|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 69097-421-07
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$288.70 |
| Max. Negotiated Rate |
$412.42 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.86
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$320.78
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Healthscope Commercial |
$412.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$389.51
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.78
|
| Rate for Payer: Priority Health SBD |
$288.70
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 50268-169-11
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.75
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.60
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.96
|
| Rate for Payer: Priority Health SBD |
$2.66
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$5.99
|
|
|
Service Code
|
NDC 60687-447-11
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna Commercial |
$5.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.89
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cofinity Commercial |
$4.19
|
| Rate for Payer: Cofinity Commercial |
$5.15
|
| Rate for Payer: Healthscope Commercial |
$5.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.09
|
| Rate for Payer: PHP Commercial |
$5.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.19
|
| Rate for Payer: Priority Health SBD |
$3.77
|
|
|
CELECOXIB 400 MG CAPSULE
|
Facility
|
IP
|
$312.48
|
|
|
Service Code
|
NDC 13668-310-60
|
| Hospital Charge Code |
33653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.86 |
| Max. Negotiated Rate |
$281.23 |
| Rate for Payer: Aetna Commercial |
$265.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.11
|
| Rate for Payer: Cash Price |
$249.98
|
| Rate for Payer: Cofinity Commercial |
$218.74
|
| Rate for Payer: Cofinity Commercial |
$268.73
|
| Rate for Payer: Healthscope Commercial |
$281.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$265.61
|
| Rate for Payer: PHP Commercial |
$265.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health SBD |
$196.86
|
|
|
CELECOXIB 400 MG CAPSULE
|
Facility
|
IP
|
$502.56
|
|
|
Service Code
|
NDC 59762-1518-2
|
| Hospital Charge Code |
33653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$316.61 |
| Max. Negotiated Rate |
$452.30 |
| Rate for Payer: Aetna Commercial |
$427.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.66
|
| Rate for Payer: Cash Price |
$402.05
|
| Rate for Payer: Cofinity Commercial |
$351.79
|
| Rate for Payer: Cofinity Commercial |
$432.20
|
| Rate for Payer: Healthscope Commercial |
$452.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$427.18
|
| Rate for Payer: PHP Commercial |
$427.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.79
|
| Rate for Payer: Priority Health SBD |
$316.61
|
|
|
CELECOXIB 400 MG CAPSULE
|
Facility
|
IP
|
$210.33
|
|
|
Service Code
|
NDC 65862-910-60
|
| Hospital Charge Code |
33653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.51 |
| Max. Negotiated Rate |
$189.30 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.71
|
| Rate for Payer: Cash Price |
$168.26
|
| Rate for Payer: Cofinity Commercial |
$147.23
|
| Rate for Payer: Cofinity Commercial |
$180.88
|
| Rate for Payer: Healthscope Commercial |
$189.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.78
|
| Rate for Payer: PHP Commercial |
$178.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.23
|
| Rate for Payer: Priority Health SBD |
$132.51
|
|
|
CELLULITIS WITH MCC
|
Facility
|
IP
|
$23,280.93
|
|
|
Service Code
|
MS-DRG 602
|
| Min. Negotiated Rate |
$10,645.12 |
| Max. Negotiated Rate |
$23,280.93 |
| Rate for Payer: Aetna Medicare |
$11,653.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,006.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,006.74
|
| Rate for Payer: BCBS MAPPO |
$11,205.39
|
| Rate for Payer: BCBS Trust/PPO |
$23,280.93
|
| Rate for Payer: BCN Medicare Advantage |
$11,205.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,205.39
|
| Rate for Payer: Mclaren Medicare |
$11,205.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,765.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,886.20
|
| Rate for Payer: PACE Medicare |
$10,645.12
|
| Rate for Payer: PACE SWMI |
$11,205.39
|
| Rate for Payer: PHP Medicare Advantage |
$11,205.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,345.51
|
| Rate for Payer: Priority Health Medicare |
$11,205.39
|
| Rate for Payer: Priority Health Narrow Network |
$17,076.41
|
| Rate for Payer: Railroad Medicare Medicare |
$11,205.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,690.33
|
| Rate for Payer: UHC Core |
$13,923.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,205.39
|
| Rate for Payer: UHC Exchange |
$14,912.19
|
| Rate for Payer: UHC Medicare Advantage |
$11,541.55
|
| Rate for Payer: VA VA |
$11,205.39
|
|
|
CELLULITIS WITHOUT MCC
|
Facility
|
IP
|
$13,495.21
|
|
|
Service Code
|
MS-DRG 603
|
| Min. Negotiated Rate |
$6,520.95 |
| Max. Negotiated Rate |
$13,495.21 |
| Rate for Payer: Aetna Medicare |
$7,138.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,580.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,580.20
|
| Rate for Payer: BCBS MAPPO |
$6,864.16
|
| Rate for Payer: BCBS Trust/PPO |
$11,102.47
|
| Rate for Payer: BCN Medicare Advantage |
$6,864.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,864.16
|
| Rate for Payer: Mclaren Medicare |
$6,864.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,207.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,893.78
|
| Rate for Payer: PACE Medicare |
$6,520.95
|
| Rate for Payer: PACE SWMI |
$6,864.16
|
| Rate for Payer: PHP Medicare Advantage |
$6,864.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,695.37
|
| Rate for Payer: Priority Health Medicare |
$6,864.16
|
| Rate for Payer: Priority Health Narrow Network |
$10,156.30
|
| Rate for Payer: Railroad Medicare Medicare |
$6,864.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,495.21
|
| Rate for Payer: UHC Core |
$8,280.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,864.16
|
| Rate for Payer: UHC Exchange |
$8,869.12
|
| Rate for Payer: UHC Medicare Advantage |
$7,070.08
|
| Rate for Payer: VA VA |
$6,864.16
|
|
|
CELLULOSE, OXIDIZED 4" X 8" PADS
|
Facility
|
IP
|
$279.50
|
|
|
Service Code
|
NDC 0990-0006-04
|
| Hospital Charge Code |
169204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$176.08 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Aetna Commercial |
$237.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.68
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cofinity Commercial |
$240.37
|
| Rate for Payer: Cofinity Commercial |
$195.65
|
| Rate for Payer: Healthscope Commercial |
$251.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$237.58
|
| Rate for Payer: PHP Commercial |
$237.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.65
|
| Rate for Payer: Priority Health SBD |
$176.08
|
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$44,890.50
|
|
|
Service Code
|
HCPCS J9119
|
| Hospital Charge Code |
188612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28,281.02 |
| Max. Negotiated Rate |
$40,401.45 |
| Rate for Payer: Aetna Commercial |
$38,156.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29,178.82
|
| Rate for Payer: Cash Price |
$35,912.40
|
| Rate for Payer: Cofinity Commercial |
$31,423.35
|
| Rate for Payer: Cofinity Commercial |
$38,605.83
|
| Rate for Payer: Healthscope Commercial |
$40,401.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38,156.92
|
| Rate for Payer: PHP Commercial |
$38,156.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31,423.35
|
| Rate for Payer: Priority Health SBD |
$28,281.02
|
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$44,890.50
|
|
|
Service Code
|
HCPCS J9119
|
| Hospital Charge Code |
188612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$40,401.45 |
| Rate for Payer: Aetna Commercial |
$38,156.92
|
| Rate for Payer: Aetna Medicare |
$28.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29,178.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.33
|
| Rate for Payer: BCBS Complete |
$15.77
|
| Rate for Payer: BCBS MAPPO |
$27.46
|
| Rate for Payer: BCBS Trust/PPO |
$81.27
|
| Rate for Payer: BCN Medicare Advantage |
$27.46
|
| Rate for Payer: Cash Price |
$35,912.40
|
| Rate for Payer: Cash Price |
$35,912.40
|
| Rate for Payer: Cofinity Commercial |
$31,423.35
|
| Rate for Payer: Cofinity Commercial |
$38,605.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.46
|
| Rate for Payer: Healthscope Commercial |
$40,401.45
|
| Rate for Payer: Mclaren Medicaid |
$15.02
|
| Rate for Payer: Mclaren Medicare |
$27.46
|
| Rate for Payer: Meridian Medicaid |
$15.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38,156.92
|
| Rate for Payer: PACE Medicare |
$26.09
|
| Rate for Payer: PACE SWMI |
$27.46
|
| Rate for Payer: PHP Commercial |
$38,156.92
|
| Rate for Payer: PHP Medicare Advantage |
$27.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31,423.35
|
| Rate for Payer: Priority Health Medicare |
$27.46
|
| Rate for Payer: Priority Health SBD |
$28,281.02
|
| Rate for Payer: Railroad Medicare Medicare |
$27.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.46
|
| Rate for Payer: UHC Medicare Advantage |
$28.28
|
| Rate for Payer: VA VA |
$27.46
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$201.40
|
|
|
Service Code
|
NDC 68180-441-01
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.91
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.19
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.98
|
| Rate for Payer: Priority Health SBD |
$126.88
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$270.25
|
|
|
Service Code
|
NDC 67877-545-88
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.26 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.66
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$189.18
|
| Rate for Payer: Cofinity Commercial |
$232.42
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.71
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.18
|
| Rate for Payer: Priority Health SBD |
$170.26
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$203.30
|
|
|
Service Code
|
NDC 0093-4177-73
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.08 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.14
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Commercial |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.80
|
| Rate for Payer: PHP Commercial |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.31
|
| Rate for Payer: Priority Health SBD |
$128.08
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$289.05
|
|
|
Service Code
|
NDC 0093-3145-01
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.10 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Commercial |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$245.69
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.34
|
| Rate for Payer: Priority Health SBD |
$182.10
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$276.45
|
|
|
Service Code
|
NDC 60687-152-01
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.16 |
| Max. Negotiated Rate |
$248.80 |
| Rate for Payer: Aetna Commercial |
$234.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.69
|
| Rate for Payer: Cash Price |
$221.16
|
| Rate for Payer: Cofinity Commercial |
$193.52
|
| Rate for Payer: Cofinity Commercial |
$237.75
|
| Rate for Payer: Healthscope Commercial |
$248.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.98
|
| Rate for Payer: PHP Commercial |
$234.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.52
|
| Rate for Payer: Priority Health SBD |
$174.16
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 67877-219-01
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.70 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna Commercial |
$235.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.24
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$194.11
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.70
|
| Rate for Payer: PHP Commercial |
$235.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.11
|
| Rate for Payer: Priority Health SBD |
$174.70
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$3.11
|
|
|
Service Code
|
NDC 60687-163-11
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.02
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.64
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health SBD |
$1.96
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 0093-3147-01
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$135.00
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.92
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.00
|
| Rate for Payer: Priority Health SBD |
$121.50
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$310.65
|
|
|
Service Code
|
NDC 60687-163-01
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.71 |
| Max. Negotiated Rate |
$279.58 |
| Rate for Payer: Aetna Commercial |
$264.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.92
|
| Rate for Payer: Cash Price |
$248.52
|
| Rate for Payer: Cofinity Commercial |
$217.46
|
| Rate for Payer: Cofinity Commercial |
$267.16
|
| Rate for Payer: Healthscope Commercial |
$279.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$264.05
|
| Rate for Payer: PHP Commercial |
$264.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.46
|
| Rate for Payer: Priority Health SBD |
$195.71
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$2.55
|
|
|
Service Code
|
NDC 50268-152-11
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.61
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$127.30
|
|
|
Service Code
|
NDC 50268-152-15
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$114.57 |
| Rate for Payer: Aetna Commercial |
$108.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.74
|
| Rate for Payer: Cash Price |
$101.84
|
| Rate for Payer: Cofinity Commercial |
$109.48
|
| Rate for Payer: Cofinity Commercial |
$89.11
|
| Rate for Payer: Healthscope Commercial |
$114.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.20
|
| Rate for Payer: PHP Commercial |
$108.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.11
|
| Rate for Payer: Priority Health SBD |
$80.20
|
|
|
CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBCUTANEOUS KIT
|
Facility
|
IP
|
$25,679.17
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
91495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16,177.88 |
| Max. Negotiated Rate |
$23,111.25 |
| Rate for Payer: Aetna Commercial |
$21,827.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,691.46
|
| Rate for Payer: Cash Price |
$20,543.34
|
| Rate for Payer: Cofinity Commercial |
$17,975.42
|
| Rate for Payer: Cofinity Commercial |
$22,084.09
|
| Rate for Payer: Healthscope Commercial |
$23,111.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,827.29
|
| Rate for Payer: PHP Commercial |
$21,827.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,975.42
|
| Rate for Payer: Priority Health SBD |
$16,177.88
|
|
|
CERVICAL SPINAL FUSION WITH CC
|
Facility
|
IP
|
$45,081.67
|
|
|
Service Code
|
MS-DRG 472
|
| Min. Negotiated Rate |
$20,688.06 |
| Max. Negotiated Rate |
$45,081.67 |
| Rate for Payer: Aetna Medicare |
$22,647.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,221.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,221.14
|
| Rate for Payer: BCBS MAPPO |
$21,776.91
|
| Rate for Payer: BCBS Trust/PPO |
$42,850.79
|
| Rate for Payer: BCN Medicare Advantage |
$21,776.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,776.91
|
| Rate for Payer: Mclaren Medicare |
$21,776.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,865.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,043.45
|
| Rate for Payer: PACE Medicare |
$20,688.06
|
| Rate for Payer: PACE SWMI |
$21,776.91
|
| Rate for Payer: PHP Medicare Advantage |
$21,776.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42,409.75
|
| Rate for Payer: Priority Health Medicare |
$21,776.91
|
| Rate for Payer: Priority Health Narrow Network |
$33,927.80
|
| Rate for Payer: Railroad Medicare Medicare |
$21,776.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45,081.67
|
| Rate for Payer: UHC Core |
$27,662.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,776.91
|
| Rate for Payer: UHC Exchange |
$29,627.89
|
| Rate for Payer: UHC Medicare Advantage |
$22,430.22
|
| Rate for Payer: VA VA |
$21,776.91
|
|
|
CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$75,034.43
|
|
|
Service Code
|
MS-DRG 471
|
| Min. Negotiated Rate |
$34,122.42 |
| Max. Negotiated Rate |
$75,034.43 |
| Rate for Payer: Aetna Medicare |
$37,355.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44,897.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44,897.92
|
| Rate for Payer: BCBS MAPPO |
$35,918.34
|
| Rate for Payer: BCBS Trust/PPO |
$56,753.04
|
| Rate for Payer: BCN Medicare Advantage |
$35,918.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,918.34
|
| Rate for Payer: Mclaren Medicare |
$35,918.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37,714.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,306.09
|
| Rate for Payer: PACE Medicare |
$34,122.42
|
| Rate for Payer: PACE SWMI |
$35,918.34
|
| Rate for Payer: PHP Medicare Advantage |
$35,918.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70,587.26
|
| Rate for Payer: Priority Health Medicare |
$35,918.34
|
| Rate for Payer: Priority Health Narrow Network |
$56,469.81
|
| Rate for Payer: Railroad Medicare Medicare |
$35,918.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75,034.43
|
| Rate for Payer: UHC Core |
$46,041.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$35,918.34
|
| Rate for Payer: UHC Exchange |
$49,312.98
|
| Rate for Payer: UHC Medicare Advantage |
$36,995.89
|
| Rate for Payer: VA VA |
$35,918.34
|
|
