|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$72.80
|
|
|
Service Code
|
NDC 43598043611
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.86 |
| Max. Negotiated Rate |
$65.52 |
| Rate for Payer: Aetna Commercial |
$61.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.32
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Cofinity Advantage |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$62.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.24
|
| Rate for Payer: Healthscope Commercial |
$65.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.60
|
| Rate for Payer: PHP Commercial |
$61.88
|
| Rate for Payer: Priority Health SBD |
$45.86
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$72.80
|
|
|
Service Code
|
NDC 43598043635
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.61 |
| Max. Negotiated Rate |
$65.52 |
| Rate for Payer: Aetna Commercial |
$61.88
|
| Rate for Payer: Aetna Medicare |
$36.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.32
|
| Rate for Payer: BCBS Complete |
$29.12
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Cofinity Advantage |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$62.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.24
|
| Rate for Payer: Healthscope Commercial |
$65.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.60
|
| Rate for Payer: PHP Commercial |
$61.88
|
| Rate for Payer: Priority Health SBD |
$45.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.32
|
| Rate for Payer: UHC Core |
$37.93
|
| Rate for Payer: UHC Exchange |
$28.61
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$132.46
|
|
|
Service Code
|
NDC 71041813
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.06 |
| Max. Negotiated Rate |
$119.21 |
| Rate for Payer: Aetna Commercial |
$112.59
|
| Rate for Payer: Aetna Medicare |
$66.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.10
|
| Rate for Payer: BCBS Complete |
$52.98
|
| Rate for Payer: Cash Price |
$105.97
|
| Rate for Payer: Cofinity Advantage |
$92.72
|
| Rate for Payer: Cofinity Commercial |
$113.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.97
|
| Rate for Payer: Healthscope Commercial |
$119.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.34
|
| Rate for Payer: PHP Commercial |
$112.59
|
| Rate for Payer: Priority Health SBD |
$83.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.10
|
| Rate for Payer: UHC Core |
$69.01
|
| Rate for Payer: UHC Exchange |
$52.06
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$132.46
|
|
|
Service Code
|
NDC 00071041813
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.45 |
| Max. Negotiated Rate |
$119.21 |
| Rate for Payer: Aetna Commercial |
$112.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.10
|
| Rate for Payer: Cash Price |
$105.97
|
| Rate for Payer: Cofinity Advantage |
$92.72
|
| Rate for Payer: Cofinity Commercial |
$113.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.97
|
| Rate for Payer: Healthscope Commercial |
$119.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.34
|
| Rate for Payer: PHP Commercial |
$112.59
|
| Rate for Payer: Priority Health SBD |
$83.45
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$72.80
|
|
|
Service Code
|
NDC 43598043611
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.61 |
| Max. Negotiated Rate |
$65.52 |
| Rate for Payer: Aetna Commercial |
$61.88
|
| Rate for Payer: Aetna Medicare |
$36.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.32
|
| Rate for Payer: BCBS Complete |
$29.12
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Cofinity Advantage |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$62.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.24
|
| Rate for Payer: Healthscope Commercial |
$65.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.60
|
| Rate for Payer: PHP Commercial |
$61.88
|
| Rate for Payer: Priority Health SBD |
$45.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.32
|
| Rate for Payer: UHC Core |
$37.93
|
| Rate for Payer: UHC Exchange |
$28.61
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$32.38
|
|
|
Service Code
|
NDC 59762330403
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.73 |
| Max. Negotiated Rate |
$29.14 |
| Rate for Payer: Aetna Commercial |
$27.52
|
| Rate for Payer: Aetna Medicare |
$16.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.05
|
| Rate for Payer: BCBS Complete |
$12.95
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cofinity Advantage |
$22.67
|
| Rate for Payer: Cofinity Commercial |
$27.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.90
|
| Rate for Payer: Healthscope Commercial |
$29.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.29
|
| Rate for Payer: PHP Commercial |
$27.52
|
| Rate for Payer: Priority Health SBD |
$20.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.05
|
| Rate for Payer: UHC Core |
$16.87
|
| Rate for Payer: UHC Exchange |
$12.73
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$132.46
|
|
|
Service Code
|
NDC 00071041813
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.06 |
| Max. Negotiated Rate |
$119.21 |
| Rate for Payer: Aetna Commercial |
$112.59
|
| Rate for Payer: Aetna Medicare |
$66.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.10
|
| Rate for Payer: BCBS Complete |
$52.98
|
| Rate for Payer: Cash Price |
$105.97
|
| Rate for Payer: Cofinity Advantage |
$92.72
|
| Rate for Payer: Cofinity Commercial |
$113.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.97
|
| Rate for Payer: Healthscope Commercial |
$119.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.34
|
| Rate for Payer: PHP Commercial |
$112.59
|
| Rate for Payer: Priority Health SBD |
$83.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.10
|
| Rate for Payer: UHC Core |
$69.01
|
| Rate for Payer: UHC Exchange |
$52.06
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$102.10
|
|
|
Service Code
|
NDC 49730011330
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.32 |
| Max. Negotiated Rate |
$91.89 |
| Rate for Payer: Aetna Commercial |
$86.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.36
|
| Rate for Payer: Cash Price |
$81.68
|
| Rate for Payer: Cofinity Advantage |
$71.47
|
| Rate for Payer: Cofinity Commercial |
$87.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.68
|
| Rate for Payer: Healthscope Commercial |
$91.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.58
|
| Rate for Payer: PHP Commercial |
$86.78
|
| Rate for Payer: Priority Health SBD |
$64.32
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$4.36
|
|
|
Service Code
|
NDC 00378911616
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.83
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: Cofinity Advantage |
$3.05
|
| Rate for Payer: Cofinity Commercial |
$3.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.49
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.27
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health SBD |
$2.75
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$102.10
|
|
|
Service Code
|
NDC 49730011330
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.13 |
| Max. Negotiated Rate |
$91.89 |
| Rate for Payer: Aetna Commercial |
$86.78
|
| Rate for Payer: Aetna Medicare |
$51.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.36
|
| Rate for Payer: BCBS Complete |
$40.84
|
| Rate for Payer: Cash Price |
$81.68
|
| Rate for Payer: Cofinity Advantage |
$71.47
|
| Rate for Payer: Cofinity Commercial |
$87.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.68
|
| Rate for Payer: Healthscope Commercial |
$91.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.58
|
| Rate for Payer: PHP Commercial |
$86.78
|
| Rate for Payer: Priority Health SBD |
$64.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.36
|
| Rate for Payer: UHC Core |
$53.19
|
| Rate for Payer: UHC Exchange |
$40.13
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$130.61
|
|
|
Service Code
|
NDC 00378911693
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.28 |
| Max. Negotiated Rate |
$117.55 |
| Rate for Payer: Aetna Commercial |
$111.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.90
|
| Rate for Payer: Cash Price |
$104.49
|
| Rate for Payer: Cofinity Advantage |
$91.43
|
| Rate for Payer: Cofinity Commercial |
$112.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.49
|
| Rate for Payer: Healthscope Commercial |
$117.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.96
|
| Rate for Payer: PHP Commercial |
$111.02
|
| Rate for Payer: Priority Health SBD |
$82.28
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
NDC 00378911616
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna Medicare |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.83
|
| Rate for Payer: BCBS Complete |
$1.74
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: Cofinity Advantage |
$3.05
|
| Rate for Payer: Cofinity Commercial |
$3.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.49
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.27
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health SBD |
$2.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.83
|
| Rate for Payer: UHC Core |
$2.27
|
| Rate for Payer: UHC Exchange |
$1.71
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$130.61
|
|
|
Service Code
|
NDC 00378911693
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.33 |
| Max. Negotiated Rate |
$117.55 |
| Rate for Payer: Aetna Commercial |
$111.02
|
| Rate for Payer: Aetna Medicare |
$65.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.90
|
| Rate for Payer: BCBS Complete |
$52.24
|
| Rate for Payer: Cash Price |
$104.49
|
| Rate for Payer: Cofinity Advantage |
$91.43
|
| Rate for Payer: Cofinity Commercial |
$112.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.49
|
| Rate for Payer: Healthscope Commercial |
$117.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.96
|
| Rate for Payer: PHP Commercial |
$111.02
|
| Rate for Payer: Priority Health SBD |
$82.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.90
|
| Rate for Payer: UHC Core |
$68.05
|
| Rate for Payer: UHC Exchange |
$51.33
|
|
|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT
|
Facility
|
OP
|
$110.88
|
|
|
Service Code
|
NDC 00281032630
|
| Hospital Charge Code |
5606
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.58 |
| Max. Negotiated Rate |
$99.79 |
| Rate for Payer: Aetna Commercial |
$94.25
|
| Rate for Payer: Aetna Medicare |
$55.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.07
|
| Rate for Payer: BCBS Complete |
$44.35
|
| Rate for Payer: Cash Price |
$88.70
|
| Rate for Payer: Cofinity Advantage |
$77.62
|
| Rate for Payer: Cofinity Commercial |
$95.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.70
|
| Rate for Payer: Healthscope Commercial |
$99.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.16
|
| Rate for Payer: PHP Commercial |
$94.25
|
| Rate for Payer: Priority Health SBD |
$69.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.07
|
| Rate for Payer: UHC Core |
$57.77
|
| Rate for Payer: UHC Exchange |
$43.58
|
|
|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT
|
Facility
|
IP
|
$110.88
|
|
|
Service Code
|
NDC 00281032630
|
| Hospital Charge Code |
5606
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.85 |
| Max. Negotiated Rate |
$99.79 |
| Rate for Payer: Aetna Commercial |
$94.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.07
|
| Rate for Payer: Cash Price |
$88.70
|
| Rate for Payer: Cofinity Advantage |
$77.62
|
| Rate for Payer: Cofinity Commercial |
$95.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.70
|
| Rate for Payer: Healthscope Commercial |
$99.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.16
|
| Rate for Payer: PHP Commercial |
$94.25
|
| Rate for Payer: Priority Health SBD |
$69.85
|
|
|
NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
15859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.83 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Advantage |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health SBD |
$57.83
|
|
|
NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
15859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Trust/PPO |
$3.82
|
| Rate for Payer: BCN Commercial |
$3.82
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Advantage |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.51
|
| Rate for Payer: UHC Core |
$2.51
|
| Rate for Payer: UHC Exchange |
$2.51
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15,157.30
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
173434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,549.10 |
| Max. Negotiated Rate |
$13,641.57 |
| Rate for Payer: Aetna Commercial |
$12,883.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,852.25
|
| Rate for Payer: Cash Price |
$12,125.84
|
| Rate for Payer: Cofinity Advantage |
$10,610.11
|
| Rate for Payer: Cofinity Commercial |
$13,035.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,125.84
|
| Rate for Payer: Healthscope Commercial |
$13,641.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,883.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,367.98
|
| Rate for Payer: PHP Commercial |
$12,883.70
|
| Rate for Payer: Priority Health SBD |
$9,549.10
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15,157.30
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
173434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$13,641.57 |
| Rate for Payer: Aetna Commercial |
$12,883.70
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,852.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.02
|
| Rate for Payer: BCBS Complete |
$18.46
|
| Rate for Payer: BCBS MAPPO |
$33.62
|
| Rate for Payer: BCBS Trust/PPO |
$84.21
|
| Rate for Payer: BCN Commercial |
$84.21
|
| Rate for Payer: BCN Medicare Advantage |
$33.62
|
| Rate for Payer: Cash Price |
$12,125.84
|
| Rate for Payer: Cash Price |
$12,125.84
|
| Rate for Payer: Cofinity Advantage |
$10,610.11
|
| Rate for Payer: Cofinity Commercial |
$13,035.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,125.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.62
|
| Rate for Payer: Healthscope Commercial |
$13,641.57
|
| Rate for Payer: Mclaren Medicaid |
$17.58
|
| Rate for Payer: Mclaren Medicare |
$33.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.30
|
| Rate for Payer: Meridian Medicaid |
$35.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,883.70
|
| Rate for Payer: Nomi Health Commercial |
$100.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,367.98
|
| Rate for Payer: PACE Medicare |
$31.94
|
| Rate for Payer: PACE SWMI |
$33.62
|
| Rate for Payer: PHP Commercial |
$12,883.70
|
| Rate for Payer: PHP Medicare Advantage |
$33.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$103.97
|
| Rate for Payer: Priority Health Medicare |
$33.62
|
| Rate for Payer: Priority Health SBD |
$9,549.10
|
| Rate for Payer: Priority Health Tiered Network |
$83.18
|
| Rate for Payer: Railroad Medicare Medicare |
$33.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.39
|
| Rate for Payer: UHC Core |
$55.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33.62
|
| Rate for Payer: UHC Exchange |
$55.39
|
| Rate for Payer: UHC Medicaid |
$17.58
|
| Rate for Payer: UHCCP Medicaid |
$17.58
|
| Rate for Payer: VA VA |
$33.62
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25,926.23
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
185666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$23,333.61 |
| Rate for Payer: Aetna Commercial |
$22,037.30
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,852.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.02
|
| Rate for Payer: BCBS Complete |
$18.46
|
| Rate for Payer: BCBS MAPPO |
$33.62
|
| Rate for Payer: BCBS Trust/PPO |
$84.21
|
| Rate for Payer: BCN Commercial |
$84.21
|
| Rate for Payer: BCN Medicare Advantage |
$33.62
|
| Rate for Payer: Cash Price |
$20,740.98
|
| Rate for Payer: Cash Price |
$20,740.98
|
| Rate for Payer: Cofinity Advantage |
$18,148.36
|
| Rate for Payer: Cofinity Commercial |
$22,296.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,740.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.62
|
| Rate for Payer: Healthscope Commercial |
$23,333.61
|
| Rate for Payer: Mclaren Medicaid |
$17.58
|
| Rate for Payer: Mclaren Medicare |
$33.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.30
|
| Rate for Payer: Meridian Medicaid |
$35.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,037.30
|
| Rate for Payer: Nomi Health Commercial |
$100.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19,444.67
|
| Rate for Payer: PACE Medicare |
$31.94
|
| Rate for Payer: PACE SWMI |
$33.62
|
| Rate for Payer: PHP Commercial |
$22,037.30
|
| Rate for Payer: PHP Medicare Advantage |
$33.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$103.97
|
| Rate for Payer: Priority Health Medicare |
$33.62
|
| Rate for Payer: Priority Health SBD |
$16,333.52
|
| Rate for Payer: Priority Health Tiered Network |
$83.18
|
| Rate for Payer: Railroad Medicare Medicare |
$33.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.39
|
| Rate for Payer: UHC Core |
$55.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33.62
|
| Rate for Payer: UHC Exchange |
$55.39
|
| Rate for Payer: UHC Medicaid |
$17.58
|
| Rate for Payer: UHCCP Medicaid |
$17.58
|
| Rate for Payer: VA VA |
$33.62
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,063.00
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
173433
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$5,456.70 |
| Rate for Payer: Aetna Commercial |
$5,153.55
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,940.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.02
|
| Rate for Payer: BCBS Complete |
$18.46
|
| Rate for Payer: BCBS MAPPO |
$33.62
|
| Rate for Payer: BCBS Trust/PPO |
$84.21
|
| Rate for Payer: BCN Commercial |
$84.21
|
| Rate for Payer: BCN Medicare Advantage |
$33.62
|
| Rate for Payer: Cash Price |
$4,850.40
|
| Rate for Payer: Cash Price |
$4,850.40
|
| Rate for Payer: Cofinity Advantage |
$4,244.10
|
| Rate for Payer: Cofinity Commercial |
$5,214.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,850.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.62
|
| Rate for Payer: Healthscope Commercial |
$5,456.70
|
| Rate for Payer: Mclaren Medicaid |
$17.58
|
| Rate for Payer: Mclaren Medicare |
$33.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.30
|
| Rate for Payer: Meridian Medicaid |
$35.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,153.55
|
| Rate for Payer: Nomi Health Commercial |
$100.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,547.25
|
| Rate for Payer: PACE Medicare |
$31.94
|
| Rate for Payer: PACE SWMI |
$33.62
|
| Rate for Payer: PHP Commercial |
$5,153.55
|
| Rate for Payer: PHP Medicare Advantage |
$33.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$103.97
|
| Rate for Payer: Priority Health Medicare |
$33.62
|
| Rate for Payer: Priority Health SBD |
$3,819.69
|
| Rate for Payer: Priority Health Tiered Network |
$83.18
|
| Rate for Payer: Railroad Medicare Medicare |
$33.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.39
|
| Rate for Payer: UHC Core |
$55.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33.62
|
| Rate for Payer: UHC Exchange |
$55.39
|
| Rate for Payer: UHC Medicaid |
$17.58
|
| Rate for Payer: UHCCP Medicaid |
$17.58
|
| Rate for Payer: VA VA |
$33.62
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC
|
Facility
|
IP
|
$37,406.87
|
|
|
Service Code
|
MSDRG 098
|
| Min. Negotiated Rate |
$17,398.79 |
| Max. Negotiated Rate |
$37,406.87 |
| Rate for Payer: Aetna Medicare |
$19,047.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,893.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,893.15
|
| Rate for Payer: BCBS MAPPO |
$18,314.52
|
| Rate for Payer: BCBS Trust/PPO |
$31,432.26
|
| Rate for Payer: BCN Commercial |
$31,432.26
|
| Rate for Payer: BCN Medicare Advantage |
$18,314.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,314.52
|
| Rate for Payer: Mclaren Medicare |
$18,314.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,230.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,061.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,145.97
|
| Rate for Payer: Nomi Health Commercial |
$29,604.21
|
| Rate for Payer: PACE Medicare |
$17,398.79
|
| Rate for Payer: PACE SWMI |
$18,314.52
|
| Rate for Payer: PHP Medicare Advantage |
$18,314.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36,998.70
|
| Rate for Payer: Priority Health Medicare |
$18,314.52
|
| Rate for Payer: Priority Health Tiered Network |
$29,598.95
|
| Rate for Payer: Railroad Medicare Medicare |
$18,314.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,406.87
|
| Rate for Payer: UHC Core |
$31,295.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,314.52
|
| Rate for Payer: UHC Exchange |
$25,558.30
|
| Rate for Payer: VA VA |
$18,314.52
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC
|
Facility
|
IP
|
$58,872.34
|
|
|
Service Code
|
MSDRG 097
|
| Min. Negotiated Rate |
$27,067.21 |
| Max. Negotiated Rate |
$58,872.34 |
| Rate for Payer: Aetna Medicare |
$29,631.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,614.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,614.75
|
| Rate for Payer: BCBS MAPPO |
$28,491.80
|
| Rate for Payer: BCBS Trust/PPO |
$40,823.55
|
| Rate for Payer: BCN Commercial |
$40,823.55
|
| Rate for Payer: BCN Medicare Advantage |
$28,491.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,491.80
|
| Rate for Payer: Mclaren Medicare |
$28,491.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,916.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,765.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$31,340.98
|
| Rate for Payer: Nomi Health Commercial |
$46,592.22
|
| Rate for Payer: PACE Medicare |
$27,067.21
|
| Rate for Payer: PACE SWMI |
$28,491.80
|
| Rate for Payer: PHP Medicare Advantage |
$28,491.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$58,229.95
|
| Rate for Payer: Priority Health Medicare |
$28,491.80
|
| Rate for Payer: Priority Health Tiered Network |
$46,583.95
|
| Rate for Payer: Railroad Medicare Medicare |
$28,491.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58,872.34
|
| Rate for Payer: UHC Core |
$49,254.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28,491.80
|
| Rate for Payer: UHC Exchange |
$40,224.62
|
| Rate for Payer: VA VA |
$28,491.80
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$31,041.35
|
|
|
Service Code
|
MSDRG 099
|
| Min. Negotiated Rate |
$10,552.55 |
| Max. Negotiated Rate |
$31,041.35 |
| Rate for Payer: PHP Medicare Advantage |
$11,107.95
|
| Rate for Payer: Aetna Medicare |
$11,552.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,884.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,884.94
|
| Rate for Payer: BCBS MAPPO |
$11,107.95
|
| Rate for Payer: BCBS Trust/PPO |
$31,041.35
|
| Rate for Payer: BCN Commercial |
$31,041.35
|
| Rate for Payer: BCN Medicare Advantage |
$11,107.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,107.95
|
| Rate for Payer: Mclaren Medicare |
$11,107.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,663.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,774.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,218.75
|
| Rate for Payer: Nomi Health Commercial |
$17,574.96
|
| Rate for Payer: PACE Medicare |
$10,552.55
|
| Rate for Payer: PACE SWMI |
$11,107.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,964.80
|
| Rate for Payer: Priority Health Medicare |
$11,107.95
|
| Rate for Payer: Priority Health Tiered Network |
$17,571.84
|
| Rate for Payer: Railroad Medicare Medicare |
$11,107.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,207.12
|
| Rate for Payer: UHC Core |
$18,579.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,107.95
|
| Rate for Payer: UHC Exchange |
$15,173.05
|
| Rate for Payer: VA VA |
$11,107.95
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$12,147.08
|
|
|
Service Code
|
APR-DRG 0503
|
| Min. Negotiated Rate |
$11,568.65 |
| Max. Negotiated Rate |
$12,147.08 |
| Rate for Payer: BCBS Complete |
$12,147.08
|
| Rate for Payer: Mclaren Medicaid |
$11,568.65
|
| Rate for Payer: Meridian Medicaid |
$12,147.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,568.65
|
| Rate for Payer: UHC Medicaid |
$11,568.65
|
| Rate for Payer: UHCCP Medicaid |
$11,568.65
|
|
