|
ANTIHEMOPHILIC FACTOR-VWF 2,400 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna Medicare |
$0.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.85
|
| Rate for Payer: BCBS Complete |
$0.50
|
| Rate for Payer: BCBS MAPPO |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.24
|
| Rate for Payer: BCN Medicare Advantage |
$0.68
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.68
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Mclaren Medicaid |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.71
|
| Rate for Payer: Meridian Medicaid |
$0.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Nomi Health Commercial |
$2.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.04
|
| Rate for Payer: PACE Senior Care Partners |
$0.65
|
| Rate for Payer: PACE SWMI |
$0.68
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: PHP Medicare Advantage |
$0.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.37
|
| Rate for Payer: Priority Health Medicare |
$0.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.89
|
| Rate for Payer: Railroad Medicare Medicare |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.39
|
| Rate for Payer: UHC Core |
$2.27
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Medicaid |
$0.48
|
| Rate for Payer: UHC Medicare Advantage |
$0.68
|
| Rate for Payer: UHCCP Medicaid |
$0.48
|
| Rate for Payer: VA VA |
$0.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
|
OP
|
$702.24
|
|
|
Service Code
|
NDC 00003089331
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna Medicare |
$182.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$219.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$219.45
|
| Rate for Payer: BCBS Complete |
$129.98
|
| Rate for Payer: BCBS MAPPO |
$175.56
|
| Rate for Payer: BCBS Trust/PPO |
$577.31
|
| Rate for Payer: BCN Commercial |
$577.31
|
| Rate for Payer: BCN Medicare Advantage |
$175.56
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.56
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: Mclaren Medicaid |
$123.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.34
|
| Rate for Payer: Meridian Medicaid |
$129.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: Nomi Health Commercial |
$575.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.68
|
| Rate for Payer: PACE Senior Care Partners |
$166.78
|
| Rate for Payer: PACE SWMI |
$175.56
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: PHP Medicare Advantage |
$175.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$610.95
|
| Rate for Payer: Priority Health Medicare |
$177.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.76
|
| Rate for Payer: Railroad Medicare Medicare |
$175.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.97
|
| Rate for Payer: UHC Core |
$586.37
|
| Rate for Payer: UHC Exchange |
$175.56
|
| Rate for Payer: UHC Medicaid |
$123.80
|
| Rate for Payer: UHC Medicare Advantage |
$175.56
|
| Rate for Payer: UHCCP Medicaid |
$123.80
|
| Rate for Payer: VA VA |
$175.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
|
IP
|
$702.24
|
|
|
Service Code
|
NDC 00003089331
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$488.76 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: BCBS Trust/PPO |
$579.98
|
| Rate for Payer: BCN Commercial |
$579.98
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: Nomi Health Commercial |
$575.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.68
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$610.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.97
|
| Rate for Payer: UHC Core |
$586.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
APIXABAN 5 MG TABLET
|
Facility
|
OP
|
$702.24
|
|
|
Service Code
|
NDC 00003089431
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna Medicare |
$182.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$219.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$219.45
|
| Rate for Payer: BCBS Complete |
$129.98
|
| Rate for Payer: BCBS MAPPO |
$175.56
|
| Rate for Payer: BCBS Trust/PPO |
$577.31
|
| Rate for Payer: BCN Commercial |
$577.31
|
| Rate for Payer: BCN Medicare Advantage |
$175.56
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.56
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: Mclaren Medicaid |
$123.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.34
|
| Rate for Payer: Meridian Medicaid |
$129.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: Nomi Health Commercial |
$575.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.68
|
| Rate for Payer: PACE Senior Care Partners |
$166.78
|
| Rate for Payer: PACE SWMI |
$175.56
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: PHP Medicare Advantage |
$175.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$610.95
|
| Rate for Payer: Priority Health Medicare |
$177.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.76
|
| Rate for Payer: Railroad Medicare Medicare |
$175.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.97
|
| Rate for Payer: UHC Core |
$586.37
|
| Rate for Payer: UHC Exchange |
$175.56
|
| Rate for Payer: UHC Medicaid |
$123.80
|
| Rate for Payer: UHC Medicare Advantage |
$175.56
|
| Rate for Payer: UHCCP Medicaid |
$123.80
|
| Rate for Payer: VA VA |
$175.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
APIXABAN 5 MG TABLET
|
Facility
|
IP
|
$702.24
|
|
|
Service Code
|
NDC 00003089431
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$488.76 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: BCBS Trust/PPO |
$579.98
|
| Rate for Payer: BCN Commercial |
$579.98
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: Nomi Health Commercial |
$575.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.68
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$610.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.97
|
| Rate for Payer: UHC Core |
$586.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$11,554.81
|
|
|
Service Code
|
APR-DRG 2333
|
| Min. Negotiated Rate |
$11,004.58 |
| Max. Negotiated Rate |
$11,554.81 |
| Rate for Payer: BCBS Complete |
$11,554.81
|
| Rate for Payer: Mclaren Medicaid |
$11,004.58
|
| Rate for Payer: Meridian Medicaid |
$11,554.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,004.58
|
| Rate for Payer: UHC Medicaid |
$11,004.58
|
| Rate for Payer: UHCCP Medicaid |
$11,004.58
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$7,503.74
|
|
|
Service Code
|
APR-DRG 2332
|
| Min. Negotiated Rate |
$7,146.42 |
| Max. Negotiated Rate |
$7,503.74 |
| Rate for Payer: BCBS Complete |
$7,503.74
|
| Rate for Payer: Mclaren Medicaid |
$7,146.42
|
| Rate for Payer: Meridian Medicaid |
$7,503.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,146.42
|
| Rate for Payer: UHC Medicaid |
$7,146.42
|
| Rate for Payer: UHCCP Medicaid |
$7,146.42
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$18,633.67
|
|
|
Service Code
|
APR-DRG 2334
|
| Min. Negotiated Rate |
$17,746.35 |
| Max. Negotiated Rate |
$18,633.67 |
| Rate for Payer: BCBS Complete |
$18,633.67
|
| Rate for Payer: Mclaren Medicaid |
$17,746.35
|
| Rate for Payer: Meridian Medicaid |
$18,633.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,746.35
|
| Rate for Payer: UHC Medicaid |
$17,746.35
|
| Rate for Payer: UHCCP Medicaid |
$17,746.35
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$5,971.96
|
|
|
Service Code
|
APR-DRG 2331
|
| Min. Negotiated Rate |
$5,687.59 |
| Max. Negotiated Rate |
$5,971.96 |
| Rate for Payer: BCBS Complete |
$5,971.96
|
| Rate for Payer: Mclaren Medicaid |
$5,687.59
|
| Rate for Payer: Meridian Medicaid |
$5,971.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,687.59
|
| Rate for Payer: UHC Medicaid |
$5,687.59
|
| Rate for Payer: UHCCP Medicaid |
$5,687.59
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$10,796.55
|
|
|
Service Code
|
APR-DRG 2343
|
| Min. Negotiated Rate |
$10,282.43 |
| Max. Negotiated Rate |
$10,796.55 |
| Rate for Payer: BCBS Complete |
$10,796.55
|
| Rate for Payer: Mclaren Medicaid |
$10,282.43
|
| Rate for Payer: Meridian Medicaid |
$10,796.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,282.43
|
| Rate for Payer: UHC Medicaid |
$10,282.43
|
| Rate for Payer: UHCCP Medicaid |
$10,282.43
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$6,948.45
|
|
|
Service Code
|
APR-DRG 2342
|
| Min. Negotiated Rate |
$6,617.57 |
| Max. Negotiated Rate |
$6,948.45 |
| Rate for Payer: BCBS Complete |
$6,948.45
|
| Rate for Payer: Mclaren Medicaid |
$6,617.57
|
| Rate for Payer: Meridian Medicaid |
$6,948.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,617.57
|
| Rate for Payer: UHC Medicaid |
$6,617.57
|
| Rate for Payer: UHCCP Medicaid |
$6,617.57
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$5,695.37
|
|
|
Service Code
|
APR-DRG 2341
|
| Min. Negotiated Rate |
$5,424.16 |
| Max. Negotiated Rate |
$5,695.37 |
| Rate for Payer: BCBS Complete |
$5,695.37
|
| Rate for Payer: Mclaren Medicaid |
$5,424.16
|
| Rate for Payer: Meridian Medicaid |
$5,695.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,424.16
|
| Rate for Payer: UHC Medicaid |
$5,424.16
|
| Rate for Payer: UHCCP Medicaid |
$5,424.16
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$14,789.78
|
|
|
Service Code
|
APR-DRG 2344
|
| Min. Negotiated Rate |
$14,085.50 |
| Max. Negotiated Rate |
$14,789.78 |
| Rate for Payer: BCBS Complete |
$14,789.78
|
| Rate for Payer: Mclaren Medicaid |
$14,085.50
|
| Rate for Payer: Meridian Medicaid |
$14,789.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,085.50
|
| Rate for Payer: UHC Medicaid |
$14,085.50
|
| Rate for Payer: UHCCP Medicaid |
$14,085.50
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
IP
|
$255.38
|
|
|
Service Code
|
NDC 00781232106
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.74 |
| Max. Negotiated Rate |
$229.84 |
| Rate for Payer: Aetna Commercial |
$217.07
|
| Rate for Payer: BCBS Trust/PPO |
$210.92
|
| Rate for Payer: BCN Commercial |
$210.92
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cofinity Commercial |
$219.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.30
|
| Rate for Payer: Healthscope Commercial |
$229.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.07
|
| Rate for Payer: Nomi Health Commercial |
$209.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.53
|
| Rate for Payer: PHP Commercial |
$217.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$222.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.73
|
| Rate for Payer: UHC Core |
$213.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.53
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
IP
|
$176.12
|
|
|
Service Code
|
NDC 13668059181
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.58 |
| Max. Negotiated Rate |
$158.51 |
| Rate for Payer: Aetna Commercial |
$149.70
|
| Rate for Payer: BCBS Trust/PPO |
$145.46
|
| Rate for Payer: BCN Commercial |
$145.46
|
| Rate for Payer: Cash Price |
$140.90
|
| Rate for Payer: Cofinity Commercial |
$151.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.90
|
| Rate for Payer: Healthscope Commercial |
$158.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.70
|
| Rate for Payer: Nomi Health Commercial |
$144.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.09
|
| Rate for Payer: PHP Commercial |
$149.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$153.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.99
|
| Rate for Payer: UHC Core |
$147.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.09
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
OP
|
$979.95
|
|
|
Service Code
|
NDC 13668059182
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.77 |
| Max. Negotiated Rate |
$881.96 |
| Rate for Payer: Aetna Commercial |
$832.96
|
| Rate for Payer: Aetna Medicare |
$254.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$306.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$306.23
|
| Rate for Payer: BCBS Complete |
$181.39
|
| Rate for Payer: BCBS MAPPO |
$244.99
|
| Rate for Payer: BCBS Trust/PPO |
$805.62
|
| Rate for Payer: BCN Commercial |
$805.62
|
| Rate for Payer: BCN Medicare Advantage |
$244.99
|
| Rate for Payer: Cash Price |
$783.96
|
| Rate for Payer: Cofinity Commercial |
$842.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$783.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.99
|
| Rate for Payer: Healthscope Commercial |
$881.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$734.96
|
| Rate for Payer: Mclaren Medicaid |
$172.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$257.24
|
| Rate for Payer: Meridian Medicaid |
$181.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$281.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$269.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$832.96
|
| Rate for Payer: Nomi Health Commercial |
$803.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$734.96
|
| Rate for Payer: PACE Senior Care Partners |
$232.74
|
| Rate for Payer: PACE SWMI |
$244.99
|
| Rate for Payer: PHP Commercial |
$832.96
|
| Rate for Payer: PHP Medicare Advantage |
$244.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$852.56
|
| Rate for Payer: Priority Health Medicare |
$247.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$682.05
|
| Rate for Payer: Railroad Medicare Medicare |
$244.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$862.36
|
| Rate for Payer: UHC Core |
$818.26
|
| Rate for Payer: UHC Exchange |
$244.99
|
| Rate for Payer: UHC Medicaid |
$172.77
|
| Rate for Payer: UHC Medicare Advantage |
$244.99
|
| Rate for Payer: UHCCP Medicaid |
$172.77
|
| Rate for Payer: VA VA |
$244.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$734.96
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
OP
|
$255.38
|
|
|
Service Code
|
NDC 00781232106
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.02 |
| Max. Negotiated Rate |
$229.84 |
| Rate for Payer: Aetna Commercial |
$217.07
|
| Rate for Payer: Aetna Medicare |
$66.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.81
|
| Rate for Payer: BCBS Complete |
$47.27
|
| Rate for Payer: BCBS MAPPO |
$63.84
|
| Rate for Payer: BCBS Trust/PPO |
$209.95
|
| Rate for Payer: BCN Commercial |
$209.95
|
| Rate for Payer: BCN Medicare Advantage |
$63.84
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cofinity Commercial |
$219.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.84
|
| Rate for Payer: Healthscope Commercial |
$229.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.53
|
| Rate for Payer: Mclaren Medicaid |
$45.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.04
|
| Rate for Payer: Meridian Medicaid |
$47.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.07
|
| Rate for Payer: Nomi Health Commercial |
$209.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.53
|
| Rate for Payer: PACE Senior Care Partners |
$60.65
|
| Rate for Payer: PACE SWMI |
$63.84
|
| Rate for Payer: PHP Commercial |
$217.07
|
| Rate for Payer: PHP Medicare Advantage |
$63.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$222.18
|
| Rate for Payer: Priority Health Medicare |
$64.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.74
|
| Rate for Payer: Railroad Medicare Medicare |
$63.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.73
|
| Rate for Payer: UHC Core |
$213.24
|
| Rate for Payer: UHC Exchange |
$63.84
|
| Rate for Payer: UHC Medicaid |
$45.02
|
| Rate for Payer: UHC Medicare Advantage |
$63.84
|
| Rate for Payer: UHCCP Medicaid |
$45.02
|
| Rate for Payer: VA VA |
$63.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.53
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
IP
|
$979.95
|
|
|
Service Code
|
NDC 13668059182
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$682.05 |
| Max. Negotiated Rate |
$881.96 |
| Rate for Payer: Aetna Commercial |
$832.96
|
| Rate for Payer: BCBS Trust/PPO |
$809.34
|
| Rate for Payer: BCN Commercial |
$809.34
|
| Rate for Payer: Cash Price |
$783.96
|
| Rate for Payer: Cofinity Commercial |
$842.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$783.96
|
| Rate for Payer: Healthscope Commercial |
$881.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$734.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$832.96
|
| Rate for Payer: Nomi Health Commercial |
$803.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$734.96
|
| Rate for Payer: PHP Commercial |
$832.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$852.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$682.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$862.36
|
| Rate for Payer: UHC Core |
$818.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$734.96
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
IP
|
$176.12
|
|
|
Service Code
|
NDC 13668059180
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.58 |
| Max. Negotiated Rate |
$158.51 |
| Rate for Payer: Aetna Commercial |
$149.70
|
| Rate for Payer: BCBS Trust/PPO |
$145.46
|
| Rate for Payer: BCN Commercial |
$145.46
|
| Rate for Payer: Cash Price |
$140.90
|
| Rate for Payer: Cofinity Commercial |
$151.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.90
|
| Rate for Payer: Healthscope Commercial |
$158.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.70
|
| Rate for Payer: Nomi Health Commercial |
$144.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.09
|
| Rate for Payer: PHP Commercial |
$149.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$153.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.99
|
| Rate for Payer: UHC Core |
$147.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.09
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
IP
|
$1,276.73
|
|
|
Service Code
|
NDC 00781232151
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$888.60 |
| Max. Negotiated Rate |
$1,149.06 |
| Rate for Payer: Aetna Commercial |
$1,085.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,054.45
|
| Rate for Payer: BCN Commercial |
$1,054.45
|
| Rate for Payer: Cash Price |
$1,021.38
|
| Rate for Payer: Cofinity Commercial |
$1,097.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.38
|
| Rate for Payer: Healthscope Commercial |
$1,149.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.22
|
| Rate for Payer: Nomi Health Commercial |
$1,046.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$957.55
|
| Rate for Payer: PHP Commercial |
$1,085.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,110.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$888.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.52
|
| Rate for Payer: UHC Core |
$1,066.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.55
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
OP
|
$176.12
|
|
|
Service Code
|
NDC 13668059181
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$158.51 |
| Rate for Payer: Aetna Commercial |
$149.70
|
| Rate for Payer: Aetna Medicare |
$45.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.04
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$44.03
|
| Rate for Payer: BCBS Trust/PPO |
$144.79
|
| Rate for Payer: BCN Commercial |
$144.79
|
| Rate for Payer: BCN Medicare Advantage |
$44.03
|
| Rate for Payer: Cash Price |
$140.90
|
| Rate for Payer: Cofinity Commercial |
$151.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.03
|
| Rate for Payer: Healthscope Commercial |
$158.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.09
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.23
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.70
|
| Rate for Payer: Nomi Health Commercial |
$144.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.09
|
| Rate for Payer: PACE Senior Care Partners |
$41.83
|
| Rate for Payer: PACE SWMI |
$44.03
|
| Rate for Payer: PHP Commercial |
$149.70
|
| Rate for Payer: PHP Medicare Advantage |
$44.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$153.22
|
| Rate for Payer: Priority Health Medicare |
$44.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.58
|
| Rate for Payer: Railroad Medicare Medicare |
$44.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.99
|
| Rate for Payer: UHC Core |
$147.06
|
| Rate for Payer: UHC Exchange |
$44.03
|
| Rate for Payer: UHC Medicaid |
$31.05
|
| Rate for Payer: UHC Medicare Advantage |
$44.03
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$44.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.09
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
OP
|
$176.12
|
|
|
Service Code
|
NDC 13668059180
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$158.51 |
| Rate for Payer: Aetna Commercial |
$149.70
|
| Rate for Payer: Aetna Medicare |
$45.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.04
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$44.03
|
| Rate for Payer: BCBS Trust/PPO |
$144.79
|
| Rate for Payer: BCN Commercial |
$144.79
|
| Rate for Payer: BCN Medicare Advantage |
$44.03
|
| Rate for Payer: Cash Price |
$140.90
|
| Rate for Payer: Cofinity Commercial |
$151.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.03
|
| Rate for Payer: Healthscope Commercial |
$158.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.09
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.23
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.70
|
| Rate for Payer: Nomi Health Commercial |
$144.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.09
|
| Rate for Payer: PACE Senior Care Partners |
$41.83
|
| Rate for Payer: PACE SWMI |
$44.03
|
| Rate for Payer: PHP Commercial |
$149.70
|
| Rate for Payer: PHP Medicare Advantage |
$44.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$153.22
|
| Rate for Payer: Priority Health Medicare |
$44.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.58
|
| Rate for Payer: Railroad Medicare Medicare |
$44.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.99
|
| Rate for Payer: UHC Core |
$147.06
|
| Rate for Payer: UHC Exchange |
$44.03
|
| Rate for Payer: UHC Medicaid |
$31.05
|
| Rate for Payer: UHC Medicare Advantage |
$44.03
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$44.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.09
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
OP
|
$1,276.73
|
|
|
Service Code
|
NDC 00781232151
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.09 |
| Max. Negotiated Rate |
$1,149.06 |
| Rate for Payer: Aetna Commercial |
$1,085.22
|
| Rate for Payer: Aetna Medicare |
$331.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$398.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$398.98
|
| Rate for Payer: BCBS Complete |
$236.32
|
| Rate for Payer: BCBS MAPPO |
$319.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.60
|
| Rate for Payer: BCN Commercial |
$1,049.60
|
| Rate for Payer: BCN Medicare Advantage |
$319.18
|
| Rate for Payer: Cash Price |
$1,021.38
|
| Rate for Payer: Cofinity Commercial |
$1,097.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.18
|
| Rate for Payer: Healthscope Commercial |
$1,149.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.55
|
| Rate for Payer: Mclaren Medicaid |
$225.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$335.14
|
| Rate for Payer: Meridian Medicaid |
$236.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$351.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.22
|
| Rate for Payer: Nomi Health Commercial |
$1,046.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$957.55
|
| Rate for Payer: PACE Senior Care Partners |
$303.22
|
| Rate for Payer: PACE SWMI |
$319.18
|
| Rate for Payer: PHP Commercial |
$1,085.22
|
| Rate for Payer: PHP Medicare Advantage |
$319.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,110.76
|
| Rate for Payer: Priority Health Medicare |
$322.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$888.60
|
| Rate for Payer: Railroad Medicare Medicare |
$319.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.52
|
| Rate for Payer: UHC Core |
$1,066.07
|
| Rate for Payer: UHC Exchange |
$319.18
|
| Rate for Payer: UHC Medicaid |
$225.09
|
| Rate for Payer: UHC Medicare Advantage |
$319.18
|
| Rate for Payer: UHCCP Medicaid |
$225.09
|
| Rate for Payer: VA VA |
$319.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.55
|
|
|
ARGATROBAN 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$224.81
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
152708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.63 |
| Max. Negotiated Rate |
$202.33 |
| Rate for Payer: Aetna Commercial |
$191.09
|
| Rate for Payer: Aetna Commercial |
$364.62
|
| Rate for Payer: Aetna Medicare |
$111.53
|
| Rate for Payer: Aetna Medicare |
$58.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.05
|
| Rate for Payer: BCBS Complete |
$41.61
|
| Rate for Payer: BCBS Complete |
$79.40
|
| Rate for Payer: BCBS MAPPO |
$56.20
|
| Rate for Payer: BCBS MAPPO |
$107.24
|
| Rate for Payer: BCBS Trust/PPO |
$184.82
|
| Rate for Payer: BCBS Trust/PPO |
$352.65
|
| Rate for Payer: BCN Commercial |
$352.65
|
| Rate for Payer: BCN Commercial |
$184.82
|
| Rate for Payer: BCN Medicare Advantage |
$107.24
|
| Rate for Payer: BCN Medicare Advantage |
$56.20
|
| Rate for Payer: Cash Price |
$179.85
|
| Rate for Payer: Cash Price |
$343.17
|
| Rate for Payer: Cofinity Commercial |
$193.34
|
| Rate for Payer: Cofinity Commercial |
$368.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.20
|
| Rate for Payer: Healthscope Commercial |
$202.33
|
| Rate for Payer: Healthscope Commercial |
$386.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.72
|
| Rate for Payer: Mclaren Medicaid |
$75.63
|
| Rate for Payer: Mclaren Medicaid |
$39.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.01
|
| Rate for Payer: Meridian Medicaid |
$41.61
|
| Rate for Payer: Meridian Medicaid |
$79.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$117.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.09
|
| Rate for Payer: Nomi Health Commercial |
$351.75
|
| Rate for Payer: Nomi Health Commercial |
$184.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.72
|
| Rate for Payer: PACE Senior Care Partners |
$101.88
|
| Rate for Payer: PACE Senior Care Partners |
$53.39
|
| Rate for Payer: PACE SWMI |
$107.24
|
| Rate for Payer: PACE SWMI |
$56.20
|
| Rate for Payer: PHP Commercial |
$191.09
|
| Rate for Payer: PHP Commercial |
$364.62
|
| Rate for Payer: PHP Medicare Advantage |
$56.20
|
| Rate for Payer: PHP Medicare Advantage |
$107.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$373.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$195.58
|
| Rate for Payer: Priority Health Medicare |
$108.31
|
| Rate for Payer: Priority Health Medicare |
$56.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$298.56
|
| Rate for Payer: Railroad Medicare Medicare |
$56.20
|
| Rate for Payer: Railroad Medicare Medicare |
$107.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.48
|
| Rate for Payer: UHC Core |
$358.18
|
| Rate for Payer: UHC Core |
$187.72
|
| Rate for Payer: UHC Exchange |
$107.24
|
| Rate for Payer: UHC Exchange |
$56.20
|
| Rate for Payer: UHC Medicaid |
$75.63
|
| Rate for Payer: UHC Medicaid |
$39.63
|
| Rate for Payer: UHC Medicare Advantage |
$56.20
|
| Rate for Payer: UHC Medicare Advantage |
$107.24
|
| Rate for Payer: UHCCP Medicaid |
$39.63
|
| Rate for Payer: UHCCP Medicaid |
$75.63
|
| Rate for Payer: VA VA |
$56.20
|
| Rate for Payer: VA VA |
$107.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.61
|
|
|
ARGATROBAN 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$224.81
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
152708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$156.47 |
| Max. Negotiated Rate |
$202.33 |
| Rate for Payer: Aetna Commercial |
$191.09
|
| Rate for Payer: Aetna Commercial |
$364.62
|
| Rate for Payer: BCBS Trust/PPO |
$185.67
|
| Rate for Payer: BCBS Trust/PPO |
$354.28
|
| Rate for Payer: BCN Commercial |
$185.67
|
| Rate for Payer: BCN Commercial |
$354.28
|
| Rate for Payer: Cash Price |
$179.85
|
| Rate for Payer: Cash Price |
$343.17
|
| Rate for Payer: Cofinity Commercial |
$368.91
|
| Rate for Payer: Cofinity Commercial |
$193.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.85
|
| Rate for Payer: Healthscope Commercial |
$202.33
|
| Rate for Payer: Healthscope Commercial |
$386.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.62
|
| Rate for Payer: Nomi Health Commercial |
$184.34
|
| Rate for Payer: Nomi Health Commercial |
$351.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.72
|
| Rate for Payer: PHP Commercial |
$364.62
|
| Rate for Payer: PHP Commercial |
$191.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$373.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$195.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$298.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.48
|
| Rate for Payer: UHC Core |
$187.72
|
| Rate for Payer: UHC Core |
$358.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.72
|
|
