|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$135.36
|
|
|
Service Code
|
NDC 68462-157-13
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.28 |
| Max. Negotiated Rate |
$121.82 |
| Rate for Payer: Aetna Commercial |
$115.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.98
|
| Rate for Payer: Cash Price |
$108.29
|
| Rate for Payer: Cofinity Commercial |
$116.41
|
| Rate for Payer: Cofinity Commercial |
$94.75
|
| Rate for Payer: Healthscope Commercial |
$121.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.06
|
| Rate for Payer: PHP Commercial |
$115.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.75
|
| Rate for Payer: Priority Health SBD |
$85.28
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$64.98
|
|
|
Service Code
|
NDC 57237-077-30
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.94 |
| Max. Negotiated Rate |
$58.48 |
| Rate for Payer: Aetna Commercial |
$55.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.24
|
| Rate for Payer: Cash Price |
$51.98
|
| Rate for Payer: Cofinity Commercial |
$45.49
|
| Rate for Payer: Cofinity Commercial |
$55.88
|
| Rate for Payer: Healthscope Commercial |
$58.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.23
|
| Rate for Payer: PHP Commercial |
$55.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.49
|
| Rate for Payer: Priority Health SBD |
$40.94
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$81.94
|
|
|
Service Code
|
NDC 0378-7732-93
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.62 |
| Max. Negotiated Rate |
$73.75 |
| Rate for Payer: Aetna Commercial |
$69.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.26
|
| Rate for Payer: Cash Price |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$57.36
|
| Rate for Payer: Cofinity Commercial |
$70.47
|
| Rate for Payer: Healthscope Commercial |
$73.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.65
|
| Rate for Payer: PHP Commercial |
$69.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.36
|
| Rate for Payer: Priority Health SBD |
$51.62
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 68462-157-40
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.94
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Healthscope Commercial |
$4.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.84
|
| Rate for Payer: PHP Commercial |
$3.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.16
|
| Rate for Payer: Priority Health SBD |
$2.85
|
|
|
ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
10777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.03 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna Commercial |
$153.85
|
| Rate for Payer: Aetna Commercial |
$84.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.65
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cofinity Commercial |
$126.70
|
| Rate for Payer: Cofinity Commercial |
$155.66
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Cofinity Commercial |
$85.14
|
| Rate for Payer: Healthscope Commercial |
$89.10
|
| Rate for Payer: Healthscope Commercial |
$162.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.15
|
| Rate for Payer: PHP Commercial |
$153.85
|
| Rate for Payer: PHP Commercial |
$84.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.70
|
| Rate for Payer: Priority Health SBD |
$114.03
|
| Rate for Payer: Priority Health SBD |
$62.37
|
|
|
ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
10777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna Commercial |
$84.15
|
| Rate for Payer: Aetna Commercial |
$153.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.65
|
| Rate for Payer: BCBS Complete |
$72.40
|
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cofinity Commercial |
$155.66
|
| Rate for Payer: Cofinity Commercial |
$126.70
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Cofinity Commercial |
$85.14
|
| Rate for Payer: Healthscope Commercial |
$89.10
|
| Rate for Payer: Healthscope Commercial |
$162.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.15
|
| Rate for Payer: PHP Commercial |
$84.15
|
| Rate for Payer: PHP Commercial |
$153.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.30
|
| Rate for Payer: Priority Health SBD |
$114.03
|
| Rate for Payer: Priority Health SBD |
$62.37
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$151.53
|
|
|
Service Code
|
NDC 51672-4091-3
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.46 |
| Max. Negotiated Rate |
$136.38 |
| Rate for Payer: Aetna Commercial |
$128.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.49
|
| Rate for Payer: Cash Price |
$121.22
|
| Rate for Payer: Cofinity Commercial |
$106.07
|
| Rate for Payer: Cofinity Commercial |
$130.32
|
| Rate for Payer: Healthscope Commercial |
$136.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.80
|
| Rate for Payer: PHP Commercial |
$128.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.07
|
| Rate for Payer: Priority Health SBD |
$95.46
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$47.74
|
|
|
Service Code
|
NDC 0904-7073-41
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.08 |
| Max. Negotiated Rate |
$42.97 |
| Rate for Payer: Aetna Commercial |
$40.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.03
|
| Rate for Payer: Cash Price |
$38.19
|
| Rate for Payer: Cofinity Commercial |
$33.42
|
| Rate for Payer: Cofinity Commercial |
$41.06
|
| Rate for Payer: Healthscope Commercial |
$42.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.58
|
| Rate for Payer: PHP Commercial |
$40.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.42
|
| Rate for Payer: Priority Health SBD |
$30.08
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$47.74
|
|
|
Service Code
|
NDC 0904-7073-93
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.08 |
| Max. Negotiated Rate |
$42.97 |
| Rate for Payer: Aetna Commercial |
$40.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.03
|
| Rate for Payer: Cash Price |
$38.19
|
| Rate for Payer: Cofinity Commercial |
$41.06
|
| Rate for Payer: Cofinity Commercial |
$33.42
|
| Rate for Payer: Healthscope Commercial |
$42.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.58
|
| Rate for Payer: PHP Commercial |
$40.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.42
|
| Rate for Payer: Priority Health SBD |
$30.08
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$112.10
|
|
|
Service Code
|
NDC 65162-691-79
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.62 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna Commercial |
$95.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.86
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$78.47
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.28
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.47
|
| Rate for Payer: Priority Health SBD |
$70.62
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$220.88
|
|
|
Service Code
|
NDC 54838-555-50
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.15 |
| Max. Negotiated Rate |
$198.79 |
| Rate for Payer: Aetna Commercial |
$187.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.57
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cofinity Commercial |
$154.62
|
| Rate for Payer: Cofinity Commercial |
$189.96
|
| Rate for Payer: Healthscope Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.75
|
| Rate for Payer: PHP Commercial |
$187.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.62
|
| Rate for Payer: Priority Health SBD |
$139.15
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$14.30
|
|
|
Service Code
|
NDC 9900-0003-46
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$12.87 |
| Rate for Payer: Aetna Commercial |
$12.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.30
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cofinity Commercial |
$10.01
|
| Rate for Payer: Cofinity Commercial |
$12.30
|
| Rate for Payer: Healthscope Commercial |
$12.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.16
|
| Rate for Payer: PHP Commercial |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.01
|
| Rate for Payer: Priority Health SBD |
$9.01
|
|
|
ONDANSETRON HCL 4 MG TABLET
|
Facility
|
OP
|
$281.20
|
|
|
Service Code
|
NDC 0904-6551-61
|
| Hospital Charge Code |
10778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$253.08 |
| Rate for Payer: Aetna Commercial |
$239.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.78
|
| Rate for Payer: BCBS Complete |
$112.48
|
| Rate for Payer: Cash Price |
$224.96
|
| Rate for Payer: Cofinity Commercial |
$196.84
|
| Rate for Payer: Cofinity Commercial |
$241.83
|
| Rate for Payer: Healthscope Commercial |
$253.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.02
|
| Rate for Payer: PHP Commercial |
$239.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.84
|
| Rate for Payer: Priority Health SBD |
$177.16
|
|
|
ONDANSETRON HCL 4 MG TABLET
|
Facility
|
IP
|
$281.20
|
|
|
Service Code
|
NDC 0904-6551-61
|
| Hospital Charge Code |
10778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.16 |
| Max. Negotiated Rate |
$253.08 |
| Rate for Payer: Aetna Commercial |
$239.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.78
|
| Rate for Payer: Cash Price |
$224.96
|
| Rate for Payer: Cofinity Commercial |
$196.84
|
| Rate for Payer: Cofinity Commercial |
$241.83
|
| Rate for Payer: Healthscope Commercial |
$253.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.02
|
| Rate for Payer: PHP Commercial |
$239.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.84
|
| Rate for Payer: Priority Health SBD |
$177.16
|
|
|
ONDANSETRON HCL 4 MG TABLET
|
Facility
|
IP
|
$3.31
|
|
|
Service Code
|
NDC 50268-621-11
|
| Hospital Charge Code |
10778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.15
|
| Rate for Payer: Cash Price |
$2.65
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Healthscope Commercial |
$2.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.81
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.32
|
| Rate for Payer: Priority Health SBD |
$2.09
|
|
|
ONDANSETRON HCL 4 MG TABLET
|
Facility
|
IP
|
$119.99
|
|
|
Service Code
|
NDC 45963-538-30
|
| Hospital Charge Code |
10778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.59 |
| Max. Negotiated Rate |
$107.99 |
| Rate for Payer: Aetna Commercial |
$101.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.99
|
| Rate for Payer: Cash Price |
$95.99
|
| Rate for Payer: Cofinity Commercial |
$103.19
|
| Rate for Payer: Cofinity Commercial |
$83.99
|
| Rate for Payer: Healthscope Commercial |
$107.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.99
|
| Rate for Payer: PHP Commercial |
$101.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.99
|
| Rate for Payer: Priority Health SBD |
$75.59
|
|
|
ONDANSETRON HCL 4 MG TABLET
|
Facility
|
IP
|
$57.11
|
|
|
Service Code
|
NDC 65862-187-30
|
| Hospital Charge Code |
10778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$51.40 |
| Rate for Payer: Aetna Commercial |
$48.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.12
|
| Rate for Payer: Cash Price |
$45.69
|
| Rate for Payer: Cofinity Commercial |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Healthscope Commercial |
$51.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.54
|
| Rate for Payer: PHP Commercial |
$48.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.98
|
| Rate for Payer: Priority Health SBD |
$35.98
|
|
|
ONDANSETRON HCL 4 MG TABLET
|
Facility
|
IP
|
$165.30
|
|
|
Service Code
|
NDC 50268-621-15
|
| Hospital Charge Code |
10778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.14 |
| Max. Negotiated Rate |
$148.77 |
| Rate for Payer: Aetna Commercial |
$140.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.44
|
| Rate for Payer: Cash Price |
$132.24
|
| Rate for Payer: Cofinity Commercial |
$115.71
|
| Rate for Payer: Cofinity Commercial |
$142.16
|
| Rate for Payer: Healthscope Commercial |
$148.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.50
|
| Rate for Payer: PHP Commercial |
$140.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.71
|
| Rate for Payer: Priority Health SBD |
$104.14
|
|
|
ONDANSETRON HCL 8 MG TABLET
|
Facility
|
OP
|
$395.20
|
|
|
Service Code
|
NDC 0904-6552-61
|
| Hospital Charge Code |
10779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.08 |
| Max. Negotiated Rate |
$355.68 |
| Rate for Payer: Aetna Commercial |
$335.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.88
|
| Rate for Payer: BCBS Complete |
$158.08
|
| Rate for Payer: Cash Price |
$316.16
|
| Rate for Payer: Cofinity Commercial |
$276.64
|
| Rate for Payer: Cofinity Commercial |
$339.87
|
| Rate for Payer: Healthscope Commercial |
$355.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$335.92
|
| Rate for Payer: PHP Commercial |
$335.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.64
|
| Rate for Payer: Priority Health SBD |
$248.98
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION (CODE)
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
163708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.92
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$6.37
|
| Rate for Payer: Cofinity Commercial |
$7.83
|
| Rate for Payer: Healthscope Commercial |
$8.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.74
|
| Rate for Payer: PHP Commercial |
$7.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.37
|
| Rate for Payer: Priority Health SBD |
$5.73
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION
|
Facility
|
OP
|
$22.65
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
105614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$20.38 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.72
|
| Rate for Payer: BCBS Complete |
$9.06
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$7.83
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$6.37
|
| Rate for Payer: Cofinity Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$20.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.74
|
| Rate for Payer: PHP Commercial |
$7.74
|
| Rate for Payer: PHP Commercial |
$19.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.37
|
| Rate for Payer: Priority Health SBD |
$14.27
|
| Rate for Payer: Priority Health SBD |
$5.73
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$15.43
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
105614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$13.89 |
| Rate for Payer: Aetna Commercial |
$13.12
|
| Rate for Payer: Aetna Commercial |
$8.88
|
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: Aetna Commercial |
$10.33
|
| Rate for Payer: Aetna Commercial |
$10.54
|
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Aetna Commercial |
$9.73
|
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Aetna Commercial |
$10.37
|
| Rate for Payer: Aetna Commercial |
$14.70
|
| Rate for Payer: Aetna Commercial |
$9.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.82
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.36
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cash Price |
$9.92
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$6.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$8.99
|
| Rate for Payer: Cofinity Commercial |
$7.35
|
| Rate for Payer: Cofinity Commercial |
$9.03
|
| Rate for Payer: Cofinity Commercial |
$7.49
|
| Rate for Payer: Cofinity Commercial |
$9.20
|
| Rate for Payer: Cofinity Commercial |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$9.85
|
| Rate for Payer: Cofinity Commercial |
$10.45
|
| Rate for Payer: Cofinity Commercial |
$8.50
|
| Rate for Payer: Cofinity Commercial |
$10.49
|
| Rate for Payer: Cofinity Commercial |
$8.54
|
| Rate for Payer: Cofinity Commercial |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$8.68
|
| Rate for Payer: Cofinity Commercial |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$13.27
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$15.86
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$7.83
|
| Rate for Payer: Healthscope Commercial |
$10.94
|
| Rate for Payer: Healthscope Commercial |
$13.89
|
| Rate for Payer: Healthscope Commercial |
$10.98
|
| Rate for Payer: Healthscope Commercial |
$10.30
|
| Rate for Payer: Healthscope Commercial |
$9.40
|
| Rate for Payer: Healthscope Commercial |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$20.38
|
| Rate for Payer: Healthscope Commercial |
$9.45
|
| Rate for Payer: Healthscope Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$9.63
|
| Rate for Payer: Healthscope Commercial |
$15.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.92
|
| Rate for Payer: PHP Commercial |
$10.37
|
| Rate for Payer: PHP Commercial |
$9.18
|
| Rate for Payer: PHP Commercial |
$10.33
|
| Rate for Payer: PHP Commercial |
$10.54
|
| Rate for Payer: PHP Commercial |
$9.10
|
| Rate for Payer: PHP Commercial |
$13.12
|
| Rate for Payer: PHP Commercial |
$8.92
|
| Rate for Payer: PHP Commercial |
$14.70
|
| Rate for Payer: PHP Commercial |
$19.25
|
| Rate for Payer: PHP Commercial |
$8.88
|
| Rate for Payer: PHP Commercial |
$9.73
|
| Rate for Payer: PHP Commercial |
$7.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.37
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: Priority Health SBD |
$10.89
|
| Rate for Payer: Priority Health SBD |
$6.58
|
| Rate for Payer: Priority Health SBD |
$7.21
|
| Rate for Payer: Priority Health SBD |
$6.74
|
| Rate for Payer: Priority Health SBD |
$7.69
|
| Rate for Payer: Priority Health SBD |
$14.27
|
| Rate for Payer: Priority Health SBD |
$5.73
|
| Rate for Payer: Priority Health SBD |
$6.62
|
| Rate for Payer: Priority Health SBD |
$9.72
|
| Rate for Payer: Priority Health SBD |
$7.81
|
| Rate for Payer: Priority Health SBD |
$7.65
|
|
|
OPEN IMPLANTATION OF HYPOGLOSSAL NERVE NEUROSTIMULATOR ARRAY, PULSE GENERATOR, AND DISTAL RESPIRATORY SENSOR ELECTRODE OR ELECTRODE ARRAY
|
Facility
|
OP
|
$34,537.55
|
|
|
Service Code
|
CPT 64582
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$822.86 |
| Max. Negotiated Rate |
$34,537.55 |
| Rate for Payer: Aetna Medicare |
$28,735.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,537.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,537.55
|
| Rate for Payer: BCBS Complete |
$15,870.69
|
| Rate for Payer: BCBS MAPPO |
$27,630.04
|
| Rate for Payer: BCBS Trust/PPO |
$22,816.81
|
| Rate for Payer: BCN Medicare Advantage |
$27,630.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,630.04
|
| Rate for Payer: Mclaren Medicaid |
$15,113.63
|
| Rate for Payer: Mclaren Medicare |
$27,630.04
|
| Rate for Payer: Meridian Medicaid |
$15,870.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29,011.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,774.55
|
| Rate for Payer: PACE Medicare |
$26,248.54
|
| Rate for Payer: PACE SWMI |
$27,630.04
|
| Rate for Payer: PHP Medicare Advantage |
$27,630.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,113.63
|
| Rate for Payer: Priority Health Medicare |
$27,630.04
|
| Rate for Payer: Railroad Medicare Medicare |
$27,630.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$905.15
|
| Rate for Payer: UHC Core |
$11,194.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$27,630.04
|
| Rate for Payer: UHC Exchange |
$822.86
|
| Rate for Payer: UHC Medicare Advantage |
$28,458.94
|
| Rate for Payer: VA VA |
$27,630.04
|
|
|
OPEN IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAMINAL PLACEMENT)
|
Facility
|
OP
|
$8,819.00
|
|
|
Service Code
|
CPT 64581
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$642.44 |
| Max. Negotiated Rate |
$8,819.00 |
| Rate for Payer: Aetna Medicare |
$6,328.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,606.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,606.78
|
| Rate for Payer: BCBS Complete |
$3,495.47
|
| Rate for Payer: BCBS MAPPO |
$6,085.42
|
| Rate for Payer: BCBS Trust/PPO |
$6,900.62
|
| Rate for Payer: BCN Medicare Advantage |
$6,085.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,085.42
|
| Rate for Payer: Mclaren Medicaid |
$3,328.72
|
| Rate for Payer: Mclaren Medicare |
$6,085.42
|
| Rate for Payer: Meridian Medicaid |
$3,495.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,389.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,998.23
|
| Rate for Payer: PACE Medicare |
$5,781.15
|
| Rate for Payer: PACE SWMI |
$6,085.42
|
| Rate for Payer: PHP Medicare Advantage |
$6,085.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,328.72
|
| Rate for Payer: Priority Health Medicare |
$6,085.42
|
| Rate for Payer: Railroad Medicare Medicare |
$6,085.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$706.68
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,085.42
|
| Rate for Payer: UHC Exchange |
$642.44
|
| Rate for Payer: UHC Medicare Advantage |
$6,267.98
|
| Rate for Payer: VA VA |
$6,085.42
|
|
|
OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC;
|
Facility
|
OP
|
$7,957.04
|
|
|
Service Code
|
CPT 23550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$572.04 |
| Max. Negotiated Rate |
$7,957.04 |
| Rate for Payer: Aetna Medicare |
$6,620.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,957.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,957.04
|
| Rate for Payer: BCBS Complete |
$3,656.42
|
| Rate for Payer: BCBS MAPPO |
$6,365.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,683.32
|
| Rate for Payer: BCN Medicare Advantage |
$6,365.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,365.63
|
| Rate for Payer: Mclaren Medicaid |
$3,482.00
|
| Rate for Payer: Mclaren Medicare |
$6,365.63
|
| Rate for Payer: Meridian Medicaid |
$3,656.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,683.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,320.47
|
| Rate for Payer: PACE Medicare |
$6,047.35
|
| Rate for Payer: PACE SWMI |
$6,365.63
|
| Rate for Payer: PHP Medicare Advantage |
$6,365.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,482.00
|
| Rate for Payer: Priority Health Medicare |
$6,365.63
|
| Rate for Payer: Railroad Medicare Medicare |
$6,365.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$629.24
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,365.63
|
| Rate for Payer: UHC Exchange |
$572.04
|
| Rate for Payer: UHC Medicare Advantage |
$6,556.60
|
| Rate for Payer: VA VA |
$6,365.63
|
|
