|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$17,342.33
|
|
|
Service Code
|
APR-DRG 3633
|
| Min. Negotiated Rate |
$16,516.50 |
| Max. Negotiated Rate |
$17,342.33 |
| Rate for Payer: BCBS Complete |
$17,342.33
|
| Rate for Payer: Mclaren Medicaid |
$16,516.50
|
| Rate for Payer: Meridian Medicaid |
$17,342.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,516.50
|
| Rate for Payer: UHC Medicaid |
$16,516.50
|
| Rate for Payer: UHCCP Medicaid |
$16,516.50
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$8,387.95
|
|
|
Service Code
|
APR-DRG 3631
|
| Min. Negotiated Rate |
$7,988.53 |
| Max. Negotiated Rate |
$8,387.95 |
| Rate for Payer: BCBS Complete |
$8,387.95
|
| Rate for Payer: Mclaren Medicaid |
$7,988.53
|
| Rate for Payer: Meridian Medicaid |
$8,387.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,988.53
|
| Rate for Payer: UHC Medicaid |
$7,988.53
|
| Rate for Payer: UHCCP Medicaid |
$7,988.53
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$11,995.16
|
|
|
Service Code
|
APR-DRG 3632
|
| Min. Negotiated Rate |
$11,423.96 |
| Max. Negotiated Rate |
$11,995.16 |
| Rate for Payer: BCBS Complete |
$11,995.16
|
| Rate for Payer: Mclaren Medicaid |
$11,423.96
|
| Rate for Payer: Meridian Medicaid |
$11,995.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,423.96
|
| Rate for Payer: UHC Medicaid |
$11,423.96
|
| Rate for Payer: UHCCP Medicaid |
$11,423.96
|
|
|
BREAST REDUCTION
|
Facility
|
OP
|
$21,396.49
|
|
|
Service Code
|
CPT 19318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,460.32 |
| Max. Negotiated Rate |
$21,396.49 |
| Rate for Payer: Aetna Medicare |
$6,880.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,270.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,270.36
|
| Rate for Payer: BCBS Complete |
$3,633.67
|
| Rate for Payer: BCBS MAPPO |
$6,616.29
|
| Rate for Payer: BCBS Trust/PPO |
$5,011.34
|
| Rate for Payer: BCN Commercial |
$5,011.34
|
| Rate for Payer: BCN Medicare Advantage |
$6,616.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,616.29
|
| Rate for Payer: Mclaren Medicaid |
$3,460.32
|
| Rate for Payer: Mclaren Medicare |
$6,616.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,947.10
|
| Rate for Payer: Meridian Medicaid |
$6,947.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,608.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,277.92
|
| Rate for Payer: Nomi Health Commercial |
$19,848.87
|
| Rate for Payer: PACE Medicare |
$6,285.48
|
| Rate for Payer: PACE SWMI |
$6,616.29
|
| Rate for Payer: PHP Medicare Advantage |
$6,616.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,460.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,396.49
|
| Rate for Payer: Priority Health Medicare |
$6,616.29
|
| Rate for Payer: Priority Health Tiered Network |
$17,117.19
|
| Rate for Payer: Railroad Medicare Medicare |
$6,616.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,616.29
|
| Rate for Payer: UHC Medicaid |
$3,460.32
|
| Rate for Payer: UHCCP Medicaid |
$3,460.32
|
| Rate for Payer: VA VA |
$6,616.29
|
|
|
BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$59,134.02
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
153416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37,254.43 |
| Max. Negotiated Rate |
$53,220.62 |
| Rate for Payer: Aetna Commercial |
$50,263.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38,437.11
|
| Rate for Payer: Cash Price |
$47,307.22
|
| Rate for Payer: Cofinity Advantage |
$41,393.81
|
| Rate for Payer: Cofinity Commercial |
$50,855.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47,307.22
|
| Rate for Payer: Healthscope Commercial |
$53,220.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50,263.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44,350.51
|
| Rate for Payer: PHP Commercial |
$50,263.92
|
| Rate for Payer: Priority Health SBD |
$37,254.43
|
|
|
BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$59,134.02
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
153416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.55 |
| Max. Negotiated Rate |
$53,220.62 |
| Rate for Payer: Aetna Commercial |
$50,263.92
|
| Rate for Payer: Aetna Medicare |
$279.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38,437.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$335.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$335.91
|
| Rate for Payer: BCBS Complete |
$147.59
|
| Rate for Payer: BCBS MAPPO |
$268.73
|
| Rate for Payer: BCBS Trust/PPO |
$661.03
|
| Rate for Payer: BCN Commercial |
$661.03
|
| Rate for Payer: BCN Medicare Advantage |
$268.73
|
| Rate for Payer: Cash Price |
$47,307.22
|
| Rate for Payer: Cash Price |
$47,307.22
|
| Rate for Payer: Cofinity Advantage |
$41,393.81
|
| Rate for Payer: Cofinity Commercial |
$50,855.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47,307.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$268.73
|
| Rate for Payer: Healthscope Commercial |
$53,220.62
|
| Rate for Payer: Mclaren Medicaid |
$140.55
|
| Rate for Payer: Mclaren Medicare |
$268.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$282.17
|
| Rate for Payer: Meridian Medicaid |
$282.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$295.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50,263.92
|
| Rate for Payer: Nomi Health Commercial |
$806.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44,350.51
|
| Rate for Payer: PACE Medicare |
$255.29
|
| Rate for Payer: PACE SWMI |
$268.73
|
| Rate for Payer: PHP Commercial |
$50,263.92
|
| Rate for Payer: PHP Medicare Advantage |
$268.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$815.74
|
| Rate for Payer: Priority Health Medicare |
$268.73
|
| Rate for Payer: Priority Health SBD |
$37,254.43
|
| Rate for Payer: Priority Health Tiered Network |
$652.59
|
| Rate for Payer: Railroad Medicare Medicare |
$268.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$442.94
|
| Rate for Payer: UHC Core |
$442.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$268.73
|
| Rate for Payer: UHC Exchange |
$442.94
|
| Rate for Payer: UHC Medicaid |
$140.55
|
| Rate for Payer: UHCCP Medicaid |
$140.55
|
| Rate for Payer: VA VA |
$268.73
|
|
|
BREXPIPRAZOLE 1 MG TABLET
|
Facility
|
IP
|
$5,353.76
|
|
|
Service Code
|
NDC 59148003713
|
| Hospital Charge Code |
174666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,372.87 |
| Max. Negotiated Rate |
$4,818.38 |
| Rate for Payer: Aetna Commercial |
$4,550.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,479.94
|
| Rate for Payer: Cash Price |
$4,283.01
|
| Rate for Payer: Cofinity Advantage |
$3,747.63
|
| Rate for Payer: Cofinity Commercial |
$4,604.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,283.01
|
| Rate for Payer: Healthscope Commercial |
$4,818.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,550.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,015.32
|
| Rate for Payer: PHP Commercial |
$4,550.70
|
| Rate for Payer: Priority Health SBD |
$3,372.87
|
|
|
BREXPIPRAZOLE 1 MG TABLET
|
Facility
|
OP
|
$5,353.76
|
|
|
Service Code
|
NDC 59148003713
|
| Hospital Charge Code |
174666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,104.03 |
| Max. Negotiated Rate |
$4,818.38 |
| Rate for Payer: Aetna Commercial |
$4,550.70
|
| Rate for Payer: Aetna Medicare |
$2,676.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,479.94
|
| Rate for Payer: BCBS Complete |
$2,141.50
|
| Rate for Payer: Cash Price |
$4,283.01
|
| Rate for Payer: Cofinity Advantage |
$3,747.63
|
| Rate for Payer: Cofinity Commercial |
$4,604.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,283.01
|
| Rate for Payer: Healthscope Commercial |
$4,818.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,283.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,550.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,015.32
|
| Rate for Payer: PHP Commercial |
$4,550.70
|
| Rate for Payer: Priority Health SBD |
$3,372.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,479.94
|
| Rate for Payer: UHC Core |
$2,789.31
|
| Rate for Payer: UHC Exchange |
$2,104.03
|
|
|
BREXPIPRAZOLE 3 MG TABLET
|
Facility
|
IP
|
$5,353.76
|
|
|
Service Code
|
NDC 59148003913
|
| Hospital Charge Code |
174668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,372.87 |
| Max. Negotiated Rate |
$4,818.38 |
| Rate for Payer: Aetna Commercial |
$4,550.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,479.94
|
| Rate for Payer: Cash Price |
$4,283.01
|
| Rate for Payer: Cofinity Advantage |
$3,747.63
|
| Rate for Payer: Cofinity Commercial |
$4,604.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,283.01
|
| Rate for Payer: Healthscope Commercial |
$4,818.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,550.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,015.32
|
| Rate for Payer: PHP Commercial |
$4,550.70
|
| Rate for Payer: Priority Health SBD |
$3,372.87
|
|
|
BREXPIPRAZOLE 3 MG TABLET
|
Facility
|
OP
|
$5,353.76
|
|
|
Service Code
|
NDC 59148003913
|
| Hospital Charge Code |
174668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,104.03 |
| Max. Negotiated Rate |
$4,818.38 |
| Rate for Payer: Aetna Commercial |
$4,550.70
|
| Rate for Payer: Aetna Medicare |
$2,676.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,479.94
|
| Rate for Payer: BCBS Complete |
$2,141.50
|
| Rate for Payer: Cash Price |
$4,283.01
|
| Rate for Payer: Cofinity Advantage |
$3,747.63
|
| Rate for Payer: Cofinity Commercial |
$4,604.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,283.01
|
| Rate for Payer: Healthscope Commercial |
$4,818.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,283.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,550.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,015.32
|
| Rate for Payer: PHP Commercial |
$4,550.70
|
| Rate for Payer: Priority Health SBD |
$3,372.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,479.94
|
| Rate for Payer: UHC Core |
$2,789.31
|
| Rate for Payer: UHC Exchange |
$2,104.03
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$20.72
|
|
|
Service Code
|
NDC 61314014305
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$18.65 |
| Rate for Payer: Aetna Commercial |
$17.61
|
| Rate for Payer: Aetna Medicare |
$10.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.47
|
| Rate for Payer: BCBS Complete |
$8.29
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cofinity Advantage |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$18.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.54
|
| Rate for Payer: PHP Commercial |
$17.61
|
| Rate for Payer: Priority Health SBD |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.47
|
| Rate for Payer: UHC Core |
$10.80
|
| Rate for Payer: UHC Exchange |
$8.14
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$20.72
|
|
|
Service Code
|
NDC 61314014305
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$18.65 |
| Rate for Payer: Aetna Commercial |
$17.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.47
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cofinity Advantage |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$18.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.54
|
| Rate for Payer: PHP Commercial |
$17.61
|
| Rate for Payer: Priority Health SBD |
$13.05
|
|
|
BRIVARACETAM 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$5,200.35
|
|
|
Service Code
|
NDC 50474087015
|
| Hospital Charge Code |
178914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,276.22 |
| Max. Negotiated Rate |
$4,680.31 |
| Rate for Payer: Aetna Commercial |
$4,420.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,380.23
|
| Rate for Payer: Cash Price |
$4,160.28
|
| Rate for Payer: Cofinity Advantage |
$3,640.24
|
| Rate for Payer: Cofinity Commercial |
$4,472.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,160.28
|
| Rate for Payer: Healthscope Commercial |
$4,680.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,420.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,900.26
|
| Rate for Payer: PHP Commercial |
$4,420.30
|
| Rate for Payer: Priority Health SBD |
$3,276.22
|
|
|
BRIVARACETAM 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$5,200.35
|
|
|
Service Code
|
NDC 50474087015
|
| Hospital Charge Code |
178914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,043.74 |
| Max. Negotiated Rate |
$4,680.31 |
| Rate for Payer: Aetna Commercial |
$4,420.30
|
| Rate for Payer: Aetna Medicare |
$2,600.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,380.23
|
| Rate for Payer: BCBS Complete |
$2,080.14
|
| Rate for Payer: Cash Price |
$4,160.28
|
| Rate for Payer: Cofinity Advantage |
$3,640.24
|
| Rate for Payer: Cofinity Commercial |
$4,472.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,160.28
|
| Rate for Payer: Healthscope Commercial |
$4,680.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,160.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,420.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,900.26
|
| Rate for Payer: PHP Commercial |
$4,420.30
|
| Rate for Payer: Priority Health SBD |
$3,276.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,380.23
|
| Rate for Payer: UHC Core |
$2,709.38
|
| Rate for Payer: UHC Exchange |
$2,043.74
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
IP
|
$186.34
|
|
|
Service Code
|
NDC 00574010603
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.39 |
| Max. Negotiated Rate |
$167.71 |
| Rate for Payer: Aetna Commercial |
$158.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.12
|
| Rate for Payer: Cash Price |
$149.07
|
| Rate for Payer: Cofinity Advantage |
$130.44
|
| Rate for Payer: Cofinity Commercial |
$160.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.07
|
| Rate for Payer: Healthscope Commercial |
$167.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.75
|
| Rate for Payer: PHP Commercial |
$158.39
|
| Rate for Payer: Priority Health SBD |
$117.39
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
IP
|
$450.72
|
|
|
Service Code
|
NDC 00574010601
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$283.95 |
| Max. Negotiated Rate |
$405.65 |
| Rate for Payer: Aetna Commercial |
$383.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.97
|
| Rate for Payer: Cash Price |
$360.58
|
| Rate for Payer: Cofinity Advantage |
$315.50
|
| Rate for Payer: Cofinity Commercial |
$387.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.58
|
| Rate for Payer: Healthscope Commercial |
$405.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$338.04
|
| Rate for Payer: PHP Commercial |
$383.11
|
| Rate for Payer: Priority Health SBD |
$283.95
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
OP
|
$636.48
|
|
|
Service Code
|
NDC 60687028621
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.14 |
| Max. Negotiated Rate |
$572.83 |
| Rate for Payer: Aetna Commercial |
$541.01
|
| Rate for Payer: Aetna Medicare |
$318.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.71
|
| Rate for Payer: BCBS Complete |
$254.59
|
| Rate for Payer: Cash Price |
$509.18
|
| Rate for Payer: Cofinity Advantage |
$445.54
|
| Rate for Payer: Cofinity Commercial |
$547.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.18
|
| Rate for Payer: Healthscope Commercial |
$572.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$509.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$477.36
|
| Rate for Payer: PHP Commercial |
$541.01
|
| Rate for Payer: Priority Health SBD |
$400.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$413.71
|
| Rate for Payer: UHC Core |
$331.61
|
| Rate for Payer: UHC Exchange |
$250.14
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
NDC 60687028611
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.91
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
OP
|
$186.34
|
|
|
Service Code
|
NDC 00574010603
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.23 |
| Max. Negotiated Rate |
$167.71 |
| Rate for Payer: Aetna Commercial |
$158.39
|
| Rate for Payer: Aetna Medicare |
$93.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.12
|
| Rate for Payer: BCBS Complete |
$74.54
|
| Rate for Payer: Cash Price |
$149.07
|
| Rate for Payer: Cofinity Advantage |
$130.44
|
| Rate for Payer: Cofinity Commercial |
$160.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.07
|
| Rate for Payer: Healthscope Commercial |
$167.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.75
|
| Rate for Payer: PHP Commercial |
$158.39
|
| Rate for Payer: Priority Health SBD |
$117.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.12
|
| Rate for Payer: UHC Core |
$97.08
|
| Rate for Payer: UHC Exchange |
$73.23
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
NDC 60687028611
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna Medicare |
$10.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.91
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.79
|
| Rate for Payer: UHC Core |
$11.06
|
| Rate for Payer: UHC Exchange |
$8.34
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
OP
|
$450.72
|
|
|
Service Code
|
NDC 00574010601
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.13 |
| Max. Negotiated Rate |
$405.65 |
| Rate for Payer: Aetna Commercial |
$383.11
|
| Rate for Payer: Aetna Medicare |
$225.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.97
|
| Rate for Payer: BCBS Complete |
$180.29
|
| Rate for Payer: Cash Price |
$360.58
|
| Rate for Payer: Cofinity Advantage |
$315.50
|
| Rate for Payer: Cofinity Commercial |
$387.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.58
|
| Rate for Payer: Healthscope Commercial |
$405.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$338.04
|
| Rate for Payer: PHP Commercial |
$383.11
|
| Rate for Payer: Priority Health SBD |
$283.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.97
|
| Rate for Payer: UHC Core |
$234.83
|
| Rate for Payer: UHC Exchange |
$177.13
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
IP
|
$636.48
|
|
|
Service Code
|
NDC 60687028621
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$400.98 |
| Max. Negotiated Rate |
$572.83 |
| Rate for Payer: Aetna Commercial |
$541.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.71
|
| Rate for Payer: Cash Price |
$509.18
|
| Rate for Payer: Cofinity Advantage |
$445.54
|
| Rate for Payer: Cofinity Commercial |
$547.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.18
|
| Rate for Payer: Healthscope Commercial |
$572.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$477.36
|
| Rate for Payer: PHP Commercial |
$541.01
|
| Rate for Payer: Priority Health SBD |
$400.98
|
|
|
BROMPHENIRAMINE-PSEUDOEPHEDRINE 1 MG-15 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$689.17
|
|
|
Service Code
|
NDC 00485020616
|
| Hospital Charge Code |
29801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$434.18 |
| Max. Negotiated Rate |
$620.25 |
| Rate for Payer: Aetna Commercial |
$585.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.96
|
| Rate for Payer: Cash Price |
$551.34
|
| Rate for Payer: Cofinity Advantage |
$482.42
|
| Rate for Payer: Cofinity Commercial |
$592.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.34
|
| Rate for Payer: Healthscope Commercial |
$620.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.88
|
| Rate for Payer: PHP Commercial |
$585.79
|
| Rate for Payer: Priority Health SBD |
$434.18
|
|
|
BROMPHENIRAMINE-PSEUDOEPHEDRINE 1 MG-15 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$689.17
|
|
|
Service Code
|
NDC 00485020616
|
| Hospital Charge Code |
29801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.84 |
| Max. Negotiated Rate |
$620.25 |
| Rate for Payer: Aetna Commercial |
$585.79
|
| Rate for Payer: Aetna Medicare |
$344.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.96
|
| Rate for Payer: BCBS Complete |
$275.67
|
| Rate for Payer: Cash Price |
$551.34
|
| Rate for Payer: Cofinity Advantage |
$482.42
|
| Rate for Payer: Cofinity Commercial |
$592.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.34
|
| Rate for Payer: Healthscope Commercial |
$620.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$551.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.88
|
| Rate for Payer: PHP Commercial |
$585.79
|
| Rate for Payer: Priority Health SBD |
$434.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.96
|
| Rate for Payer: UHC Core |
$359.06
|
| Rate for Payer: UHC Exchange |
$270.84
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$6,883.61
|
|
|
Service Code
|
APR-DRG 1383
|
| Min. Negotiated Rate |
$6,555.82 |
| Max. Negotiated Rate |
$6,883.61 |
| Rate for Payer: BCBS Complete |
$6,883.61
|
| Rate for Payer: Mclaren Medicaid |
$6,555.82
|
| Rate for Payer: Meridian Medicaid |
$6,883.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,555.82
|
| Rate for Payer: UHC Medicaid |
$6,555.82
|
| Rate for Payer: UHCCP Medicaid |
$6,555.82
|
|
