|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.37
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Aetna Commercial |
$1.82
|
| Rate for Payer: Aetna Commercial |
$2.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.85
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Cofinity Commercial |
$1.84
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Healthscope Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.01
|
| Rate for Payer: PHP Commercial |
$2.01
|
| Rate for Payer: PHP Commercial |
$1.82
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.19
|
| Rate for Payer: Priority Health SBD |
$1.35
|
| Rate for Payer: Priority Health SBD |
$2.12
|
| Rate for Payer: Priority Health SBD |
$1.49
|
| Rate for Payer: Priority Health SBD |
$2.76
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.36
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
115221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.18
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Cofinity Commercial |
$2.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health SBD |
$2.12
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
115221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Medicare |
$1.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.18
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$2.89
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.16
|
| Rate for Payer: Priority Health Narrow Network |
$0.13
|
| Rate for Payer: Priority Health SBD |
$2.12
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna Commercial |
$31.45
|
| Rate for Payer: Aetna Commercial |
$140.39
|
| Rate for Payer: Aetna Medicare |
$82.58
|
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.05
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS Complete |
$66.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$132.14
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$132.14
|
| Rate for Payer: Cofinity Commercial |
$115.62
|
| Rate for Payer: Cofinity Commercial |
$142.05
|
| Rate for Payer: Cofinity Commercial |
$25.90
|
| Rate for Payer: Cofinity Commercial |
$31.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.14
|
| Rate for Payer: Healthscope Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$148.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.45
|
| Rate for Payer: PHP Commercial |
$31.45
|
| Rate for Payer: PHP Commercial |
$140.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.16
|
| Rate for Payer: Priority Health Narrow Network |
$0.13
|
| Rate for Payer: Priority Health Narrow Network |
$0.13
|
| Rate for Payer: Priority Health SBD |
$104.06
|
| Rate for Payer: Priority Health SBD |
$23.31
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$165.17
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$104.06 |
| Max. Negotiated Rate |
$148.65 |
| Rate for Payer: Aetna Commercial |
$140.39
|
| Rate for Payer: Aetna Commercial |
$31.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.05
|
| Rate for Payer: Cash Price |
$132.14
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$115.62
|
| Rate for Payer: Cofinity Commercial |
$25.90
|
| Rate for Payer: Cofinity Commercial |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$142.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.60
|
| Rate for Payer: Healthscope Commercial |
$148.65
|
| Rate for Payer: Healthscope Commercial |
$33.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.45
|
| Rate for Payer: PHP Commercial |
$140.39
|
| Rate for Payer: PHP Commercial |
$31.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.36
|
| Rate for Payer: Priority Health SBD |
$23.31
|
| Rate for Payer: Priority Health SBD |
$104.06
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$47.60
|
|
|
Service Code
|
NDC 00054074287
|
| Hospital Charge Code |
17837
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$40.46
|
| Rate for Payer: Aetna Medicare |
$23.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.94
|
| Rate for Payer: BCBS Complete |
$19.04
|
| Rate for Payer: Cash Price |
$38.08
|
| Rate for Payer: Cofinity Commercial |
$33.32
|
| Rate for Payer: Cofinity Commercial |
$40.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.08
|
| Rate for Payer: Healthscope Commercial |
$42.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.46
|
| Rate for Payer: PHP Commercial |
$40.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.94
|
| Rate for Payer: Priority Health SBD |
$29.99
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$50.40
|
|
|
Service Code
|
NDC 69097014260
|
| Hospital Charge Code |
17837
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.76
|
| Rate for Payer: Cash Price |
$40.32
|
| Rate for Payer: Cofinity Commercial |
$35.28
|
| Rate for Payer: Cofinity Commercial |
$43.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.32
|
| Rate for Payer: Healthscope Commercial |
$45.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.84
|
| Rate for Payer: PHP Commercial |
$42.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.76
|
| Rate for Payer: Priority Health SBD |
$31.75
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$50.40
|
|
|
Service Code
|
NDC 69097014260
|
| Hospital Charge Code |
17837
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Aetna Medicare |
$25.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.76
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: Cash Price |
$40.32
|
| Rate for Payer: Cofinity Commercial |
$35.28
|
| Rate for Payer: Cofinity Commercial |
$43.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.32
|
| Rate for Payer: Healthscope Commercial |
$45.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.84
|
| Rate for Payer: PHP Commercial |
$42.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.76
|
| Rate for Payer: Priority Health SBD |
$31.75
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$47.60
|
|
|
Service Code
|
NDC 00054074287
|
| Hospital Charge Code |
17837
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$40.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.94
|
| Rate for Payer: Cash Price |
$38.08
|
| Rate for Payer: Cofinity Commercial |
$33.32
|
| Rate for Payer: Cofinity Commercial |
$40.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.08
|
| Rate for Payer: Healthscope Commercial |
$42.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.46
|
| Rate for Payer: PHP Commercial |
$40.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.94
|
| Rate for Payer: Priority Health SBD |
$29.99
|
|
|
ALDESLEUKIN 22 MILLION UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24,926.11
|
|
|
Service Code
|
HCPCS J9015
|
| Hospital Charge Code |
8993
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15,703.45 |
| Max. Negotiated Rate |
$22,433.50 |
| Rate for Payer: Aetna Commercial |
$21,187.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,201.97
|
| Rate for Payer: Cash Price |
$19,940.89
|
| Rate for Payer: Cofinity Commercial |
$17,448.28
|
| Rate for Payer: Cofinity Commercial |
$21,436.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$17,448.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,940.89
|
| Rate for Payer: Healthscope Commercial |
$22,433.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,187.19
|
| Rate for Payer: PHP Commercial |
$21,187.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,201.97
|
| Rate for Payer: Priority Health SBD |
$15,703.45
|
|
|
ALDESLEUKIN 22 MILLION UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24,926.11
|
|
|
Service Code
|
HCPCS J9015
|
| Hospital Charge Code |
8993
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,841.48 |
| Max. Negotiated Rate |
$22,433.50 |
| Rate for Payer: Aetna Commercial |
$21,187.19
|
| Rate for Payer: Aetna Medicare |
$5,513.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,201.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,626.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,626.58
|
| Rate for Payer: BCBS Complete |
$2,983.55
|
| Rate for Payer: BCBS MAPPO |
$5,301.26
|
| Rate for Payer: BCBS Trust/PPO |
$15,246.75
|
| Rate for Payer: BCN Commercial |
$15,246.75
|
| Rate for Payer: BCN Medicare Advantage |
$5,301.26
|
| Rate for Payer: Cash Price |
$19,940.89
|
| Rate for Payer: Cash Price |
$19,940.89
|
| Rate for Payer: Cofinity Commercial |
$21,436.45
|
| Rate for Payer: Cofinity Commercial |
$17,448.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$17,448.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,940.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,301.26
|
| Rate for Payer: Healthscope Commercial |
$22,433.50
|
| Rate for Payer: Mclaren Medicaid |
$2,841.48
|
| Rate for Payer: Mclaren Medicare |
$5,301.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,566.32
|
| Rate for Payer: Meridian Medicaid |
$2,983.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,096.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,187.19
|
| Rate for Payer: Nomi Health Commercial |
$15,903.78
|
| Rate for Payer: PACE Medicare |
$5,036.20
|
| Rate for Payer: PACE SWMI |
$5,301.26
|
| Rate for Payer: PHP Commercial |
$21,187.19
|
| Rate for Payer: PHP Medicare Advantage |
$5,301.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,841.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,201.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,257.12
|
| Rate for Payer: Priority Health Medicare |
$5,301.26
|
| Rate for Payer: Priority Health Narrow Network |
$12,205.70
|
| Rate for Payer: Priority Health SBD |
$15,703.45
|
| Rate for Payer: Railroad Medicare Medicare |
$5,301.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,922.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,301.26
|
| Rate for Payer: UHC Medicare Advantage |
$5,301.26
|
| Rate for Payer: UHCCP Medicaid |
$2,984.61
|
| Rate for Payer: VA VA |
$5,301.26
|
|
|
ALLOGRAFT, MORSELIZED, OR PLACEMENT OF OSTEOPROMOTIVE MATERIAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 20930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$182.18 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: BCBS Trust/PPO |
$182.18
|
| Rate for Payer: BCN Commercial |
$182.18
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$205.20
|
|
|
Service Code
|
NDC 60687067701
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.08 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna Medicare |
$102.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.38
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health SBD |
$129.28
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna Medicare |
$1.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: BCBS Complete |
$1.09
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$1.91
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health SBD |
$1.72
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$2.06
|
|
|
Service Code
|
NDC 60687067711
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.34
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Cofinity Commercial |
$1.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.65
|
| Rate for Payer: Healthscope Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.75
|
| Rate for Payer: PHP Commercial |
$1.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.34
|
| Rate for Payer: Priority Health SBD |
$1.30
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$239.70
|
|
|
Service Code
|
NDC 55111072901
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.01 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$203.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.80
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$167.79
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.74
|
| Rate for Payer: PHP Commercial |
$203.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.80
|
| Rate for Payer: Priority Health SBD |
$151.01
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$272.65
|
|
|
Service Code
|
NDC 51079020520
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.06 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna Medicare |
$136.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.22
|
| Rate for Payer: BCBS Complete |
$109.06
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$190.86
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.75
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.22
|
| Rate for Payer: Priority Health SBD |
$171.77
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$77.55
|
|
|
Service Code
|
NDC 16729013401
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.86 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.41
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$54.28
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.41
|
| Rate for Payer: Priority Health SBD |
$48.86
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$277.40
|
|
|
Service Code
|
NDC 00591554301
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.96 |
| Max. Negotiated Rate |
$249.66 |
| Rate for Payer: Aetna Commercial |
$235.79
|
| Rate for Payer: Aetna Medicare |
$138.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.31
|
| Rate for Payer: BCBS Complete |
$110.96
|
| Rate for Payer: Cash Price |
$221.92
|
| Rate for Payer: Cofinity Commercial |
$194.18
|
| Rate for Payer: Cofinity Commercial |
$238.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.92
|
| Rate for Payer: Healthscope Commercial |
$249.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.79
|
| Rate for Payer: PHP Commercial |
$235.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.31
|
| Rate for Payer: Priority Health SBD |
$174.76
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$77.55
|
|
|
Service Code
|
NDC 16729013401
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna Medicare |
$38.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.41
|
| Rate for Payer: BCBS Complete |
$31.02
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$54.28
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.41
|
| Rate for Payer: Priority Health SBD |
$48.86
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
NDC 60687067711
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.34
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Cofinity Commercial |
$1.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.65
|
| Rate for Payer: Healthscope Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.75
|
| Rate for Payer: PHP Commercial |
$1.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.34
|
| Rate for Payer: Priority Health SBD |
$1.30
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$272.65
|
|
|
Service Code
|
NDC 51079020520
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.77 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.22
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$190.86
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.75
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.22
|
| Rate for Payer: Priority Health SBD |
$171.77
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$277.40
|
|
|
Service Code
|
NDC 00591554301
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.76 |
| Max. Negotiated Rate |
$249.66 |
| Rate for Payer: Aetna Commercial |
$235.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.31
|
| Rate for Payer: Cash Price |
$221.92
|
| Rate for Payer: Cofinity Commercial |
$194.18
|
| Rate for Payer: Cofinity Commercial |
$238.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.92
|
| Rate for Payer: Healthscope Commercial |
$249.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.79
|
| Rate for Payer: PHP Commercial |
$235.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.31
|
| Rate for Payer: Priority Health SBD |
$174.76
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$239.70
|
|
|
Service Code
|
NDC 55111072901
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.88 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$203.74
|
| Rate for Payer: Aetna Medicare |
$119.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.80
|
| Rate for Payer: BCBS Complete |
$95.88
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$167.79
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.74
|
| Rate for Payer: PHP Commercial |
$203.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.80
|
| Rate for Payer: Priority Health SBD |
$151.01
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$1.91
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health SBD |
$1.72
|
|
