|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47.17
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$40.09
|
| Rate for Payer: Aetna Medicare |
$23.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.66
|
| Rate for Payer: BCBS Complete |
$18.87
|
| Rate for Payer: Cash Price |
$37.74
|
| Rate for Payer: Cofinity Commercial |
$33.02
|
| Rate for Payer: Cofinity Commercial |
$40.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.74
|
| Rate for Payer: Healthscope Commercial |
$42.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.09
|
| Rate for Payer: PHP Commercial |
$40.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.66
|
| Rate for Payer: Priority Health SBD |
$29.72
|
|
|
MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$228.16
|
|
|
Service Code
|
HCPCS J7519
|
| Hospital Charge Code |
23968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$143.74 |
| Max. Negotiated Rate |
$205.34 |
| Rate for Payer: Aetna Commercial |
$193.94
|
| Rate for Payer: Aetna Commercial |
$113.76
|
| Rate for Payer: Aetna Commercial |
$83.88
|
| Rate for Payer: Aetna Commercial |
$94.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.14
|
| Rate for Payer: Cash Price |
$182.53
|
| Rate for Payer: Cash Price |
$107.07
|
| Rate for Payer: Cash Price |
$88.57
|
| Rate for Payer: Cash Price |
$78.94
|
| Rate for Payer: Cofinity Commercial |
$77.50
|
| Rate for Payer: Cofinity Commercial |
$84.86
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$115.10
|
| Rate for Payer: Cofinity Commercial |
$93.69
|
| Rate for Payer: Cofinity Commercial |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$159.71
|
| Rate for Payer: Cofinity Commercial |
$95.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.08
|
| 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 |
$78.94
|
| Rate for Payer: Healthscope Commercial |
$120.46
|
| Rate for Payer: Healthscope Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$88.81
|
| Rate for Payer: Healthscope Commercial |
$205.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.10
|
| Rate for Payer: PHP Commercial |
$94.10
|
| Rate for Payer: PHP Commercial |
$193.94
|
| Rate for Payer: PHP Commercial |
$113.76
|
| Rate for Payer: PHP Commercial |
$83.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.14
|
| Rate for Payer: Priority Health SBD |
$69.75
|
| Rate for Payer: Priority Health SBD |
$143.74
|
| Rate for Payer: Priority Health SBD |
$84.32
|
| Rate for Payer: Priority Health SBD |
$62.17
|
|
|
MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$228.16
|
|
|
Service Code
|
HCPCS J7519
|
| Hospital Charge Code |
23968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.26 |
| Max. Negotiated Rate |
$205.34 |
| Rate for Payer: Aetna Commercial |
$193.94
|
| Rate for Payer: Aetna Commercial |
$113.76
|
| Rate for Payer: Aetna Commercial |
$83.88
|
| Rate for Payer: Aetna Commercial |
$94.10
|
| Rate for Payer: Aetna Medicare |
$49.34
|
| Rate for Payer: Aetna Medicare |
$114.08
|
| Rate for Payer: Aetna Medicare |
$66.92
|
| Rate for Payer: Aetna Medicare |
$55.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.30
|
| 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) |
$64.14
|
| Rate for Payer: BCBS Complete |
$44.28
|
| Rate for Payer: BCBS Complete |
$39.47
|
| Rate for Payer: BCBS Complete |
$53.54
|
| Rate for Payer: BCBS Complete |
$91.26
|
| Rate for Payer: Cash Price |
$78.94
|
| Rate for Payer: Cash Price |
$107.07
|
| Rate for Payer: Cash Price |
$182.53
|
| Rate for Payer: Cash Price |
$88.57
|
| Rate for Payer: Cofinity Commercial |
$93.69
|
| Rate for Payer: Cofinity Commercial |
$84.86
|
| Rate for Payer: Cofinity Commercial |
$159.71
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$77.50
|
| Rate for Payer: Cofinity Commercial |
$95.21
|
| Rate for Payer: Cofinity Commercial |
$115.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.07
|
| Rate for Payer: Healthscope Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$88.81
|
| Rate for Payer: Healthscope Commercial |
$120.46
|
| Rate for Payer: Healthscope Commercial |
$205.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.10
|
| Rate for Payer: PHP Commercial |
$113.76
|
| Rate for Payer: PHP Commercial |
$83.88
|
| Rate for Payer: PHP Commercial |
$193.94
|
| Rate for Payer: PHP Commercial |
$94.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.14
|
| Rate for Payer: Priority Health SBD |
$69.75
|
| Rate for Payer: Priority Health SBD |
$143.74
|
| Rate for Payer: Priority Health SBD |
$84.32
|
| Rate for Payer: Priority Health SBD |
$62.17
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE
|
Facility
|
IP
|
$445.55
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
15113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$280.70 |
| Max. Negotiated Rate |
$401.00 |
| 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 Commercial |
$343.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.90
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$356.44
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$259.35
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Cofinity Commercial |
$383.17
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Cofinity Commercial |
$311.88
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$311.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$401.00
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: PHP Commercial |
$3.79
|
| Rate for Payer: PHP Commercial |
$378.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.61
|
| 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
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE
|
Facility
|
OP
|
$445.55
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
15113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$178.22 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna Commercial |
$378.72
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna Medicare |
$222.78
|
| Rate for Payer: Aetna Medicare |
$202.10
|
| Rate for Payer: Aetna Medicare |
$185.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.90
|
| Rate for Payer: BCBS Complete |
$148.20
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS Complete |
$161.68
|
| Rate for Payer: BCBS Complete |
$178.22
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cash Price |
$356.44
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$311.88
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$383.17
|
| Rate for Payer: Cofinity Commercial |
$259.35
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$311.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Healthscope Commercial |
$401.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: PHP Commercial |
$3.79
|
| Rate for Payer: PHP Commercial |
$378.72
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.90
|
| 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
|
|
|
MYCOPHENOLATE MOFETIL 500 MG TABLET
|
Facility
|
OP
|
$347.52
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
21374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$139.01 |
| Max. Negotiated Rate |
$312.77 |
| Rate for Payer: Aetna Commercial |
$295.39
|
| Rate for Payer: Aetna Commercial |
$217.22
|
| Rate for Payer: Aetna Commercial |
$4.24
|
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: Aetna Medicare |
$173.76
|
| Rate for Payer: Aetna Medicare |
$127.78
|
| Rate for Payer: Aetna Medicare |
$99.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.24
|
| Rate for Payer: BCBS Complete |
$79.42
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS Complete |
$102.22
|
| Rate for Payer: BCBS Complete |
$139.01
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cash Price |
$278.02
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Cofinity Commercial |
$4.29
|
| Rate for Payer: Cofinity Commercial |
$243.26
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Cofinity Commercial |
$298.87
|
| Rate for Payer: Cofinity Commercial |
$138.99
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$243.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Healthscope Commercial |
$178.69
|
| Rate for Payer: Healthscope Commercial |
$4.49
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Healthscope Commercial |
$312.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.77
|
| Rate for Payer: PHP Commercial |
$217.22
|
| Rate for Payer: PHP Commercial |
$4.24
|
| Rate for Payer: PHP Commercial |
$295.39
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.24
|
| Rate for Payer: Priority Health SBD |
$125.09
|
| Rate for Payer: Priority Health SBD |
$218.94
|
| Rate for Payer: Priority Health SBD |
$161.00
|
| Rate for Payer: Priority Health SBD |
$3.14
|
|
|
MYCOPHENOLATE MOFETIL 500 MG TABLET
|
Facility
|
IP
|
$347.52
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
21374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$218.94 |
| Max. Negotiated Rate |
$312.77 |
| Rate for Payer: Aetna Commercial |
$295.39
|
| Rate for Payer: Aetna Commercial |
$217.22
|
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna Commercial |
$4.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.89
|
| Rate for Payer: Cash Price |
$278.02
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Cofinity Commercial |
$4.29
|
| Rate for Payer: Cofinity Commercial |
$138.99
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Cofinity Commercial |
$243.26
|
| Rate for Payer: Cofinity Commercial |
$298.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$243.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Healthscope Commercial |
$178.69
|
| Rate for Payer: Healthscope Commercial |
$4.49
|
| Rate for Payer: Healthscope Commercial |
$312.77
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.77
|
| Rate for Payer: PHP Commercial |
$217.22
|
| Rate for Payer: PHP Commercial |
$295.39
|
| Rate for Payer: PHP Commercial |
$4.24
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.11
|
| Rate for Payer: Priority Health SBD |
$218.94
|
| Rate for Payer: Priority Health SBD |
$125.09
|
| Rate for Payer: Priority Health SBD |
$161.00
|
| Rate for Payer: Priority Health SBD |
$3.14
|
|
|
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 |
$11.93
|
| Rate for Payer: Aetna Commercial |
$407.49
|
| Rate for Payer: Aetna Commercial |
$1,191.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.61
|
| Rate for Payer: Cash Price |
$268.45
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$1,121.84
|
| Rate for Payer: Cash Price |
$383.52
|
| Rate for Payer: Cofinity Commercial |
$1,205.98
|
| Rate for Payer: Cofinity Commercial |
$412.28
|
| Rate for Payer: Cofinity Commercial |
$335.58
|
| Rate for Payer: Cofinity Commercial |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$9.82
|
| Rate for Payer: Cofinity Commercial |
$288.58
|
| Rate for Payer: Cofinity Commercial |
$234.89
|
| Rate for Payer: Cofinity Commercial |
$981.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$981.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$234.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$335.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.45
|
| 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 |
$383.52
|
| Rate for Payer: Healthscope Commercial |
$12.63
|
| Rate for Payer: Healthscope Commercial |
$1,262.07
|
| Rate for Payer: Healthscope Commercial |
$431.46
|
| Rate for Payer: Healthscope Commercial |
$302.00
|
| 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 |
$11.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,191.95
|
| Rate for Payer: PHP Commercial |
$1,191.95
|
| Rate for Payer: PHP Commercial |
$285.23
|
| Rate for Payer: PHP Commercial |
$11.93
|
| Rate for Payer: PHP Commercial |
$407.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$911.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.61
|
| Rate for Payer: Priority Health SBD |
$883.45
|
| Rate for Payer: Priority Health SBD |
$211.40
|
| Rate for Payer: Priority Health SBD |
$8.84
|
| Rate for Payer: Priority Health SBD |
$302.02
|
|
|
MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$335.56
|
|
|
Service Code
|
HCPCS J7518
|
| Hospital Charge Code |
38062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.22 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna Commercial |
$285.23
|
| Rate for Payer: Aetna Commercial |
$11.93
|
| Rate for Payer: Aetna Commercial |
$407.49
|
| Rate for Payer: Aetna Commercial |
$1,191.95
|
| Rate for Payer: Aetna Medicare |
$239.70
|
| Rate for Payer: Aetna Medicare |
$167.78
|
| Rate for Payer: Aetna Medicare |
$7.01
|
| Rate for Payer: Aetna Medicare |
$701.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.61
|
| Rate for Payer: BCBS Complete |
$560.92
|
| Rate for Payer: BCBS Complete |
$191.76
|
| Rate for Payer: BCBS Complete |
$5.61
|
| Rate for Payer: BCBS Complete |
$134.22
|
| Rate for Payer: Cash Price |
$383.52
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$268.45
|
| Rate for Payer: Cash Price |
$1,121.84
|
| Rate for Payer: Cofinity Commercial |
$9.82
|
| Rate for Payer: Cofinity Commercial |
$412.28
|
| Rate for Payer: Cofinity Commercial |
$234.89
|
| Rate for Payer: Cofinity Commercial |
$335.58
|
| Rate for Payer: Cofinity Commercial |
$288.58
|
| Rate for Payer: Cofinity Commercial |
$1,205.98
|
| Rate for Payer: Cofinity Commercial |
$981.61
|
| Rate for Payer: Cofinity Commercial |
$12.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$234.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$981.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$335.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.45
|
| 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: Healthscope Commercial |
$1,262.07
|
| Rate for Payer: Healthscope Commercial |
$431.46
|
| Rate for Payer: Healthscope Commercial |
$12.63
|
| Rate for Payer: Healthscope Commercial |
$302.00
|
| 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 |
$11.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,191.95
|
| Rate for Payer: PHP Commercial |
$11.93
|
| Rate for Payer: PHP Commercial |
$407.49
|
| Rate for Payer: PHP Commercial |
$285.23
|
| Rate for Payer: PHP Commercial |
$1,191.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$911.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.61
|
| Rate for Payer: Priority Health SBD |
$883.45
|
| Rate for Payer: Priority Health SBD |
$211.40
|
| Rate for Payer: Priority Health SBD |
$8.84
|
| Rate for Payer: Priority Health SBD |
$302.02
|
|
|
MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S) WITH TOTAL WEIGHT OF 250 G OR LESS AND/OR REMOVAL OF SURFACE MYOMAS; VAGINAL APPROACH
|
Facility
|
OP
|
$8,728.81
|
|
|
Service Code
|
CPT 58145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,745.82
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION
|
Facility
|
OP
|
$637.52
|
|
|
Service Code
|
CPT 69420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$121.39 |
| Max. Negotiated Rate |
$637.52 |
| Rate for Payer: Aetna Medicare |
$235.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$283.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$283.10
|
| Rate for Payer: BCBS Complete |
$127.46
|
| Rate for Payer: BCBS MAPPO |
$226.48
|
| Rate for Payer: BCN Medicare Advantage |
$226.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.48
|
| Rate for Payer: Mclaren Medicaid |
$121.39
|
| Rate for Payer: Mclaren Medicare |
$226.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$237.80
|
| Rate for Payer: Meridian Medicaid |
$127.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.45
|
| Rate for Payer: PACE Medicare |
$215.16
|
| Rate for Payer: PACE SWMI |
$226.48
|
| Rate for Payer: PHP Medicare Advantage |
$226.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.39
|
| Rate for Payer: Priority Health Medicare |
$226.48
|
| Rate for Payer: Railroad Medicare Medicare |
$226.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$637.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.48
|
| Rate for Payer: UHC Medicare Advantage |
$226.48
|
| Rate for Payer: UHCCP Medicaid |
$127.51
|
| Rate for Payer: VA VA |
$226.48
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
IP
|
$250.75
|
|
|
Service Code
|
NDC 00904707007
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.97 |
| Max. Negotiated Rate |
$225.68 |
| Rate for Payer: Aetna Commercial |
$213.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.99
|
| Rate for Payer: Cash Price |
$200.60
|
| Rate for Payer: Cofinity Commercial |
$175.53
|
| Rate for Payer: Cofinity Commercial |
$215.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.60
|
| Rate for Payer: Healthscope Commercial |
$225.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.14
|
| Rate for Payer: PHP Commercial |
$213.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.99
|
| Rate for Payer: Priority Health SBD |
$157.97
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
OP
|
$250.75
|
|
|
Service Code
|
NDC 00904707007
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.30 |
| Max. Negotiated Rate |
$225.68 |
| Rate for Payer: Aetna Commercial |
$213.14
|
| Rate for Payer: Aetna Medicare |
$125.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.99
|
| Rate for Payer: BCBS Complete |
$100.30
|
| Rate for Payer: Cash Price |
$200.60
|
| Rate for Payer: Cofinity Commercial |
$175.53
|
| Rate for Payer: Cofinity Commercial |
$215.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.60
|
| Rate for Payer: Healthscope Commercial |
$225.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.14
|
| Rate for Payer: PHP Commercial |
$213.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.99
|
| Rate for Payer: Priority Health SBD |
$157.97
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
NDC 69097086707
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.40 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: Aetna Medicare |
$188.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.40
|
| Rate for Payer: BCBS Complete |
$150.40
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.40
|
| Rate for Payer: Priority Health SBD |
$236.88
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
OP
|
$1,150.33
|
|
|
Service Code
|
NDC 51079081220
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$460.13 |
| Max. Negotiated Rate |
$1,035.30 |
| Rate for Payer: Aetna Commercial |
$977.78
|
| Rate for Payer: Aetna Medicare |
$575.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.71
|
| Rate for Payer: BCBS Complete |
$460.13
|
| Rate for Payer: Cash Price |
$920.26
|
| Rate for Payer: Cofinity Commercial |
$805.23
|
| Rate for Payer: Cofinity Commercial |
$989.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$805.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$920.26
|
| Rate for Payer: Healthscope Commercial |
$1,035.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$977.78
|
| Rate for Payer: PHP Commercial |
$977.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.71
|
| Rate for Payer: Priority Health SBD |
$724.71
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
IP
|
$1,150.33
|
|
|
Service Code
|
NDC 51079081220
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$724.71 |
| Max. Negotiated Rate |
$1,035.30 |
| Rate for Payer: Aetna Commercial |
$977.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.71
|
| Rate for Payer: Cash Price |
$920.26
|
| Rate for Payer: Cofinity Commercial |
$805.23
|
| Rate for Payer: Cofinity Commercial |
$989.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$805.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$920.26
|
| Rate for Payer: Healthscope Commercial |
$1,035.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$977.78
|
| Rate for Payer: PHP Commercial |
$977.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.71
|
| Rate for Payer: Priority Health SBD |
$724.71
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
IP
|
$687.84
|
|
|
Service Code
|
NDC 00378002801
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$433.34 |
| Max. Negotiated Rate |
$619.06 |
| Rate for Payer: Aetna Commercial |
$584.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.10
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cofinity Commercial |
$481.49
|
| Rate for Payer: Cofinity Commercial |
$591.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$481.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.27
|
| Rate for Payer: Healthscope Commercial |
$619.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: PHP Commercial |
$584.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.10
|
| Rate for Payer: Priority Health SBD |
$433.34
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
NDC 69097086707
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.88 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.40
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.40
|
| Rate for Payer: Priority Health SBD |
$236.88
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
OP
|
$687.84
|
|
|
Service Code
|
NDC 00378002801
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.14 |
| Max. Negotiated Rate |
$619.06 |
| Rate for Payer: Aetna Commercial |
$584.66
|
| Rate for Payer: Aetna Medicare |
$343.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.10
|
| Rate for Payer: BCBS Complete |
$275.14
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cofinity Commercial |
$481.49
|
| Rate for Payer: Cofinity Commercial |
$591.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$481.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.27
|
| Rate for Payer: Healthscope Commercial |
$619.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: PHP Commercial |
$584.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.10
|
| Rate for Payer: Priority Health SBD |
$433.34
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
IP
|
$11.51
|
|
|
Service Code
|
NDC 51079081201
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$10.36 |
| Rate for Payer: Aetna Commercial |
$9.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.48
|
| Rate for Payer: Cash Price |
$9.21
|
| Rate for Payer: Cofinity Commercial |
$8.06
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.21
|
| Rate for Payer: Healthscope Commercial |
$10.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.78
|
| Rate for Payer: PHP Commercial |
$9.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.48
|
| Rate for Payer: Priority Health SBD |
$7.25
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
OP
|
$11.51
|
|
|
Service Code
|
NDC 51079081201
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$10.36 |
| Rate for Payer: Aetna Commercial |
$9.78
|
| Rate for Payer: Aetna Medicare |
$5.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.48
|
| Rate for Payer: BCBS Complete |
$4.60
|
| Rate for Payer: Cash Price |
$9.21
|
| Rate for Payer: Cofinity Commercial |
$8.06
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.21
|
| Rate for Payer: Healthscope Commercial |
$10.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.78
|
| Rate for Payer: PHP Commercial |
$9.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.48
|
| Rate for Payer: Priority Health SBD |
$7.25
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$147.74
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.08 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna Commercial |
$125.58
|
| Rate for Payer: Aetna Commercial |
$119.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.03
|
| Rate for Payer: Cash Price |
$112.39
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cofinity Commercial |
$120.82
|
| Rate for Payer: Cofinity Commercial |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Cofinity Commercial |
$98.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.19
|
| Rate for Payer: Healthscope Commercial |
$126.44
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.58
|
| Rate for Payer: PHP Commercial |
$119.42
|
| Rate for Payer: PHP Commercial |
$125.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.32
|
| Rate for Payer: Priority Health SBD |
$93.08
|
| Rate for Payer: Priority Health SBD |
$88.51
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$147.74
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna Commercial |
$125.58
|
| Rate for Payer: Aetna Commercial |
$119.42
|
| Rate for Payer: Aetna Medicare |
$70.25
|
| Rate for Payer: Aetna Medicare |
$73.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.03
|
| Rate for Payer: BCBS Complete |
$59.10
|
| Rate for Payer: BCBS Complete |
$56.20
|
| Rate for Payer: Cash Price |
$112.39
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cofinity Commercial |
$120.82
|
| Rate for Payer: Cofinity Commercial |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Cofinity Commercial |
$98.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.19
|
| Rate for Payer: Healthscope Commercial |
$126.44
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.58
|
| Rate for Payer: PHP Commercial |
$125.58
|
| Rate for Payer: PHP Commercial |
$119.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.03
|
| Rate for Payer: Priority Health SBD |
$93.08
|
| Rate for Payer: Priority Health SBD |
$88.51
|
|
|
NAFCILLIN 1 GRAM IVPB (INTRA-OP)
|
Facility
|
IP
|
$5.70
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.71
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Cofinity Commercial |
$4.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.56
|
| Rate for Payer: Healthscope Commercial |
$5.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.84
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.71
|
| Rate for Payer: Priority Health SBD |
$3.59
|
|
|
NAFCILLIN 1 GRAM IVPB (INTRA-OP)
|
Facility
|
OP
|
$5.70
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna Medicare |
$2.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.71
|
| Rate for Payer: BCBS Complete |
$2.28
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Cofinity Commercial |
$4.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.56
|
| Rate for Payer: Healthscope Commercial |
$5.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.84
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.71
|
| Rate for Payer: Priority Health SBD |
$3.59
|
|
