|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$810.79
|
|
|
Service Code
|
NDC 0078-0799-75
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$510.80 |
| Max. Negotiated Rate |
$729.71 |
| Rate for Payer: Aetna Commercial |
$689.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.01
|
| Rate for Payer: Cash Price |
$648.63
|
| Rate for Payer: Cofinity Commercial |
$567.55
|
| Rate for Payer: Cofinity Commercial |
$697.28
|
| Rate for Payer: Healthscope Commercial |
$729.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$689.17
|
| Rate for Payer: PHP Commercial |
$689.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.55
|
| Rate for Payer: Priority Health SBD |
$510.80
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$394.15
|
|
|
Service Code
|
NDC 43598-326-75
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.31 |
| Max. Negotiated Rate |
$354.74 |
| Rate for Payer: Aetna Commercial |
$335.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.20
|
| Rate for Payer: Cash Price |
$315.32
|
| Rate for Payer: Cofinity Commercial |
$275.90
|
| Rate for Payer: Cofinity Commercial |
$338.97
|
| Rate for Payer: Healthscope Commercial |
$354.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$335.03
|
| Rate for Payer: PHP Commercial |
$335.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.90
|
| Rate for Payer: Priority Health SBD |
$248.31
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$45.57
|
|
|
Service Code
|
NDC 61314-656-05
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.71 |
| Max. Negotiated Rate |
$41.01 |
| Rate for Payer: Aetna Commercial |
$38.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.62
|
| Rate for Payer: Cash Price |
$36.46
|
| Rate for Payer: Cofinity Commercial |
$31.90
|
| Rate for Payer: Cofinity Commercial |
$39.19
|
| Rate for Payer: Healthscope Commercial |
$41.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.73
|
| Rate for Payer: PHP Commercial |
$38.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.90
|
| Rate for Payer: Priority Health SBD |
$28.71
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$395.85
|
|
|
Service Code
|
NDC 0065-0656-05
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.39 |
| Max. Negotiated Rate |
$356.26 |
| Rate for Payer: Aetna Commercial |
$336.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.30
|
| Rate for Payer: Cash Price |
$316.68
|
| Rate for Payer: Cofinity Commercial |
$277.10
|
| Rate for Payer: Cofinity Commercial |
$340.43
|
| Rate for Payer: Healthscope Commercial |
$356.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$336.47
|
| Rate for Payer: PHP Commercial |
$336.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.10
|
| Rate for Payer: Priority Health SBD |
$249.39
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$253.80
|
|
|
Service Code
|
NDC 55111-126-01
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.89 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.97
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$177.66
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.73
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.66
|
| Rate for Payer: Priority Health SBD |
$159.89
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$317.25
|
|
|
Service Code
|
NDC 0143-9927-01
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.87 |
| Max. Negotiated Rate |
$285.52 |
| Rate for Payer: Aetna Commercial |
$269.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.21
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cofinity Commercial |
$222.08
|
| Rate for Payer: Cofinity Commercial |
$272.84
|
| Rate for Payer: Healthscope Commercial |
$285.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$269.66
|
| Rate for Payer: PHP Commercial |
$269.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.08
|
| Rate for Payer: Priority Health SBD |
$199.87
|
|
|
CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$51.04
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
9611
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$45.94 |
| Rate for Payer: Aetna Commercial |
$43.38
|
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: Cofinity Commercial |
$35.73
|
| Rate for Payer: Cofinity Commercial |
$29.03
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$43.89
|
| Rate for Payer: Healthscope Commercial |
$37.32
|
| Rate for Payer: Healthscope Commercial |
$45.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.38
|
| Rate for Payer: PHP Commercial |
$43.38
|
| Rate for Payer: PHP Commercial |
$35.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.73
|
| Rate for Payer: Priority Health SBD |
$26.13
|
| Rate for Payer: Priority Health SBD |
$32.16
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$32,881.52
|
|
|
Service Code
|
MS-DRG 286
|
| Min. Negotiated Rate |
$15,216.07 |
| Max. Negotiated Rate |
$32,881.52 |
| Rate for Payer: Aetna Medicare |
$16,657.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,021.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,021.15
|
| Rate for Payer: BCBS MAPPO |
$16,016.92
|
| Rate for Payer: BCBS Trust/PPO |
$32,666.21
|
| Rate for Payer: BCN Medicare Advantage |
$16,016.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,016.92
|
| Rate for Payer: Mclaren Medicare |
$16,016.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,817.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,419.46
|
| Rate for Payer: PACE Medicare |
$15,216.07
|
| Rate for Payer: PACE SWMI |
$16,016.92
|
| Rate for Payer: PHP Medicare Advantage |
$16,016.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,932.69
|
| Rate for Payer: Priority Health Medicare |
$16,016.92
|
| Rate for Payer: Priority Health Narrow Network |
$24,746.15
|
| Rate for Payer: Railroad Medicare Medicare |
$16,016.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,881.52
|
| Rate for Payer: UHC Core |
$20,176.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,016.92
|
| Rate for Payer: UHC Exchange |
$21,609.89
|
| Rate for Payer: UHC Medicare Advantage |
$16,497.43
|
| Rate for Payer: VA VA |
$16,016.92
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$20,180.32
|
|
|
Service Code
|
MS-DRG 287
|
| Min. Negotiated Rate |
$7,868.07 |
| Max. Negotiated Rate |
$20,180.32 |
| Rate for Payer: Aetna Medicare |
$8,613.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,352.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,352.72
|
| Rate for Payer: BCBS MAPPO |
$8,282.18
|
| Rate for Payer: BCBS Trust/PPO |
$20,180.32
|
| Rate for Payer: BCN Medicare Advantage |
$8,282.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,282.18
|
| Rate for Payer: Mclaren Medicare |
$8,282.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,696.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,524.51
|
| Rate for Payer: PACE Medicare |
$7,868.07
|
| Rate for Payer: PACE SWMI |
$8,282.18
|
| Rate for Payer: PHP Medicare Advantage |
$8,282.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,520.87
|
| Rate for Payer: Priority Health Medicare |
$8,282.18
|
| Rate for Payer: Priority Health Narrow Network |
$12,416.70
|
| Rate for Payer: Railroad Medicare Medicare |
$8,282.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,498.73
|
| Rate for Payer: UHC Core |
$10,123.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,282.18
|
| Rate for Payer: UHC Exchange |
$10,843.04
|
| Rate for Payer: UHC Medicare Advantage |
$8,530.65
|
| Rate for Payer: VA VA |
$8,282.18
|
|
|
CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; NEONATE (28 DAYS OF AGE OR LESS)
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 54160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$142.76 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$632.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.79
|
| Rate for Payer: BCBS Complete |
$349.14
|
| Rate for Payer: BCBS MAPPO |
$607.83
|
| Rate for Payer: BCBS Trust/PPO |
$831.08
|
| Rate for Payer: BCN Medicare Advantage |
$607.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.83
|
| Rate for Payer: Mclaren Medicaid |
$332.48
|
| Rate for Payer: Mclaren Medicare |
$607.83
|
| Rate for Payer: Meridian Medicaid |
$349.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$638.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.00
|
| Rate for Payer: PACE Medicare |
$577.44
|
| Rate for Payer: PACE SWMI |
$607.83
|
| Rate for Payer: PHP Medicare Advantage |
$607.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,875.09
|
| Rate for Payer: Priority Health Medicare |
$607.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,500.07
|
| Rate for Payer: Railroad Medicare Medicare |
$607.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.04
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.83
|
| Rate for Payer: UHC Exchange |
$142.76
|
| Rate for Payer: UHC Medicare Advantage |
$626.06
|
| Rate for Payer: VA VA |
$607.83
|
|
|
CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 28 DAYS OF AGE
|
Facility
|
OP
|
$5,561.92
|
|
|
Service Code
|
CPT 54161
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$193.85 |
| 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 |
$1,660.52
|
| 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) |
$213.24
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$193.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
CIRCUMCISION, USING CLAMP OR OTHER DEVICE WITH REGIONAL DORSAL PENILE OR RING BLOCK
|
Facility
|
OP
|
$5,561.92
|
|
|
Service Code
|
CPT 54150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$93.32 |
| 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 |
$602.59
|
| 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) |
$102.65
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$93.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC
|
Facility
|
IP
|
$15,726.87
|
|
|
Service Code
|
MS-DRG 433
|
| Min. Negotiated Rate |
$7,521.88 |
| Max. Negotiated Rate |
$15,726.87 |
| Rate for Payer: Aetna Medicare |
$8,234.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,897.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,897.21
|
| Rate for Payer: BCBS MAPPO |
$7,917.77
|
| Rate for Payer: BCBS Trust/PPO |
$14,148.18
|
| Rate for Payer: BCN Medicare Advantage |
$7,917.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,917.77
|
| Rate for Payer: Mclaren Medicare |
$7,917.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,313.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,105.44
|
| Rate for Payer: PACE Medicare |
$7,521.88
|
| Rate for Payer: PACE SWMI |
$7,917.77
|
| Rate for Payer: PHP Medicare Advantage |
$7,917.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,794.77
|
| Rate for Payer: Priority Health Medicare |
$7,917.77
|
| Rate for Payer: Priority Health Narrow Network |
$11,835.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7,917.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,726.87
|
| Rate for Payer: UHC Core |
$9,650.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,917.77
|
| Rate for Payer: UHC Exchange |
$10,335.78
|
| Rate for Payer: UHC Medicare Advantage |
$8,155.30
|
| Rate for Payer: VA VA |
$7,917.77
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC
|
Facility
|
IP
|
$32,356.59
|
|
|
Service Code
|
MS-DRG 432
|
| Min. Negotiated Rate |
$13,576.80 |
| Max. Negotiated Rate |
$32,356.59 |
| Rate for Payer: Aetna Medicare |
$14,863.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,864.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,864.21
|
| Rate for Payer: BCBS MAPPO |
$14,291.37
|
| Rate for Payer: BCBS Trust/PPO |
$32,356.59
|
| Rate for Payer: BCN Medicare Advantage |
$14,291.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,291.37
|
| Rate for Payer: Mclaren Medicare |
$14,291.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,005.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,435.08
|
| Rate for Payer: PACE Medicare |
$13,576.80
|
| Rate for Payer: PACE SWMI |
$14,291.37
|
| Rate for Payer: PHP Medicare Advantage |
$14,291.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,494.45
|
| Rate for Payer: Priority Health Medicare |
$14,291.37
|
| Rate for Payer: Priority Health Narrow Network |
$21,995.56
|
| Rate for Payer: Railroad Medicare Medicare |
$14,291.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,226.66
|
| Rate for Payer: UHC Core |
$17,933.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,291.37
|
| Rate for Payer: UHC Exchange |
$19,207.90
|
| Rate for Payer: UHC Medicare Advantage |
$14,720.11
|
| Rate for Payer: VA VA |
$14,291.37
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,212.55
|
|
|
Service Code
|
MS-DRG 434
|
| Min. Negotiated Rate |
$5,048.61 |
| Max. Negotiated Rate |
$10,212.55 |
| Rate for Payer: Aetna Medicare |
$5,526.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,642.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,642.91
|
| Rate for Payer: BCBS MAPPO |
$5,314.33
|
| Rate for Payer: BCBS Trust/PPO |
$9,495.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,314.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,314.33
|
| Rate for Payer: Mclaren Medicare |
$5,314.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,580.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,111.48
|
| Rate for Payer: PACE Medicare |
$5,048.61
|
| Rate for Payer: PACE SWMI |
$5,314.33
|
| Rate for Payer: PHP Medicare Advantage |
$5,314.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,607.27
|
| Rate for Payer: Priority Health Medicare |
$5,314.33
|
| Rate for Payer: Priority Health Narrow Network |
$7,685.82
|
| Rate for Payer: Railroad Medicare Medicare |
$5,314.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,212.55
|
| Rate for Payer: UHC Core |
$6,266.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,314.33
|
| Rate for Payer: UHC Exchange |
$6,711.74
|
| Rate for Payer: UHC Medicare Advantage |
$5,473.76
|
| Rate for Payer: VA VA |
$5,314.33
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.86
|
|
|
Service Code
|
NDC 0781-3152-70
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$23.27 |
| Rate for Payer: Aetna Commercial |
$21.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.81
|
| Rate for Payer: Cash Price |
$20.69
|
| Rate for Payer: Cofinity Commercial |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$22.24
|
| Rate for Payer: Healthscope Commercial |
$23.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.98
|
| Rate for Payer: PHP Commercial |
$21.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.10
|
| Rate for Payer: Priority Health SBD |
$16.29
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$113.84
|
|
|
Service Code
|
NDC 0074-4380-10
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.72 |
| Max. Negotiated Rate |
$102.46 |
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.00
|
| Rate for Payer: Cash Price |
$91.07
|
| Rate for Payer: Cofinity Commercial |
$79.69
|
| Rate for Payer: Cofinity Commercial |
$97.90
|
| Rate for Payer: Healthscope Commercial |
$102.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.76
|
| Rate for Payer: PHP Commercial |
$96.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.69
|
| Rate for Payer: Priority Health SBD |
$71.72
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.86
|
|
|
Service Code
|
NDC 0781-3152-95
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$23.27 |
| Rate for Payer: Aetna Commercial |
$21.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.81
|
| Rate for Payer: Cash Price |
$20.69
|
| Rate for Payer: Cofinity Commercial |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$22.24
|
| Rate for Payer: Healthscope Commercial |
$23.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.98
|
| Rate for Payer: PHP Commercial |
$21.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.10
|
| Rate for Payer: Priority Health SBD |
$16.29
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$980.51
|
|
|
Service Code
|
NDC 0074-4382-20
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$617.72 |
| Max. Negotiated Rate |
$882.46 |
| Rate for Payer: Aetna Commercial |
$833.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$637.33
|
| Rate for Payer: Cash Price |
$784.41
|
| Rate for Payer: Cofinity Commercial |
$686.36
|
| Rate for Payer: Cofinity Commercial |
$843.24
|
| Rate for Payer: Healthscope Commercial |
$882.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$833.43
|
| Rate for Payer: PHP Commercial |
$833.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.36
|
| Rate for Payer: Priority Health SBD |
$617.72
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$181.62
|
|
|
Service Code
|
NDC 70069-151-10
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$114.42 |
| Max. Negotiated Rate |
$163.46 |
| Rate for Payer: Aetna Commercial |
$154.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.05
|
| Rate for Payer: Cash Price |
$145.30
|
| Rate for Payer: Cofinity Commercial |
$127.13
|
| Rate for Payer: Cofinity Commercial |
$156.19
|
| Rate for Payer: Healthscope Commercial |
$163.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.38
|
| Rate for Payer: PHP Commercial |
$154.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.13
|
| Rate for Payer: Priority Health SBD |
$114.42
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$181.62
|
|
|
Service Code
|
NDC 70069-151-01
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$114.42 |
| Max. Negotiated Rate |
$163.46 |
| Rate for Payer: Aetna Commercial |
$154.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.05
|
| Rate for Payer: Cash Price |
$145.30
|
| Rate for Payer: Cofinity Commercial |
$127.13
|
| Rate for Payer: Cofinity Commercial |
$156.19
|
| Rate for Payer: Healthscope Commercial |
$163.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.38
|
| Rate for Payer: PHP Commercial |
$154.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.13
|
| Rate for Payer: Priority Health SBD |
$114.42
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$180.56
|
|
|
Service Code
|
NDC 0781-3153-80
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$162.50 |
| Rate for Payer: Aetna Commercial |
$153.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.36
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Cofinity Commercial |
$126.39
|
| Rate for Payer: Cofinity Commercial |
$155.28
|
| Rate for Payer: Healthscope Commercial |
$162.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.48
|
| Rate for Payer: PHP Commercial |
$153.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.39
|
| Rate for Payer: Priority Health SBD |
$113.75
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$180.56
|
|
|
Service Code
|
NDC 0781-3153-95
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$162.50 |
| Rate for Payer: Aetna Commercial |
$153.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.36
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Cofinity Commercial |
$126.39
|
| Rate for Payer: Cofinity Commercial |
$155.28
|
| Rate for Payer: Healthscope Commercial |
$162.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.48
|
| Rate for Payer: PHP Commercial |
$153.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.39
|
| Rate for Payer: Priority Health SBD |
$113.75
|
|
|
CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$199.38
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
9612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$179.44 |
| Rate for Payer: Aetna Commercial |
$169.47
|
| Rate for Payer: Aetna Commercial |
$805.12
|
| Rate for Payer: Aetna Commercial |
$182.75
|
| Rate for Payer: Aetna Commercial |
$254.40
|
| Rate for Payer: Aetna Commercial |
$501.63
|
| Rate for Payer: Aetna Commercial |
$207.19
|
| Rate for Payer: Aetna Commercial |
$233.50
|
| Rate for Payer: Aetna Commercial |
$261.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.56
|
| Rate for Payer: BCBS Complete |
$86.00
|
| Rate for Payer: BCBS Complete |
$119.72
|
| Rate for Payer: BCBS Complete |
$109.88
|
| Rate for Payer: BCBS Complete |
$123.00
|
| Rate for Payer: BCBS Complete |
$378.88
|
| Rate for Payer: BCBS Complete |
$79.75
|
| Rate for Payer: BCBS Complete |
$236.06
|
| Rate for Payer: BCBS Complete |
$97.50
|
| Rate for Payer: BCBS Trust/PPO |
$11.94
|
| Rate for Payer: BCBS Trust/PPO |
$11.94
|
| Rate for Payer: BCBS Trust/PPO |
$11.94
|
| Rate for Payer: BCBS Trust/PPO |
$11.94
|
| Rate for Payer: BCBS Trust/PPO |
$11.94
|
| Rate for Payer: BCBS Trust/PPO |
$11.94
|
| Rate for Payer: BCBS Trust/PPO |
$11.94
|
| Rate for Payer: BCBS Trust/PPO |
$11.94
|
| Rate for Payer: Cash Price |
$239.44
|
| Rate for Payer: Cash Price |
$757.76
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$239.44
|
| Rate for Payer: Cash Price |
$472.12
|
| Rate for Payer: Cash Price |
$219.76
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$757.76
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$472.12
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$219.76
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cofinity Commercial |
$139.57
|
| Rate for Payer: Cofinity Commercial |
$171.47
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Cofinity Commercial |
$184.90
|
| Rate for Payer: Cofinity Commercial |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$209.62
|
| Rate for Payer: Cofinity Commercial |
$192.29
|
| Rate for Payer: Cofinity Commercial |
$236.24
|
| Rate for Payer: Cofinity Commercial |
$209.51
|
| Rate for Payer: Cofinity Commercial |
$257.40
|
| Rate for Payer: Cofinity Commercial |
$215.25
|
| Rate for Payer: Cofinity Commercial |
$264.45
|
| Rate for Payer: Cofinity Commercial |
$413.10
|
| Rate for Payer: Cofinity Commercial |
$507.53
|
| Rate for Payer: Cofinity Commercial |
$663.04
|
| Rate for Payer: Cofinity Commercial |
$814.59
|
| Rate for Payer: Healthscope Commercial |
$219.38
|
| Rate for Payer: Healthscope Commercial |
$531.14
|
| Rate for Payer: Healthscope Commercial |
$852.48
|
| Rate for Payer: Healthscope Commercial |
$269.37
|
| Rate for Payer: Healthscope Commercial |
$179.44
|
| Rate for Payer: Healthscope Commercial |
$247.23
|
| Rate for Payer: Healthscope Commercial |
$276.75
|
| Rate for Payer: Healthscope Commercial |
$193.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$501.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$805.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.47
|
| Rate for Payer: PHP Commercial |
$169.47
|
| Rate for Payer: PHP Commercial |
$233.50
|
| Rate for Payer: PHP Commercial |
$207.19
|
| Rate for Payer: PHP Commercial |
$254.40
|
| Rate for Payer: PHP Commercial |
$261.38
|
| Rate for Payer: PHP Commercial |
$182.75
|
| Rate for Payer: PHP Commercial |
$501.63
|
| Rate for Payer: PHP Commercial |
$805.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$413.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.25
|
| Rate for Payer: Priority Health SBD |
$135.45
|
| Rate for Payer: Priority Health SBD |
$371.79
|
| Rate for Payer: Priority Health SBD |
$193.72
|
| Rate for Payer: Priority Health SBD |
$125.61
|
| Rate for Payer: Priority Health SBD |
$188.56
|
| Rate for Payer: Priority Health SBD |
$173.06
|
| Rate for Payer: Priority Health SBD |
$153.56
|
| Rate for Payer: Priority Health SBD |
$596.74
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$37.60
|
|
|
Service Code
|
NDC 0378-6231-01
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$33.84 |
| Rate for Payer: Aetna Commercial |
$31.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.44
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$32.34
|
| Rate for Payer: Healthscope Commercial |
$33.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.96
|
| Rate for Payer: PHP Commercial |
$31.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health SBD |
$23.69
|
|
