|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$35,988.61
|
|
|
Service Code
|
MS-DRG 581
|
| Min. Negotiated Rate |
$9,681.80 |
| Max. Negotiated Rate |
$35,988.61 |
| Rate for Payer: Aetna Medicare |
$10,599.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,739.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,739.21
|
| Rate for Payer: BCBS MAPPO |
$10,191.37
|
| Rate for Payer: BCBS Trust/PPO |
$35,988.61
|
| Rate for Payer: BCN Medicare Advantage |
$10,191.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,191.37
|
| Rate for Payer: Mclaren Medicare |
$10,191.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,700.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,720.08
|
| Rate for Payer: PACE Medicare |
$9,681.80
|
| Rate for Payer: PACE SWMI |
$10,191.37
|
| Rate for Payer: PHP Medicare Advantage |
$10,191.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,325.04
|
| Rate for Payer: Priority Health Medicare |
$10,191.37
|
| Rate for Payer: Priority Health Narrow Network |
$15,460.03
|
| Rate for Payer: Railroad Medicare Medicare |
$10,191.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,542.56
|
| Rate for Payer: UHC Core |
$12,605.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,191.37
|
| Rate for Payer: UHC Exchange |
$13,500.67
|
| Rate for Payer: UHC Medicare Advantage |
$10,497.11
|
| Rate for Payer: VA VA |
$10,191.37
|
|
|
OTHER VASCULAR PROCEDURES WITH CC
|
Facility
|
IP
|
$46,818.78
|
|
|
Service Code
|
MS-DRG 253
|
| Min. Negotiated Rate |
$17,921.97 |
| Max. Negotiated Rate |
$46,818.78 |
| Rate for Payer: Aetna Medicare |
$19,619.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,581.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,581.54
|
| Rate for Payer: BCBS MAPPO |
$18,865.23
|
| Rate for Payer: BCBS Trust/PPO |
$46,818.78
|
| Rate for Payer: BCN Medicare Advantage |
$18,865.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,865.23
|
| Rate for Payer: Mclaren Medicare |
$18,865.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,808.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,695.01
|
| Rate for Payer: PACE Medicare |
$17,921.97
|
| Rate for Payer: PACE SWMI |
$18,865.23
|
| Rate for Payer: PHP Medicare Advantage |
$18,865.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,608.08
|
| Rate for Payer: Priority Health Medicare |
$18,865.23
|
| Rate for Payer: Priority Health Narrow Network |
$29,286.46
|
| Rate for Payer: Railroad Medicare Medicare |
$18,865.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38,914.48
|
| Rate for Payer: UHC Core |
$23,878.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,865.23
|
| Rate for Payer: UHC Exchange |
$25,574.78
|
| Rate for Payer: UHC Medicare Advantage |
$19,431.19
|
| Rate for Payer: VA VA |
$18,865.23
|
|
|
OTHER VASCULAR PROCEDURES WITH MCC
|
Facility
|
IP
|
$81,232.93
|
|
|
Service Code
|
MS-DRG 252
|
| Min. Negotiated Rate |
$23,413.80 |
| Max. Negotiated Rate |
$81,232.93 |
| Rate for Payer: Aetna Medicare |
$25,631.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,807.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,807.64
|
| Rate for Payer: BCBS MAPPO |
$24,646.11
|
| Rate for Payer: BCBS Trust/PPO |
$81,232.93
|
| Rate for Payer: BCN Medicare Advantage |
$24,646.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,646.11
|
| Rate for Payer: Mclaren Medicare |
$24,646.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,878.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,343.03
|
| Rate for Payer: PACE Medicare |
$23,413.80
|
| Rate for Payer: PACE SWMI |
$24,646.11
|
| Rate for Payer: PHP Medicare Advantage |
$24,646.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48,126.76
|
| Rate for Payer: Priority Health Medicare |
$24,646.11
|
| Rate for Payer: Priority Health Narrow Network |
$38,501.41
|
| Rate for Payer: Railroad Medicare Medicare |
$24,646.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51,158.87
|
| Rate for Payer: UHC Core |
$31,391.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$24,646.11
|
| Rate for Payer: UHC Exchange |
$33,621.85
|
| Rate for Payer: UHC Medicare Advantage |
$25,385.49
|
| Rate for Payer: VA VA |
$24,646.11
|
|
|
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$33,342.55
|
|
|
Service Code
|
MS-DRG 254
|
| Min. Negotiated Rate |
$12,339.13 |
| Max. Negotiated Rate |
$33,342.55 |
| Rate for Payer: Aetna Medicare |
$13,508.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,235.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,235.70
|
| Rate for Payer: BCBS MAPPO |
$12,988.56
|
| Rate for Payer: BCBS Trust/PPO |
$33,342.55
|
| Rate for Payer: BCN Medicare Advantage |
$12,988.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,988.56
|
| Rate for Payer: Mclaren Medicare |
$12,988.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,637.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,936.84
|
| Rate for Payer: PACE Medicare |
$12,339.13
|
| Rate for Payer: PACE SWMI |
$12,988.56
|
| Rate for Payer: PHP Medicare Advantage |
$12,988.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,898.55
|
| Rate for Payer: Priority Health Medicare |
$12,988.56
|
| Rate for Payer: Priority Health Narrow Network |
$19,918.84
|
| Rate for Payer: Railroad Medicare Medicare |
$12,988.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,467.22
|
| Rate for Payer: UHC Core |
$16,240.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,988.56
|
| Rate for Payer: UHC Exchange |
$17,394.38
|
| Rate for Payer: UHC Medicare Advantage |
$13,378.22
|
| Rate for Payer: VA VA |
$12,988.56
|
|
|
OTITIS MEDIA AND URI WITH MCC
|
Facility
|
IP
|
$18,124.80
|
|
|
Service Code
|
MS-DRG 152
|
| Min. Negotiated Rate |
$8,597.41 |
| Max. Negotiated Rate |
$18,124.80 |
| Rate for Payer: Aetna Medicare |
$9,411.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,312.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,312.39
|
| Rate for Payer: BCBS MAPPO |
$9,049.91
|
| Rate for Payer: BCBS Trust/PPO |
$11,339.63
|
| Rate for Payer: BCN Medicare Advantage |
$9,049.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,049.91
|
| Rate for Payer: Mclaren Medicare |
$9,049.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,502.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,407.40
|
| Rate for Payer: PACE Medicare |
$8,597.41
|
| Rate for Payer: PACE SWMI |
$9,049.91
|
| Rate for Payer: PHP Medicare Advantage |
$9,049.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,050.57
|
| Rate for Payer: Priority Health Medicare |
$9,049.91
|
| Rate for Payer: Priority Health Narrow Network |
$13,640.46
|
| Rate for Payer: Railroad Medicare Medicare |
$9,049.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,124.80
|
| Rate for Payer: UHC Core |
$11,121.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,049.91
|
| Rate for Payer: UHC Exchange |
$11,911.71
|
| Rate for Payer: UHC Medicare Advantage |
$9,321.41
|
| Rate for Payer: VA VA |
$9,049.91
|
|
|
OTITIS MEDIA AND URI WITHOUT MCC
|
Facility
|
IP
|
$11,208.64
|
|
|
Service Code
|
MS-DRG 153
|
| Min. Negotiated Rate |
$5,495.38 |
| Max. Negotiated Rate |
$11,208.64 |
| Rate for Payer: Aetna Medicare |
$6,015.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,230.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,230.76
|
| Rate for Payer: BCBS MAPPO |
$5,784.61
|
| Rate for Payer: BCBS Trust/PPO |
$7,848.15
|
| Rate for Payer: BCN Medicare Advantage |
$5,784.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,784.61
|
| Rate for Payer: Mclaren Medicare |
$5,784.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,073.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,652.30
|
| Rate for Payer: PACE Medicare |
$5,495.38
|
| Rate for Payer: PACE SWMI |
$5,784.61
|
| Rate for Payer: PHP Medicare Advantage |
$5,784.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,544.32
|
| Rate for Payer: Priority Health Medicare |
$5,784.61
|
| Rate for Payer: Priority Health Narrow Network |
$8,435.46
|
| Rate for Payer: Railroad Medicare Medicare |
$5,784.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,208.64
|
| Rate for Payer: UHC Core |
$6,877.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,784.61
|
| Rate for Payer: UHC Exchange |
$7,366.37
|
| Rate for Payer: UHC Medicare Advantage |
$5,958.15
|
| Rate for Payer: VA VA |
$5,784.61
|
|
|
OTOLARYNGOLOGIC EXAMINATION UNDER GENERAL ANESTHESIA
|
Facility
|
OP
|
$1,408.21
|
|
|
Service Code
|
CPT 92502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$93.32 |
| Max. Negotiated Rate |
$1,408.21 |
| Rate for Payer: Aetna Medicare |
$509.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$611.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$611.96
|
| Rate for Payer: BCBS Complete |
$281.21
|
| Rate for Payer: BCBS MAPPO |
$489.57
|
| Rate for Payer: BCBS Trust/PPO |
$230.40
|
| Rate for Payer: BCN Medicare Advantage |
$489.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.57
|
| Rate for Payer: Mclaren Medicaid |
$267.79
|
| Rate for Payer: Mclaren Medicare |
$489.57
|
| Rate for Payer: Meridian Medicaid |
$281.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$514.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.01
|
| Rate for Payer: PACE Medicare |
$465.09
|
| Rate for Payer: PACE SWMI |
$489.57
|
| Rate for Payer: PHP Medicare Advantage |
$489.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,408.21
|
| Rate for Payer: Priority Health Medicare |
$489.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,126.56
|
| Rate for Payer: Railroad Medicare Medicare |
$489.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.65
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$489.57
|
| Rate for Payer: UHC Exchange |
$93.32
|
| Rate for Payer: UHC Medicare Advantage |
$504.26
|
| Rate for Payer: VA VA |
$489.57
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$780.70
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
99612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$491.84 |
| Max. Negotiated Rate |
$702.63 |
| Rate for Payer: Aetna Commercial |
$663.60
|
| Rate for Payer: Aetna Commercial |
$242.56
|
| Rate for Payer: Aetna Commercial |
$495.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.67
|
| Rate for Payer: Cash Price |
$228.29
|
| Rate for Payer: Cash Price |
$466.06
|
| Rate for Payer: Cash Price |
$624.56
|
| Rate for Payer: Cofinity Commercial |
$407.80
|
| Rate for Payer: Cofinity Commercial |
$199.75
|
| Rate for Payer: Cofinity Commercial |
$245.41
|
| Rate for Payer: Cofinity Commercial |
$501.01
|
| Rate for Payer: Cofinity Commercial |
$546.49
|
| Rate for Payer: Cofinity Commercial |
$671.40
|
| Rate for Payer: Healthscope Commercial |
$256.82
|
| Rate for Payer: Healthscope Commercial |
$524.31
|
| Rate for Payer: Healthscope Commercial |
$702.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$495.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$663.60
|
| Rate for Payer: PHP Commercial |
$495.18
|
| Rate for Payer: PHP Commercial |
$663.60
|
| Rate for Payer: PHP Commercial |
$242.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$407.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.75
|
| Rate for Payer: Priority Health SBD |
$179.78
|
| Rate for Payer: Priority Health SBD |
$367.02
|
| Rate for Payer: Priority Health SBD |
$491.84
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$780.70
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
99612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$702.63 |
| Rate for Payer: Aetna Commercial |
$663.60
|
| Rate for Payer: Aetna Commercial |
$495.18
|
| Rate for Payer: Aetna Commercial |
$242.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.67
|
| Rate for Payer: BCBS Complete |
$114.14
|
| Rate for Payer: BCBS Complete |
$233.03
|
| Rate for Payer: BCBS Complete |
$312.28
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: Cash Price |
$228.29
|
| Rate for Payer: Cash Price |
$228.29
|
| Rate for Payer: Cash Price |
$466.06
|
| Rate for Payer: Cash Price |
$466.06
|
| Rate for Payer: Cash Price |
$624.56
|
| Rate for Payer: Cash Price |
$624.56
|
| Rate for Payer: Cofinity Commercial |
$501.01
|
| Rate for Payer: Cofinity Commercial |
$671.40
|
| Rate for Payer: Cofinity Commercial |
$245.41
|
| Rate for Payer: Cofinity Commercial |
$407.80
|
| Rate for Payer: Cofinity Commercial |
$199.75
|
| Rate for Payer: Cofinity Commercial |
$546.49
|
| Rate for Payer: Healthscope Commercial |
$256.82
|
| Rate for Payer: Healthscope Commercial |
$524.31
|
| Rate for Payer: Healthscope Commercial |
$702.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$663.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$495.18
|
| Rate for Payer: PHP Commercial |
$663.60
|
| Rate for Payer: PHP Commercial |
$242.56
|
| Rate for Payer: PHP Commercial |
$495.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$407.80
|
| Rate for Payer: Priority Health SBD |
$367.02
|
| Rate for Payer: Priority Health SBD |
$179.78
|
| Rate for Payer: Priority Health SBD |
$491.84
|
|
|
OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$151.09
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
41598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$135.98 |
| Rate for Payer: Aetna Commercial |
$128.43
|
| Rate for Payer: Aetna Commercial |
$222.39
|
| Rate for Payer: Aetna Commercial |
$226.87
|
| Rate for Payer: Aetna Commercial |
$367.67
|
| Rate for Payer: Aetna Commercial |
$405.14
|
| Rate for Payer: Aetna Commercial |
$158.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.81
|
| Rate for Payer: BCBS Complete |
$104.65
|
| Rate for Payer: BCBS Complete |
$60.44
|
| Rate for Payer: BCBS Complete |
$190.65
|
| Rate for Payer: BCBS Complete |
$74.70
|
| Rate for Payer: BCBS Complete |
$173.02
|
| Rate for Payer: BCBS Complete |
$106.76
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Cash Price |
$120.87
|
| Rate for Payer: Cash Price |
$120.87
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Cash Price |
$149.41
|
| Rate for Payer: Cash Price |
$149.41
|
| Rate for Payer: Cash Price |
$213.53
|
| Rate for Payer: Cash Price |
$213.53
|
| Rate for Payer: Cash Price |
$346.04
|
| Rate for Payer: Cash Price |
$346.04
|
| Rate for Payer: Cash Price |
$381.30
|
| Rate for Payer: Cash Price |
$381.30
|
| Rate for Payer: Cofinity Commercial |
$186.84
|
| Rate for Payer: Cofinity Commercial |
$105.76
|
| Rate for Payer: Cofinity Commercial |
$129.94
|
| Rate for Payer: Cofinity Commercial |
$130.73
|
| Rate for Payer: Cofinity Commercial |
$160.61
|
| Rate for Payer: Cofinity Commercial |
$183.14
|
| Rate for Payer: Cofinity Commercial |
$225.00
|
| Rate for Payer: Cofinity Commercial |
$229.54
|
| Rate for Payer: Cofinity Commercial |
$302.78
|
| Rate for Payer: Cofinity Commercial |
$371.99
|
| Rate for Payer: Cofinity Commercial |
$333.64
|
| Rate for Payer: Cofinity Commercial |
$409.90
|
| Rate for Payer: Healthscope Commercial |
$135.98
|
| Rate for Payer: Healthscope Commercial |
$235.47
|
| Rate for Payer: Healthscope Commercial |
$240.22
|
| Rate for Payer: Healthscope Commercial |
$389.30
|
| Rate for Payer: Healthscope Commercial |
$428.97
|
| Rate for Payer: Healthscope Commercial |
$168.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$367.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.14
|
| Rate for Payer: PHP Commercial |
$128.43
|
| Rate for Payer: PHP Commercial |
$226.87
|
| Rate for Payer: PHP Commercial |
$158.75
|
| Rate for Payer: PHP Commercial |
$405.14
|
| Rate for Payer: PHP Commercial |
$367.67
|
| Rate for Payer: PHP Commercial |
$222.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.64
|
| Rate for Payer: Priority Health SBD |
$164.83
|
| Rate for Payer: Priority Health SBD |
$272.51
|
| Rate for Payer: Priority Health SBD |
$117.66
|
| Rate for Payer: Priority Health SBD |
$168.15
|
| Rate for Payer: Priority Health SBD |
$95.19
|
| Rate for Payer: Priority Health SBD |
$300.28
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
NDC 68084-845-01
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.37 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna Commercial |
$339.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.35
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cofinity Commercial |
$279.30
|
| Rate for Payer: Cofinity Commercial |
$343.14
|
| Rate for Payer: Healthscope Commercial |
$359.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$339.15
|
| Rate for Payer: PHP Commercial |
$339.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.30
|
| Rate for Payer: Priority Health SBD |
$251.37
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$317.25
|
|
|
Service Code
|
NDC 51991-292-01
|
| Hospital Charge Code |
27049
|
|
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
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$3.99
|
|
|
Service Code
|
NDC 68084-845-11
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.39
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.79
|
| Rate for Payer: Priority Health SBD |
$2.51
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$357.60
|
|
|
Service Code
|
NDC 60687-722-01
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.29 |
| Max. Negotiated Rate |
$321.84 |
| Rate for Payer: Aetna Commercial |
$303.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.44
|
| Rate for Payer: Cash Price |
$286.08
|
| Rate for Payer: Cofinity Commercial |
$250.32
|
| Rate for Payer: Cofinity Commercial |
$307.54
|
| Rate for Payer: Healthscope Commercial |
$321.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$303.96
|
| Rate for Payer: PHP Commercial |
$303.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.32
|
| Rate for Payer: Priority Health SBD |
$225.29
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$418.30
|
|
|
Service Code
|
NDC 51991-293-01
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.53 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.90
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$292.81
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$355.56
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.81
|
| Rate for Payer: Priority Health SBD |
$263.53
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$298.56
|
|
|
Service Code
|
NDC 68084-853-01
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.09 |
| Max. Negotiated Rate |
$268.70 |
| Rate for Payer: Aetna Commercial |
$253.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.06
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cofinity Commercial |
$208.99
|
| Rate for Payer: Cofinity Commercial |
$256.76
|
| Rate for Payer: Healthscope Commercial |
$268.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.78
|
| Rate for Payer: PHP Commercial |
$253.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.99
|
| Rate for Payer: Priority Health SBD |
$188.09
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$3.58
|
|
|
Service Code
|
NDC 60687-722-11
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: Aetna Commercial |
$3.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.33
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$3.08
|
| Rate for Payer: Healthscope Commercial |
$3.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.04
|
| Rate for Payer: PHP Commercial |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.51
|
| Rate for Payer: Priority Health SBD |
$2.26
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
NDC 68084-853-11
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.09
|
| Rate for Payer: Priority Health SBD |
$1.88
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$355.30
|
|
|
Service Code
|
NDC 68084-400-01
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.84 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.94
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$248.71
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.00
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.71
|
| Rate for Payer: Priority Health SBD |
$223.84
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$325.85
|
|
|
Service Code
|
NDC 0904-2821-61
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.29 |
| Max. Negotiated Rate |
$293.26 |
| Rate for Payer: Aetna Commercial |
$276.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.80
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$228.10
|
| Rate for Payer: Cofinity Commercial |
$280.23
|
| Rate for Payer: Healthscope Commercial |
$293.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.97
|
| Rate for Payer: PHP Commercial |
$276.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.10
|
| Rate for Payer: Priority Health SBD |
$205.29
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$355.30
|
|
|
Service Code
|
NDC 68084-400-11
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.84 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.94
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$248.71
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.00
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.71
|
| Rate for Payer: Priority Health SBD |
$223.84
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$372.41
|
|
|
Service Code
|
NDC 50268-628-15
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.62 |
| Max. Negotiated Rate |
$335.17 |
| Rate for Payer: Aetna Commercial |
$316.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.07
|
| Rate for Payer: Cash Price |
$297.93
|
| Rate for Payer: Cofinity Commercial |
$260.69
|
| Rate for Payer: Cofinity Commercial |
$320.27
|
| Rate for Payer: Healthscope Commercial |
$335.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.55
|
| Rate for Payer: PHP Commercial |
$316.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.69
|
| Rate for Payer: Priority Health SBD |
$234.62
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$7.45
|
|
|
Service Code
|
NDC 50268-628-11
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.84
|
| Rate for Payer: Cash Price |
$5.96
|
| Rate for Payer: Cofinity Commercial |
$5.22
|
| Rate for Payer: Cofinity Commercial |
$6.41
|
| Rate for Payer: Healthscope Commercial |
$6.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.33
|
| Rate for Payer: PHP Commercial |
$6.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.22
|
| Rate for Payer: Priority Health SBD |
$4.69
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$329.76
|
|
|
Service Code
|
NDC 0904-6570-06
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.75 |
| Max. Negotiated Rate |
$296.78 |
| Rate for Payer: Aetna Commercial |
$280.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.34
|
| Rate for Payer: Cash Price |
$263.81
|
| Rate for Payer: Cofinity Commercial |
$230.83
|
| Rate for Payer: Cofinity Commercial |
$283.59
|
| Rate for Payer: Healthscope Commercial |
$296.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.30
|
| Rate for Payer: PHP Commercial |
$280.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.83
|
| Rate for Payer: Priority Health SBD |
$207.75
|
|
|
OXYCODONE 10 MG TABLET
|
Facility
|
IP
|
$426.30
|
|
|
Service Code
|
NDC 68084-968-01
|
| Hospital Charge Code |
87795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.57 |
| Max. Negotiated Rate |
$383.67 |
| Rate for Payer: Aetna Commercial |
$362.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.10
|
| Rate for Payer: Cash Price |
$341.04
|
| Rate for Payer: Cofinity Commercial |
$298.41
|
| Rate for Payer: Cofinity Commercial |
$366.62
|
| Rate for Payer: Healthscope Commercial |
$383.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$362.36
|
| Rate for Payer: PHP Commercial |
$362.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.41
|
| Rate for Payer: Priority Health SBD |
$268.57
|
|
