|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$60.35
|
|
|
Service Code
|
NDC 00132007924
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare |
$30.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: BCBS Complete |
$24.14
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.28
|
| Rate for Payer: Healthscope Commercial |
$54.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.30
|
| Rate for Payer: PHP Commercial |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.23
|
| Rate for Payer: Priority Health SBD |
$38.02
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$60.35
|
|
|
Service Code
|
NDC 00132007924
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.02 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.28
|
| Rate for Payer: Healthscope Commercial |
$54.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.30
|
| Rate for Payer: PHP Commercial |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.23
|
| Rate for Payer: Priority Health SBD |
$38.02
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
NDC 00132007950
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.26 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.05
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.05
|
| Rate for Payer: Priority Health SBD |
$56.26
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$89.30
|
|
|
Service Code
|
NDC 00132007950
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.72 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna Medicare |
$44.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.05
|
| Rate for Payer: BCBS Complete |
$35.72
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.05
|
| Rate for Payer: Priority Health SBD |
$56.26
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$37.51
|
|
|
Service Code
|
NDC 00132008112
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$33.76 |
| Rate for Payer: Aetna Commercial |
$31.88
|
| Rate for Payer: Aetna Medicare |
$18.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.38
|
| Rate for Payer: BCBS Complete |
$15.00
|
| Rate for Payer: Cash Price |
$30.01
|
| Rate for Payer: Cofinity Commercial |
$26.26
|
| Rate for Payer: Cofinity Commercial |
$32.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.01
|
| Rate for Payer: Healthscope Commercial |
$33.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.88
|
| Rate for Payer: PHP Commercial |
$31.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.38
|
| Rate for Payer: Priority Health SBD |
$23.63
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$49.35
|
|
|
Service Code
|
NDC 70000042901
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.08
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Commercial |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$44.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.08
|
| Rate for Payer: Priority Health SBD |
$31.09
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$49.35
|
|
|
Service Code
|
NDC 70000042901
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.74 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: Aetna Medicare |
$24.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.08
|
| Rate for Payer: BCBS Complete |
$19.74
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Commercial |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$44.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.08
|
| Rate for Payer: Priority Health SBD |
$31.09
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$37.51
|
|
|
Service Code
|
NDC 00132008112
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.63 |
| Max. Negotiated Rate |
$33.76 |
| Rate for Payer: Aetna Commercial |
$31.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.38
|
| Rate for Payer: Cash Price |
$30.01
|
| Rate for Payer: Cofinity Commercial |
$26.26
|
| Rate for Payer: Cofinity Commercial |
$32.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.01
|
| Rate for Payer: Healthscope Commercial |
$33.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.88
|
| Rate for Payer: PHP Commercial |
$31.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.38
|
| Rate for Payer: Priority Health SBD |
$23.63
|
|
|
GLYCERIN-WITCH HAZEL 12.5 %-50 % TOPICAL PADS
|
Facility
|
OP
|
$11.70
|
|
|
Service Code
|
NDC 50289325001
|
| Hospital Charge Code |
116088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna Commercial |
$9.95
|
| Rate for Payer: Aetna Medicare |
$5.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.61
|
| Rate for Payer: BCBS Complete |
$4.68
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.95
|
| Rate for Payer: PHP Commercial |
$9.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.61
|
| Rate for Payer: Priority Health SBD |
$7.37
|
|
|
GLYCERIN-WITCH HAZEL 12.5 %-50 % TOPICAL PADS
|
Facility
|
IP
|
$11.70
|
|
|
Service Code
|
NDC 50289325001
|
| Hospital Charge Code |
116088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna Commercial |
$9.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.61
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.95
|
| Rate for Payer: PHP Commercial |
$9.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.61
|
| Rate for Payer: Priority Health SBD |
$7.37
|
|
|
GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$14.88
|
|
|
Service Code
|
HCPCS J1596
|
| Hospital Charge Code |
3497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Aetna Commercial |
$12.65
|
| Rate for Payer: Aetna Commercial |
$16.17
|
| Rate for Payer: Aetna Commercial |
$13.57
|
| Rate for Payer: Aetna Commercial |
$20.55
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Commercial |
$18.34
|
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Commercial |
$12.73
|
| Rate for Payer: Aetna Commercial |
$15.68
|
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: Aetna Commercial |
$18.47
|
| Rate for Payer: Aetna Commercial |
$13.12
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: Cash Price |
$17.26
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cash Price |
$20.23
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cash Price |
$20.23
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$17.26
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cash Price |
$15.22
|
| Rate for Payer: Cash Price |
$20.41
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cash Price |
$15.22
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$14.76
|
| Rate for Payer: Cash Price |
$14.76
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cash Price |
$20.41
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cofinity Commercial |
$13.27
|
| Rate for Payer: Cofinity Commercial |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$13.31
|
| Rate for Payer: Cofinity Commercial |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$22.35
|
| Rate for Payer: Cofinity Commercial |
$27.46
|
| Rate for Payer: Cofinity Commercial |
$16.93
|
| Rate for Payer: Cofinity Commercial |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.56
|
| Rate for Payer: Cofinity Commercial |
$10.49
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Cofinity Commercial |
$21.94
|
| Rate for Payer: Cofinity Commercial |
$21.75
|
| Rate for Payer: Cofinity Commercial |
$17.70
|
| Rate for Payer: Cofinity Commercial |
$15.21
|
| Rate for Payer: Cofinity Commercial |
$18.69
|
| Rate for Payer: Cofinity Commercial |
$13.73
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Cofinity Commercial |
$11.18
|
| Rate for Payer: Cofinity Commercial |
$10.42
|
| Rate for Payer: Cofinity Commercial |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$12.88
|
| Rate for Payer: Cofinity Commercial |
$13.67
|
| Rate for Payer: Cofinity Commercial |
$11.13
|
| Rate for Payer: Cofinity Commercial |
$12.91
|
| Rate for Payer: Cofinity Commercial |
$15.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$22.96
|
| Rate for Payer: Healthscope Commercial |
$14.37
|
| Rate for Payer: Healthscope Commercial |
$13.39
|
| Rate for Payer: Healthscope Commercial |
$13.48
|
| Rate for Payer: Healthscope Commercial |
$22.76
|
| Rate for Payer: Healthscope Commercial |
$19.42
|
| Rate for Payer: Healthscope Commercial |
$13.89
|
| Rate for Payer: Healthscope Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$19.56
|
| Rate for Payer: Healthscope Commercial |
$21.76
|
| Rate for Payer: Healthscope Commercial |
$28.74
|
| Rate for Payer: Healthscope Commercial |
$17.12
|
| Rate for Payer: Healthscope Commercial |
$16.61
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.65
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PHP Commercial |
$13.12
|
| Rate for Payer: PHP Commercial |
$27.14
|
| Rate for Payer: PHP Commercial |
$18.47
|
| Rate for Payer: PHP Commercial |
$15.68
|
| Rate for Payer: PHP Commercial |
$14.03
|
| Rate for Payer: PHP Commercial |
$13.57
|
| Rate for Payer: PHP Commercial |
$12.65
|
| Rate for Payer: PHP Commercial |
$12.73
|
| Rate for Payer: PHP Commercial |
$16.17
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Commercial |
$20.55
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: PHP Commercial |
$18.34
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.72
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health SBD |
$11.98
|
| Rate for Payer: Priority Health SBD |
$15.93
|
| Rate for Payer: Priority Health SBD |
$13.60
|
| Rate for Payer: Priority Health SBD |
$10.06
|
| Rate for Payer: Priority Health SBD |
$9.72
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: Priority Health SBD |
$10.02
|
| Rate for Payer: Priority Health SBD |
$9.37
|
| Rate for Payer: Priority Health SBD |
$9.44
|
| Rate for Payer: Priority Health SBD |
$10.40
|
| Rate for Payer: Priority Health SBD |
$15.23
|
| Rate for Payer: Priority Health SBD |
$20.12
|
| Rate for Payer: Priority Health SBD |
$11.62
|
| Rate for Payer: Priority Health SBD |
$13.69
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
|
|
GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$14.88
|
|
|
Service Code
|
HCPCS J1596
|
| Hospital Charge Code |
3497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Aetna Commercial |
$12.65
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Commercial |
$12.73
|
| Rate for Payer: Aetna Commercial |
$13.12
|
| Rate for Payer: Aetna Commercial |
$13.57
|
| Rate for Payer: Aetna Commercial |
$18.47
|
| Rate for Payer: Aetna Commercial |
$18.34
|
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: Aetna Commercial |
$16.17
|
| Rate for Payer: Aetna Commercial |
$15.68
|
| Rate for Payer: Aetna Commercial |
$20.55
|
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cash Price |
$20.23
|
| Rate for Payer: Cash Price |
$17.26
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$15.22
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cash Price |
$14.76
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cash Price |
$20.41
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cofinity Commercial |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$13.67
|
| Rate for Payer: Cofinity Commercial |
$11.13
|
| Rate for Payer: Cofinity Commercial |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$13.27
|
| Rate for Payer: Cofinity Commercial |
$10.49
|
| Rate for Payer: Cofinity Commercial |
$12.88
|
| Rate for Payer: Cofinity Commercial |
$10.42
|
| Rate for Payer: Cofinity Commercial |
$11.18
|
| Rate for Payer: Cofinity Commercial |
$13.73
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$12.91
|
| Rate for Payer: Cofinity Commercial |
$15.87
|
| Rate for Payer: Cofinity Commercial |
$13.31
|
| Rate for Payer: Cofinity Commercial |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.56
|
| Rate for Payer: Cofinity Commercial |
$15.21
|
| Rate for Payer: Cofinity Commercial |
$18.69
|
| Rate for Payer: Cofinity Commercial |
$16.93
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Cofinity Commercial |
$17.70
|
| Rate for Payer: Cofinity Commercial |
$21.75
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$21.94
|
| Rate for Payer: Cofinity Commercial |
$22.35
|
| Rate for Payer: Cofinity Commercial |
$27.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.21
|
| Rate for Payer: Healthscope Commercial |
$13.89
|
| Rate for Payer: Healthscope Commercial |
$19.56
|
| Rate for Payer: Healthscope Commercial |
$22.96
|
| Rate for Payer: Healthscope Commercial |
$13.39
|
| Rate for Payer: Healthscope Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$13.48
|
| Rate for Payer: Healthscope Commercial |
$22.76
|
| Rate for Payer: Healthscope Commercial |
$28.74
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$17.12
|
| Rate for Payer: Healthscope Commercial |
$16.61
|
| Rate for Payer: Healthscope Commercial |
$21.76
|
| Rate for Payer: Healthscope Commercial |
$19.42
|
| Rate for Payer: Healthscope Commercial |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.55
|
| Rate for Payer: PHP Commercial |
$18.34
|
| Rate for Payer: PHP Commercial |
$13.12
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: PHP Commercial |
$20.55
|
| Rate for Payer: PHP Commercial |
$15.68
|
| Rate for Payer: PHP Commercial |
$13.57
|
| Rate for Payer: PHP Commercial |
$12.65
|
| Rate for Payer: PHP Commercial |
$16.17
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: PHP Commercial |
$12.73
|
| Rate for Payer: PHP Commercial |
$27.14
|
| Rate for Payer: PHP Commercial |
$14.03
|
| Rate for Payer: PHP Commercial |
$18.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.38
|
| Rate for Payer: Priority Health SBD |
$15.93
|
| Rate for Payer: Priority Health SBD |
$15.23
|
| Rate for Payer: Priority Health SBD |
$10.40
|
| Rate for Payer: Priority Health SBD |
$10.06
|
| Rate for Payer: Priority Health SBD |
$9.44
|
| Rate for Payer: Priority Health SBD |
$9.37
|
| Rate for Payer: Priority Health SBD |
$10.02
|
| Rate for Payer: Priority Health SBD |
$20.12
|
| Rate for Payer: Priority Health SBD |
$13.69
|
| Rate for Payer: Priority Health SBD |
$13.60
|
| Rate for Payer: Priority Health SBD |
$11.98
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: Priority Health SBD |
$11.62
|
| Rate for Payer: Priority Health SBD |
$9.72
|
|
|
GLYCOPYRROLATE 0.2 MG/ML ORAL SOLN (CUSTOM)
|
Facility
|
IP
|
$442.67
|
|
|
Service Code
|
NDC 00900000230
|
| Hospital Charge Code |
158482
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$278.88 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna Commercial |
$376.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.74
|
| Rate for Payer: Cash Price |
$354.14
|
| Rate for Payer: Cofinity Commercial |
$309.87
|
| Rate for Payer: Cofinity Commercial |
$380.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.14
|
| Rate for Payer: Healthscope Commercial |
$398.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.27
|
| Rate for Payer: PHP Commercial |
$376.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.74
|
| Rate for Payer: Priority Health SBD |
$278.88
|
|
|
GLYCOPYRROLATE 0.2 MG/ML ORAL SOLN (CUSTOM)
|
Facility
|
OP
|
$442.67
|
|
|
Service Code
|
NDC 00900000230
|
| Hospital Charge Code |
158482
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$177.07 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna Commercial |
$376.27
|
| Rate for Payer: Aetna Medicare |
$221.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.74
|
| Rate for Payer: BCBS Complete |
$177.07
|
| Rate for Payer: Cash Price |
$354.14
|
| Rate for Payer: Cofinity Commercial |
$309.87
|
| Rate for Payer: Cofinity Commercial |
$380.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.14
|
| Rate for Payer: Healthscope Commercial |
$398.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.27
|
| Rate for Payer: PHP Commercial |
$376.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.74
|
| Rate for Payer: Priority Health SBD |
$278.88
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
OP
|
$246.75
|
|
|
Service Code
|
NDC 23155060601
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$222.07 |
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna Medicare |
$123.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: BCBS Complete |
$98.70
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.39
|
| Rate for Payer: Priority Health SBD |
$155.45
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
IP
|
$385.70
|
|
|
Service Code
|
NDC 69076047501
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.99 |
| Max. Negotiated Rate |
$347.13 |
| Rate for Payer: Aetna Commercial |
$327.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.71
|
| Rate for Payer: Cash Price |
$308.56
|
| Rate for Payer: Cofinity Commercial |
$269.99
|
| Rate for Payer: Cofinity Commercial |
$331.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.56
|
| Rate for Payer: Healthscope Commercial |
$347.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.85
|
| Rate for Payer: PHP Commercial |
$327.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.71
|
| Rate for Payer: Priority Health SBD |
$242.99
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
IP
|
$246.75
|
|
|
Service Code
|
NDC 23155060601
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.45 |
| Max. Negotiated Rate |
$222.07 |
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.39
|
| Rate for Payer: Priority Health SBD |
$155.45
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
IP
|
$380.16
|
|
|
Service Code
|
NDC 00904670961
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.50 |
| Max. Negotiated Rate |
$342.14 |
| Rate for Payer: Aetna Commercial |
$323.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.10
|
| Rate for Payer: Cash Price |
$304.13
|
| Rate for Payer: Cofinity Commercial |
$266.11
|
| Rate for Payer: Cofinity Commercial |
$326.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.13
|
| Rate for Payer: Healthscope Commercial |
$342.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.14
|
| Rate for Payer: PHP Commercial |
$323.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.10
|
| Rate for Payer: Priority Health SBD |
$239.50
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
OP
|
$380.16
|
|
|
Service Code
|
NDC 00904670961
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.06 |
| Max. Negotiated Rate |
$342.14 |
| Rate for Payer: Aetna Commercial |
$323.14
|
| Rate for Payer: Aetna Medicare |
$190.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.10
|
| Rate for Payer: BCBS Complete |
$152.06
|
| Rate for Payer: Cash Price |
$304.13
|
| Rate for Payer: Cofinity Commercial |
$266.11
|
| Rate for Payer: Cofinity Commercial |
$326.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.13
|
| Rate for Payer: Healthscope Commercial |
$342.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.14
|
| Rate for Payer: PHP Commercial |
$323.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.10
|
| Rate for Payer: Priority Health SBD |
$239.50
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
OP
|
$385.70
|
|
|
Service Code
|
NDC 69076047501
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$347.13 |
| Rate for Payer: Aetna Commercial |
$327.85
|
| Rate for Payer: Aetna Medicare |
$192.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.71
|
| Rate for Payer: BCBS Complete |
$154.28
|
| Rate for Payer: Cash Price |
$308.56
|
| Rate for Payer: Cofinity Commercial |
$269.99
|
| Rate for Payer: Cofinity Commercial |
$331.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.56
|
| Rate for Payer: Healthscope Commercial |
$347.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.85
|
| Rate for Payer: PHP Commercial |
$327.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.71
|
| Rate for Payer: Priority Health SBD |
$242.99
|
|
|
GOLIMUMAB 12.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,234.37
|
|
|
Service Code
|
HCPCS J1602
|
| Hospital Charge Code |
167346
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,927.65 |
| Max. Negotiated Rate |
$5,610.93 |
| Rate for Payer: Aetna Commercial |
$5,299.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,052.34
|
| Rate for Payer: Cash Price |
$4,987.50
|
| Rate for Payer: Cofinity Commercial |
$4,364.06
|
| Rate for Payer: Cofinity Commercial |
$5,361.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,364.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,987.50
|
| Rate for Payer: Healthscope Commercial |
$5,610.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,299.21
|
| Rate for Payer: PHP Commercial |
$5,299.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,052.34
|
| Rate for Payer: Priority Health SBD |
$3,927.65
|
|
|
GOLIMUMAB 12.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,234.37
|
|
|
Service Code
|
HCPCS J1602
|
| Hospital Charge Code |
167346
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$5,610.93 |
| Rate for Payer: Aetna Commercial |
$5,299.21
|
| Rate for Payer: Aetna Medicare |
$11.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,052.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.80
|
| Rate for Payer: BCBS Complete |
$6.21
|
| Rate for Payer: BCBS MAPPO |
$11.04
|
| Rate for Payer: BCN Medicare Advantage |
$11.04
|
| Rate for Payer: Cash Price |
$4,987.50
|
| Rate for Payer: Cash Price |
$4,987.50
|
| Rate for Payer: Cofinity Commercial |
$4,364.06
|
| Rate for Payer: Cofinity Commercial |
$5,361.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,364.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,987.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.04
|
| Rate for Payer: Healthscope Commercial |
$5,610.93
|
| Rate for Payer: Mclaren Medicaid |
$5.92
|
| Rate for Payer: Mclaren Medicare |
$11.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.59
|
| Rate for Payer: Meridian Medicaid |
$6.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,299.21
|
| Rate for Payer: PACE Medicare |
$10.49
|
| Rate for Payer: PACE SWMI |
$11.04
|
| Rate for Payer: PHP Commercial |
$5,299.21
|
| Rate for Payer: PHP Medicare Advantage |
$11.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,052.34
|
| Rate for Payer: Priority Health Medicare |
$11.04
|
| Rate for Payer: Priority Health SBD |
$3,927.65
|
| Rate for Payer: Railroad Medicare Medicare |
$11.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.04
|
| Rate for Payer: UHC Medicare Advantage |
$11.04
|
| Rate for Payer: UHCCP Medicaid |
$6.22
|
| Rate for Payer: VA VA |
$11.04
|
|
|
GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT
|
Facility
|
OP
|
$3,364.48
|
|
|
Service Code
|
HCPCS J9202
|
| Hospital Charge Code |
10137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$393.25 |
| Max. Negotiated Rate |
$3,028.03 |
| Rate for Payer: Aetna Commercial |
$2,859.81
|
| Rate for Payer: Aetna Medicare |
$763.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,186.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$917.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$917.09
|
| Rate for Payer: BCBS Complete |
$412.91
|
| Rate for Payer: BCBS MAPPO |
$733.67
|
| Rate for Payer: BCN Medicare Advantage |
$733.67
|
| Rate for Payer: Cash Price |
$2,691.58
|
| Rate for Payer: Cash Price |
$2,691.58
|
| Rate for Payer: Cofinity Commercial |
$2,893.45
|
| Rate for Payer: Cofinity Commercial |
$2,355.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,355.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,691.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$733.67
|
| Rate for Payer: Healthscope Commercial |
$3,028.03
|
| Rate for Payer: Mclaren Medicaid |
$393.25
|
| Rate for Payer: Mclaren Medicare |
$733.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$770.35
|
| Rate for Payer: Meridian Medicaid |
$412.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$843.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,859.81
|
| Rate for Payer: PACE Medicare |
$696.99
|
| Rate for Payer: PACE SWMI |
$733.67
|
| Rate for Payer: PHP Commercial |
$2,859.81
|
| Rate for Payer: PHP Medicare Advantage |
$733.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$393.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,186.91
|
| Rate for Payer: Priority Health Medicare |
$733.67
|
| Rate for Payer: Priority Health SBD |
$2,119.62
|
| Rate for Payer: Railroad Medicare Medicare |
$733.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,065.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$733.67
|
| Rate for Payer: UHC Medicare Advantage |
$733.67
|
| Rate for Payer: UHCCP Medicaid |
$413.06
|
| Rate for Payer: VA VA |
$733.67
|
|
|
GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT
|
Facility
|
IP
|
$3,364.48
|
|
|
Service Code
|
HCPCS J9202
|
| Hospital Charge Code |
10137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,119.62 |
| Max. Negotiated Rate |
$3,028.03 |
| Rate for Payer: Aetna Commercial |
$2,859.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,186.91
|
| Rate for Payer: Cash Price |
$2,691.58
|
| Rate for Payer: Cofinity Commercial |
$2,355.14
|
| Rate for Payer: Cofinity Commercial |
$2,893.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,355.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,691.58
|
| Rate for Payer: Healthscope Commercial |
$3,028.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,859.81
|
| Rate for Payer: PHP Commercial |
$2,859.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,186.91
|
| Rate for Payer: Priority Health SBD |
$2,119.62
|
|
|
GRAFT; EAR CARTILAGE, AUTOGENOUS, TO NOSE OR EAR (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 21235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,248.18
|
| Rate for Payer: VA VA |
$5,769.42
|
|
