|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$29.65
|
|
|
Service Code
|
NDC 00093101042
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.27
|
| Rate for Payer: Cash Price |
$23.72
|
| Rate for Payer: Cofinity Advantage |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$25.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.72
|
| Rate for Payer: Healthscope Commercial |
$26.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.24
|
| Rate for Payer: PHP Commercial |
$25.20
|
| Rate for Payer: Priority Health SBD |
$18.68
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$29.96
|
|
|
Service Code
|
NDC 68462018022
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: Cash Price |
$23.97
|
| Rate for Payer: Cofinity Advantage |
$20.97
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.97
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.47
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: Priority Health SBD |
$18.87
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$22,241.75
|
|
|
Service Code
|
APR-DRG 9123
|
| Min. Negotiated Rate |
$21,182.62 |
| Max. Negotiated Rate |
$22,241.75 |
| Rate for Payer: BCBS Complete |
$22,241.75
|
| Rate for Payer: Mclaren Medicaid |
$21,182.62
|
| Rate for Payer: Meridian Medicaid |
$22,241.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,182.62
|
| Rate for Payer: UHC Medicaid |
$21,182.62
|
| Rate for Payer: UHCCP Medicaid |
$21,182.62
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$34,700.13
|
|
|
Service Code
|
APR-DRG 9124
|
| Min. Negotiated Rate |
$33,047.74 |
| Max. Negotiated Rate |
$34,700.13 |
| Rate for Payer: BCBS Complete |
$34,700.13
|
| Rate for Payer: Mclaren Medicaid |
$33,047.74
|
| Rate for Payer: Meridian Medicaid |
$34,700.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$33,047.74
|
| Rate for Payer: UHC Medicaid |
$33,047.74
|
| Rate for Payer: UHCCP Medicaid |
$33,047.74
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$12,446.34
|
|
|
Service Code
|
APR-DRG 9121
|
| Min. Negotiated Rate |
$11,853.66 |
| Max. Negotiated Rate |
$12,446.34 |
| Rate for Payer: BCBS Complete |
$12,446.34
|
| Rate for Payer: Mclaren Medicaid |
$11,853.66
|
| Rate for Payer: Meridian Medicaid |
$12,446.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,853.66
|
| Rate for Payer: UHC Medicaid |
$11,853.66
|
| Rate for Payer: UHCCP Medicaid |
$11,853.66
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$16,546.01
|
|
|
Service Code
|
APR-DRG 9122
|
| Min. Negotiated Rate |
$15,758.11 |
| Max. Negotiated Rate |
$16,546.01 |
| Rate for Payer: BCBS Complete |
$16,546.01
|
| Rate for Payer: Mclaren Medicaid |
$15,758.11
|
| Rate for Payer: Meridian Medicaid |
$16,546.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,758.11
|
| Rate for Payer: UHC Medicaid |
$15,758.11
|
| Rate for Payer: UHCCP Medicaid |
$15,758.11
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIG
|
Facility
|
IP
|
$10,746.51
|
|
|
Service Code
|
APR-DRG 3433
|
| Min. Negotiated Rate |
$10,234.77 |
| Max. Negotiated Rate |
$10,746.51 |
| Rate for Payer: BCBS Complete |
$10,746.51
|
| Rate for Payer: Mclaren Medicaid |
$10,234.77
|
| Rate for Payer: Meridian Medicaid |
$10,746.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,234.77
|
| Rate for Payer: UHC Medicaid |
$10,234.77
|
| Rate for Payer: UHCCP Medicaid |
$10,234.77
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIG
|
Facility
|
IP
|
$17,385.90
|
|
|
Service Code
|
APR-DRG 3434
|
| Min. Negotiated Rate |
$16,558.00 |
| Max. Negotiated Rate |
$17,385.90 |
| Rate for Payer: BCBS Complete |
$17,385.90
|
| Rate for Payer: Mclaren Medicaid |
$16,558.00
|
| Rate for Payer: Meridian Medicaid |
$17,385.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,558.00
|
| Rate for Payer: UHC Medicaid |
$16,558.00
|
| Rate for Payer: UHCCP Medicaid |
$16,558.00
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIG
|
Facility
|
IP
|
$5,924.48
|
|
|
Service Code
|
APR-DRG 3431
|
| Min. Negotiated Rate |
$5,642.36 |
| Max. Negotiated Rate |
$5,924.48 |
| Rate for Payer: BCBS Complete |
$5,924.48
|
| Rate for Payer: Mclaren Medicaid |
$5,642.36
|
| Rate for Payer: Meridian Medicaid |
$5,924.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,642.36
|
| Rate for Payer: UHC Medicaid |
$5,642.36
|
| Rate for Payer: UHCCP Medicaid |
$5,642.36
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIG
|
Facility
|
IP
|
$7,243.07
|
|
|
Service Code
|
APR-DRG 3432
|
| Min. Negotiated Rate |
$6,898.16 |
| Max. Negotiated Rate |
$7,243.07 |
| Rate for Payer: BCBS Complete |
$7,243.07
|
| Rate for Payer: Mclaren Medicaid |
$6,898.16
|
| Rate for Payer: Meridian Medicaid |
$7,243.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,898.16
|
| Rate for Payer: UHC Medicaid |
$6,898.16
|
| Rate for Payer: UHCCP Medicaid |
$6,898.16
|
|
|
MVI,ADULT NO.4,VIT K,COMP(VIAL 1 OF 2) 3,300 UNIT-150 MCG/5 ML IV SOLN
|
Facility
|
OP
|
$21.01
|
|
|
Service Code
|
NDC 54643565701
|
| Hospital Charge Code |
184515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$18.91 |
| Rate for Payer: Aetna Commercial |
$17.86
|
| Rate for Payer: Aetna Medicare |
$10.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.66
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: Cash Price |
$16.81
|
| Rate for Payer: Cofinity Advantage |
$14.71
|
| Rate for Payer: Cofinity Commercial |
$18.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.81
|
| Rate for Payer: Healthscope Commercial |
$18.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.76
|
| Rate for Payer: PHP Commercial |
$17.86
|
| Rate for Payer: Priority Health SBD |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.66
|
| Rate for Payer: UHC Core |
$10.95
|
| Rate for Payer: UHC Exchange |
$8.26
|
|
|
MVI, ADULT NO.4, VIT K (VIAL 2 OF 2) 600 MCG-60 MCG-5 MCG/5 ML IV SOLN
|
Facility
|
OP
|
$21.01
|
|
|
Service Code
|
NDC 54643565901
|
| Hospital Charge Code |
184516
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$18.91 |
| Rate for Payer: Aetna Commercial |
$17.86
|
| Rate for Payer: Aetna Medicare |
$10.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.66
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: Cash Price |
$16.81
|
| Rate for Payer: Cofinity Advantage |
$14.71
|
| Rate for Payer: Cofinity Commercial |
$18.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.81
|
| Rate for Payer: Healthscope Commercial |
$18.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.76
|
| Rate for Payer: PHP Commercial |
$17.86
|
| Rate for Payer: Priority Health SBD |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.66
|
| Rate for Payer: UHC Core |
$10.95
|
| Rate for Payer: UHC Exchange |
$8.26
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$42.01
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$37.81 |
| Rate for Payer: Aetna Commercial |
$35.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.31
|
| Rate for Payer: Cash Price |
$33.61
|
| Rate for Payer: Cofinity Advantage |
$29.41
|
| Rate for Payer: Cofinity Commercial |
$36.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.61
|
| Rate for Payer: Healthscope Commercial |
$37.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.51
|
| Rate for Payer: PHP Commercial |
$35.71
|
| Rate for Payer: Priority Health SBD |
$26.47
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$42.01
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.51 |
| Max. Negotiated Rate |
$37.81 |
| Rate for Payer: Aetna Commercial |
$35.71
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.31
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.61
|
| Rate for Payer: Cofinity Advantage |
$29.41
|
| Rate for Payer: Cofinity Commercial |
$36.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.61
|
| Rate for Payer: Healthscope Commercial |
$37.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.51
|
| Rate for Payer: PHP Commercial |
$35.71
|
| Rate for Payer: Priority Health SBD |
$26.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.31
|
| Rate for Payer: UHC Core |
$21.89
|
| Rate for Payer: UHC Exchange |
$16.51
|
|
|
MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$133.84
|
|
|
Service Code
|
HCPCS J7519
|
| Hospital Charge Code |
23968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.32 |
| Max. Negotiated Rate |
$120.46 |
| Rate for Payer: Cofinity Advantage |
$159.71
|
| Rate for Payer: Aetna Commercial |
$113.76
|
| Rate for Payer: Aetna Commercial |
$94.10
|
| Rate for Payer: Aetna Commercial |
$193.94
|
| Rate for Payer: Aetna Commercial |
$82.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.30
|
| Rate for Payer: Cash Price |
$88.57
|
| Rate for Payer: Cash Price |
$107.07
|
| Rate for Payer: Cash Price |
$182.53
|
| Rate for Payer: Cash Price |
$77.97
|
| Rate for Payer: Cofinity Advantage |
$68.22
|
| Rate for Payer: Cofinity Advantage |
$93.69
|
| Rate for Payer: Cofinity Advantage |
$77.50
|
| Rate for Payer: Cofinity Commercial |
$83.82
|
| Rate for Payer: Cofinity Commercial |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$95.21
|
| Rate for Payer: Cofinity Commercial |
$115.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.97
|
| Rate for Payer: Healthscope Commercial |
$205.34
|
| Rate for Payer: Healthscope Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$120.46
|
| Rate for Payer: Healthscope Commercial |
$87.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.03
|
| Rate for Payer: PHP Commercial |
$113.76
|
| Rate for Payer: PHP Commercial |
$82.84
|
| Rate for Payer: PHP Commercial |
$193.94
|
| Rate for Payer: PHP Commercial |
$94.10
|
| Rate for Payer: Priority Health SBD |
$84.32
|
| Rate for Payer: Priority Health SBD |
$143.74
|
| Rate for Payer: Priority Health SBD |
$61.40
|
| Rate for Payer: Priority Health SBD |
$69.75
|
|
|
MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$133.84
|
|
|
Service Code
|
HCPCS J7519
|
| Hospital Charge Code |
23968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$120.46 |
| Rate for Payer: Aetna Commercial |
$113.76
|
| Rate for Payer: Aetna Commercial |
$82.84
|
| Rate for Payer: Aetna Commercial |
$193.94
|
| Rate for Payer: Aetna Commercial |
$94.10
|
| Rate for Payer: Aetna Medicare |
$66.92
|
| Rate for Payer: Aetna Medicare |
$48.73
|
| Rate for Payer: Aetna Medicare |
$114.08
|
| Rate for Payer: Aetna Medicare |
$55.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.00
|
| Rate for Payer: BCBS Complete |
$38.98
|
| Rate for Payer: BCBS Complete |
$53.54
|
| Rate for Payer: BCBS Complete |
$44.28
|
| Rate for Payer: BCBS Complete |
$91.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.91
|
| Rate for Payer: BCBS Trust/PPO |
$0.91
|
| Rate for Payer: BCBS Trust/PPO |
$0.91
|
| Rate for Payer: BCBS Trust/PPO |
$0.91
|
| Rate for Payer: BCN Commercial |
$0.91
|
| Rate for Payer: BCN Commercial |
$0.91
|
| Rate for Payer: BCN Commercial |
$0.91
|
| Rate for Payer: BCN Commercial |
$0.91
|
| Rate for Payer: Cash Price |
$107.07
|
| Rate for Payer: Cash Price |
$182.53
|
| Rate for Payer: Cash Price |
$77.97
|
| Rate for Payer: Cash Price |
$182.53
|
| Rate for Payer: Cash Price |
$88.57
|
| Rate for Payer: Cash Price |
$88.57
|
| Rate for Payer: Cash Price |
$77.97
|
| Rate for Payer: Cash Price |
$107.07
|
| Rate for Payer: Cofinity Advantage |
$68.22
|
| Rate for Payer: Cofinity Advantage |
$77.50
|
| Rate for Payer: Cofinity Advantage |
$159.71
|
| Rate for Payer: Cofinity Advantage |
$93.69
|
| Rate for Payer: Cofinity Commercial |
$95.21
|
| Rate for Payer: Cofinity Commercial |
$83.82
|
| Rate for Payer: Cofinity Commercial |
$115.10
|
| Rate for Payer: Cofinity Commercial |
$196.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.07
|
| Rate for Payer: Healthscope Commercial |
$205.34
|
| Rate for Payer: Healthscope Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$87.71
|
| Rate for Payer: Healthscope Commercial |
$120.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.09
|
| Rate for Payer: PHP Commercial |
$193.94
|
| Rate for Payer: PHP Commercial |
$113.76
|
| Rate for Payer: PHP Commercial |
$82.84
|
| Rate for Payer: PHP Commercial |
$94.10
|
| Rate for Payer: Priority Health SBD |
$69.75
|
| Rate for Payer: Priority Health SBD |
$143.74
|
| Rate for Payer: Priority Health SBD |
$61.40
|
| Rate for Payer: Priority Health SBD |
$84.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.61
|
| Rate for Payer: UHC Core |
$0.61
|
| Rate for Payer: UHC Core |
$0.61
|
| Rate for Payer: UHC Core |
$0.61
|
| Rate for Payer: UHC Core |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
|
|
MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$3,991.86
|
|
|
Service Code
|
HCPCS J7528
|
| Hospital Charge Code |
25005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,514.87 |
| Max. Negotiated Rate |
$3,592.67 |
| Rate for Payer: Aetna Commercial |
$3,393.08
|
| Rate for Payer: Aetna Commercial |
$948.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$725.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,594.71
|
| Rate for Payer: Cash Price |
$892.73
|
| Rate for Payer: Cash Price |
$3,193.49
|
| Rate for Payer: Cofinity Advantage |
$781.14
|
| Rate for Payer: Cofinity Advantage |
$2,794.30
|
| Rate for Payer: Cofinity Commercial |
$959.68
|
| Rate for Payer: Cofinity Commercial |
$3,433.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,193.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$892.73
|
| Rate for Payer: Healthscope Commercial |
$3,592.67
|
| Rate for Payer: Healthscope Commercial |
$1,004.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$948.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,393.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$836.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,993.89
|
| Rate for Payer: PHP Commercial |
$948.52
|
| Rate for Payer: PHP Commercial |
$3,393.08
|
| Rate for Payer: Priority Health SBD |
$703.02
|
| Rate for Payer: Priority Health SBD |
$2,514.87
|
|
|
MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION
|
Facility
|
OP
|
$3,991.86
|
|
|
Service Code
|
HCPCS J7528
|
| Hospital Charge Code |
25005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$3,592.67 |
| Rate for Payer: Aetna Commercial |
$3,393.08
|
| Rate for Payer: Aetna Commercial |
$948.52
|
| Rate for Payer: Aetna Medicare |
$1,995.93
|
| Rate for Payer: Aetna Medicare |
$557.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$725.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,594.71
|
| Rate for Payer: BCBS Complete |
$446.36
|
| Rate for Payer: BCBS Complete |
$1,596.74
|
| Rate for Payer: Cash Price |
$892.73
|
| Rate for Payer: Cash Price |
$892.73
|
| Rate for Payer: Cash Price |
$3,193.49
|
| Rate for Payer: Cash Price |
$3,193.49
|
| Rate for Payer: Cofinity Advantage |
$781.14
|
| Rate for Payer: Cofinity Advantage |
$2,794.30
|
| Rate for Payer: Cofinity Commercial |
$959.68
|
| Rate for Payer: Cofinity Commercial |
$3,433.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$892.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,193.49
|
| Rate for Payer: Healthscope Commercial |
$1,004.32
|
| Rate for Payer: Healthscope Commercial |
$3,592.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$892.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,193.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$948.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,393.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$836.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,993.89
|
| Rate for Payer: PHP Commercial |
$3,393.08
|
| Rate for Payer: PHP Commercial |
$948.52
|
| Rate for Payer: Priority Health SBD |
$2,514.87
|
| Rate for Payer: Priority Health SBD |
$703.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.40
|
| Rate for Payer: UHC Core |
$0.40
|
| Rate for Payer: UHC Core |
$0.40
|
| Rate for Payer: UHC Exchange |
$0.40
|
| Rate for Payer: UHC Exchange |
$0.40
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE
|
Facility
|
IP
|
$404.20
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
15113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$254.65 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna Commercial |
$378.72
|
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.82
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$356.44
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Advantage |
$311.88
|
| Rate for Payer: Cofinity Advantage |
$2.72
|
| Rate for Payer: Cofinity Advantage |
$282.94
|
| Rate for Payer: Cofinity Advantage |
$259.35
|
| Rate for Payer: Cofinity Advantage |
$135.66
|
| Rate for Payer: Cofinity Advantage |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Cofinity Commercial |
$383.17
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Healthscope Commercial |
$401.00
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.35
|
| Rate for Payer: PHP Commercial |
$3.79
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: PHP Commercial |
$378.72
|
| Rate for Payer: Priority Health SBD |
$2.44
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: Priority Health SBD |
$280.70
|
| Rate for Payer: Priority Health SBD |
$2.81
|
| Rate for Payer: Priority Health SBD |
$233.41
|
| Rate for Payer: Priority Health SBD |
$122.09
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE
|
Facility
|
OP
|
$370.50
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
15113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna Commercial |
$378.72
|
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Aetna Medicare |
$185.25
|
| Rate for Payer: Aetna Medicare |
$222.78
|
| Rate for Payer: Aetna Medicare |
$96.90
|
| Rate for Payer: Aetna Medicare |
$1.94
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna Medicare |
$202.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.61
|
| Rate for Payer: BCBS Complete |
$148.20
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS Complete |
$178.22
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: BCBS Complete |
$77.52
|
| Rate for Payer: BCBS Complete |
$161.68
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cash Price |
$356.44
|
| Rate for Payer: Cash Price |
$356.44
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Advantage |
$2.72
|
| Rate for Payer: Cofinity Advantage |
$259.35
|
| Rate for Payer: Cofinity Advantage |
$3.12
|
| Rate for Payer: Cofinity Advantage |
$282.94
|
| Rate for Payer: Cofinity Advantage |
$311.88
|
| Rate for Payer: Cofinity Advantage |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$383.17
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Healthscope Commercial |
$401.00
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$356.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.16
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: PHP Commercial |
$378.72
|
| Rate for Payer: PHP Commercial |
$3.79
|
| Rate for Payer: Priority Health SBD |
$233.41
|
| Rate for Payer: Priority Health SBD |
$280.70
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: Priority Health SBD |
$2.81
|
| Rate for Payer: Priority Health SBD |
$122.09
|
| Rate for Payer: Priority Health SBD |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.90
|
| Rate for Payer: UHC Core |
$232.13
|
| Rate for Payer: UHC Core |
$193.03
|
| Rate for Payer: UHC Core |
$2.02
|
| Rate for Payer: UHC Core |
$100.97
|
| Rate for Payer: UHC Core |
$2.32
|
| Rate for Payer: UHC Core |
$210.59
|
| Rate for Payer: UHC Exchange |
$175.10
|
| Rate for Payer: UHC Exchange |
$1.75
|
| Rate for Payer: UHC Exchange |
$158.85
|
| Rate for Payer: UHC Exchange |
$76.16
|
| Rate for Payer: UHC Exchange |
$145.61
|
| Rate for Payer: UHC Exchange |
$1.52
|
|
|
MYCOPHENOLATE MOFETIL 500 MG TABLET
|
Facility
|
OP
|
$345.45
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
21374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$310.90 |
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: Aetna Commercial |
$3.78
|
| Rate for Payer: Aetna Commercial |
$303.14
|
| Rate for Payer: Aetna Commercial |
$217.22
|
| Rate for Payer: Aetna Medicare |
$172.72
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna Medicare |
$178.32
|
| Rate for Payer: Aetna Medicare |
$127.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.54
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS Complete |
$138.18
|
| Rate for Payer: BCBS Complete |
$102.22
|
| Rate for Payer: BCBS Complete |
$142.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cash Price |
$285.31
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cash Price |
$285.31
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Advantage |
$3.12
|
| Rate for Payer: Cofinity Advantage |
$178.88
|
| Rate for Payer: Cofinity Advantage |
$249.65
|
| Rate for Payer: Cofinity Advantage |
$241.81
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Cofinity Commercial |
$3.83
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Cofinity Commercial |
$306.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Healthscope Commercial |
$320.98
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Healthscope Commercial |
$310.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$285.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.34
|
| Rate for Payer: PHP Commercial |
$303.14
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: PHP Commercial |
$3.78
|
| Rate for Payer: PHP Commercial |
$217.22
|
| Rate for Payer: Priority Health SBD |
$161.00
|
| Rate for Payer: Priority Health SBD |
$224.68
|
| Rate for Payer: Priority Health SBD |
$2.80
|
| Rate for Payer: Priority Health SBD |
$217.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
|
|
MYCOPHENOLATE MOFETIL 500 MG TABLET
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
21374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$3.78
|
| Rate for Payer: Aetna Commercial |
$303.14
|
| Rate for Payer: Aetna Commercial |
$217.22
|
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.89
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cash Price |
$285.31
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cofinity Advantage |
$241.81
|
| Rate for Payer: Cofinity Advantage |
$249.65
|
| Rate for Payer: Cofinity Advantage |
$3.12
|
| Rate for Payer: Cofinity Advantage |
$178.88
|
| Rate for Payer: Cofinity Commercial |
$306.71
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Cofinity Commercial |
$3.83
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.56
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Healthscope Commercial |
$320.98
|
| Rate for Payer: Healthscope Commercial |
$310.90
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.34
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: PHP Commercial |
$217.22
|
| Rate for Payer: PHP Commercial |
$3.78
|
| Rate for Payer: PHP Commercial |
$303.14
|
| Rate for Payer: Priority Health SBD |
$224.68
|
| Rate for Payer: Priority Health SBD |
$217.63
|
| Rate for Payer: Priority Health SBD |
$2.80
|
| Rate for Payer: Priority Health SBD |
$161.00
|
|
|
MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$335.56
|
|
|
Service Code
|
HCPCS J7518
|
| Hospital Charge Code |
38062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna Commercial |
$285.23
|
| Rate for Payer: Aetna Commercial |
$407.49
|
| Rate for Payer: Aetna Commercial |
$1,191.95
|
| Rate for Payer: Aetna Commercial |
$11.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.50
|
| Rate for Payer: Cash Price |
$268.45
|
| Rate for Payer: Cash Price |
$383.52
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$1,121.84
|
| Rate for Payer: Cofinity Advantage |
$234.89
|
| Rate for Payer: Cofinity Advantage |
$981.61
|
| Rate for Payer: Cofinity Advantage |
$335.58
|
| Rate for Payer: Cofinity Advantage |
$9.82
|
| Rate for Payer: Cofinity Commercial |
$412.28
|
| Rate for Payer: Cofinity Commercial |
$288.58
|
| Rate for Payer: Cofinity Commercial |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$1,205.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,121.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.45
|
| Rate for Payer: Healthscope Commercial |
$302.00
|
| Rate for Payer: Healthscope Commercial |
$431.46
|
| Rate for Payer: Healthscope Commercial |
$1,262.07
|
| Rate for Payer: Healthscope Commercial |
$12.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,191.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,051.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.52
|
| Rate for Payer: PHP Commercial |
$285.23
|
| Rate for Payer: PHP Commercial |
$11.93
|
| Rate for Payer: PHP Commercial |
$1,191.95
|
| Rate for Payer: PHP Commercial |
$407.49
|
| Rate for Payer: Priority Health SBD |
$8.84
|
| Rate for Payer: Priority Health SBD |
$302.02
|
| Rate for Payer: Priority Health SBD |
$211.40
|
| Rate for Payer: Priority Health SBD |
$883.45
|
|
|
MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$14.03
|
|
|
Service Code
|
HCPCS J7518
|
| Hospital Charge Code |
38062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$12.63 |
| Rate for Payer: Aetna Commercial |
$11.93
|
| Rate for Payer: Aetna Commercial |
$407.49
|
| Rate for Payer: Aetna Commercial |
$285.23
|
| Rate for Payer: Aetna Commercial |
$1,191.95
|
| Rate for Payer: Aetna Medicare |
$7.01
|
| Rate for Payer: Aetna Medicare |
$239.70
|
| Rate for Payer: Aetna Medicare |
$167.78
|
| Rate for Payer: Aetna Medicare |
$701.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.12
|
| Rate for Payer: BCBS Complete |
$191.76
|
| Rate for Payer: BCBS Complete |
$5.61
|
| Rate for Payer: BCBS Complete |
$560.92
|
| Rate for Payer: BCBS Complete |
$134.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$268.45
|
| Rate for Payer: Cash Price |
$383.52
|
| Rate for Payer: Cash Price |
$268.45
|
| Rate for Payer: Cash Price |
$1,121.84
|
| Rate for Payer: Cash Price |
$1,121.84
|
| Rate for Payer: Cash Price |
$383.52
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cofinity Advantage |
$335.58
|
| Rate for Payer: Cofinity Advantage |
$981.61
|
| Rate for Payer: Cofinity Advantage |
$234.89
|
| Rate for Payer: Cofinity Advantage |
$9.82
|
| Rate for Payer: Cofinity Commercial |
$1,205.98
|
| Rate for Payer: Cofinity Commercial |
$412.28
|
| Rate for Payer: Cofinity Commercial |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$288.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,121.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.22
|
| Rate for Payer: Healthscope Commercial |
$302.00
|
| Rate for Payer: Healthscope Commercial |
$1,262.07
|
| Rate for Payer: Healthscope Commercial |
$431.46
|
| Rate for Payer: Healthscope Commercial |
$12.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,121.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$383.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,191.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,051.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.55
|
| Rate for Payer: PHP Commercial |
$285.23
|
| Rate for Payer: PHP Commercial |
$11.93
|
| Rate for Payer: PHP Commercial |
$407.49
|
| Rate for Payer: PHP Commercial |
$1,191.95
|
| Rate for Payer: Priority Health SBD |
$883.45
|
| Rate for Payer: Priority Health SBD |
$211.40
|
| Rate for Payer: Priority Health SBD |
$302.02
|
| Rate for Payer: Priority Health SBD |
$8.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.53
|
| Rate for Payer: UHC Core |
$0.53
|
| Rate for Payer: UHC Core |
$0.53
|
| Rate for Payer: UHC Core |
$0.53
|
| Rate for Payer: UHC Core |
$0.53
|
| Rate for Payer: UHC Exchange |
$0.53
|
| Rate for Payer: UHC Exchange |
$0.53
|
| Rate for Payer: UHC Exchange |
$0.53
|
| Rate for Payer: UHC Exchange |
$0.53
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$55,397.37
|
|
|
Service Code
|
MSDRG 827
|
| Min. Negotiated Rate |
$17,518.46 |
| Max. Negotiated Rate |
$55,397.37 |
| Rate for Payer: Aetna Medicare |
$19,178.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,050.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,050.60
|
| Rate for Payer: BCBS MAPPO |
$18,440.48
|
| Rate for Payer: BCBS Trust/PPO |
$55,397.37
|
| Rate for Payer: BCN Commercial |
$55,397.37
|
| Rate for Payer: BCN Medicare Advantage |
$18,440.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,440.48
|
| Rate for Payer: Mclaren Medicare |
$18,440.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,362.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,206.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,284.53
|
| Rate for Payer: Nomi Health Commercial |
$29,814.48
|
| Rate for Payer: PACE Medicare |
$17,518.46
|
| Rate for Payer: PACE SWMI |
$18,440.48
|
| Rate for Payer: PHP Medicare Advantage |
$18,440.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,261.49
|
| Rate for Payer: Priority Health Medicare |
$18,440.48
|
| Rate for Payer: Priority Health Tiered Network |
$29,809.19
|
| Rate for Payer: Railroad Medicare Medicare |
$18,440.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,672.56
|
| Rate for Payer: UHC Core |
$31,517.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,440.48
|
| Rate for Payer: UHC Exchange |
$25,739.83
|
| Rate for Payer: VA VA |
$18,440.48
|
|
