|
BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY
|
Facility
IP
|
$191.19
|
|
|
Service Code
|
NDC 0699-3100-02
|
| Hospital Charge Code |
19696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.45 |
| Max. Negotiated Rate |
$172.07 |
| Rate for Payer: Aetna Commercial |
$162.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.27
|
| Rate for Payer: Cash Price |
$152.95
|
| Rate for Payer: Cofinity Commercial |
$133.83
|
| Rate for Payer: Cofinity Commercial |
$164.42
|
| Rate for Payer: Healthscope Commercial |
$172.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.51
|
| Rate for Payer: PHP Commercial |
$162.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.83
|
| Rate for Payer: Priority Health SBD |
$120.45
|
|
|
BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY
|
Facility
IP
|
$129.14
|
|
|
Service Code
|
NDC 0283-0679-60
|
| Hospital Charge Code |
19696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$116.23 |
| Rate for Payer: Aetna Commercial |
$109.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.94
|
| Rate for Payer: Cash Price |
$103.31
|
| Rate for Payer: Cofinity Commercial |
$111.06
|
| Rate for Payer: Cofinity Commercial |
$90.40
|
| Rate for Payer: Healthscope Commercial |
$116.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.77
|
| Rate for Payer: PHP Commercial |
$109.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.40
|
| Rate for Payer: Priority Health SBD |
$81.36
|
|
|
BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY
|
Facility
IP
|
$100.09
|
|
|
Service Code
|
NDC 0283-0679-02
|
| Hospital Charge Code |
19696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.06 |
| Max. Negotiated Rate |
$90.08 |
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.06
|
| Rate for Payer: Cash Price |
$80.07
|
| Rate for Payer: Cofinity Commercial |
$70.06
|
| Rate for Payer: Cofinity Commercial |
$86.08
|
| Rate for Payer: Healthscope Commercial |
$90.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.08
|
| Rate for Payer: PHP Commercial |
$85.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.06
|
| Rate for Payer: Priority Health SBD |
$63.06
|
|
|
BENZOCAINE 20 % TOPICAL AEROSOL
|
Facility
IP
|
$59.51
|
|
|
Service Code
|
NDC 6373637882
|
| Hospital Charge Code |
108881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$53.56 |
| Rate for Payer: Aetna Commercial |
$50.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.68
|
| Rate for Payer: Cash Price |
$47.61
|
| Rate for Payer: Cofinity Commercial |
$41.66
|
| Rate for Payer: Cofinity Commercial |
$51.18
|
| Rate for Payer: Healthscope Commercial |
$53.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.58
|
| Rate for Payer: PHP Commercial |
$50.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.66
|
| Rate for Payer: Priority Health SBD |
$37.49
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
IP
|
$404.70
|
|
|
Service Code
|
NDC 63739-029-10
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.96 |
| Max. Negotiated Rate |
$364.23 |
| Rate for Payer: Aetna Commercial |
$344.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.06
|
| Rate for Payer: Cash Price |
$323.76
|
| Rate for Payer: Cofinity Commercial |
$283.29
|
| Rate for Payer: Cofinity Commercial |
$348.04
|
| Rate for Payer: Healthscope Commercial |
$364.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$344.00
|
| Rate for Payer: PHP Commercial |
$344.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.29
|
| Rate for Payer: Priority Health SBD |
$254.96
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
IP
|
$302.10
|
|
|
Service Code
|
NDC 0904-6564-61
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.32 |
| Max. Negotiated Rate |
$271.89 |
| Rate for Payer: Aetna Commercial |
$256.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.36
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$211.47
|
| Rate for Payer: Cofinity Commercial |
$259.81
|
| Rate for Payer: Healthscope Commercial |
$271.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$256.78
|
| Rate for Payer: PHP Commercial |
$256.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.47
|
| Rate for Payer: Priority Health SBD |
$190.32
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
IP
|
$408.50
|
|
|
Service Code
|
NDC 60687-346-01
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.36 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna Commercial |
$347.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.52
|
| Rate for Payer: Cash Price |
$326.80
|
| Rate for Payer: Cofinity Commercial |
$285.95
|
| Rate for Payer: Cofinity Commercial |
$351.31
|
| Rate for Payer: Healthscope Commercial |
$367.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$347.22
|
| Rate for Payer: PHP Commercial |
$347.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.95
|
| Rate for Payer: Priority Health SBD |
$257.36
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
IP
|
$131.60
|
|
|
Service Code
|
NDC 42806-714-01
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.91 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.86
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.12
|
| Rate for Payer: Priority Health SBD |
$82.91
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
IP
|
$193.80
|
|
|
Service Code
|
NDC 68382-247-01
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.09 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Commercial |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.73
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.66
|
| Rate for Payer: Priority Health SBD |
$122.09
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
IP
|
$4.09
|
|
|
Service Code
|
NDC 60687-346-11
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.66
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health SBD |
$2.58
|
|
|
BENZTROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
IP
|
$189.80
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
9259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.57 |
| Max. Negotiated Rate |
$170.82 |
| Rate for Payer: Aetna Commercial |
$161.33
|
| Rate for Payer: Aetna Commercial |
$69.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.13
|
| Rate for Payer: Cash Price |
$65.39
|
| Rate for Payer: Cash Price |
$151.84
|
| Rate for Payer: Cofinity Commercial |
$70.30
|
| Rate for Payer: Cofinity Commercial |
$163.23
|
| Rate for Payer: Cofinity Commercial |
$132.86
|
| Rate for Payer: Cofinity Commercial |
$57.22
|
| Rate for Payer: Healthscope Commercial |
$170.82
|
| Rate for Payer: Healthscope Commercial |
$73.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.48
|
| Rate for Payer: PHP Commercial |
$69.48
|
| Rate for Payer: PHP Commercial |
$161.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.22
|
| Rate for Payer: Priority Health SBD |
$119.57
|
| Rate for Payer: Priority Health SBD |
$51.50
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
IP
|
$242.05
|
|
|
Service Code
|
NDC 76385-104-01
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.49 |
| Max. Negotiated Rate |
$217.84 |
| Rate for Payer: Aetna Commercial |
$205.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.33
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cofinity Commercial |
$169.44
|
| Rate for Payer: Cofinity Commercial |
$208.16
|
| Rate for Payer: Healthscope Commercial |
$217.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.74
|
| Rate for Payer: PHP Commercial |
$205.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.44
|
| Rate for Payer: Priority Health SBD |
$152.49
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
IP
|
$350.15
|
|
|
Service Code
|
NDC 0603-2438-21
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.59 |
| Max. Negotiated Rate |
$315.14 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Healthscope Commercial |
$315.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.63
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.10
|
| Rate for Payer: Priority Health SBD |
$220.59
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
IP
|
$287.85
|
|
|
Service Code
|
NDC 0904-6790-61
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.35 |
| Max. Negotiated Rate |
$259.06 |
| Rate for Payer: Aetna Commercial |
$244.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.10
|
| Rate for Payer: Cash Price |
$230.28
|
| Rate for Payer: Cofinity Commercial |
$201.50
|
| Rate for Payer: Cofinity Commercial |
$247.55
|
| Rate for Payer: Healthscope Commercial |
$259.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$244.67
|
| Rate for Payer: PHP Commercial |
$244.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: Priority Health SBD |
$181.35
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
IP
|
$4.32
|
|
|
Service Code
|
NDC 68084-388-11
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.81
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Healthscope Commercial |
$3.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.67
|
| Rate for Payer: PHP Commercial |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.02
|
| Rate for Payer: Priority Health SBD |
$2.72
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
IP
|
$4.34
|
|
|
Service Code
|
NDC 60687-368-11
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$3.91 |
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.82
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$3.73
|
| Rate for Payer: Healthscope Commercial |
$3.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.69
|
| Rate for Payer: PHP Commercial |
$3.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.04
|
| Rate for Payer: Priority Health SBD |
$2.73
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
IP
|
$162.15
|
|
|
Service Code
|
NDC 69315-137-01
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.40
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Commercial |
$113.50
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.83
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.50
|
| Rate for Payer: Priority Health SBD |
$102.15
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
IP
|
$431.30
|
|
|
Service Code
|
NDC 68084-388-01
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.72 |
| Max. Negotiated Rate |
$388.17 |
| Rate for Payer: Aetna Commercial |
$366.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.34
|
| Rate for Payer: Cash Price |
$345.04
|
| Rate for Payer: Cofinity Commercial |
$301.91
|
| Rate for Payer: Cofinity Commercial |
$370.92
|
| Rate for Payer: Healthscope Commercial |
$388.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$366.60
|
| Rate for Payer: PHP Commercial |
$366.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.91
|
| Rate for Payer: Priority Health SBD |
$271.72
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
IP
|
$2,021.00
|
|
|
Service Code
|
NDC 76385-104-10
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,273.23 |
| Max. Negotiated Rate |
$1,818.90 |
| Rate for Payer: Aetna Commercial |
$1,717.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,313.65
|
| Rate for Payer: Cash Price |
$1,616.80
|
| Rate for Payer: Cofinity Commercial |
$1,414.70
|
| Rate for Payer: Cofinity Commercial |
$1,738.06
|
| Rate for Payer: Healthscope Commercial |
$1,818.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,717.85
|
| Rate for Payer: PHP Commercial |
$1,717.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.70
|
| Rate for Payer: Priority Health SBD |
$1,273.23
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
IP
|
$433.20
|
|
|
Service Code
|
NDC 60687-368-01
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.92 |
| Max. Negotiated Rate |
$389.88 |
| Rate for Payer: Aetna Commercial |
$368.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.58
|
| Rate for Payer: Cash Price |
$346.56
|
| Rate for Payer: Cofinity Commercial |
$303.24
|
| Rate for Payer: Cofinity Commercial |
$372.55
|
| Rate for Payer: Healthscope Commercial |
$389.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$368.22
|
| Rate for Payer: PHP Commercial |
$368.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.24
|
| Rate for Payer: Priority Health SBD |
$272.92
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
OP
|
$153.53
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.17 |
| Max. Negotiated Rate |
$138.18 |
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.79
|
| Rate for Payer: BCBS Complete |
$61.41
|
| Rate for Payer: BCBS Trust/PPO |
$20.17
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cofinity Commercial |
$107.47
|
| Rate for Payer: Cofinity Commercial |
$132.04
|
| Rate for Payer: Healthscope Commercial |
$138.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.50
|
| Rate for Payer: PHP Commercial |
$130.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.47
|
| Rate for Payer: Priority Health SBD |
$96.72
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
IP
|
$155.53
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.98 |
| Max. Negotiated Rate |
$139.98 |
| Rate for Payer: Aetna Commercial |
$132.20
|
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna Commercial |
$131.94
|
| Rate for Payer: Aetna Commercial |
$146.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.09
|
| Rate for Payer: Cash Price |
$137.49
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cash Price |
$124.18
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cofinity Commercial |
$132.04
|
| Rate for Payer: Cofinity Commercial |
$120.30
|
| Rate for Payer: Cofinity Commercial |
$147.80
|
| Rate for Payer: Cofinity Commercial |
$108.65
|
| Rate for Payer: Cofinity Commercial |
$108.87
|
| Rate for Payer: Cofinity Commercial |
$133.76
|
| Rate for Payer: Cofinity Commercial |
$133.49
|
| Rate for Payer: Cofinity Commercial |
$107.47
|
| Rate for Payer: Healthscope Commercial |
$154.67
|
| Rate for Payer: Healthscope Commercial |
$139.98
|
| Rate for Payer: Healthscope Commercial |
$139.70
|
| Rate for Payer: Healthscope Commercial |
$138.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$146.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.94
|
| Rate for Payer: PHP Commercial |
$130.50
|
| Rate for Payer: PHP Commercial |
$131.94
|
| Rate for Payer: PHP Commercial |
$146.08
|
| Rate for Payer: PHP Commercial |
$132.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.30
|
| Rate for Payer: Priority Health SBD |
$97.79
|
| Rate for Payer: Priority Health SBD |
$96.72
|
| Rate for Payer: Priority Health SBD |
$108.27
|
| Rate for Payer: Priority Health SBD |
$97.98
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM
|
Facility
IP
|
$74.40
|
|
|
Service Code
|
NDC 0168-0040-15
|
| Hospital Charge Code |
1031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.87 |
| Max. Negotiated Rate |
$66.96 |
| Rate for Payer: Aetna Commercial |
$63.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.36
|
| Rate for Payer: Cash Price |
$59.52
|
| Rate for Payer: Cofinity Commercial |
$52.08
|
| Rate for Payer: Cofinity Commercial |
$63.98
|
| Rate for Payer: Healthscope Commercial |
$66.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.24
|
| Rate for Payer: PHP Commercial |
$63.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.08
|
| Rate for Payer: Priority Health SBD |
$46.87
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM
|
Facility
IP
|
$35.97
|
|
|
Service Code
|
NDC 0713-0326-15
|
| Hospital Charge Code |
1031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$32.37 |
| Rate for Payer: Aetna Commercial |
$30.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.38
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: Cofinity Commercial |
$25.18
|
| Rate for Payer: Cofinity Commercial |
$30.93
|
| Rate for Payer: Healthscope Commercial |
$32.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.57
|
| Rate for Payer: PHP Commercial |
$30.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.18
|
| Rate for Payer: Priority Health SBD |
$22.66
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$3,041.53
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
38022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.52 |
| Max. Negotiated Rate |
$2,737.38 |
| Rate for Payer: Aetna Commercial |
$2,585.30
|
| Rate for Payer: Aetna Commercial |
$10,341.19
|
| Rate for Payer: Aetna Medicare |
$77.04
|
| Rate for Payer: Aetna Medicare |
$77.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,907.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,976.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.59
|
| Rate for Payer: BCBS Complete |
$42.55
|
| Rate for Payer: BCBS Complete |
$42.55
|
| Rate for Payer: BCBS MAPPO |
$74.07
|
| Rate for Payer: BCBS MAPPO |
$74.07
|
| Rate for Payer: BCBS Trust/PPO |
$219.29
|
| Rate for Payer: BCBS Trust/PPO |
$219.29
|
| Rate for Payer: BCN Medicare Advantage |
$74.07
|
| Rate for Payer: BCN Medicare Advantage |
$74.07
|
| Rate for Payer: Cash Price |
$2,433.22
|
| Rate for Payer: Cash Price |
$2,433.22
|
| Rate for Payer: Cash Price |
$9,732.89
|
| Rate for Payer: Cash Price |
$9,732.89
|
| Rate for Payer: Cofinity Commercial |
$2,129.07
|
| Rate for Payer: Cofinity Commercial |
$10,462.85
|
| Rate for Payer: Cofinity Commercial |
$8,516.28
|
| Rate for Payer: Cofinity Commercial |
$2,615.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.07
|
| Rate for Payer: Healthscope Commercial |
$10,949.50
|
| Rate for Payer: Healthscope Commercial |
$2,737.38
|
| Rate for Payer: Mclaren Medicaid |
$40.52
|
| Rate for Payer: Mclaren Medicaid |
$40.52
|
| Rate for Payer: Mclaren Medicare |
$74.07
|
| Rate for Payer: Mclaren Medicare |
$74.07
|
| Rate for Payer: Meridian Medicaid |
$42.55
|
| Rate for Payer: Meridian Medicaid |
$42.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,341.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,585.30
|
| Rate for Payer: PACE Medicare |
$70.37
|
| Rate for Payer: PACE Medicare |
$70.37
|
| Rate for Payer: PACE SWMI |
$74.07
|
| Rate for Payer: PACE SWMI |
$74.07
|
| Rate for Payer: PHP Commercial |
$10,341.19
|
| Rate for Payer: PHP Commercial |
$2,585.30
|
| Rate for Payer: PHP Medicare Advantage |
$74.07
|
| Rate for Payer: PHP Medicare Advantage |
$74.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,129.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,516.28
|
| Rate for Payer: Priority Health Medicare |
$74.07
|
| Rate for Payer: Priority Health Medicare |
$74.07
|
| Rate for Payer: Priority Health SBD |
$1,916.16
|
| Rate for Payer: Priority Health SBD |
$7,664.65
|
| Rate for Payer: Railroad Medicare Medicare |
$74.07
|
| Rate for Payer: Railroad Medicare Medicare |
$74.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.07
|
| Rate for Payer: UHC Medicare Advantage |
$76.30
|
| Rate for Payer: UHC Medicare Advantage |
$76.30
|
| Rate for Payer: VA VA |
$74.07
|
| Rate for Payer: VA VA |
$74.07
|
|
