|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$75.20
|
|
|
Service Code
|
NDC 00093078701
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.55 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Aetna Medicare |
$37.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.88
|
| Rate for Payer: BCBS Complete |
$30.08
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Advantage |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.16
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.40
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health SBD |
$47.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.88
|
| Rate for Payer: UHC Core |
$39.18
|
| Rate for Payer: UHC Exchange |
$29.55
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
NDC 00093078710
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.06 |
| Max. Negotiated Rate |
$634.50 |
| Rate for Payer: Aetna Commercial |
$599.25
|
| Rate for Payer: Aetna Medicare |
$352.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.25
|
| Rate for Payer: BCBS Complete |
$282.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cofinity Advantage |
$493.50
|
| Rate for Payer: Cofinity Commercial |
$606.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.00
|
| Rate for Payer: Healthscope Commercial |
$634.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.75
|
| Rate for Payer: PHP Commercial |
$599.25
|
| Rate for Payer: Priority Health SBD |
$444.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.25
|
| Rate for Payer: UHC Core |
$367.31
|
| Rate for Payer: UHC Exchange |
$277.06
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
IP
|
$75.20
|
|
|
Service Code
|
NDC 00093078701
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.38 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.88
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Advantage |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.16
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.40
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health SBD |
$47.38
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
IP
|
$4.05
|
|
|
Service Code
|
NDC 51079075901
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.63
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Advantage |
$2.83
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.04
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: Priority Health SBD |
$2.55
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$4.05
|
|
|
Service Code
|
NDC 51079075901
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna Medicare |
$2.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.63
|
| Rate for Payer: BCBS Complete |
$1.62
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Advantage |
$2.83
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.04
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: Priority Health SBD |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.63
|
| Rate for Payer: UHC Core |
$2.11
|
| Rate for Payer: UHC Exchange |
$1.59
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
OP
|
$75.20
|
|
|
Service Code
|
NDC 00093075201
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.55 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Aetna Medicare |
$37.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.88
|
| Rate for Payer: BCBS Complete |
$30.08
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Advantage |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.16
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.40
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health SBD |
$47.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.88
|
| Rate for Payer: UHC Core |
$39.18
|
| Rate for Payer: UHC Exchange |
$29.55
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
OP
|
$70.50
|
|
|
Service Code
|
NDC 65862016901
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna Medicare |
$35.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.83
|
| Rate for Payer: BCBS Complete |
$28.20
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Advantage |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health SBD |
$44.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.83
|
| Rate for Payer: UHC Core |
$36.73
|
| Rate for Payer: UHC Exchange |
$27.71
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 00378023101
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.95 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare |
$77.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.81
|
| Rate for Payer: BCBS Complete |
$62.04
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Advantage |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.33
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health SBD |
$97.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.81
|
| Rate for Payer: UHC Core |
$80.81
|
| Rate for Payer: UHC Exchange |
$60.95
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 51079068401
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Advantage |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.85
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health SBD |
$1.56
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 65862016901
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.41 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.83
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Advantage |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health SBD |
$44.41
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 51079068401
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Advantage |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.85
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health SBD |
$1.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.61
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Exchange |
$0.97
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
IP
|
$75.20
|
|
|
Service Code
|
NDC 00093075201
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.38 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.88
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Advantage |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.16
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.40
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health SBD |
$47.38
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
IP
|
$155.10
|
|
|
Service Code
|
NDC 00378023101
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.71 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.81
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Advantage |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.33
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health SBD |
$97.71
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
IP
|
$246.75
|
|
|
Service Code
|
NDC 51079068420
|
| Hospital Charge Code |
718
|
|
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 Advantage |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.21
|
| 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: Opus (Opus Packaging Group) HMA |
$185.06
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health SBD |
$155.45
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
OP
|
$246.75
|
|
|
Service Code
|
NDC 51079068420
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.97 |
| 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 Advantage |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.06
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health SBD |
$155.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.39
|
| Rate for Payer: UHC Core |
$128.56
|
| Rate for Payer: UHC Exchange |
$96.97
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$53,597.31
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
179035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$48,237.58 |
| Rate for Payer: Aetna Commercial |
$45,557.71
|
| Rate for Payer: Aetna Medicare |
$97.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34,838.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.50
|
| Rate for Payer: BCBS Complete |
$51.62
|
| Rate for Payer: BCBS MAPPO |
$94.00
|
| Rate for Payer: BCBS Trust/PPO |
$235.60
|
| Rate for Payer: BCN Commercial |
$235.60
|
| Rate for Payer: BCN Medicare Advantage |
$94.00
|
| Rate for Payer: Cash Price |
$42,877.85
|
| Rate for Payer: Cash Price |
$42,877.85
|
| Rate for Payer: Cofinity Advantage |
$37,518.12
|
| Rate for Payer: Cofinity Commercial |
$46,093.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42,877.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$48,237.58
|
| Rate for Payer: Mclaren Medicaid |
$49.16
|
| Rate for Payer: Mclaren Medicare |
$94.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.70
|
| Rate for Payer: Meridian Medicaid |
$98.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45,557.71
|
| Rate for Payer: Nomi Health Commercial |
$282.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40,197.98
|
| Rate for Payer: PACE Medicare |
$89.30
|
| Rate for Payer: PACE SWMI |
$94.00
|
| Rate for Payer: PHP Commercial |
$45,557.71
|
| Rate for Payer: PHP Medicare Advantage |
$94.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$288.09
|
| Rate for Payer: Priority Health Medicare |
$94.00
|
| Rate for Payer: Priority Health SBD |
$33,766.31
|
| Rate for Payer: Priority Health Tiered Network |
$230.47
|
| Rate for Payer: Railroad Medicare Medicare |
$94.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.95
|
| Rate for Payer: UHC Core |
$154.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.00
|
| Rate for Payer: UHC Exchange |
$154.95
|
| Rate for Payer: UHC Medicaid |
$49.16
|
| Rate for Payer: UHCCP Medicaid |
$49.16
|
| Rate for Payer: VA VA |
$94.00
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$53,597.31
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
179035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33,766.31 |
| Max. Negotiated Rate |
$48,237.58 |
| Rate for Payer: Aetna Commercial |
$45,557.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34,838.25
|
| Rate for Payer: Cash Price |
$42,877.85
|
| Rate for Payer: Cofinity Advantage |
$37,518.12
|
| Rate for Payer: Cofinity Commercial |
$46,093.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42,877.85
|
| Rate for Payer: Healthscope Commercial |
$48,237.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45,557.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40,197.98
|
| Rate for Payer: PHP Commercial |
$45,557.71
|
| Rate for Payer: Priority Health SBD |
$33,766.31
|
|
|
ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$37,518.18
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
189931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$33,766.36 |
| Rate for Payer: Aetna Commercial |
$31,890.45
|
| Rate for Payer: Aetna Medicare |
$97.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24,386.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.50
|
| Rate for Payer: BCBS Complete |
$51.62
|
| Rate for Payer: BCBS MAPPO |
$94.00
|
| Rate for Payer: BCBS Trust/PPO |
$235.60
|
| Rate for Payer: BCN Commercial |
$235.60
|
| Rate for Payer: BCN Medicare Advantage |
$94.00
|
| Rate for Payer: Cash Price |
$30,014.54
|
| Rate for Payer: Cash Price |
$30,014.54
|
| Rate for Payer: Cofinity Advantage |
$26,262.73
|
| Rate for Payer: Cofinity Commercial |
$32,265.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,014.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$33,766.36
|
| Rate for Payer: Mclaren Medicaid |
$49.16
|
| Rate for Payer: Mclaren Medicare |
$94.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.70
|
| Rate for Payer: Meridian Medicaid |
$98.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,890.45
|
| Rate for Payer: Nomi Health Commercial |
$282.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28,138.63
|
| Rate for Payer: PACE Medicare |
$89.30
|
| Rate for Payer: PACE SWMI |
$94.00
|
| Rate for Payer: PHP Commercial |
$31,890.45
|
| Rate for Payer: PHP Medicare Advantage |
$94.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$288.09
|
| Rate for Payer: Priority Health Medicare |
$94.00
|
| Rate for Payer: Priority Health SBD |
$23,636.45
|
| Rate for Payer: Priority Health Tiered Network |
$230.47
|
| Rate for Payer: Railroad Medicare Medicare |
$94.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.95
|
| Rate for Payer: UHC Core |
$154.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.00
|
| Rate for Payer: UHC Exchange |
$154.95
|
| Rate for Payer: UHC Medicaid |
$49.16
|
| Rate for Payer: UHCCP Medicaid |
$49.16
|
| Rate for Payer: VA VA |
$94.00
|
|
|
ATHEROSCLEROSIS WITH MCC
|
Facility
|
IP
|
$28,136.42
|
|
|
Service Code
|
MSDRG 302
|
| Min. Negotiated Rate |
$9,335.25 |
| Max. Negotiated Rate |
$28,136.42 |
| Rate for Payer: Aetna Medicare |
$10,219.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,283.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,283.23
|
| Rate for Payer: BCBS MAPPO |
$9,826.58
|
| Rate for Payer: BCBS Trust/PPO |
$28,136.42
|
| Rate for Payer: BCN Commercial |
$28,136.42
|
| Rate for Payer: BCN Medicare Advantage |
$9,826.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,826.58
|
| Rate for Payer: Mclaren Medicare |
$9,826.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,317.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,300.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,809.24
|
| Rate for Payer: Nomi Health Commercial |
$15,436.14
|
| Rate for Payer: PACE Medicare |
$9,335.25
|
| Rate for Payer: PACE SWMI |
$9,826.58
|
| Rate for Payer: PHP Medicare Advantage |
$9,826.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,291.75
|
| Rate for Payer: Priority Health Medicare |
$9,826.58
|
| Rate for Payer: Priority Health Tiered Network |
$15,433.40
|
| Rate for Payer: Railroad Medicare Medicare |
$9,826.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,504.58
|
| Rate for Payer: UHC Core |
$16,318.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,826.58
|
| Rate for Payer: UHC Exchange |
$13,326.53
|
| Rate for Payer: VA VA |
$9,826.58
|
|
|
ATHEROSCLEROSIS WITHOUT MCC
|
Facility
|
IP
|
$12,930.58
|
|
|
Service Code
|
MSDRG 303
|
| Min. Negotiated Rate |
$5,492.57 |
| Max. Negotiated Rate |
$12,930.58 |
| Rate for Payer: Aetna Medicare |
$6,012.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,227.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,227.06
|
| Rate for Payer: BCBS MAPPO |
$5,781.65
|
| Rate for Payer: BCBS Trust/PPO |
$12,930.58
|
| Rate for Payer: BCN Commercial |
$12,930.58
|
| Rate for Payer: BCN Medicare Advantage |
$5,781.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,781.65
|
| Rate for Payer: Mclaren Medicare |
$5,781.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,070.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,648.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,359.81
|
| Rate for Payer: Nomi Health Commercial |
$8,684.28
|
| Rate for Payer: PACE Medicare |
$5,492.57
|
| Rate for Payer: PACE SWMI |
$5,781.65
|
| Rate for Payer: PHP Medicare Advantage |
$5,781.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,853.42
|
| Rate for Payer: Priority Health Medicare |
$5,781.65
|
| Rate for Payer: Priority Health Tiered Network |
$8,682.74
|
| Rate for Payer: Railroad Medicare Medicare |
$5,781.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,973.16
|
| Rate for Payer: UHC Core |
$9,180.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,781.65
|
| Rate for Payer: UHC Exchange |
$7,497.43
|
| Rate for Payer: VA VA |
$5,781.65
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
NDC 51079020801
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.40
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Advantage |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health SBD |
$1.36
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$215.03
|
|
|
Service Code
|
NDC 00904629006
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.51 |
| Max. Negotiated Rate |
$193.53 |
| Rate for Payer: Aetna Commercial |
$182.78
|
| Rate for Payer: Aetna Medicare |
$107.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.77
|
| Rate for Payer: BCBS Complete |
$86.01
|
| Rate for Payer: Cash Price |
$172.02
|
| Rate for Payer: Cofinity Advantage |
$150.52
|
| Rate for Payer: Cofinity Commercial |
$184.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.02
|
| Rate for Payer: Healthscope Commercial |
$193.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.27
|
| Rate for Payer: PHP Commercial |
$182.78
|
| Rate for Payer: Priority Health SBD |
$135.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.77
|
| Rate for Payer: UHC Core |
$112.03
|
| Rate for Payer: UHC Exchange |
$84.51
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
NDC 51079020801
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.40
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Advantage |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health SBD |
$1.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.40
|
| Rate for Payer: UHC Core |
$1.13
|
| Rate for Payer: UHC Exchange |
$0.85
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 68084009701
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.75 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$107.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Advantage |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.74
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health SBD |
$135.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.17
|
| Rate for Payer: UHC Core |
$112.35
|
| Rate for Payer: UHC Exchange |
$84.75
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$215.03
|
|
|
Service Code
|
NDC 00904629006
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.47 |
| Max. Negotiated Rate |
$193.53 |
| Rate for Payer: Aetna Commercial |
$182.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.77
|
| Rate for Payer: Cash Price |
$172.02
|
| Rate for Payer: Cofinity Advantage |
$150.52
|
| Rate for Payer: Cofinity Commercial |
$184.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.02
|
| Rate for Payer: Healthscope Commercial |
$193.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.27
|
| Rate for Payer: PHP Commercial |
$182.78
|
| Rate for Payer: Priority Health SBD |
$135.47
|
|
