|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
IP
|
$37.60
|
|
|
Service Code
|
NDC 00904759182
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$33.84 |
| Rate for Payer: Aetna Commercial |
$31.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.44
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$32.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.08
|
| Rate for Payer: Healthscope Commercial |
$33.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.96
|
| Rate for Payer: PHP Commercial |
$31.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.44
|
| Rate for Payer: Priority Health SBD |
$23.69
|
|
|
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 |
$0.20 |
| 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 |
$0.40
|
| Rate for Payer: Aetna Medicare |
$0.40
|
| 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 |
$0.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.48
|
| Rate for Payer: BCBS Complete |
$0.21
|
| Rate for Payer: BCBS Complete |
$0.21
|
| Rate for Payer: BCBS MAPPO |
$0.38
|
| Rate for Payer: BCBS MAPPO |
$0.38
|
| Rate for Payer: BCBS Trust/PPO |
$0.94
|
| Rate for Payer: BCBS Trust/PPO |
$0.94
|
| Rate for Payer: BCN Commercial |
$0.94
|
| Rate for Payer: BCN Commercial |
$0.94
|
| Rate for Payer: BCN Medicare Advantage |
$0.38
|
| Rate for Payer: BCN Medicare Advantage |
$0.38
|
| Rate for Payer: Cash Price |
$800.25
|
| 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: Cofinity Commercial |
$1,946.23
|
| Rate for Payer: Cofinity Commercial |
$700.22
|
| Rate for Payer: Cofinity Commercial |
$2,391.08
|
| Rate for Payer: Cofinity Commercial |
$860.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$700.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,946.23
|
| 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 |
$0.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.38
|
| Rate for Payer: Healthscope Commercial |
$2,502.30
|
| Rate for Payer: Healthscope Commercial |
$900.28
|
| Rate for Payer: Mclaren Medicaid |
$0.20
|
| Rate for Payer: Mclaren Medicaid |
$0.20
|
| Rate for Payer: Mclaren Medicare |
$0.38
|
| Rate for Payer: Mclaren Medicare |
$0.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.40
|
| Rate for Payer: Meridian Medicaid |
$0.21
|
| Rate for Payer: Meridian Medicaid |
$0.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.44
|
| 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 |
$1.14
|
| Rate for Payer: Nomi Health Commercial |
$1.14
|
| Rate for Payer: PACE Medicare |
$0.36
|
| Rate for Payer: PACE Medicare |
$0.36
|
| Rate for Payer: PACE SWMI |
$0.38
|
| Rate for Payer: PACE SWMI |
$0.38
|
| Rate for Payer: PHP Commercial |
$2,363.28
|
| Rate for Payer: PHP Commercial |
$850.26
|
| Rate for Payer: PHP Medicare Advantage |
$0.38
|
| Rate for Payer: PHP Medicare Advantage |
$0.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.98
|
| Rate for Payer: Priority Health Medicare |
$0.38
|
| Rate for Payer: Priority Health Medicare |
$0.38
|
| Rate for Payer: Priority Health Narrow Network |
$0.78
|
| Rate for Payer: Priority Health Narrow Network |
$0.78
|
| Rate for Payer: Priority Health SBD |
$1,751.61
|
| Rate for Payer: Priority Health SBD |
$630.20
|
| Rate for Payer: Railroad Medicare Medicare |
$0.38
|
| Rate for Payer: Railroad Medicare Medicare |
$0.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.38
|
| Rate for Payer: UHC Medicare Advantage |
$0.38
|
| Rate for Payer: UHC Medicare Advantage |
$0.38
|
| Rate for Payer: UHCCP Medicaid |
$0.21
|
| Rate for Payer: UHCCP Medicaid |
$0.21
|
| Rate for Payer: VA VA |
$0.38
|
| Rate for Payer: VA VA |
$0.38
|
|
|
FILGRASTIM-AAFI 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$485.96
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$437.36 |
| Rate for Payer: Aetna Commercial |
$413.07
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.36
|
| Rate for Payer: BCBS Complete |
$0.16
|
| Rate for Payer: BCBS MAPPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.78
|
| Rate for Payer: BCN Commercial |
$0.78
|
| Rate for Payer: BCN Medicare Advantage |
$0.29
|
| Rate for Payer: Cash Price |
$388.77
|
| Rate for Payer: Cash Price |
$388.77
|
| Rate for Payer: Cofinity Commercial |
$417.93
|
| Rate for Payer: Cofinity Commercial |
$340.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$340.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.29
|
| Rate for Payer: Healthscope Commercial |
$437.36
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicare |
$0.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.30
|
| Rate for Payer: Meridian Medicaid |
$0.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.07
|
| Rate for Payer: Nomi Health Commercial |
$0.87
|
| Rate for Payer: PACE Medicare |
$0.28
|
| Rate for Payer: PACE SWMI |
$0.29
|
| Rate for Payer: PHP Commercial |
$413.07
|
| Rate for Payer: PHP Medicare Advantage |
$0.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.77
|
| Rate for Payer: Priority Health Medicare |
$0.29
|
| Rate for Payer: Priority Health Narrow Network |
$0.62
|
| Rate for Payer: Priority Health SBD |
$306.15
|
| Rate for Payer: Railroad Medicare Medicare |
$0.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.29
|
| Rate for Payer: UHC Medicare Advantage |
$0.29
|
| Rate for Payer: UHCCP Medicaid |
$0.16
|
| Rate for Payer: VA VA |
$0.29
|
|
|
FILGRASTIM-AAFI 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$485.96
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$306.15 |
| Max. Negotiated Rate |
$437.36 |
| Rate for Payer: Aetna Commercial |
$413.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.87
|
| Rate for Payer: Cash Price |
$388.77
|
| Rate for Payer: Cofinity Commercial |
$340.17
|
| Rate for Payer: Cofinity Commercial |
$417.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$340.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.77
|
| Rate for Payer: Healthscope Commercial |
$437.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.07
|
| Rate for Payer: PHP Commercial |
$413.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.87
|
| Rate for Payer: Priority Health SBD |
$306.15
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$777.53
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$699.78 |
| Rate for Payer: Aetna Commercial |
$660.90
|
| Rate for Payer: Aetna Commercial |
$660.91
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.36
|
| Rate for Payer: BCBS Complete |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.16
|
| Rate for Payer: BCBS MAPPO |
$0.29
|
| Rate for Payer: BCBS MAPPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.78
|
| Rate for Payer: BCBS Trust/PPO |
$0.78
|
| Rate for Payer: BCN Commercial |
$0.78
|
| Rate for Payer: BCN Commercial |
$0.78
|
| Rate for Payer: BCN Medicare Advantage |
$0.29
|
| Rate for Payer: BCN Medicare Advantage |
$0.29
|
| Rate for Payer: Cash Price |
$622.03
|
| Rate for Payer: Cash Price |
$622.03
|
| Rate for Payer: Cash Price |
$622.02
|
| Rate for Payer: Cash Price |
$622.02
|
| Rate for Payer: Cofinity Commercial |
$544.27
|
| Rate for Payer: Cofinity Commercial |
$668.68
|
| Rate for Payer: Cofinity Commercial |
$544.28
|
| Rate for Payer: Cofinity Commercial |
$668.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.29
|
| Rate for Payer: Healthscope Commercial |
$699.79
|
| Rate for Payer: Healthscope Commercial |
$699.78
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicare |
$0.29
|
| Rate for Payer: Mclaren Medicare |
$0.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.30
|
| Rate for Payer: Meridian Medicaid |
$0.16
|
| Rate for Payer: Meridian Medicaid |
$0.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.90
|
| Rate for Payer: Nomi Health Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.87
|
| Rate for Payer: PACE Medicare |
$0.28
|
| Rate for Payer: PACE Medicare |
$0.28
|
| Rate for Payer: PACE SWMI |
$0.29
|
| Rate for Payer: PACE SWMI |
$0.29
|
| Rate for Payer: PHP Commercial |
$660.90
|
| Rate for Payer: PHP Commercial |
$660.91
|
| Rate for Payer: PHP Medicare Advantage |
$0.29
|
| Rate for Payer: PHP Medicare Advantage |
$0.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.77
|
| Rate for Payer: Priority Health Medicare |
$0.29
|
| Rate for Payer: Priority Health Medicare |
$0.29
|
| Rate for Payer: Priority Health Narrow Network |
$0.62
|
| Rate for Payer: Priority Health Narrow Network |
$0.62
|
| Rate for Payer: Priority Health SBD |
$489.85
|
| Rate for Payer: Priority Health SBD |
$489.84
|
| Rate for Payer: Railroad Medicare Medicare |
$0.29
|
| Rate for Payer: Railroad Medicare Medicare |
$0.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.29
|
| Rate for Payer: UHC Medicare Advantage |
$0.29
|
| Rate for Payer: UHC Medicare Advantage |
$0.29
|
| Rate for Payer: UHCCP Medicaid |
$0.16
|
| Rate for Payer: UHCCP Medicaid |
$0.16
|
| Rate for Payer: VA VA |
$0.29
|
| Rate for Payer: VA VA |
$0.29
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$777.53
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$489.84 |
| Max. Negotiated Rate |
$699.78 |
| Rate for Payer: Aetna Commercial |
$660.90
|
| Rate for Payer: Aetna Commercial |
$660.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.40
|
| Rate for Payer: Cash Price |
$622.02
|
| Rate for Payer: Cash Price |
$622.03
|
| Rate for Payer: Cofinity Commercial |
$544.27
|
| Rate for Payer: Cofinity Commercial |
$544.28
|
| Rate for Payer: Cofinity Commercial |
$668.68
|
| Rate for Payer: Cofinity Commercial |
$668.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.03
|
| Rate for Payer: Healthscope Commercial |
$699.78
|
| Rate for Payer: Healthscope Commercial |
$699.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.91
|
| Rate for Payer: PHP Commercial |
$660.90
|
| Rate for Payer: PHP Commercial |
$660.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.39
|
| Rate for Payer: Priority Health SBD |
$489.85
|
| Rate for Payer: Priority Health SBD |
$489.84
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$493.81
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$311.10 |
| Max. Negotiated Rate |
$444.43 |
| Rate for Payer: Aetna Commercial |
$419.74
|
| Rate for Payer: Aetna Commercial |
$419.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Cash Price |
$395.05
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$424.69
|
| Rate for Payer: Cofinity Commercial |
$424.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.06
|
| Rate for Payer: Healthscope Commercial |
$444.43
|
| Rate for Payer: Healthscope Commercial |
$444.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.75
|
| Rate for Payer: PHP Commercial |
$419.74
|
| Rate for Payer: PHP Commercial |
$419.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.98
|
| Rate for Payer: Priority Health SBD |
$311.11
|
| Rate for Payer: Priority Health SBD |
$311.10
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$493.81
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$444.43 |
| Rate for Payer: Aetna Commercial |
$419.74
|
| Rate for Payer: Aetna Commercial |
$419.75
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.45
|
| Rate for Payer: BCBS Complete |
$0.20
|
| Rate for Payer: BCBS Complete |
$0.20
|
| Rate for Payer: BCBS MAPPO |
$0.36
|
| Rate for Payer: BCBS MAPPO |
$0.36
|
| Rate for Payer: BCBS Trust/PPO |
$1.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.00
|
| Rate for Payer: BCN Commercial |
$1.00
|
| Rate for Payer: BCN Commercial |
$1.00
|
| Rate for Payer: BCN Medicare Advantage |
$0.36
|
| Rate for Payer: BCN Medicare Advantage |
$0.36
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Cash Price |
$395.05
|
| Rate for Payer: Cash Price |
$395.05
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$424.69
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$424.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.36
|
| Rate for Payer: Healthscope Commercial |
$444.44
|
| Rate for Payer: Healthscope Commercial |
$444.43
|
| Rate for Payer: Mclaren Medicaid |
$0.19
|
| Rate for Payer: Mclaren Medicaid |
$0.19
|
| Rate for Payer: Mclaren Medicare |
$0.36
|
| Rate for Payer: Mclaren Medicare |
$0.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.38
|
| Rate for Payer: Meridian Medicaid |
$0.20
|
| Rate for Payer: Meridian Medicaid |
$0.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.74
|
| Rate for Payer: Nomi Health Commercial |
$1.08
|
| Rate for Payer: Nomi Health Commercial |
$1.08
|
| Rate for Payer: PACE Medicare |
$0.34
|
| Rate for Payer: PACE Medicare |
$0.34
|
| Rate for Payer: PACE SWMI |
$0.36
|
| Rate for Payer: PACE SWMI |
$0.36
|
| Rate for Payer: PHP Commercial |
$419.74
|
| Rate for Payer: PHP Commercial |
$419.75
|
| Rate for Payer: PHP Medicare Advantage |
$0.36
|
| Rate for Payer: PHP Medicare Advantage |
$0.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.05
|
| Rate for Payer: Priority Health Medicare |
$0.36
|
| Rate for Payer: Priority Health Medicare |
$0.36
|
| Rate for Payer: Priority Health Narrow Network |
$0.84
|
| Rate for Payer: Priority Health Narrow Network |
$0.84
|
| Rate for Payer: Priority Health SBD |
$311.11
|
| Rate for Payer: Priority Health SBD |
$311.10
|
| Rate for Payer: Railroad Medicare Medicare |
$0.36
|
| Rate for Payer: Railroad Medicare Medicare |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.36
|
| Rate for Payer: UHC Medicare Advantage |
$0.36
|
| Rate for Payer: UHC Medicare Advantage |
$0.36
|
| Rate for Payer: UHCCP Medicaid |
$0.20
|
| Rate for Payer: UHCCP Medicaid |
$0.20
|
| Rate for Payer: VA VA |
$0.36
|
| Rate for Payer: VA VA |
$0.36
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
IP
|
$790.10
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$497.76 |
| Max. Negotiated Rate |
$711.09 |
| Rate for Payer: Aetna Commercial |
$671.58
|
| Rate for Payer: Aetna Commercial |
$671.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.56
|
| Rate for Payer: Cash Price |
$632.07
|
| Rate for Payer: Cash Price |
$632.08
|
| Rate for Payer: Cofinity Commercial |
$679.49
|
| Rate for Payer: Cofinity Commercial |
$553.07
|
| Rate for Payer: Cofinity Commercial |
$553.06
|
| Rate for Payer: Cofinity Commercial |
$679.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$553.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$553.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.08
|
| Rate for Payer: Healthscope Commercial |
$711.09
|
| Rate for Payer: Healthscope Commercial |
$711.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.58
|
| Rate for Payer: PHP Commercial |
$671.58
|
| Rate for Payer: PHP Commercial |
$671.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.56
|
| Rate for Payer: Priority Health SBD |
$497.76
|
| Rate for Payer: Priority Health SBD |
$497.76
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
OP
|
$790.10
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$711.09 |
| Rate for Payer: Aetna Commercial |
$671.58
|
| Rate for Payer: Aetna Commercial |
$671.58
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.45
|
| Rate for Payer: BCBS Complete |
$0.20
|
| Rate for Payer: BCBS Complete |
$0.20
|
| Rate for Payer: BCBS MAPPO |
$0.36
|
| Rate for Payer: BCBS MAPPO |
$0.36
|
| Rate for Payer: BCBS Trust/PPO |
$1.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.00
|
| Rate for Payer: BCN Commercial |
$1.00
|
| Rate for Payer: BCN Commercial |
$1.00
|
| Rate for Payer: BCN Medicare Advantage |
$0.36
|
| Rate for Payer: BCN Medicare Advantage |
$0.36
|
| Rate for Payer: Cash Price |
$632.07
|
| Rate for Payer: Cash Price |
$632.07
|
| Rate for Payer: Cash Price |
$632.08
|
| Rate for Payer: Cash Price |
$632.08
|
| Rate for Payer: Cofinity Commercial |
$553.07
|
| Rate for Payer: Cofinity Commercial |
$553.06
|
| Rate for Payer: Cofinity Commercial |
$679.49
|
| Rate for Payer: Cofinity Commercial |
$679.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$553.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$553.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.36
|
| Rate for Payer: Healthscope Commercial |
$711.09
|
| Rate for Payer: Healthscope Commercial |
$711.08
|
| Rate for Payer: Mclaren Medicaid |
$0.19
|
| Rate for Payer: Mclaren Medicaid |
$0.19
|
| Rate for Payer: Mclaren Medicare |
$0.36
|
| Rate for Payer: Mclaren Medicare |
$0.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.38
|
| Rate for Payer: Meridian Medicaid |
$0.20
|
| Rate for Payer: Meridian Medicaid |
$0.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.58
|
| Rate for Payer: Nomi Health Commercial |
$1.08
|
| Rate for Payer: Nomi Health Commercial |
$1.08
|
| Rate for Payer: PACE Medicare |
$0.34
|
| Rate for Payer: PACE Medicare |
$0.34
|
| Rate for Payer: PACE SWMI |
$0.36
|
| Rate for Payer: PACE SWMI |
$0.36
|
| Rate for Payer: PHP Commercial |
$671.58
|
| Rate for Payer: PHP Commercial |
$671.58
|
| Rate for Payer: PHP Medicare Advantage |
$0.36
|
| Rate for Payer: PHP Medicare Advantage |
$0.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.05
|
| Rate for Payer: Priority Health Medicare |
$0.36
|
| Rate for Payer: Priority Health Medicare |
$0.36
|
| Rate for Payer: Priority Health Narrow Network |
$0.84
|
| Rate for Payer: Priority Health Narrow Network |
$0.84
|
| Rate for Payer: Priority Health SBD |
$497.76
|
| Rate for Payer: Priority Health SBD |
$497.76
|
| Rate for Payer: Railroad Medicare Medicare |
$0.36
|
| Rate for Payer: Railroad Medicare Medicare |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.36
|
| Rate for Payer: UHC Medicare Advantage |
$0.36
|
| Rate for Payer: UHC Medicare Advantage |
$0.36
|
| Rate for Payer: UHCCP Medicaid |
$0.20
|
| Rate for Payer: UHCCP Medicaid |
$0.20
|
| Rate for Payer: VA VA |
$0.36
|
| Rate for Payer: VA VA |
$0.36
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$53.58
|
|
|
Service Code
|
NDC 16729009010
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.43 |
| Max. Negotiated Rate |
$48.22 |
| Rate for Payer: Aetna Commercial |
$45.54
|
| Rate for Payer: Aetna Medicare |
$26.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.83
|
| Rate for Payer: BCBS Complete |
$21.43
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Commercial |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$46.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Healthscope Commercial |
$48.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.54
|
| Rate for Payer: PHP Commercial |
$45.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.83
|
| Rate for Payer: Priority Health SBD |
$33.76
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 50268031411
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.80
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.45
|
| Rate for Payer: Healthscope Commercial |
$3.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.66
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health SBD |
$2.72
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$195.70
|
|
|
Service Code
|
NDC 00904683006
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.28 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna Medicare |
$97.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.20
|
| Rate for Payer: Priority Health SBD |
$123.29
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$53.58
|
|
|
Service Code
|
NDC 16729009010
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.76 |
| Max. Negotiated Rate |
$48.22 |
| Rate for Payer: Aetna Commercial |
$45.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.83
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Commercial |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$46.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Healthscope Commercial |
$48.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.54
|
| Rate for Payer: PHP Commercial |
$45.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.83
|
| Rate for Payer: Priority Health SBD |
$33.76
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$215.18
|
|
|
Service Code
|
NDC 50268031415
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.07 |
| Max. Negotiated Rate |
$193.66 |
| Rate for Payer: Aetna Commercial |
$182.90
|
| Rate for Payer: Aetna Medicare |
$107.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.87
|
| Rate for Payer: BCBS Complete |
$86.07
|
| Rate for Payer: Cash Price |
$172.14
|
| Rate for Payer: Cofinity Commercial |
$150.63
|
| Rate for Payer: Cofinity Commercial |
$185.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.14
|
| Rate for Payer: Healthscope Commercial |
$193.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.90
|
| Rate for Payer: PHP Commercial |
$182.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.87
|
| Rate for Payer: Priority Health SBD |
$135.56
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
NDC 16729009001
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.22 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna Medicare |
$74.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: BCBS Complete |
$59.22
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: Priority Health SBD |
$93.27
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 50268031411
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Aetna Medicare |
$2.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.80
|
| Rate for Payer: BCBS Complete |
$1.72
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.45
|
| Rate for Payer: Healthscope Commercial |
$3.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.66
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health SBD |
$2.72
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 16729009001
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.27 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: Priority Health SBD |
$93.27
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 00904683006
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.29 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.20
|
| Rate for Payer: Priority Health SBD |
$123.29
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$215.18
|
|
|
Service Code
|
NDC 50268031415
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.56 |
| Max. Negotiated Rate |
$193.66 |
| Rate for Payer: Aetna Commercial |
$182.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.87
|
| Rate for Payer: Cash Price |
$172.14
|
| Rate for Payer: Cofinity Commercial |
$150.63
|
| Rate for Payer: Cofinity Commercial |
$185.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.14
|
| Rate for Payer: Healthscope Commercial |
$193.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.90
|
| Rate for Payer: PHP Commercial |
$182.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.87
|
| Rate for Payer: Priority Health SBD |
$135.56
|
|
|
FINE NEEDLE ASPIRATION BIOPSY, INCLUDING ULTRASOUND GUIDANCE; FIRST LESION
|
Facility
|
OP
|
$2,166.65
|
|
|
Service Code
|
CPT 10005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.07 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$765.98
|
| Rate for Payer: BCCCP Commercial |
$126.90
|
| Rate for Payer: BCN Commercial |
$765.98
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Nomi Health Commercial |
$1,447.66
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.07
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$388.11
|
| Rate for Payer: VA VA |
$689.36
|
|
|
FISSURECTOMY, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED
|
Facility
|
OP
|
$8,445.02
|
|
|
Service Code
|
CPT 46200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$353.92 |
| Max. Negotiated Rate |
$8,445.02 |
| Rate for Payer: Aetna Medicare |
$2,794.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,358.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,358.68
|
| Rate for Payer: BCBS Complete |
$1,512.21
|
| Rate for Payer: BCBS MAPPO |
$2,686.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,408.78
|
| Rate for Payer: BCN Commercial |
$1,408.78
|
| Rate for Payer: BCN Medicare Advantage |
$2,686.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,686.94
|
| Rate for Payer: Mclaren Medicaid |
$1,440.20
|
| Rate for Payer: Mclaren Medicare |
$2,686.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,821.29
|
| Rate for Payer: Meridian Medicaid |
$1,512.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,089.98
|
| Rate for Payer: Nomi Health Commercial |
$5,642.57
|
| Rate for Payer: PACE Medicare |
$2,552.59
|
| Rate for Payer: PACE SWMI |
$2,686.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,686.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,440.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,445.02
|
| Rate for Payer: Priority Health Medicare |
$2,686.94
|
| Rate for Payer: Priority Health Narrow Network |
$6,756.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2,686.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.92
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,686.94
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.94
|
| Rate for Payer: UHCCP Medicaid |
$1,512.75
|
| Rate for Payer: VA VA |
$2,686.94
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$258.50
|
|
|
Service Code
|
NDC 53746064101
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.86 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.02
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Commercial |
$180.95
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.02
|
| Rate for Payer: Priority Health SBD |
$162.86
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$153.80
|
|
|
Service Code
|
NDC 00054001021
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.89 |
| Max. Negotiated Rate |
$138.42 |
| Rate for Payer: Aetna Commercial |
$130.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.97
|
| Rate for Payer: Cash Price |
$123.04
|
| Rate for Payer: Cofinity Commercial |
$107.66
|
| Rate for Payer: Cofinity Commercial |
$132.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.04
|
| Rate for Payer: Healthscope Commercial |
$138.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.73
|
| Rate for Payer: PHP Commercial |
$130.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.97
|
| Rate for Payer: Priority Health SBD |
$96.89
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
OP
|
$153.80
|
|
|
Service Code
|
NDC 00054001021
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.52 |
| Max. Negotiated Rate |
$138.42 |
| Rate for Payer: Aetna Commercial |
$130.73
|
| Rate for Payer: Aetna Medicare |
$76.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.97
|
| Rate for Payer: BCBS Complete |
$61.52
|
| Rate for Payer: Cash Price |
$123.04
|
| Rate for Payer: Cofinity Commercial |
$107.66
|
| Rate for Payer: Cofinity Commercial |
$132.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.04
|
| Rate for Payer: Healthscope Commercial |
$138.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.73
|
| Rate for Payer: PHP Commercial |
$130.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.97
|
| Rate for Payer: Priority Health SBD |
$96.89
|
|
