|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$364.80
|
|
|
Service Code
|
NDC 62584098801
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.12 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna Commercial |
$328.32
|
| Rate for Payer: ASR ASR |
$353.86
|
| Rate for Payer: ASR Commercial |
$353.86
|
| Rate for Payer: BCBS Trust/PPO |
$297.28
|
| Rate for Payer: BCN Commercial |
$282.83
|
| Rate for Payer: Cash Price |
$291.84
|
| Rate for Payer: Cofinity Commercial |
$342.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.84
|
| Rate for Payer: Healthscope Commercial |
$364.80
|
| Rate for Payer: Healthscope Whirlpool |
$353.86
|
| Rate for Payer: Mclaren Commercial |
$328.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.08
|
| Rate for Payer: Nomi Health Commercial |
$299.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.02
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$205.20
|
|
|
Service Code
|
NDC 60687067701
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.08 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$184.68
|
| Rate for Payer: Aetna Medicare |
$102.60
|
| Rate for Payer: ASR ASR |
$199.04
|
| Rate for Payer: ASR Commercial |
$199.04
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: BCBS Trust/PPO |
$168.04
|
| Rate for Payer: BCN Commercial |
$159.09
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$192.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Healthscope Whirlpool |
$199.04
|
| Rate for Payer: Mclaren Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.80
|
| Rate for Payer: Priority Health Narrow Network |
$143.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.58
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$451.20
|
|
|
Service Code
|
NDC 00904704161
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.28 |
| Max. Negotiated Rate |
$451.20 |
| Rate for Payer: Aetna Commercial |
$406.08
|
| Rate for Payer: ASR ASR |
$437.66
|
| Rate for Payer: ASR Commercial |
$437.66
|
| Rate for Payer: BCBS Trust/PPO |
$367.68
|
| Rate for Payer: BCN Commercial |
$349.82
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$424.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$451.20
|
| Rate for Payer: Healthscope Whirlpool |
$437.66
|
| Rate for Payer: Mclaren Commercial |
$406.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: Nomi Health Commercial |
$369.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.06
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$2.05
|
|
|
Service Code
|
NDC 60687067711
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: ASR ASR |
$1.99
|
| Rate for Payer: ASR Commercial |
$1.99
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: BCBS Trust/PPO |
$1.68
|
| Rate for Payer: BCN Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$1.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.64
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Healthscope Whirlpool |
$1.99
|
| Rate for Payer: Mclaren Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.74
|
| Rate for Payer: Nomi Health Commercial |
$1.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.80
|
| Rate for Payer: Priority Health Narrow Network |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.80
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: ASR ASR |
$2.65
|
| Rate for Payer: ASR Commercial |
$2.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Healthscope Whirlpool |
$2.65
|
| Rate for Payer: Mclaren Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: Nomi Health Commercial |
$2.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.40
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$2.05
|
|
|
Service Code
|
NDC 60687067711
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: ASR ASR |
$1.99
|
| Rate for Payer: ASR Commercial |
$1.99
|
| Rate for Payer: BCBS Trust/PPO |
$1.67
|
| Rate for Payer: BCN Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$1.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.64
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Healthscope Whirlpool |
$1.99
|
| Rate for Payer: Mclaren Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.74
|
| Rate for Payer: Nomi Health Commercial |
$1.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.80
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$64.75
|
|
|
Service Code
|
NDC 65862067601
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$64.75 |
| Rate for Payer: Aetna Commercial |
$58.28
|
| Rate for Payer: Aetna Medicare |
$32.38
|
| Rate for Payer: ASR ASR |
$62.81
|
| Rate for Payer: ASR Commercial |
$62.81
|
| Rate for Payer: BCBS Complete |
$25.90
|
| Rate for Payer: BCBS Trust/PPO |
$53.02
|
| Rate for Payer: BCN Commercial |
$50.20
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cofinity Commercial |
$60.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$64.75
|
| Rate for Payer: Healthscope Whirlpool |
$62.81
|
| Rate for Payer: Mclaren Commercial |
$58.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.04
|
| Rate for Payer: Nomi Health Commercial |
$53.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.73
|
| Rate for Payer: Priority Health Narrow Network |
$45.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.98
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$64.75
|
|
|
Service Code
|
NDC 65862067601
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.09 |
| Max. Negotiated Rate |
$64.75 |
| Rate for Payer: Aetna Commercial |
$58.28
|
| Rate for Payer: ASR ASR |
$62.81
|
| Rate for Payer: ASR Commercial |
$62.81
|
| Rate for Payer: BCBS Trust/PPO |
$52.76
|
| Rate for Payer: BCN Commercial |
$50.20
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cofinity Commercial |
$60.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$64.75
|
| Rate for Payer: Healthscope Whirlpool |
$62.81
|
| Rate for Payer: Mclaren Commercial |
$58.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.04
|
| Rate for Payer: Nomi Health Commercial |
$53.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.98
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$0.93
|
|
|
Service Code
|
NDC 51079078901
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.47
|
| Rate for Payer: ASR ASR |
$0.90
|
| Rate for Payer: ASR Commercial |
$0.90
|
| Rate for Payer: BCBS Complete |
$0.37
|
| Rate for Payer: BCBS Trust/PPO |
$0.76
|
| Rate for Payer: BCN Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$0.93
|
| Rate for Payer: Healthscope Whirlpool |
$0.90
|
| Rate for Payer: Mclaren Commercial |
$0.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.79
|
| Rate for Payer: Nomi Health Commercial |
$0.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.81
|
| Rate for Payer: Priority Health Narrow Network |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.82
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$59.50
|
|
|
Service Code
|
NDC 65862067701
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.68 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: ASR ASR |
$57.72
|
| Rate for Payer: ASR Commercial |
$57.72
|
| Rate for Payer: BCBS Trust/PPO |
$48.49
|
| Rate for Payer: BCN Commercial |
$46.13
|
| Rate for Payer: Cash Price |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.60
|
| Rate for Payer: Healthscope Commercial |
$59.50
|
| Rate for Payer: Healthscope Whirlpool |
$57.72
|
| Rate for Payer: Mclaren Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.58
|
| Rate for Payer: Nomi Health Commercial |
$48.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.36
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$59.50
|
|
|
Service Code
|
NDC 65862067701
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: Aetna Medicare |
$29.75
|
| Rate for Payer: ASR ASR |
$57.72
|
| Rate for Payer: ASR Commercial |
$57.72
|
| Rate for Payer: BCBS Complete |
$23.80
|
| Rate for Payer: BCBS Trust/PPO |
$48.72
|
| Rate for Payer: BCN Commercial |
$46.13
|
| Rate for Payer: Cash Price |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.60
|
| Rate for Payer: Healthscope Commercial |
$59.50
|
| Rate for Payer: Healthscope Whirlpool |
$57.72
|
| Rate for Payer: Mclaren Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.58
|
| Rate for Payer: Nomi Health Commercial |
$48.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.13
|
| Rate for Payer: Priority Health Narrow Network |
$41.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.36
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$0.93
|
|
|
Service Code
|
NDC 51079078901
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: ASR ASR |
$0.90
|
| Rate for Payer: ASR Commercial |
$0.90
|
| Rate for Payer: BCBS Trust/PPO |
$0.76
|
| Rate for Payer: BCN Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$0.93
|
| Rate for Payer: Healthscope Whirlpool |
$0.90
|
| Rate for Payer: Mclaren Commercial |
$0.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.79
|
| Rate for Payer: Nomi Health Commercial |
$0.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.82
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,743.40 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: ASR Commercial |
$27,970.92
|
| Rate for Payer: BCBS Trust/PPO |
$23,498.46
|
| Rate for Payer: BCN Commercial |
$22,356.55
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$28,836.00
|
| Rate for Payer: Healthscope Whirlpool |
$27,970.92
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.03 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: Aetna Medicare |
$91.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.35
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: ASR Commercial |
$27,970.92
|
| Rate for Payer: BCBS Complete |
$51.48
|
| Rate for Payer: BCBS MAPPO |
$91.48
|
| Rate for Payer: BCBS Trust/PPO |
$23,613.80
|
| Rate for Payer: BCN Commercial |
$22,356.55
|
| Rate for Payer: BCN Medicare Advantage |
$91.48
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.48
|
| Rate for Payer: Healthscope Commercial |
$28,836.00
|
| Rate for Payer: Healthscope Whirlpool |
$27,970.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$91.48
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Mclaren Medicaid |
$49.03
|
| Rate for Payer: Mclaren Medicare |
$91.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.05
|
| Rate for Payer: Meridian Medicaid |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: PACE Medicare |
$86.91
|
| Rate for Payer: PACE SWMI |
$91.48
|
| Rate for Payer: PHP Commercial |
$100.63
|
| Rate for Payer: PHP Medicaid |
$49.03
|
| Rate for Payer: PHP Medicare Advantage |
$91.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.91
|
| Rate for Payer: Priority Health Medicare |
$91.48
|
| Rate for Payer: Priority Health Narrow Network |
$75.93
|
| Rate for Payer: Railroad Medicare Medicare |
$91.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.48
|
| Rate for Payer: UHC Exchange |
$141.79
|
| Rate for Payer: UHC Medicare Advantage |
$91.48
|
| Rate for Payer: UHCCP DNSP |
$91.48
|
| Rate for Payer: UHCCP Medicaid |
$49.03
|
| Rate for Payer: VA VA |
$91.48
|
|
|
ALTEPLASE 100 MG IV INFUSION FOR STROKE
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,743.40 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: ASR Commercial |
$27,970.92
|
| Rate for Payer: BCBS Trust/PPO |
$23,498.46
|
| Rate for Payer: BCN Commercial |
$22,356.55
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$28,836.00
|
| Rate for Payer: Healthscope Whirlpool |
$27,970.92
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
|
|
ALTEPLASE 100 MG IV INFUSION FOR STROKE
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.03 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: Aetna Medicare |
$91.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.35
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: ASR Commercial |
$27,970.92
|
| Rate for Payer: BCBS Complete |
$51.48
|
| Rate for Payer: BCBS MAPPO |
$91.48
|
| Rate for Payer: BCBS Trust/PPO |
$23,613.80
|
| Rate for Payer: BCN Commercial |
$22,356.55
|
| Rate for Payer: BCN Medicare Advantage |
$91.48
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.48
|
| Rate for Payer: Healthscope Commercial |
$28,836.00
|
| Rate for Payer: Healthscope Whirlpool |
$27,970.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$91.48
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Mclaren Medicaid |
$49.03
|
| Rate for Payer: Mclaren Medicare |
$91.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.05
|
| Rate for Payer: Meridian Medicaid |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: PACE Medicare |
$86.91
|
| Rate for Payer: PACE SWMI |
$91.48
|
| Rate for Payer: PHP Commercial |
$100.63
|
| Rate for Payer: PHP Medicaid |
$49.03
|
| Rate for Payer: PHP Medicare Advantage |
$91.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.91
|
| Rate for Payer: Priority Health Medicare |
$91.48
|
| Rate for Payer: Priority Health Narrow Network |
$75.93
|
| Rate for Payer: Railroad Medicare Medicare |
$91.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.48
|
| Rate for Payer: UHC Exchange |
$141.79
|
| Rate for Payer: UHC Medicare Advantage |
$91.48
|
| Rate for Payer: UHCCP DNSP |
$91.48
|
| Rate for Payer: UHCCP Medicaid |
$49.03
|
| Rate for Payer: VA VA |
$91.48
|
|
|
ALTEPLASE 100MG IV SOLUTION FOR PE
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.03 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: Aetna Medicare |
$91.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.35
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: ASR Commercial |
$27,970.92
|
| Rate for Payer: BCBS Complete |
$51.48
|
| Rate for Payer: BCBS MAPPO |
$91.48
|
| Rate for Payer: BCBS Trust/PPO |
$23,613.80
|
| Rate for Payer: BCN Commercial |
$22,356.55
|
| Rate for Payer: BCN Medicare Advantage |
$91.48
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.48
|
| Rate for Payer: Healthscope Commercial |
$28,836.00
|
| Rate for Payer: Healthscope Whirlpool |
$27,970.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$91.48
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Mclaren Medicaid |
$49.03
|
| Rate for Payer: Mclaren Medicare |
$91.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.05
|
| Rate for Payer: Meridian Medicaid |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: PACE Medicare |
$86.91
|
| Rate for Payer: PACE SWMI |
$91.48
|
| Rate for Payer: PHP Commercial |
$100.63
|
| Rate for Payer: PHP Medicaid |
$49.03
|
| Rate for Payer: PHP Medicare Advantage |
$91.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.91
|
| Rate for Payer: Priority Health Medicare |
$91.48
|
| Rate for Payer: Priority Health Narrow Network |
$75.93
|
| Rate for Payer: Railroad Medicare Medicare |
$91.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.48
|
| Rate for Payer: UHC Exchange |
$141.79
|
| Rate for Payer: UHC Medicare Advantage |
$91.48
|
| Rate for Payer: UHCCP DNSP |
$91.48
|
| Rate for Payer: UHCCP Medicaid |
$49.03
|
| Rate for Payer: VA VA |
$91.48
|
|
|
ALTEPLASE 100MG IV SOLUTION FOR PE
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,743.40 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: ASR Commercial |
$27,970.92
|
| Rate for Payer: BCBS Trust/PPO |
$23,498.46
|
| Rate for Payer: BCN Commercial |
$22,356.55
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$28,836.00
|
| Rate for Payer: Healthscope Whirlpool |
$27,970.92
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION
|
Facility
|
OP
|
$640.92
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
31310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.03 |
| Max. Negotiated Rate |
$640.92 |
| Rate for Payer: Aetna Commercial |
$576.83
|
| Rate for Payer: Aetna Commercial |
$576.79
|
| Rate for Payer: Aetna Medicare |
$91.48
|
| Rate for Payer: Aetna Medicare |
$91.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.35
|
| Rate for Payer: ASR ASR |
$621.69
|
| Rate for Payer: ASR ASR |
$621.65
|
| Rate for Payer: ASR Commercial |
$621.69
|
| Rate for Payer: ASR Commercial |
$621.65
|
| Rate for Payer: BCBS Complete |
$51.48
|
| Rate for Payer: BCBS Complete |
$51.48
|
| Rate for Payer: BCBS MAPPO |
$91.48
|
| Rate for Payer: BCBS MAPPO |
$91.48
|
| Rate for Payer: BCBS Trust/PPO |
$524.82
|
| Rate for Payer: BCBS Trust/PPO |
$524.85
|
| Rate for Payer: BCN Commercial |
$496.87
|
| Rate for Payer: BCN Commercial |
$496.91
|
| Rate for Payer: BCN Medicare Advantage |
$91.48
|
| Rate for Payer: BCN Medicare Advantage |
$91.48
|
| Rate for Payer: Cash Price |
$512.71
|
| Rate for Payer: Cash Price |
$512.71
|
| Rate for Payer: Cash Price |
$512.73
|
| Rate for Payer: Cash Price |
$512.73
|
| Rate for Payer: Cofinity Commercial |
$602.46
|
| Rate for Payer: Cofinity Commercial |
$602.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.48
|
| Rate for Payer: Healthscope Commercial |
$640.88
|
| Rate for Payer: Healthscope Commercial |
$640.92
|
| Rate for Payer: Healthscope Whirlpool |
$621.69
|
| Rate for Payer: Healthscope Whirlpool |
$621.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$91.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$91.48
|
| Rate for Payer: Mclaren Commercial |
$576.83
|
| Rate for Payer: Mclaren Commercial |
$576.79
|
| Rate for Payer: Mclaren Medicaid |
$49.03
|
| Rate for Payer: Mclaren Medicaid |
$49.03
|
| Rate for Payer: Mclaren Medicare |
$91.48
|
| Rate for Payer: Mclaren Medicare |
$91.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.05
|
| Rate for Payer: Meridian Medicaid |
$51.48
|
| Rate for Payer: Meridian Medicaid |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.75
|
| Rate for Payer: Nomi Health Commercial |
$525.52
|
| Rate for Payer: Nomi Health Commercial |
$525.55
|
| Rate for Payer: PACE Medicare |
$86.91
|
| Rate for Payer: PACE Medicare |
$86.91
|
| Rate for Payer: PACE SWMI |
$91.48
|
| Rate for Payer: PACE SWMI |
$91.48
|
| Rate for Payer: PHP Commercial |
$100.63
|
| Rate for Payer: PHP Commercial |
$100.63
|
| Rate for Payer: PHP Medicaid |
$49.03
|
| Rate for Payer: PHP Medicaid |
$49.03
|
| Rate for Payer: PHP Medicare Advantage |
$91.48
|
| Rate for Payer: PHP Medicare Advantage |
$91.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.91
|
| Rate for Payer: Priority Health Medicare |
$91.48
|
| Rate for Payer: Priority Health Medicare |
$91.48
|
| Rate for Payer: Priority Health Narrow Network |
$75.93
|
| Rate for Payer: Priority Health Narrow Network |
$75.93
|
| Rate for Payer: Railroad Medicare Medicare |
$91.48
|
| Rate for Payer: Railroad Medicare Medicare |
$91.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$563.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$564.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.48
|
| Rate for Payer: UHC Exchange |
$141.79
|
| Rate for Payer: UHC Exchange |
$141.79
|
| Rate for Payer: UHC Medicare Advantage |
$91.48
|
| Rate for Payer: UHC Medicare Advantage |
$91.48
|
| Rate for Payer: UHCCP DNSP |
$91.48
|
| Rate for Payer: UHCCP DNSP |
$91.48
|
| Rate for Payer: UHCCP Medicaid |
$49.03
|
| Rate for Payer: UHCCP Medicaid |
$49.03
|
| Rate for Payer: VA VA |
$91.48
|
| Rate for Payer: VA VA |
$91.48
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION
|
Facility
|
IP
|
$640.88
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
31310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$416.57 |
| Max. Negotiated Rate |
$640.88 |
| Rate for Payer: Aetna Commercial |
$576.79
|
| Rate for Payer: Aetna Commercial |
$576.83
|
| Rate for Payer: ASR ASR |
$621.69
|
| Rate for Payer: ASR ASR |
$621.65
|
| Rate for Payer: ASR Commercial |
$621.65
|
| Rate for Payer: ASR Commercial |
$621.69
|
| Rate for Payer: BCBS Trust/PPO |
$522.29
|
| Rate for Payer: BCBS Trust/PPO |
$522.25
|
| Rate for Payer: BCN Commercial |
$496.87
|
| Rate for Payer: BCN Commercial |
$496.91
|
| Rate for Payer: Cash Price |
$512.71
|
| Rate for Payer: Cash Price |
$512.73
|
| Rate for Payer: Cofinity Commercial |
$602.46
|
| Rate for Payer: Cofinity Commercial |
$602.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.70
|
| Rate for Payer: Healthscope Commercial |
$640.88
|
| Rate for Payer: Healthscope Commercial |
$640.92
|
| Rate for Payer: Healthscope Whirlpool |
$621.69
|
| Rate for Payer: Healthscope Whirlpool |
$621.65
|
| Rate for Payer: Mclaren Commercial |
$576.83
|
| Rate for Payer: Mclaren Commercial |
$576.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.75
|
| Rate for Payer: Nomi Health Commercial |
$525.52
|
| Rate for Payer: Nomi Health Commercial |
$525.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$564.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$563.97
|
|
|
ALTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.03 |
| Max. Negotiated Rate |
$14,418.00 |
| Rate for Payer: Aetna Commercial |
$12,976.20
|
| Rate for Payer: Aetna Medicare |
$91.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.35
|
| Rate for Payer: ASR ASR |
$13,985.46
|
| Rate for Payer: ASR Commercial |
$13,985.46
|
| Rate for Payer: BCBS Complete |
$51.48
|
| Rate for Payer: BCBS MAPPO |
$91.48
|
| Rate for Payer: BCBS Trust/PPO |
$11,806.90
|
| Rate for Payer: BCN Commercial |
$11,178.28
|
| Rate for Payer: BCN Medicare Advantage |
$91.48
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Commercial |
$13,552.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.48
|
| Rate for Payer: Healthscope Commercial |
$14,418.00
|
| Rate for Payer: Healthscope Whirlpool |
$13,985.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$91.48
|
| Rate for Payer: Mclaren Commercial |
$12,976.20
|
| Rate for Payer: Mclaren Medicaid |
$49.03
|
| Rate for Payer: Mclaren Medicare |
$91.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.05
|
| Rate for Payer: Meridian Medicaid |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: Nomi Health Commercial |
$11,822.76
|
| Rate for Payer: PACE Medicare |
$86.91
|
| Rate for Payer: PACE SWMI |
$91.48
|
| Rate for Payer: PHP Commercial |
$100.63
|
| Rate for Payer: PHP Medicaid |
$49.03
|
| Rate for Payer: PHP Medicare Advantage |
$91.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,371.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.91
|
| Rate for Payer: Priority Health Medicare |
$91.48
|
| Rate for Payer: Priority Health Narrow Network |
$75.93
|
| Rate for Payer: Railroad Medicare Medicare |
$91.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,687.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.48
|
| Rate for Payer: UHC Exchange |
$141.79
|
| Rate for Payer: UHC Medicare Advantage |
$91.48
|
| Rate for Payer: UHCCP DNSP |
$91.48
|
| Rate for Payer: UHCCP Medicaid |
$49.03
|
| Rate for Payer: VA VA |
$91.48
|
|
|
ALTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,371.70 |
| Max. Negotiated Rate |
$14,418.00 |
| Rate for Payer: Aetna Commercial |
$12,976.20
|
| Rate for Payer: ASR ASR |
$13,985.46
|
| Rate for Payer: ASR Commercial |
$13,985.46
|
| Rate for Payer: BCBS Trust/PPO |
$11,749.23
|
| Rate for Payer: BCN Commercial |
$11,178.28
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Commercial |
$13,552.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Healthscope Commercial |
$14,418.00
|
| Rate for Payer: Healthscope Whirlpool |
$13,985.46
|
| Rate for Payer: Mclaren Commercial |
$12,976.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: Nomi Health Commercial |
$11,822.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,371.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,687.84
|
|
|
ALTEPLASE INFUSION FOR CARDIAC ARREST
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
300766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,743.40 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: ASR Commercial |
$27,970.92
|
| Rate for Payer: BCBS Trust/PPO |
$23,498.46
|
| Rate for Payer: BCN Commercial |
$22,356.55
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$28,836.00
|
| Rate for Payer: Healthscope Whirlpool |
$27,970.92
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
|
|
ALTEPLASE INFUSION FOR CARDIAC ARREST
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
300766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.03 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: Aetna Medicare |
$91.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.35
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: ASR Commercial |
$27,970.92
|
| Rate for Payer: BCBS Complete |
$51.48
|
| Rate for Payer: BCBS MAPPO |
$91.48
|
| Rate for Payer: BCBS Trust/PPO |
$23,613.80
|
| Rate for Payer: BCN Commercial |
$22,356.55
|
| Rate for Payer: BCN Medicare Advantage |
$91.48
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.48
|
| Rate for Payer: Healthscope Commercial |
$28,836.00
|
| Rate for Payer: Healthscope Whirlpool |
$27,970.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$91.48
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Mclaren Medicaid |
$49.03
|
| Rate for Payer: Mclaren Medicare |
$91.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.05
|
| Rate for Payer: Meridian Medicaid |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: PACE Medicare |
$86.91
|
| Rate for Payer: PACE SWMI |
$91.48
|
| Rate for Payer: PHP Commercial |
$100.63
|
| Rate for Payer: PHP Medicaid |
$49.03
|
| Rate for Payer: PHP Medicare Advantage |
$91.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.91
|
| Rate for Payer: Priority Health Medicare |
$91.48
|
| Rate for Payer: Priority Health Narrow Network |
$75.93
|
| Rate for Payer: Railroad Medicare Medicare |
$91.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.48
|
| Rate for Payer: UHC Exchange |
$141.79
|
| Rate for Payer: UHC Medicare Advantage |
$91.48
|
| Rate for Payer: UHCCP DNSP |
$91.48
|
| Rate for Payer: UHCCP Medicaid |
$49.03
|
| Rate for Payer: VA VA |
$91.48
|
|
|
ALTEPLASE IV BOLUS (FROM KIT)
|
Facility
|
OP
|
$141.79
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150840
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.03 |
| Max. Negotiated Rate |
$141.79 |
| Rate for Payer: Aetna Medicare |
$91.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.35
|
| Rate for Payer: BCBS Complete |
$51.48
|
| Rate for Payer: BCBS MAPPO |
$91.48
|
| Rate for Payer: BCN Medicare Advantage |
$91.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$91.48
|
| Rate for Payer: Mclaren Medicaid |
$49.03
|
| Rate for Payer: Mclaren Medicare |
$91.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.05
|
| Rate for Payer: Meridian Medicaid |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.20
|
| Rate for Payer: PACE Medicare |
$86.91
|
| Rate for Payer: PACE SWMI |
$91.48
|
| Rate for Payer: PHP Commercial |
$100.63
|
| Rate for Payer: PHP Medicaid |
$49.03
|
| Rate for Payer: PHP Medicare Advantage |
$91.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.91
|
| Rate for Payer: Priority Health Medicare |
$91.48
|
| Rate for Payer: Priority Health Narrow Network |
$75.93
|
| Rate for Payer: Railroad Medicare Medicare |
$91.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.48
|
| Rate for Payer: UHC Exchange |
$141.79
|
| Rate for Payer: UHC Medicare Advantage |
$91.48
|
| Rate for Payer: UHCCP DNSP |
$91.48
|
| Rate for Payer: UHCCP Medicaid |
$49.03
|
| Rate for Payer: VA VA |
$91.48
|
|
