|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC
|
Facility
|
IP
|
$15,507.80
|
|
|
Service Code
|
MSDRG 191
|
| Min. Negotiated Rate |
$6,739.20 |
| Max. Negotiated Rate |
$15,507.80 |
| Rate for Payer: Aetna Medicare |
$7,377.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,867.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,867.38
|
| Rate for Payer: BCBS MAPPO |
$7,093.90
|
| Rate for Payer: BCBS Trust/PPO |
$15,507.80
|
| Rate for Payer: BCN Commercial |
$15,507.80
|
| Rate for Payer: BCN Medicare Advantage |
$7,093.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,093.90
|
| Rate for Payer: Mclaren Medicare |
$7,093.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,448.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,157.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,803.29
|
| Rate for Payer: Nomi Health Commercial |
$10,874.70
|
| Rate for Payer: PACE Medicare |
$6,739.20
|
| Rate for Payer: PACE SWMI |
$7,093.90
|
| Rate for Payer: PHP Medicare Advantage |
$7,093.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,590.96
|
| Rate for Payer: Priority Health Medicare |
$7,093.90
|
| Rate for Payer: Priority Health Tiered Network |
$10,872.77
|
| Rate for Payer: Railroad Medicare Medicare |
$7,093.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,740.90
|
| Rate for Payer: UHC Core |
$11,495.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,093.90
|
| Rate for Payer: UHC Exchange |
$9,388.49
|
| Rate for Payer: VA VA |
$7,093.90
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC
|
Facility
|
IP
|
$18,055.51
|
|
|
Service Code
|
MSDRG 190
|
| Min. Negotiated Rate |
$8,682.58 |
| Max. Negotiated Rate |
$18,055.51 |
| Rate for Payer: Aetna Medicare |
$9,505.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,424.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,424.45
|
| Rate for Payer: BCBS MAPPO |
$9,139.56
|
| Rate for Payer: BCBS Trust/PPO |
$17,427.26
|
| Rate for Payer: BCN Commercial |
$17,427.26
|
| Rate for Payer: BCN Medicare Advantage |
$9,139.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,139.56
|
| Rate for Payer: Mclaren Medicare |
$9,139.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,596.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,510.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,053.52
|
| Rate for Payer: Nomi Health Commercial |
$14,289.33
|
| Rate for Payer: PACE Medicare |
$8,682.58
|
| Rate for Payer: PACE SWMI |
$9,139.56
|
| Rate for Payer: PHP Medicare Advantage |
$9,139.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,858.49
|
| Rate for Payer: Priority Health Medicare |
$9,139.56
|
| Rate for Payer: Priority Health Tiered Network |
$14,286.79
|
| Rate for Payer: Railroad Medicare Medicare |
$9,139.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,055.51
|
| Rate for Payer: UHC Core |
$15,105.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,139.56
|
| Rate for Payer: UHC Exchange |
$12,336.45
|
| Rate for Payer: VA VA |
$9,139.56
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$11,378.63
|
|
|
Service Code
|
MSDRG 192
|
| Min. Negotiated Rate |
$5,263.50 |
| Max. Negotiated Rate |
$11,378.63 |
| Rate for Payer: Aetna Medicare |
$5,762.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,925.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,925.66
|
| Rate for Payer: BCBS MAPPO |
$5,540.53
|
| Rate for Payer: BCBS Trust/PPO |
$11,378.63
|
| Rate for Payer: BCN Commercial |
$11,378.63
|
| Rate for Payer: BCN Medicare Advantage |
$5,540.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,540.53
|
| Rate for Payer: Mclaren Medicare |
$5,540.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,817.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,371.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,094.58
|
| Rate for Payer: Nomi Health Commercial |
$8,281.80
|
| Rate for Payer: PACE Medicare |
$5,263.50
|
| Rate for Payer: PACE SWMI |
$5,540.53
|
| Rate for Payer: PHP Medicare Advantage |
$5,540.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,350.41
|
| Rate for Payer: Priority Health Medicare |
$5,540.53
|
| Rate for Payer: Priority Health Tiered Network |
$8,280.33
|
| Rate for Payer: Railroad Medicare Medicare |
$5,540.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,464.60
|
| Rate for Payer: UHC Core |
$8,754.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,540.53
|
| Rate for Payer: UHC Exchange |
$7,149.95
|
| Rate for Payer: VA VA |
$5,540.53
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
IP
|
$3.56
|
|
|
Service Code
|
NDC 50268017711
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.31
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Cofinity Advantage |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.85
|
| Rate for Payer: Healthscope Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.67
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: Priority Health SBD |
$2.24
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
OP
|
$177.60
|
|
|
Service Code
|
NDC 50268017715
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.80 |
| Max. Negotiated Rate |
$159.84 |
| Rate for Payer: Aetna Commercial |
$150.96
|
| Rate for Payer: Aetna Medicare |
$88.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.44
|
| Rate for Payer: BCBS Complete |
$71.04
|
| Rate for Payer: Cash Price |
$142.08
|
| Rate for Payer: Cofinity Advantage |
$124.32
|
| Rate for Payer: Cofinity Commercial |
$152.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.08
|
| Rate for Payer: Healthscope Commercial |
$159.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.20
|
| Rate for Payer: PHP Commercial |
$150.96
|
| Rate for Payer: Priority Health SBD |
$111.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.44
|
| Rate for Payer: UHC Core |
$92.53
|
| Rate for Payer: UHC Exchange |
$69.80
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
OP
|
$143.82
|
|
|
Service Code
|
NDC 60505252201
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.52 |
| Max. Negotiated Rate |
$129.44 |
| Rate for Payer: Aetna Commercial |
$122.25
|
| Rate for Payer: Aetna Medicare |
$71.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.48
|
| Rate for Payer: BCBS Complete |
$57.53
|
| Rate for Payer: Cash Price |
$115.06
|
| Rate for Payer: Cofinity Advantage |
$100.67
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.06
|
| Rate for Payer: Healthscope Commercial |
$129.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.86
|
| Rate for Payer: PHP Commercial |
$122.25
|
| Rate for Payer: Priority Health SBD |
$90.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.48
|
| Rate for Payer: UHC Core |
$74.93
|
| Rate for Payer: UHC Exchange |
$56.52
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
IP
|
$177.60
|
|
|
Service Code
|
NDC 50268017715
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.89 |
| Max. Negotiated Rate |
$159.84 |
| Rate for Payer: Aetna Commercial |
$150.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.44
|
| Rate for Payer: Cash Price |
$142.08
|
| Rate for Payer: Cofinity Advantage |
$124.32
|
| Rate for Payer: Cofinity Commercial |
$152.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.08
|
| Rate for Payer: Healthscope Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.20
|
| Rate for Payer: PHP Commercial |
$150.96
|
| Rate for Payer: Priority Health SBD |
$111.89
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
OP
|
$3.56
|
|
|
Service Code
|
NDC 50268017711
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna Medicare |
$1.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.31
|
| Rate for Payer: BCBS Complete |
$1.42
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Cofinity Advantage |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.85
|
| Rate for Payer: Healthscope Commercial |
$3.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.67
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: Priority Health SBD |
$2.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.31
|
| Rate for Payer: UHC Core |
$1.85
|
| Rate for Payer: UHC Exchange |
$1.40
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
IP
|
$143.82
|
|
|
Service Code
|
NDC 60505252201
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.61 |
| Max. Negotiated Rate |
$129.44 |
| Rate for Payer: Aetna Commercial |
$122.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.48
|
| Rate for Payer: Cash Price |
$115.06
|
| Rate for Payer: Cofinity Advantage |
$100.67
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.06
|
| Rate for Payer: Healthscope Commercial |
$129.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.86
|
| Rate for Payer: PHP Commercial |
$122.25
|
| Rate for Payer: Priority Health SBD |
$90.61
|
|
|
CILOSTAZOL 50 MG TABLET
|
Facility
|
IP
|
$3.62
|
|
|
Service Code
|
NDC 50268017611
|
| Hospital Charge Code |
24473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.35
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cofinity Advantage |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$3.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.71
|
| Rate for Payer: PHP Commercial |
$3.08
|
| Rate for Payer: Priority Health SBD |
$2.28
|
|
|
CILOSTAZOL 50 MG TABLET
|
Facility
|
OP
|
$3.62
|
|
|
Service Code
|
NDC 50268017611
|
| Hospital Charge Code |
24473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Aetna Medicare |
$1.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.35
|
| Rate for Payer: BCBS Complete |
$1.45
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cofinity Advantage |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$3.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.71
|
| Rate for Payer: PHP Commercial |
$3.08
|
| Rate for Payer: Priority Health SBD |
$2.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.35
|
| Rate for Payer: UHC Core |
$1.89
|
| Rate for Payer: UHC Exchange |
$1.42
|
|
|
CILOSTAZOL 50 MG TABLET
|
Facility
|
IP
|
$180.96
|
|
|
Service Code
|
NDC 50268017615
|
| Hospital Charge Code |
24473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$162.86 |
| Rate for Payer: Aetna Commercial |
$153.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.62
|
| Rate for Payer: Cash Price |
$144.77
|
| Rate for Payer: Cofinity Advantage |
$126.67
|
| Rate for Payer: Cofinity Commercial |
$155.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.77
|
| Rate for Payer: Healthscope Commercial |
$162.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.72
|
| Rate for Payer: PHP Commercial |
$153.82
|
| Rate for Payer: Priority Health SBD |
$114.00
|
|
|
CILOSTAZOL 50 MG TABLET
|
Facility
|
OP
|
$180.96
|
|
|
Service Code
|
NDC 50268017615
|
| Hospital Charge Code |
24473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.12 |
| Max. Negotiated Rate |
$162.86 |
| Rate for Payer: Aetna Commercial |
$153.82
|
| Rate for Payer: Aetna Medicare |
$90.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.62
|
| Rate for Payer: BCBS Complete |
$72.38
|
| Rate for Payer: Cash Price |
$144.77
|
| Rate for Payer: Cofinity Advantage |
$126.67
|
| Rate for Payer: Cofinity Commercial |
$155.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.77
|
| Rate for Payer: Healthscope Commercial |
$162.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.72
|
| Rate for Payer: PHP Commercial |
$153.82
|
| Rate for Payer: Priority Health SBD |
$114.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.62
|
| Rate for Payer: UHC Core |
$94.28
|
| Rate for Payer: UHC Exchange |
$71.12
|
|
|
CIMETIDINE 200 MG TABLET
|
Facility
|
IP
|
$314.45
|
|
|
Service Code
|
NDC 00378005301
|
| Hospital Charge Code |
9604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.10 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna Commercial |
$267.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.39
|
| Rate for Payer: Cash Price |
$251.56
|
| Rate for Payer: Cofinity Advantage |
$220.12
|
| Rate for Payer: Cofinity Commercial |
$270.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.56
|
| Rate for Payer: Healthscope Commercial |
$283.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$235.84
|
| Rate for Payer: PHP Commercial |
$267.28
|
| Rate for Payer: Priority Health SBD |
$198.10
|
|
|
CIMETIDINE 200 MG TABLET
|
Facility
|
OP
|
$314.45
|
|
|
Service Code
|
NDC 00378005301
|
| Hospital Charge Code |
9604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.58 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna Commercial |
$267.28
|
| Rate for Payer: Aetna Medicare |
$157.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.39
|
| Rate for Payer: BCBS Complete |
$125.78
|
| Rate for Payer: Cash Price |
$251.56
|
| Rate for Payer: Cofinity Advantage |
$220.12
|
| Rate for Payer: Cofinity Commercial |
$270.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.56
|
| Rate for Payer: Healthscope Commercial |
$283.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$235.84
|
| Rate for Payer: PHP Commercial |
$267.28
|
| Rate for Payer: Priority Health SBD |
$198.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.39
|
| Rate for Payer: UHC Core |
$163.83
|
| Rate for Payer: UHC Exchange |
$123.58
|
|
|
CINACALCET 30 MG TABLET
|
Facility
|
OP
|
$1,807.86
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
38100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$710.49 |
| Max. Negotiated Rate |
$1,627.07 |
| Rate for Payer: Aetna Commercial |
$1,536.68
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna Commercial |
$101.75
|
| Rate for Payer: Aetna Commercial |
$80.19
|
| Rate for Payer: Aetna Medicare |
$903.93
|
| Rate for Payer: Aetna Medicare |
$47.17
|
| Rate for Payer: Aetna Medicare |
$66.27
|
| Rate for Payer: Aetna Medicare |
$59.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: BCBS Complete |
$53.01
|
| Rate for Payer: BCBS Complete |
$723.14
|
| Rate for Payer: BCBS Complete |
$37.74
|
| Rate for Payer: BCBS Complete |
$47.88
|
| Rate for Payer: Cash Price |
$95.76
|
| Rate for Payer: Cash Price |
$75.47
|
| Rate for Payer: Cash Price |
$1,446.29
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cofinity Advantage |
$83.79
|
| Rate for Payer: Cofinity Advantage |
$1,265.50
|
| Rate for Payer: Cofinity Advantage |
$92.77
|
| Rate for Payer: Cofinity Advantage |
$66.04
|
| Rate for Payer: Cofinity Commercial |
$81.13
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Cofinity Commercial |
$1,554.76
|
| Rate for Payer: Cofinity Commercial |
$102.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,446.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.76
|
| Rate for Payer: Healthscope Commercial |
$1,627.07
|
| Rate for Payer: Healthscope Commercial |
$107.73
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Healthscope Commercial |
$84.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,446.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,536.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,355.89
|
| Rate for Payer: PHP Commercial |
$1,536.68
|
| Rate for Payer: PHP Commercial |
$80.19
|
| Rate for Payer: PHP Commercial |
$101.75
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health SBD |
$1,138.95
|
| Rate for Payer: Priority Health SBD |
$59.43
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: Priority Health SBD |
$75.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,175.11
|
| Rate for Payer: UHC Core |
$941.90
|
| Rate for Payer: UHC Core |
$49.15
|
| Rate for Payer: UHC Core |
$69.05
|
| Rate for Payer: UHC Core |
$62.36
|
| Rate for Payer: UHC Exchange |
$37.08
|
| Rate for Payer: UHC Exchange |
$47.04
|
| Rate for Payer: UHC Exchange |
$52.08
|
| Rate for Payer: UHC Exchange |
$710.49
|
|
|
CINACALCET 30 MG TABLET
|
Facility
|
IP
|
$1,807.86
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
38100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,138.95 |
| Max. Negotiated Rate |
$1,627.07 |
| Rate for Payer: Aetna Commercial |
$1,536.68
|
| Rate for Payer: Aetna Commercial |
$80.19
|
| Rate for Payer: Aetna Commercial |
$101.75
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.81
|
| Rate for Payer: Cash Price |
$1,446.29
|
| Rate for Payer: Cash Price |
$75.47
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cash Price |
$95.76
|
| Rate for Payer: Cofinity Advantage |
$1,265.50
|
| Rate for Payer: Cofinity Advantage |
$83.79
|
| Rate for Payer: Cofinity Advantage |
$66.04
|
| Rate for Payer: Cofinity Advantage |
$92.77
|
| Rate for Payer: Cofinity Commercial |
$81.13
|
| Rate for Payer: Cofinity Commercial |
$1,554.76
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Cofinity Commercial |
$102.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,446.29
|
| Rate for Payer: Healthscope Commercial |
$1,627.07
|
| Rate for Payer: Healthscope Commercial |
$84.91
|
| Rate for Payer: Healthscope Commercial |
$107.73
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,536.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,355.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.40
|
| Rate for Payer: PHP Commercial |
$1,536.68
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: PHP Commercial |
$101.75
|
| Rate for Payer: PHP Commercial |
$80.19
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: Priority Health SBD |
$59.43
|
| Rate for Payer: Priority Health SBD |
$1,138.95
|
| Rate for Payer: Priority Health SBD |
$75.41
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$261.56
|
|
|
Service Code
|
NDC 72485062513
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.79 |
| Max. Negotiated Rate |
$235.40 |
| Rate for Payer: Aetna Commercial |
$222.33
|
| Rate for Payer: Aetna Medicare |
$130.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.01
|
| Rate for Payer: BCBS Complete |
$104.62
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cofinity Advantage |
$183.09
|
| Rate for Payer: Cofinity Commercial |
$224.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.25
|
| Rate for Payer: Healthscope Commercial |
$235.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.17
|
| Rate for Payer: PHP Commercial |
$222.33
|
| Rate for Payer: Priority Health SBD |
$164.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.01
|
| Rate for Payer: UHC Core |
$136.27
|
| Rate for Payer: UHC Exchange |
$102.79
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$810.79
|
|
|
Service Code
|
NDC 00078079975
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$318.64 |
| Max. Negotiated Rate |
$729.71 |
| Rate for Payer: Aetna Commercial |
$689.17
|
| Rate for Payer: Aetna Medicare |
$405.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.01
|
| Rate for Payer: BCBS Complete |
$324.32
|
| Rate for Payer: Cash Price |
$648.63
|
| Rate for Payer: Cofinity Advantage |
$567.55
|
| Rate for Payer: Cofinity Commercial |
$697.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.63
|
| Rate for Payer: Healthscope Commercial |
$729.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$648.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$608.09
|
| Rate for Payer: PHP Commercial |
$689.17
|
| Rate for Payer: Priority Health SBD |
$510.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$527.01
|
| Rate for Payer: UHC Core |
$422.42
|
| Rate for Payer: UHC Exchange |
$318.64
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$729.73
|
|
|
Service Code
|
NDC 62756042790
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.78 |
| Max. Negotiated Rate |
$656.76 |
| Rate for Payer: Aetna Commercial |
$620.27
|
| Rate for Payer: Aetna Medicare |
$364.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.32
|
| Rate for Payer: BCBS Complete |
$291.89
|
| Rate for Payer: Cash Price |
$583.78
|
| Rate for Payer: Cofinity Advantage |
$510.81
|
| Rate for Payer: Cofinity Commercial |
$627.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.78
|
| Rate for Payer: Healthscope Commercial |
$656.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$583.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$547.30
|
| Rate for Payer: PHP Commercial |
$620.27
|
| Rate for Payer: Priority Health SBD |
$459.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$474.32
|
| Rate for Payer: UHC Core |
$380.19
|
| Rate for Payer: UHC Exchange |
$286.78
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$375.48
|
|
|
Service Code
|
NDC 43598032675
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.55 |
| Max. Negotiated Rate |
$337.93 |
| Rate for Payer: Aetna Commercial |
$319.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.06
|
| Rate for Payer: Cash Price |
$300.38
|
| Rate for Payer: Cofinity Advantage |
$262.84
|
| Rate for Payer: Cofinity Commercial |
$322.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.38
|
| Rate for Payer: Healthscope Commercial |
$337.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.61
|
| Rate for Payer: PHP Commercial |
$319.16
|
| Rate for Payer: Priority Health SBD |
$236.55
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$729.73
|
|
|
Service Code
|
NDC 62756042790
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$459.73 |
| Max. Negotiated Rate |
$656.76 |
| Rate for Payer: Aetna Commercial |
$620.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.32
|
| Rate for Payer: Cash Price |
$583.78
|
| Rate for Payer: Cofinity Advantage |
$510.81
|
| Rate for Payer: Cofinity Commercial |
$627.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.78
|
| Rate for Payer: Healthscope Commercial |
$656.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$547.30
|
| Rate for Payer: PHP Commercial |
$620.27
|
| Rate for Payer: Priority Health SBD |
$459.73
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$810.79
|
|
|
Service Code
|
NDC 00078079975
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$510.80 |
| Max. Negotiated Rate |
$729.71 |
| Rate for Payer: Aetna Commercial |
$689.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.01
|
| Rate for Payer: Cash Price |
$648.63
|
| Rate for Payer: Cofinity Advantage |
$567.55
|
| Rate for Payer: Cofinity Commercial |
$697.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.63
|
| Rate for Payer: Healthscope Commercial |
$729.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$608.09
|
| Rate for Payer: PHP Commercial |
$689.17
|
| Rate for Payer: Priority Health SBD |
$510.80
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$375.48
|
|
|
Service Code
|
NDC 43598032675
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.56 |
| Max. Negotiated Rate |
$337.93 |
| Rate for Payer: Aetna Commercial |
$319.16
|
| Rate for Payer: Aetna Medicare |
$187.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.06
|
| Rate for Payer: BCBS Complete |
$150.19
|
| Rate for Payer: Cash Price |
$300.38
|
| Rate for Payer: Cofinity Advantage |
$262.84
|
| Rate for Payer: Cofinity Commercial |
$322.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.38
|
| Rate for Payer: Healthscope Commercial |
$337.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.61
|
| Rate for Payer: PHP Commercial |
$319.16
|
| Rate for Payer: Priority Health SBD |
$236.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.06
|
| Rate for Payer: UHC Core |
$195.63
|
| Rate for Payer: UHC Exchange |
$147.56
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$261.56
|
|
|
Service Code
|
NDC 72485062513
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.78 |
| Max. Negotiated Rate |
$235.40 |
| Rate for Payer: Aetna Commercial |
$222.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.01
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cofinity Advantage |
$183.09
|
| Rate for Payer: Cofinity Commercial |
$224.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.25
|
| Rate for Payer: Healthscope Commercial |
$235.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.17
|
| Rate for Payer: PHP Commercial |
$222.33
|
| Rate for Payer: Priority Health SBD |
$164.78
|
|
