|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$441.00
|
|
|
Service Code
|
NDC 0904-6794-80
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.83 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna Commercial |
$374.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.65
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$308.70
|
| Rate for Payer: Cofinity Commercial |
$379.26
|
| Rate for Payer: Healthscope Commercial |
$396.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$374.85
|
| Rate for Payer: PHP Commercial |
$374.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.70
|
| Rate for Payer: Priority Health SBD |
$277.83
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
NDC 16103-366-11
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.76 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$176.40
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.20
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.40
|
| Rate for Payer: Priority Health SBD |
$158.76
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$544.50
|
|
|
Service Code
|
NDC 66553-002-01
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$343.04 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Aetna Commercial |
$462.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.92
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cofinity Commercial |
$381.15
|
| Rate for Payer: Cofinity Commercial |
$468.27
|
| Rate for Payer: Healthscope Commercial |
$490.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$462.82
|
| Rate for Payer: PHP Commercial |
$462.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.15
|
| Rate for Payer: Priority Health SBD |
$343.04
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$1,134.00
|
|
|
Service Code
|
NDC 63739-434-01
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$714.42 |
| Max. Negotiated Rate |
$1,020.60 |
| Rate for Payer: Aetna Commercial |
$963.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.10
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cofinity Commercial |
$793.80
|
| Rate for Payer: Cofinity Commercial |
$975.24
|
| Rate for Payer: Healthscope Commercial |
$1,020.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$963.90
|
| Rate for Payer: PHP Commercial |
$963.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.80
|
| Rate for Payer: Priority Health SBD |
$714.42
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$47.63
|
|
|
Service Code
|
NDC 57896-911-36
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.01 |
| Max. Negotiated Rate |
$42.87 |
| Rate for Payer: Aetna Commercial |
$40.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.96
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Cofinity Commercial |
$33.34
|
| Rate for Payer: Cofinity Commercial |
$40.96
|
| Rate for Payer: Healthscope Commercial |
$42.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.49
|
| Rate for Payer: PHP Commercial |
$40.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.34
|
| Rate for Payer: Priority Health SBD |
$30.01
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$58.97
|
|
|
Service Code
|
NDC 0536-1008-36
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$53.07 |
| Rate for Payer: Aetna Commercial |
$50.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.33
|
| Rate for Payer: Cash Price |
$47.18
|
| Rate for Payer: Cofinity Commercial |
$41.28
|
| Rate for Payer: Cofinity Commercial |
$50.71
|
| Rate for Payer: Healthscope Commercial |
$53.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.12
|
| Rate for Payer: PHP Commercial |
$50.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.28
|
| Rate for Payer: Priority Health SBD |
$37.15
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
IP
|
$4.85
|
|
|
Service Code
|
NDC 47682-228-64
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.15
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$4.17
|
| Rate for Payer: Healthscope Commercial |
$4.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.12
|
| Rate for Payer: PHP Commercial |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.40
|
| Rate for Payer: Priority Health SBD |
$3.06
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
IP
|
$46.82
|
|
|
Service Code
|
NDC 70000-0146-1
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.80
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.77
|
| Rate for Payer: Priority Health SBD |
$29.50
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
IP
|
$44.65
|
|
|
Service Code
|
NDC 0904-5135-59
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$40.18 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.02
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$31.26
|
| Rate for Payer: Cofinity Commercial |
$38.40
|
| Rate for Payer: Healthscope Commercial |
$40.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.95
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.26
|
| Rate for Payer: Priority Health SBD |
$28.13
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
IP
|
$46.82
|
|
|
Service Code
|
NDC 9629512960
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.80
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.77
|
| Rate for Payer: Priority Health SBD |
$29.50
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
IP
|
$58.75
|
|
|
Service Code
|
NDC 0536-1326-01
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.01 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.19
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Commercial |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.94
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.12
|
| Rate for Payer: Priority Health SBD |
$37.01
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
IP
|
$75.20
|
|
|
Service Code
|
NDC 0093-0787-01
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.38 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.88
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.92
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.64
|
| Rate for Payer: Priority Health SBD |
$47.38
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
IP
|
$380.70
|
|
|
Service Code
|
NDC 51079-759-20
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.84 |
| Max. Negotiated Rate |
$342.63 |
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.46
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Commercial |
$266.49
|
| Rate for Payer: Cofinity Commercial |
$327.40
|
| Rate for Payer: Healthscope Commercial |
$342.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.60
|
| Rate for Payer: PHP Commercial |
$323.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.49
|
| Rate for Payer: Priority Health SBD |
$239.84
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
OP
|
$3.81
|
|
|
Service Code
|
NDC 51079-759-01
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.48
|
| Rate for Payer: BCBS Complete |
$1.52
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$3.28
|
| Rate for Payer: Healthscope Commercial |
$3.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.24
|
| Rate for Payer: PHP Commercial |
$3.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.67
|
| Rate for Payer: Priority Health SBD |
$2.40
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
IP
|
$705.00
|
|
|
Service Code
|
NDC 0093-0787-10
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$444.15 |
| Max. Negotiated Rate |
$634.50 |
| Rate for Payer: Aetna Commercial |
$599.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.25
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cofinity Commercial |
$493.50
|
| Rate for Payer: Cofinity Commercial |
$606.30
|
| Rate for Payer: Healthscope Commercial |
$634.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$599.25
|
| Rate for Payer: PHP Commercial |
$599.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.50
|
| Rate for Payer: Priority Health SBD |
$444.15
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
OP
|
$380.70
|
|
|
Service Code
|
NDC 51079-759-20
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.28 |
| Max. Negotiated Rate |
$342.63 |
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.46
|
| Rate for Payer: BCBS Complete |
$152.28
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Commercial |
$266.49
|
| Rate for Payer: Cofinity Commercial |
$327.40
|
| Rate for Payer: Healthscope Commercial |
$342.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.60
|
| Rate for Payer: PHP Commercial |
$323.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.49
|
| Rate for Payer: Priority Health SBD |
$239.84
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
IP
|
$3.81
|
|
|
Service Code
|
NDC 51079-759-01
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.48
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$3.28
|
| Rate for Payer: Healthscope Commercial |
$3.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.24
|
| Rate for Payer: PHP Commercial |
$3.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.67
|
| Rate for Payer: Priority Health SBD |
$2.40
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
IP
|
$75.20
|
|
|
Service Code
|
NDC 0093-0752-01
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.38 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.88
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.92
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.64
|
| Rate for Payer: Priority Health SBD |
$47.38
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
IP
|
$65.80
|
|
|
Service Code
|
NDC 65862-169-01
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.45 |
| Max. Negotiated Rate |
$59.22 |
| Rate for Payer: Aetna Commercial |
$55.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.77
|
| Rate for Payer: Cash Price |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$56.59
|
| Rate for Payer: Healthscope Commercial |
$59.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.93
|
| Rate for Payer: PHP Commercial |
$55.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.06
|
| Rate for Payer: Priority Health SBD |
$41.45
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
IP
|
$199.75
|
|
|
Service Code
|
NDC 51079-684-20
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.84 |
| Max. Negotiated Rate |
$179.78 |
| Rate for Payer: Aetna Commercial |
$169.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.84
|
| Rate for Payer: Cash Price |
$159.80
|
| Rate for Payer: Cofinity Commercial |
$139.82
|
| Rate for Payer: Cofinity Commercial |
$171.78
|
| Rate for Payer: Healthscope Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.79
|
| Rate for Payer: PHP Commercial |
$169.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.82
|
| Rate for Payer: Priority Health SBD |
$125.84
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
IP
|
$493.50
|
|
|
Service Code
|
NDC 0781-1506-10
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$310.90 |
| Max. Negotiated Rate |
$444.15 |
| Rate for Payer: Aetna Commercial |
$419.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.78
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cofinity Commercial |
$345.45
|
| Rate for Payer: Cofinity Commercial |
$424.41
|
| Rate for Payer: Healthscope Commercial |
$444.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$419.48
|
| Rate for Payer: PHP Commercial |
$419.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.45
|
| Rate for Payer: Priority Health SBD |
$310.90
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
NDC 51079-684-01
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna Commercial |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.30
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Healthscope Commercial |
$1.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.70
|
| Rate for Payer: PHP Commercial |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health SBD |
$1.26
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
IP
|
$155.10
|
|
|
Service Code
|
NDC 0378-0231-01
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.71 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.82
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.84
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.57
|
| Rate for Payer: Priority Health SBD |
$97.71
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION
|
Facility
OP
|
$47,620.59
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
179035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$42,858.53 |
| Rate for Payer: Aetna Commercial |
$40,477.50
|
| Rate for Payer: Aetna Medicare |
$88.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,953.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.26
|
| Rate for Payer: BCBS Complete |
$48.83
|
| Rate for Payer: BCBS MAPPO |
$85.01
|
| Rate for Payer: BCBS Trust/PPO |
$251.66
|
| Rate for Payer: BCN Medicare Advantage |
$85.01
|
| Rate for Payer: Cash Price |
$38,096.47
|
| Rate for Payer: Cash Price |
$38,096.47
|
| Rate for Payer: Cofinity Commercial |
$40,953.71
|
| Rate for Payer: Cofinity Commercial |
$33,334.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.01
|
| Rate for Payer: Healthscope Commercial |
$42,858.53
|
| Rate for Payer: Mclaren Medicaid |
$46.50
|
| Rate for Payer: Mclaren Medicare |
$85.01
|
| Rate for Payer: Meridian Medicaid |
$48.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40,477.50
|
| Rate for Payer: PACE Medicare |
$80.76
|
| Rate for Payer: PACE SWMI |
$85.01
|
| Rate for Payer: PHP Commercial |
$40,477.50
|
| Rate for Payer: PHP Medicare Advantage |
$85.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33,334.41
|
| Rate for Payer: Priority Health Medicare |
$85.01
|
| Rate for Payer: Priority Health SBD |
$30,000.97
|
| Rate for Payer: Railroad Medicare Medicare |
$85.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.01
|
| Rate for Payer: UHC Medicare Advantage |
$87.56
|
| Rate for Payer: VA VA |
$85.01
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$47,620.59
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
179035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30,000.97 |
| Max. Negotiated Rate |
$42,858.53 |
| Rate for Payer: Aetna Commercial |
$40,477.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,953.38
|
| Rate for Payer: Cash Price |
$38,096.47
|
| Rate for Payer: Cofinity Commercial |
$40,953.71
|
| Rate for Payer: Cofinity Commercial |
$33,334.41
|
| Rate for Payer: Healthscope Commercial |
$42,858.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40,477.50
|
| Rate for Payer: PHP Commercial |
$40,477.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33,334.41
|
| Rate for Payer: Priority Health SBD |
$30,000.97
|
|
