|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$139,502.32
|
|
|
Service Code
|
MSDRG 219
|
| Min. Negotiated Rate |
$56,922.74 |
| Max. Negotiated Rate |
$139,502.32 |
| Rate for Payer: Aetna Medicare |
$62,315.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74,898.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74,898.34
|
| Rate for Payer: BCBS MAPPO |
$59,918.67
|
| Rate for Payer: BCBS Trust/PPO |
$139,502.32
|
| Rate for Payer: BCN Commercial |
$139,502.32
|
| Rate for Payer: BCN Medicare Advantage |
$59,918.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59,918.67
|
| Rate for Payer: Mclaren Medicare |
$59,918.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62,914.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68,906.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$65,910.54
|
| Rate for Payer: Nomi Health Commercial |
$99,050.07
|
| Rate for Payer: PACE Medicare |
$56,922.74
|
| Rate for Payer: PACE SWMI |
$59,918.67
|
| Rate for Payer: PHP Medicare Advantage |
$59,918.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$123,790.63
|
| Rate for Payer: Priority Health Medicare |
$59,918.67
|
| Rate for Payer: Priority Health Tiered Network |
$99,032.49
|
| Rate for Payer: Railroad Medicare Medicare |
$59,918.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125,156.29
|
| Rate for Payer: UHC Core |
$104,708.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$59,918.67
|
| Rate for Payer: UHC Exchange |
$85,513.23
|
| Rate for Payer: VA VA |
$59,918.67
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$88,634.39
|
|
|
Service Code
|
MSDRG 221
|
| Min. Negotiated Rate |
$37,554.28 |
| Max. Negotiated Rate |
$88,634.39 |
| Rate for Payer: Aetna Medicare |
$41,112.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49,413.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49,413.53
|
| Rate for Payer: BCBS MAPPO |
$39,530.82
|
| Rate for Payer: BCBS Trust/PPO |
$88,634.39
|
| Rate for Payer: BCN Commercial |
$88,634.39
|
| Rate for Payer: BCN Medicare Advantage |
$39,530.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39,530.82
|
| Rate for Payer: Mclaren Medicare |
$39,530.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41,507.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45,460.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$43,483.90
|
| Rate for Payer: Nomi Health Commercial |
$65,018.58
|
| Rate for Payer: PACE Medicare |
$37,554.28
|
| Rate for Payer: PACE SWMI |
$39,530.82
|
| Rate for Payer: PHP Medicare Advantage |
$39,530.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$81,258.81
|
| Rate for Payer: Priority Health Medicare |
$39,530.82
|
| Rate for Payer: Priority Health Tiered Network |
$65,007.04
|
| Rate for Payer: Railroad Medicare Medicare |
$39,530.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82,155.26
|
| Rate for Payer: UHC Core |
$68,733.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$39,530.82
|
| Rate for Payer: UHC Exchange |
$56,132.71
|
| Rate for Payer: VA VA |
$39,530.82
|
|
|
CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$38,686.28
|
|
|
Service Code
|
APR-DRG 1623
|
| Min. Negotiated Rate |
$36,844.08 |
| Max. Negotiated Rate |
$38,686.28 |
| Rate for Payer: BCBS Complete |
$38,686.28
|
| Rate for Payer: Mclaren Medicaid |
$36,844.08
|
| Rate for Payer: Meridian Medicaid |
$38,686.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$36,844.08
|
| Rate for Payer: UHC Medicaid |
$36,844.08
|
| Rate for Payer: UHCCP Medicaid |
$36,844.08
|
|
|
CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$32,541.65
|
|
|
Service Code
|
APR-DRG 1622
|
| Min. Negotiated Rate |
$30,992.05 |
| Max. Negotiated Rate |
$32,541.65 |
| Rate for Payer: BCBS Complete |
$32,541.65
|
| Rate for Payer: Mclaren Medicaid |
$30,992.05
|
| Rate for Payer: Meridian Medicaid |
$32,541.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$30,992.05
|
| Rate for Payer: UHC Medicaid |
$30,992.05
|
| Rate for Payer: UHCCP Medicaid |
$30,992.05
|
|
|
CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$52,705.76
|
|
|
Service Code
|
APR-DRG 1624
|
| Min. Negotiated Rate |
$50,195.96 |
| Max. Negotiated Rate |
$52,705.76 |
| Rate for Payer: BCBS Complete |
$52,705.76
|
| Rate for Payer: Mclaren Medicaid |
$50,195.96
|
| Rate for Payer: Meridian Medicaid |
$52,705.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$50,195.96
|
| Rate for Payer: UHC Medicaid |
$50,195.96
|
| Rate for Payer: UHCCP Medicaid |
$50,195.96
|
|
|
CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$26,582.20
|
|
|
Service Code
|
APR-DRG 1621
|
| Min. Negotiated Rate |
$25,316.38 |
| Max. Negotiated Rate |
$26,582.20 |
| Rate for Payer: BCBS Complete |
$26,582.20
|
| Rate for Payer: Mclaren Medicaid |
$25,316.38
|
| Rate for Payer: Meridian Medicaid |
$26,582.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$25,316.38
|
| Rate for Payer: UHC Medicaid |
$25,316.38
|
| Rate for Payer: UHCCP Medicaid |
$25,316.38
|
|
|
CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$51,308.63
|
|
|
Service Code
|
APR-DRG 1634
|
| Min. Negotiated Rate |
$48,865.36 |
| Max. Negotiated Rate |
$51,308.63 |
| Rate for Payer: BCBS Complete |
$51,308.63
|
| Rate for Payer: Mclaren Medicaid |
$48,865.36
|
| Rate for Payer: Meridian Medicaid |
$51,308.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$48,865.36
|
| Rate for Payer: UHC Medicaid |
$48,865.36
|
| Rate for Payer: UHCCP Medicaid |
$48,865.36
|
|
|
CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$24,392.77
|
|
|
Service Code
|
APR-DRG 1632
|
| Min. Negotiated Rate |
$23,231.21 |
| Max. Negotiated Rate |
$24,392.77 |
| Rate for Payer: BCBS Complete |
$24,392.77
|
| Rate for Payer: Mclaren Medicaid |
$23,231.21
|
| Rate for Payer: Meridian Medicaid |
$24,392.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,231.21
|
| Rate for Payer: UHC Medicaid |
$23,231.21
|
| Rate for Payer: UHCCP Medicaid |
$23,231.21
|
|
|
CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$31,946.57
|
|
|
Service Code
|
APR-DRG 1633
|
| Min. Negotiated Rate |
$30,425.30 |
| Max. Negotiated Rate |
$31,946.57 |
| Rate for Payer: BCBS Complete |
$31,946.57
|
| Rate for Payer: Mclaren Medicaid |
$30,425.30
|
| Rate for Payer: Meridian Medicaid |
$31,946.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$30,425.30
|
| Rate for Payer: UHC Medicaid |
$30,425.30
|
| Rate for Payer: UHCCP Medicaid |
$30,425.30
|
|
|
CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$22,489.99
|
|
|
Service Code
|
APR-DRG 1631
|
| Min. Negotiated Rate |
$21,419.03 |
| Max. Negotiated Rate |
$22,489.99 |
| Rate for Payer: BCBS Complete |
$22,489.99
|
| Rate for Payer: Mclaren Medicaid |
$21,419.03
|
| Rate for Payer: Meridian Medicaid |
$22,489.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,419.03
|
| Rate for Payer: UHC Medicaid |
$21,419.03
|
| Rate for Payer: UHCCP Medicaid |
$21,419.03
|
|
|
CARDIOMYOPATHY
|
Facility
|
IP
|
$6,148.64
|
|
|
Service Code
|
APR-DRG 2053
|
| Min. Negotiated Rate |
$5,855.85 |
| Max. Negotiated Rate |
$6,148.64 |
| Rate for Payer: BCBS Complete |
$6,148.64
|
| Rate for Payer: Mclaren Medicaid |
$5,855.85
|
| Rate for Payer: Meridian Medicaid |
$6,148.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,855.85
|
| Rate for Payer: UHC Medicaid |
$5,855.85
|
| Rate for Payer: UHCCP Medicaid |
$5,855.85
|
|
|
CARDIOMYOPATHY
|
Facility
|
IP
|
$12,650.44
|
|
|
Service Code
|
APR-DRG 2054
|
| Min. Negotiated Rate |
$12,048.04 |
| Max. Negotiated Rate |
$12,650.44 |
| Rate for Payer: BCBS Complete |
$12,650.44
|
| Rate for Payer: Mclaren Medicaid |
$12,048.04
|
| Rate for Payer: Meridian Medicaid |
$12,650.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,048.04
|
| Rate for Payer: UHC Medicaid |
$12,048.04
|
| Rate for Payer: UHCCP Medicaid |
$12,048.04
|
|
|
CARDIOMYOPATHY
|
Facility
|
IP
|
$4,524.48
|
|
|
Service Code
|
APR-DRG 2052
|
| Min. Negotiated Rate |
$4,309.03 |
| Max. Negotiated Rate |
$4,524.48 |
| Rate for Payer: BCBS Complete |
$4,524.48
|
| Rate for Payer: Mclaren Medicaid |
$4,309.03
|
| Rate for Payer: Meridian Medicaid |
$4,524.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,309.03
|
| Rate for Payer: UHC Medicaid |
$4,309.03
|
| Rate for Payer: UHCCP Medicaid |
$4,309.03
|
|
|
CARDIOMYOPATHY
|
Facility
|
IP
|
$3,522.36
|
|
|
Service Code
|
APR-DRG 2051
|
| Min. Negotiated Rate |
$3,354.62 |
| Max. Negotiated Rate |
$3,522.36 |
| Rate for Payer: BCBS Complete |
$3,522.36
|
| Rate for Payer: Mclaren Medicaid |
$3,354.62
|
| Rate for Payer: Meridian Medicaid |
$3,522.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,354.62
|
| Rate for Payer: UHC Medicaid |
$3,354.62
|
| Rate for Payer: UHCCP Medicaid |
$3,354.62
|
|
|
CARFILZOMIB 30 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$8,496.88
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
179327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$7,647.19 |
| Rate for Payer: Aetna Commercial |
$7,222.35
|
| Rate for Payer: Aetna Medicare |
$58.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,522.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.30
|
| Rate for Payer: BCBS Complete |
$30.89
|
| Rate for Payer: BCBS MAPPO |
$56.24
|
| Rate for Payer: BCBS Trust/PPO |
$136.91
|
| Rate for Payer: BCN Commercial |
$136.91
|
| Rate for Payer: BCN Medicare Advantage |
$56.24
|
| Rate for Payer: Cash Price |
$6,797.50
|
| Rate for Payer: Cash Price |
$6,797.50
|
| Rate for Payer: Cofinity Advantage |
$5,947.82
|
| Rate for Payer: Cofinity Commercial |
$7,307.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,797.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$7,647.19
|
| Rate for Payer: Mclaren Medicaid |
$29.41
|
| Rate for Payer: Mclaren Medicare |
$56.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.05
|
| Rate for Payer: Meridian Medicaid |
$59.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,222.35
|
| Rate for Payer: Nomi Health Commercial |
$168.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,372.66
|
| Rate for Payer: PACE Medicare |
$53.43
|
| Rate for Payer: PACE SWMI |
$56.24
|
| Rate for Payer: PHP Commercial |
$7,222.35
|
| Rate for Payer: PHP Medicare Advantage |
$56.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$175.50
|
| Rate for Payer: Priority Health Medicare |
$56.24
|
| Rate for Payer: Priority Health SBD |
$5,353.03
|
| Rate for Payer: Priority Health Tiered Network |
$140.40
|
| Rate for Payer: Railroad Medicare Medicare |
$56.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.76
|
| Rate for Payer: UHC Core |
$91.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56.24
|
| Rate for Payer: UHC Exchange |
$91.76
|
| Rate for Payer: UHC Medicaid |
$29.41
|
| Rate for Payer: UHCCP Medicaid |
$29.41
|
| Rate for Payer: VA VA |
$56.24
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16,993.71
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
161768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$15,294.34 |
| Rate for Payer: Aetna Commercial |
$14,444.65
|
| Rate for Payer: Aetna Medicare |
$58.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,045.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.30
|
| Rate for Payer: BCBS Complete |
$30.89
|
| Rate for Payer: BCBS MAPPO |
$56.24
|
| Rate for Payer: BCBS Trust/PPO |
$136.91
|
| Rate for Payer: BCN Commercial |
$136.91
|
| Rate for Payer: BCN Medicare Advantage |
$56.24
|
| Rate for Payer: Cash Price |
$13,594.97
|
| Rate for Payer: Cash Price |
$13,594.97
|
| Rate for Payer: Cofinity Advantage |
$11,895.60
|
| Rate for Payer: Cofinity Commercial |
$14,614.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,594.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$15,294.34
|
| Rate for Payer: Mclaren Medicaid |
$29.41
|
| Rate for Payer: Mclaren Medicare |
$56.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.05
|
| Rate for Payer: Meridian Medicaid |
$59.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,444.65
|
| Rate for Payer: Nomi Health Commercial |
$168.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,745.28
|
| Rate for Payer: PACE Medicare |
$53.43
|
| Rate for Payer: PACE SWMI |
$56.24
|
| Rate for Payer: PHP Commercial |
$14,444.65
|
| Rate for Payer: PHP Medicare Advantage |
$56.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$175.50
|
| Rate for Payer: Priority Health Medicare |
$56.24
|
| Rate for Payer: Priority Health SBD |
$10,706.04
|
| Rate for Payer: Priority Health Tiered Network |
$140.40
|
| Rate for Payer: Railroad Medicare Medicare |
$56.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.76
|
| Rate for Payer: UHC Core |
$91.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56.24
|
| Rate for Payer: UHC Exchange |
$91.76
|
| Rate for Payer: UHC Medicaid |
$29.41
|
| Rate for Payer: UHCCP Medicaid |
$29.41
|
| Rate for Payer: VA VA |
$56.24
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16,993.71
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
161768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,706.04 |
| Max. Negotiated Rate |
$15,294.34 |
| Rate for Payer: Aetna Commercial |
$14,444.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,045.91
|
| Rate for Payer: Cash Price |
$13,594.97
|
| Rate for Payer: Cofinity Advantage |
$11,895.60
|
| Rate for Payer: Cofinity Commercial |
$14,614.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,594.97
|
| Rate for Payer: Healthscope Commercial |
$15,294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,444.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,745.28
|
| Rate for Payer: PHP Commercial |
$14,444.65
|
| Rate for Payer: Priority Health SBD |
$10,706.04
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$3,656.71
|
|
|
Service Code
|
NDC 61874011520
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,303.73 |
| Max. Negotiated Rate |
$3,291.04 |
| Rate for Payer: Aetna Commercial |
$3,108.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,376.86
|
| Rate for Payer: Cash Price |
$2,925.37
|
| Rate for Payer: Cofinity Advantage |
$2,559.70
|
| Rate for Payer: Cofinity Commercial |
$3,144.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,925.37
|
| Rate for Payer: Healthscope Commercial |
$3,291.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,108.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,742.53
|
| Rate for Payer: PHP Commercial |
$3,108.20
|
| Rate for Payer: Priority Health SBD |
$2,303.73
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$3,656.71
|
|
|
Service Code
|
NDC 61874011520
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,437.09 |
| Max. Negotiated Rate |
$3,291.04 |
| Rate for Payer: Aetna Commercial |
$3,108.20
|
| Rate for Payer: Aetna Medicare |
$1,828.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,376.86
|
| Rate for Payer: BCBS Complete |
$1,462.68
|
| Rate for Payer: Cash Price |
$2,925.37
|
| Rate for Payer: Cofinity Advantage |
$2,559.70
|
| Rate for Payer: Cofinity Commercial |
$3,144.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,925.37
|
| Rate for Payer: Healthscope Commercial |
$3,291.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,925.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,108.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,742.53
|
| Rate for Payer: PHP Commercial |
$3,108.20
|
| Rate for Payer: Priority Health SBD |
$2,303.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,376.86
|
| Rate for Payer: UHC Core |
$1,905.15
|
| Rate for Payer: UHC Exchange |
$1,437.09
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$1,828.36
|
|
|
Service Code
|
NDC 61874011511
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,151.87 |
| Max. Negotiated Rate |
$1,645.52 |
| Rate for Payer: Aetna Commercial |
$1,554.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,188.43
|
| Rate for Payer: Cash Price |
$1,462.69
|
| Rate for Payer: Cofinity Advantage |
$1,279.85
|
| Rate for Payer: Cofinity Commercial |
$1,572.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,462.69
|
| Rate for Payer: Healthscope Commercial |
$1,645.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,554.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,371.27
|
| Rate for Payer: PHP Commercial |
$1,554.11
|
| Rate for Payer: Priority Health SBD |
$1,151.87
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$1,828.36
|
|
|
Service Code
|
NDC 61874011511
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$718.55 |
| Max. Negotiated Rate |
$1,645.52 |
| Rate for Payer: Aetna Commercial |
$1,554.11
|
| Rate for Payer: Aetna Medicare |
$914.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,188.43
|
| Rate for Payer: BCBS Complete |
$731.34
|
| Rate for Payer: Cash Price |
$1,462.69
|
| Rate for Payer: Cofinity Advantage |
$1,279.85
|
| Rate for Payer: Cofinity Commercial |
$1,572.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,462.69
|
| Rate for Payer: Healthscope Commercial |
$1,645.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,462.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,554.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,371.27
|
| Rate for Payer: PHP Commercial |
$1,554.11
|
| Rate for Payer: Priority Health SBD |
$1,151.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,188.43
|
| Rate for Payer: UHC Core |
$952.58
|
| Rate for Payer: UHC Exchange |
$718.55
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
IP
|
$3,656.71
|
|
|
Service Code
|
NDC 61874013020
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,303.73 |
| Max. Negotiated Rate |
$3,291.04 |
| Rate for Payer: Aetna Commercial |
$3,108.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,376.86
|
| Rate for Payer: Cash Price |
$2,925.37
|
| Rate for Payer: Cofinity Advantage |
$2,559.70
|
| Rate for Payer: Cofinity Commercial |
$3,144.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,925.37
|
| Rate for Payer: Healthscope Commercial |
$3,291.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,108.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,742.53
|
| Rate for Payer: PHP Commercial |
$3,108.20
|
| Rate for Payer: Priority Health SBD |
$2,303.73
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
OP
|
$1,828.36
|
|
|
Service Code
|
NDC 61874013011
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$718.55 |
| Max. Negotiated Rate |
$1,645.52 |
| Rate for Payer: Aetna Commercial |
$1,554.11
|
| Rate for Payer: Aetna Medicare |
$914.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,188.43
|
| Rate for Payer: BCBS Complete |
$731.34
|
| Rate for Payer: Cash Price |
$1,462.69
|
| Rate for Payer: Cofinity Advantage |
$1,279.85
|
| Rate for Payer: Cofinity Commercial |
$1,572.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,462.69
|
| Rate for Payer: Healthscope Commercial |
$1,645.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,462.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,554.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,371.27
|
| Rate for Payer: PHP Commercial |
$1,554.11
|
| Rate for Payer: Priority Health SBD |
$1,151.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,188.43
|
| Rate for Payer: UHC Core |
$952.58
|
| Rate for Payer: UHC Exchange |
$718.55
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
OP
|
$3,656.71
|
|
|
Service Code
|
NDC 61874013020
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,437.09 |
| Max. Negotiated Rate |
$3,291.04 |
| Rate for Payer: Aetna Commercial |
$3,108.20
|
| Rate for Payer: Aetna Medicare |
$1,828.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,376.86
|
| Rate for Payer: BCBS Complete |
$1,462.68
|
| Rate for Payer: Cash Price |
$2,925.37
|
| Rate for Payer: Cofinity Advantage |
$2,559.70
|
| Rate for Payer: Cofinity Commercial |
$3,144.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,925.37
|
| Rate for Payer: Healthscope Commercial |
$3,291.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,925.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,108.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,742.53
|
| Rate for Payer: PHP Commercial |
$3,108.20
|
| Rate for Payer: Priority Health SBD |
$2,303.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,376.86
|
| Rate for Payer: UHC Core |
$1,905.15
|
| Rate for Payer: UHC Exchange |
$1,437.09
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
IP
|
$5,485.07
|
|
|
Service Code
|
NDC 61874013030
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,455.59 |
| Max. Negotiated Rate |
$4,936.56 |
| Rate for Payer: Aetna Commercial |
$4,662.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,565.30
|
| Rate for Payer: Cash Price |
$4,388.06
|
| Rate for Payer: Cofinity Advantage |
$3,839.55
|
| Rate for Payer: Cofinity Commercial |
$4,717.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,388.06
|
| Rate for Payer: Healthscope Commercial |
$4,936.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,662.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,113.80
|
| Rate for Payer: PHP Commercial |
$4,662.31
|
| Rate for Payer: Priority Health SBD |
$3,455.59
|
|
