|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$3.78
|
|
|
Service Code
|
NDC 50268085511
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: ASR ASR |
$3.67
|
| Rate for Payer: BCBS Trust/PPO |
$3.11
|
| Rate for Payer: BCN Commercial |
$3.11
|
| Rate for Payer: Cash Price |
$3.03
|
| Rate for Payer: Cofinity Commercial |
$3.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.03
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Healthscope Whirlpool |
$3.78
|
| Rate for Payer: Mclaren Commercial |
$3.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.22
|
| Rate for Payer: Nomi Health Commercial |
$3.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.33
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$171.55
|
|
|
Service Code
|
NDC 20555000600
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.66 |
| Max. Negotiated Rate |
$171.55 |
| Rate for Payer: Aetna Commercial |
$154.40
|
| Rate for Payer: ASR ASR |
$166.40
|
| Rate for Payer: BCBS Trust/PPO |
$140.88
|
| Rate for Payer: BCN Commercial |
$140.88
|
| Rate for Payer: Cash Price |
$137.24
|
| Rate for Payer: Cofinity Commercial |
$161.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.24
|
| Rate for Payer: Healthscope Commercial |
$166.40
|
| Rate for Payer: Healthscope Whirlpool |
$171.55
|
| Rate for Payer: Mclaren Commercial |
$154.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.82
|
| Rate for Payer: Nomi Health Commercial |
$140.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.96
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
OP
|
$171.55
|
|
|
Service Code
|
NDC 20555000600
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$171.55 |
| Rate for Payer: Aetna Commercial |
$154.40
|
| Rate for Payer: Aetna Medicare |
$63.47
|
| Rate for Payer: ASR ASR |
$166.40
|
| Rate for Payer: BCBS Complete |
$68.62
|
| Rate for Payer: BCBS Trust/PPO |
$141.44
|
| Rate for Payer: BCN Commercial |
$141.44
|
| Rate for Payer: Cash Price |
$137.24
|
| Rate for Payer: Cofinity Commercial |
$161.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.24
|
| Rate for Payer: Healthscope Commercial |
$166.40
|
| Rate for Payer: Healthscope Whirlpool |
$171.55
|
| Rate for Payer: Mclaren Commercial |
$154.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.82
|
| Rate for Payer: Nomi Health Commercial |
$140.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$150.31
|
| Rate for Payer: Priority Health Narrow Network |
$120.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.96
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
OP
|
$404.20
|
|
|
Service Code
|
NDC 77333093810
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.55 |
| Max. Negotiated Rate |
$404.20 |
| Rate for Payer: Aetna Commercial |
$363.78
|
| Rate for Payer: Aetna Medicare |
$149.55
|
| Rate for Payer: ASR ASR |
$392.07
|
| Rate for Payer: BCBS Complete |
$161.68
|
| Rate for Payer: BCBS Trust/PPO |
$333.26
|
| Rate for Payer: BCN Commercial |
$333.26
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$392.07
|
| Rate for Payer: Healthscope Whirlpool |
$404.20
|
| Rate for Payer: Mclaren Commercial |
$363.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$354.16
|
| Rate for Payer: Priority Health Narrow Network |
$283.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.70
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$4.04
|
|
|
Service Code
|
NDC 77333093825
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.64
|
| Rate for Payer: ASR ASR |
$3.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.23
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Healthscope Whirlpool |
$4.04
|
| Rate for Payer: Mclaren Commercial |
$3.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.44
|
| Rate for Payer: Nomi Health Commercial |
$3.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.56
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$18.86
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: ASR ASR |
$18.29
|
| Rate for Payer: BCBS Trust/PPO |
$15.48
|
| Rate for Payer: BCN Commercial |
$15.48
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$18.29
|
| Rate for Payer: Healthscope Whirlpool |
$18.86
|
| Rate for Payer: Mclaren Commercial |
$16.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.03
|
| Rate for Payer: Nomi Health Commercial |
$15.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.59
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$110.01
|
|
|
Service Code
|
NDC 65039602
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: ASR ASR |
$106.70
|
| Rate for Payer: BCBS Trust/PPO |
$90.34
|
| Rate for Payer: BCN Commercial |
$90.34
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$103.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Healthscope Commercial |
$106.70
|
| Rate for Payer: Healthscope Whirlpool |
$110.00
|
| Rate for Payer: Mclaren Commercial |
$99.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.50
|
| Rate for Payer: Nomi Health Commercial |
$90.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.80
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$40.25
|
|
|
Service Code
|
NDC 24208073501
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.19 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna Commercial |
$36.23
|
| Rate for Payer: ASR ASR |
$39.04
|
| Rate for Payer: BCBS Trust/PPO |
$33.05
|
| Rate for Payer: BCN Commercial |
$33.05
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Healthscope Commercial |
$39.04
|
| Rate for Payer: Healthscope Whirlpool |
$40.25
|
| Rate for Payer: Mclaren Commercial |
$36.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Nomi Health Commercial |
$33.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.42
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$16.97
|
|
|
Service Code
|
NDC 61314039601
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$16.96 |
| Rate for Payer: Aetna Commercial |
$15.27
|
| Rate for Payer: Aetna Medicare |
$6.28
|
| Rate for Payer: ASR ASR |
$16.46
|
| Rate for Payer: BCBS Complete |
$6.79
|
| Rate for Payer: BCBS Trust/PPO |
$13.99
|
| Rate for Payer: BCN Commercial |
$13.99
|
| Rate for Payer: Cash Price |
$13.57
|
| Rate for Payer: Cofinity Commercial |
$15.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.57
|
| Rate for Payer: Healthscope Commercial |
$16.46
|
| Rate for Payer: Healthscope Whirlpool |
$16.96
|
| Rate for Payer: Mclaren Commercial |
$15.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.42
|
| Rate for Payer: Nomi Health Commercial |
$13.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.86
|
| Rate for Payer: Priority Health Narrow Network |
$11.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.93
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$18.86
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: ASR ASR |
$18.29
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: BCBS Trust/PPO |
$15.55
|
| Rate for Payer: BCN Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$18.29
|
| Rate for Payer: Healthscope Whirlpool |
$18.86
|
| Rate for Payer: Mclaren Commercial |
$16.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.03
|
| Rate for Payer: Nomi Health Commercial |
$15.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.52
|
| Rate for Payer: Priority Health Narrow Network |
$13.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.59
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$16.97
|
|
|
Service Code
|
NDC 61314039601
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$16.96 |
| Rate for Payer: Aetna Commercial |
$15.27
|
| Rate for Payer: ASR ASR |
$16.46
|
| Rate for Payer: BCBS Trust/PPO |
$13.93
|
| Rate for Payer: BCN Commercial |
$13.93
|
| Rate for Payer: Cash Price |
$13.57
|
| Rate for Payer: Cofinity Commercial |
$15.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.57
|
| Rate for Payer: Healthscope Commercial |
$16.46
|
| Rate for Payer: Healthscope Whirlpool |
$16.96
|
| Rate for Payer: Mclaren Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.42
|
| Rate for Payer: Nomi Health Commercial |
$13.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.93
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$40.25
|
|
|
Service Code
|
NDC 24208073501
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna Commercial |
$36.23
|
| Rate for Payer: Aetna Medicare |
$14.89
|
| Rate for Payer: ASR ASR |
$39.04
|
| Rate for Payer: BCBS Complete |
$16.10
|
| Rate for Payer: BCBS Trust/PPO |
$33.19
|
| Rate for Payer: BCN Commercial |
$33.19
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Healthscope Commercial |
$39.04
|
| Rate for Payer: Healthscope Whirlpool |
$40.25
|
| Rate for Payer: Mclaren Commercial |
$36.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Nomi Health Commercial |
$33.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35.27
|
| Rate for Payer: Priority Health Narrow Network |
$28.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.42
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$110.01
|
|
|
Service Code
|
NDC 65039602
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Medicare |
$40.70
|
| Rate for Payer: ASR ASR |
$106.70
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS Trust/PPO |
$90.70
|
| Rate for Payer: BCN Commercial |
$90.70
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$103.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Healthscope Commercial |
$106.70
|
| Rate for Payer: Healthscope Whirlpool |
$110.00
|
| Rate for Payer: Mclaren Commercial |
$99.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.50
|
| Rate for Payer: Nomi Health Commercial |
$90.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$96.39
|
| Rate for Payer: Priority Health Narrow Network |
$77.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.80
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE
|
Facility
|
IP
|
$221.76
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.32 |
| Max. Negotiated Rate |
$221.76 |
| Rate for Payer: Aetna Commercial |
$199.58
|
| Rate for Payer: Aetna Commercial |
$6.65
|
| Rate for Payer: ASR ASR |
$7.17
|
| Rate for Payer: ASR ASR |
$215.11
|
| Rate for Payer: BCBS Trust/PPO |
$6.07
|
| Rate for Payer: BCBS Trust/PPO |
$182.11
|
| Rate for Payer: BCN Commercial |
$6.07
|
| Rate for Payer: BCN Commercial |
$182.11
|
| Rate for Payer: Cash Price |
$5.91
|
| Rate for Payer: Cash Price |
$177.41
|
| Rate for Payer: Cofinity Commercial |
$208.45
|
| Rate for Payer: Cofinity Commercial |
$6.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.41
|
| Rate for Payer: Healthscope Commercial |
$215.11
|
| Rate for Payer: Healthscope Commercial |
$7.17
|
| Rate for Payer: Healthscope Whirlpool |
$7.39
|
| Rate for Payer: Healthscope Whirlpool |
$221.76
|
| Rate for Payer: Mclaren Commercial |
$6.65
|
| Rate for Payer: Mclaren Commercial |
$199.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.50
|
| Rate for Payer: Nomi Health Commercial |
$6.06
|
| Rate for Payer: Nomi Health Commercial |
$181.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.50
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE
|
Facility
|
OP
|
$7.39
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$7.39 |
| Rate for Payer: Aetna Commercial |
$6.65
|
| Rate for Payer: Aetna Commercial |
$199.58
|
| Rate for Payer: Aetna Medicare |
$82.05
|
| Rate for Payer: Aetna Medicare |
$2.74
|
| Rate for Payer: ASR ASR |
$7.17
|
| Rate for Payer: ASR ASR |
$215.11
|
| Rate for Payer: BCBS Complete |
$88.70
|
| Rate for Payer: BCBS Complete |
$2.96
|
| Rate for Payer: BCBS Trust/PPO |
$6.09
|
| Rate for Payer: BCBS Trust/PPO |
$182.84
|
| Rate for Payer: BCN Commercial |
$182.84
|
| Rate for Payer: BCN Commercial |
$6.09
|
| Rate for Payer: Cash Price |
$5.91
|
| Rate for Payer: Cash Price |
$177.41
|
| Rate for Payer: Cash Price |
$5.91
|
| Rate for Payer: Cash Price |
$177.41
|
| Rate for Payer: Cofinity Commercial |
$208.45
|
| Rate for Payer: Cofinity Commercial |
$6.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.41
|
| Rate for Payer: Healthscope Commercial |
$7.17
|
| Rate for Payer: Healthscope Commercial |
$215.11
|
| Rate for Payer: Healthscope Whirlpool |
$7.39
|
| Rate for Payer: Healthscope Whirlpool |
$221.76
|
| Rate for Payer: Mclaren Commercial |
$6.65
|
| Rate for Payer: Mclaren Commercial |
$199.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.28
|
| Rate for Payer: Nomi Health Commercial |
$181.84
|
| Rate for Payer: Nomi Health Commercial |
$6.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.88
|
| Rate for Payer: Priority Health Narrow Network |
$1.50
|
| Rate for Payer: Priority Health Narrow Network |
$1.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.50
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE
|
Facility
|
IP
|
$122.84
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
28842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$122.83 |
| Rate for Payer: Aetna Commercial |
$110.55
|
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: ASR ASR |
$3.97
|
| Rate for Payer: ASR ASR |
$119.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.36
|
| Rate for Payer: BCBS Trust/PPO |
$100.87
|
| Rate for Payer: BCN Commercial |
$3.36
|
| Rate for Payer: BCN Commercial |
$100.87
|
| Rate for Payer: Cash Price |
$3.28
|
| Rate for Payer: Cash Price |
$98.27
|
| Rate for Payer: Cofinity Commercial |
$115.46
|
| Rate for Payer: Cofinity Commercial |
$3.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.27
|
| Rate for Payer: Healthscope Commercial |
$119.15
|
| Rate for Payer: Healthscope Commercial |
$3.97
|
| Rate for Payer: Healthscope Whirlpool |
$4.09
|
| Rate for Payer: Healthscope Whirlpool |
$122.83
|
| Rate for Payer: Mclaren Commercial |
$3.69
|
| Rate for Payer: Mclaren Commercial |
$110.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.41
|
| Rate for Payer: Nomi Health Commercial |
$3.36
|
| Rate for Payer: Nomi Health Commercial |
$100.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.60
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE
|
Facility
|
OP
|
$4.10
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
28842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: Aetna Commercial |
$110.55
|
| Rate for Payer: Aetna Medicare |
$45.45
|
| Rate for Payer: Aetna Medicare |
$1.52
|
| Rate for Payer: ASR ASR |
$3.97
|
| Rate for Payer: ASR ASR |
$119.15
|
| Rate for Payer: BCBS Complete |
$49.13
|
| Rate for Payer: BCBS Complete |
$1.64
|
| Rate for Payer: BCBS Trust/PPO |
$3.38
|
| Rate for Payer: BCBS Trust/PPO |
$101.28
|
| Rate for Payer: BCN Commercial |
$101.28
|
| Rate for Payer: BCN Commercial |
$3.38
|
| Rate for Payer: Cash Price |
$3.28
|
| Rate for Payer: Cash Price |
$98.27
|
| Rate for Payer: Cash Price |
$3.28
|
| Rate for Payer: Cash Price |
$98.27
|
| Rate for Payer: Cofinity Commercial |
$115.46
|
| Rate for Payer: Cofinity Commercial |
$3.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.27
|
| Rate for Payer: Healthscope Commercial |
$3.97
|
| Rate for Payer: Healthscope Commercial |
$119.15
|
| Rate for Payer: Healthscope Whirlpool |
$4.09
|
| Rate for Payer: Healthscope Whirlpool |
$122.83
|
| Rate for Payer: Mclaren Commercial |
$3.69
|
| Rate for Payer: Mclaren Commercial |
$110.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: Nomi Health Commercial |
$100.72
|
| Rate for Payer: Nomi Health Commercial |
$3.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.55
|
| Rate for Payer: Priority Health Narrow Network |
$0.44
|
| Rate for Payer: Priority Health Narrow Network |
$0.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.60
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$14,655.34
|
|
|
Service Code
|
APR-DRG 1313
|
| Min. Negotiated Rate |
$13,250.18 |
| Max. Negotiated Rate |
$14,655.34 |
| Rate for Payer: BCBS Complete |
$14,655.34
|
| Rate for Payer: Mclaren Medicaid |
$13,957.47
|
| Rate for Payer: Meridian Medicaid |
$14,655.34
|
| Rate for Payer: PHP Medicaid |
$13,250.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,957.47
|
| Rate for Payer: UHC Medicaid |
$13,957.47
|
| Rate for Payer: UHCCP Medicaid |
$13,957.47
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$15,503.28
|
|
|
Service Code
|
APR-DRG 1314
|
| Min. Negotiated Rate |
$14,016.82 |
| Max. Negotiated Rate |
$15,503.28 |
| Rate for Payer: BCBS Complete |
$15,503.28
|
| Rate for Payer: Mclaren Medicaid |
$14,765.03
|
| Rate for Payer: Meridian Medicaid |
$15,503.28
|
| Rate for Payer: PHP Medicaid |
$14,016.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,765.03
|
| Rate for Payer: UHC Medicaid |
$14,765.03
|
| Rate for Payer: UHCCP Medicaid |
$14,765.03
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$12,109.88
|
|
|
Service Code
|
APR-DRG 1312
|
| Min. Negotiated Rate |
$10,948.78 |
| Max. Negotiated Rate |
$12,109.88 |
| Rate for Payer: BCBS Complete |
$12,109.88
|
| Rate for Payer: Mclaren Medicaid |
$11,533.22
|
| Rate for Payer: Meridian Medicaid |
$12,109.88
|
| Rate for Payer: PHP Medicaid |
$10,948.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,533.22
|
| Rate for Payer: UHC Medicaid |
$11,533.22
|
| Rate for Payer: UHCCP Medicaid |
$11,533.22
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$7,414.04
|
|
|
Service Code
|
APR-DRG 1311
|
| Min. Negotiated Rate |
$6,703.18 |
| Max. Negotiated Rate |
$7,414.04 |
| Rate for Payer: BCBS Complete |
$7,414.04
|
| Rate for Payer: Mclaren Medicaid |
$7,060.99
|
| Rate for Payer: Meridian Medicaid |
$7,414.04
|
| Rate for Payer: PHP Medicaid |
$6,703.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,060.99
|
| Rate for Payer: UHC Medicaid |
$7,060.99
|
| Rate for Payer: UHCCP Medicaid |
$7,060.99
|
|
|
DALBAVANCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,744.00
|
|
|
Service Code
|
HCPCS J0875
|
| Hospital Charge Code |
171111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,058.00 |
| Max. Negotiated Rate |
$6,744.00 |
| Rate for Payer: Aetna Commercial |
$6,069.60
|
| Rate for Payer: ASR ASR |
$6,541.68
|
| Rate for Payer: BCBS Trust/PPO |
$5,538.17
|
| Rate for Payer: BCN Commercial |
$5,538.17
|
| Rate for Payer: Cash Price |
$5,395.20
|
| Rate for Payer: Cofinity Commercial |
$6,339.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,395.20
|
| Rate for Payer: Healthscope Commercial |
$6,541.68
|
| Rate for Payer: Healthscope Whirlpool |
$6,744.00
|
| Rate for Payer: Mclaren Commercial |
$6,069.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,732.40
|
| Rate for Payer: Nomi Health Commercial |
$5,530.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,058.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,934.72
|
|
|
DALBAVANCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,744.00
|
|
|
Service Code
|
HCPCS J0875
|
| Hospital Charge Code |
171111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$6,744.00 |
| Rate for Payer: Aetna Commercial |
$6,069.60
|
| Rate for Payer: Aetna Medicare |
$15.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.75
|
| Rate for Payer: ASR ASR |
$6,541.68
|
| Rate for Payer: BCBS Complete |
$8.24
|
| Rate for Payer: BCBS MAPPO |
$15.00
|
| Rate for Payer: BCBS Trust/PPO |
$5,560.43
|
| Rate for Payer: BCN Commercial |
$5,560.43
|
| Rate for Payer: BCN Medicare Advantage |
$15.00
|
| Rate for Payer: Cash Price |
$5,395.20
|
| Rate for Payer: Cash Price |
$5,395.20
|
| Rate for Payer: Cofinity Commercial |
$6,339.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,395.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.00
|
| Rate for Payer: Healthscope Commercial |
$6,541.68
|
| Rate for Payer: Healthscope Whirlpool |
$6,744.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.00
|
| Rate for Payer: Mclaren Commercial |
$6,069.60
|
| Rate for Payer: Mclaren Medicaid |
$15.00
|
| Rate for Payer: Mclaren Medicare |
$15.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.75
|
| Rate for Payer: Meridian Medicaid |
$8.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,732.40
|
| Rate for Payer: Nomi Health Commercial |
$5,530.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,058.00
|
| Rate for Payer: PACE Medicare |
$14.25
|
| Rate for Payer: PACE SWMI |
$15.00
|
| Rate for Payer: PHP Commercial |
$16.50
|
| Rate for Payer: PHP Medicaid |
$8.04
|
| Rate for Payer: PHP Medicare Advantage |
$15.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.18
|
| Rate for Payer: Priority Health Medicare |
$15.00
|
| Rate for Payer: Priority Health Narrow Network |
$12.94
|
| Rate for Payer: Railroad Medicare Medicare |
$15.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,934.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.00
|
| Rate for Payer: UHC Exchange |
$23.25
|
| Rate for Payer: UHC Medicaid |
$7.84
|
| Rate for Payer: UHCCP DNSP |
$15.00
|
| Rate for Payer: UHCCP Medicaid |
$7.84
|
| Rate for Payer: VA VA |
$15.00
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$292.65
|
|
|
Service Code
|
NDC 42023012306
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$219.48 |
| Max. Negotiated Rate |
$292.64 |
| Rate for Payer: Aetna Commercial |
$263.38
|
| Rate for Payer: ASR ASR |
$283.87
|
| Rate for Payer: BCBS Trust/PPO |
$240.32
|
| Rate for Payer: BCN Commercial |
$240.32
|
| Rate for Payer: Cash Price |
$234.12
|
| Rate for Payer: Cofinity Commercial |
$275.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.12
|
| Rate for Payer: Healthscope Commercial |
$283.87
|
| Rate for Payer: Healthscope Whirlpool |
$292.64
|
| Rate for Payer: Mclaren Commercial |
$263.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.75
|
| Rate for Payer: Nomi Health Commercial |
$239.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.53
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$218.92
|
|
|
Service Code
|
NDC 78670000367
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$218.92 |
| Rate for Payer: Aetna Commercial |
$197.03
|
| Rate for Payer: Aetna Medicare |
$81.00
|
| Rate for Payer: ASR ASR |
$212.35
|
| Rate for Payer: BCBS Complete |
$87.57
|
| Rate for Payer: BCBS Trust/PPO |
$180.50
|
| Rate for Payer: BCN Commercial |
$180.50
|
| Rate for Payer: Cash Price |
$175.13
|
| Rate for Payer: Cofinity Commercial |
$205.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.13
|
| Rate for Payer: Healthscope Commercial |
$212.35
|
| Rate for Payer: Healthscope Whirlpool |
$218.92
|
| Rate for Payer: Mclaren Commercial |
$197.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.08
|
| Rate for Payer: Nomi Health Commercial |
$179.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$191.82
|
| Rate for Payer: Priority Health Narrow Network |
$153.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$192.65
|
|
