|
CIPROFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$45.57
|
|
|
Service Code
|
NDC 61314065605
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$41.01 |
| Rate for Payer: Aetna Commercial |
$38.73
|
| Rate for Payer: Aetna Medicare |
$22.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.62
|
| Rate for Payer: BCBS Complete |
$18.23
|
| Rate for Payer: Cash Price |
$36.46
|
| Rate for Payer: Cofinity Advantage |
$31.90
|
| Rate for Payer: Cofinity Commercial |
$39.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.46
|
| Rate for Payer: Healthscope Commercial |
$41.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.18
|
| Rate for Payer: PHP Commercial |
$38.73
|
| Rate for Payer: Priority Health SBD |
$28.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.62
|
| Rate for Payer: UHC Core |
$23.74
|
| Rate for Payer: UHC Exchange |
$17.91
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$45.57
|
|
|
Service Code
|
NDC 61314065605
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.71 |
| Max. Negotiated Rate |
$41.01 |
| Rate for Payer: Aetna Commercial |
$38.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.62
|
| Rate for Payer: Cash Price |
$36.46
|
| Rate for Payer: Cofinity Advantage |
$31.90
|
| Rate for Payer: Cofinity Commercial |
$39.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.46
|
| Rate for Payer: Healthscope Commercial |
$41.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.18
|
| Rate for Payer: PHP Commercial |
$38.73
|
| Rate for Payer: Priority Health SBD |
$28.71
|
|
|
CIPROFLOXACIN 200 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$73.42
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
91237
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.25 |
| Max. Negotiated Rate |
$66.08 |
| Rate for Payer: Aetna Commercial |
$62.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.72
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Advantage |
$51.39
|
| Rate for Payer: Cofinity Commercial |
$63.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Healthscope Commercial |
$66.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.06
|
| Rate for Payer: PHP Commercial |
$62.41
|
| Rate for Payer: Priority Health SBD |
$46.25
|
|
|
CIPROFLOXACIN 200 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$73.42
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
91237
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$66.08 |
| Rate for Payer: Aetna Commercial |
$62.41
|
| Rate for Payer: Aetna Medicare |
$36.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.72
|
| Rate for Payer: BCBS Complete |
$29.37
|
| Rate for Payer: BCBS Trust/PPO |
$5.00
|
| Rate for Payer: BCN Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Advantage |
$51.39
|
| Rate for Payer: Cofinity Commercial |
$63.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Healthscope Commercial |
$66.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.06
|
| Rate for Payer: PHP Commercial |
$62.41
|
| Rate for Payer: Priority Health SBD |
$46.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.30
|
| Rate for Payer: UHC Core |
$3.30
|
| Rate for Payer: UHC Exchange |
$3.30
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
OP
|
$253.80
|
|
|
Service Code
|
NDC 55111012601
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.74 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna Medicare |
$126.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.97
|
| Rate for Payer: BCBS Complete |
$101.52
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Advantage |
$177.66
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.35
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: Priority Health SBD |
$159.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.97
|
| Rate for Payer: UHC Core |
$132.23
|
| Rate for Payer: UHC Exchange |
$99.74
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 43547068810
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.95 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare |
$77.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.81
|
| Rate for Payer: BCBS Complete |
$62.04
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Advantage |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.33
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health SBD |
$97.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.81
|
| Rate for Payer: UHC Core |
$80.81
|
| Rate for Payer: UHC Exchange |
$60.95
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$361.90
|
|
|
Service Code
|
NDC 65862007601
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Advantage |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.43
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health SBD |
$228.00
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$317.25
|
|
|
Service Code
|
NDC 00143992701
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.87 |
| Max. Negotiated Rate |
$285.52 |
| Rate for Payer: Aetna Commercial |
$269.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.21
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cofinity Advantage |
$222.07
|
| Rate for Payer: Cofinity Commercial |
$272.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.80
|
| Rate for Payer: Healthscope Commercial |
$285.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.94
|
| Rate for Payer: PHP Commercial |
$269.66
|
| Rate for Payer: Priority Health SBD |
$199.87
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$220.90
|
|
|
Service Code
|
NDC 59651086601
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.17 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.59
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Advantage |
$154.63
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.68
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health SBD |
$139.17
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
OP
|
$317.25
|
|
|
Service Code
|
NDC 00143992701
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.68 |
| Max. Negotiated Rate |
$285.52 |
| Rate for Payer: Aetna Commercial |
$269.66
|
| Rate for Payer: Aetna Medicare |
$158.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.21
|
| Rate for Payer: BCBS Complete |
$126.90
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cofinity Advantage |
$222.07
|
| Rate for Payer: Cofinity Commercial |
$272.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.80
|
| Rate for Payer: Healthscope Commercial |
$285.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.94
|
| Rate for Payer: PHP Commercial |
$269.66
|
| Rate for Payer: Priority Health SBD |
$199.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.21
|
| Rate for Payer: UHC Core |
$165.29
|
| Rate for Payer: UHC Exchange |
$124.68
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$155.10
|
|
|
Service Code
|
NDC 43547068810
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.71 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.81
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Advantage |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.33
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health SBD |
$97.71
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
OP
|
$220.90
|
|
|
Service Code
|
NDC 59651086601
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.81 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: Aetna Medicare |
$110.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.59
|
| Rate for Payer: BCBS Complete |
$88.36
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Advantage |
$154.63
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.68
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health SBD |
$139.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.59
|
| Rate for Payer: UHC Core |
$115.09
|
| Rate for Payer: UHC Exchange |
$86.81
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$253.80
|
|
|
Service Code
|
NDC 55111012601
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.89 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.97
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Advantage |
$177.66
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.35
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: Priority Health SBD |
$159.89
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
OP
|
$361.90
|
|
|
Service Code
|
NDC 65862007601
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.23 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna Medicare |
$180.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: BCBS Complete |
$144.76
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Advantage |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$289.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.43
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.24
|
| Rate for Payer: UHC Core |
$188.55
|
| Rate for Payer: UHC Exchange |
$142.23
|
|
|
CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$41.47
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
9611
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$37.32 |
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Aetna Commercial |
$43.38
|
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Aetna Medicare |
$20.73
|
| Rate for Payer: Aetna Medicare |
$25.52
|
| Rate for Payer: Aetna Medicare |
$33.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.16
|
| Rate for Payer: BCBS Complete |
$27.18
|
| Rate for Payer: BCBS Complete |
$16.59
|
| Rate for Payer: BCBS Complete |
$20.42
|
| Rate for Payer: BCBS Trust/PPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.00
|
| Rate for Payer: BCN Commercial |
$5.00
|
| Rate for Payer: BCN Commercial |
$5.00
|
| Rate for Payer: BCN Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$54.35
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: Cash Price |
$54.35
|
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: Cofinity Advantage |
$35.73
|
| Rate for Payer: Cofinity Advantage |
$29.03
|
| Rate for Payer: Cofinity Advantage |
$47.56
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$43.89
|
| Rate for Payer: Cofinity Commercial |
$58.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Healthscope Commercial |
$61.15
|
| Rate for Payer: Healthscope Commercial |
$45.94
|
| Rate for Payer: Healthscope Commercial |
$37.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.95
|
| Rate for Payer: PHP Commercial |
$35.25
|
| Rate for Payer: PHP Commercial |
$43.38
|
| Rate for Payer: PHP Commercial |
$57.75
|
| Rate for Payer: Priority Health SBD |
$26.13
|
| Rate for Payer: Priority Health SBD |
$42.80
|
| Rate for Payer: Priority Health SBD |
$32.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.30
|
| Rate for Payer: UHC Core |
$3.30
|
| Rate for Payer: UHC Core |
$3.30
|
| Rate for Payer: UHC Core |
$3.30
|
| Rate for Payer: UHC Exchange |
$3.30
|
| Rate for Payer: UHC Exchange |
$3.30
|
| Rate for Payer: UHC Exchange |
$3.30
|
|
|
CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$51.04
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
9611
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$45.94 |
| Rate for Payer: Aetna Commercial |
$43.38
|
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.96
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: Cash Price |
$54.35
|
| Rate for Payer: Cofinity Advantage |
$47.56
|
| Rate for Payer: Cofinity Advantage |
$29.03
|
| Rate for Payer: Cofinity Advantage |
$35.73
|
| Rate for Payer: Cofinity Commercial |
$43.89
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$58.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.83
|
| Rate for Payer: Healthscope Commercial |
$61.15
|
| Rate for Payer: Healthscope Commercial |
$37.32
|
| Rate for Payer: Healthscope Commercial |
$45.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.28
|
| Rate for Payer: PHP Commercial |
$35.25
|
| Rate for Payer: PHP Commercial |
$57.75
|
| Rate for Payer: PHP Commercial |
$43.38
|
| Rate for Payer: Priority Health SBD |
$42.80
|
| Rate for Payer: Priority Health SBD |
$32.16
|
| Rate for Payer: Priority Health SBD |
$26.13
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$1,551.00
|
|
|
Service Code
|
NDC 59651086705
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$609.54 |
| Max. Negotiated Rate |
$1,395.90 |
| Rate for Payer: Aetna Commercial |
$1,318.35
|
| Rate for Payer: Aetna Medicare |
$775.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,008.15
|
| Rate for Payer: BCBS Complete |
$620.40
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cofinity Advantage |
$1,085.70
|
| Rate for Payer: Cofinity Commercial |
$1,333.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,240.80
|
| Rate for Payer: Healthscope Commercial |
$1,395.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,240.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,318.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,163.25
|
| Rate for Payer: PHP Commercial |
$1,318.35
|
| Rate for Payer: Priority Health SBD |
$977.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,008.15
|
| Rate for Payer: UHC Core |
$808.07
|
| Rate for Payer: UHC Exchange |
$609.54
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$1,551.00
|
|
|
Service Code
|
NDC 59651086705
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$977.13 |
| Max. Negotiated Rate |
$1,395.90 |
| Rate for Payer: Aetna Commercial |
$1,318.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,008.15
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cofinity Advantage |
$1,085.70
|
| Rate for Payer: Cofinity Commercial |
$1,333.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,240.80
|
| Rate for Payer: Healthscope Commercial |
$1,395.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,318.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,163.25
|
| Rate for Payer: PHP Commercial |
$1,318.35
|
| Rate for Payer: Priority Health SBD |
$977.13
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$36,068.64
|
|
|
Service Code
|
MSDRG 286
|
| Min. Negotiated Rate |
$16,796.02 |
| Max. Negotiated Rate |
$36,068.64 |
| Rate for Payer: Aetna Medicare |
$18,387.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,100.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,100.03
|
| Rate for Payer: BCBS MAPPO |
$17,680.02
|
| Rate for Payer: BCBS Trust/PPO |
$34,821.74
|
| Rate for Payer: BCN Commercial |
$34,821.74
|
| Rate for Payer: BCN Medicare Advantage |
$17,680.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,680.02
|
| Rate for Payer: Mclaren Medicare |
$17,680.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,564.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,332.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,448.02
|
| Rate for Payer: Nomi Health Commercial |
$28,545.12
|
| Rate for Payer: PACE Medicare |
$16,796.02
|
| Rate for Payer: PACE SWMI |
$17,680.02
|
| Rate for Payer: PHP Medicare Advantage |
$17,680.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35,675.07
|
| Rate for Payer: Priority Health Medicare |
$17,680.02
|
| Rate for Payer: Priority Health Tiered Network |
$28,540.05
|
| Rate for Payer: Railroad Medicare Medicare |
$17,680.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36,068.64
|
| Rate for Payer: UHC Core |
$30,175.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,680.02
|
| Rate for Payer: UHC Exchange |
$24,643.95
|
| Rate for Payer: VA VA |
$17,680.02
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$21,511.95
|
|
|
Service Code
|
MSDRG 287
|
| Min. Negotiated Rate |
$8,406.54 |
| Max. Negotiated Rate |
$21,511.95 |
| Rate for Payer: Aetna Medicare |
$9,202.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,061.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,061.24
|
| Rate for Payer: BCBS MAPPO |
$8,848.99
|
| Rate for Payer: BCBS Trust/PPO |
$21,511.95
|
| Rate for Payer: BCN Commercial |
$21,511.95
|
| Rate for Payer: BCN Medicare Advantage |
$8,848.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,848.99
|
| Rate for Payer: Mclaren Medicare |
$8,848.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,291.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,176.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,733.89
|
| Rate for Payer: Nomi Health Commercial |
$13,804.29
|
| Rate for Payer: PACE Medicare |
$8,406.54
|
| Rate for Payer: PACE SWMI |
$8,848.99
|
| Rate for Payer: PHP Medicare Advantage |
$8,848.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,252.30
|
| Rate for Payer: Priority Health Medicare |
$8,848.99
|
| Rate for Payer: Priority Health Tiered Network |
$13,801.84
|
| Rate for Payer: Railroad Medicare Medicare |
$8,848.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,442.63
|
| Rate for Payer: UHC Core |
$14,592.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,848.99
|
| Rate for Payer: UHC Exchange |
$11,917.70
|
| Rate for Payer: VA VA |
$8,848.99
|
|
|
CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 28 DAYS OF AGE
|
Facility
|
OP
|
$6,735.82
|
|
|
Service Code
|
CPT 54161
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,190.20
|
| Rate for Payer: BCN Commercial |
$2,190.20
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Mclaren Medicaid |
$1,089.34
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC
|
Facility
|
IP
|
$17,216.06
|
|
|
Service Code
|
MSDRG 433
|
| Min. Negotiated Rate |
$8,304.47 |
| Max. Negotiated Rate |
$17,216.06 |
| Rate for Payer: Aetna Medicare |
$9,091.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,926.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,926.94
|
| Rate for Payer: BCBS MAPPO |
$8,741.55
|
| Rate for Payer: BCBS Trust/PPO |
$15,081.77
|
| Rate for Payer: BCN Commercial |
$15,081.77
|
| Rate for Payer: BCN Medicare Advantage |
$8,741.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,741.55
|
| Rate for Payer: Mclaren Medicare |
$8,741.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,178.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,052.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,615.70
|
| Rate for Payer: Nomi Health Commercial |
$13,624.98
|
| Rate for Payer: PACE Medicare |
$8,304.47
|
| Rate for Payer: PACE SWMI |
$8,741.55
|
| Rate for Payer: PHP Medicare Advantage |
$8,741.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,028.20
|
| Rate for Payer: Priority Health Medicare |
$8,741.55
|
| Rate for Payer: Priority Health Tiered Network |
$13,622.56
|
| Rate for Payer: Railroad Medicare Medicare |
$8,741.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,216.06
|
| Rate for Payer: UHC Core |
$14,403.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,741.55
|
| Rate for Payer: UHC Exchange |
$11,762.90
|
| Rate for Payer: VA VA |
$8,741.55
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC
|
Facility
|
IP
|
$34,491.69
|
|
|
Service Code
|
MSDRG 432
|
| Min. Negotiated Rate |
$15,000.22 |
| Max. Negotiated Rate |
$34,491.69 |
| Rate for Payer: Nomi Health Commercial |
$25,389.78
|
| Rate for Payer: Aetna Medicare |
$16,421.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,737.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,737.12
|
| Rate for Payer: BCBS MAPPO |
$15,789.70
|
| Rate for Payer: BCBS Trust/PPO |
$34,491.69
|
| Rate for Payer: BCN Commercial |
$34,491.69
|
| Rate for Payer: BCN Medicare Advantage |
$15,789.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,789.70
|
| Rate for Payer: Mclaren Medicare |
$15,789.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,579.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,158.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,368.67
|
| Rate for Payer: PACE Medicare |
$15,000.22
|
| Rate for Payer: PACE SWMI |
$15,789.70
|
| Rate for Payer: PHP Medicare Advantage |
$15,789.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31,731.60
|
| Rate for Payer: Priority Health Medicare |
$15,789.70
|
| Rate for Payer: Priority Health Tiered Network |
$25,385.27
|
| Rate for Payer: Railroad Medicare Medicare |
$15,789.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,081.66
|
| Rate for Payer: UHC Core |
$26,840.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,789.70
|
| Rate for Payer: UHC Exchange |
$21,919.84
|
| Rate for Payer: VA VA |
$15,789.70
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$11,613.75
|
|
|
Service Code
|
MSDRG 434
|
| Min. Negotiated Rate |
$5,781.09 |
| Max. Negotiated Rate |
$11,613.75 |
| Rate for Payer: Aetna Medicare |
$6,328.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,606.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,606.70
|
| Rate for Payer: BCBS MAPPO |
$6,085.36
|
| Rate for Payer: BCBS Trust/PPO |
$10,121.62
|
| Rate for Payer: BCN Commercial |
$10,121.62
|
| Rate for Payer: BCN Medicare Advantage |
$6,085.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,085.36
|
| Rate for Payer: Mclaren Medicare |
$6,085.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,389.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,998.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,693.90
|
| Rate for Payer: Nomi Health Commercial |
$9,191.25
|
| Rate for Payer: PACE Medicare |
$5,781.09
|
| Rate for Payer: PACE SWMI |
$6,085.36
|
| Rate for Payer: PHP Medicare Advantage |
$6,085.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,487.02
|
| Rate for Payer: Priority Health Medicare |
$6,085.36
|
| Rate for Payer: Priority Health Tiered Network |
$9,189.62
|
| Rate for Payer: Railroad Medicare Medicare |
$6,085.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,613.75
|
| Rate for Payer: UHC Core |
$9,716.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,085.36
|
| Rate for Payer: UHC Exchange |
$7,935.11
|
| Rate for Payer: VA VA |
$6,085.36
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.99
|
|
|
Service Code
|
NDC 00781315270
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$19.79 |
| Rate for Payer: Aetna Commercial |
$18.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.29
|
| Rate for Payer: Cash Price |
$17.59
|
| Rate for Payer: Cofinity Advantage |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$18.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.59
|
| Rate for Payer: Healthscope Commercial |
$19.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.49
|
| Rate for Payer: PHP Commercial |
$18.69
|
| Rate for Payer: Priority Health SBD |
$13.85
|
|
