer: BCBS MAPPO |
$382.19
|
| Rate for Payer: BCBS Trust/PPO |
$961.81
|
| Rate for Payer: BCN Commercial |
$961.81
|
| Rate for Payer: BCN Medicare Advantage |
$382.19
|
| Rate for Payer: Cash Price |
$11,627.85
|
| Rate for Payer: Cash Price |
$11,627.85
|
| Rate for Payer: Cofinity Advantage |
$10,174.37
|
| Rate for Payer: Cofinity Commercial |
$12,499.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,627.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$382.19
|
| Rate for Payer: Healthscope Commercial |
$13,081.33
|
| Rate for Payer: Mclaren Medicaid |
$199.89
|
| Rate for Payer: Mclaren Medicare |
$382.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$401.30
|
| Rate for Payer: Meridian Medicaid |
$401.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$439.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$420.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,354.59
|
| Rate for Payer: Nomi Health Commercial |
$1,146.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,901.11
|
| Rate for Payer: PACE Medicare |
$363.08
|
| Rate for Payer: PACE SWMI |
$382.19
|
| Rate for Payer: PHP Commercial |
$12,354.59
|
| Rate for Payer: PHP Medicare Advantage |
$382.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,190.68
|
| Rate for Payer: Priority Health Medicare |
$382.19
|
| Rate for Payer: Priority Health SBD |
$9,156.93
|
| Rate for Payer: Priority Health Tiered Network |
$952.54
|
| Rate for Payer: Railroad Medicare Medicare |
$382.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$632.56
|
| Rate for Payer: UHC Core |
$632.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$382.19
|
| Rate for Payer: UHC Exchange |
$632.56
|
| Rate for Payer: UHC Medicaid |
$199.89
|
| Rate for Payer: UHCCP Medicaid |
$199.89
|
| Rate for Payer: VA VA |
$382.19
|
|
|
RASBURICASE 7.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,534.81
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
76868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,156.93 |
| Max. Negotiated Rate |
$13,081.33 |
| Rate for Payer: Aetna Commercial |
$12,354.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,447.63
|
| Rate for Payer: Cash Price |
$11,627.85
|
| Rate for Payer: Cofinity Advantage |
$10,174.37
|
| Rate for Payer: Cofinity Commercial |
$12,499.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,627.85
|
| Rate for Payer: Healthscope Commercial |
$13,081.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,354.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,901.11
|
| Rate for Payer: PHP Commercial |
$12,354.59
|
| Rate for Payer: Priority Health SBD |
$9,156.93
|
|
|
RECTAL RESECTION WITH CC
|
Facility
|
IP
|
$44,868.45
|
|
|
Service Code
|
MSDRG 333
|
| Min. Negotiated Rate |
$17,746.06 |
| Max. Negotiated Rate |
$44,868.45 |
| Rate for Payer: Aetna Medicare |
$19,427.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,350.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,350.08
|
| Rate for Payer: BCBS MAPPO |
$18,680.06
|
| Rate for Payer: BCBS Trust/PPO |
$44,868.45
|
| Rate for Payer: BCN Commercial |
$44,868.45
|
| Rate for Payer: BCN Medicare Advantage |
$18,680.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,680.06
|
| Rate for Payer: Mclaren Medicare |
$18,680.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,614.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,482.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,548.07
|
| Rate for Payer: Nomi Health Commercial |
$30,214.38
|
| Rate for Payer: PACE Medicare |
$17,746.06
|
| Rate for Payer: PACE SWMI |
$18,680.06
|
| Rate for Payer: PHP Medicare Advantage |
$18,680.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,761.28
|
| Rate for Payer: Priority Health Medicare |
$18,680.06
|
| Rate for Payer: Priority Health Tiered Network |
$30,209.02
|
| Rate for Payer: Railroad Medicare Medicare |
$18,680.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38,177.86
|
| Rate for Payer: UHC Core |
$31,940.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,680.06
|
| Rate for Payer: UHC Exchange |
$26,085.08
|
| Rate for Payer: VA VA |
$18,680.06
|
|
|
RECTAL RESECTION WITH MCC
|
Facility
|
IP
|
$59,017.41
|
|
|
Service Code
|
MSDRG 332
|
| Min. Negotiated Rate |
$27,132.58 |
| Max. Negotiated Rate |
$59,017.41 |
| Rate for Payer: Aetna Medicare |
$29,703.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,700.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,700.76
|
| Rate for Payer: BCBS MAPPO |
$28,560.61
|
| Rate for Payer: BCBS Trust/PPO |
$57,604.75
|
| Rate for Payer: BCN Commercial |
$57,604.75
|
| Rate for Payer: BCN Medicare Advantage |
$28,560.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,560.61
|
| Rate for Payer: Mclaren Medicare |
$28,560.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,988.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,844.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$31,416.67
|
| Rate for Payer: Nomi Health Commercial |
$46,707.03
|
| Rate for Payer: PACE Medicare |
$27,132.58
|
| Rate for Payer: PACE SWMI |
$28,560.61
|
| Rate for Payer: PHP Medicare Advantage |
$28,560.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$58,373.43
|
| Rate for Payer: Priority Health Medicare |
$28,560.61
|
| Rate for Payer: Priority Health Tiered Network |
$46,698.74
|
| Rate for Payer: Railroad Medicare Medicare |
$28,560.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59,017.41
|
| Rate for Payer: UHC Core |
$49,375.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28,560.61
|
| Rate for Payer: UHC Exchange |
$40,323.74
|
| Rate for Payer: VA VA |
$28,560.61
|
|
|
RECTAL RESECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$35,177.54
|
|
|
Service Code
|
MSDRG 334
|
| Min. Negotiated Rate |
$12,575.21 |
| Max. Negotiated Rate |
$35,177.54 |
| Rate for Payer: Aetna Medicare |
$13,766.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,546.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,546.33
|
| Rate for Payer: BCBS MAPPO |
$13,237.06
|
| Rate for Payer: BCBS Trust/PPO |
$35,177.54
|
| Rate for Payer: BCN Commercial |
$35,177.54
|
| Rate for Payer: BCN Medicare Advantage |
$13,237.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,237.06
|
| Rate for Payer: Mclaren Medicare |
$13,237.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,898.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,222.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,560.77
|
| Rate for Payer: Nomi Health Commercial |
$21,128.91
|
| Rate for Payer: PACE Medicare |
$12,575.21
|
| Rate for Payer: PACE SWMI |
$13,237.06
|
| Rate for Payer: PHP Medicare Advantage |
$13,237.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,406.45
|
| Rate for Payer: Priority Health Medicare |
$13,237.06
|
| Rate for Payer: Priority Health Tiered Network |
$21,125.16
|
| Rate for Payer: Railroad Medicare Medicare |
$13,237.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,697.77
|
| Rate for Payer: UHC Core |
$22,336.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,237.06
|
| Rate for Payer: UHC Exchange |
$18,241.29
|
| Rate for Payer: VA VA |
$13,237.06
|
|
|
RED BLOOD CELL DISORDERS WITH MCC
|
Facility
|
IP
|
$23,473.54
|
|
|
Service Code
|
MSDRG 811
|
| Min. Negotiated Rate |
$10,860.15 |
| Max. Negotiated Rate |
$23,473.54 |
| Rate for Payer: Aetna Medicare |
$11,889.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,289.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,289.67
|
| Rate for Payer: BCBS MAPPO |
$11,431.74
|
| Rate for Payer: BCBS Trust/PPO |
$23,473.54
|
| Rate for Payer: BCN Commercial |
$23,473.54
|
| Rate for Payer: BCN Medicare Advantage |
$11,431.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,431.74
|
| Rate for Payer: Mclaren Medicare |
$11,431.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,003.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,146.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,574.91
|
| Rate for Payer: Nomi Health Commercial |
$18,115.47
|
| Rate for Payer: PACE Medicare |
$10,860.15
|
| Rate for Payer: PACE SWMI |
$11,431.74
|
| Rate for Payer: PHP Medicare Advantage |
$11,431.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,640.32
|
| Rate for Payer: Priority Health Medicare |
$11,431.74
|
| Rate for Payer: Priority Health Tiered Network |
$18,112.25
|
| Rate for Payer: Railroad Medicare Medicare |
$11,431.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,890.09
|
| Rate for Payer: UHC Core |
$19,150.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,431.74
|
| Rate for Payer: UHC Exchange |
$15,639.69
|
| Rate for Payer: VA VA |
$11,431.74
|
|
|
RED BLOOD CELL DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$16,167.91
|
|
|
Service Code
|
MSDRG 812
|
| Min. Negotiated Rate |
$7,291.30 |
| Max. Negotiated Rate |
$16,167.91 |
| Rate for Payer: Aetna Medicare |
$7,982.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,593.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,593.81
|
| Rate for Payer: BCBS MAPPO |
$7,675.05
|
| Rate for Payer: BCBS Trust/PPO |
$16,167.91
|
| Rate for Payer: BCN Commercial |
$16,167.91
|
| Rate for Payer: BCN Medicare Advantage |
$7,675.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,675.05
|
| Rate for Payer: Mclaren Medicare |
$7,675.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,058.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,826.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,442.56
|
| Rate for Payer: Nomi Health Commercial |
$11,844.78
|
| Rate for Payer: PACE Medicare |
$7,291.30
|
| Rate for Payer: PACE SWMI |
$7,675.05
|
| Rate for Payer: PHP Medicare Advantage |
$7,675.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,803.35
|
| Rate for Payer: Priority Health Medicare |
$7,675.05
|
| Rate for Payer: Priority Health Tiered Network |
$11,842.68
|
| Rate for Payer: Railroad Medicare Medicare |
$7,675.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,966.66
|
| Rate for Payer: UHC Core |
$12,521.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,675.05
|
| Rate for Payer: UHC Exchange |
$10,225.99
|
| Rate for Payer: VA VA |
$7,675.05
|
|
|
REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUT FIXATION OF CONTRALATERAL TESTIS
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 54600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,836.94 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,656.45
|
| Rate for Payer: BCN Commercial |
$2,656.45
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$1,836.94
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$851.01
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$765.91 |
| Rate for Payer: Aetna Commercial |
$723.36
|
| Rate for Payer: Aetna Commercial |
$31.09
|
| Rate for Payer: Aetna Commercial |
$30.72
|
| Rate for Payer: Aetna Commercial |
$45.74
|
| Rate for Payer: Aetna Commercial |
$112.76
|
| Rate for Payer: Aetna Medicare |
$66.33
|
| Rate for Payer: Aetna Medicare |
$18.07
|
| Rate for Payer: Aetna Medicare |
$18.29
|
| Rate for Payer: Aetna Medicare |
$425.50
|
| Rate for Payer: Aetna Medicare |
$26.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.23
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS Complete |
$14.46
|
| Rate for Payer: BCBS Complete |
$14.63
|
| Rate for Payer: BCBS Complete |
$53.06
|
| Rate for Payer: BCBS Complete |
$21.52
|
| Rate for Payer: BCBS Trust/PPO |
$6.70
|
| Rate for Payer: BCBS Trust/PPO |
$6.70
|
| Rate for Payer: BCBS Trust/PPO |
$6.70
|
| Rate for Payer: BCBS Trust/PPO |
$6.70
|
| Rate for Payer: BCBS Trust/PPO |
$6.70
|
| Rate for Payer: BCN Commercial |
$6.70
|
| Rate for Payer: BCN Commercial |
$6.70
|
| Rate for Payer: BCN Commercial |
$6.70
|
| Rate for Payer: BCN Commercial |
$6.70
|
| Rate for Payer: BCN Commercial |
$6.70
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cash Price |
$28.91
|
| Rate for Payer: Cash Price |
$106.13
|
| Rate for Payer: Cash Price |
$106.13
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cash Price |
$28.91
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cash Price |
$680.81
|
| Rate for Payer: Cash Price |
$680.81
|
| Rate for Payer: Cofinity Advantage |
$595.71
|
| Rate for Payer: Cofinity Advantage |
$37.67
|
| Rate for Payer: Cofinity Advantage |
$25.30
|
| Rate for Payer: Cofinity Advantage |
$92.86
|
| Rate for Payer: Cofinity Advantage |
$25.61
|
| Rate for Payer: Cofinity Commercial |
$31.46
|
| Rate for Payer: Cofinity Commercial |
$31.08
|
| Rate for Payer: Cofinity Commercial |
$46.28
|
| Rate for Payer: Cofinity Commercial |
$731.87
|
| Rate for Payer: Cofinity Commercial |
$114.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.91
|
| Rate for Payer: Healthscope Commercial |
$32.53
|
| Rate for Payer: Healthscope Commercial |
$765.91
|
| Rate for Payer: Healthscope Commercial |
$48.43
|
| Rate for Payer: Healthscope Commercial |
$32.92
|
| Rate for Payer: Healthscope Commercial |
$119.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$680.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$638.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.36
|
| Rate for Payer: PHP Commercial |
$31.09
|
| Rate for Payer: PHP Commercial |
$30.72
|
| Rate for Payer: PHP Commercial |
$112.76
|
| Rate for Payer: PHP Commercial |
$723.36
|
| Rate for Payer: PHP Commercial |
$45.74
|
| Rate for Payer: Priority Health SBD |
$23.05
|
| Rate for Payer: Priority Health SBD |
$33.90
|
| Rate for Payer: Priority Health SBD |
$536.14
|
| Rate for Payer: Priority Health SBD |
$22.77
|
| Rate for Payer: Priority Health SBD |
$83.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
|
