|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$273.60
|
|
|
Service Code
|
NDC 51079054420
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna Medicare |
$136.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: BCBS Complete |
$109.44
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Advantage |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.20
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.84
|
| Rate for Payer: UHC Core |
$142.55
|
| Rate for Payer: UHC Exchange |
$107.52
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$392.45
|
|
|
Service Code
|
NDC 00904642761
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.23 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna Medicare |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: BCBS Complete |
$156.98
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Advantage |
$274.71
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.09
|
| Rate for Payer: UHC Core |
$204.47
|
| Rate for Payer: UHC Exchange |
$154.23
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
OP
|
$218.55
|
|
|
Service Code
|
NDC 65862037301
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.89 |
| Max. Negotiated Rate |
$196.69 |
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna Medicare |
$109.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.06
|
| Rate for Payer: BCBS Complete |
$87.42
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Advantage |
$152.99
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health SBD |
$137.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.06
|
| Rate for Payer: UHC Core |
$113.86
|
| Rate for Payer: UHC Exchange |
$85.89
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
OP
|
$218.55
|
|
|
Service Code
|
NDC 13668013501
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.89 |
| Max. Negotiated Rate |
$196.69 |
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna Medicare |
$109.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.06
|
| Rate for Payer: BCBS Complete |
$87.42
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Advantage |
$152.99
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health SBD |
$137.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.06
|
| Rate for Payer: UHC Core |
$113.86
|
| Rate for Payer: UHC Exchange |
$85.89
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 65862037301
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.69 |
| Max. Negotiated Rate |
$196.69 |
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.06
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Advantage |
$152.99
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health SBD |
$137.69
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 13668013501
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.69 |
| Max. Negotiated Rate |
$196.69 |
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.06
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Advantage |
$152.99
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health SBD |
$137.69
|
|
|
ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$50.33
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
9957
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.71 |
| Max. Negotiated Rate |
$45.30 |
| Rate for Payer: Aetna Commercial |
$42.78
|
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.96
|
| Rate for Payer: Cash Price |
$40.26
|
| Rate for Payer: Cash Price |
$59.42
|
| Rate for Payer: Cash Price |
$22.01
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cofinity Advantage |
$35.23
|
| Rate for Payer: Cofinity Advantage |
$18.27
|
| Rate for Payer: Cofinity Advantage |
$52.00
|
| Rate for Payer: Cofinity Advantage |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$63.88
|
| Rate for Payer: Cofinity Commercial |
$43.28
|
| Rate for Payer: Cofinity Commercial |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$22.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.26
|
| Rate for Payer: Healthscope Commercial |
$45.30
|
| Rate for Payer: Healthscope Commercial |
$66.85
|
| Rate for Payer: Healthscope Commercial |
$23.49
|
| Rate for Payer: Healthscope Commercial |
$24.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.63
|
| Rate for Payer: PHP Commercial |
$42.78
|
| Rate for Payer: PHP Commercial |
$23.38
|
| Rate for Payer: PHP Commercial |
$22.18
|
| Rate for Payer: PHP Commercial |
$63.14
|
| Rate for Payer: Priority Health SBD |
$17.33
|
| Rate for Payer: Priority Health SBD |
$46.80
|
| Rate for Payer: Priority Health SBD |
$31.71
|
| Rate for Payer: Priority Health SBD |
$16.44
|
|
|
ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.51
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
9957
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$24.76 |
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Aetna Commercial |
$42.78
|
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Aetna Medicare |
$13.76
|
| Rate for Payer: Aetna Medicare |
$37.14
|
| Rate for Payer: Aetna Medicare |
$25.16
|
| Rate for Payer: Aetna Medicare |
$13.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.88
|
| Rate for Payer: BCBS Complete |
$29.71
|
| Rate for Payer: BCBS Complete |
$11.00
|
| Rate for Payer: BCBS Complete |
$10.44
|
| Rate for Payer: BCBS Complete |
$20.13
|
| Rate for Payer: BCBS Trust/PPO |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$0.52
|
| Rate for Payer: BCN Commercial |
$0.52
|
| Rate for Payer: BCN Commercial |
$0.52
|
| Rate for Payer: BCN Commercial |
$0.52
|
| Rate for Payer: BCN Commercial |
$0.52
|
| Rate for Payer: Cash Price |
$22.01
|
| Rate for Payer: Cash Price |
$40.26
|
| Rate for Payer: Cash Price |
$59.42
|
| Rate for Payer: Cash Price |
$40.26
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$59.42
|
| Rate for Payer: Cash Price |
$22.01
|
| Rate for Payer: Cofinity Advantage |
$52.00
|
| Rate for Payer: Cofinity Advantage |
$18.27
|
| Rate for Payer: Cofinity Advantage |
$35.23
|
| Rate for Payer: Cofinity Advantage |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$22.45
|
| Rate for Payer: Cofinity Commercial |
$63.88
|
| Rate for Payer: Cofinity Commercial |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$43.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.01
|
| Rate for Payer: Healthscope Commercial |
$45.30
|
| Rate for Payer: Healthscope Commercial |
$23.49
|
| Rate for Payer: Healthscope Commercial |
$66.85
|
| Rate for Payer: Healthscope Commercial |
$24.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.71
|
| Rate for Payer: PHP Commercial |
$42.78
|
| Rate for Payer: PHP Commercial |
$23.38
|
| Rate for Payer: PHP Commercial |
$63.14
|
| Rate for Payer: PHP Commercial |
$22.18
|
| Rate for Payer: Priority Health SBD |
$16.44
|
| Rate for Payer: Priority Health SBD |
$31.71
|
| Rate for Payer: Priority Health SBD |
$46.80
|
| Rate for Payer: Priority Health SBD |
$17.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.35
|
| Rate for Payer: UHC Core |
$0.35
|
| Rate for Payer: UHC Core |
$0.35
|
| Rate for Payer: UHC Core |
$0.35
|
| Rate for Payer: UHC Core |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.35
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV
|
Facility
|
IP
|
$366.56
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$230.93 |
| Max. Negotiated Rate |
$329.90 |
| Rate for Payer: Aetna Commercial |
$311.58
|
| Rate for Payer: Aetna Commercial |
$496.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.65
|
| Rate for Payer: Cash Price |
$293.25
|
| Rate for Payer: Cash Price |
$467.26
|
| Rate for Payer: Cofinity Advantage |
$256.59
|
| Rate for Payer: Cofinity Advantage |
$408.86
|
| Rate for Payer: Cofinity Commercial |
$315.24
|
| Rate for Payer: Cofinity Commercial |
$502.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.25
|
| Rate for Payer: Healthscope Commercial |
$525.67
|
| Rate for Payer: Healthscope Commercial |
$329.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$438.06
|
| Rate for Payer: PHP Commercial |
$311.58
|
| Rate for Payer: PHP Commercial |
$496.47
|
| Rate for Payer: Priority Health SBD |
$230.93
|
| Rate for Payer: Priority Health SBD |
$367.97
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV
|
Facility
|
OP
|
$584.08
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$525.67 |
| Rate for Payer: Aetna Commercial |
$496.47
|
| Rate for Payer: Aetna Commercial |
$311.58
|
| Rate for Payer: Aetna Medicare |
$292.04
|
| Rate for Payer: Aetna Medicare |
$183.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.65
|
| Rate for Payer: BCBS Complete |
$233.63
|
| Rate for Payer: BCBS Complete |
$146.62
|
| Rate for Payer: BCBS Trust/PPO |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$0.52
|
| Rate for Payer: BCN Commercial |
$0.52
|
| Rate for Payer: BCN Commercial |
$0.52
|
| Rate for Payer: Cash Price |
$293.25
|
| Rate for Payer: Cash Price |
$293.25
|
| Rate for Payer: Cash Price |
$467.26
|
| Rate for Payer: Cash Price |
$467.26
|
| Rate for Payer: Cofinity Advantage |
$256.59
|
| Rate for Payer: Cofinity Advantage |
$408.86
|
| Rate for Payer: Cofinity Commercial |
$502.31
|
| Rate for Payer: Cofinity Commercial |
$315.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.25
|
| Rate for Payer: Healthscope Commercial |
$329.90
|
| Rate for Payer: Healthscope Commercial |
$525.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$467.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$438.06
|
| Rate for Payer: PHP Commercial |
$496.47
|
| Rate for Payer: PHP Commercial |
$311.58
|
| Rate for Payer: Priority Health SBD |
$230.93
|
| Rate for Payer: Priority Health SBD |
$367.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.35
|
| Rate for Payer: UHC Core |
$0.35
|
| Rate for Payer: UHC Core |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.35
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN STERILE WATER INTRAVENOUS SOLN
|
Facility
|
OP
|
$250.56
|
|
|
Service Code
|
HCPCS J1806
|
| Hospital Charge Code |
185900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$225.50 |
| Rate for Payer: Aetna Commercial |
$212.98
|
| Rate for Payer: Aetna Medicare |
$125.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.86
|
| Rate for Payer: BCBS Complete |
$100.22
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: Cash Price |
$200.45
|
| Rate for Payer: Cash Price |
$200.45
|
| Rate for Payer: Cofinity Advantage |
$175.39
|
| Rate for Payer: Cofinity Commercial |
$215.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.45
|
| Rate for Payer: Healthscope Commercial |
$225.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.92
|
| Rate for Payer: PHP Commercial |
$212.98
|
| Rate for Payer: Priority Health SBD |
$157.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN STERILE WATER INTRAVENOUS SOLN
|
Facility
|
IP
|
$250.56
|
|
|
Service Code
|
HCPCS J1806
|
| Hospital Charge Code |
185900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.85 |
| Max. Negotiated Rate |
$225.50 |
| Rate for Payer: Aetna Commercial |
$212.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.86
|
| Rate for Payer: Cash Price |
$200.45
|
| Rate for Payer: Cofinity Advantage |
$175.39
|
| Rate for Payer: Cofinity Commercial |
$215.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.45
|
| Rate for Payer: Healthscope Commercial |
$225.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.92
|
| Rate for Payer: PHP Commercial |
$212.98
|
| Rate for Payer: Priority Health SBD |
$157.85
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC
|
Facility
|
IP
|
$20,673.29
|
|
|
Service Code
|
MSDRG 391
|
| Min. Negotiated Rate |
$9,861.67 |
| Max. Negotiated Rate |
$20,673.29 |
| Rate for Payer: Aetna Medicare |
$10,795.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,975.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,975.88
|
| Rate for Payer: BCBS MAPPO |
$10,380.70
|
| Rate for Payer: BCBS Trust/PPO |
$20,156.63
|
| Rate for Payer: BCN Commercial |
$20,156.63
|
| Rate for Payer: BCN Medicare Advantage |
$10,380.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,380.70
|
| Rate for Payer: Mclaren Medicare |
$10,380.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,899.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,937.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,418.77
|
| Rate for Payer: Nomi Health Commercial |
$16,361.07
|
| Rate for Payer: PACE Medicare |
$9,861.67
|
| Rate for Payer: PACE SWMI |
$10,380.70
|
| Rate for Payer: PHP Medicare Advantage |
$10,380.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,447.71
|
| Rate for Payer: Priority Health Medicare |
$10,380.70
|
| Rate for Payer: Priority Health Tiered Network |
$16,358.17
|
| Rate for Payer: Railroad Medicare Medicare |
$10,380.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,673.29
|
| Rate for Payer: UHC Core |
$17,295.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,380.70
|
| Rate for Payer: UHC Exchange |
$14,125.06
|
| Rate for Payer: VA VA |
$10,380.70
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$12,707.48
|
|
|
Service Code
|
MSDRG 392
|
| Min. Negotiated Rate |
$6,273.71 |
| Max. Negotiated Rate |
$12,707.48 |
| Rate for Payer: Aetna Medicare |
$6,868.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,254.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,254.89
|
| Rate for Payer: BCBS MAPPO |
$6,603.91
|
| Rate for Payer: BCBS Trust/PPO |
$12,317.29
|
| Rate for Payer: BCN Commercial |
$12,317.29
|
| Rate for Payer: BCN Medicare Advantage |
$6,603.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,603.91
|
| Rate for Payer: Mclaren Medicare |
$6,603.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,934.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,594.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,264.30
|
| Rate for Payer: Nomi Health Commercial |
$10,056.84
|
| Rate for Payer: PACE Medicare |
$6,273.71
|
| Rate for Payer: PACE SWMI |
$6,603.91
|
| Rate for Payer: PHP Medicare Advantage |
$6,603.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,568.82
|
| Rate for Payer: Priority Health Medicare |
$6,603.91
|
| Rate for Payer: Priority Health Tiered Network |
$10,055.05
|
| Rate for Payer: Railroad Medicare Medicare |
$6,603.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,707.48
|
| Rate for Payer: UHC Core |
$10,631.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,603.91
|
| Rate for Payer: UHC Exchange |
$8,682.41
|
| Rate for Payer: VA VA |
$6,603.91
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,922.56
|
|
|
Service Code
|
CPT 43235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$509.54
|
| Rate for Payer: BCN Commercial |
$509.54
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED)
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$999.98 |
| Max. Negotiated Rate |
$6,183.25 |
| Rate for Payer: Aetna Medicare |
$1,988.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,390.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,390.01
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,846.10
|
| Rate for Payer: BCN Commercial |
$1,846.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Mclaren Medicaid |
$999.98
|
| Rate for Payer: Mclaren Medicare |
$1,912.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,007.61
|
| Rate for Payer: Meridian Medicaid |
$2,007.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,198.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,103.21
|
| Rate for Payer: Nomi Health Commercial |
$5,736.03
|
| Rate for Payer: PACE Medicare |
$1,816.41
|
| Rate for Payer: PACE SWMI |
$1,912.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,912.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$999.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,183.25
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health Tiered Network |
$4,946.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,912.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,912.01
|
| Rate for Payer: UHC Medicaid |
$999.98
|
| Rate for Payer: UHCCP Medicaid |
$999.98
|
| Rate for Payer: VA VA |
$1,912.01
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$2,922.56
|
|
|
Service Code
|
CPT 43239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$618.38
|
| Rate for Payer: BCN Commercial |
$618.38
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH CONTROL OF BLEEDING, ANY METHOD
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$999.98 |
| Max. Negotiated Rate |
$6,183.25 |
| Rate for Payer: Aetna Medicare |
$1,988.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,390.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,390.01
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,335.70
|
| Rate for Payer: BCN Commercial |
$1,335.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Mclaren Medicaid |
$999.98
|
| Rate for Payer: Mclaren Medicare |
$1,912.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,007.61
|
| Rate for Payer: Meridian Medicaid |
$2,007.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,198.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,103.21
|
| Rate for Payer: Nomi Health Commercial |
$5,736.03
|
| Rate for Payer: PACE Medicare |
$1,816.41
|
| Rate for Payer: PACE SWMI |
$1,912.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,912.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$999.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,183.25
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health Tiered Network |
$4,946.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,912.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,912.01
|
| Rate for Payer: UHC Medicaid |
$999.98
|
| Rate for Payer: UHCCP Medicaid |
$999.98
|
| Rate for Payer: VA VA |
$1,912.01
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED PLACEMENT OF PERCUTANEOUS GASTROSTOMY TUBE
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43246
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$999.98 |
| Max. Negotiated Rate |
$6,183.25 |
| Rate for Payer: Aetna Medicare |
$1,988.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,390.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,390.01
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,154.36
|
| Rate for Payer: BCN Commercial |
$1,154.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Mclaren Medicaid |
$999.98
|
| Rate for Payer: Mclaren Medicare |
$1,912.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,007.61
|
| Rate for Payer: Meridian Medicaid |
$2,007.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,198.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,103.21
|
| Rate for Payer: Nomi Health Commercial |
$5,736.03
|
| Rate for Payer: PACE Medicare |
$1,816.41
|
| Rate for Payer: PACE SWMI |
$1,912.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,912.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$999.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,183.25
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health Tiered Network |
$4,946.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,912.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,912.01
|
| Rate for Payer: UHC Medicaid |
$999.98
|
| Rate for Payer: UHCCP Medicaid |
$999.98
|
| Rate for Payer: VA VA |
$1,912.01
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH INSERTION OF GUIDE WIRE FOLLOWED BY PASSAGE OF DILATOR(S) THROUGH ESOPHAGUS OVER GUIDE WIRE
|
Facility
|
OP
|
$2,922.56
|
|
|
Service Code
|
CPT 43248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$505.13
|
| Rate for Payer: BCN Commercial |
$505.13
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43251
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$999.98 |
| Max. Negotiated Rate |
$6,183.25 |
| Rate for Payer: Aetna Medicare |
$1,988.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,390.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,390.01
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,071.11
|
| Rate for Payer: BCN Commercial |
$1,071.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Mclaren Medicaid |
$999.98
|
| Rate for Payer: Mclaren Medicare |
$1,912.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,007.61
|
| Rate for Payer: Meridian Medicaid |
$2,007.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,198.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,103.21
|
| Rate for Payer: Nomi Health Commercial |
$5,736.03
|
| Rate for Payer: PACE Medicare |
$1,816.41
|
| Rate for Payer: PACE SWMI |
$1,912.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,912.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$999.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,183.25
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health Tiered Network |
$4,946.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,912.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,912.01
|
| Rate for Payer: UHC Medicaid |
$999.98
|
| Rate for Payer: UHCCP Medicaid |
$999.98
|
| Rate for Payer: VA VA |
$1,912.01
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION OF ESOPHAGUS (LESS THAN 30 MM DIAMETER)
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43249
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$812.41 |
| Max. Negotiated Rate |
$6,183.25 |
| Rate for Payer: Aetna Medicare |
$1,988.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,390.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,390.01
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$812.41
|
| Rate for Payer: BCN Commercial |
$812.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Mclaren Medicaid |
$999.98
|
| Rate for Payer: Mclaren Medicare |
$1,912.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,007.61
|
| Rate for Payer: Meridian Medicaid |
$2,007.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,198.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,103.21
|
| Rate for Payer: Nomi Health Commercial |
$5,736.03
|
| Rate for Payer: PACE Medicare |
$1,816.41
|
| Rate for Payer: PACE SWMI |
$1,912.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,912.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$999.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,183.25
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health Tiered Network |
$4,946.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,912.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,912.01
|
| Rate for Payer: UHC Medicaid |
$999.98
|
| Rate for Payer: UHCCP Medicaid |
$999.98
|
| Rate for Payer: VA VA |
$1,912.01
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
OP
|
$271.70
|
|
|
Service Code
|
NDC 00555088602
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.78 |
| Max. Negotiated Rate |
$244.53 |
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: Aetna Medicare |
$135.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.60
|
| Rate for Payer: BCBS Complete |
$108.68
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Advantage |
$190.19
|
| Rate for Payer: Cofinity Commercial |
$233.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$244.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.78
|
| Rate for Payer: PHP Commercial |
$230.94
|
| Rate for Payer: Priority Health SBD |
$171.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.60
|
| Rate for Payer: UHC Core |
$141.56
|
| Rate for Payer: UHC Exchange |
$106.78
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
OP
|
$380.55
|
|
|
Service Code
|
NDC 60687087665
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.56 |
| Max. Negotiated Rate |
$342.50 |
| Rate for Payer: Aetna Commercial |
$323.47
|
| Rate for Payer: Aetna Medicare |
$190.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.36
|
| Rate for Payer: BCBS Complete |
$152.22
|
| Rate for Payer: Cash Price |
$304.44
|
| Rate for Payer: Cofinity Advantage |
$266.38
|
| Rate for Payer: Cofinity Commercial |
$327.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.44
|
| Rate for Payer: Healthscope Commercial |
$342.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.41
|
| Rate for Payer: PHP Commercial |
$323.47
|
| Rate for Payer: Priority Health SBD |
$239.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.36
|
| Rate for Payer: UHC Core |
$198.27
|
| Rate for Payer: UHC Exchange |
$149.56
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
OP
|
$7.62
|
|
|
Service Code
|
NDC 60687087611
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$6.86 |
| Rate for Payer: Aetna Commercial |
$6.48
|
| Rate for Payer: Aetna Medicare |
$3.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.95
|
| Rate for Payer: BCBS Complete |
$3.05
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cofinity Advantage |
$5.33
|
| Rate for Payer: Cofinity Commercial |
$6.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.10
|
| Rate for Payer: Healthscope Commercial |
$6.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.71
|
| Rate for Payer: PHP Commercial |
$6.48
|
| Rate for Payer: Priority Health SBD |
$4.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.95
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: UHC Exchange |
$2.99
|
|
