|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$469.44
|
|
|
Service Code
|
NDC 00904680461
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.78 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna Commercial |
$399.02
|
| Rate for Payer: Aetna Medicare |
$234.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.14
|
| Rate for Payer: BCBS Complete |
$187.78
|
| Rate for Payer: Cash Price |
$375.55
|
| Rate for Payer: Cofinity Commercial |
$328.61
|
| Rate for Payer: Cofinity Commercial |
$403.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$328.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.55
|
| Rate for Payer: Healthscope Commercial |
$422.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.02
|
| Rate for Payer: PHP Commercial |
$399.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.14
|
| Rate for Payer: Priority Health SBD |
$295.75
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$469.44
|
|
|
Service Code
|
NDC 00904680461
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$295.75 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna Commercial |
$399.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.14
|
| Rate for Payer: Cash Price |
$375.55
|
| Rate for Payer: Cofinity Commercial |
$328.61
|
| Rate for Payer: Cofinity Commercial |
$403.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$328.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.55
|
| Rate for Payer: Healthscope Commercial |
$422.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.02
|
| Rate for Payer: PHP Commercial |
$399.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.14
|
| Rate for Payer: Priority Health SBD |
$295.75
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,686.98
|
|
|
Service Code
|
NDC 00310028060
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,062.80 |
| Max. Negotiated Rate |
$1,518.28 |
| Rate for Payer: Aetna Commercial |
$1,433.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.54
|
| Rate for Payer: Cash Price |
$1,349.58
|
| Rate for Payer: Cofinity Commercial |
$1,180.89
|
| Rate for Payer: Cofinity Commercial |
$1,450.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,180.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.58
|
| Rate for Payer: Healthscope Commercial |
$1,518.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.93
|
| Rate for Payer: PHP Commercial |
$1,433.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,096.54
|
| Rate for Payer: Priority Health SBD |
$1,062.80
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,686.98
|
|
|
Service Code
|
NDC 00310028060
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$674.79 |
| Max. Negotiated Rate |
$1,518.28 |
| Rate for Payer: Aetna Commercial |
$1,433.93
|
| Rate for Payer: Aetna Medicare |
$843.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.54
|
| Rate for Payer: BCBS Complete |
$674.79
|
| Rate for Payer: Cash Price |
$1,349.58
|
| Rate for Payer: Cofinity Commercial |
$1,180.89
|
| Rate for Payer: Cofinity Commercial |
$1,450.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,180.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.58
|
| Rate for Payer: Healthscope Commercial |
$1,518.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.93
|
| Rate for Payer: PHP Commercial |
$1,433.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,096.54
|
| Rate for Payer: Priority Health SBD |
$1,062.80
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$301.92
|
|
|
Service Code
|
NDC 00904680161
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.21 |
| Max. Negotiated Rate |
$271.73 |
| Rate for Payer: Aetna Commercial |
$256.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.25
|
| Rate for Payer: Cash Price |
$241.54
|
| Rate for Payer: Cofinity Commercial |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$259.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.54
|
| Rate for Payer: Healthscope Commercial |
$271.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.63
|
| Rate for Payer: PHP Commercial |
$256.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.25
|
| Rate for Payer: Priority Health SBD |
$190.21
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$301.92
|
|
|
Service Code
|
NDC 00904680161
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$271.73 |
| Rate for Payer: Aetna Commercial |
$256.63
|
| Rate for Payer: Aetna Medicare |
$150.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.25
|
| Rate for Payer: BCBS Complete |
$120.77
|
| Rate for Payer: Cash Price |
$241.54
|
| Rate for Payer: Cofinity Commercial |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$259.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.54
|
| Rate for Payer: Healthscope Commercial |
$271.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.63
|
| Rate for Payer: PHP Commercial |
$256.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.25
|
| Rate for Payer: Priority Health SBD |
$190.21
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$2,016.48
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,270.38 |
| Max. Negotiated Rate |
$1,814.83 |
| Rate for Payer: Aetna Commercial |
$1,714.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,310.71
|
| Rate for Payer: Cash Price |
$1,613.18
|
| Rate for Payer: Cofinity Commercial |
$1,411.54
|
| Rate for Payer: Cofinity Commercial |
$1,734.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,411.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,613.18
|
| Rate for Payer: Healthscope Commercial |
$1,814.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,714.01
|
| Rate for Payer: PHP Commercial |
$1,714.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,310.71
|
| Rate for Payer: Priority Health SBD |
$1,270.38
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$2,016.48
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$150.28 |
| Max. Negotiated Rate |
$1,814.83 |
| Rate for Payer: Aetna Commercial |
$1,714.01
|
| Rate for Payer: Aetna Medicare |
$291.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,310.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$350.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$350.46
|
| Rate for Payer: BCBS Complete |
$157.79
|
| Rate for Payer: BCBS MAPPO |
$280.37
|
| Rate for Payer: BCBS Trust/PPO |
$928.23
|
| Rate for Payer: BCN Commercial |
$928.23
|
| Rate for Payer: BCN Medicare Advantage |
$280.37
|
| Rate for Payer: Cash Price |
$1,613.18
|
| Rate for Payer: Cash Price |
$1,613.18
|
| Rate for Payer: Cofinity Commercial |
$1,411.54
|
| Rate for Payer: Cofinity Commercial |
$1,734.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,411.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,613.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$280.37
|
| Rate for Payer: Healthscope Commercial |
$1,814.83
|
| Rate for Payer: Mclaren Medicaid |
$150.28
|
| Rate for Payer: Mclaren Medicare |
$280.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$294.39
|
| Rate for Payer: Meridian Medicaid |
$157.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$322.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,714.01
|
| Rate for Payer: Nomi Health Commercial |
$841.11
|
| Rate for Payer: PACE Medicare |
$266.35
|
| Rate for Payer: PACE SWMI |
$280.37
|
| Rate for Payer: PHP Commercial |
$1,714.01
|
| Rate for Payer: PHP Medicare Advantage |
$280.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,310.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.02
|
| Rate for Payer: Priority Health Medicare |
$280.37
|
| Rate for Payer: Priority Health Narrow Network |
$662.42
|
| Rate for Payer: Priority Health SBD |
$1,270.38
|
| Rate for Payer: Railroad Medicare Medicare |
$280.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$789.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$280.37
|
| Rate for Payer: UHC Medicare Advantage |
$280.37
|
| Rate for Payer: UHCCP Medicaid |
$157.85
|
| Rate for Payer: VA VA |
$280.37
|
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$986.51
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
11257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$621.50 |
| Max. Negotiated Rate |
$887.86 |
| Rate for Payer: Aetna Commercial |
$838.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.23
|
| Rate for Payer: Cash Price |
$789.21
|
| Rate for Payer: Cofinity Commercial |
$690.56
|
| Rate for Payer: Cofinity Commercial |
$848.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$690.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.21
|
| Rate for Payer: Healthscope Commercial |
$887.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.53
|
| Rate for Payer: PHP Commercial |
$838.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.23
|
| Rate for Payer: Priority Health SBD |
$621.50
|
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$986.51
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
11257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.69 |
| Max. Negotiated Rate |
$1,230.80 |
| Rate for Payer: Aetna Commercial |
$838.53
|
| Rate for Payer: Aetna Medicare |
$340.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$409.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$409.72
|
| Rate for Payer: BCBS Complete |
$184.47
|
| Rate for Payer: BCBS MAPPO |
$327.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,230.80
|
| Rate for Payer: BCN Commercial |
$1,230.80
|
| Rate for Payer: BCN Medicare Advantage |
$327.78
|
| Rate for Payer: Cash Price |
$789.21
|
| Rate for Payer: Cash Price |
$789.21
|
| Rate for Payer: Cofinity Commercial |
$848.40
|
| Rate for Payer: Cofinity Commercial |
$690.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$690.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.78
|
| Rate for Payer: Healthscope Commercial |
$887.86
|
| Rate for Payer: Mclaren Medicaid |
$175.69
|
| Rate for Payer: Mclaren Medicare |
$327.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$344.17
|
| Rate for Payer: Meridian Medicaid |
$184.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.53
|
| Rate for Payer: Nomi Health Commercial |
$983.34
|
| Rate for Payer: PACE Medicare |
$311.39
|
| Rate for Payer: PACE SWMI |
$327.78
|
| Rate for Payer: PHP Commercial |
$838.53
|
| Rate for Payer: PHP Medicare Advantage |
$327.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,007.71
|
| Rate for Payer: Priority Health Medicare |
$327.78
|
| Rate for Payer: Priority Health Narrow Network |
$806.17
|
| Rate for Payer: Priority Health SBD |
$621.50
|
| Rate for Payer: Railroad Medicare Medicare |
$327.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$922.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.78
|
| Rate for Payer: UHC Medicare Advantage |
$327.78
|
| Rate for Payer: UHCCP Medicaid |
$184.54
|
| Rate for Payer: VA VA |
$327.78
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
IP
|
$1,018.31
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$641.54 |
| Max. Negotiated Rate |
$916.48 |
| Rate for Payer: Aetna Commercial |
$865.56
|
| Rate for Payer: Aetna Commercial |
$1,030.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.40
|
| Rate for Payer: Cash Price |
$814.65
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cofinity Commercial |
$712.82
|
| Rate for Payer: Cofinity Commercial |
$1,043.12
|
| Rate for Payer: Cofinity Commercial |
$849.05
|
| Rate for Payer: Cofinity Commercial |
$875.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$712.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$814.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.34
|
| Rate for Payer: Healthscope Commercial |
$916.48
|
| Rate for Payer: Healthscope Commercial |
$1,091.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$865.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.99
|
| Rate for Payer: PHP Commercial |
$865.56
|
| Rate for Payer: PHP Commercial |
$1,030.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.90
|
| Rate for Payer: Priority Health SBD |
$764.15
|
| Rate for Payer: Priority Health SBD |
$641.54
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
OP
|
$1,018.31
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.69 |
| Max. Negotiated Rate |
$1,230.80 |
| Rate for Payer: Aetna Commercial |
$865.56
|
| Rate for Payer: Aetna Commercial |
$1,030.99
|
| Rate for Payer: Aetna Medicare |
$340.89
|
| Rate for Payer: Aetna Medicare |
$340.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$409.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$409.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$409.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$409.72
|
| Rate for Payer: BCBS Complete |
$184.47
|
| Rate for Payer: BCBS Complete |
$184.47
|
| Rate for Payer: BCBS MAPPO |
$327.78
|
| Rate for Payer: BCBS MAPPO |
$327.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,230.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,230.80
|
| Rate for Payer: BCN Commercial |
$1,230.80
|
| Rate for Payer: BCN Commercial |
$1,230.80
|
| Rate for Payer: BCN Medicare Advantage |
$327.78
|
| Rate for Payer: BCN Medicare Advantage |
$327.78
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cash Price |
$814.65
|
| Rate for Payer: Cash Price |
$814.65
|
| Rate for Payer: Cofinity Commercial |
$712.82
|
| Rate for Payer: Cofinity Commercial |
$849.05
|
| Rate for Payer: Cofinity Commercial |
$1,043.12
|
| Rate for Payer: Cofinity Commercial |
$875.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$712.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$814.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.78
|
| Rate for Payer: Healthscope Commercial |
$1,091.64
|
| Rate for Payer: Healthscope Commercial |
$916.48
|
| Rate for Payer: Mclaren Medicaid |
$175.69
|
| Rate for Payer: Mclaren Medicaid |
$175.69
|
| Rate for Payer: Mclaren Medicare |
$327.78
|
| Rate for Payer: Mclaren Medicare |
$327.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$344.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$344.17
|
| Rate for Payer: Meridian Medicaid |
$184.47
|
| Rate for Payer: Meridian Medicaid |
$184.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$865.56
|
| Rate for Payer: Nomi Health Commercial |
$983.34
|
| Rate for Payer: Nomi Health Commercial |
$983.34
|
| Rate for Payer: PACE Medicare |
$311.39
|
| Rate for Payer: PACE Medicare |
$311.39
|
| Rate for Payer: PACE SWMI |
$327.78
|
| Rate for Payer: PACE SWMI |
$327.78
|
| Rate for Payer: PHP Commercial |
$865.56
|
| Rate for Payer: PHP Commercial |
$1,030.99
|
| Rate for Payer: PHP Medicare Advantage |
$327.78
|
| Rate for Payer: PHP Medicare Advantage |
$327.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,007.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,007.71
|
| Rate for Payer: Priority Health Medicare |
$327.78
|
| Rate for Payer: Priority Health Medicare |
$327.78
|
| Rate for Payer: Priority Health Narrow Network |
$806.17
|
| Rate for Payer: Priority Health Narrow Network |
$806.17
|
| Rate for Payer: Priority Health SBD |
$764.15
|
| Rate for Payer: Priority Health SBD |
$641.54
|
| Rate for Payer: Railroad Medicare Medicare |
$327.78
|
| Rate for Payer: Railroad Medicare Medicare |
$327.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$922.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$922.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.78
|
| Rate for Payer: UHC Medicare Advantage |
$327.78
|
| Rate for Payer: UHC Medicare Advantage |
$327.78
|
| Rate for Payer: UHCCP Medicaid |
$184.54
|
| Rate for Payer: UHCCP Medicaid |
$184.54
|
| Rate for Payer: VA VA |
$327.78
|
| Rate for Payer: VA VA |
$327.78
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 00487278401
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health SBD |
$2.34
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$6.69
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna Commercial |
$5.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.35
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cofinity Commercial |
$4.68
|
| Rate for Payer: Cofinity Commercial |
$5.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.35
|
| Rate for Payer: Healthscope Commercial |
$6.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.69
|
| Rate for Payer: PHP Commercial |
$5.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.35
|
| Rate for Payer: Priority Health SBD |
$4.21
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$6.69
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna Commercial |
$5.69
|
| Rate for Payer: Aetna Medicare |
$3.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.35
|
| Rate for Payer: BCBS Complete |
$2.68
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cofinity Commercial |
$4.68
|
| Rate for Payer: Cofinity Commercial |
$5.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.35
|
| Rate for Payer: Healthscope Commercial |
$6.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.69
|
| Rate for Payer: PHP Commercial |
$5.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.35
|
| Rate for Payer: Priority Health SBD |
$4.21
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
NDC 00487278401
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| Rate for Payer: BCBS Complete |
$1.49
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health SBD |
$2.34
|
|
|
RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVITIS, FUNGUS, TBC, OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS); EXTENSORS, WITH OR WITHOUT TRANSPOSITION OF DORSAL RETINACULUM
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 25116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$645.10 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.09
|
| Rate for Payer: BCN Commercial |
$1,271.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$645.10
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$714.29
|
|
|
Service Code
|
NDC 00002418430
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$285.72 |
| Max. Negotiated Rate |
$642.86 |
| Rate for Payer: Aetna Commercial |
$607.15
|
| Rate for Payer: Aetna Medicare |
$357.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.29
|
| Rate for Payer: BCBS Complete |
$285.72
|
| Rate for Payer: Cash Price |
$571.43
|
| Rate for Payer: Cofinity Commercial |
$500.00
|
| Rate for Payer: Cofinity Commercial |
$614.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$500.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.43
|
| Rate for Payer: Healthscope Commercial |
$642.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.15
|
| Rate for Payer: PHP Commercial |
$607.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.29
|
| Rate for Payer: Priority Health SBD |
$450.00
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$19.94
|
|
|
Service Code
|
NDC 60687026611
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$17.95 |
| Rate for Payer: Aetna Commercial |
$16.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.96
|
| Rate for Payer: Cash Price |
$15.95
|
| Rate for Payer: Cofinity Commercial |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$17.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.95
|
| Rate for Payer: Healthscope Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.95
|
| Rate for Payer: PHP Commercial |
$16.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.96
|
| Rate for Payer: Priority Health SBD |
$12.56
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$597.96
|
|
|
Service Code
|
NDC 60687026621
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.18 |
| Max. Negotiated Rate |
$538.16 |
| Rate for Payer: Aetna Commercial |
$508.27
|
| Rate for Payer: Aetna Medicare |
$298.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.67
|
| Rate for Payer: BCBS Complete |
$239.18
|
| Rate for Payer: Cash Price |
$478.37
|
| Rate for Payer: Cofinity Commercial |
$418.57
|
| Rate for Payer: Cofinity Commercial |
$514.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$418.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$478.37
|
| Rate for Payer: Healthscope Commercial |
$538.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$508.27
|
| Rate for Payer: PHP Commercial |
$508.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.67
|
| Rate for Payer: Priority Health SBD |
$376.71
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$19.94
|
|
|
Service Code
|
NDC 60687026611
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$17.95 |
| Rate for Payer: Aetna Commercial |
$16.95
|
| Rate for Payer: Aetna Medicare |
$9.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.96
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: Cash Price |
$15.95
|
| Rate for Payer: Cofinity Commercial |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$17.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.95
|
| Rate for Payer: Healthscope Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.95
|
| Rate for Payer: PHP Commercial |
$16.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.96
|
| Rate for Payer: Priority Health SBD |
$12.56
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$488.03
|
|
|
Service Code
|
NDC 50268069415
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.21 |
| Max. Negotiated Rate |
$439.23 |
| Rate for Payer: Aetna Commercial |
$414.83
|
| Rate for Payer: Aetna Medicare |
$244.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.22
|
| Rate for Payer: BCBS Complete |
$195.21
|
| Rate for Payer: Cash Price |
$390.42
|
| Rate for Payer: Cofinity Commercial |
$341.62
|
| Rate for Payer: Cofinity Commercial |
$419.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$341.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.42
|
| Rate for Payer: Healthscope Commercial |
$439.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.83
|
| Rate for Payer: PHP Commercial |
$414.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.22
|
| Rate for Payer: Priority Health SBD |
$307.46
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$597.96
|
|
|
Service Code
|
NDC 60687026621
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$376.71 |
| Max. Negotiated Rate |
$538.16 |
| Rate for Payer: Aetna Commercial |
$508.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.67
|
| Rate for Payer: Cash Price |
$478.37
|
| Rate for Payer: Cofinity Commercial |
$418.57
|
| Rate for Payer: Cofinity Commercial |
$514.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$418.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$478.37
|
| Rate for Payer: Healthscope Commercial |
$538.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$508.27
|
| Rate for Payer: PHP Commercial |
$508.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.67
|
| Rate for Payer: Priority Health SBD |
$376.71
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$87.12
|
|
|
Service Code
|
NDC 65162005703
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$78.41 |
| Rate for Payer: Aetna Commercial |
$74.05
|
| Rate for Payer: Aetna Medicare |
$43.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.63
|
| Rate for Payer: BCBS Complete |
$34.85
|
| Rate for Payer: Cash Price |
$69.70
|
| Rate for Payer: Cofinity Commercial |
$60.98
|
| Rate for Payer: Cofinity Commercial |
$74.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.70
|
| Rate for Payer: Healthscope Commercial |
$78.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.05
|
| Rate for Payer: PHP Commercial |
$74.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.63
|
| Rate for Payer: Priority Health SBD |
$54.89
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$87.12
|
|
|
Service Code
|
NDC 65162005703
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.89 |
| Max. Negotiated Rate |
$78.41 |
| Rate for Payer: Aetna Commercial |
$74.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.63
|
| Rate for Payer: Cash Price |
$69.70
|
| Rate for Payer: Cofinity Commercial |
$60.98
|
| Rate for Payer: Cofinity Commercial |
$74.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.70
|
| Rate for Payer: Healthscope Commercial |
$78.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.05
|
| Rate for Payer: PHP Commercial |
$74.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.63
|
| Rate for Payer: Priority Health SBD |
$54.89
|
|
