QUETIAPINE 300 MG TABLET
|
Facility
|
IP
|
$211.11
|
|
Service Code
|
NDC 47335-906-86
|
Hospital Charge Code |
29267
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$133.00 |
Max. Negotiated Rate |
$190.00 |
Rate for Payer: Aetna Commercial |
$179.44
|
Rate for Payer: Aetna New Business (MI Preferred) |
$137.22
|
Rate for Payer: Cash Price |
$168.89
|
Rate for Payer: Cofinity Commercial |
$147.78
|
Rate for Payer: Cofinity Commercial |
$181.55
|
Rate for Payer: Healthscope Commercial |
$190.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.44
|
Rate for Payer: PHP Commercial |
$179.44
|
Rate for Payer: Priority Health Cigna Priority Health |
$147.78
|
Rate for Payer: Priority Health SBD |
$133.00
|
|
QUETIAPINE 300 MG TABLET
|
Facility
|
IP
|
$190.35
|
|
Service Code
|
NDC 67877-247-60
|
Hospital Charge Code |
29267
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$119.92 |
Max. Negotiated Rate |
$171.32 |
Rate for Payer: Aetna Commercial |
$161.80
|
Rate for Payer: Aetna New Business (MI Preferred) |
$123.73
|
Rate for Payer: Cash Price |
$152.28
|
Rate for Payer: Cofinity Commercial |
$133.24
|
Rate for Payer: Cofinity Commercial |
$163.70
|
Rate for Payer: Healthscope Commercial |
$171.32
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.80
|
Rate for Payer: PHP Commercial |
$161.80
|
Rate for Payer: Priority Health Cigna Priority Health |
$133.24
|
Rate for Payer: Priority Health SBD |
$119.92
|
|
QUETIAPINE 300 MG TABLET
|
Facility
|
IP
|
$303.05
|
|
Service Code
|
NDC 0904-6642-61
|
Hospital Charge Code |
29267
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$190.92 |
Max. Negotiated Rate |
$272.74 |
Rate for Payer: Aetna Commercial |
$257.59
|
Rate for Payer: Aetna New Business (MI Preferred) |
$196.98
|
Rate for Payer: Cash Price |
$242.44
|
Rate for Payer: Cofinity Commercial |
$212.14
|
Rate for Payer: Cofinity Commercial |
$260.62
|
Rate for Payer: Healthscope Commercial |
$272.74
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.59
|
Rate for Payer: PHP Commercial |
$257.59
|
Rate for Payer: Priority Health Cigna Priority Health |
$212.14
|
Rate for Payer: Priority Health SBD |
$190.92
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
IP
|
$413.28
|
|
Service Code
|
NDC 47335-907-88
|
Hospital Charge Code |
70398
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$260.37 |
Max. Negotiated Rate |
$371.95 |
Rate for Payer: Aetna Commercial |
$351.29
|
Rate for Payer: Aetna New Business (MI Preferred) |
$268.63
|
Rate for Payer: Cash Price |
$330.62
|
Rate for Payer: Cofinity Commercial |
$289.30
|
Rate for Payer: Cofinity Commercial |
$355.42
|
Rate for Payer: Healthscope Commercial |
$371.95
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.29
|
Rate for Payer: PHP Commercial |
$351.29
|
Rate for Payer: Priority Health Cigna Priority Health |
$289.30
|
Rate for Payer: Priority Health SBD |
$260.37
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
IP
|
$350.88
|
|
Service Code
|
NDC 0904-6643-61
|
Hospital Charge Code |
70398
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$221.05 |
Max. Negotiated Rate |
$315.79 |
Rate for Payer: Aetna Commercial |
$298.25
|
Rate for Payer: Aetna New Business (MI Preferred) |
$228.07
|
Rate for Payer: Cash Price |
$280.70
|
Rate for Payer: Cofinity Commercial |
$245.62
|
Rate for Payer: Cofinity Commercial |
$301.76
|
Rate for Payer: Healthscope Commercial |
$315.79
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.25
|
Rate for Payer: PHP Commercial |
$298.25
|
Rate for Payer: Priority Health Cigna Priority Health |
$245.62
|
Rate for Payer: Priority Health SBD |
$221.05
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
IP
|
$194.75
|
|
Service Code
|
NDC 0904-6639-61
|
Hospital Charge Code |
70397
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$122.69 |
Max. Negotiated Rate |
$175.28 |
Rate for Payer: Aetna Commercial |
$165.54
|
Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
Rate for Payer: Cash Price |
$155.80
|
Rate for Payer: Cofinity Commercial |
$136.32
|
Rate for Payer: Cofinity Commercial |
$167.48
|
Rate for Payer: Healthscope Commercial |
$175.28
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.54
|
Rate for Payer: PHP Commercial |
$165.54
|
Rate for Payer: Priority Health Cigna Priority Health |
$136.32
|
Rate for Payer: Priority Health SBD |
$122.69
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$128.25
|
|
Service Code
|
NDC 68180-613-07
|
Hospital Charge Code |
96233
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$80.80 |
Max. Negotiated Rate |
$115.42 |
Rate for Payer: Aetna Commercial |
$109.01
|
Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
Rate for Payer: Cash Price |
$102.60
|
Rate for Payer: Cofinity Commercial |
$110.30
|
Rate for Payer: Cofinity Commercial |
$89.78
|
Rate for Payer: Healthscope Commercial |
$115.42
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.01
|
Rate for Payer: PHP Commercial |
$109.01
|
Rate for Payer: Priority Health Cigna Priority Health |
$89.78
|
Rate for Payer: Priority Health SBD |
$80.80
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2,861.81
|
|
Service Code
|
NDC 0310-0281-60
|
Hospital Charge Code |
96233
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$1,802.94 |
Max. Negotiated Rate |
$2,575.63 |
Rate for Payer: Aetna Commercial |
$2,432.54
|
Rate for Payer: Aetna New Business (MI Preferred) |
$1,860.18
|
Rate for Payer: Cash Price |
$2,289.45
|
Rate for Payer: Cofinity Commercial |
$2,003.27
|
Rate for Payer: Cofinity Commercial |
$2,461.16
|
Rate for Payer: Healthscope Commercial |
$2,575.63
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,432.54
|
Rate for Payer: PHP Commercial |
$2,432.54
|
Rate for Payer: Priority Health Cigna Priority Health |
$2,003.27
|
Rate for Payer: Priority Health SBD |
$1,802.94
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$310.08
|
|
Service Code
|
NDC 0904-6802-61
|
Hospital Charge Code |
96233
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$195.35 |
Max. Negotiated Rate |
$279.07 |
Rate for Payer: Aetna Commercial |
$263.57
|
Rate for Payer: Aetna New Business (MI Preferred) |
$201.55
|
Rate for Payer: Cash Price |
$248.06
|
Rate for Payer: Cofinity Commercial |
$217.06
|
Rate for Payer: Cofinity Commercial |
$266.67
|
Rate for Payer: Healthscope Commercial |
$279.07
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.57
|
Rate for Payer: PHP Commercial |
$263.57
|
Rate for Payer: Priority Health Cigna Priority Health |
$217.06
|
Rate for Payer: Priority Health SBD |
$195.35
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3,149.74
|
|
Service Code
|
NDC 0310-0282-60
|
Hospital Charge Code |
82089
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$1,984.34 |
Max. Negotiated Rate |
$2,834.77 |
Rate for Payer: Aetna Commercial |
$2,677.28
|
Rate for Payer: Aetna New Business (MI Preferred) |
$2,047.33
|
Rate for Payer: Cash Price |
$2,519.79
|
Rate for Payer: Cofinity Commercial |
$2,204.82
|
Rate for Payer: Cofinity Commercial |
$2,708.78
|
Rate for Payer: Healthscope Commercial |
$2,834.77
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,677.28
|
Rate for Payer: PHP Commercial |
$2,677.28
|
Rate for Payer: Priority Health Cigna Priority Health |
$2,204.82
|
Rate for Payer: Priority Health SBD |
$1,984.34
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$149.34
|
|
Service Code
|
NDC 68180-614-07
|
Hospital Charge Code |
82089
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$94.08 |
Max. Negotiated Rate |
$134.41 |
Rate for Payer: Aetna Commercial |
$126.94
|
Rate for Payer: Aetna New Business (MI Preferred) |
$97.07
|
Rate for Payer: Cash Price |
$119.47
|
Rate for Payer: Cofinity Commercial |
$104.54
|
Rate for Payer: Cofinity Commercial |
$128.43
|
Rate for Payer: Healthscope Commercial |
$134.41
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.94
|
Rate for Payer: PHP Commercial |
$126.94
|
Rate for Payer: Priority Health Cigna Priority Health |
$104.54
|
Rate for Payer: Priority Health SBD |
$94.08
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$157.89
|
|
Service Code
|
NDC 16729-095-12
|
Hospital Charge Code |
82089
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$99.47 |
Max. Negotiated Rate |
$142.10 |
Rate for Payer: Aetna Commercial |
$134.21
|
Rate for Payer: Aetna New Business (MI Preferred) |
$102.63
|
Rate for Payer: Cash Price |
$126.31
|
Rate for Payer: Cofinity Commercial |
$110.52
|
Rate for Payer: Cofinity Commercial |
$135.79
|
Rate for Payer: Healthscope Commercial |
$142.10
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.21
|
Rate for Payer: PHP Commercial |
$134.21
|
Rate for Payer: Priority Health Cigna Priority Health |
$110.52
|
Rate for Payer: Priority Health SBD |
$99.47
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$428.64
|
|
Service Code
|
NDC 0904-6803-61
|
Hospital Charge Code |
82089
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$270.04 |
Max. Negotiated Rate |
$385.78 |
Rate for Payer: Aetna Commercial |
$364.34
|
Rate for Payer: Aetna New Business (MI Preferred) |
$278.62
|
Rate for Payer: Cash Price |
$342.91
|
Rate for Payer: Cofinity Commercial |
$300.05
|
Rate for Payer: Cofinity Commercial |
$368.63
|
Rate for Payer: Healthscope Commercial |
$385.78
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.34
|
Rate for Payer: PHP Commercial |
$364.34
|
Rate for Payer: Priority Health Cigna Priority Health |
$300.05
|
Rate for Payer: Priority Health SBD |
$270.04
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4,041.96
|
|
Service Code
|
NDC 0310-0283-60
|
Hospital Charge Code |
82090
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$2,546.43 |
Max. Negotiated Rate |
$3,637.76 |
Rate for Payer: Aetna Commercial |
$3,435.67
|
Rate for Payer: Aetna New Business (MI Preferred) |
$2,627.27
|
Rate for Payer: Cash Price |
$3,233.57
|
Rate for Payer: Cofinity Commercial |
$2,829.37
|
Rate for Payer: Cofinity Commercial |
$3,476.09
|
Rate for Payer: Healthscope Commercial |
$3,637.76
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,435.67
|
Rate for Payer: PHP Commercial |
$3,435.67
|
Rate for Payer: Priority Health Cigna Priority Health |
$2,829.37
|
Rate for Payer: Priority Health SBD |
$2,546.43
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$458.40
|
|
Service Code
|
NDC 0904-6804-61
|
Hospital Charge Code |
82090
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$288.79 |
Max. Negotiated Rate |
$412.56 |
Rate for Payer: Aetna Commercial |
$389.64
|
Rate for Payer: Aetna New Business (MI Preferred) |
$297.96
|
Rate for Payer: Cash Price |
$366.72
|
Rate for Payer: Cofinity Commercial |
$320.88
|
Rate for Payer: Cofinity Commercial |
$394.22
|
Rate for Payer: Healthscope Commercial |
$412.56
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$389.64
|
Rate for Payer: PHP Commercial |
$389.64
|
Rate for Payer: Priority Health Cigna Priority Health |
$320.88
|
Rate for Payer: Priority Health SBD |
$288.79
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$295.20
|
|
Service Code
|
NDC 0904-6801-61
|
Hospital Charge Code |
95676
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$185.98 |
Max. Negotiated Rate |
$265.68 |
Rate for Payer: Aetna Commercial |
$250.92
|
Rate for Payer: Aetna New Business (MI Preferred) |
$191.88
|
Rate for Payer: Cash Price |
$236.16
|
Rate for Payer: Cofinity Commercial |
$206.64
|
Rate for Payer: Cofinity Commercial |
$253.87
|
Rate for Payer: Healthscope Commercial |
$265.68
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.92
|
Rate for Payer: PHP Commercial |
$250.92
|
Rate for Payer: Priority Health Cigna Priority Health |
$206.64
|
Rate for Payer: Priority Health SBD |
$185.98
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,686.98
|
|
Service Code
|
NDC 0310-0280-60
|
Hospital Charge Code |
95676
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$1,062.80 |
Max. Negotiated Rate |
$1,518.28 |
Rate for Payer: Aetna Commercial |
$1,433.93
|
Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.54
|
Rate for Payer: Cash Price |
$1,349.58
|
Rate for Payer: Cofinity Commercial |
$1,180.89
|
Rate for Payer: Cofinity Commercial |
$1,450.80
|
Rate for Payer: Healthscope Commercial |
$1,518.28
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,433.93
|
Rate for Payer: PHP Commercial |
$1,433.93
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,180.89
|
Rate for Payer: Priority Health SBD |
$1,062.80
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$2,014.85
|
|
Service Code
|
HCPCS 90375
|
Hospital Charge Code |
186395
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1,269.36 |
Max. Negotiated Rate |
$1,813.36 |
Rate for Payer: Aetna Commercial |
$1,712.62
|
Rate for Payer: Aetna New Business (MI Preferred) |
$1,309.65
|
Rate for Payer: Cash Price |
$1,611.88
|
Rate for Payer: Cofinity Commercial |
$1,410.40
|
Rate for Payer: Cofinity Commercial |
$1,732.77
|
Rate for Payer: Healthscope Commercial |
$1,813.36
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,712.62
|
Rate for Payer: PHP Commercial |
$1,712.62
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,410.40
|
Rate for Payer: Priority Health SBD |
$1,269.36
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$986.51
|
|
Service Code
|
HCPCS 90675
|
Hospital Charge Code |
11257
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$621.50 |
Max. Negotiated Rate |
$887.86 |
Rate for Payer: Aetna Commercial |
$838.53
|
Rate for Payer: Aetna New Business (MI Preferred) |
$641.23
|
Rate for Payer: Cash Price |
$789.21
|
Rate for Payer: Cofinity Commercial |
$690.56
|
Rate for Payer: Cofinity Commercial |
$848.40
|
Rate for Payer: Healthscope Commercial |
$887.86
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$838.53
|
Rate for Payer: PHP Commercial |
$838.53
|
Rate for Payer: Priority Health Cigna Priority Health |
$690.56
|
Rate for Payer: Priority Health SBD |
$621.50
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
IP
|
$1,212.93
|
|
Service Code
|
HCPCS 90675
|
Hospital Charge Code |
22120
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$764.15 |
Max. Negotiated Rate |
$1,091.64 |
Rate for Payer: Aetna Commercial |
$1,030.99
|
Rate for Payer: Aetna Commercial |
$864.36
|
Rate for Payer: Aetna New Business (MI Preferred) |
$660.98
|
Rate for Payer: Aetna New Business (MI Preferred) |
$788.40
|
Rate for Payer: Cash Price |
$813.52
|
Rate for Payer: Cash Price |
$970.34
|
Rate for Payer: Cofinity Commercial |
$1,043.12
|
Rate for Payer: Cofinity Commercial |
$849.05
|
Rate for Payer: Cofinity Commercial |
$874.53
|
Rate for Payer: Cofinity Commercial |
$711.83
|
Rate for Payer: Healthscope Commercial |
$915.21
|
Rate for Payer: Healthscope Commercial |
$1,091.64
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,030.99
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$864.36
|
Rate for Payer: PHP Commercial |
$864.36
|
Rate for Payer: PHP Commercial |
$1,030.99
|
Rate for Payer: Priority Health Cigna Priority Health |
$711.83
|
Rate for Payer: Priority Health Cigna Priority Health |
$849.05
|
Rate for Payer: Priority Health SBD |
$640.65
|
Rate for Payer: Priority Health SBD |
$764.15
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.72
|
|
Service Code
|
NDC 0487-2784-01
|
Hospital Charge Code |
2851
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$2.34 |
Max. Negotiated Rate |
$3.35 |
Rate for Payer: Aetna Commercial |
$3.16
|
Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
Rate for Payer: Cash Price |
$2.98
|
Rate for Payer: Cofinity Commercial |
$2.60
|
Rate for Payer: Cofinity Commercial |
$3.20
|
Rate for Payer: Healthscope Commercial |
$3.35
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.16
|
Rate for Payer: PHP Commercial |
$3.16
|
Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
Rate for Payer: Priority Health SBD |
$2.34
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$6.69
|
|
Service Code
|
NDC 0487-5901-99
|
Hospital Charge Code |
2851
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$4.21 |
Max. Negotiated Rate |
$6.02 |
Rate for Payer: Aetna Commercial |
$5.69
|
Rate for Payer: Aetna New Business (MI Preferred) |
$4.35
|
Rate for Payer: Cash Price |
$5.35
|
Rate for Payer: Cofinity Commercial |
$4.68
|
Rate for Payer: Cofinity Commercial |
$5.75
|
Rate for Payer: Healthscope Commercial |
$6.02
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.69
|
Rate for Payer: PHP Commercial |
$5.69
|
Rate for Payer: Priority Health Cigna Priority Health |
$4.68
|
Rate for Payer: Priority Health SBD |
$4.21
|
|
RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVITIS, FUNGUS, TBC, OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS); EXTENSORS, WITH OR WITHOUT TRANSPOSITION OF DORSAL RETINACULUM
|
Facility
|
OP
|
$8,817.68
|
|
Service Code
|
CPT 25116
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$606.10 |
Max. Negotiated Rate |
$8,817.68 |
Rate for Payer: Aetna Medicare |
$2,995.31
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
Rate for Payer: BCBS Complete |
$1,654.34
|
Rate for Payer: BCBS MAPPO |
$2,880.11
|
Rate for Payer: BCBS Trust/PPO |
$1,234.36
|
Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
Rate for Payer: Mclaren Medicaid |
$1,575.42
|
Rate for Payer: Mclaren Medicare |
$2,880.11
|
Rate for Payer: Meridian Medicaid |
$1,654.34
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
Rate for Payer: PACE Medicare |
$2,736.10
|
Rate for Payer: PACE SWMI |
$2,880.11
|
Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,817.68
|
Rate for Payer: Priority Health Medicare |
$2,880.11
|
Rate for Payer: Priority Health Narrow Network |
$7,054.14
|
Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$666.71
|
Rate for Payer: UHC Core |
$4,155.00
|
Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
Rate for Payer: UHC Exchange |
$606.10
|
Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
Rate for Payer: VA VA |
$2,880.11
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$55,505.76
|
|
Service Code
|
MS-DRG 849
|
Min. Negotiated Rate |
$18,881.85 |
Max. Negotiated Rate |
$55,505.76 |
Rate for Payer: Aetna Medicare |
$20,670.66
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,844.54
|
Rate for Payer: Amish Plain Church Group Commercial |
$24,844.54
|
Rate for Payer: BCBS MAPPO |
$19,875.63
|
Rate for Payer: BCBS Trust/PPO |
$55,505.76
|
Rate for Payer: BCN Medicare Advantage |
$19,875.63
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,875.63
|
Rate for Payer: Mclaren Medicare |
$19,875.63
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,869.41
|
Rate for Payer: MI Amish Medical Board Commercial |
$22,856.97
|
Rate for Payer: PACE Medicare |
$18,881.85
|
Rate for Payer: PACE SWMI |
$19,875.63
|
Rate for Payer: PHP Medicare Advantage |
$19,875.63
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,621.37
|
Rate for Payer: Priority Health Medicare |
$19,875.63
|
Rate for Payer: Priority Health Narrow Network |
$30,897.10
|
Rate for Payer: Railroad Medicare Medicare |
$19,875.63
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$41,054.62
|
Rate for Payer: UHC Core |
$25,191.50
|
Rate for Payer: UHC Dual Complete DSNP |
$19,875.63
|
Rate for Payer: UHC Exchange |
$26,981.29
|
Rate for Payer: UHC Medicare Advantage |
$20,471.90
|
Rate for Payer: VA VA |
$19,875.63
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$9.67
|
|
Service Code
|
NDC 50268-694-11
|
Hospital Charge Code |
22143
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$6.09 |
Max. Negotiated Rate |
$8.70 |
Rate for Payer: Aetna Commercial |
$8.22
|
Rate for Payer: Aetna New Business (MI Preferred) |
$6.29
|
Rate for Payer: Cash Price |
$7.74
|
Rate for Payer: Cofinity Commercial |
$6.77
|
Rate for Payer: Cofinity Commercial |
$8.32
|
Rate for Payer: Healthscope Commercial |
$8.70
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.22
|
Rate for Payer: PHP Commercial |
$8.22
|
Rate for Payer: Priority Health Cigna Priority Health |
$6.77
|
Rate for Payer: Priority Health SBD |
$6.09
|
|