|
RASAGILINE 0.5 MG TABLET
|
Facility
|
IP
|
$342.44
|
|
|
Service Code
|
NDC 67877025930
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.74 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Aetna Commercial |
$291.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.59
|
| Rate for Payer: Cash Price |
$273.95
|
| Rate for Payer: Cofinity Commercial |
$239.71
|
| Rate for Payer: Cofinity Commercial |
$294.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.95
|
| Rate for Payer: Healthscope Commercial |
$308.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.07
|
| Rate for Payer: PHP Commercial |
$291.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.59
|
| Rate for Payer: Priority Health SBD |
$215.74
|
|
|
RASAGILINE 1 MG TABLET
|
Facility
|
OP
|
$4,305.03
|
|
|
Service Code
|
NDC 68546022956
|
| Hospital Charge Code |
76481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,722.01 |
| Max. Negotiated Rate |
$3,874.53 |
| Rate for Payer: Aetna Commercial |
$3,659.28
|
| Rate for Payer: Aetna Medicare |
$2,152.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,798.27
|
| Rate for Payer: BCBS Complete |
$1,722.01
|
| Rate for Payer: Cash Price |
$3,444.02
|
| Rate for Payer: Cofinity Commercial |
$3,013.52
|
| Rate for Payer: Cofinity Commercial |
$3,702.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,013.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,444.02
|
| Rate for Payer: Healthscope Commercial |
$3,874.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,659.28
|
| Rate for Payer: PHP Commercial |
$3,659.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,798.27
|
| Rate for Payer: Priority Health SBD |
$2,712.17
|
|
|
RASAGILINE 1 MG TABLET
|
Facility
|
IP
|
$4,305.03
|
|
|
Service Code
|
NDC 68546022956
|
| Hospital Charge Code |
76481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,712.17 |
| Max. Negotiated Rate |
$3,874.53 |
| Rate for Payer: Aetna Commercial |
$3,659.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,798.27
|
| Rate for Payer: Cash Price |
$3,444.02
|
| Rate for Payer: Cofinity Commercial |
$3,013.52
|
| Rate for Payer: Cofinity Commercial |
$3,702.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,013.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,444.02
|
| Rate for Payer: Healthscope Commercial |
$3,874.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,659.28
|
| Rate for Payer: PHP Commercial |
$3,659.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,798.27
|
| Rate for Payer: Priority Health SBD |
$2,712.17
|
|
|
RASAGILINE 1 MG TABLET
|
Facility
|
OP
|
$737.04
|
|
|
Service Code
|
NDC 00093306156
|
| Hospital Charge Code |
76481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.82 |
| Max. Negotiated Rate |
$663.34 |
| Rate for Payer: Aetna Commercial |
$626.48
|
| Rate for Payer: Aetna Medicare |
$368.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.08
|
| Rate for Payer: BCBS Complete |
$294.82
|
| Rate for Payer: Cash Price |
$589.63
|
| Rate for Payer: Cofinity Commercial |
$515.93
|
| Rate for Payer: Cofinity Commercial |
$633.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$515.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.63
|
| Rate for Payer: Healthscope Commercial |
$663.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.48
|
| Rate for Payer: PHP Commercial |
$626.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.08
|
| Rate for Payer: Priority Health SBD |
$464.34
|
|
|
RASAGILINE 1 MG TABLET
|
Facility
|
IP
|
$737.04
|
|
|
Service Code
|
NDC 00093306156
|
| Hospital Charge Code |
76481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$464.34 |
| Max. Negotiated Rate |
$663.34 |
| Rate for Payer: Aetna Commercial |
$626.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.08
|
| Rate for Payer: Cash Price |
$589.63
|
| Rate for Payer: Cofinity Commercial |
$515.93
|
| Rate for Payer: Cofinity Commercial |
$633.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$515.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.63
|
| Rate for Payer: Healthscope Commercial |
$663.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.48
|
| Rate for Payer: PHP Commercial |
$626.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.08
|
| Rate for Payer: Priority Health SBD |
$464.34
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,490.03
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
33591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$202.35 |
| Max. Negotiated Rate |
$3,141.03 |
| Rate for Payer: Aetna Commercial |
$2,966.53
|
| Rate for Payer: Aetna Medicare |
$392.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,268.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$471.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$471.90
|
| Rate for Payer: BCBS Complete |
$212.47
|
| Rate for Payer: BCBS MAPPO |
$377.52
|
| Rate for Payer: BCN Medicare Advantage |
$377.52
|
| Rate for Payer: Cash Price |
$2,792.02
|
| Rate for Payer: Cash Price |
$2,792.02
|
| Rate for Payer: Cofinity Commercial |
$3,001.43
|
| Rate for Payer: Cofinity Commercial |
$2,443.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,443.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,792.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$377.52
|
| Rate for Payer: Healthscope Commercial |
$3,141.03
|
| Rate for Payer: Mclaren Medicaid |
$202.35
|
| Rate for Payer: Mclaren Medicare |
$377.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$396.40
|
| Rate for Payer: Meridian Medicaid |
$212.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$434.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,966.53
|
| Rate for Payer: PACE Medicare |
$358.64
|
| Rate for Payer: PACE SWMI |
$377.52
|
| Rate for Payer: PHP Commercial |
$2,966.53
|
| Rate for Payer: PHP Medicare Advantage |
$377.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,268.52
|
| Rate for Payer: Priority Health Medicare |
$377.52
|
| Rate for Payer: Priority Health SBD |
$2,198.72
|
| Rate for Payer: Railroad Medicare Medicare |
$377.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,062.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$377.52
|
| Rate for Payer: UHC Medicare Advantage |
$377.52
|
| Rate for Payer: UHCCP Medicaid |
$212.54
|
| Rate for Payer: VA VA |
$377.52
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,490.03
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
33591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,198.72 |
| Max. Negotiated Rate |
$3,141.03 |
| Rate for Payer: Aetna Commercial |
$2,966.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,268.52
|
| Rate for Payer: Cash Price |
$2,792.02
|
| Rate for Payer: Cofinity Commercial |
$2,443.02
|
| Rate for Payer: Cofinity Commercial |
$3,001.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,443.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,792.02
|
| Rate for Payer: Healthscope Commercial |
$3,141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,966.53
|
| Rate for Payer: PHP Commercial |
$2,966.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,268.52
|
| Rate for Payer: Priority Health SBD |
$2,198.72
|
|
|
RASBURICASE 7.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,178.22
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
76868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$202.35 |
| Max. Negotiated Rate |
$12,760.40 |
| Rate for Payer: Aetna Commercial |
$12,051.49
|
| Rate for Payer: Aetna Medicare |
$392.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,215.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$471.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$471.90
|
| Rate for Payer: BCBS Complete |
$212.47
|
| Rate for Payer: BCBS MAPPO |
$377.52
|
| Rate for Payer: BCN Medicare Advantage |
$377.52
|
| Rate for Payer: Cash Price |
$11,342.58
|
| Rate for Payer: Cash Price |
$11,342.58
|
| Rate for Payer: Cofinity Commercial |
$12,193.27
|
| Rate for Payer: Cofinity Commercial |
$9,924.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,924.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,342.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$377.52
|
| Rate for Payer: Healthscope Commercial |
$12,760.40
|
| Rate for Payer: Mclaren Medicaid |
$202.35
|
| Rate for Payer: Mclaren Medicare |
$377.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$396.40
|
| Rate for Payer: Meridian Medicaid |
$212.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$434.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,051.49
|
| Rate for Payer: PACE Medicare |
$358.64
|
| Rate for Payer: PACE SWMI |
$377.52
|
| Rate for Payer: PHP Commercial |
$12,051.49
|
| Rate for Payer: PHP Medicare Advantage |
$377.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,215.84
|
| Rate for Payer: Priority Health Medicare |
$377.52
|
| Rate for Payer: Priority Health SBD |
$8,932.28
|
| Rate for Payer: Railroad Medicare Medicare |
$377.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,062.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$377.52
|
| Rate for Payer: UHC Medicare Advantage |
$377.52
|
| Rate for Payer: UHCCP Medicaid |
$212.54
|
| Rate for Payer: VA VA |
$377.52
|
|
|
RASBURICASE 7.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,178.22
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
76868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,932.28 |
| Max. Negotiated Rate |
$12,760.40 |
| Rate for Payer: Aetna Commercial |
$12,051.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,215.84
|
| Rate for Payer: Cash Price |
$11,342.58
|
| Rate for Payer: Cofinity Commercial |
$12,193.27
|
| Rate for Payer: Cofinity Commercial |
$9,924.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,924.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,342.58
|
| Rate for Payer: Healthscope Commercial |
$12,760.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,051.49
|
| Rate for Payer: PHP Commercial |
$12,051.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,215.84
|
| Rate for Payer: Priority Health SBD |
$8,932.28
|
|
|
RECONSTRUCTION (ADVANCEMENT), POSTERIOR TIBIAL TENDON WITH EXCISION OF ACCESSORY TARSAL NAVICULAR BONE (EG, KIDNER TYPE PROCEDURE)
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 28238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,922.50
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
RECONSTRUCTION, ANGULAR DEFORMITY OF TOE, SOFT TISSUE PROCEDURES ONLY (EG, OVERLAPPING SECOND TOE, FIFTH TOE, CURLY TOES)
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28313
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,781.56
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
RECONSTRUCTION OF COMPLETE SHOULDER (ROTATOR) CUFF AVULSION, CHRONIC (INCLUDES ACROMIOPLASTY)
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 23420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,922.50
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE ADVANCEMENT OR RELEASE (EG, CAMPBELL, GOLDWAITE TYPE PROCEDURE)
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 27422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,922.50
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUT FIXATION OF CONTRALATERAL TESTIS
|
Facility
|
OP
|
$9,468.51
|
|
|
Service Code
|
CPT 54600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.95 |
| Max. Negotiated Rate |
$9,468.51 |
| Rate for Payer: Aetna Medicare |
$3,498.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,468.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,893.77
|
| Rate for Payer: VA VA |
$3,363.71
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$131.55
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.88 |
| Max. Negotiated Rate |
$118.39 |
| Rate for Payer: Aetna Commercial |
$111.82
|
| Rate for Payer: Aetna Commercial |
$31.09
|
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Commercial |
$58.86
|
| Rate for Payer: Aetna Commercial |
$723.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.78
|
| Rate for Payer: Cash Price |
$680.81
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cash Price |
$55.40
|
| Rate for Payer: Cash Price |
$53.05
|
| Rate for Payer: Cash Price |
$105.24
|
| Rate for Payer: Cofinity Commercial |
$25.61
|
| Rate for Payer: Cofinity Commercial |
$113.13
|
| Rate for Payer: Cofinity Commercial |
$92.08
|
| Rate for Payer: Cofinity Commercial |
$731.87
|
| Rate for Payer: Cofinity Commercial |
$595.71
|
| Rate for Payer: Cofinity Commercial |
$31.46
|
| Rate for Payer: Cofinity Commercial |
$59.55
|
| Rate for Payer: Cofinity Commercial |
$48.48
|
| Rate for Payer: Cofinity Commercial |
$46.42
|
| Rate for Payer: Cofinity Commercial |
$57.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$595.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.81
|
| Rate for Payer: Healthscope Commercial |
$59.68
|
| Rate for Payer: Healthscope Commercial |
$32.92
|
| Rate for Payer: Healthscope Commercial |
$118.39
|
| Rate for Payer: Healthscope Commercial |
$62.33
|
| Rate for Payer: Healthscope Commercial |
$765.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.82
|
| Rate for Payer: PHP Commercial |
$58.86
|
| Rate for Payer: PHP Commercial |
$723.36
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: PHP Commercial |
$31.09
|
| Rate for Payer: PHP Commercial |
$111.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.01
|
| Rate for Payer: Priority Health SBD |
$43.63
|
| Rate for Payer: Priority Health SBD |
$23.05
|
| Rate for Payer: Priority Health SBD |
$41.78
|
| Rate for Payer: Priority Health SBD |
$82.88
|
| Rate for Payer: Priority Health SBD |
$536.14
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$69.25
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.70 |
| Max. Negotiated Rate |
$62.33 |
| Rate for Payer: Aetna Commercial |
$58.86
|
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Commercial |
$723.36
|
| Rate for Payer: Aetna Commercial |
$111.82
|
| Rate for Payer: Aetna Commercial |
$31.09
|
| Rate for Payer: Aetna Medicare |
$33.16
|
| Rate for Payer: Aetna Medicare |
$425.50
|
| Rate for Payer: Aetna Medicare |
$34.62
|
| Rate for Payer: Aetna Medicare |
$18.29
|
| Rate for Payer: Aetna Medicare |
$65.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.51
|
| Rate for Payer: BCBS Complete |
$14.63
|
| Rate for Payer: BCBS Complete |
$27.70
|
| Rate for Payer: BCBS Complete |
$26.52
|
| Rate for Payer: BCBS Complete |
$52.62
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: Cash Price |
$105.24
|
| Rate for Payer: Cash Price |
$53.05
|
| Rate for Payer: Cash Price |
$680.81
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cash Price |
$55.40
|
| Rate for Payer: Cofinity Commercial |
$59.55
|
| Rate for Payer: Cofinity Commercial |
$113.13
|
| Rate for Payer: Cofinity Commercial |
$92.08
|
| Rate for Payer: Cofinity Commercial |
$25.61
|
| Rate for Payer: Cofinity Commercial |
$31.46
|
| Rate for Payer: Cofinity Commercial |
$46.42
|
| Rate for Payer: Cofinity Commercial |
$57.03
|
| Rate for Payer: Cofinity Commercial |
$48.48
|
| Rate for Payer: Cofinity Commercial |
$595.71
|
| Rate for Payer: Cofinity Commercial |
$731.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$595.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Healthscope Commercial |
$32.92
|
| Rate for Payer: Healthscope Commercial |
$118.39
|
| Rate for Payer: Healthscope Commercial |
$62.33
|
| Rate for Payer: Healthscope Commercial |
$765.91
|
| Rate for Payer: Healthscope Commercial |
$59.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.36
|
| Rate for Payer: PHP Commercial |
$58.86
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: PHP Commercial |
$31.09
|
| Rate for Payer: PHP Commercial |
$111.82
|
| Rate for Payer: PHP Commercial |
$723.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: Priority Health SBD |
$536.14
|
| Rate for Payer: Priority Health SBD |
$82.88
|
| Rate for Payer: Priority Health SBD |
$23.05
|
| Rate for Payer: Priority Health SBD |
$43.63
|
| Rate for Payer: Priority Health SBD |
$41.78
|
|
|
REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 24342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,922.50
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
RELEASE, TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)
|
Facility
|
OP
|
$5,360.98
|
|
|
Service Code
|
CPT 28035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,072.23
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$2,031.52
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$1,828.37 |
| Rate for Payer: Aetna Commercial |
$1,726.79
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.41
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.73
|
| Rate for Payer: Cash Price |
$1,625.22
|
| Rate for Payer: Cash Price |
$1,625.22
|
| Rate for Payer: Cofinity Commercial |
$1,747.11
|
| Rate for Payer: Cofinity Commercial |
$1,422.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,422.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Healthscope Commercial |
$1,828.37
|
| Rate for Payer: Mclaren Medicaid |
$3.61
|
| Rate for Payer: Mclaren Medicare |
$6.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: Meridian Medicaid |
$3.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.79
|
| Rate for Payer: PACE Medicare |
$6.39
|
| Rate for Payer: PACE SWMI |
$6.73
|
| Rate for Payer: PHP Commercial |
$1,726.79
|
| Rate for Payer: PHP Medicare Advantage |
$6.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.49
|
| Rate for Payer: Priority Health Medicare |
$6.73
|
| Rate for Payer: Priority Health SBD |
$1,279.86
|
| Rate for Payer: Railroad Medicare Medicare |
$6.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.73
|
| Rate for Payer: UHC Medicare Advantage |
$6.73
|
| Rate for Payer: UHCCP Medicaid |
$3.79
|
| Rate for Payer: VA VA |
$6.73
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$2,031.52
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,279.86 |
| Max. Negotiated Rate |
$1,828.37 |
| Rate for Payer: Aetna Commercial |
$1,726.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.49
|
| Rate for Payer: Cash Price |
$1,625.22
|
| Rate for Payer: Cofinity Commercial |
$1,422.06
|
| Rate for Payer: Cofinity Commercial |
$1,747.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,422.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.22
|
| Rate for Payer: Healthscope Commercial |
$1,828.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.79
|
| Rate for Payer: PHP Commercial |
$1,726.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.49
|
| Rate for Payer: Priority Health SBD |
$1,279.86
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$238.60
|
|
|
Service Code
|
NDC 63323072301
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$150.32 |
| Max. Negotiated Rate |
$214.74 |
| Rate for Payer: Aetna Commercial |
$202.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.09
|
| Rate for Payer: Cash Price |
$190.88
|
| Rate for Payer: Cofinity Commercial |
$167.02
|
| Rate for Payer: Cofinity Commercial |
$205.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.88
|
| Rate for Payer: Healthscope Commercial |
$214.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.81
|
| Rate for Payer: PHP Commercial |
$202.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.09
|
| Rate for Payer: Priority Health SBD |
$150.32
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$281.33
|
|
|
Service Code
|
NDC 00143939101
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$112.53 |
| Max. Negotiated Rate |
$253.20 |
| Rate for Payer: Aetna Commercial |
$239.13
|
| Rate for Payer: Aetna Medicare |
$140.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.86
|
| Rate for Payer: BCBS Complete |
$112.53
|
| Rate for Payer: Cash Price |
$225.06
|
| Rate for Payer: Cofinity Commercial |
$196.93
|
| Rate for Payer: Cofinity Commercial |
$241.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.06
|
| Rate for Payer: Healthscope Commercial |
$253.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.13
|
| Rate for Payer: PHP Commercial |
$239.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.86
|
| Rate for Payer: Priority Health SBD |
$177.24
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$238.60
|
|
|
Service Code
|
NDC 63323072301
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.44 |
| Max. Negotiated Rate |
$214.74 |
| Rate for Payer: Aetna Commercial |
$202.81
|
| Rate for Payer: Aetna Medicare |
$119.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.09
|
| Rate for Payer: BCBS Complete |
$95.44
|
| Rate for Payer: Cash Price |
$190.88
|
| Rate for Payer: Cofinity Commercial |
$167.02
|
| Rate for Payer: Cofinity Commercial |
$205.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.88
|
| Rate for Payer: Healthscope Commercial |
$214.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.81
|
| Rate for Payer: PHP Commercial |
$202.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.09
|
| Rate for Payer: Priority Health SBD |
$150.32
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$281.33
|
|
|
Service Code
|
NDC 00143939110
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$177.24 |
| Max. Negotiated Rate |
$253.20 |
| Rate for Payer: Aetna Commercial |
$239.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.86
|
| Rate for Payer: Cash Price |
$225.06
|
| Rate for Payer: Cofinity Commercial |
$196.93
|
| Rate for Payer: Cofinity Commercial |
$241.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.06
|
| Rate for Payer: Healthscope Commercial |
$253.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.13
|
| Rate for Payer: PHP Commercial |
$239.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.86
|
| Rate for Payer: Priority Health SBD |
$177.24
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$229.46
|
|
|
Service Code
|
NDC 67457019803
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.78 |
| Max. Negotiated Rate |
$206.51 |
| Rate for Payer: Aetna Commercial |
$195.04
|
| Rate for Payer: Aetna Medicare |
$114.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.15
|
| Rate for Payer: BCBS Complete |
$91.78
|
| Rate for Payer: Cash Price |
$183.57
|
| Rate for Payer: Cofinity Commercial |
$160.62
|
| Rate for Payer: Cofinity Commercial |
$197.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.57
|
| Rate for Payer: Healthscope Commercial |
$206.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.04
|
| Rate for Payer: PHP Commercial |
$195.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.15
|
| Rate for Payer: Priority Health SBD |
$144.56
|
|
