|
FERRIC SUBSULFATE 1.04 GM TOPICAL PASTE
|
Facility
|
IP
|
$76.83
|
|
|
Service Code
|
NDC 48783011308
|
| Hospital Charge Code |
155166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$69.15 |
| Rate for Payer: Aetna Commercial |
$65.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.94
|
| Rate for Payer: Cash Price |
$61.46
|
| Rate for Payer: Cofinity Advantage |
$53.78
|
| Rate for Payer: Cofinity Commercial |
$66.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.46
|
| Rate for Payer: Healthscope Commercial |
$69.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.62
|
| Rate for Payer: PHP Commercial |
$65.31
|
| Rate for Payer: Priority Health SBD |
$48.40
|
|
|
FERRIC SUBSULFATE 1.04 GM TOPICAL PASTE
|
Facility
|
OP
|
$76.83
|
|
|
Service Code
|
NDC 48783011308
|
| Hospital Charge Code |
155166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.19 |
| Max. Negotiated Rate |
$69.15 |
| Rate for Payer: Aetna Commercial |
$65.31
|
| Rate for Payer: Aetna Medicare |
$38.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.94
|
| Rate for Payer: BCBS Complete |
$30.73
|
| Rate for Payer: Cash Price |
$61.46
|
| Rate for Payer: Cofinity Advantage |
$53.78
|
| Rate for Payer: Cofinity Commercial |
$66.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.46
|
| Rate for Payer: Healthscope Commercial |
$69.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.62
|
| Rate for Payer: PHP Commercial |
$65.31
|
| Rate for Payer: Priority Health SBD |
$48.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.94
|
| Rate for Payer: UHC Core |
$40.03
|
| Rate for Payer: UHC Exchange |
$30.19
|
|
|
FERRIC SUBSULFATE 1.04 GM TOPICAL PASTE
|
Facility
|
IP
|
$87.81
|
|
|
Service Code
|
NDC 48783011208
|
| Hospital Charge Code |
155166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.32 |
| Max. Negotiated Rate |
$79.03 |
| Rate for Payer: Aetna Commercial |
$74.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.08
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Cofinity Advantage |
$61.47
|
| Rate for Payer: Cofinity Commercial |
$75.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.25
|
| Rate for Payer: Healthscope Commercial |
$79.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.86
|
| Rate for Payer: PHP Commercial |
$74.64
|
| Rate for Payer: Priority Health SBD |
$55.32
|
|
|
FERRIC SUBSULFATE 1.04 GM TOPICAL PASTE
|
Facility
|
OP
|
$87.81
|
|
|
Service Code
|
NDC 48783011208
|
| Hospital Charge Code |
155166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$79.03 |
| Rate for Payer: Aetna Commercial |
$74.64
|
| Rate for Payer: Aetna Medicare |
$43.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.08
|
| Rate for Payer: BCBS Complete |
$35.12
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Cofinity Advantage |
$61.47
|
| Rate for Payer: Cofinity Commercial |
$75.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.25
|
| Rate for Payer: Healthscope Commercial |
$79.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.86
|
| Rate for Payer: PHP Commercial |
$74.64
|
| Rate for Payer: Priority Health SBD |
$55.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.08
|
| Rate for Payer: UHC Core |
$45.75
|
| Rate for Payer: UHC Exchange |
$34.51
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
IP
|
$54.17
|
|
|
Service Code
|
NDC 59365606500
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.13 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna Commercial |
$46.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.21
|
| Rate for Payer: Cash Price |
$43.34
|
| Rate for Payer: Cofinity Advantage |
$37.92
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.34
|
| Rate for Payer: Healthscope Commercial |
$48.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.63
|
| Rate for Payer: PHP Commercial |
$46.04
|
| Rate for Payer: Priority Health SBD |
$34.13
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
IP
|
$54.17
|
|
|
Service Code
|
NDC 59365606501
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.13 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna Commercial |
$46.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.21
|
| Rate for Payer: Cash Price |
$43.34
|
| Rate for Payer: Cofinity Advantage |
$37.92
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.34
|
| Rate for Payer: Healthscope Commercial |
$48.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.63
|
| Rate for Payer: PHP Commercial |
$46.04
|
| Rate for Payer: Priority Health SBD |
$34.13
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
OP
|
$54.17
|
|
|
Service Code
|
NDC 59365606500
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.29 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna Commercial |
$46.04
|
| Rate for Payer: Aetna Medicare |
$27.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.21
|
| Rate for Payer: BCBS Complete |
$21.67
|
| Rate for Payer: Cash Price |
$43.34
|
| Rate for Payer: Cofinity Advantage |
$37.92
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.34
|
| Rate for Payer: Healthscope Commercial |
$48.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.63
|
| Rate for Payer: PHP Commercial |
$46.04
|
| Rate for Payer: Priority Health SBD |
$34.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.21
|
| Rate for Payer: UHC Core |
$28.22
|
| Rate for Payer: UHC Exchange |
$21.29
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
OP
|
$54.17
|
|
|
Service Code
|
NDC 59365606501
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.29 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna Commercial |
$46.04
|
| Rate for Payer: Aetna Medicare |
$27.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.21
|
| Rate for Payer: BCBS Complete |
$21.67
|
| Rate for Payer: Cash Price |
$43.34
|
| Rate for Payer: Cofinity Advantage |
$37.92
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.34
|
| Rate for Payer: Healthscope Commercial |
$48.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.63
|
| Rate for Payer: PHP Commercial |
$46.04
|
| Rate for Payer: Priority Health SBD |
$34.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.21
|
| Rate for Payer: UHC Core |
$28.22
|
| Rate for Payer: UHC Exchange |
$21.29
|
|
|
FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS
|
Facility
|
OP
|
$64.63
|
|
|
Service Code
|
NDC 50383062750
|
| Hospital Charge Code |
95693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$58.17 |
| Rate for Payer: Aetna Commercial |
$54.94
|
| Rate for Payer: Aetna Medicare |
$32.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.01
|
| Rate for Payer: BCBS Complete |
$25.85
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cofinity Advantage |
$45.24
|
| Rate for Payer: Cofinity Commercial |
$55.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.70
|
| Rate for Payer: Healthscope Commercial |
$58.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.47
|
| Rate for Payer: PHP Commercial |
$54.94
|
| Rate for Payer: Priority Health SBD |
$40.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.01
|
| Rate for Payer: UHC Core |
$33.67
|
| Rate for Payer: UHC Exchange |
$25.40
|
|
|
FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS
|
Facility
|
IP
|
$64.63
|
|
|
Service Code
|
NDC 50383062750
|
| Hospital Charge Code |
95693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$58.17 |
| Rate for Payer: Aetna Commercial |
$54.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.01
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cofinity Advantage |
$45.24
|
| Rate for Payer: Cofinity Commercial |
$55.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.70
|
| Rate for Payer: Healthscope Commercial |
$58.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.47
|
| Rate for Payer: PHP Commercial |
$54.94
|
| Rate for Payer: Priority Health SBD |
$40.72
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
IP
|
$13.32
|
|
|
Service Code
|
NDC 50268033624
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$11.99 |
| Rate for Payer: Aetna Commercial |
$11.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.66
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cofinity Advantage |
$9.32
|
| Rate for Payer: Cofinity Commercial |
$11.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.66
|
| Rate for Payer: Healthscope Commercial |
$11.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.99
|
| Rate for Payer: PHP Commercial |
$11.32
|
| Rate for Payer: Priority Health SBD |
$8.39
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
IP
|
$13.32
|
|
|
Service Code
|
NDC 50268033611
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$11.99 |
| Rate for Payer: Aetna Commercial |
$11.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.66
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cofinity Advantage |
$9.32
|
| Rate for Payer: Cofinity Commercial |
$11.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.66
|
| Rate for Payer: Healthscope Commercial |
$11.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.99
|
| Rate for Payer: PHP Commercial |
$11.32
|
| Rate for Payer: Priority Health SBD |
$8.39
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
OP
|
$13.32
|
|
|
Service Code
|
NDC 50268033624
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$11.99 |
| Rate for Payer: Aetna Commercial |
$11.32
|
| Rate for Payer: Aetna Medicare |
$6.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.66
|
| Rate for Payer: BCBS Complete |
$5.33
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cofinity Advantage |
$9.32
|
| Rate for Payer: Cofinity Commercial |
$11.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.66
|
| Rate for Payer: Healthscope Commercial |
$11.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.99
|
| Rate for Payer: PHP Commercial |
$11.32
|
| Rate for Payer: Priority Health SBD |
$8.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.66
|
| Rate for Payer: UHC Core |
$6.94
|
| Rate for Payer: UHC Exchange |
$5.23
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
OP
|
$9.96
|
|
|
Service Code
|
NDC 00121053005
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Aetna Commercial |
$8.47
|
| Rate for Payer: Aetna Medicare |
$4.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.47
|
| Rate for Payer: BCBS Complete |
$3.98
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cofinity Advantage |
$6.97
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.97
|
| Rate for Payer: Healthscope Commercial |
$8.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.47
|
| Rate for Payer: PHP Commercial |
$8.47
|
| Rate for Payer: Priority Health SBD |
$6.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.47
|
| Rate for Payer: UHC Core |
$5.19
|
| Rate for Payer: UHC Exchange |
$3.91
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
IP
|
$9.96
|
|
|
Service Code
|
NDC 00121053005
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Aetna Commercial |
$8.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.47
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cofinity Advantage |
$6.97
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.97
|
| Rate for Payer: Healthscope Commercial |
$8.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.47
|
| Rate for Payer: PHP Commercial |
$8.47
|
| Rate for Payer: Priority Health SBD |
$6.27
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
OP
|
$13.32
|
|
|
Service Code
|
NDC 50268033611
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$11.99 |
| Rate for Payer: Aetna Commercial |
$11.32
|
| Rate for Payer: Aetna Medicare |
$6.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.66
|
| Rate for Payer: BCBS Complete |
$5.33
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cofinity Advantage |
$9.32
|
| Rate for Payer: Cofinity Commercial |
$11.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.66
|
| Rate for Payer: Healthscope Commercial |
$11.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.99
|
| Rate for Payer: PHP Commercial |
$11.32
|
| Rate for Payer: Priority Health SBD |
$8.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.66
|
| Rate for Payer: UHC Core |
$6.94
|
| Rate for Payer: UHC Exchange |
$5.23
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
NDC 00904759182
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Advantage |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health SBD |
$25.17
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
OP
|
$68.15
|
|
|
Service Code
|
NDC 00904759161
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$61.34 |
| Rate for Payer: Aetna Commercial |
$57.93
|
| Rate for Payer: Aetna Medicare |
$34.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.30
|
| Rate for Payer: BCBS Complete |
$27.26
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Advantage |
$47.70
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.52
|
| Rate for Payer: Healthscope Commercial |
$61.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.11
|
| Rate for Payer: PHP Commercial |
$57.93
|
| Rate for Payer: Priority Health SBD |
$42.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.30
|
| Rate for Payer: UHC Core |
$35.51
|
| Rate for Payer: UHC Exchange |
$26.78
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 00904759180
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.88 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Advantage |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.20
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: UHC Exchange |
$73.88
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
OP
|
$39.95
|
|
|
Service Code
|
NDC 00904759182
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.70 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: Aetna Medicare |
$19.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: BCBS Complete |
$15.98
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Advantage |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health SBD |
$25.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.97
|
| Rate for Payer: UHC Core |
$20.81
|
| Rate for Payer: UHC Exchange |
$15.70
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
IP
|
$68.15
|
|
|
Service Code
|
NDC 00904759161
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.93 |
| Max. Negotiated Rate |
$61.34 |
| Rate for Payer: Aetna Commercial |
$57.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.30
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Advantage |
$47.70
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.52
|
| Rate for Payer: Healthscope Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.11
|
| Rate for Payer: PHP Commercial |
$57.93
|
| Rate for Payer: Priority Health SBD |
$42.93
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 00904759180
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.44 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Advantage |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health SBD |
$118.44
|
|
|
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,000.31
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
98312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$630.20 |
| Max. Negotiated Rate |
$900.28 |
| Rate for Payer: Aetna Commercial |
$850.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.20
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cofinity Advantage |
$700.22
|
| Rate for Payer: Cofinity Commercial |
$860.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.25
|
| Rate for Payer: Healthscope Commercial |
$900.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$850.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$750.23
|
| Rate for Payer: PHP Commercial |
$850.26
|
| Rate for Payer: Priority Health SBD |
$630.20
|
|
|
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,780.33
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
98312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$2,502.30 |
| Rate for Payer: Aetna Commercial |
$2,363.28
|
| Rate for Payer: Aetna Commercial |
$850.26
|
| Rate for Payer: Aetna Medicare |
$0.24
|
| Rate for Payer: Aetna Medicare |
$0.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,807.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.29
|
| Rate for Payer: BCBS Complete |
$0.13
|
| Rate for Payer: BCBS Complete |
$0.13
|
| Rate for Payer: BCBS MAPPO |
$0.23
|
| Rate for Payer: BCBS MAPPO |
$0.23
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: BCN Medicare Advantage |
$0.23
|
| Rate for Payer: BCN Medicare Advantage |
$0.23
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cash Price |
$2,224.26
|
| Rate for Payer: Cash Price |
$2,224.26
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cofinity Advantage |
$700.22
|
| Rate for Payer: Cofinity Advantage |
$1,946.23
|
| Rate for Payer: Cofinity Commercial |
$2,391.08
|
| Rate for Payer: Cofinity Commercial |
$860.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.23
|
| Rate for Payer: Healthscope Commercial |
$2,502.30
|
| Rate for Payer: Healthscope Commercial |
$900.28
|
| Rate for Payer: Mclaren Medicaid |
$0.12
|
| Rate for Payer: Mclaren Medicaid |
$0.12
|
| Rate for Payer: Mclaren Medicare |
$0.23
|
| Rate for Payer: Mclaren Medicare |
$0.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.24
|
| Rate for Payer: Meridian Medicaid |
$0.24
|
| Rate for Payer: Meridian Medicaid |
$0.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$850.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.28
|
| Rate for Payer: Nomi Health Commercial |
$0.69
|
| Rate for Payer: Nomi Health Commercial |
$0.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,085.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$750.23
|
| Rate for Payer: PACE Medicare |
$0.22
|
| Rate for Payer: PACE Medicare |
$0.22
|
| Rate for Payer: PACE SWMI |
$0.23
|
| Rate for Payer: PACE SWMI |
$0.23
|
| Rate for Payer: PHP Commercial |
$2,363.28
|
| Rate for Payer: PHP Commercial |
$850.26
|
| Rate for Payer: PHP Medicare Advantage |
$0.23
|
| Rate for Payer: PHP Medicare Advantage |
$0.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.01
|
| Rate for Payer: Priority Health Medicare |
$0.23
|
| Rate for Payer: Priority Health Medicare |
$0.23
|
| Rate for Payer: Priority Health SBD |
$630.20
|
| Rate for Payer: Priority Health SBD |
$1,751.61
|
| Rate for Payer: Priority Health Tiered Network |
$0.81
|
| Rate for Payer: Priority Health Tiered Network |
$0.81
|
| Rate for Payer: Railroad Medicare Medicare |
$0.23
|
| Rate for Payer: Railroad Medicare Medicare |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.59
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UHC Medicaid |
$0.12
|
| Rate for Payer: UHC Medicaid |
$0.12
|
| Rate for Payer: UHCCP Medicaid |
$0.12
|
| Rate for Payer: UHCCP Medicaid |
$0.12
|
| Rate for Payer: VA VA |
$0.23
|
| Rate for Payer: VA VA |
$0.23
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$5,003.19
|
|
|
Service Code
|
APR-DRG 7223
|
| Min. Negotiated Rate |
$4,764.94 |
| Max. Negotiated Rate |
$5,003.19 |
| Rate for Payer: BCBS Complete |
$5,003.19
|
| Rate for Payer: Mclaren Medicaid |
$4,764.94
|
| Rate for Payer: Meridian Medicaid |
$5,003.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,764.94
|
| Rate for Payer: UHC Medicaid |
$4,764.94
|
| Rate for Payer: UHCCP Medicaid |
$4,764.94
|
|
