|
LUMATEPERONE 42 MG CAPSULE
|
Facility
|
OP
|
$5,127.76
|
|
|
Service Code
|
NDC 72060014230
|
| Hospital Charge Code |
192596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,015.21 |
| Max. Negotiated Rate |
$4,614.98 |
| Rate for Payer: Aetna Commercial |
$4,358.60
|
| Rate for Payer: Aetna Medicare |
$2,563.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,333.04
|
| Rate for Payer: BCBS Complete |
$2,051.10
|
| Rate for Payer: Cash Price |
$4,102.21
|
| Rate for Payer: Cofinity Advantage |
$3,589.43
|
| Rate for Payer: Cofinity Commercial |
$4,409.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,102.21
|
| Rate for Payer: Healthscope Commercial |
$4,614.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,102.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,358.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,845.82
|
| Rate for Payer: PHP Commercial |
$4,358.60
|
| Rate for Payer: Priority Health SBD |
$3,230.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,333.04
|
| Rate for Payer: UHC Core |
$2,671.56
|
| Rate for Payer: UHC Exchange |
$2,015.21
|
|
|
LUMATEPERONE 42 MG CAPSULE
|
Facility
|
IP
|
$5,127.76
|
|
|
Service Code
|
NDC 72060014230
|
| Hospital Charge Code |
192596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,230.49 |
| Max. Negotiated Rate |
$4,614.98 |
| Rate for Payer: Aetna Commercial |
$4,358.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,333.04
|
| Rate for Payer: Cash Price |
$4,102.21
|
| Rate for Payer: Cofinity Advantage |
$3,589.43
|
| Rate for Payer: Cofinity Commercial |
$4,409.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,102.21
|
| Rate for Payer: Healthscope Commercial |
$4,614.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,358.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,845.82
|
| Rate for Payer: PHP Commercial |
$4,358.60
|
| Rate for Payer: Priority Health SBD |
$3,230.49
|
|
|
LUNG TRANSPLANT
|
Facility
|
IP
|
$211,613.00
|
|
|
Service Code
|
MSDRG 007
|
| Min. Negotiated Rate |
$95,628.04 |
| Max. Negotiated Rate |
$211,613.00 |
| Rate for Payer: Aetna Medicare |
$104,687.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125,826.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125,826.38
|
| Rate for Payer: BCBS MAPPO |
$100,661.10
|
| Rate for Payer: BCBS Trust/PPO |
$211,613.00
|
| Rate for Payer: BCN Commercial |
$211,613.00
|
| Rate for Payer: BCN Medicare Advantage |
$100,661.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100,661.10
|
| Rate for Payer: Mclaren Medicare |
$100,661.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105,694.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115,760.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$110,727.21
|
| Rate for Payer: Nomi Health Commercial |
$167,057.58
|
| Rate for Payer: PACE Medicare |
$95,628.04
|
| Rate for Payer: PACE SWMI |
$100,661.10
|
| Rate for Payer: PHP Medicare Advantage |
$100,661.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$208,784.94
|
| Rate for Payer: Priority Health Medicare |
$100,661.10
|
| Rate for Payer: Priority Health Tiered Network |
$167,027.92
|
| Rate for Payer: Railroad Medicare Medicare |
$100,661.10
|
| Rate for Payer: VA VA |
$100,661.10
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
IP
|
$9.90
|
|
|
Service Code
|
NDC 60687074711
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$8.91 |
| Rate for Payer: Aetna Commercial |
$8.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.43
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Advantage |
$6.93
|
| Rate for Payer: Cofinity Commercial |
$8.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.42
|
| Rate for Payer: PHP Commercial |
$8.41
|
| Rate for Payer: Priority Health SBD |
$6.24
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
OP
|
$92.88
|
|
|
Service Code
|
NDC 00904735504
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.50 |
| Max. Negotiated Rate |
$83.59 |
| Rate for Payer: Aetna Commercial |
$78.95
|
| Rate for Payer: Aetna Medicare |
$46.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.37
|
| Rate for Payer: BCBS Complete |
$37.15
|
| Rate for Payer: Cash Price |
$74.30
|
| Rate for Payer: Cofinity Advantage |
$65.02
|
| Rate for Payer: Cofinity Commercial |
$79.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.30
|
| Rate for Payer: Healthscope Commercial |
$83.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.66
|
| Rate for Payer: PHP Commercial |
$78.95
|
| Rate for Payer: Priority Health SBD |
$58.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.37
|
| Rate for Payer: UHC Core |
$48.39
|
| Rate for Payer: UHC Exchange |
$36.50
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
IP
|
$103.17
|
|
|
Service Code
|
NDC 67877063830
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$92.85 |
| Rate for Payer: Aetna Commercial |
$87.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.06
|
| Rate for Payer: Cash Price |
$82.54
|
| Rate for Payer: Cofinity Advantage |
$72.22
|
| Rate for Payer: Cofinity Commercial |
$88.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.54
|
| Rate for Payer: Healthscope Commercial |
$92.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.38
|
| Rate for Payer: PHP Commercial |
$87.69
|
| Rate for Payer: Priority Health SBD |
$65.00
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
OP
|
$9.90
|
|
|
Service Code
|
NDC 60687074711
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$8.91 |
| Rate for Payer: Aetna Commercial |
$8.41
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.43
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Advantage |
$6.93
|
| Rate for Payer: Cofinity Commercial |
$8.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$8.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.42
|
| Rate for Payer: PHP Commercial |
$8.41
|
| Rate for Payer: Priority Health SBD |
$6.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.43
|
| Rate for Payer: UHC Core |
$5.16
|
| Rate for Payer: UHC Exchange |
$3.89
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
IP
|
$92.88
|
|
|
Service Code
|
NDC 00904735504
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.51 |
| Max. Negotiated Rate |
$83.59 |
| Rate for Payer: Aetna Commercial |
$78.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.37
|
| Rate for Payer: Cash Price |
$74.30
|
| Rate for Payer: Cofinity Advantage |
$65.02
|
| Rate for Payer: Cofinity Commercial |
$79.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.30
|
| Rate for Payer: Healthscope Commercial |
$83.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.66
|
| Rate for Payer: PHP Commercial |
$78.95
|
| Rate for Payer: Priority Health SBD |
$58.51
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
IP
|
$296.71
|
|
|
Service Code
|
NDC 60687074721
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.93 |
| Max. Negotiated Rate |
$267.04 |
| Rate for Payer: Aetna Commercial |
$252.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.86
|
| Rate for Payer: Cash Price |
$237.37
|
| Rate for Payer: Cofinity Advantage |
$207.70
|
| Rate for Payer: Cofinity Commercial |
$255.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.37
|
| Rate for Payer: Healthscope Commercial |
$267.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.53
|
| Rate for Payer: PHP Commercial |
$252.20
|
| Rate for Payer: Priority Health SBD |
$186.93
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
OP
|
$103.17
|
|
|
Service Code
|
NDC 67877063830
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.55 |
| Max. Negotiated Rate |
$92.85 |
| Rate for Payer: Aetna Commercial |
$87.69
|
| Rate for Payer: Aetna Medicare |
$51.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.06
|
| Rate for Payer: BCBS Complete |
$41.27
|
| Rate for Payer: Cash Price |
$82.54
|
| Rate for Payer: Cofinity Advantage |
$72.22
|
| Rate for Payer: Cofinity Commercial |
$88.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.54
|
| Rate for Payer: Healthscope Commercial |
$92.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.38
|
| Rate for Payer: PHP Commercial |
$87.69
|
| Rate for Payer: Priority Health SBD |
$65.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.06
|
| Rate for Payer: UHC Core |
$53.75
|
| Rate for Payer: UHC Exchange |
$40.55
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
OP
|
$296.71
|
|
|
Service Code
|
NDC 60687074721
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.61 |
| Max. Negotiated Rate |
$267.04 |
| Rate for Payer: Aetna Commercial |
$252.20
|
| Rate for Payer: Aetna Medicare |
$148.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.86
|
| Rate for Payer: BCBS Complete |
$118.68
|
| Rate for Payer: Cash Price |
$237.37
|
| Rate for Payer: Cofinity Advantage |
$207.70
|
| Rate for Payer: Cofinity Commercial |
$255.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.37
|
| Rate for Payer: Healthscope Commercial |
$267.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.53
|
| Rate for Payer: PHP Commercial |
$252.20
|
| Rate for Payer: Priority Health SBD |
$186.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.86
|
| Rate for Payer: UHC Core |
$154.59
|
| Rate for Payer: UHC Exchange |
$116.61
|
|
|
LURASIDONE 40 MG TABLET
|
Facility
|
OP
|
$412.80
|
|
|
Service Code
|
NDC 00904735661
|
| Hospital Charge Code |
107668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.23 |
| Max. Negotiated Rate |
$371.52 |
| Rate for Payer: Aetna Commercial |
$350.88
|
| Rate for Payer: Aetna Medicare |
$206.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.32
|
| Rate for Payer: BCBS Complete |
$165.12
|
| Rate for Payer: Cash Price |
$330.24
|
| Rate for Payer: Cofinity Advantage |
$288.96
|
| Rate for Payer: Cofinity Commercial |
$355.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.24
|
| Rate for Payer: Healthscope Commercial |
$371.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$330.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.60
|
| Rate for Payer: PHP Commercial |
$350.88
|
| Rate for Payer: Priority Health SBD |
$260.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.32
|
| Rate for Payer: UHC Core |
$215.07
|
| Rate for Payer: UHC Exchange |
$162.23
|
|
|
LURASIDONE 40 MG TABLET
|
Facility
|
OP
|
$5,028.19
|
|
|
Service Code
|
NDC 63402030430
|
| Hospital Charge Code |
107668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,976.08 |
| Max. Negotiated Rate |
$4,525.37 |
| Rate for Payer: Aetna Commercial |
$4,273.96
|
| Rate for Payer: Aetna Medicare |
$2,514.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,268.32
|
| Rate for Payer: BCBS Complete |
$2,011.28
|
| Rate for Payer: Cash Price |
$4,022.55
|
| Rate for Payer: Cofinity Advantage |
$3,519.73
|
| Rate for Payer: Cofinity Commercial |
$4,324.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,022.55
|
| Rate for Payer: Healthscope Commercial |
$4,525.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,022.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,273.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,771.14
|
| Rate for Payer: PHP Commercial |
$4,273.96
|
| Rate for Payer: Priority Health SBD |
$3,167.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,268.32
|
| Rate for Payer: UHC Core |
$2,619.69
|
| Rate for Payer: UHC Exchange |
$1,976.08
|
|
|
LURASIDONE 40 MG TABLET
|
Facility
|
IP
|
$5,028.19
|
|
|
Service Code
|
NDC 63402030430
|
| Hospital Charge Code |
107668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,167.76 |
| Max. Negotiated Rate |
$4,525.37 |
| Rate for Payer: Aetna Commercial |
$4,273.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,268.32
|
| Rate for Payer: Cash Price |
$4,022.55
|
| Rate for Payer: Cofinity Advantage |
$3,519.73
|
| Rate for Payer: Cofinity Commercial |
$4,324.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,022.55
|
| Rate for Payer: Healthscope Commercial |
$4,525.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,273.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,771.14
|
| Rate for Payer: PHP Commercial |
$4,273.96
|
| Rate for Payer: Priority Health SBD |
$3,167.76
|
|
|
LURASIDONE 40 MG TABLET
|
Facility
|
IP
|
$412.80
|
|
|
Service Code
|
NDC 00904735661
|
| Hospital Charge Code |
107668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.06 |
| Max. Negotiated Rate |
$371.52 |
| Rate for Payer: Aetna Commercial |
$350.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.32
|
| Rate for Payer: Cash Price |
$330.24
|
| Rate for Payer: Cofinity Advantage |
$288.96
|
| Rate for Payer: Cofinity Commercial |
$355.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.24
|
| Rate for Payer: Healthscope Commercial |
$371.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.60
|
| Rate for Payer: PHP Commercial |
$350.88
|
| Rate for Payer: Priority Health SBD |
$260.06
|
|
|
LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21,450.00
|
|
|
Service Code
|
HCPCS J9223
|
| Hospital Charge Code |
194141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.93 |
| Max. Negotiated Rate |
$19,305.00 |
| Rate for Payer: Aetna Commercial |
$18,232.50
|
| Rate for Payer: Aetna Medicare |
$220.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,942.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$265.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$265.12
|
| Rate for Payer: BCBS Complete |
$116.49
|
| Rate for Payer: BCBS MAPPO |
$212.10
|
| Rate for Payer: BCBS Trust/PPO |
$528.83
|
| Rate for Payer: BCN Commercial |
$528.83
|
| Rate for Payer: BCN Medicare Advantage |
$212.10
|
| Rate for Payer: Cash Price |
$17,160.00
|
| Rate for Payer: Cash Price |
$17,160.00
|
| Rate for Payer: Cofinity Advantage |
$15,015.00
|
| Rate for Payer: Cofinity Commercial |
$18,447.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,160.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.10
|
| Rate for Payer: Healthscope Commercial |
$19,305.00
|
| Rate for Payer: Mclaren Medicaid |
$110.93
|
| Rate for Payer: Mclaren Medicare |
$212.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.71
|
| Rate for Payer: Meridian Medicaid |
$222.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,232.50
|
| Rate for Payer: Nomi Health Commercial |
$636.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16,087.50
|
| Rate for Payer: PACE Medicare |
$201.50
|
| Rate for Payer: PACE SWMI |
$212.10
|
| Rate for Payer: PHP Commercial |
$18,232.50
|
| Rate for Payer: PHP Medicare Advantage |
$212.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$653.28
|
| Rate for Payer: Priority Health Medicare |
$212.10
|
| Rate for Payer: Priority Health SBD |
$13,513.50
|
| Rate for Payer: Priority Health Tiered Network |
$522.62
|
| Rate for Payer: Railroad Medicare Medicare |
$212.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.79
|
| Rate for Payer: UHC Core |
$347.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$212.10
|
| Rate for Payer: UHC Exchange |
$347.79
|
| Rate for Payer: UHC Medicaid |
$110.93
|
| Rate for Payer: UHCCP Medicaid |
$110.93
|
| Rate for Payer: VA VA |
$212.10
|
|
|
LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$18,202.00
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$16,381.80 |
| Rate for Payer: Aetna Commercial |
$15,471.70
|
| Rate for Payer: Aetna Medicare |
$44.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,831.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.44
|
| Rate for Payer: BCBS Complete |
$23.48
|
| Rate for Payer: BCBS MAPPO |
$42.75
|
| Rate for Payer: BCBS Trust/PPO |
$107.31
|
| Rate for Payer: BCN Commercial |
$107.31
|
| Rate for Payer: BCN Medicare Advantage |
$42.75
|
| Rate for Payer: Cash Price |
$14,561.60
|
| Rate for Payer: Cash Price |
$14,561.60
|
| Rate for Payer: Cofinity Advantage |
$12,741.40
|
| Rate for Payer: Cofinity Commercial |
$15,653.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,561.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$16,381.80
|
| Rate for Payer: Mclaren Medicaid |
$22.36
|
| Rate for Payer: Mclaren Medicare |
$42.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.89
|
| Rate for Payer: Meridian Medicaid |
$44.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,471.70
|
| Rate for Payer: Nomi Health Commercial |
$128.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,651.50
|
| Rate for Payer: PACE Medicare |
$40.61
|
| Rate for Payer: PACE SWMI |
$42.75
|
| Rate for Payer: PHP Commercial |
$15,471.70
|
| Rate for Payer: PHP Medicare Advantage |
$42.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$132.40
|
| Rate for Payer: Priority Health Medicare |
$42.75
|
| Rate for Payer: Priority Health SBD |
$11,467.26
|
| Rate for Payer: Priority Health Tiered Network |
$105.92
|
| Rate for Payer: Railroad Medicare Medicare |
$42.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.57
|
| Rate for Payer: UHC Core |
$70.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.75
|
| Rate for Payer: UHC Exchange |
$70.57
|
| Rate for Payer: UHC Medicaid |
$22.36
|
| Rate for Payer: UHCCP Medicaid |
$22.36
|
| Rate for Payer: VA VA |
$42.75
|
|
|
LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$18,202.00
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,467.26 |
| Max. Negotiated Rate |
$16,381.80 |
| Rate for Payer: Aetna Commercial |
$15,471.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,831.30
|
| Rate for Payer: Cash Price |
$14,561.60
|
| Rate for Payer: Cofinity Advantage |
$12,741.40
|
| Rate for Payer: Cofinity Commercial |
$15,653.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,561.60
|
| Rate for Payer: Healthscope Commercial |
$16,381.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,471.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,651.50
|
| Rate for Payer: PHP Commercial |
$15,471.70
|
| Rate for Payer: Priority Health SBD |
$11,467.26
|
|
|
LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$54,605.00
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$49,144.50 |
| Rate for Payer: Aetna Commercial |
$46,414.25
|
| Rate for Payer: Aetna Medicare |
$44.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35,493.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.44
|
| Rate for Payer: BCBS Complete |
$23.48
|
| Rate for Payer: BCBS MAPPO |
$42.75
|
| Rate for Payer: BCBS Trust/PPO |
$107.31
|
| Rate for Payer: BCN Commercial |
$107.31
|
| Rate for Payer: BCN Medicare Advantage |
$42.75
|
| Rate for Payer: Cash Price |
$43,684.00
|
| Rate for Payer: Cash Price |
$43,684.00
|
| Rate for Payer: Cofinity Advantage |
$38,223.50
|
| Rate for Payer: Cofinity Commercial |
$46,960.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43,684.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$49,144.50
|
| Rate for Payer: Mclaren Medicaid |
$22.36
|
| Rate for Payer: Mclaren Medicare |
$42.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.89
|
| Rate for Payer: Meridian Medicaid |
$44.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46,414.25
|
| Rate for Payer: Nomi Health Commercial |
$128.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40,953.75
|
| Rate for Payer: PACE Medicare |
$40.61
|
| Rate for Payer: PACE SWMI |
$42.75
|
| Rate for Payer: PHP Commercial |
$46,414.25
|
| Rate for Payer: PHP Medicare Advantage |
$42.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$132.40
|
| Rate for Payer: Priority Health Medicare |
$42.75
|
| Rate for Payer: Priority Health SBD |
$34,401.15
|
| Rate for Payer: Priority Health Tiered Network |
$105.92
|
| Rate for Payer: Railroad Medicare Medicare |
$42.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.57
|
| Rate for Payer: UHC Core |
$70.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.75
|
| Rate for Payer: UHC Exchange |
$70.57
|
| Rate for Payer: UHC Medicaid |
$22.36
|
| Rate for Payer: UHCCP Medicaid |
$22.36
|
| Rate for Payer: VA VA |
$42.75
|
|
|
LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$54,605.00
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34,401.15 |
| Max. Negotiated Rate |
$49,144.50 |
| Rate for Payer: Aetna Commercial |
$46,414.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35,493.25
|
| Rate for Payer: Cash Price |
$43,684.00
|
| Rate for Payer: Cofinity Advantage |
$38,223.50
|
| Rate for Payer: Cofinity Commercial |
$46,960.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43,684.00
|
| Rate for Payer: Healthscope Commercial |
$49,144.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46,414.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40,953.75
|
| Rate for Payer: PHP Commercial |
$46,414.25
|
| Rate for Payer: Priority Health SBD |
$34,401.15
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$4,369.12
|
|
|
Service Code
|
APR-DRG 6941
|
| Min. Negotiated Rate |
$4,161.07 |
| Max. Negotiated Rate |
$4,369.12 |
| Rate for Payer: BCBS Complete |
$4,369.12
|
| Rate for Payer: Mclaren Medicaid |
$4,161.07
|
| Rate for Payer: Meridian Medicaid |
$4,369.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,161.07
|
| Rate for Payer: UHC Medicaid |
$4,161.07
|
| Rate for Payer: UHCCP Medicaid |
$4,161.07
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$11,753.80
|
|
|
Service Code
|
APR-DRG 6944
|
| Min. Negotiated Rate |
$11,194.09 |
| Max. Negotiated Rate |
$11,753.80 |
| Rate for Payer: BCBS Complete |
$11,753.80
|
| Rate for Payer: Mclaren Medicaid |
$11,194.09
|
| Rate for Payer: Meridian Medicaid |
$11,753.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,194.09
|
| Rate for Payer: UHC Medicaid |
$11,194.09
|
| Rate for Payer: UHCCP Medicaid |
$11,194.09
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$7,953.96
|
|
|
Service Code
|
APR-DRG 6943
|
| Min. Negotiated Rate |
$7,575.20 |
| Max. Negotiated Rate |
$7,953.96 |
| Rate for Payer: BCBS Complete |
$7,953.96
|
| Rate for Payer: Mclaren Medicaid |
$7,575.20
|
| Rate for Payer: Meridian Medicaid |
$7,953.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,575.20
|
| Rate for Payer: UHC Medicaid |
$7,575.20
|
| Rate for Payer: UHCCP Medicaid |
$7,575.20
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$6,347.00
|
|
|
Service Code
|
APR-DRG 6942
|
| Min. Negotiated Rate |
$6,044.77 |
| Max. Negotiated Rate |
$6,347.00 |
| Rate for Payer: BCBS Complete |
$6,347.00
|
| Rate for Payer: Mclaren Medicaid |
$6,044.77
|
| Rate for Payer: Meridian Medicaid |
$6,347.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,044.77
|
| Rate for Payer: UHC Medicaid |
$6,044.77
|
| Rate for Payer: UHCCP Medicaid |
$6,044.77
|
|
|
LYMPHOCYTE,ANTI-THYMO IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12,850.05
|
|
|
Service Code
|
HCPCS J7504
|
| Hospital Charge Code |
10475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,767.94 |
| Max. Negotiated Rate |
$16,195.91 |
| Rate for Payer: Aetna Commercial |
$10,922.54
|
| Rate for Payer: Aetna Medicare |
$5,504.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,352.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,615.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,615.54
|
| Rate for Payer: BCBS Complete |
$2,906.60
|
| Rate for Payer: BCBS MAPPO |
$5,292.43
|
| Rate for Payer: BCBS Trust/PPO |
$13,316.83
|
| Rate for Payer: BCN Commercial |
$13,316.83
|
| Rate for Payer: BCN Medicare Advantage |
$5,292.43
|
| Rate for Payer: Cash Price |
$10,280.04
|
| Rate for Payer: Cash Price |
$10,280.04
|
| Rate for Payer: Cofinity Advantage |
$8,995.03
|
| Rate for Payer: Cofinity Commercial |
$11,051.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,280.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,292.43
|
| Rate for Payer: Healthscope Commercial |
$11,565.05
|
| Rate for Payer: Mclaren Medicaid |
$2,767.94
|
| Rate for Payer: Mclaren Medicare |
$5,292.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,557.05
|
| Rate for Payer: Meridian Medicaid |
$5,557.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,086.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,821.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,922.54
|
| Rate for Payer: Nomi Health Commercial |
$15,877.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,637.54
|
| Rate for Payer: PACE Medicare |
$5,027.81
|
| Rate for Payer: PACE SWMI |
$5,292.43
|
| Rate for Payer: PHP Commercial |
$10,922.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,292.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,767.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,195.91
|
| Rate for Payer: Priority Health Medicare |
$5,292.43
|
| Rate for Payer: Priority Health SBD |
$8,095.53
|
| Rate for Payer: Priority Health Tiered Network |
$12,956.73
|
| Rate for Payer: Railroad Medicare Medicare |
$5,292.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,758.08
|
| Rate for Payer: UHC Core |
$8,758.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,292.43
|
| Rate for Payer: UHC Exchange |
$8,758.08
|
| Rate for Payer: UHC Medicaid |
$2,767.94
|
| Rate for Payer: UHCCP Medicaid |
$2,767.94
|
| Rate for Payer: VA VA |
$5,292.43
|
|
