|
ARTHROSCOPY, SHOULDER, SURGICAL; REPAIR OF SLAP LESION
|
Facility
OP
|
$7,957.04
|
|
|
Service Code
|
CPT 29807
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,023.91 |
| Max. Negotiated Rate |
$7,957.04 |
| Rate for Payer: Aetna Medicare |
$6,620.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,957.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,957.04
|
| Rate for Payer: BCBS Complete |
$3,656.42
|
| Rate for Payer: BCBS MAPPO |
$6,365.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,222.89
|
| Rate for Payer: BCN Medicare Advantage |
$6,365.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,365.63
|
| Rate for Payer: Mclaren Medicaid |
$3,482.00
|
| Rate for Payer: Mclaren Medicare |
$6,365.63
|
| Rate for Payer: Meridian Medicaid |
$3,656.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,683.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,320.47
|
| Rate for Payer: PACE Medicare |
$6,047.35
|
| Rate for Payer: PACE SWMI |
$6,365.63
|
| Rate for Payer: PHP Medicare Advantage |
$6,365.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,482.00
|
| Rate for Payer: Priority Health Medicare |
$6,365.63
|
| Rate for Payer: Railroad Medicare Medicare |
$6,365.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,126.30
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,365.63
|
| Rate for Payer: UHC Exchange |
$1,023.91
|
| Rate for Payer: UHC Medicare Advantage |
$6,556.60
|
| Rate for Payer: VA VA |
$6,365.63
|
|
|
ARTHROSCOPY, SHOULDER, SURGICAL; WITH ROTATOR CUFF REPAIR
|
Facility
OP
|
$7,957.04
|
|
|
Service Code
|
CPT 29827
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,056.33 |
| Max. Negotiated Rate |
$7,957.04 |
| Rate for Payer: Aetna Medicare |
$6,620.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,957.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,957.04
|
| Rate for Payer: BCBS Complete |
$3,656.42
|
| Rate for Payer: BCBS MAPPO |
$6,365.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,065.23
|
| Rate for Payer: BCN Medicare Advantage |
$6,365.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,365.63
|
| Rate for Payer: Mclaren Medicaid |
$3,482.00
|
| Rate for Payer: Mclaren Medicare |
$6,365.63
|
| Rate for Payer: Meridian Medicaid |
$3,656.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,683.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,320.47
|
| Rate for Payer: PACE Medicare |
$6,047.35
|
| Rate for Payer: PACE SWMI |
$6,365.63
|
| Rate for Payer: PHP Medicare Advantage |
$6,365.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,482.00
|
| Rate for Payer: Priority Health Medicare |
$6,365.63
|
| Rate for Payer: Railroad Medicare Medicare |
$6,365.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,161.96
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,365.63
|
| Rate for Payer: UHC Exchange |
$1,056.33
|
| Rate for Payer: UHC Medicare Advantage |
$6,556.60
|
| Rate for Payer: VA VA |
$6,365.63
|
|
|
ARTHROTOMY, ACROMIOCLAVICULAR, STERNOCLAVICULAR JOINT, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY
|
Facility
OP
|
$8,925.64
|
|
|
Service Code
|
CPT 23044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.18 |
| Max. Negotiated Rate |
$8,925.64 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,234.36
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,925.64
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Priority Health Narrow Network |
$7,140.51
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$620.60
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$564.18
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
ARTHROTOMY, ANKLE, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY
|
Facility
OP
|
$8,925.64
|
|
|
Service Code
|
CPT 27610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$641.13 |
| Max. Negotiated Rate |
$8,925.64 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,322.54
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,925.64
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Priority Health Narrow Network |
$7,140.51
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$705.24
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$641.13
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
ARTHROTOMY, GLENOHUMERAL JOINT, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY
|
Facility
OP
|
$8,925.64
|
|
|
Service Code
|
CPT 23040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$714.15 |
| Max. Negotiated Rate |
$8,925.64 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,322.54
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,925.64
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Priority Health Narrow Network |
$7,140.51
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$785.56
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$714.15
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
ARTHROTOMY, GLENOHUMERAL JOINT, WITH JOINT EXPLORATION, WITH OR WITHOUT REMOVAL OF LOOSE OR FOREIGN BODY
|
Facility
OP
|
$19,834.21
|
|
|
Service Code
|
CPT 23107
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$663.72 |
| Max. Negotiated Rate |
$19,834.21 |
| Rate for Payer: Aetna Medicare |
$6,620.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,957.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,957.04
|
| Rate for Payer: BCBS Complete |
$3,656.42
|
| Rate for Payer: BCBS MAPPO |
$6,365.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,299.99
|
| Rate for Payer: BCN Medicare Advantage |
$6,365.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,365.63
|
| Rate for Payer: Mclaren Medicaid |
$3,482.00
|
| Rate for Payer: Mclaren Medicare |
$6,365.63
|
| Rate for Payer: Meridian Medicaid |
$3,656.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,683.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,320.47
|
| Rate for Payer: PACE Medicare |
$6,047.35
|
| Rate for Payer: PACE SWMI |
$6,365.63
|
| Rate for Payer: PHP Medicare Advantage |
$6,365.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,482.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,834.21
|
| Rate for Payer: Priority Health Medicare |
$6,365.63
|
| Rate for Payer: Priority Health Narrow Network |
$15,867.37
|
| Rate for Payer: Railroad Medicare Medicare |
$6,365.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$730.09
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,365.63
|
| Rate for Payer: UHC Exchange |
$663.72
|
| Rate for Payer: UHC Medicare Advantage |
$6,556.60
|
| Rate for Payer: VA VA |
$6,365.63
|
|
|
ARTHROTOMY, WITH SYNOVECTOMY, KNEE; ANTERIOR OR POSTERIOR
|
Facility
OP
|
$8,817.68
|
|
|
Service Code
|
CPT 27334
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$684.68 |
| Max. Negotiated Rate |
$8,817.68 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,322.54
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,817.68
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Priority Health Narrow Network |
$7,054.14
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$753.15
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$684.68
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
IP
|
$58.14
|
|
|
Service Code
|
NDC 0536-1325-94
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.63 |
| Max. Negotiated Rate |
$52.33 |
| Rate for Payer: Aetna Commercial |
$49.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.79
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$40.70
|
| Rate for Payer: Cofinity Commercial |
$50.00
|
| Rate for Payer: Healthscope Commercial |
$52.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.42
|
| Rate for Payer: PHP Commercial |
$49.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.70
|
| Rate for Payer: Priority Health SBD |
$36.63
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
IP
|
$110.45
|
|
|
Service Code
|
NDC 7985430035
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.58 |
| Max. Negotiated Rate |
$99.40 |
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Commercial |
$77.32
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Healthscope Commercial |
$99.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.88
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.32
|
| Rate for Payer: Priority Health SBD |
$69.58
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
IP
|
$68.15
|
|
|
Service Code
|
NDC 904052361
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.93 |
| Max. Negotiated Rate |
$61.34 |
| Rate for Payer: Aetna Commercial |
$57.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.30
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Commercial |
$47.70
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Healthscope Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.93
|
| Rate for Payer: PHP Commercial |
$57.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.70
|
| Rate for Payer: Priority Health SBD |
$42.93
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
IP
|
$84.60
|
|
|
Service Code
|
NDC 1184551701
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.99
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$59.22
|
| Rate for Payer: Cofinity Commercial |
$72.76
|
| Rate for Payer: Healthscope Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.91
|
| Rate for Payer: PHP Commercial |
$71.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.22
|
| Rate for Payer: Priority Health SBD |
$53.30
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
IP
|
$70.50
|
|
|
Service Code
|
NDC 1184505171
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.42 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.82
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.92
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.35
|
| Rate for Payer: Priority Health SBD |
$44.42
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
IP
|
$129.25
|
|
|
Service Code
|
NDC 7985430105
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.43 |
| Max. Negotiated Rate |
$116.32 |
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.01
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Cofinity Commercial |
$90.48
|
| Rate for Payer: Healthscope Commercial |
$116.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.86
|
| Rate for Payer: PHP Commercial |
$109.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health SBD |
$81.43
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
IP
|
$183.30
|
|
|
Service Code
|
NDC 904052372
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.14
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Cofinity Commercial |
$128.31
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.80
|
| Rate for Payer: PHP Commercial |
$155.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.31
|
| Rate for Payer: Priority Health SBD |
$115.48
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
IP
|
$1,239.65
|
|
|
Service Code
|
NDC 59762-2012-6
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$780.98 |
| Max. Negotiated Rate |
$1,115.68 |
| Rate for Payer: Aetna Commercial |
$1,053.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.77
|
| Rate for Payer: Cash Price |
$991.72
|
| Rate for Payer: Cofinity Commercial |
$1,066.10
|
| Rate for Payer: Cofinity Commercial |
$867.76
|
| Rate for Payer: Healthscope Commercial |
$1,115.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,053.70
|
| Rate for Payer: PHP Commercial |
$1,053.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$867.76
|
| Rate for Payer: Priority Health SBD |
$780.98
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
IP
|
$123.95
|
|
|
Service Code
|
NDC 62332-198-10
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.09 |
| Max. Negotiated Rate |
$111.56 |
| Rate for Payer: Aetna Commercial |
$105.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.57
|
| Rate for Payer: Cash Price |
$99.16
|
| Rate for Payer: Cofinity Commercial |
$106.60
|
| Rate for Payer: Cofinity Commercial |
$86.76
|
| Rate for Payer: Healthscope Commercial |
$111.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.36
|
| Rate for Payer: PHP Commercial |
$105.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.76
|
| Rate for Payer: Priority Health SBD |
$78.09
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
IP
|
$1,052.95
|
|
|
Service Code
|
NDC 51991-358-60
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$663.36 |
| Max. Negotiated Rate |
$947.66 |
| Rate for Payer: Aetna Commercial |
$895.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.42
|
| Rate for Payer: Cash Price |
$842.36
|
| Rate for Payer: Cofinity Commercial |
$737.06
|
| Rate for Payer: Cofinity Commercial |
$905.54
|
| Rate for Payer: Healthscope Commercial |
$947.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$895.01
|
| Rate for Payer: PHP Commercial |
$895.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.06
|
| Rate for Payer: Priority Health SBD |
$663.36
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
IP
|
$206.61
|
|
|
Service Code
|
NDC 59762-2012-1
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.16 |
| Max. Negotiated Rate |
$185.95 |
| Rate for Payer: Aetna Commercial |
$175.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.30
|
| Rate for Payer: Cash Price |
$165.29
|
| Rate for Payer: Cofinity Commercial |
$144.63
|
| Rate for Payer: Cofinity Commercial |
$177.68
|
| Rate for Payer: Healthscope Commercial |
$185.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.62
|
| Rate for Payer: PHP Commercial |
$175.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.63
|
| Rate for Payer: Priority Health SBD |
$130.16
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
IP
|
$1,239.50
|
|
|
Service Code
|
NDC 62332-198-31
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$780.88 |
| Max. Negotiated Rate |
$1,115.55 |
| Rate for Payer: Aetna Commercial |
$1,053.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.68
|
| Rate for Payer: Cash Price |
$991.60
|
| Rate for Payer: Cofinity Commercial |
$1,065.97
|
| Rate for Payer: Cofinity Commercial |
$867.65
|
| Rate for Payer: Healthscope Commercial |
$1,115.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,053.58
|
| Rate for Payer: PHP Commercial |
$1,053.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$867.65
|
| Rate for Payer: Priority Health SBD |
$780.88
|
|
|
ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER
|
Facility
OP
|
$5,561.92
|
|
|
Service Code
|
CPT 51102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$138.18 |
| Max. Negotiated Rate |
$5,561.92 |
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,265.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,265.42
|
| Rate for Payer: BCBS Complete |
$1,041.01
|
| Rate for Payer: BCBS MAPPO |
$1,812.34
|
| Rate for Payer: BCBS Trust/PPO |
$802.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Mclaren Medicaid |
$991.35
|
| Rate for Payer: Mclaren Medicare |
$1,812.34
|
| Rate for Payer: Meridian Medicaid |
$1,041.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,902.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,084.19
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,812.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,561.92
|
| Rate for Payer: Priority Health Medicare |
$1,812.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,449.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.00
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$138.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE
|
Facility
IP
|
$215.14
|
|
|
Service Code
|
NDC 68462-405-60
|
| Hospital Charge Code |
27644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.54 |
| Max. Negotiated Rate |
$193.63 |
| Rate for Payer: Aetna Commercial |
$182.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.84
|
| Rate for Payer: Cash Price |
$172.11
|
| Rate for Payer: Cofinity Commercial |
$150.60
|
| Rate for Payer: Cofinity Commercial |
$185.02
|
| Rate for Payer: Healthscope Commercial |
$193.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.87
|
| Rate for Payer: PHP Commercial |
$182.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.60
|
| Rate for Payer: Priority Health SBD |
$135.54
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$36.43
|
|
|
Service Code
|
NDC 0574-7034-12
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$32.79 |
| Rate for Payer: Aetna Commercial |
$30.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.68
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cofinity Commercial |
$25.50
|
| Rate for Payer: Cofinity Commercial |
$31.33
|
| Rate for Payer: Healthscope Commercial |
$32.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.97
|
| Rate for Payer: PHP Commercial |
$30.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.50
|
| Rate for Payer: Priority Health SBD |
$22.95
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
IP
|
$511.50
|
|
|
Service Code
|
NDC 66553-001-01
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$322.24 |
| Max. Negotiated Rate |
$460.35 |
| Rate for Payer: Aetna Commercial |
$434.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.48
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cofinity Commercial |
$358.05
|
| Rate for Payer: Cofinity Commercial |
$439.89
|
| Rate for Payer: Healthscope Commercial |
$460.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.78
|
| Rate for Payer: PHP Commercial |
$434.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.05
|
| Rate for Payer: Priority Health SBD |
$322.24
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$544.50
|
|
|
Service Code
|
NDC 66553-002-01
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$343.04 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Aetna Commercial |
$462.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.92
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cofinity Commercial |
$381.15
|
| Rate for Payer: Cofinity Commercial |
$468.27
|
| Rate for Payer: Healthscope Commercial |
$490.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$462.82
|
| Rate for Payer: PHP Commercial |
$462.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.15
|
| Rate for Payer: Priority Health SBD |
$343.04
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$58.97
|
|
|
Service Code
|
NDC 0536-1008-36
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$53.07 |
| Rate for Payer: Aetna Commercial |
$50.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.33
|
| Rate for Payer: Cash Price |
$47.18
|
| Rate for Payer: Cofinity Commercial |
$41.28
|
| Rate for Payer: Cofinity Commercial |
$50.71
|
| Rate for Payer: Healthscope Commercial |
$53.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.12
|
| Rate for Payer: PHP Commercial |
$50.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.28
|
| Rate for Payer: Priority Health SBD |
$37.15
|
|
