|
IPL HANDS & ARMS FIRST
|
Professional
|
Both
|
$368.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$147.20 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Medicare |
$184.00
|
| Rate for Payer: BCBS Complete |
$147.20
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.00
|
|
|
IPL HANDS & ARMS SECOND
|
Professional
|
Both
|
$237.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$177.75 |
| Rate for Payer: Aetna Medicare |
$118.50
|
| Rate for Payer: BCBS Complete |
$94.80
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.75
|
|
|
IPL NECK
|
Professional
|
Both
|
$105.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
|
|
IPL NOSE & CHEEKS FIRST
|
Professional
|
Both
|
$158.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Aetna Medicare |
$79.00
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN
|
Facility
|
OP
|
$2.66
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
30510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: Aetna Commercial |
$3.78
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna Medicare |
$1.61
|
| Rate for Payer: Aetna Medicare |
$1.45
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: Aetna Medicare |
$1.46
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna Medicare |
$2.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS Complete |
$1.29
|
| Rate for Payer: BCBS Complete |
$1.77
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Advantage |
$2.03
|
| Rate for Payer: Cofinity Advantage |
$2.26
|
| Rate for Payer: Cofinity Advantage |
$1.88
|
| Rate for Payer: Cofinity Advantage |
$1.86
|
| Rate for Payer: Cofinity Advantage |
$3.09
|
| Rate for Payer: Cofinity Advantage |
$2.04
|
| Rate for Payer: Cofinity Advantage |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.83
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.56
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Healthscope Commercial |
$2.91
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$3.98
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: PHP Commercial |
$3.78
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: PHP Commercial |
$3.76
|
| Rate for Payer: PHP Commercial |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.20
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: Priority Health SBD |
$2.80
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: Priority Health SBD |
$2.03
|
| Rate for Payer: Priority Health SBD |
$2.78
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: Priority Health Tiered Network |
$0.16
|
| Rate for Payer: Priority Health Tiered Network |
$0.16
|
| Rate for Payer: Priority Health Tiered Network |
$0.16
|
| Rate for Payer: Priority Health Tiered Network |
$0.16
|
| Rate for Payer: Priority Health Tiered Network |
$0.16
|
| Rate for Payer: Priority Health Tiered Network |
$0.16
|
| Rate for Payer: Priority Health Tiered Network |
$0.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.89
|
| Rate for Payer: UHC Core |
$1.51
|
| Rate for Payer: UHC Core |
$2.32
|
| Rate for Payer: UHC Core |
$1.39
|
| Rate for Payer: UHC Core |
$1.52
|
| Rate for Payer: UHC Core |
$1.68
|
| Rate for Payer: UHC Core |
$1.40
|
| Rate for Payer: UHC Core |
$2.30
|
| Rate for Payer: UHC Exchange |
$1.27
|
| Rate for Payer: UHC Exchange |
$1.14
|
| Rate for Payer: UHC Exchange |
$1.05
|
| Rate for Payer: UHC Exchange |
$1.14
|
| Rate for Payer: UHC Exchange |
$1.74
|
| Rate for Payer: UHC Exchange |
$1.75
|
| Rate for Payer: UHC Exchange |
$1.05
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
30510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Advantage |
$2.04
|
| Rate for Payer: Cofinity Advantage |
$1.86
|
| Rate for Payer: Cofinity Advantage |
$3.09
|
| Rate for Payer: Cofinity Advantage |
$1.88
|
| Rate for Payer: Cofinity Advantage |
$2.26
|
| Rate for Payer: Cofinity Advantage |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.91
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: Healthscope Commercial |
$3.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.47
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$3.76
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: Priority Health SBD |
$2.03
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: Priority Health SBD |
$2.78
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION
|
Facility
|
IP
|
$6.58
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
12580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Aetna Commercial |
$5.59
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna Commercial |
$4.65
|
| Rate for Payer: Aetna Commercial |
$5.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.28
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cofinity Advantage |
$4.49
|
| Rate for Payer: Cofinity Advantage |
$3.83
|
| Rate for Payer: Cofinity Advantage |
$4.61
|
| Rate for Payer: Cofinity Advantage |
$2.47
|
| Rate for Payer: Cofinity Advantage |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$5.66
|
| Rate for Payer: Cofinity Commercial |
$4.70
|
| Rate for Payer: Cofinity Commercial |
$5.51
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.26
|
| Rate for Payer: Healthscope Commercial |
$4.92
|
| Rate for Payer: Healthscope Commercial |
$5.92
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$5.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.93
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: PHP Commercial |
$5.45
|
| Rate for Payer: PHP Commercial |
$5.59
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$4.65
|
| Rate for Payer: Priority Health SBD |
$4.04
|
| Rate for Payer: Priority Health SBD |
$3.45
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: Priority Health SBD |
$4.15
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION
|
Facility
|
OP
|
$6.58
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
12580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Aetna Commercial |
$5.59
|
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna Commercial |
$4.65
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Commercial |
$5.45
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: Aetna Medicare |
$2.73
|
| Rate for Payer: Aetna Medicare |
$2.29
|
| Rate for Payer: Aetna Medicare |
$3.29
|
| Rate for Payer: Aetna Medicare |
$3.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.17
|
| Rate for Payer: BCBS Complete |
$2.56
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS Complete |
$2.19
|
| Rate for Payer: BCBS Complete |
$1.41
|
| Rate for Payer: BCBS Complete |
$2.63
|
| Rate for Payer: BCBS Trust/PPO |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$0.98
|
| Rate for Payer: BCN Commercial |
$0.98
|
| Rate for Payer: BCN Commercial |
$0.98
|
| Rate for Payer: BCN Commercial |
$0.98
|
| Rate for Payer: BCN Commercial |
$0.98
|
| Rate for Payer: BCN Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cofinity Advantage |
$3.83
|
| Rate for Payer: Cofinity Advantage |
$3.21
|
| Rate for Payer: Cofinity Advantage |
$2.47
|
| Rate for Payer: Cofinity Advantage |
$4.61
|
| Rate for Payer: Cofinity Advantage |
$4.49
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$4.70
|
| Rate for Payer: Cofinity Commercial |
$5.51
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Cofinity Commercial |
$5.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.13
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$5.77
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Healthscope Commercial |
$5.92
|
| Rate for Payer: Healthscope Commercial |
$4.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.93
|
| Rate for Payer: PHP Commercial |
$4.65
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$5.45
|
| Rate for Payer: PHP Commercial |
$5.59
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.40
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: Priority Health SBD |
$3.45
|
| Rate for Payer: Priority Health SBD |
$4.15
|
| Rate for Payer: Priority Health SBD |
$4.04
|
| Rate for Payer: Priority Health Tiered Network |
$0.32
|
| Rate for Payer: Priority Health Tiered Network |
$0.32
|
| Rate for Payer: Priority Health Tiered Network |
$0.32
|
| Rate for Payer: Priority Health Tiered Network |
$0.32
|
| Rate for Payer: Priority Health Tiered Network |
$0.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.17
|
| Rate for Payer: UHC Core |
$1.84
|
| Rate for Payer: UHC Core |
$3.34
|
| Rate for Payer: UHC Core |
$3.43
|
| Rate for Payer: UHC Core |
$2.39
|
| Rate for Payer: UHC Core |
$2.85
|
| Rate for Payer: UHC Exchange |
$1.39
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UHC Exchange |
$2.15
|
| Rate for Payer: UHC Exchange |
$2.52
|
| Rate for Payer: UHC Exchange |
$2.59
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY
|
Facility
|
IP
|
$117.18
|
|
|
Service Code
|
NDC 00054004641
|
| Hospital Charge Code |
16071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.82 |
| Max. Negotiated Rate |
$105.46 |
| Rate for Payer: Aetna Commercial |
$99.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.17
|
| Rate for Payer: Cash Price |
$93.74
|
| Rate for Payer: Cofinity Advantage |
$82.03
|
| Rate for Payer: Cofinity Commercial |
$100.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.74
|
| Rate for Payer: Healthscope Commercial |
$105.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.89
|
| Rate for Payer: PHP Commercial |
$99.60
|
| Rate for Payer: Priority Health SBD |
$73.82
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY
|
Facility
|
IP
|
$111.36
|
|
|
Service Code
|
NDC 69238201702
|
| Hospital Charge Code |
16071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.16 |
| Max. Negotiated Rate |
$100.22 |
| Rate for Payer: Aetna Commercial |
$94.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.38
|
| Rate for Payer: Cash Price |
$89.09
|
| Rate for Payer: Cofinity Advantage |
$77.95
|
| Rate for Payer: Cofinity Commercial |
$95.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.09
|
| Rate for Payer: Healthscope Commercial |
$100.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.52
|
| Rate for Payer: PHP Commercial |
$94.66
|
| Rate for Payer: Priority Health SBD |
$70.16
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY
|
Facility
|
OP
|
$111.36
|
|
|
Service Code
|
NDC 69238201702
|
| Hospital Charge Code |
16071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$100.22 |
| Rate for Payer: Aetna Commercial |
$94.66
|
| Rate for Payer: Aetna Medicare |
$55.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.38
|
| Rate for Payer: BCBS Complete |
$44.54
|
| Rate for Payer: Cash Price |
$89.09
|
| Rate for Payer: Cofinity Advantage |
$77.95
|
| Rate for Payer: Cofinity Commercial |
$95.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.09
|
| Rate for Payer: Healthscope Commercial |
$100.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.52
|
| Rate for Payer: PHP Commercial |
$94.66
|
| Rate for Payer: Priority Health SBD |
$70.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.38
|
| Rate for Payer: UHC Core |
$58.02
|
| Rate for Payer: UHC Exchange |
$43.76
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY
|
Facility
|
OP
|
$117.18
|
|
|
Service Code
|
NDC 00054004641
|
| Hospital Charge Code |
16071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.05 |
| Max. Negotiated Rate |
$105.46 |
| Rate for Payer: Aetna Commercial |
$99.60
|
| Rate for Payer: Aetna Medicare |
$58.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.17
|
| Rate for Payer: BCBS Complete |
$46.87
|
| Rate for Payer: Cash Price |
$93.74
|
| Rate for Payer: Cofinity Advantage |
$82.03
|
| Rate for Payer: Cofinity Commercial |
$100.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.74
|
| Rate for Payer: Healthscope Commercial |
$105.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.89
|
| Rate for Payer: PHP Commercial |
$99.60
|
| Rate for Payer: Priority Health SBD |
$73.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.17
|
| Rate for Payer: UHC Core |
$61.05
|
| Rate for Payer: UHC Exchange |
$46.05
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$112.14
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
17450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$100.93 |
| Rate for Payer: Aetna Commercial |
$95.32
|
| Rate for Payer: Aetna Commercial |
$226.87
|
| Rate for Payer: Aetna Commercial |
$232.02
|
| Rate for Payer: Aetna Commercial |
$167.56
|
| Rate for Payer: Aetna Medicare |
$98.56
|
| Rate for Payer: Aetna Medicare |
$133.46
|
| Rate for Payer: Aetna Medicare |
$56.07
|
| Rate for Payer: Aetna Medicare |
$136.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.49
|
| Rate for Payer: BCBS Complete |
$109.18
|
| 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 Trust/PPO |
$4.41
|
| Rate for Payer: BCBS Trust/PPO |
$4.41
|
| Rate for Payer: BCBS Trust/PPO |
$4.41
|
| Rate for Payer: BCBS Trust/PPO |
$4.41
|
| Rate for Payer: BCN Commercial |
$4.41
|
| Rate for Payer: BCN Commercial |
$4.41
|
| Rate for Payer: BCN Commercial |
$4.41
|
| Rate for Payer: BCN Commercial |
$4.41
|
| Rate for Payer: Cash Price |
$218.37
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cash Price |
$89.71
|
| Rate for Payer: Cash Price |
$213.53
|
| 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 |
$218.37
|
| Rate for Payer: Cofinity Advantage |
$186.84
|
| Rate for Payer: Cofinity Advantage |
$78.50
|
| Rate for Payer: Cofinity Advantage |
$137.99
|
| Rate for Payer: Cofinity Advantage |
$191.07
|
| Rate for Payer: Cofinity Commercial |
$169.53
|
| Rate for Payer: Cofinity Commercial |
$96.44
|
| Rate for Payer: Cofinity Commercial |
$229.54
|
| Rate for Payer: Cofinity Commercial |
$234.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.71
|
| Rate for Payer: Healthscope Commercial |
$245.66
|
| Rate for Payer: Healthscope Commercial |
$100.93
|
| Rate for Payer: Healthscope Commercial |
$240.22
|
| Rate for Payer: Healthscope Commercial |
$177.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.72
|
| Rate for Payer: PHP Commercial |
$167.56
|
| Rate for Payer: PHP Commercial |
$226.87
|
| Rate for Payer: PHP Commercial |
$232.02
|
| Rate for Payer: PHP Commercial |
$95.32
|
| Rate for Payer: Priority Health SBD |
$168.15
|
| Rate for Payer: Priority Health SBD |
$70.65
|
| Rate for Payer: Priority Health SBD |
$124.19
|
| Rate for Payer: Priority Health SBD |
$171.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.95
|
| Rate for Payer: UHC Core |
$2.95
|
| Rate for Payer: UHC Core |
$2.95
|
| Rate for Payer: UHC Core |
$2.95
|
| Rate for Payer: UHC Core |
$2.95
|
| Rate for Payer: UHC Exchange |
$2.95
|
| Rate for Payer: UHC Exchange |
$2.95
|
| Rate for Payer: UHC Exchange |
$2.95
|
| Rate for Payer: UHC Exchange |
$2.95
|
|
|
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 Advantage |
$78.50
|
| Rate for Payer: Cofinity Commercial |
$96.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.71
|
| Rate for Payer: Healthscope Commercial |
$100.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.11
|
| Rate for Payer: PHP Commercial |
$95.32
|
| 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 Advantage |
$696.68
|
| Rate for Payer: Cofinity Commercial |
$855.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$796.21
|
| Rate for Payer: Healthscope Commercial |
$895.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$746.45
|
| Rate for Payer: PHP Commercial |
$845.97
|
| Rate for Payer: Priority Health SBD |
$627.01
|
|
|
IRINOTECAN 300 MG/15 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$995.26
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
120104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$895.73 |
| Rate for Payer: Aetna Commercial |
$845.97
|
| Rate for Payer: Aetna Medicare |
$497.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.92
|
| Rate for Payer: BCBS Complete |
$398.10
|
| Rate for Payer: BCBS Trust/PPO |
$4.41
|
| Rate for Payer: BCN Commercial |
$4.41
|
| Rate for Payer: Cash Price |
$796.21
|
| Rate for Payer: Cash Price |
$796.21
|
| Rate for Payer: Cofinity Advantage |
$696.68
|
| Rate for Payer: Cofinity Commercial |
$855.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$796.21
|
| Rate for Payer: Healthscope Commercial |
$895.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$796.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$746.45
|
| Rate for Payer: PHP Commercial |
$845.97
|
| Rate for Payer: Priority Health SBD |
$627.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.95
|
| Rate for Payer: UHC Core |
$2.95
|
| Rate for Payer: UHC Exchange |
$2.95
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS
|
Facility
|
OP
|
$13,707.97
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
176129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.71 |
| Max. Negotiated Rate |
$12,337.17 |
| Rate for Payer: Aetna Commercial |
$11,651.77
|
| Rate for Payer: Aetna Medicare |
$69.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,910.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.96
|
| Rate for Payer: BCBS Complete |
$36.45
|
| Rate for Payer: BCBS MAPPO |
$66.37
|
| Rate for Payer: BCBS Trust/PPO |
$165.47
|
| Rate for Payer: BCN Commercial |
$165.47
|
| Rate for Payer: BCN Medicare Advantage |
$66.37
|
| Rate for Payer: Cash Price |
$10,966.38
|
| Rate for Payer: Cash Price |
$10,966.38
|
| Rate for Payer: Cofinity Advantage |
$9,595.58
|
| Rate for Payer: Cofinity Commercial |
$11,788.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,966.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.37
|
| Rate for Payer: Healthscope Commercial |
$12,337.17
|
| Rate for Payer: Mclaren Medicaid |
$34.71
|
| Rate for Payer: Mclaren Medicare |
$66.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.69
|
| Rate for Payer: Meridian Medicaid |
$69.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$73.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,651.77
|
| Rate for Payer: Nomi Health Commercial |
$199.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,280.98
|
| Rate for Payer: PACE Medicare |
$63.05
|
| Rate for Payer: PACE SWMI |
$66.37
|
| Rate for Payer: PHP Commercial |
$11,651.77
|
| Rate for Payer: PHP Medicare Advantage |
$66.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$208.17
|
| Rate for Payer: Priority Health Medicare |
$66.37
|
| Rate for Payer: Priority Health SBD |
$8,636.02
|
| Rate for Payer: Priority Health Tiered Network |
$166.54
|
| Rate for Payer: Railroad Medicare Medicare |
$66.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.83
|
| Rate for Payer: UHC Core |
$108.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$66.37
|
| Rate for Payer: UHC Exchange |
$108.83
|
| Rate for Payer: UHC Medicaid |
$34.71
|
| Rate for Payer: UHCCP Medicaid |
$34.71
|
| Rate for Payer: VA VA |
$66.37
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS
|
Facility
|
IP
|
$13,707.97
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
176129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,636.02 |
| Max. Negotiated Rate |
$12,337.17 |
| Rate for Payer: Aetna Commercial |
$11,651.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,910.18
|
| Rate for Payer: Cash Price |
$10,966.38
|
| Rate for Payer: Cofinity Advantage |
$9,595.58
|
| Rate for Payer: Cofinity Commercial |
$11,788.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,966.38
|
| Rate for Payer: Healthscope Commercial |
$12,337.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,651.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,280.98
|
| Rate for Payer: PHP Commercial |
$11,651.77
|
| Rate for Payer: Priority Health SBD |
$8,636.02
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$169.77
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.96 |
| Max. Negotiated Rate |
$152.79 |
| Rate for Payer: Aetna Commercial |
$144.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.35
|
| Rate for Payer: Cash Price |
$135.82
|
| Rate for Payer: Cofinity Advantage |
$118.84
|
| Rate for Payer: Cofinity Commercial |
$146.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.82
|
| Rate for Payer: Healthscope Commercial |
$152.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.33
|
| Rate for Payer: PHP Commercial |
$144.30
|
| Rate for Payer: Priority Health SBD |
$106.96
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$169.77
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$152.79 |
| Rate for Payer: Aetna Commercial |
$144.30
|
| Rate for Payer: Aetna Medicare |
$18.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.64
|
| Rate for Payer: BCBS Complete |
$9.95
|
| Rate for Payer: BCBS MAPPO |
$18.11
|
| Rate for Payer: BCBS Trust/PPO |
$45.36
|
| Rate for Payer: BCN Commercial |
$45.36
|
| Rate for Payer: BCN Medicare Advantage |
$18.11
|
| Rate for Payer: Cash Price |
$135.82
|
| Rate for Payer: Cash Price |
$135.82
|
| Rate for Payer: Cofinity Advantage |
$118.84
|
| Rate for Payer: Cofinity Commercial |
$146.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.11
|
| Rate for Payer: Healthscope Commercial |
$152.79
|
| Rate for Payer: Mclaren Medicaid |
$9.47
|
| Rate for Payer: Mclaren Medicare |
$18.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.02
|
| Rate for Payer: Meridian Medicaid |
$19.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.30
|
| Rate for Payer: Nomi Health Commercial |
$54.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.33
|
| Rate for Payer: PACE Medicare |
$17.20
|
| Rate for Payer: PACE SWMI |
$18.11
|
| Rate for Payer: PHP Commercial |
$144.30
|
| Rate for Payer: PHP Medicare Advantage |
$18.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$57.12
|
| Rate for Payer: Priority Health Medicare |
$18.11
|
| Rate for Payer: Priority Health SBD |
$106.96
|
| Rate for Payer: Priority Health Tiered Network |
$45.70
|
| Rate for Payer: Railroad Medicare Medicare |
$18.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.83
|
| Rate for Payer: UHC Core |
$29.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.11
|
| Rate for Payer: UHC Exchange |
$29.83
|
| Rate for Payer: UHC Medicaid |
$9.47
|
| Rate for Payer: UHCCP Medicaid |
$9.47
|
| Rate for Payer: VA VA |
$18.11
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$71.45
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.01 |
| Max. Negotiated Rate |
$64.31 |
| Rate for Payer: Aetna Commercial |
$60.73
|
| Rate for Payer: Aetna Commercial |
$84.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.87
|
| Rate for Payer: Cash Price |
$57.16
|
| Rate for Payer: Cash Price |
$79.84
|
| Rate for Payer: Cofinity Advantage |
$50.02
|
| Rate for Payer: Cofinity Advantage |
$69.86
|
| Rate for Payer: Cofinity Commercial |
$61.45
|
| Rate for Payer: Cofinity Commercial |
$85.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.16
|
| Rate for Payer: Healthscope Commercial |
$89.82
|
| Rate for Payer: Healthscope Commercial |
$64.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.85
|
| Rate for Payer: PHP Commercial |
$60.73
|
| Rate for Payer: PHP Commercial |
$84.83
|
| Rate for Payer: Priority Health SBD |
$45.01
|
| Rate for Payer: Priority Health SBD |
$62.87
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$99.80
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$89.82 |
| Rate for Payer: Aetna Commercial |
$84.83
|
| Rate for Payer: Aetna Commercial |
$60.73
|
| Rate for Payer: Aetna Medicare |
$49.90
|
| Rate for Payer: Aetna Medicare |
$35.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.87
|
| Rate for Payer: BCBS Complete |
$39.92
|
| Rate for Payer: BCBS Complete |
$28.58
|
| Rate for Payer: BCBS Trust/PPO |
$0.59
|
| Rate for Payer: BCBS Trust/PPO |
$0.59
|
| Rate for Payer: BCN Commercial |
$0.59
|
| Rate for Payer: BCN Commercial |
$0.59
|
| Rate for Payer: Cash Price |
$57.16
|
| Rate for Payer: Cash Price |
$57.16
|
| Rate for Payer: Cash Price |
$79.84
|
| Rate for Payer: Cash Price |
$79.84
|
| Rate for Payer: Cofinity Advantage |
$50.02
|
| Rate for Payer: Cofinity Advantage |
$69.86
|
| Rate for Payer: Cofinity Commercial |
$85.83
|
| Rate for Payer: Cofinity Commercial |
$61.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.16
|
| Rate for Payer: Healthscope Commercial |
$64.31
|
| Rate for Payer: Healthscope Commercial |
$89.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.85
|
| Rate for Payer: PHP Commercial |
$84.83
|
| Rate for Payer: PHP Commercial |
$60.73
|
| Rate for Payer: Priority Health SBD |
$45.01
|
| Rate for Payer: Priority Health SBD |
$62.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.40
|
| Rate for Payer: UHC Core |
$0.40
|
| Rate for Payer: UHC Core |
$0.40
|
| Rate for Payer: UHC Exchange |
$0.40
|
| Rate for Payer: UHC Exchange |
$0.40
|
|
|
IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$199.59
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
152314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.74 |
| Max. Negotiated Rate |
$179.63 |
| Rate for Payer: Aetna Commercial |
$169.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.73
|
| Rate for Payer: Cash Price |
$159.67
|
| Rate for Payer: Cofinity Advantage |
$139.71
|
| Rate for Payer: Cofinity Commercial |
$171.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.67
|
| Rate for Payer: Healthscope Commercial |
$179.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.69
|
| Rate for Payer: PHP Commercial |
$169.65
|
| Rate for Payer: Priority Health SBD |
$125.74
|
|
|
IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$199.59
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
152314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$179.63 |
| Rate for Payer: Aetna Commercial |
$169.65
|
| Rate for Payer: Aetna Medicare |
$99.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.73
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS Trust/PPO |
$0.59
|
| Rate for Payer: BCN Commercial |
$0.59
|
| Rate for Payer: Cash Price |
$159.67
|
| Rate for Payer: Cash Price |
$159.67
|
| Rate for Payer: Cofinity Advantage |
$139.71
|
| Rate for Payer: Cofinity Commercial |
$171.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.67
|
| Rate for Payer: Healthscope Commercial |
$179.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.69
|
| Rate for Payer: PHP Commercial |
$169.65
|
| Rate for Payer: Priority Health SBD |
$125.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.40
|
| Rate for Payer: UHC Core |
$0.40
|
| Rate for Payer: UHC Exchange |
$0.40
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC
|
Facility
|
IP
|
$34,753.86
|
|
|
Service Code
|
MSDRG 062
|
| Min. Negotiated Rate |
$13,451.09 |
| Max. Negotiated Rate |
$34,753.86 |
| Rate for Payer: Aetna Medicare |
$14,725.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,698.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,698.80
|
| Rate for Payer: BCBS MAPPO |
$14,159.04
|
| Rate for Payer: BCBS Trust/PPO |
$34,753.86
|
| Rate for Payer: BCN Commercial |
$34,753.86
|
| Rate for Payer: BCN Medicare Advantage |
$14,159.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,159.04
|
| Rate for Payer: Mclaren Medicare |
$14,159.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,866.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,282.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,574.94
|
| Rate for Payer: Nomi Health Commercial |
$22,667.88
|
| Rate for Payer: PACE Medicare |
$13,451.09
|
| Rate for Payer: PACE SWMI |
$14,159.04
|
| Rate for Payer: PHP Medicare Advantage |
$14,159.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28,329.82
|
| Rate for Payer: Priority Health Medicare |
$14,159.04
|
| Rate for Payer: Priority Health Tiered Network |
$22,663.86
|
| Rate for Payer: Railroad Medicare Medicare |
$14,159.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,642.36
|
| Rate for Payer: UHC Core |
$23,962.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,159.04
|
| Rate for Payer: UHC Exchange |
$19,569.94
|
| Rate for Payer: VA VA |
$14,159.04
|
|
