|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 23900001252
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: Priority Health SBD |
$15.65
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$24.84
|
|
|
Service Code
|
NDC 23900001252
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna Medicare |
$12.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: BCBS Complete |
$9.94
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: Priority Health SBD |
$15.65
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$27.15
|
|
|
Service Code
|
NDC 41100081123
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$24.43 |
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cofinity Commercial |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$23.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.72
|
| Rate for Payer: Healthscope Commercial |
$24.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.08
|
| Rate for Payer: PHP Commercial |
$23.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.65
|
| Rate for Payer: Priority Health SBD |
$17.10
|
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$728.19
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
5944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$458.76 |
| Max. Negotiated Rate |
$655.37 |
| Rate for Payer: Aetna Commercial |
$618.96
|
| Rate for Payer: Aetna Commercial |
$11.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.32
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$582.55
|
| Rate for Payer: Cofinity Commercial |
$11.25
|
| Rate for Payer: Cofinity Commercial |
$509.73
|
| Rate for Payer: Cofinity Commercial |
$626.24
|
| Rate for Payer: Cofinity Commercial |
$9.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$509.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.55
|
| Rate for Payer: Healthscope Commercial |
$11.77
|
| Rate for Payer: Healthscope Commercial |
$655.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$618.96
|
| Rate for Payer: PHP Commercial |
$11.12
|
| Rate for Payer: PHP Commercial |
$618.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.50
|
| Rate for Payer: Priority Health SBD |
$458.76
|
| Rate for Payer: Priority Health SBD |
$8.24
|
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$728.19
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
5944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$291.28 |
| Max. Negotiated Rate |
$655.37 |
| Rate for Payer: Aetna Commercial |
$618.96
|
| Rate for Payer: Aetna Commercial |
$11.12
|
| Rate for Payer: Aetna Medicare |
$6.54
|
| Rate for Payer: Aetna Medicare |
$364.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.32
|
| Rate for Payer: BCBS Complete |
$291.28
|
| Rate for Payer: BCBS Complete |
$5.23
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$582.55
|
| Rate for Payer: Cofinity Commercial |
$11.25
|
| Rate for Payer: Cofinity Commercial |
$509.73
|
| Rate for Payer: Cofinity Commercial |
$626.24
|
| Rate for Payer: Cofinity Commercial |
$9.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$509.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.55
|
| Rate for Payer: Healthscope Commercial |
$11.77
|
| Rate for Payer: Healthscope Commercial |
$655.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$618.96
|
| Rate for Payer: PHP Commercial |
$618.96
|
| Rate for Payer: PHP Commercial |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.32
|
| Rate for Payer: Priority Health SBD |
$458.76
|
| Rate for Payer: Priority Health SBD |
$8.24
|
|
|
OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
115673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$112.38
|
| Rate for Payer: Aetna Medicare |
$66.11
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.94
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$52.88
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$105.77
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$113.70
|
| Rate for Payer: Cofinity Commercial |
$92.55
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$118.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.38
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$112.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health SBD |
$83.29
|
| Rate for Payer: Priority Health SBD |
$42.33
|
|
|
OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$132.21
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
115673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.29 |
| Max. Negotiated Rate |
$118.99 |
| Rate for Payer: Aetna Commercial |
$112.38
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Cash Price |
$105.77
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$113.70
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$92.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$118.99
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$112.38
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.94
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$83.29
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
IP
|
$505.05
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
10843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$318.18 |
| Max. Negotiated Rate |
$454.55 |
| Rate for Payer: Aetna Commercial |
$429.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.28
|
| Rate for Payer: Cash Price |
$404.04
|
| Rate for Payer: Cofinity Commercial |
$353.54
|
| Rate for Payer: Cofinity Commercial |
$434.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$353.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.04
|
| Rate for Payer: Healthscope Commercial |
$454.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.29
|
| Rate for Payer: PHP Commercial |
$429.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.28
|
| Rate for Payer: Priority Health SBD |
$318.18
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
OP
|
$1,112.32
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
10843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$444.93 |
| Max. Negotiated Rate |
$1,001.09 |
| Rate for Payer: Aetna Commercial |
$945.47
|
| Rate for Payer: Aetna Commercial |
$429.29
|
| Rate for Payer: Aetna Commercial |
$304.50
|
| Rate for Payer: Aetna Commercial |
$369.41
|
| Rate for Payer: Aetna Commercial |
$402.17
|
| Rate for Payer: Aetna Commercial |
$302.76
|
| Rate for Payer: Aetna Commercial |
$303.64
|
| Rate for Payer: Aetna Medicare |
$217.30
|
| Rate for Payer: Aetna Medicare |
$236.57
|
| Rate for Payer: Aetna Medicare |
$178.61
|
| Rate for Payer: Aetna Medicare |
$252.53
|
| Rate for Payer: Aetna Medicare |
$556.16
|
| Rate for Payer: Aetna Medicare |
$178.09
|
| Rate for Payer: Aetna Medicare |
$179.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$723.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.49
|
| Rate for Payer: BCBS Complete |
$202.02
|
| Rate for Payer: BCBS Complete |
$142.89
|
| Rate for Payer: BCBS Complete |
$173.84
|
| Rate for Payer: BCBS Complete |
$143.30
|
| Rate for Payer: BCBS Complete |
$142.48
|
| Rate for Payer: BCBS Complete |
$189.26
|
| Rate for Payer: BCBS Complete |
$444.93
|
| Rate for Payer: Cash Price |
$889.86
|
| Rate for Payer: Cash Price |
$284.95
|
| Rate for Payer: Cash Price |
$285.78
|
| Rate for Payer: Cash Price |
$286.59
|
| Rate for Payer: Cash Price |
$347.68
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cash Price |
$404.04
|
| Rate for Payer: Cofinity Commercial |
$778.62
|
| Rate for Payer: Cofinity Commercial |
$306.32
|
| Rate for Payer: Cofinity Commercial |
$249.33
|
| Rate for Payer: Cofinity Commercial |
$956.60
|
| Rate for Payer: Cofinity Commercial |
$434.34
|
| Rate for Payer: Cofinity Commercial |
$353.54
|
| Rate for Payer: Cofinity Commercial |
$250.05
|
| Rate for Payer: Cofinity Commercial |
$307.21
|
| Rate for Payer: Cofinity Commercial |
$331.20
|
| Rate for Payer: Cofinity Commercial |
$406.90
|
| Rate for Payer: Cofinity Commercial |
$373.76
|
| Rate for Payer: Cofinity Commercial |
$304.22
|
| Rate for Payer: Cofinity Commercial |
$250.77
|
| Rate for Payer: Cofinity Commercial |
$308.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$778.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$353.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$331.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.78
|
| Rate for Payer: Healthscope Commercial |
$425.83
|
| Rate for Payer: Healthscope Commercial |
$320.57
|
| Rate for Payer: Healthscope Commercial |
$454.55
|
| Rate for Payer: Healthscope Commercial |
$1,001.09
|
| Rate for Payer: Healthscope Commercial |
$321.50
|
| Rate for Payer: Healthscope Commercial |
$391.14
|
| Rate for Payer: Healthscope Commercial |
$322.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$945.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.76
|
| Rate for Payer: PHP Commercial |
$369.41
|
| Rate for Payer: PHP Commercial |
$304.50
|
| Rate for Payer: PHP Commercial |
$302.76
|
| Rate for Payer: PHP Commercial |
$303.64
|
| Rate for Payer: PHP Commercial |
$402.17
|
| Rate for Payer: PHP Commercial |
$429.29
|
| Rate for Payer: PHP Commercial |
$945.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$723.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.28
|
| Rate for Payer: Priority Health SBD |
$700.76
|
| Rate for Payer: Priority Health SBD |
$224.40
|
| Rate for Payer: Priority Health SBD |
$273.80
|
| Rate for Payer: Priority Health SBD |
$298.08
|
| Rate for Payer: Priority Health SBD |
$318.18
|
| Rate for Payer: Priority Health SBD |
$225.69
|
| Rate for Payer: Priority Health SBD |
$225.05
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION
|
Facility
|
OP
|
$4,058.79
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
40475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$3,652.91 |
| Rate for Payer: Aetna Commercial |
$3,449.97
|
| Rate for Payer: Aetna Commercial |
$5,879.55
|
| Rate for Payer: Aetna Medicare |
$10.96
|
| Rate for Payer: Aetna Medicare |
$10.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,638.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,496.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.18
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.54
|
| Rate for Payer: BCBS MAPPO |
$10.54
|
| Rate for Payer: BCN Medicare Advantage |
$10.54
|
| Rate for Payer: BCN Medicare Advantage |
$10.54
|
| Rate for Payer: Cash Price |
$5,533.70
|
| Rate for Payer: Cash Price |
$5,533.70
|
| Rate for Payer: Cash Price |
$3,247.03
|
| Rate for Payer: Cash Price |
$3,247.03
|
| Rate for Payer: Cofinity Commercial |
$4,841.98
|
| Rate for Payer: Cofinity Commercial |
$5,948.72
|
| Rate for Payer: Cofinity Commercial |
$3,490.56
|
| Rate for Payer: Cofinity Commercial |
$2,841.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,841.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,841.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,533.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,247.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.54
|
| Rate for Payer: Healthscope Commercial |
$3,652.91
|
| Rate for Payer: Healthscope Commercial |
$6,225.41
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.54
|
| Rate for Payer: Mclaren Medicare |
$10.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.07
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,449.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,879.55
|
| Rate for Payer: PACE Medicare |
$10.01
|
| Rate for Payer: PACE Medicare |
$10.01
|
| Rate for Payer: PACE SWMI |
$10.54
|
| Rate for Payer: PACE SWMI |
$10.54
|
| Rate for Payer: PHP Commercial |
$5,879.55
|
| Rate for Payer: PHP Commercial |
$3,449.97
|
| Rate for Payer: PHP Medicare Advantage |
$10.54
|
| Rate for Payer: PHP Medicare Advantage |
$10.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,496.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,638.21
|
| Rate for Payer: Priority Health Medicare |
$10.54
|
| Rate for Payer: Priority Health Medicare |
$10.54
|
| Rate for Payer: Priority Health SBD |
$4,357.79
|
| Rate for Payer: Priority Health SBD |
$2,557.04
|
| Rate for Payer: Railroad Medicare Medicare |
$10.54
|
| Rate for Payer: Railroad Medicare Medicare |
$10.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.54
|
| Rate for Payer: UHC Medicare Advantage |
$10.54
|
| Rate for Payer: UHC Medicare Advantage |
$10.54
|
| Rate for Payer: UHCCP Medicaid |
$5.93
|
| Rate for Payer: UHCCP Medicaid |
$5.93
|
| Rate for Payer: VA VA |
$10.54
|
| Rate for Payer: VA VA |
$10.54
|
|
|
PALATOPHARYNGOPLASTY (EG, UVULOPALATOPHARYNGOPLASTY, UVULOPHARYNGOPLASTY)
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 42145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,248.18
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,265.18
|
|
|
Service Code
|
NDC 50458055401
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$506.07 |
| Max. Negotiated Rate |
$1,138.66 |
| Rate for Payer: Aetna Commercial |
$1,075.40
|
| Rate for Payer: Aetna Medicare |
$632.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.37
|
| Rate for Payer: BCBS Complete |
$506.07
|
| Rate for Payer: Cash Price |
$1,012.14
|
| Rate for Payer: Cofinity Commercial |
$1,088.05
|
| Rate for Payer: Cofinity Commercial |
$885.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$885.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.14
|
| Rate for Payer: Healthscope Commercial |
$1,138.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.40
|
| Rate for Payer: PHP Commercial |
$1,075.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.37
|
| Rate for Payer: Priority Health SBD |
$797.06
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$223.67
|
|
|
Service Code
|
NDC 43975034903
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.91 |
| Max. Negotiated Rate |
$201.30 |
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.39
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Cofinity Commercial |
$156.57
|
| Rate for Payer: Cofinity Commercial |
$192.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.94
|
| Rate for Payer: Healthscope Commercial |
$201.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.12
|
| Rate for Payer: PHP Commercial |
$190.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.39
|
| Rate for Payer: Priority Health SBD |
$140.91
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,136.76
|
|
|
Service Code
|
NDC 10147095103
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$454.70 |
| Max. Negotiated Rate |
$1,023.08 |
| Rate for Payer: Aetna Commercial |
$966.25
|
| Rate for Payer: Aetna Medicare |
$568.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.89
|
| Rate for Payer: BCBS Complete |
$454.70
|
| Rate for Payer: Cash Price |
$909.41
|
| Rate for Payer: Cofinity Commercial |
$795.73
|
| Rate for Payer: Cofinity Commercial |
$977.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$795.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$909.41
|
| Rate for Payer: Healthscope Commercial |
$1,023.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$966.25
|
| Rate for Payer: PHP Commercial |
$966.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$738.89
|
| Rate for Payer: Priority Health SBD |
$716.16
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$223.67
|
|
|
Service Code
|
NDC 43975034903
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.47 |
| Max. Negotiated Rate |
$201.30 |
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna Medicare |
$111.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.39
|
| Rate for Payer: BCBS Complete |
$89.47
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Cofinity Commercial |
$156.57
|
| Rate for Payer: Cofinity Commercial |
$192.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.94
|
| Rate for Payer: Healthscope Commercial |
$201.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.12
|
| Rate for Payer: PHP Commercial |
$190.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.39
|
| Rate for Payer: Priority Health SBD |
$140.91
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,265.18
|
|
|
Service Code
|
NDC 50458055401
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$797.06 |
| Max. Negotiated Rate |
$1,138.66 |
| Rate for Payer: Aetna Commercial |
$1,075.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.37
|
| Rate for Payer: Cash Price |
$1,012.14
|
| Rate for Payer: Cofinity Commercial |
$1,088.05
|
| Rate for Payer: Cofinity Commercial |
$885.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$885.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.14
|
| Rate for Payer: Healthscope Commercial |
$1,138.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.40
|
| Rate for Payer: PHP Commercial |
$1,075.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.37
|
| Rate for Payer: Priority Health SBD |
$797.06
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,136.76
|
|
|
Service Code
|
NDC 10147095103
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$716.16 |
| Max. Negotiated Rate |
$1,023.08 |
| Rate for Payer: Aetna Commercial |
$966.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.89
|
| Rate for Payer: Cash Price |
$909.41
|
| Rate for Payer: Cofinity Commercial |
$795.73
|
| Rate for Payer: Cofinity Commercial |
$977.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$795.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$909.41
|
| Rate for Payer: Healthscope Commercial |
$1,023.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$966.25
|
| Rate for Payer: PHP Commercial |
$966.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$738.89
|
| Rate for Payer: Priority Health SBD |
$716.16
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,265.18
|
|
|
Service Code
|
NDC 50458055001
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$506.07 |
| Max. Negotiated Rate |
$1,138.66 |
| Rate for Payer: Aetna Commercial |
$1,075.40
|
| Rate for Payer: Aetna Medicare |
$632.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.37
|
| Rate for Payer: BCBS Complete |
$506.07
|
| Rate for Payer: Cash Price |
$1,012.14
|
| Rate for Payer: Cofinity Commercial |
$1,088.05
|
| Rate for Payer: Cofinity Commercial |
$885.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$885.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.14
|
| Rate for Payer: Healthscope Commercial |
$1,138.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.40
|
| Rate for Payer: PHP Commercial |
$1,075.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.37
|
| Rate for Payer: Priority Health SBD |
$797.06
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4,078.51
|
|
|
Service Code
|
NDC 00904693561
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,569.46 |
| Max. Negotiated Rate |
$3,670.66 |
| Rate for Payer: Aetna Commercial |
$3,466.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,651.03
|
| Rate for Payer: Cash Price |
$3,262.81
|
| Rate for Payer: Cofinity Commercial |
$2,854.96
|
| Rate for Payer: Cofinity Commercial |
$3,507.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,854.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,262.81
|
| Rate for Payer: Healthscope Commercial |
$3,670.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,466.73
|
| Rate for Payer: PHP Commercial |
$3,466.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,651.03
|
| Rate for Payer: Priority Health SBD |
$2,569.46
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4,078.51
|
|
|
Service Code
|
NDC 00904693561
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,631.40 |
| Max. Negotiated Rate |
$3,670.66 |
| Rate for Payer: Aetna Commercial |
$3,466.73
|
| Rate for Payer: Aetna Medicare |
$2,039.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,651.03
|
| Rate for Payer: BCBS Complete |
$1,631.40
|
| Rate for Payer: Cash Price |
$3,262.81
|
| Rate for Payer: Cofinity Commercial |
$2,854.96
|
| Rate for Payer: Cofinity Commercial |
$3,507.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,854.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,262.81
|
| Rate for Payer: Healthscope Commercial |
$3,670.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,466.73
|
| Rate for Payer: PHP Commercial |
$3,466.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,651.03
|
| Rate for Payer: Priority Health SBD |
$2,569.46
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,136.76
|
|
|
Service Code
|
NDC 10147095203
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$716.16 |
| Max. Negotiated Rate |
$1,023.08 |
| Rate for Payer: Aetna Commercial |
$966.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.89
|
| Rate for Payer: Cash Price |
$909.41
|
| Rate for Payer: Cofinity Commercial |
$795.73
|
| Rate for Payer: Cofinity Commercial |
$977.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$795.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$909.41
|
| Rate for Payer: Healthscope Commercial |
$1,023.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$966.25
|
| Rate for Payer: PHP Commercial |
$966.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$738.89
|
| Rate for Payer: Priority Health SBD |
$716.16
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,136.76
|
|
|
Service Code
|
NDC 10147095203
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$454.70 |
| Max. Negotiated Rate |
$1,023.08 |
| Rate for Payer: Aetna Commercial |
$966.25
|
| Rate for Payer: Aetna Medicare |
$568.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.89
|
| Rate for Payer: BCBS Complete |
$454.70
|
| Rate for Payer: Cash Price |
$909.41
|
| Rate for Payer: Cofinity Commercial |
$795.73
|
| Rate for Payer: Cofinity Commercial |
$977.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$795.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$909.41
|
| Rate for Payer: Healthscope Commercial |
$1,023.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$966.25
|
| Rate for Payer: PHP Commercial |
$966.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$738.89
|
| Rate for Payer: Priority Health SBD |
$716.16
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,265.18
|
|
|
Service Code
|
NDC 50458055001
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$797.06 |
| Max. Negotiated Rate |
$1,138.66 |
| Rate for Payer: Aetna Commercial |
$1,075.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.37
|
| Rate for Payer: Cash Price |
$1,012.14
|
| Rate for Payer: Cofinity Commercial |
$1,088.05
|
| Rate for Payer: Cofinity Commercial |
$885.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$885.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.14
|
| Rate for Payer: Healthscope Commercial |
$1,138.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.40
|
| Rate for Payer: PHP Commercial |
$1,075.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.37
|
| Rate for Payer: Priority Health SBD |
$797.06
|
|
|
PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$223.67
|
|
|
Service Code
|
NDC 68180052506
|
| Hospital Charge Code |
78065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.91 |
| Max. Negotiated Rate |
$201.30 |
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.39
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Cofinity Commercial |
$156.57
|
| Rate for Payer: Cofinity Commercial |
$192.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.94
|
| Rate for Payer: Healthscope Commercial |
$201.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.12
|
| Rate for Payer: PHP Commercial |
$190.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.39
|
| Rate for Payer: Priority Health SBD |
$140.91
|
|
|
PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$223.67
|
|
|
Service Code
|
NDC 68180052506
|
| Hospital Charge Code |
78065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.47 |
| Max. Negotiated Rate |
$201.30 |
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna Medicare |
$111.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.39
|
| Rate for Payer: BCBS Complete |
$89.47
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Cofinity Commercial |
$156.57
|
| Rate for Payer: Cofinity Commercial |
$192.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.94
|
| Rate for Payer: Healthscope Commercial |
$201.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.12
|
| Rate for Payer: PHP Commercial |
$190.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.39
|
| Rate for Payer: Priority Health SBD |
$140.91
|
|
