|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$187.36
|
|
|
Service Code
|
NDC 00065081701
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.94 |
| Max. Negotiated Rate |
$168.62 |
| Rate for Payer: Aetna Commercial |
$159.26
|
| Rate for Payer: Aetna Medicare |
$93.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.78
|
| Rate for Payer: BCBS Complete |
$74.94
|
| Rate for Payer: Cash Price |
$149.89
|
| Rate for Payer: Cofinity Commercial |
$131.15
|
| Rate for Payer: Cofinity Commercial |
$161.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.89
|
| Rate for Payer: Healthscope Commercial |
$168.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.26
|
| Rate for Payer: PHP Commercial |
$159.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.78
|
| Rate for Payer: Priority Health SBD |
$118.04
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$153.23
|
|
|
Service Code
|
NDC 60219174903
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.53 |
| Max. Negotiated Rate |
$137.91 |
| Rate for Payer: Aetna Commercial |
$130.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.60
|
| Rate for Payer: Cash Price |
$122.58
|
| Rate for Payer: Cofinity Commercial |
$107.26
|
| Rate for Payer: Cofinity Commercial |
$131.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.58
|
| Rate for Payer: Healthscope Commercial |
$137.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.25
|
| Rate for Payer: PHP Commercial |
$130.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.60
|
| Rate for Payer: Priority Health SBD |
$96.53
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$122.08
|
|
|
Service Code
|
NDC 17478021505
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.91 |
| Max. Negotiated Rate |
$109.87 |
| Rate for Payer: Aetna Commercial |
$103.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.35
|
| Rate for Payer: Cash Price |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$104.99
|
| Rate for Payer: Cofinity Commercial |
$85.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.66
|
| Rate for Payer: Healthscope Commercial |
$109.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.77
|
| Rate for Payer: PHP Commercial |
$103.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.35
|
| Rate for Payer: Priority Health SBD |
$76.91
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$291.33
|
|
|
Service Code
|
NDC 17478021515
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.53 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$247.63
|
| Rate for Payer: Aetna Medicare |
$145.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.36
|
| Rate for Payer: BCBS Complete |
$116.53
|
| Rate for Payer: Cash Price |
$233.06
|
| Rate for Payer: Cofinity Commercial |
$203.93
|
| Rate for Payer: Cofinity Commercial |
$250.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.06
|
| Rate for Payer: Healthscope Commercial |
$262.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.63
|
| Rate for Payer: PHP Commercial |
$247.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.36
|
| Rate for Payer: Priority Health SBD |
$183.54
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$153.23
|
|
|
Service Code
|
NDC 60219174903
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.29 |
| Max. Negotiated Rate |
$137.91 |
| Rate for Payer: Aetna Commercial |
$130.25
|
| Rate for Payer: Aetna Medicare |
$76.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.60
|
| Rate for Payer: BCBS Complete |
$61.29
|
| Rate for Payer: Cash Price |
$122.58
|
| Rate for Payer: Cofinity Commercial |
$107.26
|
| Rate for Payer: Cofinity Commercial |
$131.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.58
|
| Rate for Payer: Healthscope Commercial |
$137.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.25
|
| Rate for Payer: PHP Commercial |
$130.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.60
|
| Rate for Payer: Priority Health SBD |
$96.53
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
IP
|
$30.29
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$27.26 |
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.69
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.75
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.69
|
| Rate for Payer: Priority Health SBD |
$19.08
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
OP
|
$30.35
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$27.32 |
| Rate for Payer: Aetna Commercial |
$25.80
|
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna Medicare |
$15.14
|
| Rate for Payer: Aetna Medicare |
$15.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.69
|
| Rate for Payer: BCBS Complete |
$12.12
|
| Rate for Payer: BCBS Complete |
$12.14
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cash Price |
$24.28
|
| Rate for Payer: Cash Price |
$24.28
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$21.24
|
| Rate for Payer: Cofinity Commercial |
$26.10
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.28
|
| Rate for Payer: Healthscope Commercial |
$27.32
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.80
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: PHP Commercial |
$25.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.73
|
| Rate for Payer: Priority Health SBD |
$19.12
|
| Rate for Payer: Priority Health SBD |
$19.08
|
|
|
ATROPINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$49.25
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
195981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.03 |
| Max. Negotiated Rate |
$44.32 |
| Rate for Payer: Aetna Commercial |
$41.86
|
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.01
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Cofinity Commercial |
$42.36
|
| Rate for Payer: Cofinity Commercial |
$34.48
|
| Rate for Payer: Cofinity Commercial |
$31.06
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.40
|
| Rate for Payer: Healthscope Commercial |
$44.32
|
| Rate for Payer: Healthscope Commercial |
$39.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.86
|
| Rate for Payer: PHP Commercial |
$41.86
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.01
|
| Rate for Payer: Priority Health SBD |
$27.95
|
| Rate for Payer: Priority Health SBD |
$31.03
|
|
|
ATROPINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$44.37
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
195981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$39.93 |
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: Aetna Commercial |
$41.86
|
| Rate for Payer: Aetna Medicare |
$24.62
|
| Rate for Payer: Aetna Medicare |
$22.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.01
|
| Rate for Payer: BCBS Complete |
$19.70
|
| Rate for Payer: BCBS Complete |
$17.75
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Cofinity Commercial |
$31.06
|
| Rate for Payer: Cofinity Commercial |
$34.48
|
| Rate for Payer: Cofinity Commercial |
$42.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.40
|
| Rate for Payer: Healthscope Commercial |
$44.32
|
| Rate for Payer: Healthscope Commercial |
$39.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: PHP Commercial |
$41.86
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.84
|
| Rate for Payer: Priority Health SBD |
$31.03
|
| Rate for Payer: Priority Health SBD |
$27.95
|
|
|
AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); LOCAL (EG, RIBS, SPINOUS PROCESS, OR LAMINAR FRAGMENTS) OBTAINED FROM SAME INCISION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$5,811.00
|
|
|
Service Code
|
CPT 20936
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$213.12 |
| Max. Negotiated Rate |
$5,811.00 |
| Rate for Payer: BCBS Trust/PPO |
$213.12
|
| Rate for Payer: BCN Commercial |
$213.12
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACH ADDITIONAL NAIL PLATE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 11732
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: BCBS Trust/PPO |
$65.26
|
| Rate for Payer: BCN Commercial |
$65.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.91
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$56.72 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$99.66
|
| Rate for Payer: BCN Commercial |
$99.66
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.72
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$109.60
|
| Rate for Payer: VA VA |
$194.68
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.72 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$99.66
|
| Rate for Payer: BCN Commercial |
$99.66
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.72
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$109.60
|
| Rate for Payer: VA VA |
$194.68
|
|
|
AXILLARY LYMPHADENECTOMY; COMPLETE
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 38745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$950.78 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,126.28
|
| Rate for Payer: BCN Commercial |
$2,126.28
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$950.78
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$8,174.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,218.33
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
AZACITIDINE 100 MG/10 ML SOLN
|
Facility
|
OP
|
$267.38
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
168892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$240.64 |
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Commercial |
$243.70
|
| Rate for Payer: Aetna Commercial |
$278.28
|
| Rate for Payer: Aetna Commercial |
$595.27
|
| Rate for Payer: Aetna Medicare |
$350.16
|
| Rate for Payer: Aetna Medicare |
$228.88
|
| Rate for Payer: Aetna Medicare |
$163.70
|
| Rate for Payer: Aetna Medicare |
$1,313.86
|
| Rate for Payer: Aetna Medicare |
$143.35
|
| Rate for Payer: Aetna Medicare |
$133.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.80
|
| Rate for Payer: BCBS Complete |
$1,051.09
|
| Rate for Payer: BCBS Complete |
$106.95
|
| Rate for Payer: BCBS Complete |
$183.11
|
| Rate for Payer: BCBS Complete |
$114.68
|
| Rate for Payer: BCBS Complete |
$130.96
|
| Rate for Payer: BCBS Complete |
$280.13
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$261.91
|
| Rate for Payer: Cash Price |
$261.91
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cash Price |
$560.26
|
| Rate for Payer: Cash Price |
$560.26
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$246.56
|
| Rate for Payer: Cofinity Commercial |
$200.69
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Commercial |
$229.17
|
| Rate for Payer: Cofinity Commercial |
$281.56
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$490.22
|
| Rate for Payer: Cofinity Commercial |
$602.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$490.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Healthscope Commercial |
$258.03
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$294.65
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Healthscope Commercial |
$630.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.27
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: PHP Commercial |
$595.27
|
| Rate for Payer: PHP Commercial |
$278.28
|
| Rate for Payer: PHP Commercial |
$243.70
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.36
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: Priority Health SBD |
$180.62
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$441.20
|
| Rate for Payer: Priority Health SBD |
$206.26
|
|
|
AZACITIDINE 100 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$267.38
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
78420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.45 |
| Max. Negotiated Rate |
$240.64 |
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$168.45
|
|
|
AZACITIDINE 100 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$327.39
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
78420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$294.65 |
| Rate for Payer: Aetna Commercial |
$278.28
|
| Rate for Payer: Aetna Commercial |
$595.27
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Commercial |
$243.70
|
| Rate for Payer: Aetna Medicare |
$133.69
|
| Rate for Payer: Aetna Medicare |
$350.16
|
| Rate for Payer: Aetna Medicare |
$143.35
|
| Rate for Payer: Aetna Medicare |
$1,313.86
|
| Rate for Payer: Aetna Medicare |
$163.70
|
| Rate for Payer: Aetna Medicare |
$228.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: BCBS Complete |
$130.96
|
| Rate for Payer: BCBS Complete |
$114.68
|
| Rate for Payer: BCBS Complete |
$1,051.09
|
| Rate for Payer: BCBS Complete |
$106.95
|
| Rate for Payer: BCBS Complete |
$280.13
|
| Rate for Payer: BCBS Complete |
$183.11
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$560.26
|
| Rate for Payer: Cash Price |
$560.26
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$261.91
|
| Rate for Payer: Cash Price |
$261.91
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$200.69
|
| Rate for Payer: Cofinity Commercial |
$246.56
|
| Rate for Payer: Cofinity Commercial |
$229.17
|
| Rate for Payer: Cofinity Commercial |
$281.56
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$490.22
|
| Rate for Payer: Cofinity Commercial |
$602.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$490.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Healthscope Commercial |
$294.65
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$258.03
|
| Rate for Payer: Healthscope Commercial |
$630.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.70
|
| Rate for Payer: PHP Commercial |
$278.28
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$595.27
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$243.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.36
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: Priority Health SBD |
$180.62
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$441.20
|
| Rate for Payer: Priority Health SBD |
$206.26
|
|
|
AZATHIOPRINE 50 MG TABLET
|
Facility
|
OP
|
$410.40
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
9183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$369.36 |
| Rate for Payer: Aetna Commercial |
$348.84
|
| Rate for Payer: Aetna Commercial |
$226.03
|
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Medicare |
$199.02
|
| Rate for Payer: Aetna Medicare |
$132.96
|
| Rate for Payer: Aetna Medicare |
$205.20
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: BCBS Complete |
$159.22
|
| Rate for Payer: BCBS Complete |
$164.16
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Complete |
$106.37
|
| Rate for Payer: BCBS Trust/PPO |
$4.55
|
| Rate for Payer: BCBS Trust/PPO |
$4.55
|
| Rate for Payer: BCBS Trust/PPO |
$4.55
|
| Rate for Payer: BCBS Trust/PPO |
$4.55
|
| Rate for Payer: BCN Commercial |
$4.55
|
| Rate for Payer: BCN Commercial |
$4.55
|
| Rate for Payer: BCN Commercial |
$4.55
|
| Rate for Payer: BCN Commercial |
$4.55
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cash Price |
$212.74
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cash Price |
$212.74
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$186.14
|
| Rate for Payer: Cofinity Commercial |
$228.69
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$278.64
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Cofinity Commercial |
$287.28
|
| Rate for Payer: Cofinity Commercial |
$352.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$369.36
|
| Rate for Payer: Healthscope Commercial |
$358.24
|
| Rate for Payer: Healthscope Commercial |
$239.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.84
|
| Rate for Payer: PHP Commercial |
$348.84
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: PHP Commercial |
$226.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health SBD |
$258.55
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: Priority Health SBD |
$167.53
|
| Rate for Payer: Priority Health SBD |
$250.77
|
|
|
AZATHIOPRINE 50 MG TABLET
|
Facility
|
IP
|
$398.05
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
9183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$250.77 |
| Max. Negotiated Rate |
$358.24 |
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Commercial |
$348.84
|
| Rate for Payer: Aetna Commercial |
$226.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.76
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cash Price |
$212.74
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cofinity Commercial |
$186.14
|
| Rate for Payer: Cofinity Commercial |
$352.94
|
| Rate for Payer: Cofinity Commercial |
$287.28
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Cofinity Commercial |
$278.64
|
| Rate for Payer: Cofinity Commercial |
$228.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.32
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$239.33
|
| Rate for Payer: Healthscope Commercial |
$369.36
|
| Rate for Payer: Healthscope Commercial |
$358.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.03
|
| Rate for Payer: PHP Commercial |
$226.03
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$348.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health SBD |
$167.53
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: Priority Health SBD |
$258.55
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$96.62
|
|
|
Service Code
|
NDC 42806015134
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.65 |
| Max. Negotiated Rate |
$86.96 |
| Rate for Payer: Aetna Commercial |
$82.13
|
| Rate for Payer: Aetna Medicare |
$48.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.80
|
| Rate for Payer: BCBS Complete |
$38.65
|
| Rate for Payer: Cash Price |
$77.30
|
| Rate for Payer: Cofinity Commercial |
$67.63
|
| Rate for Payer: Cofinity Commercial |
$83.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.30
|
| Rate for Payer: Healthscope Commercial |
$86.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.13
|
| Rate for Payer: PHP Commercial |
$82.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.80
|
| Rate for Payer: Priority Health SBD |
$60.87
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$116.79
|
|
|
Service Code
|
NDC 00093202631
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.72 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna Commercial |
$99.27
|
| Rate for Payer: Aetna Medicare |
$58.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.91
|
| Rate for Payer: BCBS Complete |
$46.72
|
| Rate for Payer: Cash Price |
$93.43
|
| Rate for Payer: Cofinity Commercial |
$100.44
|
| Rate for Payer: Cofinity Commercial |
$81.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.43
|
| Rate for Payer: Healthscope Commercial |
$105.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.27
|
| Rate for Payer: PHP Commercial |
$99.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.91
|
| Rate for Payer: Priority Health SBD |
$73.58
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$96.62
|
|
|
Service Code
|
NDC 42806015134
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$86.96 |
| Rate for Payer: Aetna Commercial |
$82.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.80
|
| Rate for Payer: Cash Price |
$77.30
|
| Rate for Payer: Cofinity Commercial |
$67.63
|
| Rate for Payer: Cofinity Commercial |
$83.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.30
|
| Rate for Payer: Healthscope Commercial |
$86.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.13
|
| Rate for Payer: PHP Commercial |
$82.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.80
|
| Rate for Payer: Priority Health SBD |
$60.87
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$89.28
|
|
|
Service Code
|
NDC 59762314001
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Commercial |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.03
|
| Rate for Payer: Priority Health SBD |
$56.25
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$124.55
|
|
|
Service Code
|
NDC 70710146002
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.82 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Aetna Commercial |
$105.87
|
| Rate for Payer: Aetna Medicare |
$62.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.96
|
| Rate for Payer: BCBS Complete |
$49.82
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Commercial |
$107.11
|
| Rate for Payer: Cofinity Commercial |
$87.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.87
|
| Rate for Payer: PHP Commercial |
$105.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.96
|
| Rate for Payer: Priority Health SBD |
$78.47
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$89.28
|
|
|
Service Code
|
NDC 59762314001
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.71 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna Medicare |
$44.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: BCBS Complete |
$35.71
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Commercial |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.03
|
| Rate for Payer: Priority Health SBD |
$56.25
|
|
