|
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; OTHER THAN FIRST METATARSAL, EACH
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28308
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,781.56
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
OTOLARYNGOLOGIC EXAMINATION UNDER GENERAL ANESTHESIA
|
Facility
|
OP
|
$1,398.05
|
|
|
Service Code
|
CPT 92502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$266.21 |
| Max. Negotiated Rate |
$1,398.05 |
| Rate for Payer: Aetna Medicare |
$516.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$620.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$620.83
|
| Rate for Payer: BCBS Complete |
$279.52
|
| Rate for Payer: BCBS MAPPO |
$496.66
|
| Rate for Payer: BCN Medicare Advantage |
$496.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.66
|
| Rate for Payer: Mclaren Medicaid |
$266.21
|
| Rate for Payer: Mclaren Medicare |
$496.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$521.49
|
| Rate for Payer: Meridian Medicaid |
$279.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$571.16
|
| Rate for Payer: PACE Medicare |
$471.83
|
| Rate for Payer: PACE SWMI |
$496.66
|
| Rate for Payer: PHP Medicare Advantage |
$496.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.21
|
| Rate for Payer: Priority Health Medicare |
$496.66
|
| Rate for Payer: Railroad Medicare Medicare |
$496.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,398.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$496.66
|
| Rate for Payer: UHC Medicare Advantage |
$496.66
|
| Rate for Payer: UHCCP Medicaid |
$279.62
|
| Rate for Payer: VA VA |
$496.66
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$231.65
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
99612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.66 |
| Max. Negotiated Rate |
$208.49 |
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: Aetna Commercial |
$766.60
|
| Rate for Payer: Aetna Commercial |
$239.07
|
| Rate for Payer: Aetna Medicare |
$450.94
|
| Rate for Payer: Aetna Medicare |
$115.83
|
| Rate for Payer: Aetna Medicare |
$140.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.82
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS Complete |
$92.66
|
| Rate for Payer: BCBS Complete |
$360.75
|
| Rate for Payer: Cash Price |
$721.50
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cash Price |
$225.01
|
| Rate for Payer: Cofinity Commercial |
$775.62
|
| Rate for Payer: Cofinity Commercial |
$199.22
|
| Rate for Payer: Cofinity Commercial |
$162.16
|
| Rate for Payer: Cofinity Commercial |
$241.88
|
| Rate for Payer: Cofinity Commercial |
$196.88
|
| Rate for Payer: Cofinity Commercial |
$631.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$631.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Healthscope Commercial |
$253.13
|
| Rate for Payer: Healthscope Commercial |
$208.49
|
| Rate for Payer: Healthscope Commercial |
$811.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$766.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: PHP Commercial |
$239.07
|
| Rate for Payer: PHP Commercial |
$196.90
|
| Rate for Payer: PHP Commercial |
$766.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.82
|
| Rate for Payer: Priority Health SBD |
$568.18
|
| Rate for Payer: Priority Health SBD |
$177.19
|
| Rate for Payer: Priority Health SBD |
$145.94
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$231.65
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
99612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.94 |
| Max. Negotiated Rate |
$208.49 |
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: Aetna Commercial |
$239.07
|
| Rate for Payer: Aetna Commercial |
$766.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.22
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cash Price |
$225.01
|
| Rate for Payer: Cash Price |
$721.50
|
| Rate for Payer: Cofinity Commercial |
$631.32
|
| Rate for Payer: Cofinity Commercial |
$162.16
|
| Rate for Payer: Cofinity Commercial |
$199.22
|
| Rate for Payer: Cofinity Commercial |
$775.62
|
| Rate for Payer: Cofinity Commercial |
$196.88
|
| Rate for Payer: Cofinity Commercial |
$241.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$631.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.50
|
| Rate for Payer: Healthscope Commercial |
$253.13
|
| Rate for Payer: Healthscope Commercial |
$811.69
|
| Rate for Payer: Healthscope Commercial |
$208.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$766.60
|
| Rate for Payer: PHP Commercial |
$766.60
|
| Rate for Payer: PHP Commercial |
$196.90
|
| Rate for Payer: PHP Commercial |
$239.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.82
|
| Rate for Payer: Priority Health SBD |
$568.18
|
| Rate for Payer: Priority Health SBD |
$145.94
|
| Rate for Payer: Priority Health SBD |
$177.19
|
|
|
OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$266.91
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
41598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.76 |
| Max. Negotiated Rate |
$240.22 |
| Rate for Payer: Aetna Commercial |
$226.87
|
| Rate for Payer: Aetna Commercial |
$115.88
|
| Rate for Payer: Aetna Commercial |
$222.39
|
| Rate for Payer: Aetna Commercial |
$158.75
|
| Rate for Payer: Aetna Commercial |
$405.14
|
| Rate for Payer: Aetna Commercial |
$367.67
|
| Rate for Payer: Aetna Medicare |
$133.46
|
| Rate for Payer: Aetna Medicare |
$68.17
|
| Rate for Payer: Aetna Medicare |
$130.81
|
| Rate for Payer: Aetna Medicare |
$238.31
|
| Rate for Payer: Aetna Medicare |
$93.38
|
| Rate for Payer: Aetna Medicare |
$216.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.81
|
| Rate for Payer: BCBS Complete |
$104.65
|
| Rate for Payer: BCBS Complete |
$74.70
|
| Rate for Payer: BCBS Complete |
$173.02
|
| Rate for Payer: BCBS Complete |
$54.53
|
| Rate for Payer: BCBS Complete |
$190.65
|
| Rate for Payer: BCBS Complete |
$106.76
|
| Rate for Payer: Cash Price |
$109.06
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Cash Price |
$149.41
|
| Rate for Payer: Cash Price |
$381.30
|
| Rate for Payer: Cash Price |
$346.04
|
| Rate for Payer: Cash Price |
$213.53
|
| Rate for Payer: Cofinity Commercial |
$160.61
|
| Rate for Payer: Cofinity Commercial |
$130.73
|
| Rate for Payer: Cofinity Commercial |
$409.90
|
| Rate for Payer: Cofinity Commercial |
$333.64
|
| Rate for Payer: Cofinity Commercial |
$225.00
|
| Rate for Payer: Cofinity Commercial |
$95.43
|
| Rate for Payer: Cofinity Commercial |
$302.79
|
| Rate for Payer: Cofinity Commercial |
$117.24
|
| Rate for Payer: Cofinity Commercial |
$186.84
|
| Rate for Payer: Cofinity Commercial |
$229.54
|
| Rate for Payer: Cofinity Commercial |
$371.99
|
| Rate for Payer: Cofinity Commercial |
$183.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$333.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.30
|
| Rate for Payer: Healthscope Commercial |
$122.70
|
| Rate for Payer: Healthscope Commercial |
$428.97
|
| Rate for Payer: Healthscope Commercial |
$240.22
|
| Rate for Payer: Healthscope Commercial |
$389.30
|
| Rate for Payer: Healthscope Commercial |
$168.08
|
| Rate for Payer: Healthscope Commercial |
$235.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.88
|
| Rate for Payer: PHP Commercial |
$115.88
|
| Rate for Payer: PHP Commercial |
$405.14
|
| Rate for Payer: PHP Commercial |
$226.87
|
| Rate for Payer: PHP Commercial |
$367.67
|
| Rate for Payer: PHP Commercial |
$158.75
|
| Rate for Payer: PHP Commercial |
$222.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.81
|
| Rate for Payer: Priority Health SBD |
$272.51
|
| Rate for Payer: Priority Health SBD |
$168.15
|
| Rate for Payer: Priority Health SBD |
$164.83
|
| Rate for Payer: Priority Health SBD |
$117.66
|
| Rate for Payer: Priority Health SBD |
$85.89
|
| Rate for Payer: Priority Health SBD |
$300.28
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
NDC 68084084501
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna Commercial |
$339.15
|
| Rate for Payer: Aetna Medicare |
$199.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.35
|
| Rate for Payer: BCBS Complete |
$159.60
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cofinity Commercial |
$279.30
|
| Rate for Payer: Cofinity Commercial |
$343.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$279.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.20
|
| Rate for Payer: Healthscope Commercial |
$359.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.15
|
| Rate for Payer: PHP Commercial |
$339.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.35
|
| Rate for Payer: Priority Health SBD |
$251.37
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
OP
|
$3.99
|
|
|
Service Code
|
NDC 68084084511
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.39
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.59
|
| Rate for Payer: Priority Health SBD |
$2.51
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 51991029201
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.71 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: Priority Health SBD |
$211.71
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$3.99
|
|
|
Service Code
|
NDC 68084084511
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.39
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.59
|
| Rate for Payer: Priority Health SBD |
$2.51
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
OP
|
$336.05
|
|
|
Service Code
|
NDC 51991029201
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna Medicare |
$168.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| Rate for Payer: BCBS Complete |
$134.42
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: Priority Health SBD |
$211.71
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
NDC 68084084501
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.37 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna Commercial |
$339.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.35
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cofinity Commercial |
$279.30
|
| Rate for Payer: Cofinity Commercial |
$343.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$279.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.20
|
| Rate for Payer: Healthscope Commercial |
$359.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.15
|
| Rate for Payer: PHP Commercial |
$339.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.35
|
| Rate for Payer: Priority Health SBD |
$251.37
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$357.60
|
|
|
Service Code
|
NDC 60687072201
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.04 |
| Max. Negotiated Rate |
$321.84 |
| Rate for Payer: Aetna Commercial |
$303.96
|
| Rate for Payer: Aetna Medicare |
$178.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.44
|
| Rate for Payer: BCBS Complete |
$143.04
|
| Rate for Payer: Cash Price |
$286.08
|
| Rate for Payer: Cofinity Commercial |
$250.32
|
| Rate for Payer: Cofinity Commercial |
$307.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.08
|
| Rate for Payer: Healthscope Commercial |
$321.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.96
|
| Rate for Payer: PHP Commercial |
$303.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.44
|
| Rate for Payer: Priority Health SBD |
$225.29
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$3.58
|
|
|
Service Code
|
NDC 60687072211
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: Aetna Commercial |
$3.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.33
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$3.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.86
|
| Rate for Payer: Healthscope Commercial |
$3.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.04
|
| Rate for Payer: PHP Commercial |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.33
|
| Rate for Payer: Priority Health SBD |
$2.26
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$3.58
|
|
|
Service Code
|
NDC 60687072211
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: Aetna Commercial |
$3.04
|
| Rate for Payer: Aetna Medicare |
$1.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.33
|
| Rate for Payer: BCBS Complete |
$1.43
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$3.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.86
|
| Rate for Payer: Healthscope Commercial |
$3.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.04
|
| Rate for Payer: PHP Commercial |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.33
|
| Rate for Payer: Priority Health SBD |
$2.26
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$357.60
|
|
|
Service Code
|
NDC 60687072201
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.29 |
| Max. Negotiated Rate |
$321.84 |
| Rate for Payer: Aetna Commercial |
$303.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.44
|
| Rate for Payer: Cash Price |
$286.08
|
| Rate for Payer: Cofinity Commercial |
$250.32
|
| Rate for Payer: Cofinity Commercial |
$307.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.08
|
| Rate for Payer: Healthscope Commercial |
$321.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.96
|
| Rate for Payer: PHP Commercial |
$303.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.44
|
| Rate for Payer: Priority Health SBD |
$225.29
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$298.56
|
|
|
Service Code
|
NDC 68084085301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.09 |
| Max. Negotiated Rate |
$268.70 |
| Rate for Payer: Aetna Commercial |
$253.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.06
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cofinity Commercial |
$208.99
|
| Rate for Payer: Cofinity Commercial |
$256.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.85
|
| Rate for Payer: Healthscope Commercial |
$268.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.78
|
| Rate for Payer: PHP Commercial |
$253.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.06
|
| Rate for Payer: Priority Health SBD |
$188.09
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$298.56
|
|
|
Service Code
|
NDC 68084085301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.42 |
| Max. Negotiated Rate |
$268.70 |
| Rate for Payer: Aetna Commercial |
$253.78
|
| Rate for Payer: Aetna Medicare |
$149.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.06
|
| Rate for Payer: BCBS Complete |
$119.42
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cofinity Commercial |
$208.99
|
| Rate for Payer: Cofinity Commercial |
$256.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.85
|
| Rate for Payer: Healthscope Commercial |
$268.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.78
|
| Rate for Payer: PHP Commercial |
$253.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.06
|
| Rate for Payer: Priority Health SBD |
$188.09
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
NDC 68084085311
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.94
|
| Rate for Payer: Priority Health SBD |
$1.88
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$418.30
|
|
|
Service Code
|
NDC 51991029301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.32 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna Medicare |
$209.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.89
|
| Rate for Payer: BCBS Complete |
$167.32
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$292.81
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$292.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.89
|
| Rate for Payer: Priority Health SBD |
$263.53
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$418.30
|
|
|
Service Code
|
NDC 51991029301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.53 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.89
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$292.81
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$292.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.89
|
| Rate for Payer: Priority Health SBD |
$263.53
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$2.99
|
|
|
Service Code
|
NDC 68084085311
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.94
|
| Rate for Payer: Priority Health SBD |
$1.88
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$355.30
|
|
|
Service Code
|
NDC 68084040011
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.84 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.94
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$248.71
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.94
|
| Rate for Payer: Priority Health SBD |
$223.84
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$325.85
|
|
|
Service Code
|
NDC 00904282161
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.29 |
| Max. Negotiated Rate |
$293.26 |
| Rate for Payer: Aetna Commercial |
$276.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.80
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$228.09
|
| Rate for Payer: Cofinity Commercial |
$280.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.68
|
| Rate for Payer: Healthscope Commercial |
$293.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.97
|
| Rate for Payer: PHP Commercial |
$276.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.80
|
| Rate for Payer: Priority Health SBD |
$205.29
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$325.85
|
|
|
Service Code
|
NDC 00904282161
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$293.26 |
| Rate for Payer: Aetna Commercial |
$276.97
|
| Rate for Payer: Aetna Medicare |
$162.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.80
|
| Rate for Payer: BCBS Complete |
$130.34
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$228.09
|
| Rate for Payer: Cofinity Commercial |
$280.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.68
|
| Rate for Payer: Healthscope Commercial |
$293.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.97
|
| Rate for Payer: PHP Commercial |
$276.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.80
|
| Rate for Payer: Priority Health SBD |
$205.29
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$355.30
|
|
|
Service Code
|
NDC 68084040001
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.84 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.94
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$248.71
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.94
|
| Rate for Payer: Priority Health SBD |
$223.84
|
|
