|
NEOMYCIN-BACITRACIN-POLY-HC 3.5 MG-400-10,000 UNIT/G-1 % EYE OINTMENT
|
Facility
|
IP
|
$60.69
|
|
|
Service Code
|
NDC 24208-785-55
|
| Hospital Charge Code |
849
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.23 |
| Max. Negotiated Rate |
$54.62 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.45
|
| Rate for Payer: Cash Price |
$48.55
|
| Rate for Payer: Cofinity Commercial |
$42.48
|
| Rate for Payer: Cofinity Commercial |
$52.19
|
| Rate for Payer: Healthscope Commercial |
$54.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.59
|
| Rate for Payer: PHP Commercial |
$51.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.48
|
| Rate for Payer: Priority Health SBD |
$38.23
|
|
|
NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT
|
Facility
|
IP
|
$148.34
|
|
|
Service Code
|
NDC 24208-780-55
|
| Hospital Charge Code |
38701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.45 |
| Max. Negotiated Rate |
$133.51 |
| Rate for Payer: Aetna Commercial |
$126.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.42
|
| Rate for Payer: Cash Price |
$118.67
|
| Rate for Payer: Cofinity Commercial |
$103.84
|
| Rate for Payer: Cofinity Commercial |
$127.57
|
| Rate for Payer: Healthscope Commercial |
$133.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.09
|
| Rate for Payer: PHP Commercial |
$126.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.84
|
| Rate for Payer: Priority Health SBD |
$93.45
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$9.41
|
|
|
Service Code
|
NDC 45802-143-01
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: Aetna Commercial |
$8.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.12
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cofinity Commercial |
$6.59
|
| Rate for Payer: Cofinity Commercial |
$8.09
|
| Rate for Payer: Healthscope Commercial |
$8.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.00
|
| Rate for Payer: PHP Commercial |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.59
|
| Rate for Payer: Priority Health SBD |
$5.93
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$7.98
|
|
|
Service Code
|
NDC 61269-179-34
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$7.18 |
| Rate for Payer: Aetna Commercial |
$6.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.19
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cofinity Commercial |
$5.59
|
| Rate for Payer: Cofinity Commercial |
$6.86
|
| Rate for Payer: Healthscope Commercial |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.78
|
| Rate for Payer: PHP Commercial |
$6.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.59
|
| Rate for Payer: Priority Health SBD |
$5.03
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
NDC 81073088
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.04
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.85
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$3.08
|
|
|
Service Code
|
NDC 45802-143-00
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.00
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$2.65
|
| Rate for Payer: Healthscope Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.62
|
| Rate for Payer: PHP Commercial |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health SBD |
$1.94
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$3.08
|
|
|
Service Code
|
NDC 45802-143-70
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.00
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$2.65
|
| Rate for Payer: Healthscope Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.62
|
| Rate for Payer: PHP Commercial |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health SBD |
$1.94
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
OP
|
$473.76
|
|
|
Service Code
|
NDC 47682-223-35
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.50 |
| Max. Negotiated Rate |
$426.38 |
| Rate for Payer: Aetna Commercial |
$402.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.94
|
| Rate for Payer: BCBS Complete |
$189.50
|
| Rate for Payer: Cash Price |
$379.01
|
| Rate for Payer: Cofinity Commercial |
$331.63
|
| Rate for Payer: Cofinity Commercial |
$407.43
|
| Rate for Payer: Healthscope Commercial |
$426.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.70
|
| Rate for Payer: PHP Commercial |
$402.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.63
|
| Rate for Payer: Priority Health SBD |
$298.47
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
OP
|
$3.29
|
|
|
Service Code
|
NDC 47682-223-99
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna Commercial |
$2.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.14
|
| Rate for Payer: BCBS Complete |
$1.32
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$2.83
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.80
|
| Rate for Payer: PHP Commercial |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.30
|
| Rate for Payer: Priority Health SBD |
$2.07
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$3.29
|
|
|
Service Code
|
NDC 47682-223-99
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna Commercial |
$2.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.14
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.83
|
| Rate for Payer: Healthscope Commercial |
$2.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.80
|
| Rate for Payer: PHP Commercial |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.30
|
| Rate for Payer: Priority Health SBD |
$2.07
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$473.76
|
|
|
Service Code
|
NDC 47682-223-35
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$298.47 |
| Max. Negotiated Rate |
$426.38 |
| Rate for Payer: Aetna Commercial |
$402.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.94
|
| Rate for Payer: Cash Price |
$379.01
|
| Rate for Payer: Cofinity Commercial |
$331.63
|
| Rate for Payer: Cofinity Commercial |
$407.43
|
| Rate for Payer: Healthscope Commercial |
$426.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.70
|
| Rate for Payer: PHP Commercial |
$402.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.63
|
| Rate for Payer: Priority Health SBD |
$298.47
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
IP
|
$44.28
|
|
|
Service Code
|
NDC 24208-830-60
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Aetna Commercial |
$37.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.78
|
| Rate for Payer: Cash Price |
$35.42
|
| Rate for Payer: Cofinity Commercial |
$31.00
|
| Rate for Payer: Cofinity Commercial |
$38.08
|
| Rate for Payer: Healthscope Commercial |
$39.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.64
|
| Rate for Payer: PHP Commercial |
$37.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.00
|
| Rate for Payer: Priority Health SBD |
$27.90
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
IP
|
$62.97
|
|
|
Service Code
|
NDC 61314-630-06
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.67 |
| Max. Negotiated Rate |
$56.67 |
| Rate for Payer: Aetna Commercial |
$53.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.93
|
| Rate for Payer: Cash Price |
$50.38
|
| Rate for Payer: Cofinity Commercial |
$44.08
|
| Rate for Payer: Cofinity Commercial |
$54.15
|
| Rate for Payer: Healthscope Commercial |
$56.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.52
|
| Rate for Payer: PHP Commercial |
$53.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.08
|
| Rate for Payer: Priority Health SBD |
$39.67
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
IP
|
$149.49
|
|
|
Service Code
|
NDC 24208-635-62
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.18 |
| Max. Negotiated Rate |
$134.54 |
| Rate for Payer: Aetna Commercial |
$127.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.17
|
| Rate for Payer: Cash Price |
$119.59
|
| Rate for Payer: Cofinity Commercial |
$104.64
|
| Rate for Payer: Cofinity Commercial |
$128.56
|
| Rate for Payer: Healthscope Commercial |
$134.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.07
|
| Rate for Payer: PHP Commercial |
$127.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.64
|
| Rate for Payer: Priority Health SBD |
$94.18
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
IP
|
$175.11
|
|
|
Service Code
|
NDC 24208-631-10
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.32 |
| Max. Negotiated Rate |
$157.60 |
| Rate for Payer: Aetna Commercial |
$148.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.82
|
| Rate for Payer: Cash Price |
$140.09
|
| Rate for Payer: Cofinity Commercial |
$122.58
|
| Rate for Payer: Cofinity Commercial |
$150.59
|
| Rate for Payer: Healthscope Commercial |
$157.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.84
|
| Rate for Payer: PHP Commercial |
$148.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.58
|
| Rate for Payer: Priority Health SBD |
$110.32
|
|
|
NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY
|
Facility
|
IP
|
$27,753.13
|
|
|
Service Code
|
MS-DRG 789
|
| Min. Negotiated Rate |
$678.00 |
| Max. Negotiated Rate |
$27,753.13 |
| Rate for Payer: Aetna Medicare |
$14,139.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,994.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,994.60
|
| Rate for Payer: BCBS MAPPO |
$13,595.68
|
| Rate for Payer: BCBS Trust/PPO |
$4,084.37
|
| Rate for Payer: BCN Medicare Advantage |
$13,595.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,595.68
|
| Rate for Payer: Mclaren Medicare |
$13,595.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,275.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,635.03
|
| Rate for Payer: PACE Medicare |
$12,915.90
|
| Rate for Payer: PACE SWMI |
$13,595.68
|
| Rate for Payer: PHP Medicare Advantage |
$13,595.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,108.24
|
| Rate for Payer: Priority Health Medicare |
$13,595.68
|
| Rate for Payer: Priority Health Narrow Network |
$20,886.59
|
| Rate for Payer: Railroad Medicare Medicare |
$13,595.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,753.13
|
| Rate for Payer: UHC Core |
$678.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,595.68
|
| Rate for Payer: UHC Medicare Advantage |
$14,003.55
|
| Rate for Payer: VA VA |
$13,595.68
|
|
|
NEONATE WITH OTHER SIGNIFICANT PROBLEMS
|
Facility
|
IP
|
$22,726.93
|
|
|
Service Code
|
MS-DRG 794
|
| Min. Negotiated Rate |
$678.00 |
| Max. Negotiated Rate |
$22,726.93 |
| Rate for Payer: Aetna Medicare |
$11,671.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,028.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,028.35
|
| Rate for Payer: BCBS MAPPO |
$11,222.68
|
| Rate for Payer: BCBS Trust/PPO |
$3,085.24
|
| Rate for Payer: BCN Medicare Advantage |
$11,222.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,222.68
|
| Rate for Payer: Mclaren Medicare |
$11,222.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,783.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,906.08
|
| Rate for Payer: PACE Medicare |
$10,661.55
|
| Rate for Payer: PACE SWMI |
$11,222.68
|
| Rate for Payer: PHP Medicare Advantage |
$11,222.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,379.95
|
| Rate for Payer: Priority Health Medicare |
$11,222.68
|
| Rate for Payer: Priority Health Narrow Network |
$17,103.96
|
| Rate for Payer: Railroad Medicare Medicare |
$11,222.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,726.93
|
| Rate for Payer: UHC Core |
$678.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,222.68
|
| Rate for Payer: UHC Medicare Advantage |
$11,559.36
|
| Rate for Payer: VA VA |
$11,222.68
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.85
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
167219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna Commercial |
$18.57
|
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Commercial |
$17.86
|
| Rate for Payer: Aetna Commercial |
$63.32
|
| Rate for Payer: Aetna Commercial |
$17.89
|
| Rate for Payer: Aetna Commercial |
$20.95
|
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Cash Price |
$59.60
|
| Rate for Payer: Cash Price |
$16.84
|
| Rate for Payer: Cash Price |
$16.81
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cofinity Commercial |
$64.07
|
| Rate for Payer: Cofinity Commercial |
$17.26
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$14.71
|
| Rate for Payer: Cofinity Commercial |
$18.07
|
| Rate for Payer: Cofinity Commercial |
$17.30
|
| Rate for Payer: Cofinity Commercial |
$14.08
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$15.30
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$52.15
|
| Rate for Payer: Healthscope Commercial |
$67.05
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Healthscope Commercial |
$18.91
|
| Rate for Payer: Healthscope Commercial |
$18.94
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Healthscope Commercial |
$18.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.95
|
| Rate for Payer: PHP Commercial |
$17.10
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$18.57
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: PHP Commercial |
$17.89
|
| Rate for Payer: PHP Commercial |
$17.86
|
| Rate for Payer: PHP Commercial |
$20.95
|
| Rate for Payer: PHP Commercial |
$63.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.15
|
| Rate for Payer: Priority Health SBD |
$15.73
|
| Rate for Payer: Priority Health SBD |
$15.53
|
| Rate for Payer: Priority Health SBD |
$13.77
|
| Rate for Payer: Priority Health SBD |
$13.26
|
| Rate for Payer: Priority Health SBD |
$13.24
|
| Rate for Payer: Priority Health SBD |
$12.68
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: Priority Health SBD |
$46.94
|
|
|
NEPAFENAC 0.3 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$998.10
|
|
|
Service Code
|
NDC 0065-1750-14
|
| Hospital Charge Code |
164011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$628.80 |
| Max. Negotiated Rate |
$898.29 |
| Rate for Payer: Aetna Commercial |
$848.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.76
|
| Rate for Payer: Cash Price |
$798.48
|
| Rate for Payer: Cofinity Commercial |
$698.67
|
| Rate for Payer: Cofinity Commercial |
$858.37
|
| Rate for Payer: Healthscope Commercial |
$898.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$848.38
|
| Rate for Payer: PHP Commercial |
$848.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$698.67
|
| Rate for Payer: Priority Health SBD |
$628.80
|
|
|
NERVOUS SYSTEM NEOPLASMS WITH MCC
|
Facility
|
IP
|
$22,476.77
|
|
|
Service Code
|
MS-DRG 054
|
| Min. Negotiated Rate |
$10,549.34 |
| Max. Negotiated Rate |
$22,476.77 |
| Rate for Payer: Aetna Medicare |
$11,548.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,880.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,880.71
|
| Rate for Payer: BCBS MAPPO |
$11,104.57
|
| Rate for Payer: BCBS Trust/PPO |
$22,191.77
|
| Rate for Payer: BCN Medicare Advantage |
$11,104.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,104.57
|
| Rate for Payer: Mclaren Medicare |
$11,104.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,659.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,770.26
|
| Rate for Payer: PACE Medicare |
$10,549.34
|
| Rate for Payer: PACE SWMI |
$11,104.57
|
| Rate for Payer: PHP Medicare Advantage |
$11,104.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,144.61
|
| Rate for Payer: Priority Health Medicare |
$11,104.57
|
| Rate for Payer: Priority Health Narrow Network |
$16,915.69
|
| Rate for Payer: Railroad Medicare Medicare |
$11,104.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,476.77
|
| Rate for Payer: UHC Core |
$13,791.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,104.57
|
| Rate for Payer: UHC Exchange |
$14,771.84
|
| Rate for Payer: UHC Medicare Advantage |
$11,437.71
|
| Rate for Payer: VA VA |
$11,104.57
|
|
|
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC
|
Facility
|
IP
|
$20,904.97
|
|
|
Service Code
|
MS-DRG 055
|
| Min. Negotiated Rate |
$7,810.61 |
| Max. Negotiated Rate |
$20,904.97 |
| Rate for Payer: Aetna Medicare |
$8,550.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,277.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,277.11
|
| Rate for Payer: BCBS MAPPO |
$8,221.69
|
| Rate for Payer: BCBS Trust/PPO |
$20,904.97
|
| Rate for Payer: BCN Medicare Advantage |
$8,221.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,221.69
|
| Rate for Payer: Mclaren Medicare |
$8,221.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,632.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,454.94
|
| Rate for Payer: PACE Medicare |
$7,810.61
|
| Rate for Payer: PACE SWMI |
$8,221.69
|
| Rate for Payer: PHP Medicare Advantage |
$8,221.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,400.33
|
| Rate for Payer: Priority Health Medicare |
$8,221.69
|
| Rate for Payer: Priority Health Narrow Network |
$12,320.26
|
| Rate for Payer: Railroad Medicare Medicare |
$8,221.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,370.59
|
| Rate for Payer: UHC Core |
$10,045.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,221.69
|
| Rate for Payer: UHC Exchange |
$10,758.83
|
| Rate for Payer: UHC Medicare Advantage |
$8,468.34
|
| Rate for Payer: VA VA |
$8,221.69
|
|
|
NETARSUDIL 0.02 % EYE DROPS
|
Facility
|
IP
|
$1,056.06
|
|
|
Service Code
|
NDC 70727-497-25
|
| Hospital Charge Code |
186103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$665.32 |
| Max. Negotiated Rate |
$950.45 |
| Rate for Payer: Aetna Commercial |
$897.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.44
|
| Rate for Payer: Cash Price |
$844.85
|
| Rate for Payer: Cofinity Commercial |
$739.24
|
| Rate for Payer: Cofinity Commercial |
$908.21
|
| Rate for Payer: Healthscope Commercial |
$950.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$897.65
|
| Rate for Payer: PHP Commercial |
$897.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.24
|
| Rate for Payer: Priority Health SBD |
$665.32
|
|
|
NEURECTOMY, INTRINSIC MUSCULATURE OF FOOT
|
Facility
|
OP
|
$5,402.75
|
|
|
Service Code
|
CPT 28055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$385.40 |
| Max. Negotiated Rate |
$5,402.75 |
| Rate for Payer: Aetna Medicare |
$1,786.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,147.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,147.49
|
| Rate for Payer: BCBS Complete |
$986.81
|
| Rate for Payer: BCBS MAPPO |
$1,717.99
|
| Rate for Payer: BCBS Trust/PPO |
$798.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,717.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,717.99
|
| Rate for Payer: Mclaren Medicaid |
$939.74
|
| Rate for Payer: Mclaren Medicare |
$1,717.99
|
| Rate for Payer: Meridian Medicaid |
$986.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,803.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,975.69
|
| Rate for Payer: PACE Medicare |
$1,632.09
|
| Rate for Payer: PACE SWMI |
$1,717.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,717.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$939.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,402.75
|
| Rate for Payer: Priority Health Medicare |
$1,717.99
|
| Rate for Payer: Priority Health Narrow Network |
$4,322.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,717.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.94
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,717.99
|
| Rate for Payer: UHC Exchange |
$385.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,769.53
|
| Rate for Payer: VA VA |
$1,717.99
|
|
|
NEUROLOGICAL EYE DISORDERS
|
Facility
|
IP
|
$18,436.78
|
|
|
Service Code
|
MS-DRG 123
|
| Min. Negotiated Rate |
$5,968.83 |
| Max. Negotiated Rate |
$18,436.78 |
| Rate for Payer: Aetna Medicare |
$6,534.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,853.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,853.72
|
| Rate for Payer: BCBS MAPPO |
$6,282.98
|
| Rate for Payer: BCBS Trust/PPO |
$18,436.78
|
| Rate for Payer: BCN Medicare Advantage |
$6,282.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,282.98
|
| Rate for Payer: Mclaren Medicare |
$6,282.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,597.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,225.43
|
| Rate for Payer: PACE Medicare |
$5,968.83
|
| Rate for Payer: PACE SWMI |
$6,282.98
|
| Rate for Payer: PHP Medicare Advantage |
$6,282.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,537.34
|
| Rate for Payer: Priority Health Medicare |
$6,282.98
|
| Rate for Payer: Priority Health Narrow Network |
$9,229.87
|
| Rate for Payer: Railroad Medicare Medicare |
$6,282.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,264.22
|
| Rate for Payer: UHC Core |
$7,525.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,282.98
|
| Rate for Payer: UHC Exchange |
$8,060.10
|
| Rate for Payer: UHC Medicare Advantage |
$6,471.47
|
| Rate for Payer: VA VA |
$6,282.98
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL
|
Facility
|
OP
|
$5,467.25
|
|
|
Service Code
|
CPT 64721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$437.79 |
| Max. Negotiated Rate |
$5,467.25 |
| Rate for Payer: Aetna Medicare |
$1,786.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,147.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,147.49
|
| Rate for Payer: BCBS Complete |
$986.81
|
| Rate for Payer: BCBS MAPPO |
$1,717.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,114.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,717.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,717.99
|
| Rate for Payer: Mclaren Medicaid |
$939.74
|
| Rate for Payer: Mclaren Medicare |
$1,717.99
|
| Rate for Payer: Meridian Medicaid |
$986.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,803.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,975.69
|
| Rate for Payer: PACE Medicare |
$1,632.09
|
| Rate for Payer: PACE SWMI |
$1,717.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,717.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$939.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,467.25
|
| Rate for Payer: Priority Health Medicare |
$1,717.99
|
| Rate for Payer: Priority Health Narrow Network |
$4,373.80
|
| Rate for Payer: Railroad Medicare Medicare |
$1,717.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$481.57
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,717.99
|
| Rate for Payer: UHC Exchange |
$437.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,769.53
|
| Rate for Payer: VA VA |
$1,717.99
|
|
