|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$3,411.71
|
|
|
Service Code
|
APR-DRG 2801
|
| Min. Negotiated Rate |
$3,249.25 |
| Max. Negotiated Rate |
$3,411.71 |
| Rate for Payer: BCBS Complete |
$3,411.71
|
| Rate for Payer: Mclaren Medicaid |
$3,249.25
|
| Rate for Payer: Meridian Medicaid |
$3,411.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,249.25
|
| Rate for Payer: UHC Medicaid |
$3,249.25
|
| Rate for Payer: UHCCP Medicaid |
$3,249.25
|
|
|
ALDESLEUKIN 22 MILLION UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24,926.11
|
|
|
Service Code
|
HCPCS J9015
|
| Hospital Charge Code |
8993
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,746.23 |
| Max. Negotiated Rate |
$22,433.50 |
| Rate for Payer: Aetna Commercial |
$21,187.19
|
| Rate for Payer: Aetna Medicare |
$3,472.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,201.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,173.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,173.59
|
| Rate for Payer: BCBS Complete |
$1,833.71
|
| Rate for Payer: BCBS MAPPO |
$3,338.87
|
| Rate for Payer: BCBS Trust/PPO |
$14,767.53
|
| Rate for Payer: BCN Commercial |
$14,767.53
|
| Rate for Payer: BCN Medicare Advantage |
$3,338.87
|
| Rate for Payer: Cash Price |
$19,940.89
|
| Rate for Payer: Cash Price |
$19,940.89
|
| Rate for Payer: Cofinity Advantage |
$17,448.28
|
| Rate for Payer: Cofinity Commercial |
$21,436.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,940.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,338.87
|
| Rate for Payer: Healthscope Commercial |
$22,433.50
|
| Rate for Payer: Mclaren Medicaid |
$1,746.23
|
| Rate for Payer: Mclaren Medicare |
$3,338.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,505.81
|
| Rate for Payer: Meridian Medicaid |
$3,505.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,839.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,672.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,187.19
|
| Rate for Payer: Nomi Health Commercial |
$10,016.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,694.58
|
| Rate for Payer: PACE Medicare |
$3,171.93
|
| Rate for Payer: PACE SWMI |
$3,338.87
|
| Rate for Payer: PHP Commercial |
$21,187.19
|
| Rate for Payer: PHP Medicare Advantage |
$3,338.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,746.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,530.69
|
| Rate for Payer: Priority Health Medicare |
$3,338.87
|
| Rate for Payer: Priority Health SBD |
$15,703.45
|
| Rate for Payer: Priority Health Tiered Network |
$8,424.55
|
| Rate for Payer: Railroad Medicare Medicare |
$3,338.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,201.97
|
| Rate for Payer: UHC Core |
$12,986.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,338.87
|
| Rate for Payer: UHC Exchange |
$9,795.96
|
| Rate for Payer: UHC Medicaid |
$1,746.23
|
| Rate for Payer: UHCCP Medicaid |
$1,746.23
|
| Rate for Payer: VA VA |
$3,338.87
|
|
|
ALDESLEUKIN 22 MILLION UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24,926.11
|
|
|
Service Code
|
HCPCS J9015
|
| Hospital Charge Code |
8993
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15,703.45 |
| Max. Negotiated Rate |
$22,433.50 |
| Rate for Payer: Aetna Commercial |
$21,187.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,201.97
|
| Rate for Payer: Cash Price |
$19,940.89
|
| Rate for Payer: Cofinity Advantage |
$17,448.28
|
| Rate for Payer: Cofinity Commercial |
$21,436.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,940.89
|
| Rate for Payer: Healthscope Commercial |
$22,433.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,187.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,694.58
|
| Rate for Payer: PHP Commercial |
$21,187.19
|
| Rate for Payer: Priority Health SBD |
$15,703.45
|
|
|
ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$241.11
|
|
|
Service Code
|
NDC 57237011490
|
| Hospital Charge Code |
36982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.76 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna Commercial |
$204.94
|
| Rate for Payer: Aetna Medicare |
$120.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.72
|
| Rate for Payer: BCBS Complete |
$96.44
|
| Rate for Payer: Cash Price |
$192.89
|
| Rate for Payer: Cofinity Advantage |
$168.78
|
| Rate for Payer: Cofinity Commercial |
$207.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.89
|
| Rate for Payer: Healthscope Commercial |
$217.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.83
|
| Rate for Payer: PHP Commercial |
$204.94
|
| Rate for Payer: Priority Health SBD |
$151.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.72
|
| Rate for Payer: UHC Core |
$125.62
|
| Rate for Payer: UHC Exchange |
$94.76
|
|
|
ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$241.11
|
|
|
Service Code
|
NDC 57237011490
|
| Hospital Charge Code |
36982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.90 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna Commercial |
$204.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.72
|
| Rate for Payer: Cash Price |
$192.89
|
| Rate for Payer: Cofinity Advantage |
$168.78
|
| Rate for Payer: Cofinity Commercial |
$207.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.89
|
| Rate for Payer: Healthscope Commercial |
$217.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.83
|
| Rate for Payer: PHP Commercial |
$204.94
|
| Rate for Payer: Priority Health SBD |
$151.90
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$10,282.14
|
|
|
Service Code
|
APR-DRG 8114
|
| Min. Negotiated Rate |
$9,792.51 |
| Max. Negotiated Rate |
$10,282.14 |
| Rate for Payer: BCBS Complete |
$10,282.14
|
| Rate for Payer: Mclaren Medicaid |
$9,792.51
|
| Rate for Payer: Meridian Medicaid |
$10,282.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,792.51
|
| Rate for Payer: UHC Medicaid |
$9,792.51
|
| Rate for Payer: UHCCP Medicaid |
$9,792.51
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$5,111.54
|
|
|
Service Code
|
APR-DRG 8113
|
| Min. Negotiated Rate |
$4,868.14 |
| Max. Negotiated Rate |
$5,111.54 |
| Rate for Payer: BCBS Complete |
$5,111.54
|
| Rate for Payer: Mclaren Medicaid |
$4,868.14
|
| Rate for Payer: Meridian Medicaid |
$5,111.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,868.14
|
| Rate for Payer: UHC Medicaid |
$4,868.14
|
| Rate for Payer: UHCCP Medicaid |
$4,868.14
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$2,302.95
|
|
|
Service Code
|
APR-DRG 8112
|
| Min. Negotiated Rate |
$2,193.28 |
| Max. Negotiated Rate |
$2,302.95 |
| Rate for Payer: BCBS Complete |
$2,302.95
|
| Rate for Payer: Mclaren Medicaid |
$2,193.28
|
| Rate for Payer: Meridian Medicaid |
$2,302.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,193.28
|
| Rate for Payer: UHC Medicaid |
$2,193.28
|
| Rate for Payer: UHCCP Medicaid |
$2,193.28
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$1,595.49
|
|
|
Service Code
|
APR-DRG 8111
|
| Min. Negotiated Rate |
$1,519.52 |
| Max. Negotiated Rate |
$1,595.49 |
| Rate for Payer: BCBS Complete |
$1,595.49
|
| Rate for Payer: Mclaren Medicaid |
$1,519.52
|
| Rate for Payer: Meridian Medicaid |
$1,595.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,519.52
|
| Rate for Payer: UHC Medicaid |
$1,519.52
|
| Rate for Payer: UHCCP Medicaid |
$1,519.52
|
|
|
ALLERGIC REACTIONS WITH MCC
|
Facility
|
IP
|
$30,271.23
|
|
|
Service Code
|
MSDRG 915
|
| Min. Negotiated Rate |
$12,896.05 |
| Max. Negotiated Rate |
$30,271.23 |
| Rate for Payer: Aetna Medicare |
$14,117.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,968.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,968.49
|
| Rate for Payer: BCBS MAPPO |
$13,574.79
|
| Rate for Payer: BCBS Trust/PPO |
$30,271.23
|
| Rate for Payer: BCN Commercial |
$30,271.23
|
| Rate for Payer: BCN Medicare Advantage |
$13,574.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,574.79
|
| Rate for Payer: Mclaren Medicare |
$13,574.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,253.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,611.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,932.27
|
| Rate for Payer: Nomi Health Commercial |
$21,692.64
|
| Rate for Payer: PACE Medicare |
$12,896.05
|
| Rate for Payer: PACE SWMI |
$13,574.79
|
| Rate for Payer: PHP Medicare Advantage |
$13,574.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,110.99
|
| Rate for Payer: Priority Health Medicare |
$13,574.79
|
| Rate for Payer: Priority Health Tiered Network |
$21,688.79
|
| Rate for Payer: Railroad Medicare Medicare |
$13,574.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,410.08
|
| Rate for Payer: UHC Core |
$22,931.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,574.79
|
| Rate for Payer: UHC Exchange |
$18,727.98
|
| Rate for Payer: VA VA |
$13,574.79
|
|
|
ALLERGIC REACTIONS WITHOUT MCC
|
Facility
|
IP
|
$10,860.69
|
|
|
Service Code
|
MSDRG 916
|
| Min. Negotiated Rate |
$5,441.90 |
| Max. Negotiated Rate |
$10,860.69 |
| Rate for Payer: Aetna Medicare |
$5,957.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,160.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,160.40
|
| Rate for Payer: BCBS MAPPO |
$5,728.32
|
| Rate for Payer: BCBS Trust/PPO |
$10,779.38
|
| Rate for Payer: BCN Commercial |
$10,779.38
|
| Rate for Payer: BCN Medicare Advantage |
$5,728.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,728.32
|
| Rate for Payer: Mclaren Medicare |
$5,728.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,014.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,587.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,301.15
|
| Rate for Payer: Nomi Health Commercial |
$8,595.27
|
| Rate for Payer: PACE Medicare |
$5,441.90
|
| Rate for Payer: PACE SWMI |
$5,728.32
|
| Rate for Payer: PHP Medicare Advantage |
$5,728.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,742.18
|
| Rate for Payer: Priority Health Medicare |
$5,728.32
|
| Rate for Payer: Priority Health Tiered Network |
$8,593.74
|
| Rate for Payer: Railroad Medicare Medicare |
$5,728.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,860.69
|
| Rate for Payer: UHC Core |
$9,086.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,728.32
|
| Rate for Payer: UHC Exchange |
$7,420.58
|
| Rate for Payer: VA VA |
$5,728.32
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$135,192.74
|
|
|
Service Code
|
APR-DRG 0074
|
| Min. Negotiated Rate |
$128,754.99 |
| Max. Negotiated Rate |
$135,192.74 |
| Rate for Payer: BCBS Complete |
$135,192.74
|
| Rate for Payer: Mclaren Medicaid |
$128,754.99
|
| Rate for Payer: Meridian Medicaid |
$135,192.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$128,754.99
|
| Rate for Payer: UHC Medicaid |
$128,754.99
|
| Rate for Payer: UHCCP Medicaid |
$128,754.99
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$61,928.44
|
|
|
Service Code
|
APR-DRG 0072
|
| Min. Negotiated Rate |
$58,979.47 |
| Max. Negotiated Rate |
$61,928.44 |
| Rate for Payer: BCBS Complete |
$61,928.44
|
| Rate for Payer: Mclaren Medicaid |
$58,979.47
|
| Rate for Payer: Meridian Medicaid |
$61,928.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$58,979.47
|
| Rate for Payer: UHC Medicaid |
$58,979.47
|
| Rate for Payer: UHCCP Medicaid |
$58,979.47
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$64,455.55
|
|
|
Service Code
|
APR-DRG 0073
|
| Min. Negotiated Rate |
$61,386.23 |
| Max. Negotiated Rate |
$64,455.55 |
| Rate for Payer: BCBS Complete |
$64,455.55
|
| Rate for Payer: Mclaren Medicaid |
$61,386.23
|
| Rate for Payer: Meridian Medicaid |
$64,455.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$61,386.23
|
| Rate for Payer: UHC Medicaid |
$61,386.23
|
| Rate for Payer: UHCCP Medicaid |
$61,386.23
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$53,080.13
|
|
|
Service Code
|
APR-DRG 0071
|
| Min. Negotiated Rate |
$50,552.50 |
| Max. Negotiated Rate |
$53,080.13 |
| Rate for Payer: BCBS Complete |
$53,080.13
|
| Rate for Payer: Mclaren Medicaid |
$50,552.50
|
| Rate for Payer: Meridian Medicaid |
$53,080.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$50,552.50
|
| Rate for Payer: UHC Medicaid |
$50,552.50
|
| Rate for Payer: UHCCP Medicaid |
$50,552.50
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$327,367.90
|
|
|
Service Code
|
MSDRG 014
|
| Min. Negotiated Rate |
$88,783.28 |
| Max. Negotiated Rate |
$327,367.90 |
| Rate for Payer: Aetna Medicare |
$97,194.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116,820.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116,820.10
|
| Rate for Payer: BCBS MAPPO |
$93,456.08
|
| Rate for Payer: BCBS Trust/PPO |
$327,367.90
|
| Rate for Payer: BCN Commercial |
$327,367.90
|
| Rate for Payer: BCN Medicare Advantage |
$93,456.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93,456.08
|
| Rate for Payer: Mclaren Medicare |
$93,456.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98,128.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107,474.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$102,801.69
|
| Rate for Payer: Nomi Health Commercial |
$155,030.91
|
| Rate for Payer: PACE Medicare |
$88,783.28
|
| Rate for Payer: PACE SWMI |
$93,456.08
|
| Rate for Payer: PHP Medicare Advantage |
$93,456.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$193,754.27
|
| Rate for Payer: Priority Health Medicare |
$93,456.08
|
| Rate for Payer: Priority Health Tiered Network |
$155,003.39
|
| Rate for Payer: Railroad Medicare Medicare |
$93,456.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$93,456.08
|
| Rate for Payer: VA VA |
$93,456.08
|
|
|
ALLOGRAFT, MORSELIZED, OR PLACEMENT OF OSTEOPROMOTIVE MATERIAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$233.35
|
|
|
Service Code
|
CPT 20930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$233.35 |
| Max. Negotiated Rate |
$233.35 |
| Rate for Payer: BCBS Trust/PPO |
$233.35
|
| Rate for Payer: BCN Commercial |
$233.35
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$77.55
|
|
|
Service Code
|
NDC 16729013401
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna Medicare |
$38.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.41
|
| Rate for Payer: BCBS Complete |
$31.02
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Advantage |
$54.28
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: Priority Health SBD |
$48.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.41
|
| Rate for Payer: UHC Core |
$40.40
|
| Rate for Payer: UHC Exchange |
$30.48
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 60687067701
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.86 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Advantage |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.74
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health SBD |
$135.86
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$2.56
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Advantage |
$1.79
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.92
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health SBD |
$1.61
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$255.55
|
|
|
Service Code
|
NDC 51079020520
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$217.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.11
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cofinity Advantage |
$178.88
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.66
|
| Rate for Payer: PHP Commercial |
$217.22
|
| Rate for Payer: Priority Health SBD |
$161.00
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$277.40
|
|
|
Service Code
|
NDC 00591554301
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.02 |
| Max. Negotiated Rate |
$249.66 |
| Rate for Payer: Aetna Commercial |
$235.79
|
| Rate for Payer: Aetna Medicare |
$138.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.31
|
| Rate for Payer: BCBS Complete |
$110.96
|
| Rate for Payer: Cash Price |
$221.92
|
| Rate for Payer: Cofinity Advantage |
$194.18
|
| Rate for Payer: Cofinity Commercial |
$238.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.92
|
| Rate for Payer: Healthscope Commercial |
$249.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.05
|
| Rate for Payer: PHP Commercial |
$235.79
|
| Rate for Payer: Priority Health SBD |
$174.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.31
|
| Rate for Payer: UHC Core |
$144.53
|
| Rate for Payer: UHC Exchange |
$109.02
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$239.70
|
|
|
Service Code
|
NDC 55111072901
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.01 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$203.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.81
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Advantage |
$167.79
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.78
|
| Rate for Payer: PHP Commercial |
$203.75
|
| Rate for Payer: Priority Health SBD |
$151.01
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 60687067701
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.75 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$107.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Advantage |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.74
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health SBD |
$135.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.17
|
| Rate for Payer: UHC Core |
$112.35
|
| Rate for Payer: UHC Exchange |
$84.75
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$2.56
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Advantage |
$1.79
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.92
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.66
|
| Rate for Payer: UHC Core |
$1.33
|
| Rate for Payer: UHC Exchange |
$1.01
|
|
