|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$18.86
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$16.97 |
| Rate for Payer: Aetna Commercial |
$16.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.26
|
| Rate for Payer: Cash Price |
$15.09
|
| Rate for Payer: Cofinity Advantage |
$13.20
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.09
|
| Rate for Payer: Healthscope Commercial |
$16.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.14
|
| Rate for Payer: PHP Commercial |
$16.03
|
| Rate for Payer: Priority Health SBD |
$11.88
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$16.97
|
|
|
Service Code
|
NDC 61314039601
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: Aetna Commercial |
$14.42
|
| Rate for Payer: Aetna Medicare |
$8.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.03
|
| Rate for Payer: BCBS Complete |
$6.79
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cofinity Advantage |
$11.88
|
| Rate for Payer: Cofinity Commercial |
$14.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.58
|
| Rate for Payer: Healthscope Commercial |
$15.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.73
|
| Rate for Payer: PHP Commercial |
$14.42
|
| Rate for Payer: Priority Health SBD |
$10.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.03
|
| Rate for Payer: UHC Core |
$8.84
|
| Rate for Payer: UHC Exchange |
$6.67
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$110.01
|
|
|
Service Code
|
NDC 00065039602
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$99.01 |
| Rate for Payer: Aetna Commercial |
$93.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.51
|
| Rate for Payer: Cash Price |
$88.01
|
| Rate for Payer: Cofinity Advantage |
$77.01
|
| Rate for Payer: Cofinity Commercial |
$94.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.01
|
| Rate for Payer: Healthscope Commercial |
$99.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.51
|
| Rate for Payer: PHP Commercial |
$93.51
|
| Rate for Payer: Priority Health SBD |
$69.31
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$40.25
|
|
|
Service Code
|
NDC 24208073501
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$36.23 |
| Rate for Payer: Aetna Commercial |
$34.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.16
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Advantage |
$28.18
|
| Rate for Payer: Cofinity Commercial |
$34.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Healthscope Commercial |
$36.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.19
|
| Rate for Payer: PHP Commercial |
$34.21
|
| Rate for Payer: Priority Health SBD |
$25.36
|
|
|
CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,929.38
|
|
|
Service Code
|
HCPCS J9071
|
| Hospital Charge Code |
194691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$2,636.44 |
| Rate for Payer: Aetna Commercial |
$2,489.97
|
| Rate for Payer: Aetna Commercial |
$1,176.61
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$899.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,904.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.65
|
| Rate for Payer: BCBS Complete |
$0.29
|
| Rate for Payer: BCBS Complete |
$0.29
|
| Rate for Payer: BCBS MAPPO |
$0.52
|
| Rate for Payer: BCBS MAPPO |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: BCN Medicare Advantage |
$0.52
|
| Rate for Payer: BCN Medicare Advantage |
$0.52
|
| Rate for Payer: Cash Price |
$1,107.40
|
| Rate for Payer: Cash Price |
$1,107.40
|
| Rate for Payer: Cash Price |
$2,343.50
|
| Rate for Payer: Cash Price |
$2,343.50
|
| Rate for Payer: Cofinity Advantage |
$2,050.57
|
| Rate for Payer: Cofinity Advantage |
$968.98
|
| Rate for Payer: Cofinity Commercial |
$2,519.27
|
| Rate for Payer: Cofinity Commercial |
$1,190.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,107.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,343.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.52
|
| Rate for Payer: Healthscope Commercial |
$1,245.83
|
| Rate for Payer: Healthscope Commercial |
$2,636.44
|
| Rate for Payer: Mclaren Medicaid |
$0.27
|
| Rate for Payer: Mclaren Medicaid |
$0.27
|
| Rate for Payer: Mclaren Medicare |
$0.52
|
| Rate for Payer: Mclaren Medicare |
$0.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,176.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,489.97
|
| Rate for Payer: Nomi Health Commercial |
$1.56
|
| Rate for Payer: Nomi Health Commercial |
$1.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,197.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,038.19
|
| Rate for Payer: PACE Medicare |
$0.49
|
| Rate for Payer: PACE Medicare |
$0.49
|
| Rate for Payer: PACE SWMI |
$0.52
|
| Rate for Payer: PACE SWMI |
$0.52
|
| Rate for Payer: PHP Commercial |
$1,176.61
|
| Rate for Payer: PHP Commercial |
$2,489.97
|
| Rate for Payer: PHP Medicare Advantage |
$0.52
|
| Rate for Payer: PHP Medicare Advantage |
$0.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.99
|
| Rate for Payer: Priority Health Medicare |
$0.52
|
| Rate for Payer: Priority Health Medicare |
$0.52
|
| Rate for Payer: Priority Health SBD |
$1,845.51
|
| Rate for Payer: Priority Health SBD |
$872.08
|
| Rate for Payer: Priority Health Tiered Network |
$1.59
|
| Rate for Payer: Priority Health Tiered Network |
$1.59
|
| Rate for Payer: Railroad Medicare Medicare |
$0.52
|
| Rate for Payer: Railroad Medicare Medicare |
$0.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.01
|
| Rate for Payer: UHC Core |
$1.01
|
| Rate for Payer: UHC Core |
$1.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.52
|
| Rate for Payer: UHC Exchange |
$1.01
|
| Rate for Payer: UHC Exchange |
$1.01
|
| Rate for Payer: UHC Medicaid |
$0.27
|
| Rate for Payer: UHC Medicaid |
$0.27
|
| Rate for Payer: UHCCP Medicaid |
$0.27
|
| Rate for Payer: UHCCP Medicaid |
$0.27
|
| Rate for Payer: VA VA |
$0.52
|
| Rate for Payer: VA VA |
$0.52
|
|
|
CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,136.88
|
|
|
Service Code
|
HCPCS J9075
|
| Hospital Charge Code |
194691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1,023.19 |
| Rate for Payer: Aetna Commercial |
$966.35
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.96
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: BCBS MAPPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$1.45
|
| Rate for Payer: BCN Commercial |
$1.45
|
| Rate for Payer: BCN Medicare Advantage |
$0.77
|
| Rate for Payer: Cash Price |
$909.50
|
| Rate for Payer: Cash Price |
$909.50
|
| Rate for Payer: Cofinity Advantage |
$795.82
|
| Rate for Payer: Cofinity Commercial |
$977.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$909.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.77
|
| Rate for Payer: Healthscope Commercial |
$1,023.19
|
| Rate for Payer: Mclaren Medicaid |
$0.40
|
| Rate for Payer: Mclaren Medicare |
$0.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.81
|
| Rate for Payer: Meridian Medicaid |
$0.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$966.35
|
| Rate for Payer: Nomi Health Commercial |
$2.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.66
|
| Rate for Payer: PACE Medicare |
$0.73
|
| Rate for Payer: PACE SWMI |
$0.77
|
| Rate for Payer: PHP Commercial |
$966.35
|
| Rate for Payer: PHP Medicare Advantage |
$0.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.53
|
| Rate for Payer: Priority Health Medicare |
$0.77
|
| Rate for Payer: Priority Health SBD |
$716.23
|
| Rate for Payer: Priority Health Tiered Network |
$1.22
|
| Rate for Payer: Railroad Medicare Medicare |
$0.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.77
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Medicaid |
$0.40
|
| Rate for Payer: UHCCP Medicaid |
$0.40
|
| Rate for Payer: VA VA |
$0.77
|
|
|
CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,149.02
|
|
|
Service Code
|
HCPCS J9073
|
| Hospital Charge Code |
194691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1,934.12 |
| Rate for Payer: Aetna Commercial |
$1,826.67
|
| Rate for Payer: Aetna Medicare |
$0.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,396.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.63
|
| Rate for Payer: BCBS Complete |
$0.27
|
| Rate for Payer: BCBS MAPPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Medicare Advantage |
$0.50
|
| Rate for Payer: Cash Price |
$1,719.22
|
| Rate for Payer: Cash Price |
$1,719.22
|
| Rate for Payer: Cofinity Advantage |
$1,504.31
|
| Rate for Payer: Cofinity Commercial |
$1,848.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,719.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.50
|
| Rate for Payer: Healthscope Commercial |
$1,934.12
|
| Rate for Payer: Mclaren Medicaid |
$0.26
|
| Rate for Payer: Mclaren Medicare |
$0.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.53
|
| Rate for Payer: Meridian Medicaid |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,826.67
|
| Rate for Payer: Nomi Health Commercial |
$1.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,611.77
|
| Rate for Payer: PACE Medicare |
$0.48
|
| Rate for Payer: PACE SWMI |
$0.50
|
| Rate for Payer: PHP Commercial |
$1,826.67
|
| Rate for Payer: PHP Medicare Advantage |
$0.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2.48
|
| Rate for Payer: Priority Health Medicare |
$0.50
|
| Rate for Payer: Priority Health SBD |
$1,353.88
|
| Rate for Payer: Priority Health Tiered Network |
$1.98
|
| Rate for Payer: Railroad Medicare Medicare |
$0.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.16
|
| Rate for Payer: UHC Core |
$1.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.50
|
| Rate for Payer: UHC Exchange |
$1.16
|
| Rate for Payer: UHC Medicaid |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: VA VA |
$0.50
|
|
|
CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,136.88
|
|
|
Service Code
|
HCPCS J9075
|
| Hospital Charge Code |
194691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$716.23 |
| Max. Negotiated Rate |
$1,023.19 |
| Rate for Payer: Aetna Commercial |
$966.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.97
|
| Rate for Payer: Cash Price |
$909.50
|
| Rate for Payer: Cofinity Advantage |
$795.82
|
| Rate for Payer: Cofinity Commercial |
$977.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$909.50
|
| Rate for Payer: Healthscope Commercial |
$1,023.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$966.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.66
|
| Rate for Payer: PHP Commercial |
$966.35
|
| Rate for Payer: Priority Health SBD |
$716.23
|
|
|
CYCLOSPORINE 25 MG CAPSULE
|
Facility
|
OP
|
$481.74
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
9707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$433.57 |
| Rate for Payer: Aetna Commercial |
$409.48
|
| Rate for Payer: Aetna Medicare |
$240.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.13
|
| Rate for Payer: BCBS Complete |
$192.70
|
| Rate for Payer: BCBS Trust/PPO |
$1.31
|
| Rate for Payer: BCN Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$385.39
|
| Rate for Payer: Cash Price |
$385.39
|
| Rate for Payer: Cofinity Advantage |
$337.22
|
| Rate for Payer: Cofinity Commercial |
$414.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.39
|
| Rate for Payer: Healthscope Commercial |
$433.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$385.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$361.31
|
| Rate for Payer: PHP Commercial |
$409.48
|
| Rate for Payer: Priority Health SBD |
$303.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
|
|
CYCLOSPORINE 25 MG CAPSULE
|
Facility
|
IP
|
$481.74
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
9707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$303.50 |
| Max. Negotiated Rate |
$433.57 |
| Rate for Payer: Aetna Commercial |
$409.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.13
|
| Rate for Payer: Cash Price |
$385.39
|
| Rate for Payer: Cofinity Advantage |
$337.22
|
| Rate for Payer: Cofinity Commercial |
$414.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.39
|
| Rate for Payer: Healthscope Commercial |
$433.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$361.31
|
| Rate for Payer: PHP Commercial |
$409.48
|
| Rate for Payer: Priority Health SBD |
$303.50
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE
|
Facility
|
OP
|
$41.28
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$37.15 |
| Rate for Payer: Aetna Commercial |
$35.09
|
| Rate for Payer: Aetna Commercial |
$1,052.48
|
| Rate for Payer: Aetna Medicare |
$619.11
|
| Rate for Payer: Aetna Medicare |
$20.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.84
|
| Rate for Payer: BCBS Complete |
$495.28
|
| Rate for Payer: BCBS Complete |
$16.51
|
| Rate for Payer: BCBS Trust/PPO |
$4.53
|
| Rate for Payer: BCBS Trust/PPO |
$4.53
|
| Rate for Payer: BCN Commercial |
$4.53
|
| Rate for Payer: BCN Commercial |
$4.53
|
| Rate for Payer: Cash Price |
$33.02
|
| Rate for Payer: Cash Price |
$990.57
|
| Rate for Payer: Cash Price |
$33.02
|
| Rate for Payer: Cash Price |
$990.57
|
| Rate for Payer: Cofinity Advantage |
$28.90
|
| Rate for Payer: Cofinity Advantage |
$866.75
|
| Rate for Payer: Cofinity Commercial |
$35.50
|
| Rate for Payer: Cofinity Commercial |
$1,064.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.02
|
| Rate for Payer: Healthscope Commercial |
$1,114.39
|
| Rate for Payer: Healthscope Commercial |
$37.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$990.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.66
|
| Rate for Payer: PHP Commercial |
$35.09
|
| Rate for Payer: PHP Commercial |
$1,052.48
|
| Rate for Payer: Priority Health SBD |
$26.01
|
| Rate for Payer: Priority Health SBD |
$780.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE
|
Facility
|
IP
|
$41.28
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$37.15 |
| Rate for Payer: Aetna Commercial |
$35.09
|
| Rate for Payer: Aetna Commercial |
$1,052.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.83
|
| Rate for Payer: Cash Price |
$990.57
|
| Rate for Payer: Cash Price |
$33.02
|
| Rate for Payer: Cofinity Advantage |
$866.75
|
| Rate for Payer: Cofinity Advantage |
$28.90
|
| Rate for Payer: Cofinity Commercial |
$1,064.86
|
| Rate for Payer: Cofinity Commercial |
$35.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.57
|
| Rate for Payer: Healthscope Commercial |
$37.15
|
| Rate for Payer: Healthscope Commercial |
$1,114.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.96
|
| Rate for Payer: PHP Commercial |
$1,052.48
|
| Rate for Payer: PHP Commercial |
$35.09
|
| Rate for Payer: Priority Health SBD |
$780.07
|
| Rate for Payer: Priority Health SBD |
$26.01
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$2,128.00
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28844
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,340.64 |
| Max. Negotiated Rate |
$1,915.20 |
| Rate for Payer: Aetna Commercial |
$1,808.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,383.20
|
| Rate for Payer: Cash Price |
$1,702.40
|
| Rate for Payer: Cofinity Advantage |
$1,489.60
|
| Rate for Payer: Cofinity Commercial |
$1,830.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.40
|
| Rate for Payer: Healthscope Commercial |
$1,915.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,808.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,596.00
|
| Rate for Payer: PHP Commercial |
$1,808.80
|
| Rate for Payer: Priority Health SBD |
$1,340.64
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$2,128.00
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28844
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$1,915.20 |
| Rate for Payer: Aetna Commercial |
$1,808.80
|
| Rate for Payer: Aetna Medicare |
$1,064.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,383.20
|
| Rate for Payer: BCBS Complete |
$851.20
|
| Rate for Payer: BCBS Trust/PPO |
$4.53
|
| Rate for Payer: BCN Commercial |
$4.53
|
| Rate for Payer: Cash Price |
$1,702.40
|
| Rate for Payer: Cash Price |
$1,702.40
|
| Rate for Payer: Cofinity Advantage |
$1,489.60
|
| Rate for Payer: Cofinity Commercial |
$1,830.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.40
|
| Rate for Payer: Healthscope Commercial |
$1,915.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,702.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,808.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,596.00
|
| Rate for Payer: PHP Commercial |
$1,808.80
|
| Rate for Payer: Priority Health SBD |
$1,340.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,383.20
|
| Rate for Payer: UHC Core |
$1,108.69
|
| Rate for Payer: UHC Exchange |
$836.30
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE
|
Facility
|
OP
|
$309.92
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
28842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$278.93 |
| Rate for Payer: Aetna Commercial |
$263.43
|
| Rate for Payer: Aetna Medicare |
$154.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.45
|
| Rate for Payer: BCBS Complete |
$123.97
|
| Rate for Payer: BCBS Trust/PPO |
$1.31
|
| Rate for Payer: BCN Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$247.94
|
| Rate for Payer: Cash Price |
$247.94
|
| Rate for Payer: Cofinity Advantage |
$216.94
|
| Rate for Payer: Cofinity Commercial |
$266.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.94
|
| Rate for Payer: Healthscope Commercial |
$278.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.44
|
| Rate for Payer: PHP Commercial |
$263.43
|
| Rate for Payer: Priority Health SBD |
$195.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE
|
Facility
|
IP
|
$309.92
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
28842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.25 |
| Max. Negotiated Rate |
$278.93 |
| Rate for Payer: Aetna Commercial |
$263.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.45
|
| Rate for Payer: Cash Price |
$247.94
|
| Rate for Payer: Cofinity Advantage |
$216.94
|
| Rate for Payer: Cofinity Commercial |
$266.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.94
|
| Rate for Payer: Healthscope Commercial |
$278.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.44
|
| Rate for Payer: PHP Commercial |
$263.43
|
| Rate for Payer: Priority Health SBD |
$195.25
|
|
|
CYPROHEPTADINE 4 MG TABLET
|
Facility
|
OP
|
$2.91
|
|
|
Service Code
|
NDC 50268018911
|
| Hospital Charge Code |
2033
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: Aetna Medicare |
$1.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cofinity Advantage |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.33
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.47
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.89
|
| Rate for Payer: UHC Core |
$1.52
|
| Rate for Payer: UHC Exchange |
$1.14
|
|
|
CYPROHEPTADINE 4 MG TABLET
|
Facility
|
IP
|
$145.20
|
|
|
Service Code
|
NDC 50268018915
|
| Hospital Charge Code |
2033
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.48 |
| Max. Negotiated Rate |
$130.68 |
| Rate for Payer: Aetna Commercial |
$123.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.38
|
| Rate for Payer: Cash Price |
$116.16
|
| Rate for Payer: Cofinity Advantage |
$101.64
|
| Rate for Payer: Cofinity Commercial |
$124.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.16
|
| Rate for Payer: Healthscope Commercial |
$130.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.90
|
| Rate for Payer: PHP Commercial |
$123.42
|
| Rate for Payer: Priority Health SBD |
$91.48
|
|
|
CYPROHEPTADINE 4 MG TABLET
|
Facility
|
IP
|
$2.91
|
|
|
Service Code
|
NDC 50268018911
|
| Hospital Charge Code |
2033
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cofinity Advantage |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.33
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.47
|
| Rate for Payer: Priority Health SBD |
$1.83
|
|
|
CYPROHEPTADINE 4 MG TABLET
|
Facility
|
IP
|
$229.90
|
|
|
Service Code
|
NDC 52817021010
|
| Hospital Charge Code |
2033
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.84 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna Commercial |
$195.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.44
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Advantage |
$160.93
|
| Rate for Payer: Cofinity Commercial |
$197.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$206.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.43
|
| Rate for Payer: PHP Commercial |
$195.41
|
| Rate for Payer: Priority Health SBD |
$144.84
|
|
|
CYPROHEPTADINE 4 MG TABLET
|
Facility
|
OP
|
$229.90
|
|
|
Service Code
|
NDC 52817021010
|
| Hospital Charge Code |
2033
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.35 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna Commercial |
$195.41
|
| Rate for Payer: Aetna Medicare |
$114.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.44
|
| Rate for Payer: BCBS Complete |
$91.96
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Advantage |
$160.93
|
| Rate for Payer: Cofinity Commercial |
$197.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$206.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.43
|
| Rate for Payer: PHP Commercial |
$195.41
|
| Rate for Payer: Priority Health SBD |
$144.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.44
|
| Rate for Payer: UHC Core |
$119.78
|
| Rate for Payer: UHC Exchange |
$90.35
|
|
|
CYPROHEPTADINE 4 MG TABLET
|
Facility
|
OP
|
$145.20
|
|
|
Service Code
|
NDC 50268018915
|
| Hospital Charge Code |
2033
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.06 |
| Max. Negotiated Rate |
$130.68 |
| Rate for Payer: Aetna Commercial |
$123.42
|
| Rate for Payer: Aetna Medicare |
$72.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.38
|
| Rate for Payer: BCBS Complete |
$58.08
|
| Rate for Payer: Cash Price |
$116.16
|
| Rate for Payer: Cofinity Advantage |
$101.64
|
| Rate for Payer: Cofinity Commercial |
$124.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.16
|
| Rate for Payer: Healthscope Commercial |
$130.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.90
|
| Rate for Payer: PHP Commercial |
$123.42
|
| Rate for Payer: Priority Health SBD |
$91.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.38
|
| Rate for Payer: UHC Core |
$75.65
|
| Rate for Payer: UHC Exchange |
$57.06
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$7,799.75
|
|
|
Service Code
|
APR-DRG 1311
|
| Min. Negotiated Rate |
$7,428.33 |
| Max. Negotiated Rate |
$7,799.75 |
| Rate for Payer: BCBS Complete |
$7,799.75
|
| Rate for Payer: Mclaren Medicaid |
$7,428.33
|
| Rate for Payer: Meridian Medicaid |
$7,799.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,428.33
|
| Rate for Payer: UHC Medicaid |
$7,428.33
|
| Rate for Payer: UHCCP Medicaid |
$7,428.33
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$16,309.81
|
|
|
Service Code
|
APR-DRG 1314
|
| Min. Negotiated Rate |
$15,533.15 |
| Max. Negotiated Rate |
$16,309.81 |
| Rate for Payer: BCBS Complete |
$16,309.81
|
| Rate for Payer: Mclaren Medicaid |
$15,533.15
|
| Rate for Payer: Meridian Medicaid |
$16,309.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,533.15
|
| Rate for Payer: UHC Medicaid |
$15,533.15
|
| Rate for Payer: UHCCP Medicaid |
$15,533.15
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$12,739.87
|
|
|
Service Code
|
APR-DRG 1312
|
| Min. Negotiated Rate |
$12,133.21 |
| Max. Negotiated Rate |
$12,739.87 |
| Rate for Payer: BCBS Complete |
$12,739.87
|
| Rate for Payer: Mclaren Medicaid |
$12,133.21
|
| Rate for Payer: Meridian Medicaid |
$12,739.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,133.21
|
| Rate for Payer: UHC Medicaid |
$12,133.21
|
| Rate for Payer: UHCCP Medicaid |
$12,133.21
|
|
