|
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
|
|
|
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 |
$198.30 |
| Max. Negotiated Rate |
$3,141.03 |
| Rate for Payer: Aetna Commercial |
$2,966.53
|
| Rate for Payer: Aetna Medicare |
$384.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,268.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$462.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$462.46
|
| Rate for Payer: BCBS Complete |
$208.22
|
| Rate for Payer: BCBS MAPPO |
$369.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,048.81
|
| Rate for Payer: BCN Commercial |
$1,048.81
|
| Rate for Payer: BCN Medicare Advantage |
$369.97
|
| Rate for Payer: Cash Price |
$2,792.02
|
| 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: Health Alliance Plan Medicare Advantage |
$369.97
|
| Rate for Payer: Healthscope Commercial |
$3,141.03
|
| Rate for Payer: Mclaren Medicaid |
$198.30
|
| Rate for Payer: Mclaren Medicare |
$369.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$388.47
|
| Rate for Payer: Meridian Medicaid |
$208.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$425.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,966.53
|
| Rate for Payer: Nomi Health Commercial |
$1,109.91
|
| Rate for Payer: PACE Medicare |
$351.47
|
| Rate for Payer: PACE SWMI |
$369.97
|
| Rate for Payer: PHP Commercial |
$2,966.53
|
| Rate for Payer: PHP Medicare Advantage |
$369.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,268.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,068.58
|
| Rate for Payer: Priority Health Medicare |
$369.97
|
| Rate for Payer: Priority Health Narrow Network |
$854.86
|
| Rate for Payer: Priority Health SBD |
$2,198.72
|
| Rate for Payer: Railroad Medicare Medicare |
$369.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,041.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$369.97
|
| Rate for Payer: UHC Medicare Advantage |
$369.97
|
| Rate for Payer: UHCCP Medicaid |
$208.29
|
| Rate for Payer: VA VA |
$369.97
|
|
|
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 |
$198.30 |
| Max. Negotiated Rate |
$12,760.40 |
| Rate for Payer: Aetna Commercial |
$12,051.49
|
| Rate for Payer: Aetna Medicare |
$384.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,215.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$462.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$462.46
|
| Rate for Payer: BCBS Complete |
$208.22
|
| Rate for Payer: BCBS MAPPO |
$369.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,048.81
|
| Rate for Payer: BCN Commercial |
$1,048.81
|
| Rate for Payer: BCN Medicare Advantage |
$369.97
|
| Rate for Payer: Cash Price |
$11,342.58
|
| Rate for Payer: Cash Price |
$11,342.58
|
| Rate for Payer: Cofinity Commercial |
$9,924.75
|
| Rate for Payer: Cofinity Commercial |
$12,193.27
|
| 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 |
$369.97
|
| Rate for Payer: Healthscope Commercial |
$12,760.40
|
| Rate for Payer: Mclaren Medicaid |
$198.30
|
| Rate for Payer: Mclaren Medicare |
$369.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$388.47
|
| Rate for Payer: Meridian Medicaid |
$208.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$425.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,051.49
|
| Rate for Payer: Nomi Health Commercial |
$1,109.91
|
| Rate for Payer: PACE Medicare |
$351.47
|
| Rate for Payer: PACE SWMI |
$369.97
|
| Rate for Payer: PHP Commercial |
$12,051.49
|
| Rate for Payer: PHP Medicare Advantage |
$369.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,215.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,068.58
|
| Rate for Payer: Priority Health Medicare |
$369.97
|
| Rate for Payer: Priority Health Narrow Network |
$854.86
|
| Rate for Payer: Priority Health SBD |
$8,932.28
|
| Rate for Payer: Railroad Medicare Medicare |
$369.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,041.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$369.97
|
| Rate for Payer: UHC Medicare Advantage |
$369.97
|
| Rate for Payer: UHCCP Medicaid |
$208.29
|
| Rate for Payer: VA VA |
$369.97
|
|
|
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
|
$21,998.64
|
|
|
Service Code
|
CPT 28238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$519.41 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,524.52
|
| Rate for Payer: BCN Commercial |
$2,524.52
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.41
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$8,174.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,940.59
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
RECONSTRUCTION, ANGULAR DEFORMITY OF TOE, SOFT TISSUE PROCEDURES ONLY (EG, OVERLAPPING SECOND TOE, FIFTH TOE, CURLY TOES)
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28313
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$383.40 |
| 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 |
$1,089.51
|
| Rate for Payer: BCN Commercial |
$1,089.51
|
| 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) |
$383.40
|
| 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
|
|
|
RECONSTRUCTION OF COMPLETE SHOULDER (ROTATOR) CUFF AVULSION, CHRONIC (INCLUDES ACROMIOPLASTY)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 23420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,038.42 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,763.16
|
| Rate for Payer: BCN Commercial |
$2,763.16
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,038.42
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,940.59
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE ADVANCEMENT OR RELEASE (EG, CAMPBELL, GOLDWAITE TYPE PROCEDURE)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 27422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$792.43 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,368.43
|
| Rate for Payer: BCN Commercial |
$2,368.43
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$792.43
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,940.59
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUT FIXATION OF CONTRALATERAL TESTIS
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 54600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$480.27 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,073.93
|
| Rate for Payer: BCN Commercial |
$2,073.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.27
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,902.51
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
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 |
$118.40 |
| 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 |
$59.56
|
| 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 |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$62.32
|
| 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
|
$66.31
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$59.68 |
| 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 |
$58.86
|
| Rate for Payer: Aetna Commercial |
$31.09
|
| Rate for Payer: Aetna Medicare |
$34.62
|
| Rate for Payer: Aetna Medicare |
$33.16
|
| Rate for Payer: Aetna Medicare |
$65.78
|
| Rate for Payer: Aetna Medicare |
$18.29
|
| Rate for Payer: Aetna Medicare |
$425.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.78
|
| 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) |
$43.10
|
| Rate for Payer: BCBS Complete |
$52.62
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS Complete |
$26.52
|
| Rate for Payer: BCBS Complete |
$27.70
|
| Rate for Payer: BCBS Complete |
$14.63
|
| Rate for Payer: BCBS Trust/PPO |
$8.12
|
| Rate for Payer: BCBS Trust/PPO |
$8.12
|
| Rate for Payer: BCBS Trust/PPO |
$8.12
|
| Rate for Payer: BCBS Trust/PPO |
$8.12
|
| Rate for Payer: BCBS Trust/PPO |
$8.12
|
| Rate for Payer: BCN Commercial |
$8.12
|
| Rate for Payer: BCN Commercial |
$8.12
|
| Rate for Payer: BCN Commercial |
$8.12
|
| Rate for Payer: BCN Commercial |
$8.12
|
| Rate for Payer: BCN Commercial |
$8.12
|
| Rate for Payer: Cash Price |
$55.40
|
| Rate for Payer: Cash Price |
$105.24
|
| Rate for Payer: Cash Price |
$680.81
|
| Rate for Payer: Cash Price |
$53.05
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cash Price |
$680.81
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cash Price |
$53.05
|
| Rate for Payer: Cash Price |
$105.24
|
| Rate for Payer: Cash Price |
$55.40
|
| Rate for Payer: Cofinity Commercial |
$731.87
|
| Rate for Payer: Cofinity Commercial |
$595.71
|
| 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 |
$59.56
|
| 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: Cofinity Medicare Advantage |
$595.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.40
|
| Rate for Payer: Healthscope Commercial |
$59.68
|
| Rate for Payer: Healthscope Commercial |
$765.91
|
| Rate for Payer: Healthscope Commercial |
$32.92
|
| Rate for Payer: Healthscope Commercial |
$62.32
|
| Rate for Payer: Healthscope Commercial |
$118.40
|
| 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 |
$31.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.86
|
| Rate for Payer: PHP Commercial |
$723.36
|
| Rate for Payer: PHP Commercial |
$111.82
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: PHP Commercial |
$31.09
|
| Rate for Payer: PHP Commercial |
$58.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.78
|
| 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 Cigna Priority Health |
$553.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.51
|
| 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
|
| Rate for Payer: Priority Health SBD |
$43.63
|
|
|
REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 24342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$826.25 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,678.98
|
| Rate for Payer: BCN Commercial |
$2,678.98
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$826.25
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,940.59
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
RELEASE, TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)
|
Facility
|
OP
|
$6,013.44
|
|
|
Service Code
|
CPT 28035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$379.48 |
| Max. Negotiated Rate |
$6,013.44 |
| Rate for Payer: Aetna Medicare |
$1,989.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,391.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,391.60
|
| Rate for Payer: BCBS Complete |
$1,076.79
|
| Rate for Payer: BCBS MAPPO |
$1,913.28
|
| Rate for Payer: BCBS Trust/PPO |
$852.09
|
| Rate for Payer: BCN Commercial |
$852.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,913.28
|
| Rate for Payer: Mclaren Medicaid |
$1,025.52
|
| Rate for Payer: Mclaren Medicare |
$1,913.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,008.94
|
| Rate for Payer: Meridian Medicaid |
$1,076.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,200.27
|
| Rate for Payer: Nomi Health Commercial |
$4,017.89
|
| Rate for Payer: PACE Medicare |
$1,817.62
|
| Rate for Payer: PACE SWMI |
$1,913.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,913.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,025.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,013.44
|
| Rate for Payer: Priority Health Medicare |
$1,913.28
|
| Rate for Payer: Priority Health Narrow Network |
$4,810.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.48
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,913.28
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,913.28
|
| Rate for Payer: UHCCP Medicaid |
$1,077.18
|
| Rate for Payer: VA VA |
$1,913.28
|
|
|
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 |
$3.40 |
| Max. Negotiated Rate |
$1,828.37 |
| Rate for Payer: Aetna Commercial |
$1,726.79
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.94
|
| Rate for Payer: BCBS Complete |
$3.57
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$17.94
|
| Rate for Payer: BCN Commercial |
$17.94
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| 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 |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$1,828.37
|
| Rate for Payer: Mclaren Medicaid |
$3.40
|
| Rate for Payer: Mclaren Medicare |
$6.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.67
|
| Rate for Payer: Meridian Medicaid |
$3.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.79
|
| Rate for Payer: Nomi Health Commercial |
$19.05
|
| Rate for Payer: PACE Medicare |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$1,726.79
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.30
|
| Rate for Payer: Priority Health Medicare |
$6.35
|
| Rate for Payer: Priority Health Narrow Network |
$14.64
|
| Rate for Payer: Priority Health SBD |
$1,279.86
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.58
|
| Rate for Payer: VA VA |
$6.35
|
|
|
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
|
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
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$229.46
|
|
|
Service Code
|
NDC 67457019800
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$144.56 |
| Max. Negotiated Rate |
$206.51 |
| Rate for Payer: Aetna Commercial |
$195.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.15
|
| 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
|
|
|
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
|
OP
|
$281.33
|
|
|
Service Code
|
NDC 00143939110
|
| 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 63323072303
|
| 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
|
OP
|
$229.46
|
|
|
Service Code
|
NDC 67457019800
|
| 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
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$229.46
|
|
|
Service Code
|
NDC 67457019803
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$144.56 |
| Max. Negotiated Rate |
$206.51 |
| Rate for Payer: Aetna Commercial |
$195.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.15
|
| 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
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$238.60
|
|
|
Service Code
|
NDC 63323072303
|
| 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
|
|
