|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$192.06
|
|
|
Service Code
|
NDC 00517210201
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.82 |
| Max. Negotiated Rate |
$172.85 |
| Rate for Payer: Aetna Commercial |
$163.25
|
| Rate for Payer: Aetna Medicare |
$96.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.84
|
| Rate for Payer: BCBS Complete |
$76.82
|
| Rate for Payer: Cash Price |
$153.65
|
| Rate for Payer: Cofinity Commercial |
$134.44
|
| Rate for Payer: Cofinity Commercial |
$165.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.65
|
| Rate for Payer: Healthscope Commercial |
$172.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.25
|
| Rate for Payer: PHP Commercial |
$163.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.84
|
| Rate for Payer: Priority Health SBD |
$121.00
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$199.45
|
|
|
Service Code
|
NDC 00409729501
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$125.65 |
| Max. Negotiated Rate |
$179.50 |
| Rate for Payer: Aetna Commercial |
$169.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.64
|
| Rate for Payer: Cash Price |
$159.56
|
| Rate for Payer: Cofinity Commercial |
$139.62
|
| Rate for Payer: Cofinity Commercial |
$171.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.56
|
| Rate for Payer: Healthscope Commercial |
$179.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.53
|
| Rate for Payer: PHP Commercial |
$169.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.64
|
| Rate for Payer: Priority Health SBD |
$125.65
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$759.80
|
|
|
Service Code
|
NDC 65219005629
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$478.67 |
| Max. Negotiated Rate |
$683.82 |
| Rate for Payer: Aetna Commercial |
$645.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.87
|
| Rate for Payer: Cash Price |
$607.84
|
| Rate for Payer: Cofinity Commercial |
$531.86
|
| Rate for Payer: Cofinity Commercial |
$653.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$531.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.84
|
| Rate for Payer: Healthscope Commercial |
$683.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.83
|
| Rate for Payer: PHP Commercial |
$645.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.87
|
| Rate for Payer: Priority Health SBD |
$478.67
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$759.80
|
|
|
Service Code
|
NDC 65219005609
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$303.92 |
| Max. Negotiated Rate |
$683.82 |
| Rate for Payer: Aetna Commercial |
$645.83
|
| Rate for Payer: Aetna Medicare |
$379.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.87
|
| Rate for Payer: BCBS Complete |
$303.92
|
| Rate for Payer: Cash Price |
$607.84
|
| Rate for Payer: Cofinity Commercial |
$531.86
|
| Rate for Payer: Cofinity Commercial |
$653.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$531.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.84
|
| Rate for Payer: Healthscope Commercial |
$683.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.83
|
| Rate for Payer: PHP Commercial |
$645.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.87
|
| Rate for Payer: Priority Health SBD |
$478.67
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$759.80
|
|
|
Service Code
|
NDC 65219005609
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$478.67 |
| Max. Negotiated Rate |
$683.82 |
| Rate for Payer: Aetna Commercial |
$645.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.87
|
| Rate for Payer: Cash Price |
$607.84
|
| Rate for Payer: Cofinity Commercial |
$531.86
|
| Rate for Payer: Cofinity Commercial |
$653.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$531.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.84
|
| Rate for Payer: Healthscope Commercial |
$683.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.83
|
| Rate for Payer: PHP Commercial |
$645.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.87
|
| Rate for Payer: Priority Health SBD |
$478.67
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$410.64
|
|
|
Service Code
|
NDC 63323008615
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.26 |
| Max. Negotiated Rate |
$369.58 |
| Rate for Payer: Aetna Commercial |
$349.04
|
| Rate for Payer: Aetna Medicare |
$205.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.92
|
| Rate for Payer: BCBS Complete |
$164.26
|
| Rate for Payer: Cash Price |
$328.51
|
| Rate for Payer: Cofinity Commercial |
$287.45
|
| Rate for Payer: Cofinity Commercial |
$353.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.51
|
| Rate for Payer: Healthscope Commercial |
$369.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.04
|
| Rate for Payer: PHP Commercial |
$349.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.92
|
| Rate for Payer: Priority Health SBD |
$258.70
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$759.80
|
|
|
Service Code
|
NDC 65219005629
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$303.92 |
| Max. Negotiated Rate |
$683.82 |
| Rate for Payer: Aetna Commercial |
$645.83
|
| Rate for Payer: Aetna Medicare |
$379.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.87
|
| Rate for Payer: BCBS Complete |
$303.92
|
| Rate for Payer: Cash Price |
$607.84
|
| Rate for Payer: Cofinity Commercial |
$531.86
|
| Rate for Payer: Cofinity Commercial |
$653.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$531.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.84
|
| Rate for Payer: Healthscope Commercial |
$683.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.83
|
| Rate for Payer: PHP Commercial |
$645.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.87
|
| Rate for Payer: Priority Health SBD |
$478.67
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$192.06
|
|
|
Service Code
|
NDC 00517210201
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$172.85 |
| Rate for Payer: Aetna Commercial |
$163.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.84
|
| Rate for Payer: Cash Price |
$153.65
|
| Rate for Payer: Cofinity Commercial |
$134.44
|
| Rate for Payer: Cofinity Commercial |
$165.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.65
|
| Rate for Payer: Healthscope Commercial |
$172.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.25
|
| Rate for Payer: PHP Commercial |
$163.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.84
|
| Rate for Payer: Priority Health SBD |
$121.00
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$410.64
|
|
|
Service Code
|
NDC 63323008615
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$258.70 |
| Max. Negotiated Rate |
$369.58 |
| Rate for Payer: Aetna Commercial |
$349.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.92
|
| Rate for Payer: Cash Price |
$328.51
|
| Rate for Payer: Cofinity Commercial |
$287.45
|
| Rate for Payer: Cofinity Commercial |
$353.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.51
|
| Rate for Payer: Healthscope Commercial |
$369.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.04
|
| Rate for Payer: PHP Commercial |
$349.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.92
|
| Rate for Payer: Priority Health SBD |
$258.70
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$192.06
|
|
|
Service Code
|
NDC 00517210225
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.82 |
| Max. Negotiated Rate |
$172.85 |
| Rate for Payer: Aetna Commercial |
$163.25
|
| Rate for Payer: Aetna Medicare |
$96.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.84
|
| Rate for Payer: BCBS Complete |
$76.82
|
| Rate for Payer: Cash Price |
$153.65
|
| Rate for Payer: Cofinity Commercial |
$134.44
|
| Rate for Payer: Cofinity Commercial |
$165.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.65
|
| Rate for Payer: Healthscope Commercial |
$172.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.25
|
| Rate for Payer: PHP Commercial |
$163.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.84
|
| Rate for Payer: Priority Health SBD |
$121.00
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$192.06
|
|
|
Service Code
|
NDC 00517210225
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$172.85 |
| Rate for Payer: Aetna Commercial |
$163.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.84
|
| Rate for Payer: Cash Price |
$153.65
|
| Rate for Payer: Cofinity Commercial |
$134.44
|
| Rate for Payer: Cofinity Commercial |
$165.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.65
|
| Rate for Payer: Healthscope Commercial |
$172.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.25
|
| Rate for Payer: PHP Commercial |
$163.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.84
|
| Rate for Payer: Priority Health SBD |
$121.00
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$199.45
|
|
|
Service Code
|
NDC 00409729501
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.78 |
| Max. Negotiated Rate |
$179.50 |
| Rate for Payer: Aetna Commercial |
$169.53
|
| Rate for Payer: Aetna Medicare |
$99.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.64
|
| Rate for Payer: BCBS Complete |
$79.78
|
| Rate for Payer: Cash Price |
$159.56
|
| Rate for Payer: Cofinity Commercial |
$139.62
|
| Rate for Payer: Cofinity Commercial |
$171.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.56
|
| Rate for Payer: Healthscope Commercial |
$179.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.53
|
| Rate for Payer: PHP Commercial |
$169.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.64
|
| Rate for Payer: Priority Health SBD |
$125.65
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
OP
|
$777.74
|
|
|
Service Code
|
NDC 09900001921
|
| Hospital Charge Code |
301289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$311.10 |
| Max. Negotiated Rate |
$699.97 |
| Rate for Payer: Aetna Commercial |
$661.08
|
| Rate for Payer: Aetna Medicare |
$388.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.53
|
| Rate for Payer: BCBS Complete |
$311.10
|
| Rate for Payer: Cash Price |
$622.19
|
| Rate for Payer: Cofinity Commercial |
$544.42
|
| Rate for Payer: Cofinity Commercial |
$668.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.19
|
| Rate for Payer: Healthscope Commercial |
$699.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.08
|
| Rate for Payer: PHP Commercial |
$661.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.53
|
| Rate for Payer: Priority Health SBD |
$489.98
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
IP
|
$777.74
|
|
|
Service Code
|
NDC 09900001921
|
| Hospital Charge Code |
301289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$489.98 |
| Max. Negotiated Rate |
$699.97 |
| Rate for Payer: Aetna Commercial |
$661.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.53
|
| Rate for Payer: Cash Price |
$622.19
|
| Rate for Payer: Cofinity Commercial |
$544.42
|
| Rate for Payer: Cofinity Commercial |
$668.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.19
|
| Rate for Payer: Healthscope Commercial |
$699.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.08
|
| Rate for Payer: PHP Commercial |
$661.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.53
|
| Rate for Payer: Priority Health SBD |
$489.98
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
OP
|
$21.29
|
|
|
Service Code
|
NDC 00395232516
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$19.16 |
| Rate for Payer: Aetna Commercial |
$18.10
|
| Rate for Payer: Aetna Medicare |
$10.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.84
|
| Rate for Payer: BCBS Complete |
$8.52
|
| Rate for Payer: Cash Price |
$17.03
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$19.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.10
|
| Rate for Payer: PHP Commercial |
$18.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.84
|
| Rate for Payer: Priority Health SBD |
$13.41
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
OP
|
$14.94
|
|
|
Service Code
|
NDC 52380190508
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$13.45 |
| Rate for Payer: Aetna Commercial |
$12.70
|
| Rate for Payer: Aetna Medicare |
$7.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.71
|
| Rate for Payer: BCBS Complete |
$5.98
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cofinity Commercial |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$12.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.95
|
| Rate for Payer: Healthscope Commercial |
$13.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.70
|
| Rate for Payer: PHP Commercial |
$12.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health SBD |
$9.41
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
IP
|
$14.94
|
|
|
Service Code
|
NDC 52380190508
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$13.45 |
| Rate for Payer: Aetna Commercial |
$12.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.71
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cofinity Commercial |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$12.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.95
|
| Rate for Payer: Healthscope Commercial |
$13.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.70
|
| Rate for Payer: PHP Commercial |
$12.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health SBD |
$9.41
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
IP
|
$21.29
|
|
|
Service Code
|
NDC 00395232516
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$19.16 |
| Rate for Payer: Aetna Commercial |
$18.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.84
|
| Rate for Payer: Cash Price |
$17.03
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$19.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.10
|
| Rate for Payer: PHP Commercial |
$18.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.84
|
| Rate for Payer: Priority Health SBD |
$13.41
|
|
|
POVIDONE-IODINE 5 % EYE SOLUTION
|
Facility
|
OP
|
$33.39
|
|
|
Service Code
|
NDC 00065041130
|
| Hospital Charge Code |
19791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$30.05 |
| Rate for Payer: Aetna Commercial |
$28.38
|
| Rate for Payer: Aetna Medicare |
$16.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.70
|
| Rate for Payer: BCBS Complete |
$13.36
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$28.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.71
|
| Rate for Payer: Healthscope Commercial |
$30.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.38
|
| Rate for Payer: PHP Commercial |
$28.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health SBD |
$21.04
|
|
|
POVIDONE-IODINE 5 % EYE SOLUTION
|
Facility
|
IP
|
$33.39
|
|
|
Service Code
|
NDC 00065041130
|
| Hospital Charge Code |
19791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.04 |
| Max. Negotiated Rate |
$30.05 |
| Rate for Payer: Aetna Commercial |
$28.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.70
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$28.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.71
|
| Rate for Payer: Healthscope Commercial |
$30.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.38
|
| Rate for Payer: PHP Commercial |
$28.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health SBD |
$21.04
|
|
|
PR 1 STAGE PROX PENILE/PENOSCROTAL HYPOSPADIAS RPR
|
Professional
|
Both
|
$2,098.00
|
|
|
Service Code
|
HCPCS 54332
|
| Min. Negotiated Rate |
$645.39 |
| Max. Negotiated Rate |
$177,350.00 |
| Rate for Payer: Aetna Commercial |
$1,292.63
|
| Rate for Payer: Aetna Medicare |
$1,003.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,292.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,389.10
|
| Rate for Payer: BCBS Complete |
$677.66
|
| Rate for Payer: BCBS MAPPO |
$964.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,967.99
|
| Rate for Payer: BCN Commercial |
$1,452.84
|
| Rate for Payer: BCN Medicare Advantage |
$964.65
|
| Rate for Payer: Cash Price |
$1,678.40
|
| Rate for Payer: Cash Price |
$1,678.40
|
| Rate for Payer: Cofinity Commercial |
$1,389.10
|
| Rate for Payer: Cofinity Commercial |
$1,292.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$964.65
|
| Rate for Payer: Healthscope Commercial |
$1,784.60
|
| Rate for Payer: Healthscope Commercial |
$1,543.44
|
| Rate for Payer: Mclaren Medicaid |
$645.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,012.88
|
| Rate for Payer: Meridian Medicaid |
$677.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177,350.00
|
| Rate for Payer: Nomi Health Commercial |
$1,157.58
|
| Rate for Payer: PACE SWMI |
$964.65
|
| Rate for Payer: PHP Medicare Advantage |
$964.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,363.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,602.59
|
| Rate for Payer: Priority Health Medicare |
$964.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,602.59
|
| Rate for Payer: Priority Health SBD |
$1,602.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,363.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$964.65
|
| Rate for Payer: UHC Exchange |
$1,363.90
|
| Rate for Payer: UHC Medicare Advantage |
$964.65
|
| Rate for Payer: UHCCP Medicaid |
$645.39
|
|
|
PR 1 STG DSTL HYPOSPADIAS RPR URTP SKN FLAPS
|
Professional
|
Both
|
$1,774.00
|
|
|
Service Code
|
HCPCS 54326
|
| Min. Negotiated Rate |
$602.36 |
| Max. Negotiated Rate |
$165,530.00 |
| Rate for Payer: Aetna Commercial |
$1,205.73
|
| Rate for Payer: Aetna Medicare |
$935.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,205.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,295.71
|
| Rate for Payer: BCBS Complete |
$632.48
|
| Rate for Payer: BCBS MAPPO |
$899.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,714.41
|
| Rate for Payer: BCN Commercial |
$1,356.57
|
| Rate for Payer: BCN Medicare Advantage |
$899.80
|
| Rate for Payer: Cash Price |
$1,419.20
|
| Rate for Payer: Cash Price |
$1,419.20
|
| Rate for Payer: Cofinity Commercial |
$1,295.71
|
| Rate for Payer: Cofinity Commercial |
$1,205.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$899.80
|
| Rate for Payer: Healthscope Commercial |
$1,664.63
|
| Rate for Payer: Healthscope Commercial |
$1,439.68
|
| Rate for Payer: Mclaren Medicaid |
$602.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$944.79
|
| Rate for Payer: Meridian Medicaid |
$632.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165,530.00
|
| Rate for Payer: Nomi Health Commercial |
$1,079.76
|
| Rate for Payer: PACE SWMI |
$899.80
|
| Rate for Payer: PHP Medicare Advantage |
$899.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$602.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,153.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,496.61
|
| Rate for Payer: Priority Health Medicare |
$899.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,496.61
|
| Rate for Payer: Priority Health SBD |
$1,496.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,252.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$899.80
|
| Rate for Payer: UHC Exchange |
$1,252.09
|
| Rate for Payer: UHC Medicare Advantage |
$899.80
|
| Rate for Payer: UHCCP Medicaid |
$602.36
|
|
|
PR 1 STG DSTL HYPOSPADIAS RPR W/SMPL MEATAL ADVMNT
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 54322
|
| Min. Negotiated Rate |
$362.41 |
| Max. Negotiated Rate |
$137,354.00 |
| Rate for Payer: Aetna Commercial |
$1,000.38
|
| Rate for Payer: Aetna Medicare |
$776.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,000.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.03
|
| Rate for Payer: BCBS Complete |
$525.13
|
| Rate for Payer: BCBS MAPPO |
$746.55
|
| Rate for Payer: BCBS Trust/PPO |
$362.41
|
| Rate for Payer: BCN Commercial |
$1,126.40
|
| Rate for Payer: BCN Medicare Advantage |
$746.55
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cofinity Commercial |
$1,075.03
|
| Rate for Payer: Cofinity Commercial |
$1,000.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$746.55
|
| Rate for Payer: Healthscope Commercial |
$1,381.12
|
| Rate for Payer: Healthscope Commercial |
$1,194.48
|
| Rate for Payer: Mclaren Medicaid |
$500.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$783.88
|
| Rate for Payer: Meridian Medicaid |
$525.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137,354.00
|
| Rate for Payer: Nomi Health Commercial |
$895.86
|
| Rate for Payer: PACE SWMI |
$746.55
|
| Rate for Payer: PHP Medicare Advantage |
$746.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,250.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,242.02
|
| Rate for Payer: Priority Health Medicare |
$746.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,242.02
|
| Rate for Payer: Priority Health SBD |
$1,242.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$983.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$746.55
|
| Rate for Payer: UHC Exchange |
$983.01
|
| Rate for Payer: UHC Medicare Advantage |
$746.55
|
| Rate for Payer: UHCCP Medicaid |
$500.12
|
|
|
PR 1 STG DSTL HYPOSPADIAS RPR W/URTP SKIN FLAPS
|
Professional
|
Both
|
$2,012.00
|
|
|
Service Code
|
HCPCS 54324
|
| Min. Negotiated Rate |
$517.21 |
| Max. Negotiated Rate |
$170,046.00 |
| Rate for Payer: Aetna Commercial |
$1,238.98
|
| Rate for Payer: Aetna Medicare |
$961.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,238.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,331.44
|
| Rate for Payer: BCBS Complete |
$649.71
|
| Rate for Payer: BCBS MAPPO |
$924.61
|
| Rate for Payer: BCBS Trust/PPO |
$517.21
|
| Rate for Payer: BCN Commercial |
$1,393.22
|
| Rate for Payer: BCN Medicare Advantage |
$924.61
|
| Rate for Payer: Cash Price |
$1,609.60
|
| Rate for Payer: Cash Price |
$1,609.60
|
| Rate for Payer: Cofinity Commercial |
$1,331.44
|
| Rate for Payer: Cofinity Commercial |
$1,238.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$924.61
|
| Rate for Payer: Healthscope Commercial |
$1,710.53
|
| Rate for Payer: Healthscope Commercial |
$1,479.38
|
| Rate for Payer: Mclaren Medicaid |
$618.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$970.84
|
| Rate for Payer: Meridian Medicaid |
$649.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170,046.00
|
| Rate for Payer: Nomi Health Commercial |
$1,109.53
|
| Rate for Payer: PACE SWMI |
$924.61
|
| Rate for Payer: PHP Medicare Advantage |
$924.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$618.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,307.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,537.09
|
| Rate for Payer: Priority Health Medicare |
$924.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,537.09
|
| Rate for Payer: Priority Health SBD |
$1,537.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,307.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$924.61
|
| Rate for Payer: UHC Exchange |
$1,307.77
|
| Rate for Payer: UHC Medicare Advantage |
$924.61
|
| Rate for Payer: UHCCP Medicaid |
$618.77
|
|
|
PR 1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 99460
|
| Min. Negotiated Rate |
$58.36 |
| Max. Negotiated Rate |
$13,658.00 |
| Rate for Payer: Aetna Commercial |
$117.08
|
| Rate for Payer: Aetna Medicare |
$90.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.81
|
| Rate for Payer: BCBS Complete |
$61.28
|
| Rate for Payer: BCBS MAPPO |
$87.37
|
| Rate for Payer: BCBS Trust/PPO |
$190.72
|
| Rate for Payer: BCN Commercial |
$133.89
|
| Rate for Payer: BCN Medicare Advantage |
$87.37
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$125.81
|
| Rate for Payer: Cofinity Commercial |
$117.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.37
|
| Rate for Payer: Healthscope Commercial |
$139.79
|
| Rate for Payer: Healthscope Commercial |
$161.63
|
| Rate for Payer: Mclaren Medicaid |
$58.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.74
|
| Rate for Payer: Meridian Medicaid |
$61.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,658.00
|
| Rate for Payer: Nomi Health Commercial |
$104.84
|
| Rate for Payer: PACE SWMI |
$87.37
|
| Rate for Payer: PHP Medicare Advantage |
$87.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.40
|
| Rate for Payer: Priority Health Medicare |
$87.37
|
| Rate for Payer: Priority Health Narrow Network |
$123.40
|
| Rate for Payer: Priority Health SBD |
$123.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.37
|
| Rate for Payer: UHC Medicare Advantage |
$87.37
|
| Rate for Payer: UHCCP Medicaid |
$58.36
|
|
