|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
NDC 68084-355-11
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$401.31 |
| Max. Negotiated Rate |
$573.30 |
| Rate for Payer: Aetna Commercial |
$541.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.05
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Cofinity Commercial |
$445.90
|
| Rate for Payer: Cofinity Commercial |
$547.82
|
| Rate for Payer: Healthscope Commercial |
$573.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$541.45
|
| Rate for Payer: PHP Commercial |
$541.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health SBD |
$401.31
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$1,105.30
|
|
|
Service Code
|
NDC 0406-0522-62
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$696.34 |
| Max. Negotiated Rate |
$994.77 |
| Rate for Payer: Aetna Commercial |
$939.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$718.44
|
| Rate for Payer: Cash Price |
$884.24
|
| Rate for Payer: Cofinity Commercial |
$773.71
|
| Rate for Payer: Cofinity Commercial |
$950.56
|
| Rate for Payer: Healthscope Commercial |
$994.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$939.50
|
| Rate for Payer: PHP Commercial |
$939.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$773.71
|
| Rate for Payer: Priority Health SBD |
$696.34
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
NDC 0904-6438-61
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.88 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Aetna Commercial |
$404.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.40
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: Cofinity Commercial |
$333.20
|
| Rate for Payer: Cofinity Commercial |
$409.36
|
| Rate for Payer: Healthscope Commercial |
$428.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$404.60
|
| Rate for Payer: PHP Commercial |
$404.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.20
|
| Rate for Payer: Priority Health SBD |
$299.88
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$246.75
|
|
|
Service Code
|
NDC 13107-045-01
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.45 |
| Max. Negotiated Rate |
$222.08 |
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.20
|
| Rate for Payer: Healthscope Commercial |
$222.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.74
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.72
|
| Rate for Payer: Priority Health SBD |
$155.45
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$11.06
|
|
|
Service Code
|
NDC 0406-0522-23
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$9.95 |
| Rate for Payer: Aetna Commercial |
$9.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.19
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cofinity Commercial |
$7.74
|
| Rate for Payer: Cofinity Commercial |
$9.51
|
| Rate for Payer: Healthscope Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.40
|
| Rate for Payer: PHP Commercial |
$9.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.74
|
| Rate for Payer: Priority Health SBD |
$6.97
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$298.74
|
|
|
Service Code
|
NDC 59011-410-20
|
| Hospital Charge Code |
173651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.21 |
| Max. Negotiated Rate |
$268.87 |
| Rate for Payer: Aetna Commercial |
$253.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.18
|
| Rate for Payer: Cash Price |
$238.99
|
| Rate for Payer: Cofinity Commercial |
$256.92
|
| Rate for Payer: Cofinity Commercial |
$209.12
|
| Rate for Payer: Healthscope Commercial |
$268.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.93
|
| Rate for Payer: PHP Commercial |
$253.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.12
|
| Rate for Payer: Priority Health SBD |
$188.21
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$877.11
|
|
|
Service Code
|
NDC 0093-5731-01
|
| Hospital Charge Code |
173651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$552.58 |
| Max. Negotiated Rate |
$789.40 |
| Rate for Payer: Aetna Commercial |
$745.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.12
|
| Rate for Payer: Cash Price |
$701.69
|
| Rate for Payer: Cofinity Commercial |
$613.98
|
| Rate for Payer: Cofinity Commercial |
$754.31
|
| Rate for Payer: Healthscope Commercial |
$789.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$745.54
|
| Rate for Payer: PHP Commercial |
$745.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.98
|
| Rate for Payer: Priority Health SBD |
$552.58
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$470.98
|
|
|
Service Code
|
NDC 59011-420-20
|
| Hospital Charge Code |
173653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.72 |
| Max. Negotiated Rate |
$423.88 |
| Rate for Payer: Aetna Commercial |
$400.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.14
|
| Rate for Payer: Cash Price |
$376.78
|
| Rate for Payer: Cofinity Commercial |
$329.69
|
| Rate for Payer: Cofinity Commercial |
$405.04
|
| Rate for Payer: Healthscope Commercial |
$423.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$400.33
|
| Rate for Payer: PHP Commercial |
$400.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.69
|
| Rate for Payer: Priority Health SBD |
$296.72
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$9.32
|
|
|
Service Code
|
NDC 0904-6761-30
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$8.39 |
| Rate for Payer: Aetna Commercial |
$7.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.06
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$6.52
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Healthscope Commercial |
$8.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.92
|
| Rate for Payer: PHP Commercial |
$7.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.52
|
| Rate for Payer: Priority Health SBD |
$5.87
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 2390001252
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.39
|
| Rate for Payer: Priority Health SBD |
$15.65
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$10.53
|
|
|
Service Code
|
NDC 0904-7006-35
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$9.48 |
| Rate for Payer: Aetna Commercial |
$8.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.84
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Commercial |
$7.37
|
| Rate for Payer: Cofinity Commercial |
$9.06
|
| Rate for Payer: Healthscope Commercial |
$9.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.95
|
| Rate for Payer: PHP Commercial |
$8.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.37
|
| Rate for Payer: Priority Health SBD |
$6.63
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$27.15
|
|
|
Service Code
|
NDC 4110081123
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cofinity Commercial |
$23.35
|
| Rate for Payer: Cofinity Commercial |
$19.00
|
| Rate for Payer: Healthscope Commercial |
$24.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.08
|
| Rate for Payer: PHP Commercial |
$23.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.00
|
| Rate for Payer: Priority Health SBD |
$17.10
|
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$13.08
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
5944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$11.77 |
| Rate for Payer: Aetna Commercial |
$11.12
|
| Rate for Payer: Aetna Commercial |
$542.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$415.08
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$510.86
|
| Rate for Payer: Cofinity Commercial |
$447.01
|
| Rate for Payer: Cofinity Commercial |
$11.25
|
| Rate for Payer: Cofinity Commercial |
$9.16
|
| Rate for Payer: Cofinity Commercial |
$549.18
|
| Rate for Payer: Healthscope Commercial |
$574.72
|
| Rate for Payer: Healthscope Commercial |
$11.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$542.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.12
|
| Rate for Payer: PHP Commercial |
$542.79
|
| Rate for Payer: PHP Commercial |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.01
|
| Rate for Payer: Priority Health SBD |
$8.24
|
| Rate for Payer: Priority Health SBD |
$402.31
|
|
|
OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$132.21
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
115673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.29 |
| Max. Negotiated Rate |
$118.99 |
| Rate for Payer: Aetna Commercial |
$112.38
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Cash Price |
$105.77
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$113.70
|
| Rate for Payer: Cofinity Commercial |
$92.55
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$118.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.38
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$112.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.55
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$83.29
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
IP
|
$611.43
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
10843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$385.20 |
| Max. Negotiated Rate |
$550.29 |
| Rate for Payer: Aetna Commercial |
$519.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.43
|
| Rate for Payer: Cash Price |
$489.14
|
| Rate for Payer: Cofinity Commercial |
$428.00
|
| Rate for Payer: Cofinity Commercial |
$525.83
|
| Rate for Payer: Healthscope Commercial |
$550.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$519.72
|
| Rate for Payer: PHP Commercial |
$519.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.00
|
| Rate for Payer: Priority Health SBD |
$385.20
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
OP
|
$473.14
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
10843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$425.83 |
| Rate for Payer: Aetna Commercial |
$402.17
|
| Rate for Payer: Aetna Commercial |
$945.47
|
| Rate for Payer: Aetna Commercial |
$302.76
|
| Rate for Payer: Aetna Commercial |
$519.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$723.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.52
|
| Rate for Payer: BCBS Complete |
$244.57
|
| Rate for Payer: BCBS Complete |
$142.48
|
| Rate for Payer: BCBS Complete |
$189.26
|
| Rate for Payer: BCBS Complete |
$444.93
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: Cash Price |
$489.14
|
| Rate for Payer: Cash Price |
$889.86
|
| Rate for Payer: Cash Price |
$889.86
|
| Rate for Payer: Cash Price |
$284.95
|
| Rate for Payer: Cash Price |
$284.95
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cash Price |
$489.14
|
| Rate for Payer: Cofinity Commercial |
$778.62
|
| Rate for Payer: Cofinity Commercial |
$525.83
|
| Rate for Payer: Cofinity Commercial |
$306.32
|
| Rate for Payer: Cofinity Commercial |
$428.00
|
| Rate for Payer: Cofinity Commercial |
$249.33
|
| Rate for Payer: Cofinity Commercial |
$331.20
|
| Rate for Payer: Cofinity Commercial |
$406.90
|
| Rate for Payer: Cofinity Commercial |
$956.60
|
| Rate for Payer: Healthscope Commercial |
$1,001.09
|
| Rate for Payer: Healthscope Commercial |
$425.83
|
| Rate for Payer: Healthscope Commercial |
$550.29
|
| Rate for Payer: Healthscope Commercial |
$320.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$945.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$519.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.17
|
| Rate for Payer: PHP Commercial |
$519.72
|
| Rate for Payer: PHP Commercial |
$945.47
|
| Rate for Payer: PHP Commercial |
$302.76
|
| Rate for Payer: PHP Commercial |
$402.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.33
|
| Rate for Payer: Priority Health SBD |
$298.08
|
| Rate for Payer: Priority Health SBD |
$224.40
|
| Rate for Payer: Priority Health SBD |
$700.76
|
| Rate for Payer: Priority Health SBD |
$385.20
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION
|
Facility
|
OP
|
$6,917.12
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
40475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$6,225.41 |
| Rate for Payer: Aetna Commercial |
$5,879.55
|
| Rate for Payer: Aetna Commercial |
$3,449.97
|
| Rate for Payer: Aetna Medicare |
$14.87
|
| Rate for Payer: Aetna Medicare |
$14.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,638.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,496.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.87
|
| Rate for Payer: BCBS Complete |
$8.21
|
| Rate for Payer: BCBS Complete |
$8.21
|
| Rate for Payer: BCBS MAPPO |
$14.29
|
| Rate for Payer: BCBS MAPPO |
$14.29
|
| Rate for Payer: BCBS Trust/PPO |
$42.31
|
| Rate for Payer: BCBS Trust/PPO |
$42.31
|
| Rate for Payer: BCN Medicare Advantage |
$14.29
|
| Rate for Payer: BCN Medicare Advantage |
$14.29
|
| Rate for Payer: Cash Price |
$5,533.70
|
| Rate for Payer: Cash Price |
$5,533.70
|
| Rate for Payer: Cash Price |
$3,247.03
|
| Rate for Payer: Cash Price |
$3,247.03
|
| Rate for Payer: Cofinity Commercial |
$2,841.15
|
| Rate for Payer: Cofinity Commercial |
$3,490.56
|
| Rate for Payer: Cofinity Commercial |
$4,841.98
|
| Rate for Payer: Cofinity Commercial |
$5,948.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.29
|
| Rate for Payer: Healthscope Commercial |
$6,225.41
|
| Rate for Payer: Healthscope Commercial |
$3,652.91
|
| Rate for Payer: Mclaren Medicaid |
$7.82
|
| Rate for Payer: Mclaren Medicaid |
$7.82
|
| Rate for Payer: Mclaren Medicare |
$14.29
|
| Rate for Payer: Mclaren Medicare |
$14.29
|
| Rate for Payer: Meridian Medicaid |
$8.21
|
| Rate for Payer: Meridian Medicaid |
$8.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,449.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,879.55
|
| Rate for Payer: PACE Medicare |
$13.58
|
| Rate for Payer: PACE Medicare |
$13.58
|
| Rate for Payer: PACE SWMI |
$14.29
|
| Rate for Payer: PACE SWMI |
$14.29
|
| Rate for Payer: PHP Commercial |
$5,879.55
|
| Rate for Payer: PHP Commercial |
$3,449.97
|
| Rate for Payer: PHP Medicare Advantage |
$14.29
|
| Rate for Payer: PHP Medicare Advantage |
$14.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,841.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,841.98
|
| Rate for Payer: Priority Health Medicare |
$14.29
|
| Rate for Payer: Priority Health Medicare |
$14.29
|
| Rate for Payer: Priority Health SBD |
$2,557.04
|
| Rate for Payer: Priority Health SBD |
$4,357.79
|
| Rate for Payer: Railroad Medicare Medicare |
$14.29
|
| Rate for Payer: Railroad Medicare Medicare |
$14.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.29
|
| Rate for Payer: UHC Medicare Advantage |
$14.72
|
| Rate for Payer: UHC Medicare Advantage |
$14.72
|
| Rate for Payer: VA VA |
$14.29
|
| Rate for Payer: VA VA |
$14.29
|
|
|
PALATOPHARYNGOPLASTY (EG, UVULOPALATOPHARYNGOPLASTY, UVULOPHARYNGOPLASTY)
|
Facility
|
OP
|
$15,835.74
|
|
|
Service Code
|
CPT 42145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$680.75 |
| Max. Negotiated Rate |
$15,835.74 |
| Rate for Payer: Aetna Medicare |
$5,419.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,513.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,513.48
|
| Rate for Payer: BCBS Complete |
$2,993.07
|
| Rate for Payer: BCBS MAPPO |
$5,210.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,872.08
|
| Rate for Payer: BCN Medicare Advantage |
$5,210.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,210.78
|
| Rate for Payer: Mclaren Medicaid |
$2,850.30
|
| Rate for Payer: Mclaren Medicare |
$5,210.78
|
| Rate for Payer: Meridian Medicaid |
$2,993.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,471.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,992.40
|
| Rate for Payer: PACE Medicare |
$4,950.24
|
| Rate for Payer: PACE SWMI |
$5,210.78
|
| Rate for Payer: PHP Medicare Advantage |
$5,210.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,850.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,835.74
|
| Rate for Payer: Priority Health Medicare |
$5,210.78
|
| Rate for Payer: Priority Health Narrow Network |
$12,668.59
|
| Rate for Payer: Railroad Medicare Medicare |
$5,210.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.82
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,210.78
|
| Rate for Payer: UHC Exchange |
$680.75
|
| Rate for Payer: UHC Medicare Advantage |
$5,367.10
|
| Rate for Payer: VA VA |
$5,210.78
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,136.76
|
|
|
Service Code
|
NDC 10147-0951-3
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$716.16 |
| Max. Negotiated Rate |
$1,023.08 |
| Rate for Payer: Aetna Commercial |
$966.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.89
|
| Rate for Payer: Cash Price |
$909.41
|
| Rate for Payer: Cofinity Commercial |
$795.73
|
| Rate for Payer: Cofinity Commercial |
$977.61
|
| Rate for Payer: Healthscope Commercial |
$1,023.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$966.25
|
| Rate for Payer: PHP Commercial |
$966.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$795.73
|
| Rate for Payer: Priority Health SBD |
$716.16
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$223.67
|
|
|
Service Code
|
NDC 43975-349-03
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.91 |
| Max. Negotiated Rate |
$201.30 |
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.39
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Cofinity Commercial |
$156.57
|
| Rate for Payer: Cofinity Commercial |
$192.36
|
| Rate for Payer: Healthscope Commercial |
$201.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$190.12
|
| Rate for Payer: PHP Commercial |
$190.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.57
|
| Rate for Payer: Priority Health SBD |
$140.91
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,265.18
|
|
|
Service Code
|
NDC 50458-554-01
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$797.06 |
| Max. Negotiated Rate |
$1,138.66 |
| Rate for Payer: Aetna Commercial |
$1,075.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.37
|
| Rate for Payer: Cash Price |
$1,012.14
|
| Rate for Payer: Cofinity Commercial |
$1,088.05
|
| Rate for Payer: Cofinity Commercial |
$885.63
|
| Rate for Payer: Healthscope Commercial |
$1,138.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,075.40
|
| Rate for Payer: PHP Commercial |
$1,075.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.63
|
| Rate for Payer: Priority Health SBD |
$797.06
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,265.18
|
|
|
Service Code
|
NDC 50458-550-01
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$797.06 |
| Max. Negotiated Rate |
$1,138.66 |
| Rate for Payer: Aetna Commercial |
$1,075.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.37
|
| Rate for Payer: Cash Price |
$1,012.14
|
| Rate for Payer: Cofinity Commercial |
$1,088.05
|
| Rate for Payer: Cofinity Commercial |
$885.63
|
| Rate for Payer: Healthscope Commercial |
$1,138.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,075.40
|
| Rate for Payer: PHP Commercial |
$1,075.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.63
|
| Rate for Payer: Priority Health SBD |
$797.06
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,136.76
|
|
|
Service Code
|
NDC 10147-0952-3
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$716.16 |
| Max. Negotiated Rate |
$1,023.08 |
| Rate for Payer: Aetna Commercial |
$966.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.89
|
| Rate for Payer: Cash Price |
$909.41
|
| Rate for Payer: Cofinity Commercial |
$795.73
|
| Rate for Payer: Cofinity Commercial |
$977.61
|
| Rate for Payer: Healthscope Commercial |
$1,023.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$966.25
|
| Rate for Payer: PHP Commercial |
$966.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$795.73
|
| Rate for Payer: Priority Health SBD |
$716.16
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3,988.23
|
|
|
Service Code
|
NDC 0904-6935-61
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,512.58 |
| Max. Negotiated Rate |
$3,589.41 |
| Rate for Payer: Aetna Commercial |
$3,390.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,592.35
|
| Rate for Payer: Cash Price |
$3,190.58
|
| Rate for Payer: Cofinity Commercial |
$2,791.76
|
| Rate for Payer: Cofinity Commercial |
$3,429.88
|
| Rate for Payer: Healthscope Commercial |
$3,589.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,390.00
|
| Rate for Payer: PHP Commercial |
$3,390.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,791.76
|
| Rate for Payer: Priority Health SBD |
$2,512.58
|
|
|
PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$292.38
|
|
|
Service Code
|
NDC 47335-766-83
|
| Hospital Charge Code |
78065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$263.14 |
| Rate for Payer: Aetna Commercial |
$248.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.05
|
| Rate for Payer: Cash Price |
$233.90
|
| Rate for Payer: Cofinity Commercial |
$204.67
|
| Rate for Payer: Cofinity Commercial |
$251.45
|
| Rate for Payer: Healthscope Commercial |
$263.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.52
|
| Rate for Payer: PHP Commercial |
$248.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.67
|
| Rate for Payer: Priority Health SBD |
$184.20
|
|
