|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$259.35
|
|
|
Service Code
|
NDC 68084034701
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.39 |
| Max. Negotiated Rate |
$233.41 |
| Rate for Payer: Aetna Commercial |
$220.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.58
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Advantage |
$181.54
|
| Rate for Payer: Cofinity Commercial |
$223.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$233.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.51
|
| Rate for Payer: PHP Commercial |
$220.45
|
| Rate for Payer: Priority Health SBD |
$163.39
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$67.68
|
|
|
Service Code
|
NDC 65862020290
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$60.91 |
| Rate for Payer: Aetna Commercial |
$57.53
|
| Rate for Payer: Aetna Medicare |
$33.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.99
|
| Rate for Payer: BCBS Complete |
$27.07
|
| Rate for Payer: Cash Price |
$54.14
|
| Rate for Payer: Cofinity Advantage |
$47.38
|
| Rate for Payer: Cofinity Commercial |
$58.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.14
|
| Rate for Payer: Healthscope Commercial |
$60.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.76
|
| Rate for Payer: PHP Commercial |
$57.53
|
| Rate for Payer: Priority Health SBD |
$42.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.99
|
| Rate for Payer: UHC Core |
$35.26
|
| Rate for Payer: UHC Exchange |
$26.60
|
|
|
LOTEPREDNOL ETABONATE 0.5 % EYE GEL DROPS
|
Facility
|
OP
|
$843.29
|
|
|
Service Code
|
NDC 24208050307
|
| Hospital Charge Code |
163667
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$331.41 |
| Max. Negotiated Rate |
$758.96 |
| Rate for Payer: Aetna Commercial |
$716.80
|
| Rate for Payer: Aetna Medicare |
$421.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$548.14
|
| Rate for Payer: BCBS Complete |
$337.32
|
| Rate for Payer: Cash Price |
$674.63
|
| Rate for Payer: Cofinity Advantage |
$590.30
|
| Rate for Payer: Cofinity Commercial |
$725.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$674.63
|
| Rate for Payer: Healthscope Commercial |
$758.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$674.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$632.47
|
| Rate for Payer: PHP Commercial |
$716.80
|
| Rate for Payer: Priority Health SBD |
$531.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$548.14
|
| Rate for Payer: UHC Core |
$439.35
|
| Rate for Payer: UHC Exchange |
$331.41
|
|
|
LOTEPREDNOL ETABONATE 0.5 % EYE GEL DROPS
|
Facility
|
IP
|
$843.29
|
|
|
Service Code
|
NDC 24208050307
|
| Hospital Charge Code |
163667
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$531.27 |
| Max. Negotiated Rate |
$758.96 |
| Rate for Payer: Aetna Commercial |
$716.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$548.14
|
| Rate for Payer: Cash Price |
$674.63
|
| Rate for Payer: Cofinity Advantage |
$590.30
|
| Rate for Payer: Cofinity Commercial |
$725.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$674.63
|
| Rate for Payer: Healthscope Commercial |
$758.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$632.47
|
| Rate for Payer: PHP Commercial |
$716.80
|
| Rate for Payer: Priority Health SBD |
$531.27
|
|
|
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC
|
Facility
|
IP
|
$49,046.78
|
|
|
Service Code
|
MSDRG 493
|
| Min. Negotiated Rate |
$19,169.63 |
| Max. Negotiated Rate |
$49,046.78 |
| Rate for Payer: Aetna Medicare |
$20,985.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,223.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,223.20
|
| Rate for Payer: BCBS MAPPO |
$20,178.56
|
| Rate for Payer: BCBS Trust/PPO |
$49,046.78
|
| Rate for Payer: BCN Commercial |
$49,046.78
|
| Rate for Payer: BCN Medicare Advantage |
$20,178.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,178.56
|
| Rate for Payer: Mclaren Medicare |
$20,178.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,187.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,205.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,196.42
|
| Rate for Payer: Nomi Health Commercial |
$32,715.69
|
| Rate for Payer: PACE Medicare |
$19,169.63
|
| Rate for Payer: PACE SWMI |
$20,178.56
|
| Rate for Payer: PHP Medicare Advantage |
$20,178.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$40,887.36
|
| Rate for Payer: Priority Health Medicare |
$20,178.56
|
| Rate for Payer: Priority Health Tiered Network |
$32,709.88
|
| Rate for Payer: Railroad Medicare Medicare |
$20,178.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41,338.43
|
| Rate for Payer: UHC Core |
$34,584.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,178.56
|
| Rate for Payer: UHC Exchange |
$28,244.55
|
| Rate for Payer: VA VA |
$20,178.56
|
|
|
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC
|
Facility
|
IP
|
$61,661.35
|
|
|
Service Code
|
MSDRG 492
|
| Min. Negotiated Rate |
$27,506.27 |
| Max. Negotiated Rate |
$61,661.35 |
| Rate for Payer: Aetna Medicare |
$30,112.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36,192.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36,192.46
|
| Rate for Payer: BCBS MAPPO |
$28,953.97
|
| Rate for Payer: BCBS Trust/PPO |
$61,661.35
|
| Rate for Payer: BCN Commercial |
$61,661.35
|
| Rate for Payer: BCN Medicare Advantage |
$28,953.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,953.97
|
| Rate for Payer: Mclaren Medicare |
$28,953.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30,401.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33,297.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$31,849.37
|
| Rate for Payer: Nomi Health Commercial |
$47,363.64
|
| Rate for Payer: PACE Medicare |
$27,506.27
|
| Rate for Payer: PACE SWMI |
$28,953.97
|
| Rate for Payer: PHP Medicare Advantage |
$28,953.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$59,194.05
|
| Rate for Payer: Priority Health Medicare |
$28,953.97
|
| Rate for Payer: Priority Health Tiered Network |
$47,355.23
|
| Rate for Payer: Railroad Medicare Medicare |
$28,953.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59,847.08
|
| Rate for Payer: UHC Core |
$50,069.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28,953.97
|
| Rate for Payer: UHC Exchange |
$40,890.61
|
| Rate for Payer: VA VA |
$28,953.97
|
|
|
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC
|
Facility
|
IP
|
$33,354.06
|
|
|
Service Code
|
MSDRG 494
|
| Min. Negotiated Rate |
$15,281.41 |
| Max. Negotiated Rate |
$33,354.06 |
| Rate for Payer: Aetna Medicare |
$16,729.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,107.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,107.11
|
| Rate for Payer: BCBS MAPPO |
$16,085.69
|
| Rate for Payer: BCBS Trust/PPO |
$33,354.06
|
| Rate for Payer: BCN Commercial |
$33,354.06
|
| Rate for Payer: BCN Medicare Advantage |
$16,085.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,085.69
|
| Rate for Payer: Mclaren Medicare |
$16,085.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,889.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,498.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,694.26
|
| Rate for Payer: Nomi Health Commercial |
$25,883.85
|
| Rate for Payer: PACE Medicare |
$15,281.41
|
| Rate for Payer: PACE SWMI |
$16,085.69
|
| Rate for Payer: PHP Medicare Advantage |
$16,085.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$32,349.07
|
| Rate for Payer: Priority Health Medicare |
$16,085.69
|
| Rate for Payer: Priority Health Tiered Network |
$25,879.26
|
| Rate for Payer: Railroad Medicare Medicare |
$16,085.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,705.95
|
| Rate for Payer: UHC Core |
$27,362.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,085.69
|
| Rate for Payer: UHC Exchange |
$22,346.39
|
| Rate for Payer: VA VA |
$16,085.69
|
|
|
LOWER VASCULAR PROCEDURES
|
Facility
|
IP
|
$14,505.64
|
|
|
Service Code
|
APR-DRG 1812
|
| Min. Negotiated Rate |
$13,814.89 |
| Max. Negotiated Rate |
$14,505.64 |
| Rate for Payer: BCBS Complete |
$14,505.64
|
| Rate for Payer: Mclaren Medicaid |
$13,814.89
|
| Rate for Payer: Meridian Medicaid |
$14,505.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,814.89
|
| Rate for Payer: UHC Medicaid |
$13,814.89
|
| Rate for Payer: UHCCP Medicaid |
$13,814.89
|
|
|
LOWER VASCULAR PROCEDURES
|
Facility
|
IP
|
$29,116.19
|
|
|
Service Code
|
APR-DRG 1814
|
| Min. Negotiated Rate |
$27,729.70 |
| Max. Negotiated Rate |
$29,116.19 |
| Rate for Payer: BCBS Complete |
$29,116.19
|
| Rate for Payer: Mclaren Medicaid |
$27,729.70
|
| Rate for Payer: Meridian Medicaid |
$29,116.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$27,729.70
|
| Rate for Payer: UHC Medicaid |
$27,729.70
|
| Rate for Payer: UHCCP Medicaid |
$27,729.70
|
|
|
LOWER VASCULAR PROCEDURES
|
Facility
|
IP
|
$9,925.54
|
|
|
Service Code
|
APR-DRG 1811
|
| Min. Negotiated Rate |
$9,452.90 |
| Max. Negotiated Rate |
$9,925.54 |
| Rate for Payer: BCBS Complete |
$9,925.54
|
| Rate for Payer: Mclaren Medicaid |
$9,452.90
|
| Rate for Payer: Meridian Medicaid |
$9,925.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,452.90
|
| Rate for Payer: UHC Medicaid |
$9,452.90
|
| Rate for Payer: UHCCP Medicaid |
$9,452.90
|
|
|
LOWER VASCULAR PROCEDURES
|
Facility
|
IP
|
$19,800.06
|
|
|
Service Code
|
APR-DRG 1813
|
| Min. Negotiated Rate |
$18,857.20 |
| Max. Negotiated Rate |
$19,800.06 |
| Rate for Payer: BCBS Complete |
$19,800.06
|
| Rate for Payer: Mclaren Medicaid |
$18,857.20
|
| Rate for Payer: Meridian Medicaid |
$19,800.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,857.20
|
| Rate for Payer: UHC Medicaid |
$18,857.20
|
| Rate for Payer: UHCCP Medicaid |
$18,857.20
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
OP
|
$1,391.94
|
|
|
Service Code
|
NDC 23635050860
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$547.03 |
| Max. Negotiated Rate |
$1,252.75 |
| Rate for Payer: Aetna Commercial |
$1,183.15
|
| Rate for Payer: Aetna Medicare |
$695.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$904.76
|
| Rate for Payer: BCBS Complete |
$556.78
|
| Rate for Payer: Cash Price |
$1,113.55
|
| Rate for Payer: Cofinity Advantage |
$974.36
|
| Rate for Payer: Cofinity Commercial |
$1,197.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,113.55
|
| Rate for Payer: Healthscope Commercial |
$1,252.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,113.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,183.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,043.95
|
| Rate for Payer: PHP Commercial |
$1,183.15
|
| Rate for Payer: Priority Health SBD |
$876.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$904.76
|
| Rate for Payer: UHC Core |
$725.20
|
| Rate for Payer: UHC Exchange |
$547.03
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
OP
|
$1,818.48
|
|
|
Service Code
|
NDC 69339016217
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$714.66 |
| Max. Negotiated Rate |
$1,636.63 |
| Rate for Payer: Aetna Commercial |
$1,545.71
|
| Rate for Payer: Aetna Medicare |
$909.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.01
|
| Rate for Payer: BCBS Complete |
$727.39
|
| Rate for Payer: Cash Price |
$1,454.78
|
| Rate for Payer: Cofinity Advantage |
$1,272.94
|
| Rate for Payer: Cofinity Commercial |
$1,563.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,454.78
|
| Rate for Payer: Healthscope Commercial |
$1,636.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,454.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,545.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,363.86
|
| Rate for Payer: PHP Commercial |
$1,545.71
|
| Rate for Payer: Priority Health SBD |
$1,145.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,182.01
|
| Rate for Payer: UHC Core |
$947.43
|
| Rate for Payer: UHC Exchange |
$714.66
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
IP
|
$45.47
|
|
|
Service Code
|
NDC 69339016298
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.65 |
| Max. Negotiated Rate |
$40.92 |
| Rate for Payer: Aetna Commercial |
$38.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.56
|
| Rate for Payer: Cash Price |
$36.38
|
| Rate for Payer: Cofinity Advantage |
$31.83
|
| Rate for Payer: Cofinity Commercial |
$39.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.38
|
| Rate for Payer: Healthscope Commercial |
$40.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.10
|
| Rate for Payer: PHP Commercial |
$38.65
|
| Rate for Payer: Priority Health SBD |
$28.65
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
IP
|
$1,391.94
|
|
|
Service Code
|
NDC 23635050860
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$876.92 |
| Max. Negotiated Rate |
$1,252.75 |
| Rate for Payer: Aetna Commercial |
$1,183.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$904.76
|
| Rate for Payer: Cash Price |
$1,113.55
|
| Rate for Payer: Cofinity Advantage |
$974.36
|
| Rate for Payer: Cofinity Commercial |
$1,197.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,113.55
|
| Rate for Payer: Healthscope Commercial |
$1,252.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,183.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,043.95
|
| Rate for Payer: PHP Commercial |
$1,183.15
|
| Rate for Payer: Priority Health SBD |
$876.92
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
OP
|
$472.04
|
|
|
Service Code
|
NDC 63304035160
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.51 |
| Max. Negotiated Rate |
$424.84 |
| Rate for Payer: Aetna Commercial |
$401.23
|
| Rate for Payer: Aetna Medicare |
$236.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.83
|
| Rate for Payer: BCBS Complete |
$188.82
|
| Rate for Payer: Cash Price |
$377.63
|
| Rate for Payer: Cofinity Advantage |
$330.43
|
| Rate for Payer: Cofinity Commercial |
$405.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.63
|
| Rate for Payer: Healthscope Commercial |
$424.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$377.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.03
|
| Rate for Payer: PHP Commercial |
$401.23
|
| Rate for Payer: Priority Health SBD |
$297.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.83
|
| Rate for Payer: UHC Core |
$245.93
|
| Rate for Payer: UHC Exchange |
$185.51
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 00254302802
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.74 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Advantage |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health SBD |
$168.74
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
IP
|
$1,276.95
|
|
|
Service Code
|
NDC 64764008060
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$804.48 |
| Max. Negotiated Rate |
$1,149.26 |
| Rate for Payer: Aetna Commercial |
$1,085.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.02
|
| Rate for Payer: Cash Price |
$1,021.56
|
| Rate for Payer: Cofinity Advantage |
$893.87
|
| Rate for Payer: Cofinity Commercial |
$1,098.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.56
|
| Rate for Payer: Healthscope Commercial |
$1,149.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$957.71
|
| Rate for Payer: PHP Commercial |
$1,085.41
|
| Rate for Payer: Priority Health SBD |
$804.48
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
IP
|
$1,818.48
|
|
|
Service Code
|
NDC 69339016217
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,145.64 |
| Max. Negotiated Rate |
$1,636.63 |
| Rate for Payer: Aetna Commercial |
$1,545.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.01
|
| Rate for Payer: Cash Price |
$1,454.78
|
| Rate for Payer: Cofinity Advantage |
$1,272.94
|
| Rate for Payer: Cofinity Commercial |
$1,563.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,454.78
|
| Rate for Payer: Healthscope Commercial |
$1,636.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,545.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,363.86
|
| Rate for Payer: PHP Commercial |
$1,545.71
|
| Rate for Payer: Priority Health SBD |
$1,145.64
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
OP
|
$45.47
|
|
|
Service Code
|
NDC 69339016298
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.87 |
| Max. Negotiated Rate |
$40.92 |
| Rate for Payer: Aetna Commercial |
$38.65
|
| Rate for Payer: Aetna Medicare |
$22.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.56
|
| Rate for Payer: BCBS Complete |
$18.19
|
| Rate for Payer: Cash Price |
$36.38
|
| Rate for Payer: Cofinity Advantage |
$31.83
|
| Rate for Payer: Cofinity Commercial |
$39.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.38
|
| Rate for Payer: Healthscope Commercial |
$40.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.10
|
| Rate for Payer: PHP Commercial |
$38.65
|
| Rate for Payer: Priority Health SBD |
$28.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.56
|
| Rate for Payer: UHC Core |
$23.69
|
| Rate for Payer: UHC Exchange |
$17.87
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
OP
|
$1,276.95
|
|
|
Service Code
|
NDC 64764008060
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$501.84 |
| Max. Negotiated Rate |
$1,149.26 |
| Rate for Payer: Aetna Commercial |
$1,085.41
|
| Rate for Payer: Aetna Medicare |
$638.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.02
|
| Rate for Payer: BCBS Complete |
$510.78
|
| Rate for Payer: Cash Price |
$1,021.56
|
| Rate for Payer: Cofinity Advantage |
$893.87
|
| Rate for Payer: Cofinity Commercial |
$1,098.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.56
|
| Rate for Payer: Healthscope Commercial |
$1,149.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,021.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$957.71
|
| Rate for Payer: PHP Commercial |
$1,085.41
|
| Rate for Payer: Priority Health SBD |
$804.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$830.02
|
| Rate for Payer: UHC Core |
$665.29
|
| Rate for Payer: UHC Exchange |
$501.84
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 00254302802
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.26 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna Medicare |
$133.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: BCBS Complete |
$107.14
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Advantage |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.10
|
| Rate for Payer: UHC Core |
$139.54
|
| Rate for Payer: UHC Exchange |
$105.26
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
IP
|
$472.04
|
|
|
Service Code
|
NDC 63304035160
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.39 |
| Max. Negotiated Rate |
$424.84 |
| Rate for Payer: Aetna Commercial |
$401.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.83
|
| Rate for Payer: Cash Price |
$377.63
|
| Rate for Payer: Cofinity Advantage |
$330.43
|
| Rate for Payer: Cofinity Commercial |
$405.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.63
|
| Rate for Payer: Healthscope Commercial |
$424.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.03
|
| Rate for Payer: PHP Commercial |
$401.23
|
| Rate for Payer: Priority Health SBD |
$297.39
|
|
|
LUMATEPERONE 42 MG CAPSULE
|
Facility
|
IP
|
$170.93
|
|
|
Service Code
|
NDC 72060014201
|
| Hospital Charge Code |
192596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.69 |
| Max. Negotiated Rate |
$153.84 |
| Rate for Payer: Aetna Commercial |
$145.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.10
|
| Rate for Payer: Cash Price |
$136.74
|
| Rate for Payer: Cofinity Advantage |
$119.65
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.74
|
| Rate for Payer: Healthscope Commercial |
$153.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.20
|
| Rate for Payer: PHP Commercial |
$145.29
|
| Rate for Payer: Priority Health SBD |
$107.69
|
|
|
LUMATEPERONE 42 MG CAPSULE
|
Facility
|
OP
|
$170.93
|
|
|
Service Code
|
NDC 72060014201
|
| Hospital Charge Code |
192596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.18 |
| Max. Negotiated Rate |
$153.84 |
| Rate for Payer: Aetna Commercial |
$145.29
|
| Rate for Payer: Aetna Medicare |
$85.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.10
|
| Rate for Payer: BCBS Complete |
$68.37
|
| Rate for Payer: Cash Price |
$136.74
|
| Rate for Payer: Cofinity Advantage |
$119.65
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.74
|
| Rate for Payer: Healthscope Commercial |
$153.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.20
|
| Rate for Payer: PHP Commercial |
$145.29
|
| Rate for Payer: Priority Health SBD |
$107.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.10
|
| Rate for Payer: UHC Core |
$89.05
|
| Rate for Payer: UHC Exchange |
$67.18
|
|
