|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$5,682.09
|
|
|
Service Code
|
NDC 00025152534
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,579.72 |
| Max. Negotiated Rate |
$5,113.88 |
| Rate for Payer: Aetna Commercial |
$4,829.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,693.36
|
| Rate for Payer: Cash Price |
$4,545.67
|
| Rate for Payer: Cofinity Advantage |
$3,977.46
|
| Rate for Payer: Cofinity Commercial |
$4,886.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,545.67
|
| Rate for Payer: Healthscope Commercial |
$5,113.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,829.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,261.57
|
| Rate for Payer: PHP Commercial |
$4,829.78
|
| Rate for Payer: Priority Health SBD |
$3,579.72
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$202.10
|
|
|
Service Code
|
NDC 33342015711
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.32 |
| Max. Negotiated Rate |
$181.89 |
| Rate for Payer: Aetna Commercial |
$171.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.37
|
| Rate for Payer: Cash Price |
$161.68
|
| Rate for Payer: Cofinity Advantage |
$141.47
|
| Rate for Payer: Cofinity Commercial |
$173.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.68
|
| Rate for Payer: Healthscope Commercial |
$181.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.57
|
| Rate for Payer: PHP Commercial |
$171.78
|
| Rate for Payer: Priority Health SBD |
$127.32
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$233.76
|
|
|
Service Code
|
NDC 50268016915
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.27 |
| Max. Negotiated Rate |
$210.38 |
| Rate for Payer: Aetna Commercial |
$198.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.94
|
| Rate for Payer: Cash Price |
$187.01
|
| Rate for Payer: Cofinity Advantage |
$163.63
|
| Rate for Payer: Cofinity Commercial |
$201.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.01
|
| Rate for Payer: Healthscope Commercial |
$210.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.32
|
| Rate for Payer: PHP Commercial |
$198.70
|
| Rate for Payer: Priority Health SBD |
$147.27
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$4.68
|
|
|
Service Code
|
NDC 50268016911
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.04
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Advantage |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.51
|
| Rate for Payer: PHP Commercial |
$3.98
|
| Rate for Payer: Priority Health SBD |
$2.95
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$506.40
|
|
|
Service Code
|
NDC 00904650361
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.02 |
| Max. Negotiated Rate |
$455.76 |
| Rate for Payer: Aetna Commercial |
$430.44
|
| Rate for Payer: Aetna Medicare |
$253.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.16
|
| Rate for Payer: BCBS Complete |
$202.56
|
| Rate for Payer: Cash Price |
$405.12
|
| Rate for Payer: Cofinity Advantage |
$354.48
|
| Rate for Payer: Cofinity Commercial |
$435.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.12
|
| Rate for Payer: Healthscope Commercial |
$455.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$405.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$430.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$379.80
|
| Rate for Payer: PHP Commercial |
$430.44
|
| Rate for Payer: Priority Health SBD |
$319.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.16
|
| Rate for Payer: UHC Core |
$263.83
|
| Rate for Payer: UHC Exchange |
$199.02
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$387.75
|
|
|
Service Code
|
NDC 69097042107
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.39 |
| Max. Negotiated Rate |
$348.98 |
| Rate for Payer: Aetna Commercial |
$329.59
|
| Rate for Payer: Aetna Medicare |
$193.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.04
|
| Rate for Payer: BCBS Complete |
$155.10
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Advantage |
$271.43
|
| Rate for Payer: Cofinity Commercial |
$333.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$348.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$310.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.81
|
| Rate for Payer: PHP Commercial |
$329.59
|
| Rate for Payer: Priority Health SBD |
$244.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.04
|
| Rate for Payer: UHC Core |
$202.02
|
| Rate for Payer: UHC Exchange |
$152.39
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$7.63
|
|
|
Service Code
|
NDC 60687044711
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$6.87 |
| Rate for Payer: Aetna Commercial |
$6.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.96
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cofinity Advantage |
$5.34
|
| Rate for Payer: Cofinity Commercial |
$6.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.10
|
| Rate for Payer: Healthscope Commercial |
$6.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.72
|
| Rate for Payer: PHP Commercial |
$6.49
|
| Rate for Payer: Priority Health SBD |
$4.81
|
|
|
CELECOXIB 400 MG CAPSULE
|
Facility
|
OP
|
$175.56
|
|
|
Service Code
|
NDC 65862091060
|
| Hospital Charge Code |
33653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna Commercial |
$149.23
|
| Rate for Payer: Aetna Medicare |
$87.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.11
|
| Rate for Payer: BCBS Complete |
$70.22
|
| Rate for Payer: Cash Price |
$140.45
|
| Rate for Payer: Cofinity Advantage |
$122.89
|
| Rate for Payer: Cofinity Commercial |
$150.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.45
|
| Rate for Payer: Healthscope Commercial |
$158.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.67
|
| Rate for Payer: PHP Commercial |
$149.23
|
| Rate for Payer: Priority Health SBD |
$110.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.11
|
| Rate for Payer: UHC Core |
$91.47
|
| Rate for Payer: UHC Exchange |
$69.00
|
|
|
CELECOXIB 400 MG CAPSULE
|
Facility
|
IP
|
$175.56
|
|
|
Service Code
|
NDC 65862091060
|
| Hospital Charge Code |
33653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna Commercial |
$149.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.11
|
| Rate for Payer: Cash Price |
$140.45
|
| Rate for Payer: Cofinity Advantage |
$122.89
|
| Rate for Payer: Cofinity Commercial |
$150.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.45
|
| Rate for Payer: Healthscope Commercial |
$158.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.67
|
| Rate for Payer: PHP Commercial |
$149.23
|
| Rate for Payer: Priority Health SBD |
$110.60
|
|
|
CELECOXIB 400 MG CAPSULE
|
Facility
|
IP
|
$502.56
|
|
|
Service Code
|
NDC 59762151802
|
| Hospital Charge Code |
33653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$316.61 |
| Max. Negotiated Rate |
$452.30 |
| Rate for Payer: Aetna Commercial |
$427.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.66
|
| Rate for Payer: Cash Price |
$402.05
|
| Rate for Payer: Cofinity Advantage |
$351.79
|
| Rate for Payer: Cofinity Commercial |
$432.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.05
|
| Rate for Payer: Healthscope Commercial |
$452.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$376.92
|
| Rate for Payer: PHP Commercial |
$427.18
|
| Rate for Payer: Priority Health SBD |
$316.61
|
|
|
CELECOXIB 400 MG CAPSULE
|
Facility
|
IP
|
$312.48
|
|
|
Service Code
|
NDC 13668031060
|
| Hospital Charge Code |
33653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.86 |
| Max. Negotiated Rate |
$281.23 |
| Rate for Payer: Aetna Commercial |
$265.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.11
|
| Rate for Payer: Cash Price |
$249.98
|
| Rate for Payer: Cofinity Advantage |
$218.74
|
| Rate for Payer: Cofinity Commercial |
$268.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.98
|
| Rate for Payer: Healthscope Commercial |
$281.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.36
|
| Rate for Payer: PHP Commercial |
$265.61
|
| Rate for Payer: Priority Health SBD |
$196.86
|
|
|
CELECOXIB 400 MG CAPSULE
|
Facility
|
OP
|
$312.48
|
|
|
Service Code
|
NDC 13668031060
|
| Hospital Charge Code |
33653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.80 |
| Max. Negotiated Rate |
$281.23 |
| Rate for Payer: Aetna Commercial |
$265.61
|
| Rate for Payer: Aetna Medicare |
$156.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.11
|
| Rate for Payer: BCBS Complete |
$124.99
|
| Rate for Payer: Cash Price |
$249.98
|
| Rate for Payer: Cofinity Advantage |
$218.74
|
| Rate for Payer: Cofinity Commercial |
$268.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.98
|
| Rate for Payer: Healthscope Commercial |
$281.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.36
|
| Rate for Payer: PHP Commercial |
$265.61
|
| Rate for Payer: Priority Health SBD |
$196.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.11
|
| Rate for Payer: UHC Core |
$162.80
|
| Rate for Payer: UHC Exchange |
$122.80
|
|
|
CELECOXIB 400 MG CAPSULE
|
Facility
|
OP
|
$502.56
|
|
|
Service Code
|
NDC 59762151802
|
| Hospital Charge Code |
33653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.51 |
| Max. Negotiated Rate |
$452.30 |
| Rate for Payer: Aetna Commercial |
$427.18
|
| Rate for Payer: Aetna Medicare |
$251.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.66
|
| Rate for Payer: BCBS Complete |
$201.02
|
| Rate for Payer: Cash Price |
$402.05
|
| Rate for Payer: Cofinity Advantage |
$351.79
|
| Rate for Payer: Cofinity Commercial |
$432.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.05
|
| Rate for Payer: Healthscope Commercial |
$452.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$376.92
|
| Rate for Payer: PHP Commercial |
$427.18
|
| Rate for Payer: Priority Health SBD |
$316.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.66
|
| Rate for Payer: UHC Core |
$261.83
|
| Rate for Payer: UHC Exchange |
$197.51
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$6,289.10
|
|
|
Service Code
|
APR-DRG 3833
|
| Min. Negotiated Rate |
$5,989.62 |
| Max. Negotiated Rate |
$6,289.10 |
| Rate for Payer: BCBS Complete |
$6,289.10
|
| Rate for Payer: Mclaren Medicaid |
$5,989.62
|
| Rate for Payer: Meridian Medicaid |
$6,289.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,989.62
|
| Rate for Payer: UHC Medicaid |
$5,989.62
|
| Rate for Payer: UHCCP Medicaid |
$5,989.62
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$3,261.50
|
|
|
Service Code
|
APR-DRG 3831
|
| Min. Negotiated Rate |
$3,106.19 |
| Max. Negotiated Rate |
$3,261.50 |
| Rate for Payer: BCBS Complete |
$3,261.50
|
| Rate for Payer: Mclaren Medicaid |
$3,106.19
|
| Rate for Payer: Meridian Medicaid |
$3,261.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.19
|
| Rate for Payer: UHC Medicaid |
$3,106.19
|
| Rate for Payer: UHCCP Medicaid |
$3,106.19
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$9,531.11
|
|
|
Service Code
|
APR-DRG 3834
|
| Min. Negotiated Rate |
$9,077.25 |
| Max. Negotiated Rate |
$9,531.11 |
| Rate for Payer: BCBS Complete |
$9,531.11
|
| Rate for Payer: Mclaren Medicaid |
$9,077.25
|
| Rate for Payer: Meridian Medicaid |
$9,531.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,077.25
|
| Rate for Payer: UHC Medicaid |
$9,077.25
|
| Rate for Payer: UHCCP Medicaid |
$9,077.25
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$4,213.76
|
|
|
Service Code
|
APR-DRG 3832
|
| Min. Negotiated Rate |
$4,013.10 |
| Max. Negotiated Rate |
$4,213.76 |
| Rate for Payer: BCBS Complete |
$4,213.76
|
| Rate for Payer: Mclaren Medicaid |
$4,013.10
|
| Rate for Payer: Meridian Medicaid |
$4,213.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,013.10
|
| Rate for Payer: UHC Medicaid |
$4,013.10
|
| Rate for Payer: UHCCP Medicaid |
$4,013.10
|
|
|
CELLULITIS WITH MCC
|
Facility
|
IP
|
$24,817.16
|
|
|
Service Code
|
MSDRG 602
|
| Min. Negotiated Rate |
$10,984.95 |
| Max. Negotiated Rate |
$24,817.16 |
| Rate for Payer: Aetna Medicare |
$12,025.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,453.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,453.89
|
| Rate for Payer: BCBS MAPPO |
$11,563.11
|
| Rate for Payer: BCBS Trust/PPO |
$24,817.16
|
| Rate for Payer: BCN Commercial |
$24,817.16
|
| Rate for Payer: BCN Medicare Advantage |
$11,563.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,563.11
|
| Rate for Payer: Mclaren Medicare |
$11,563.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,141.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,297.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,719.42
|
| Rate for Payer: Nomi Health Commercial |
$18,334.77
|
| Rate for Payer: PACE Medicare |
$10,984.95
|
| Rate for Payer: PACE SWMI |
$11,563.11
|
| Rate for Payer: PHP Medicare Advantage |
$11,563.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,914.40
|
| Rate for Payer: Priority Health Medicare |
$11,563.11
|
| Rate for Payer: Priority Health Tiered Network |
$18,331.52
|
| Rate for Payer: Railroad Medicare Medicare |
$11,563.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,167.19
|
| Rate for Payer: UHC Core |
$19,382.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,563.11
|
| Rate for Payer: UHC Exchange |
$15,829.02
|
| Rate for Payer: VA VA |
$11,563.11
|
|
|
CELLULITIS WITHOUT MCC
|
Facility
|
IP
|
$14,195.67
|
|
|
Service Code
|
MSDRG 603
|
| Min. Negotiated Rate |
$6,944.05 |
| Max. Negotiated Rate |
$14,195.67 |
| Rate for Payer: Aetna Medicare |
$7,601.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,136.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,136.91
|
| Rate for Payer: BCBS MAPPO |
$7,309.53
|
| Rate for Payer: BCBS Trust/PPO |
$11,835.08
|
| Rate for Payer: BCN Commercial |
$11,835.08
|
| Rate for Payer: BCN Medicare Advantage |
$7,309.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,309.53
|
| Rate for Payer: Mclaren Medicare |
$7,309.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,675.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,405.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,040.48
|
| Rate for Payer: Nomi Health Commercial |
$11,234.61
|
| Rate for Payer: PACE Medicare |
$6,944.05
|
| Rate for Payer: PACE SWMI |
$7,309.53
|
| Rate for Payer: PHP Medicare Advantage |
$7,309.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,040.77
|
| Rate for Payer: Priority Health Medicare |
$7,309.53
|
| Rate for Payer: Priority Health Tiered Network |
$11,232.62
|
| Rate for Payer: Railroad Medicare Medicare |
$7,309.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,195.67
|
| Rate for Payer: UHC Core |
$11,876.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,309.53
|
| Rate for Payer: UHC Exchange |
$9,699.21
|
| Rate for Payer: VA VA |
$7,309.53
|
|
|
CELLULOSE, OXIDIZED 4" X 8" PADS
|
Facility
|
IP
|
$279.50
|
|
|
Service Code
|
NDC 09900000604
|
| Hospital Charge Code |
169204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$176.09 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Aetna Commercial |
$237.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.68
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cofinity Advantage |
$195.65
|
| Rate for Payer: Cofinity Commercial |
$240.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.60
|
| Rate for Payer: Healthscope Commercial |
$251.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.62
|
| Rate for Payer: PHP Commercial |
$237.57
|
| Rate for Payer: Priority Health SBD |
$176.09
|
|
|
CELLULOSE, OXIDIZED 4" X 8" PADS
|
Facility
|
OP
|
$279.50
|
|
|
Service Code
|
NDC 09900000604
|
| Hospital Charge Code |
169204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$109.84 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Aetna Commercial |
$237.57
|
| Rate for Payer: Aetna Medicare |
$139.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.68
|
| Rate for Payer: BCBS Complete |
$111.80
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cofinity Advantage |
$195.65
|
| Rate for Payer: Cofinity Commercial |
$240.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.60
|
| Rate for Payer: Healthscope Commercial |
$251.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.62
|
| Rate for Payer: PHP Commercial |
$237.57
|
| Rate for Payer: Priority Health SBD |
$176.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.68
|
| Rate for Payer: UHC Core |
$145.62
|
| Rate for Payer: UHC Exchange |
$109.84
|
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$50,892.59
|
|
|
Service Code
|
HCPCS J9119
|
| Hospital Charge Code |
188612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$45,803.33 |
| Rate for Payer: Aetna Commercial |
$43,258.70
|
| Rate for Payer: Aetna Medicare |
$30.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33,080.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.20
|
| Rate for Payer: BCBS Complete |
$16.34
|
| Rate for Payer: BCBS MAPPO |
$29.76
|
| Rate for Payer: BCBS Trust/PPO |
$71.98
|
| Rate for Payer: BCN Commercial |
$71.98
|
| Rate for Payer: BCN Medicare Advantage |
$29.76
|
| Rate for Payer: Cash Price |
$40,714.07
|
| Rate for Payer: Cash Price |
$40,714.07
|
| Rate for Payer: Cofinity Advantage |
$35,624.81
|
| Rate for Payer: Cofinity Commercial |
$43,767.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,714.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.76
|
| Rate for Payer: Healthscope Commercial |
$45,803.33
|
| Rate for Payer: Mclaren Medicaid |
$15.56
|
| Rate for Payer: Mclaren Medicare |
$29.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.25
|
| Rate for Payer: Meridian Medicaid |
$31.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43,258.70
|
| Rate for Payer: Nomi Health Commercial |
$89.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38,169.44
|
| Rate for Payer: PACE Medicare |
$28.27
|
| Rate for Payer: PACE SWMI |
$29.76
|
| Rate for Payer: PHP Commercial |
$43,258.70
|
| Rate for Payer: PHP Medicare Advantage |
$29.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92.38
|
| Rate for Payer: Priority Health Medicare |
$29.76
|
| Rate for Payer: Priority Health SBD |
$32,062.33
|
| Rate for Payer: Priority Health Tiered Network |
$73.90
|
| Rate for Payer: Railroad Medicare Medicare |
$29.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.34
|
| Rate for Payer: UHC Core |
$47.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.76
|
| Rate for Payer: UHC Exchange |
$47.34
|
| Rate for Payer: UHC Medicaid |
$15.56
|
| Rate for Payer: UHCCP Medicaid |
$15.56
|
| Rate for Payer: VA VA |
$29.76
|
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$50,892.59
|
|
|
Service Code
|
HCPCS J9119
|
| Hospital Charge Code |
188612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32,062.33 |
| Max. Negotiated Rate |
$45,803.33 |
| Rate for Payer: Aetna Commercial |
$43,258.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33,080.18
|
| Rate for Payer: Cash Price |
$40,714.07
|
| Rate for Payer: Cofinity Advantage |
$35,624.81
|
| Rate for Payer: Cofinity Commercial |
$43,767.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,714.07
|
| Rate for Payer: Healthscope Commercial |
$45,803.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43,258.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38,169.44
|
| Rate for Payer: PHP Commercial |
$43,258.70
|
| Rate for Payer: Priority Health SBD |
$32,062.33
|
|
|
CENOBAMATE 150 MG TABLET
|
Facility
|
IP
|
$4,182.15
|
|
|
Service Code
|
NDC 71699015030
|
| Hospital Charge Code |
192890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,634.75 |
| Max. Negotiated Rate |
$3,763.93 |
| Rate for Payer: Aetna Commercial |
$3,554.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,718.40
|
| Rate for Payer: Cash Price |
$3,345.72
|
| Rate for Payer: Cofinity Advantage |
$2,927.51
|
| Rate for Payer: Cofinity Commercial |
$3,596.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,345.72
|
| Rate for Payer: Healthscope Commercial |
$3,763.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,554.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,136.61
|
| Rate for Payer: PHP Commercial |
$3,554.83
|
| Rate for Payer: Priority Health SBD |
$2,634.75
|
|
|
CENOBAMATE 150 MG TABLET
|
Facility
|
OP
|
$4,182.15
|
|
|
Service Code
|
NDC 71699015030
|
| Hospital Charge Code |
192890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,643.58 |
| Max. Negotiated Rate |
$3,763.93 |
| Rate for Payer: Aetna Commercial |
$3,554.83
|
| Rate for Payer: Aetna Medicare |
$2,091.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,718.40
|
| Rate for Payer: BCBS Complete |
$1,672.86
|
| Rate for Payer: Cash Price |
$3,345.72
|
| Rate for Payer: Cofinity Advantage |
$2,927.51
|
| Rate for Payer: Cofinity Commercial |
$3,596.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,345.72
|
| Rate for Payer: Healthscope Commercial |
$3,763.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,345.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,554.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,136.61
|
| Rate for Payer: PHP Commercial |
$3,554.83
|
| Rate for Payer: Priority Health SBD |
$2,634.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,718.40
|
| Rate for Payer: UHC Core |
$2,178.90
|
| Rate for Payer: UHC Exchange |
$1,643.58
|
|
