|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN
|
Facility
|
OP
|
$3.14
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
30510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna Commercial |
$2.67
|
| Rate for Payer: Aetna Commercial |
$3.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.04
|
| Rate for Payer: BCBS Complete |
$1.26
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$3.83
|
| Rate for Payer: Healthscope Commercial |
$2.83
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.67
|
| Rate for Payer: PHP Commercial |
$2.67
|
| Rate for Payer: PHP Commercial |
$3.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.12
|
| Rate for Payer: Priority Health SBD |
$1.98
|
| Rate for Payer: Priority Health SBD |
$2.80
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
30510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Aetna Commercial |
$2.67
|
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.15
|
| Rate for Payer: Cash Price |
$2.65
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cofinity Commercial |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Cofinity Commercial |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Healthscope Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.98
|
| Rate for Payer: Healthscope Commercial |
$2.83
|
| Rate for Payer: Healthscope Commercial |
$2.67
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.52
|
| Rate for Payer: PHP Commercial |
$2.47
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.52
|
| Rate for Payer: PHP Commercial |
$2.67
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: PHP Commercial |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: Priority Health SBD |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: Priority Health SBD |
$1.98
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: Priority Health SBD |
$2.78
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION
|
Facility
|
IP
|
$3.29
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
12580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna Commercial |
$2.80
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Commercial |
$4.30
|
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.29
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$2.83
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$4.35
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Healthscope Commercial |
$4.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.40
|
| Rate for Payer: PHP Commercial |
$2.80
|
| Rate for Payer: PHP Commercial |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$4.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.54
|
| Rate for Payer: Priority Health SBD |
$3.19
|
| Rate for Payer: Priority Health SBD |
$2.07
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: Priority Health SBD |
$2.52
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY
|
Facility
|
IP
|
$125.95
|
|
|
Service Code
|
NDC 0054-0046-41
|
| Hospital Charge Code |
16071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.35 |
| Max. Negotiated Rate |
$113.36 |
| Rate for Payer: Aetna Commercial |
$107.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.87
|
| Rate for Payer: Cash Price |
$100.76
|
| Rate for Payer: Cofinity Commercial |
$108.32
|
| Rate for Payer: Cofinity Commercial |
$88.16
|
| Rate for Payer: Healthscope Commercial |
$113.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.06
|
| Rate for Payer: PHP Commercial |
$107.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.16
|
| Rate for Payer: Priority Health SBD |
$79.35
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
NDC 69238-2017-2
|
| Hospital Charge Code |
16071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.46 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.30
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$29.40
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.70
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health SBD |
$26.46
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$226.75
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
17450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$204.08 |
| Rate for Payer: Aetna Commercial |
$192.74
|
| Rate for Payer: Aetna Commercial |
$95.32
|
| Rate for Payer: Aetna Commercial |
$167.56
|
| Rate for Payer: Aetna Commercial |
$226.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.89
|
| Rate for Payer: BCBS Complete |
$106.76
|
| Rate for Payer: BCBS Complete |
$44.86
|
| Rate for Payer: BCBS Complete |
$78.85
|
| Rate for Payer: BCBS Complete |
$90.70
|
| Rate for Payer: BCBS Trust/PPO |
$5.75
|
| Rate for Payer: BCBS Trust/PPO |
$5.75
|
| Rate for Payer: BCBS Trust/PPO |
$5.75
|
| Rate for Payer: BCBS Trust/PPO |
$5.75
|
| Rate for Payer: Cash Price |
$213.53
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cash Price |
$181.40
|
| Rate for Payer: Cash Price |
$181.40
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cash Price |
$213.53
|
| Rate for Payer: Cash Price |
$89.71
|
| Rate for Payer: Cash Price |
$89.71
|
| Rate for Payer: Cofinity Commercial |
$137.99
|
| Rate for Payer: Cofinity Commercial |
$96.44
|
| Rate for Payer: Cofinity Commercial |
$78.50
|
| Rate for Payer: Cofinity Commercial |
$229.54
|
| Rate for Payer: Cofinity Commercial |
$158.72
|
| Rate for Payer: Cofinity Commercial |
$195.00
|
| Rate for Payer: Cofinity Commercial |
$186.84
|
| Rate for Payer: Cofinity Commercial |
$169.53
|
| Rate for Payer: Healthscope Commercial |
$100.93
|
| Rate for Payer: Healthscope Commercial |
$204.08
|
| Rate for Payer: Healthscope Commercial |
$177.42
|
| Rate for Payer: Healthscope Commercial |
$240.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$167.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.32
|
| Rate for Payer: PHP Commercial |
$167.56
|
| Rate for Payer: PHP Commercial |
$95.32
|
| Rate for Payer: PHP Commercial |
$192.74
|
| Rate for Payer: PHP Commercial |
$226.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.84
|
| Rate for Payer: Priority Health SBD |
$124.19
|
| Rate for Payer: Priority Health SBD |
$70.65
|
| Rate for Payer: Priority Health SBD |
$168.15
|
| Rate for Payer: Priority Health SBD |
$142.85
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$112.14
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
17450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.65 |
| Max. Negotiated Rate |
$100.93 |
| Rate for Payer: Aetna Commercial |
$95.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.89
|
| Rate for Payer: Cash Price |
$89.71
|
| Rate for Payer: Cofinity Commercial |
$78.50
|
| Rate for Payer: Cofinity Commercial |
$96.44
|
| Rate for Payer: Healthscope Commercial |
$100.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.32
|
| Rate for Payer: PHP Commercial |
$95.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.50
|
| Rate for Payer: Priority Health SBD |
$70.65
|
|
|
IRINOTECAN 300 MG/15 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$995.26
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
120104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$627.01 |
| Max. Negotiated Rate |
$895.73 |
| Rate for Payer: Aetna Commercial |
$845.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.92
|
| Rate for Payer: Cash Price |
$796.21
|
| Rate for Payer: Cofinity Commercial |
$696.68
|
| Rate for Payer: Cofinity Commercial |
$855.92
|
| Rate for Payer: Healthscope Commercial |
$895.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$845.97
|
| Rate for Payer: PHP Commercial |
$845.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.68
|
| Rate for Payer: Priority Health SBD |
$627.01
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS
|
Facility
|
IP
|
$12,419.34
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
176129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,824.18 |
| Max. Negotiated Rate |
$11,177.41 |
| Rate for Payer: Aetna Commercial |
$10,556.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,072.57
|
| Rate for Payer: Cash Price |
$9,935.47
|
| Rate for Payer: Cofinity Commercial |
$10,680.63
|
| Rate for Payer: Cofinity Commercial |
$8,693.54
|
| Rate for Payer: Healthscope Commercial |
$11,177.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,556.44
|
| Rate for Payer: PHP Commercial |
$10,556.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,693.54
|
| Rate for Payer: Priority Health SBD |
$7,824.18
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS
|
Facility
|
OP
|
$12,419.34
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
176129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.92 |
| Max. Negotiated Rate |
$11,177.41 |
| Rate for Payer: Aetna Commercial |
$10,556.44
|
| Rate for Payer: Aetna Medicare |
$64.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,072.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.52
|
| Rate for Payer: BCBS Complete |
$35.62
|
| Rate for Payer: BCBS MAPPO |
$62.02
|
| Rate for Payer: BCBS Trust/PPO |
$183.61
|
| Rate for Payer: BCN Medicare Advantage |
$62.02
|
| Rate for Payer: Cash Price |
$9,935.47
|
| Rate for Payer: Cash Price |
$9,935.47
|
| Rate for Payer: Cofinity Commercial |
$10,680.63
|
| Rate for Payer: Cofinity Commercial |
$8,693.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.02
|
| Rate for Payer: Healthscope Commercial |
$11,177.41
|
| Rate for Payer: Mclaren Medicaid |
$33.92
|
| Rate for Payer: Mclaren Medicare |
$62.02
|
| Rate for Payer: Meridian Medicaid |
$35.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,556.44
|
| Rate for Payer: PACE Medicare |
$58.92
|
| Rate for Payer: PACE SWMI |
$62.02
|
| Rate for Payer: PHP Commercial |
$10,556.44
|
| Rate for Payer: PHP Medicare Advantage |
$62.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,693.54
|
| Rate for Payer: Priority Health Medicare |
$62.02
|
| Rate for Payer: Priority Health SBD |
$7,824.18
|
| Rate for Payer: Railroad Medicare Medicare |
$62.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.02
|
| Rate for Payer: UHC Medicare Advantage |
$63.88
|
| Rate for Payer: VA VA |
$62.02
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$146.88
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna Commercial |
$124.85
|
| Rate for Payer: Aetna Medicare |
$18.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.66
|
| Rate for Payer: BCBS Complete |
$9.95
|
| Rate for Payer: BCBS MAPPO |
$17.32
|
| Rate for Payer: BCBS Trust/PPO |
$51.29
|
| Rate for Payer: BCN Medicare Advantage |
$17.32
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cofinity Commercial |
$102.82
|
| Rate for Payer: Cofinity Commercial |
$126.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$132.19
|
| Rate for Payer: Mclaren Medicaid |
$9.48
|
| Rate for Payer: Mclaren Medicare |
$17.32
|
| Rate for Payer: Meridian Medicaid |
$9.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.85
|
| Rate for Payer: PACE Medicare |
$16.46
|
| Rate for Payer: PACE SWMI |
$17.32
|
| Rate for Payer: PHP Commercial |
$124.85
|
| Rate for Payer: PHP Medicare Advantage |
$17.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.82
|
| Rate for Payer: Priority Health Medicare |
$17.32
|
| Rate for Payer: Priority Health SBD |
$92.53
|
| Rate for Payer: Railroad Medicare Medicare |
$17.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.32
|
| Rate for Payer: UHC Medicare Advantage |
$17.84
|
| Rate for Payer: VA VA |
$17.32
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$146.88
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.53 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna Commercial |
$124.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.47
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cofinity Commercial |
$102.82
|
| Rate for Payer: Cofinity Commercial |
$126.32
|
| Rate for Payer: Healthscope Commercial |
$132.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.85
|
| Rate for Payer: PHP Commercial |
$124.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.82
|
| Rate for Payer: Priority Health SBD |
$92.53
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$146.94
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.57 |
| Max. Negotiated Rate |
$132.25 |
| Rate for Payer: Aetna Commercial |
$124.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.51
|
| Rate for Payer: Cash Price |
$117.55
|
| Rate for Payer: Cofinity Commercial |
$102.86
|
| Rate for Payer: Cofinity Commercial |
$126.37
|
| Rate for Payer: Healthscope Commercial |
$132.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.90
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.86
|
| Rate for Payer: Priority Health SBD |
$92.57
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$146.94
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$132.25 |
| Rate for Payer: Aetna Commercial |
$124.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.51
|
| Rate for Payer: BCBS Complete |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: Cash Price |
$117.55
|
| Rate for Payer: Cash Price |
$117.55
|
| Rate for Payer: Cofinity Commercial |
$102.86
|
| Rate for Payer: Cofinity Commercial |
$126.37
|
| Rate for Payer: Healthscope Commercial |
$132.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.90
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.86
|
| Rate for Payer: Priority Health SBD |
$92.57
|
|
|
IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$224.05
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
152314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$201.64 |
| Rate for Payer: Aetna Commercial |
$190.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.63
|
| Rate for Payer: BCBS Complete |
$89.62
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: Cash Price |
$179.24
|
| Rate for Payer: Cash Price |
$179.24
|
| Rate for Payer: Cofinity Commercial |
$156.84
|
| Rate for Payer: Cofinity Commercial |
$192.68
|
| Rate for Payer: Healthscope Commercial |
$201.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$190.44
|
| Rate for Payer: PHP Commercial |
$190.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.84
|
| Rate for Payer: Priority Health SBD |
$141.15
|
|
|
IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$224.05
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
152314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$141.15 |
| Max. Negotiated Rate |
$201.64 |
| Rate for Payer: Aetna Commercial |
$190.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.63
|
| Rate for Payer: Cash Price |
$179.24
|
| Rate for Payer: Cofinity Commercial |
$192.68
|
| Rate for Payer: Cofinity Commercial |
$156.84
|
| Rate for Payer: Healthscope Commercial |
$201.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$190.44
|
| Rate for Payer: PHP Commercial |
$190.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.84
|
| Rate for Payer: Priority Health SBD |
$141.15
|
|
|
IRRIGATION OF IMPLANTED VENOUS ACCESS DEVICE FOR DRUG DELIVERY SYSTEMS
|
Facility
|
OP
|
$173.33
|
|
|
Service Code
|
CPT 96523
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$173.33 |
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS Trust/PPO |
$103.84
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.33
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$138.66
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$24.56
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC
|
Facility
|
IP
|
$32,602.53
|
|
|
Service Code
|
MS-DRG 062
|
| Min. Negotiated Rate |
$13,273.70 |
| Max. Negotiated Rate |
$32,602.53 |
| Rate for Payer: Aetna Medicare |
$14,531.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,465.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,465.40
|
| Rate for Payer: BCBS MAPPO |
$13,972.32
|
| Rate for Payer: BCBS Trust/PPO |
$32,602.53
|
| Rate for Payer: BCN Medicare Advantage |
$13,972.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,972.32
|
| Rate for Payer: Mclaren Medicare |
$13,972.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,670.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,068.17
|
| Rate for Payer: PACE Medicare |
$13,273.70
|
| Rate for Payer: PACE SWMI |
$13,972.32
|
| Rate for Payer: PHP Medicare Advantage |
$13,972.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,858.75
|
| Rate for Payer: Priority Health Medicare |
$13,972.32
|
| Rate for Payer: Priority Health Narrow Network |
$21,487.00
|
| Rate for Payer: Railroad Medicare Medicare |
$13,972.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,550.91
|
| Rate for Payer: UHC Core |
$17,519.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,972.32
|
| Rate for Payer: UHC Exchange |
$18,763.79
|
| Rate for Payer: UHC Medicare Advantage |
$14,391.49
|
| Rate for Payer: VA VA |
$13,972.32
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC
|
Facility
|
IP
|
$52,018.68
|
|
|
Service Code
|
MS-DRG 061
|
| Min. Negotiated Rate |
$19,644.00 |
| Max. Negotiated Rate |
$52,018.68 |
| Rate for Payer: Aetna Medicare |
$21,505.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,847.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,847.38
|
| Rate for Payer: BCBS MAPPO |
$20,677.90
|
| Rate for Payer: BCBS Trust/PPO |
$52,018.68
|
| Rate for Payer: BCN Medicare Advantage |
$20,677.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,677.90
|
| Rate for Payer: Mclaren Medicare |
$20,677.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,711.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,779.58
|
| Rate for Payer: PACE Medicare |
$19,644.00
|
| Rate for Payer: PACE SWMI |
$20,677.90
|
| Rate for Payer: PHP Medicare Advantage |
$20,677.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40,219.96
|
| Rate for Payer: Priority Health Medicare |
$20,677.90
|
| Rate for Payer: Priority Health Narrow Network |
$32,175.97
|
| Rate for Payer: Railroad Medicare Medicare |
$20,677.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42,753.91
|
| Rate for Payer: UHC Core |
$26,234.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,677.90
|
| Rate for Payer: UHC Exchange |
$28,098.07
|
| Rate for Payer: UHC Medicare Advantage |
$21,298.24
|
| Rate for Payer: VA VA |
$20,677.90
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC
|
Facility
|
IP
|
$32,358.78
|
|
|
Service Code
|
MS-DRG 063
|
| Min. Negotiated Rate |
$10,640.33 |
| Max. Negotiated Rate |
$32,358.78 |
| Rate for Payer: Aetna Medicare |
$11,648.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,000.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,000.44
|
| Rate for Payer: BCBS MAPPO |
$11,200.35
|
| Rate for Payer: BCBS Trust/PPO |
$32,358.78
|
| Rate for Payer: BCN Medicare Advantage |
$11,200.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,200.35
|
| Rate for Payer: Mclaren Medicare |
$11,200.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,760.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,880.40
|
| Rate for Payer: PACE Medicare |
$10,640.33
|
| Rate for Payer: PACE SWMI |
$11,200.35
|
| Rate for Payer: PHP Medicare Advantage |
$11,200.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,335.46
|
| Rate for Payer: Priority Health Medicare |
$11,200.35
|
| Rate for Payer: Priority Health Narrow Network |
$17,068.37
|
| Rate for Payer: Railroad Medicare Medicare |
$11,200.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,679.65
|
| Rate for Payer: UHC Core |
$13,916.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,200.35
|
| Rate for Payer: UHC Exchange |
$14,905.17
|
| Rate for Payer: UHC Medicare Advantage |
$11,536.36
|
| Rate for Payer: VA VA |
$11,200.35
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
IP
|
$383.05
|
|
|
Service Code
|
NDC 0555-0071-02
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.32 |
| Max. Negotiated Rate |
$344.74 |
| Rate for Payer: Aetna Commercial |
$325.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.98
|
| Rate for Payer: Cash Price |
$306.44
|
| Rate for Payer: Cofinity Commercial |
$268.14
|
| Rate for Payer: Cofinity Commercial |
$329.42
|
| Rate for Payer: Healthscope Commercial |
$344.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.59
|
| Rate for Payer: PHP Commercial |
$325.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.14
|
| Rate for Payer: Priority Health SBD |
$241.32
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
IP
|
$4.60
|
|
|
Service Code
|
NDC 51079-083-01
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.99
|
| Rate for Payer: Cash Price |
$3.68
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Healthscope Commercial |
$4.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.91
|
| Rate for Payer: PHP Commercial |
$3.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.22
|
| Rate for Payer: Priority Health SBD |
$2.90
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
IP
|
$459.84
|
|
|
Service Code
|
NDC 51079-083-20
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.70 |
| Max. Negotiated Rate |
$413.86 |
| Rate for Payer: Aetna Commercial |
$390.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.90
|
| Rate for Payer: Cash Price |
$367.87
|
| Rate for Payer: Cofinity Commercial |
$321.89
|
| Rate for Payer: Cofinity Commercial |
$395.46
|
| Rate for Payer: Healthscope Commercial |
$413.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$390.86
|
| Rate for Payer: PHP Commercial |
$390.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.89
|
| Rate for Payer: Priority Health SBD |
$289.70
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$138.72
|
|
|
Service Code
|
NDC 50268-448-15
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.39 |
| Max. Negotiated Rate |
$124.85 |
| Rate for Payer: Aetna Commercial |
$117.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.17
|
| Rate for Payer: Cash Price |
$110.98
|
| Rate for Payer: Cofinity Commercial |
$119.30
|
| Rate for Payer: Cofinity Commercial |
$97.10
|
| Rate for Payer: Healthscope Commercial |
$124.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.91
|
| Rate for Payer: PHP Commercial |
$117.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.10
|
| Rate for Payer: Priority Health SBD |
$87.39
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 68084-082-11
|
| Hospital Charge Code |
4064
|
|
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 Commercial |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.10
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.56
|
|
