|
ATORVASTATIN 80 MG TABLET
|
Facility
IP
|
$3.90
|
|
|
Service Code
|
NDC 51079-211-01
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.54
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$3.35
|
| Rate for Payer: Healthscope Commercial |
$3.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.32
|
| Rate for Payer: PHP Commercial |
$3.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.73
|
| Rate for Payer: Priority Health SBD |
$2.46
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
IP
|
$82.94
|
|
|
Service Code
|
NDC 0904-6293-04
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.25 |
| Max. Negotiated Rate |
$74.65 |
| Rate for Payer: Aetna Commercial |
$70.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.91
|
| Rate for Payer: Cash Price |
$66.35
|
| Rate for Payer: Cofinity Commercial |
$58.06
|
| Rate for Payer: Cofinity Commercial |
$71.33
|
| Rate for Payer: Healthscope Commercial |
$74.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.50
|
| Rate for Payer: PHP Commercial |
$70.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.06
|
| Rate for Payer: Priority Health SBD |
$52.25
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
IP
|
$196.70
|
|
|
Service Code
|
NDC 69097-947-05
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.92 |
| Max. Negotiated Rate |
$177.03 |
| Rate for Payer: Aetna Commercial |
$167.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.86
|
| Rate for Payer: Cash Price |
$157.36
|
| Rate for Payer: Cofinity Commercial |
$137.69
|
| Rate for Payer: Cofinity Commercial |
$169.16
|
| Rate for Payer: Healthscope Commercial |
$177.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$167.20
|
| Rate for Payer: PHP Commercial |
$167.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.69
|
| Rate for Payer: Priority Health SBD |
$123.92
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
IP
|
$304.56
|
|
|
Service Code
|
NDC 0378-3953-77
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.87 |
| Max. Negotiated Rate |
$274.10 |
| Rate for Payer: Aetna Commercial |
$258.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.96
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cofinity Commercial |
$213.19
|
| Rate for Payer: Cofinity Commercial |
$261.92
|
| Rate for Payer: Healthscope Commercial |
$274.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.88
|
| Rate for Payer: PHP Commercial |
$258.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.19
|
| Rate for Payer: Priority Health SBD |
$191.87
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
IP
|
$5,451.21
|
|
|
Service Code
|
NDC 0071-0158-23
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,434.26 |
| Max. Negotiated Rate |
$4,906.09 |
| Rate for Payer: Aetna Commercial |
$4,633.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,543.29
|
| Rate for Payer: Cash Price |
$4,360.97
|
| Rate for Payer: Cofinity Commercial |
$3,815.85
|
| Rate for Payer: Cofinity Commercial |
$4,688.04
|
| Rate for Payer: Healthscope Commercial |
$4,906.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,633.53
|
| Rate for Payer: PHP Commercial |
$4,633.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,815.85
|
| Rate for Payer: Priority Health SBD |
$3,434.26
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
IP
|
$116.85
|
|
|
Service Code
|
NDC 51079-211-03
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.62 |
| Max. Negotiated Rate |
$105.16 |
| Rate for Payer: Aetna Commercial |
$99.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.95
|
| Rate for Payer: Cash Price |
$93.48
|
| Rate for Payer: Cofinity Commercial |
$100.49
|
| Rate for Payer: Cofinity Commercial |
$81.80
|
| Rate for Payer: Healthscope Commercial |
$105.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.32
|
| Rate for Payer: PHP Commercial |
$99.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.80
|
| Rate for Payer: Priority Health SBD |
$73.62
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
IP
|
$28.22
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$25.40 |
| Rate for Payer: Aetna Commercial |
$23.99
|
| Rate for Payer: Aetna Commercial |
$55.30
|
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Commercial |
$33.25
|
| Rate for Payer: Aetna Commercial |
$30.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.43
|
| Rate for Payer: Cash Price |
$22.58
|
| Rate for Payer: Cash Price |
$28.66
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cash Price |
$52.05
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$19.75
|
| Rate for Payer: Cofinity Commercial |
$24.27
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Commercial |
$25.08
|
| Rate for Payer: Cofinity Commercial |
$30.81
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Cofinity Commercial |
$33.64
|
| Rate for Payer: Cofinity Commercial |
$45.54
|
| Rate for Payer: Cofinity Commercial |
$55.95
|
| Rate for Payer: Healthscope Commercial |
$25.40
|
| Rate for Payer: Healthscope Commercial |
$32.25
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Healthscope Commercial |
$35.21
|
| Rate for Payer: Healthscope Commercial |
$58.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.99
|
| Rate for Payer: PHP Commercial |
$23.99
|
| Rate for Payer: PHP Commercial |
$30.46
|
| Rate for Payer: PHP Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$33.25
|
| Rate for Payer: PHP Commercial |
$55.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.38
|
| Rate for Payer: Priority Health SBD |
$24.65
|
| Rate for Payer: Priority Health SBD |
$22.57
|
| Rate for Payer: Priority Health SBD |
$17.78
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: Priority Health SBD |
$40.99
|
|
|
ATROPINE 0.1 MG/ML SYRINGE (CODE)
|
Facility
IP
|
$39.12
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
163701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.65 |
| Max. Negotiated Rate |
$35.21 |
| Rate for Payer: Aetna Commercial |
$33.25
|
| Rate for Payer: Aetna Commercial |
$30.46
|
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.29
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cash Price |
$28.66
|
| Rate for Payer: Cofinity Commercial |
$33.64
|
| Rate for Payer: Cofinity Commercial |
$25.08
|
| Rate for Payer: Cofinity Commercial |
$30.81
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Healthscope Commercial |
$35.21
|
| Rate for Payer: Healthscope Commercial |
$32.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.46
|
| Rate for Payer: PHP Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$33.25
|
| Rate for Payer: PHP Commercial |
$30.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.38
|
| Rate for Payer: Priority Health SBD |
$22.57
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: Priority Health SBD |
$24.65
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION
|
Facility
IP
|
$123.18
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$110.86 |
| Rate for Payer: Aetna Commercial |
$104.70
|
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.07
|
| Rate for Payer: Cash Price |
$98.54
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cofinity Commercial |
$12.92
|
| Rate for Payer: Cofinity Commercial |
$105.93
|
| Rate for Payer: Cofinity Commercial |
$86.23
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Healthscope Commercial |
$110.86
|
| Rate for Payer: Healthscope Commercial |
$16.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.70
|
| Rate for Payer: PHP Commercial |
$104.70
|
| Rate for Payer: PHP Commercial |
$15.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.92
|
| Rate for Payer: Priority Health SBD |
$11.63
|
| Rate for Payer: Priority Health SBD |
$77.60
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION
|
Facility
OP
|
$18.46
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$16.61 |
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Commercial |
$104.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.00
|
| Rate for Payer: BCBS Complete |
$49.27
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: Cash Price |
$98.54
|
| Rate for Payer: Cash Price |
$98.54
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cofinity Commercial |
$86.23
|
| Rate for Payer: Cofinity Commercial |
$105.93
|
| Rate for Payer: Cofinity Commercial |
$12.92
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Healthscope Commercial |
$16.61
|
| Rate for Payer: Healthscope Commercial |
$110.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.69
|
| Rate for Payer: PHP Commercial |
$15.69
|
| Rate for Payer: PHP Commercial |
$104.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.92
|
| Rate for Payer: Priority Health SBD |
$77.60
|
| Rate for Payer: Priority Health SBD |
$11.63
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
IP
|
$161.25
|
|
|
Service Code
|
NDC 0065-0303-55
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$145.12 |
| Rate for Payer: Aetna Commercial |
$137.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.81
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cofinity Commercial |
$112.88
|
| Rate for Payer: Cofinity Commercial |
$138.68
|
| Rate for Payer: Healthscope Commercial |
$145.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.06
|
| Rate for Payer: PHP Commercial |
$137.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.88
|
| Rate for Payer: Priority Health SBD |
$101.59
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
IP
|
$291.33
|
|
|
Service Code
|
NDC 17478-215-15
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.54 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$247.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.36
|
| Rate for Payer: Cash Price |
$233.06
|
| Rate for Payer: Cofinity Commercial |
$203.93
|
| Rate for Payer: Cofinity Commercial |
$250.54
|
| Rate for Payer: Healthscope Commercial |
$262.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$247.63
|
| Rate for Payer: PHP Commercial |
$247.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.93
|
| Rate for Payer: Priority Health SBD |
$183.54
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
IP
|
$176.79
|
|
|
Service Code
|
NDC 0065-0817-01
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$159.11 |
| Rate for Payer: Aetna Commercial |
$150.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.91
|
| Rate for Payer: Cash Price |
$141.43
|
| Rate for Payer: Cofinity Commercial |
$123.75
|
| Rate for Payer: Cofinity Commercial |
$152.04
|
| Rate for Payer: Healthscope Commercial |
$159.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.27
|
| Rate for Payer: PHP Commercial |
$150.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.75
|
| Rate for Payer: Priority Health SBD |
$111.38
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
IP
|
$122.08
|
|
|
Service Code
|
NDC 17478-215-05
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.91 |
| Max. Negotiated Rate |
$109.87 |
| Rate for Payer: Aetna Commercial |
$103.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.35
|
| Rate for Payer: Cash Price |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$104.99
|
| Rate for Payer: Cofinity Commercial |
$85.46
|
| Rate for Payer: Healthscope Commercial |
$109.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.77
|
| Rate for Payer: PHP Commercial |
$103.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.46
|
| Rate for Payer: Priority Health SBD |
$76.91
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
IP
|
$120.72
|
|
|
Service Code
|
NDC 60219-1749-3
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.05 |
| Max. Negotiated Rate |
$108.65 |
| Rate for Payer: Aetna Commercial |
$102.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.47
|
| Rate for Payer: Cash Price |
$96.58
|
| Rate for Payer: Cofinity Commercial |
$103.82
|
| Rate for Payer: Cofinity Commercial |
$84.50
|
| Rate for Payer: Healthscope Commercial |
$108.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.61
|
| Rate for Payer: PHP Commercial |
$102.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.50
|
| Rate for Payer: Priority Health SBD |
$76.05
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
IP
|
$30.29
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$27.26 |
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.69
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.75
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.20
|
| Rate for Payer: Priority Health SBD |
$19.08
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
OP
|
$30.35
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$27.32 |
| Rate for Payer: Aetna Commercial |
$25.80
|
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.73
|
| Rate for Payer: BCBS Complete |
$12.14
|
| Rate for Payer: BCBS Complete |
$12.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: Cash Price |
$24.28
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cash Price |
$24.28
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cofinity Commercial |
$21.24
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Cofinity Commercial |
$26.10
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Healthscope Commercial |
$27.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.80
|
| Rate for Payer: PHP Commercial |
$25.80
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.24
|
| Rate for Payer: Priority Health SBD |
$19.08
|
| Rate for Payer: Priority Health SBD |
$19.12
|
|
|
ATROPINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$88.44
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
195981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$79.60 |
| Rate for Payer: Aetna Commercial |
$75.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.49
|
| Rate for Payer: BCBS Complete |
$35.38
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cofinity Commercial |
$76.06
|
| Rate for Payer: Cofinity Commercial |
$61.91
|
| Rate for Payer: Healthscope Commercial |
$79.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.17
|
| Rate for Payer: PHP Commercial |
$75.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.91
|
| Rate for Payer: Priority Health SBD |
$55.72
|
|
|
ATROPINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$88.44
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
195981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.72 |
| Max. Negotiated Rate |
$79.60 |
| Rate for Payer: Aetna Commercial |
$75.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.49
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cofinity Commercial |
$61.91
|
| Rate for Payer: Cofinity Commercial |
$76.06
|
| Rate for Payer: Healthscope Commercial |
$79.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.17
|
| Rate for Payer: PHP Commercial |
$75.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.91
|
| Rate for Payer: Priority Health SBD |
$55.72
|
|
|
AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); LOCAL (EG, RIBS, SPINOUS PROCESS, OR LAMINAR FRAGMENTS) OBTAINED FROM SAME INCISION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
OP
|
$5,427.00
|
|
|
Service Code
|
CPT 20936
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$206.96 |
| Max. Negotiated Rate |
$5,427.00 |
| Rate for Payer: BCBS Trust/PPO |
$206.96
|
| Rate for Payer: UHC Core |
$5,427.00
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC
|
Facility
IP
|
$195,391.18
|
|
|
Service Code
|
MS-DRG 016
|
| Min. Negotiated Rate |
$42,729.28 |
| Max. Negotiated Rate |
$195,391.18 |
| Rate for Payer: Aetna Medicare |
$46,777.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56,222.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56,222.74
|
| Rate for Payer: BCBS MAPPO |
$44,978.19
|
| Rate for Payer: BCBS Trust/PPO |
$195,391.18
|
| Rate for Payer: BCN Medicare Advantage |
$44,978.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44,978.19
|
| Rate for Payer: Mclaren Medicare |
$44,978.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47,227.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51,724.92
|
| Rate for Payer: PACE Medicare |
$42,729.28
|
| Rate for Payer: PACE SWMI |
$44,978.19
|
| Rate for Payer: PHP Medicare Advantage |
$44,978.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88,639.46
|
| Rate for Payer: Priority Health Medicare |
$44,978.19
|
| Rate for Payer: Priority Health Narrow Network |
$70,911.57
|
| Rate for Payer: Railroad Medicare Medicare |
$44,978.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94,223.96
|
| Rate for Payer: UHC Core |
$57,816.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$44,978.19
|
| Rate for Payer: UHC Exchange |
$61,924.43
|
| Rate for Payer: UHC Medicare Advantage |
$46,327.54
|
| Rate for Payer: VA VA |
$44,978.19
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC
|
Facility
IP
|
$99,966.15
|
|
|
Service Code
|
MS-DRG 017
|
| Min. Negotiated Rate |
$42,729.28 |
| Max. Negotiated Rate |
$99,966.15 |
| Rate for Payer: Aetna Medicare |
$46,777.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56,222.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56,222.74
|
| Rate for Payer: BCBS MAPPO |
$44,978.19
|
| Rate for Payer: BCBS Trust/PPO |
$99,966.15
|
| Rate for Payer: BCN Medicare Advantage |
$44,978.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44,978.19
|
| Rate for Payer: Mclaren Medicare |
$44,978.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47,227.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51,724.92
|
| Rate for Payer: PACE Medicare |
$42,729.28
|
| Rate for Payer: PACE SWMI |
$44,978.19
|
| Rate for Payer: PHP Medicare Advantage |
$44,978.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88,639.46
|
| Rate for Payer: Priority Health Medicare |
$44,978.19
|
| Rate for Payer: Priority Health Narrow Network |
$70,911.57
|
| Rate for Payer: Railroad Medicare Medicare |
$44,978.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94,223.96
|
| Rate for Payer: UHC Core |
$57,816.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$44,978.19
|
| Rate for Payer: UHC Exchange |
$61,924.43
|
| Rate for Payer: UHC Medicare Advantage |
$46,327.54
|
| Rate for Payer: VA VA |
$44,978.19
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACH ADDITIONAL NAIL PLATE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
OP
|
$878.00
|
|
|
Service Code
|
CPT 11732
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: BCBS Trust/PPO |
$63.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.01
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$16.37
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
|
Facility
OP
|
$878.00
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$52.39 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$96.78
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.63
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$52.39
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
|
Facility
OP
|
$878.00
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$52.39 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$96.78
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.63
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$52.39
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
