|
SPINAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$97,935.29
|
|
|
Service Code
|
MSDRG 028
|
| Min. Negotiated Rate |
$44,661.89 |
| Max. Negotiated Rate |
$97,935.29 |
| Rate for Payer: Aetna Medicare |
$48,893.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58,765.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58,765.65
|
| Rate for Payer: BCBS MAPPO |
$47,012.52
|
| Rate for Payer: BCBS Trust/PPO |
$91,026.69
|
| Rate for Payer: BCN Commercial |
$91,026.69
|
| Rate for Payer: BCN Medicare Advantage |
$47,012.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47,012.52
|
| Rate for Payer: Mclaren Medicare |
$47,012.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49,363.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54,064.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$51,713.77
|
| Rate for Payer: Nomi Health Commercial |
$77,507.07
|
| Rate for Payer: PACE Medicare |
$44,661.89
|
| Rate for Payer: PACE SWMI |
$47,012.52
|
| Rate for Payer: PHP Medicare Advantage |
$47,012.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$96,866.65
|
| Rate for Payer: Priority Health Medicare |
$47,012.52
|
| Rate for Payer: Priority Health Tiered Network |
$77,493.31
|
| Rate for Payer: Railroad Medicare Medicare |
$47,012.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97,935.29
|
| Rate for Payer: UHC Core |
$81,935.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47,012.52
|
| Rate for Payer: UHC Exchange |
$66,914.44
|
| Rate for Payer: VA VA |
$47,012.52
|
|
|
SPINAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$43,897.02
|
|
|
Service Code
|
MSDRG 030
|
| Min. Negotiated Rate |
$16,666.81 |
| Max. Negotiated Rate |
$43,897.02 |
| Rate for Payer: Aetna Medicare |
$18,245.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,930.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,930.01
|
| Rate for Payer: BCBS MAPPO |
$17,544.01
|
| Rate for Payer: BCBS Trust/PPO |
$43,897.02
|
| Rate for Payer: BCN Commercial |
$43,897.02
|
| Rate for Payer: BCN Medicare Advantage |
$17,544.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,544.01
|
| Rate for Payer: Mclaren Medicare |
$17,544.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,421.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,175.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,298.41
|
| Rate for Payer: Nomi Health Commercial |
$28,318.08
|
| Rate for Payer: PACE Medicare |
$16,666.81
|
| Rate for Payer: PACE SWMI |
$17,544.01
|
| Rate for Payer: PHP Medicare Advantage |
$17,544.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35,391.32
|
| Rate for Payer: Priority Health Medicare |
$17,544.01
|
| Rate for Payer: Priority Health Tiered Network |
$28,313.05
|
| Rate for Payer: Railroad Medicare Medicare |
$17,544.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,781.76
|
| Rate for Payer: UHC Core |
$29,935.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,544.01
|
| Rate for Payer: UHC Exchange |
$24,447.94
|
| Rate for Payer: VA VA |
$17,544.01
|
|
|
SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC;
|
Facility
|
OP
|
$2,274.56
|
|
|
Service Code
|
CPT 62270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$699.34
|
| Rate for Payer: BCN Commercial |
$699.34
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$368.95
|
|
|
Service Code
|
NDC 51079010320
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.44 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.82
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Advantage |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.71
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health SBD |
$232.44
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$109.98
|
|
|
Service Code
|
NDC 63629106403
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$98.98 |
| Rate for Payer: Aetna Commercial |
$93.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.49
|
| Rate for Payer: Cash Price |
$87.98
|
| Rate for Payer: Cofinity Advantage |
$76.99
|
| Rate for Payer: Cofinity Commercial |
$94.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.98
|
| Rate for Payer: Healthscope Commercial |
$98.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.48
|
| Rate for Payer: PHP Commercial |
$93.48
|
| Rate for Payer: Priority Health SBD |
$69.29
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 51079010301
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Advantage |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health SBD |
$2.32
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$368.95
|
|
|
Service Code
|
NDC 60687046501
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.00 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna Medicare |
$184.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.82
|
| Rate for Payer: BCBS Complete |
$147.58
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Advantage |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$295.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.71
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health SBD |
$232.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.82
|
| Rate for Payer: UHC Core |
$192.22
|
| Rate for Payer: UHC Exchange |
$145.00
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
NDC 63739054410
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.83 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna Medicare |
$141.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.30
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Advantage |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: Priority Health SBD |
$177.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.30
|
| Rate for Payer: UHC Core |
$146.92
|
| Rate for Payer: UHC Exchange |
$110.83
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
NDC 63739054410
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.66 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.30
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Advantage |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: Priority Health SBD |
$177.66
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 60687046511
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Advantage |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health SBD |
$2.32
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 53746051101
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.22 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.72
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Advantage |
$192.47
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.21
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health SBD |
$173.22
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 51079010301
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Advantage |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.40
|
| Rate for Payer: UHC Core |
$1.92
|
| Rate for Payer: UHC Exchange |
$1.45
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$157.45
|
|
|
Service Code
|
NDC 68382066001
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.19 |
| Max. Negotiated Rate |
$141.71 |
| Rate for Payer: Aetna Commercial |
$133.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.34
|
| Rate for Payer: Cash Price |
$125.96
|
| Rate for Payer: Cofinity Advantage |
$110.22
|
| Rate for Payer: Cofinity Commercial |
$135.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.96
|
| Rate for Payer: Healthscope Commercial |
$141.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.09
|
| Rate for Payer: PHP Commercial |
$133.83
|
| Rate for Payer: Priority Health SBD |
$99.19
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$368.95
|
|
|
Service Code
|
NDC 60687046501
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.44 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.82
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Advantage |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.71
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health SBD |
$232.44
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$157.45
|
|
|
Service Code
|
NDC 68382066001
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$141.71 |
| Rate for Payer: Aetna Commercial |
$133.83
|
| Rate for Payer: Aetna Medicare |
$78.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.34
|
| Rate for Payer: BCBS Complete |
$62.98
|
| Rate for Payer: Cash Price |
$125.96
|
| Rate for Payer: Cofinity Advantage |
$110.22
|
| Rate for Payer: Cofinity Commercial |
$135.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.96
|
| Rate for Payer: Healthscope Commercial |
$141.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.09
|
| Rate for Payer: PHP Commercial |
$133.83
|
| Rate for Payer: Priority Health SBD |
$99.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.34
|
| Rate for Payer: UHC Core |
$82.03
|
| Rate for Payer: UHC Exchange |
$61.88
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$274.95
|
|
|
Service Code
|
NDC 53746051101
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.06 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna Medicare |
$137.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.72
|
| Rate for Payer: BCBS Complete |
$109.98
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Advantage |
$192.47
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.21
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health SBD |
$173.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.72
|
| Rate for Payer: UHC Core |
$143.25
|
| Rate for Payer: UHC Exchange |
$108.06
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$109.98
|
|
|
Service Code
|
NDC 63629106403
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.22 |
| Max. Negotiated Rate |
$98.98 |
| Rate for Payer: Aetna Commercial |
$93.48
|
| Rate for Payer: Aetna Medicare |
$54.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.49
|
| Rate for Payer: BCBS Complete |
$43.99
|
| Rate for Payer: Cash Price |
$87.98
|
| Rate for Payer: Cofinity Advantage |
$76.99
|
| Rate for Payer: Cofinity Commercial |
$94.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.98
|
| Rate for Payer: Healthscope Commercial |
$98.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.48
|
| Rate for Payer: PHP Commercial |
$93.48
|
| Rate for Payer: Priority Health SBD |
$69.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.49
|
| Rate for Payer: UHC Core |
$57.30
|
| Rate for Payer: UHC Exchange |
$43.22
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$368.95
|
|
|
Service Code
|
NDC 51079010320
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.00 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna Medicare |
$184.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.82
|
| Rate for Payer: BCBS Complete |
$147.58
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Advantage |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$295.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.71
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health SBD |
$232.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.82
|
| Rate for Payer: UHC Core |
$192.22
|
| Rate for Payer: UHC Exchange |
$145.00
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 60687046511
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Advantage |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.40
|
| Rate for Payer: UHC Core |
$1.92
|
| Rate for Payer: UHC Exchange |
$1.45
|
|
|
SPIRONOLACTONE 50 MG TABLET
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
NDC 60687047611
|
| Hospital Charge Code |
11426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Advantage |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health SBD |
$1.68
|
|
|
SPIRONOLACTONE 50 MG TABLET
|
Facility
|
IP
|
$262.20
|
|
|
Service Code
|
NDC 53746051401
|
| Hospital Charge Code |
11426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.19 |
| Max. Negotiated Rate |
$235.98 |
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.43
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Advantage |
$183.54
|
| Rate for Payer: Cofinity Commercial |
$225.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$235.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health SBD |
$165.19
|
|
|
SPIRONOLACTONE 50 MG TABLET
|
Facility
|
OP
|
$2.66
|
|
|
Service Code
|
NDC 60687047611
|
| Hospital Charge Code |
11426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Advantage |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.73
|
| Rate for Payer: UHC Core |
$1.39
|
| Rate for Payer: UHC Exchange |
$1.05
|
|
|
SPIRONOLACTONE 50 MG TABLET
|
Facility
|
OP
|
$262.20
|
|
|
Service Code
|
NDC 53746051401
|
| Hospital Charge Code |
11426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.04 |
| Max. Negotiated Rate |
$235.98 |
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: Aetna Medicare |
$131.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.43
|
| Rate for Payer: BCBS Complete |
$104.88
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Advantage |
$183.54
|
| Rate for Payer: Cofinity Commercial |
$225.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$235.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health SBD |
$165.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.43
|
| Rate for Payer: UHC Core |
$136.61
|
| Rate for Payer: UHC Exchange |
$103.04
|
|
|
SPIRONOLACTONE 50 MG TABLET
|
Facility
|
OP
|
$290.70
|
|
|
Service Code
|
NDC 63739054510
|
| Hospital Charge Code |
11426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.25 |
| Max. Negotiated Rate |
$261.63 |
| Rate for Payer: Aetna Commercial |
$247.09
|
| Rate for Payer: Aetna Medicare |
$145.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.96
|
| Rate for Payer: BCBS Complete |
$116.28
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Advantage |
$203.49
|
| Rate for Payer: Cofinity Commercial |
$250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$261.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.03
|
| Rate for Payer: PHP Commercial |
$247.09
|
| Rate for Payer: Priority Health SBD |
$183.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.96
|
| Rate for Payer: UHC Core |
$151.45
|
| Rate for Payer: UHC Exchange |
$114.25
|
|
|
SPIRONOLACTONE 50 MG TABLET
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
NDC 60687047601
|
| Hospital Charge Code |
11426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.58 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Aetna Commercial |
$226.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.90
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cofinity Advantage |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$228.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.80
|
| Rate for Payer: Healthscope Commercial |
$239.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.50
|
| Rate for Payer: PHP Commercial |
$226.10
|
| Rate for Payer: Priority Health SBD |
$167.58
|
|
