|
MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK
|
Facility
|
IP
|
$66.10
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
14961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.64 |
| Max. Negotiated Rate |
$59.49 |
| Rate for Payer: Aetna Commercial |
$56.19
|
| Rate for Payer: Aetna Commercial |
$44.74
|
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.22
|
| Rate for Payer: Cash Price |
$42.11
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Advantage |
$36.85
|
| Rate for Payer: Cofinity Advantage |
$46.27
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Cofinity Commercial |
$45.27
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.88
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Healthscope Commercial |
$47.38
|
| Rate for Payer: Healthscope Commercial |
$59.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.58
|
| Rate for Payer: PHP Commercial |
$44.74
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: PHP Commercial |
$56.19
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: Priority Health SBD |
$41.64
|
| Rate for Payer: Priority Health SBD |
$33.16
|
|
|
MINERAL OIL
|
Facility
|
IP
|
$78.37
|
|
|
Service Code
|
NDC 63323025410
|
| Hospital Charge Code |
109056
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$70.53 |
| Rate for Payer: Aetna Commercial |
$66.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.94
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cofinity Advantage |
$54.86
|
| Rate for Payer: Cofinity Commercial |
$67.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.70
|
| Rate for Payer: Healthscope Commercial |
$70.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.78
|
| Rate for Payer: PHP Commercial |
$66.61
|
| Rate for Payer: Priority Health SBD |
$49.37
|
|
|
MINERAL OIL
|
Facility
|
OP
|
$78.37
|
|
|
Service Code
|
NDC 63323025410
|
| Hospital Charge Code |
109056
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$70.53 |
| Rate for Payer: Aetna Commercial |
$66.61
|
| Rate for Payer: Aetna Medicare |
$39.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.94
|
| Rate for Payer: BCBS Complete |
$31.35
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cofinity Advantage |
$54.86
|
| Rate for Payer: Cofinity Commercial |
$67.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.70
|
| Rate for Payer: Healthscope Commercial |
$70.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.78
|
| Rate for Payer: PHP Commercial |
$66.61
|
| Rate for Payer: Priority Health SBD |
$49.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.94
|
| Rate for Payer: UHC Core |
$40.83
|
| Rate for Payer: UHC Exchange |
$30.80
|
|
|
MINERAL OIL ENEMA
|
Facility
|
OP
|
$59.39
|
|
|
Service Code
|
NDC 00132030140
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$53.45 |
| Rate for Payer: Aetna Commercial |
$50.48
|
| Rate for Payer: Aetna Medicare |
$29.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.60
|
| Rate for Payer: BCBS Complete |
$23.76
|
| Rate for Payer: Cash Price |
$47.51
|
| Rate for Payer: Cofinity Advantage |
$41.57
|
| Rate for Payer: Cofinity Commercial |
$51.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.51
|
| Rate for Payer: Healthscope Commercial |
$53.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.54
|
| Rate for Payer: PHP Commercial |
$50.48
|
| Rate for Payer: Priority Health SBD |
$37.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.60
|
| Rate for Payer: UHC Core |
$30.94
|
| Rate for Payer: UHC Exchange |
$23.34
|
|
|
MINERAL OIL ENEMA
|
Facility
|
IP
|
$59.39
|
|
|
Service Code
|
NDC 00132030140
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.42 |
| Max. Negotiated Rate |
$53.45 |
| Rate for Payer: Aetna Commercial |
$50.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.60
|
| Rate for Payer: Cash Price |
$47.51
|
| Rate for Payer: Cofinity Advantage |
$41.57
|
| Rate for Payer: Cofinity Commercial |
$51.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.51
|
| Rate for Payer: Healthscope Commercial |
$53.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.54
|
| Rate for Payer: PHP Commercial |
$50.48
|
| Rate for Payer: Priority Health SBD |
$37.42
|
|
|
MINERAL OIL ORAL
|
Facility
|
IP
|
$8.76
|
|
|
Service Code
|
NDC 09629514323
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$7.88 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.69
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cofinity Advantage |
$6.13
|
| Rate for Payer: Cofinity Commercial |
$7.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.01
|
| Rate for Payer: Healthscope Commercial |
$7.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.57
|
| Rate for Payer: PHP Commercial |
$7.45
|
| Rate for Payer: Priority Health SBD |
$5.52
|
|
|
MINERAL OIL ORAL
|
Facility
|
OP
|
$8.76
|
|
|
Service Code
|
NDC 09629514323
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$7.88 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Aetna Medicare |
$4.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.69
|
| Rate for Payer: BCBS Complete |
$3.50
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cofinity Advantage |
$6.13
|
| Rate for Payer: Cofinity Commercial |
$7.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.01
|
| Rate for Payer: Healthscope Commercial |
$7.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.57
|
| Rate for Payer: PHP Commercial |
$7.45
|
| Rate for Payer: Priority Health SBD |
$5.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.69
|
| Rate for Payer: UHC Core |
$4.56
|
| Rate for Payer: UHC Exchange |
$3.44
|
|
|
MINERAL OIL ORAL
|
Facility
|
OP
|
$8.88
|
|
|
Service Code
|
NDC 96295010183
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.77
|
| Rate for Payer: BCBS Complete |
$3.55
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Advantage |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.66
|
| Rate for Payer: PHP Commercial |
$7.55
|
| Rate for Payer: Priority Health SBD |
$5.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.77
|
| Rate for Payer: UHC Core |
$4.63
|
| Rate for Payer: UHC Exchange |
$3.49
|
|
|
MINERAL OIL ORAL
|
Facility
|
IP
|
$8.88
|
|
|
Service Code
|
NDC 96295010183
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.77
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Advantage |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.66
|
| Rate for Payer: PHP Commercial |
$7.55
|
| Rate for Payer: Priority Health SBD |
$5.59
|
|
|
MINOCYCLINE 50 MG CAPSULE
|
Facility
|
OP
|
$234.65
|
|
|
Service Code
|
NDC 00591569401
|
| Hospital Charge Code |
5111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.22 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna Medicare |
$117.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.52
|
| Rate for Payer: BCBS Complete |
$93.86
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Advantage |
$164.25
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health SBD |
$147.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.52
|
| Rate for Payer: UHC Core |
$122.25
|
| Rate for Payer: UHC Exchange |
$92.22
|
|
|
MINOCYCLINE 50 MG CAPSULE
|
Facility
|
IP
|
$234.65
|
|
|
Service Code
|
NDC 00591569401
|
| Hospital Charge Code |
5111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.83 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.52
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Advantage |
$164.25
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health SBD |
$147.83
|
|
|
MINOCYCLINE 50 MG CAPSULE
|
Facility
|
IP
|
$448.85
|
|
|
Service Code
|
NDC 68382031601
|
| Hospital Charge Code |
5111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$282.78 |
| Max. Negotiated Rate |
$403.96 |
| Rate for Payer: Aetna Commercial |
$381.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.75
|
| Rate for Payer: Cash Price |
$359.08
|
| Rate for Payer: Cofinity Advantage |
$314.19
|
| Rate for Payer: Cofinity Commercial |
$386.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.08
|
| Rate for Payer: Healthscope Commercial |
$403.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$336.64
|
| Rate for Payer: PHP Commercial |
$381.52
|
| Rate for Payer: Priority Health SBD |
$282.78
|
|
|
MINOCYCLINE 50 MG CAPSULE
|
Facility
|
OP
|
$448.85
|
|
|
Service Code
|
NDC 68382031601
|
| Hospital Charge Code |
5111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$403.96 |
| Rate for Payer: Aetna Commercial |
$381.52
|
| Rate for Payer: Aetna Medicare |
$224.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.75
|
| Rate for Payer: BCBS Complete |
$179.54
|
| Rate for Payer: Cash Price |
$359.08
|
| Rate for Payer: Cofinity Advantage |
$314.19
|
| Rate for Payer: Cofinity Commercial |
$386.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.08
|
| Rate for Payer: Healthscope Commercial |
$403.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$359.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$336.64
|
| Rate for Payer: PHP Commercial |
$381.52
|
| Rate for Payer: Priority Health SBD |
$282.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.75
|
| Rate for Payer: UHC Core |
$233.85
|
| Rate for Payer: UHC Exchange |
$176.40
|
|
|
MINOR BLADDER PROCEDURES WITH CC
|
Facility
|
IP
|
$31,965.96
|
|
|
Service Code
|
MSDRG 663
|
| Min. Negotiated Rate |
$11,711.08 |
| Max. Negotiated Rate |
$31,965.96 |
| Rate for Payer: Aetna Medicare |
$12,820.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,409.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,409.31
|
| Rate for Payer: BCBS MAPPO |
$12,327.45
|
| Rate for Payer: BCBS Trust/PPO |
$31,965.96
|
| Rate for Payer: BCN Commercial |
$31,965.96
|
| Rate for Payer: BCN Medicare Advantage |
$12,327.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,327.45
|
| Rate for Payer: Mclaren Medicare |
$12,327.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,943.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,176.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,560.19
|
| Rate for Payer: Nomi Health Commercial |
$19,610.58
|
| Rate for Payer: PACE Medicare |
$11,711.08
|
| Rate for Payer: PACE SWMI |
$12,327.45
|
| Rate for Payer: PHP Medicare Advantage |
$12,327.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,508.88
|
| Rate for Payer: Priority Health Medicare |
$12,327.45
|
| Rate for Payer: Priority Health Tiered Network |
$19,607.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12,327.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,779.26
|
| Rate for Payer: UHC Core |
$20,730.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,327.45
|
| Rate for Payer: UHC Exchange |
$16,930.47
|
| Rate for Payer: VA VA |
$12,327.45
|
|
|
MINOR BLADDER PROCEDURES WITH MCC
|
Facility
|
IP
|
$51,602.94
|
|
|
Service Code
|
MSDRG 662
|
| Min. Negotiated Rate |
$23,027.00 |
| Max. Negotiated Rate |
$51,602.94 |
| Rate for Payer: Aetna Medicare |
$25,208.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,298.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,298.69
|
| Rate for Payer: BCBS MAPPO |
$24,238.95
|
| Rate for Payer: BCBS Trust/PPO |
$51,602.94
|
| Rate for Payer: BCN Commercial |
$51,602.94
|
| Rate for Payer: BCN Medicare Advantage |
$24,238.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,238.95
|
| Rate for Payer: Mclaren Medicare |
$24,238.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,450.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,874.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$26,662.85
|
| Rate for Payer: Nomi Health Commercial |
$39,493.35
|
| Rate for Payer: PACE Medicare |
$23,027.00
|
| Rate for Payer: PACE SWMI |
$24,238.95
|
| Rate for Payer: PHP Medicare Advantage |
$24,238.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49,357.93
|
| Rate for Payer: Priority Health Medicare |
$24,238.95
|
| Rate for Payer: Priority Health Tiered Network |
$39,486.34
|
| Rate for Payer: Railroad Medicare Medicare |
$24,238.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,902.45
|
| Rate for Payer: UHC Core |
$41,749.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,238.95
|
| Rate for Payer: UHC Exchange |
$34,095.93
|
| Rate for Payer: VA VA |
$24,238.95
|
|
|
MINOR BLADDER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$23,260.53
|
|
|
Service Code
|
MSDRG 664
|
| Min. Negotiated Rate |
$8,236.20 |
| Max. Negotiated Rate |
$23,260.53 |
| Rate for Payer: Aetna Medicare |
$9,016.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,837.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,837.10
|
| Rate for Payer: BCBS MAPPO |
$8,669.68
|
| Rate for Payer: BCBS Trust/PPO |
$23,260.53
|
| Rate for Payer: BCN Commercial |
$23,260.53
|
| Rate for Payer: BCN Medicare Advantage |
$8,669.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,669.68
|
| Rate for Payer: Mclaren Medicare |
$8,669.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,103.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,970.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,536.65
|
| Rate for Payer: Nomi Health Commercial |
$13,505.01
|
| Rate for Payer: PACE Medicare |
$8,236.20
|
| Rate for Payer: PACE SWMI |
$8,669.68
|
| Rate for Payer: PHP Medicare Advantage |
$8,669.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,878.27
|
| Rate for Payer: Priority Health Medicare |
$8,669.68
|
| Rate for Payer: Priority Health Tiered Network |
$13,502.61
|
| Rate for Payer: Railroad Medicare Medicare |
$8,669.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,064.47
|
| Rate for Payer: UHC Core |
$14,276.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,669.68
|
| Rate for Payer: UHC Exchange |
$11,659.33
|
| Rate for Payer: VA VA |
$8,669.68
|
|
|
MINOR SKIN DISORDERS WITH MCC
|
Facility
|
IP
|
$26,090.56
|
|
|
Service Code
|
MSDRG 606
|
| Min. Negotiated Rate |
$11,659.69 |
| Max. Negotiated Rate |
$26,090.56 |
| Rate for Payer: Aetna Medicare |
$12,764.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,341.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,341.70
|
| Rate for Payer: BCBS MAPPO |
$12,273.36
|
| Rate for Payer: BCBS Trust/PPO |
$26,090.56
|
| Rate for Payer: BCN Commercial |
$26,090.56
|
| Rate for Payer: BCN Medicare Advantage |
$12,273.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,273.36
|
| Rate for Payer: Mclaren Medicare |
$12,273.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,887.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,114.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,500.70
|
| Rate for Payer: Nomi Health Commercial |
$19,520.28
|
| Rate for Payer: PACE Medicare |
$11,659.69
|
| Rate for Payer: PACE SWMI |
$12,273.36
|
| Rate for Payer: PHP Medicare Advantage |
$12,273.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,396.02
|
| Rate for Payer: Priority Health Medicare |
$12,273.36
|
| Rate for Payer: Priority Health Tiered Network |
$19,516.81
|
| Rate for Payer: Railroad Medicare Medicare |
$12,273.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,665.16
|
| Rate for Payer: UHC Core |
$20,635.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,273.36
|
| Rate for Payer: UHC Exchange |
$16,852.51
|
| Rate for Payer: VA VA |
$12,273.36
|
|
|
MINOR SKIN DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$14,774.32
|
|
|
Service Code
|
MSDRG 607
|
| Min. Negotiated Rate |
$7,204.68 |
| Max. Negotiated Rate |
$14,774.32 |
| Rate for Payer: Aetna Medicare |
$7,887.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,479.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,479.84
|
| Rate for Payer: BCBS MAPPO |
$7,583.87
|
| Rate for Payer: BCBS Trust/PPO |
$12,602.87
|
| Rate for Payer: BCN Commercial |
$12,602.87
|
| Rate for Payer: BCN Medicare Advantage |
$7,583.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,583.87
|
| Rate for Payer: Mclaren Medicare |
$7,583.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,963.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,721.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,342.26
|
| Rate for Payer: Nomi Health Commercial |
$11,692.56
|
| Rate for Payer: PACE Medicare |
$7,204.68
|
| Rate for Payer: PACE SWMI |
$7,583.87
|
| Rate for Payer: PHP Medicare Advantage |
$7,583.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,613.11
|
| Rate for Payer: Priority Health Medicare |
$7,583.87
|
| Rate for Payer: Priority Health Tiered Network |
$11,690.48
|
| Rate for Payer: Railroad Medicare Medicare |
$7,583.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,774.32
|
| Rate for Payer: UHC Core |
$12,360.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,583.87
|
| Rate for Payer: UHC Exchange |
$10,094.58
|
| Rate for Payer: VA VA |
$7,583.87
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC
|
Facility
|
IP
|
$28,962.72
|
|
|
Service Code
|
MSDRG 345
|
| Min. Negotiated Rate |
$11,597.28 |
| Max. Negotiated Rate |
$28,962.72 |
| Rate for Payer: Aetna Medicare |
$12,695.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,259.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,259.58
|
| Rate for Payer: BCBS MAPPO |
$12,207.66
|
| Rate for Payer: BCBS Trust/PPO |
$28,962.72
|
| Rate for Payer: BCN Commercial |
$28,962.72
|
| Rate for Payer: BCN Medicare Advantage |
$12,207.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,207.66
|
| Rate for Payer: Mclaren Medicare |
$12,207.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,818.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,038.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,428.43
|
| Rate for Payer: Nomi Health Commercial |
$19,410.63
|
| Rate for Payer: PACE Medicare |
$11,597.28
|
| Rate for Payer: PACE SWMI |
$12,207.66
|
| Rate for Payer: PHP Medicare Advantage |
$12,207.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,258.98
|
| Rate for Payer: Priority Health Medicare |
$12,207.66
|
| Rate for Payer: Priority Health Tiered Network |
$19,407.18
|
| Rate for Payer: Railroad Medicare Medicare |
$12,207.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,526.61
|
| Rate for Payer: UHC Core |
$20,519.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,207.66
|
| Rate for Payer: UHC Exchange |
$16,757.84
|
| Rate for Payer: VA VA |
$12,207.66
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC
|
Facility
|
IP
|
$50,331.88
|
|
|
Service Code
|
MSDRG 344
|
| Min. Negotiated Rate |
$19,512.50 |
| Max. Negotiated Rate |
$50,331.88 |
| Rate for Payer: Aetna Medicare |
$21,361.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,674.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,674.34
|
| Rate for Payer: BCBS MAPPO |
$20,539.47
|
| Rate for Payer: BCBS Trust/PPO |
$50,331.88
|
| Rate for Payer: BCN Commercial |
$50,331.88
|
| Rate for Payer: BCN Medicare Advantage |
$20,539.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,539.47
|
| Rate for Payer: Mclaren Medicare |
$20,539.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,566.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,620.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,593.42
|
| Rate for Payer: Nomi Health Commercial |
$33,318.12
|
| Rate for Payer: PACE Medicare |
$19,512.50
|
| Rate for Payer: PACE SWMI |
$20,539.47
|
| Rate for Payer: PHP Medicare Advantage |
$20,539.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,640.26
|
| Rate for Payer: Priority Health Medicare |
$20,539.47
|
| Rate for Payer: Priority Health Tiered Network |
$33,312.21
|
| Rate for Payer: Railroad Medicare Medicare |
$20,539.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42,099.64
|
| Rate for Payer: UHC Core |
$35,221.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,539.47
|
| Rate for Payer: UHC Exchange |
$28,764.64
|
| Rate for Payer: VA VA |
$20,539.47
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,961.33
|
|
|
Service Code
|
MSDRG 346
|
| Min. Negotiated Rate |
$9,258.91 |
| Max. Negotiated Rate |
$26,961.33 |
| Rate for Payer: Aetna Medicare |
$10,136.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,182.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,182.77
|
| Rate for Payer: BCBS MAPPO |
$9,746.22
|
| Rate for Payer: BCBS Trust/PPO |
$26,961.33
|
| Rate for Payer: BCN Commercial |
$26,961.33
|
| Rate for Payer: BCN Medicare Advantage |
$9,746.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,746.22
|
| Rate for Payer: Mclaren Medicare |
$9,746.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,233.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,208.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,720.84
|
| Rate for Payer: Nomi Health Commercial |
$15,301.98
|
| Rate for Payer: PACE Medicare |
$9,258.91
|
| Rate for Payer: PACE SWMI |
$9,746.22
|
| Rate for Payer: PHP Medicare Advantage |
$9,746.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,124.08
|
| Rate for Payer: Priority Health Medicare |
$9,746.22
|
| Rate for Payer: Priority Health Tiered Network |
$15,299.26
|
| Rate for Payer: Railroad Medicare Medicare |
$9,746.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,335.06
|
| Rate for Payer: UHC Core |
$16,176.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,746.22
|
| Rate for Payer: UHC Exchange |
$13,210.71
|
| Rate for Payer: VA VA |
$9,746.22
|
|
|
MINOXIDIL 2.5 MG TABLET
|
Facility
|
OP
|
$462.95
|
|
|
Service Code
|
NDC 00591564201
|
| Hospital Charge Code |
5115
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.94 |
| Max. Negotiated Rate |
$416.65 |
| Rate for Payer: Aetna Commercial |
$393.51
|
| Rate for Payer: Aetna Medicare |
$231.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.92
|
| Rate for Payer: BCBS Complete |
$185.18
|
| Rate for Payer: Cash Price |
$370.36
|
| Rate for Payer: Cofinity Advantage |
$324.06
|
| Rate for Payer: Cofinity Commercial |
$398.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.36
|
| Rate for Payer: Healthscope Commercial |
$416.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$370.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$347.21
|
| Rate for Payer: PHP Commercial |
$393.51
|
| Rate for Payer: Priority Health SBD |
$291.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.92
|
| Rate for Payer: UHC Core |
$241.20
|
| Rate for Payer: UHC Exchange |
$181.94
|
|
|
MINOXIDIL 2.5 MG TABLET
|
Facility
|
IP
|
$462.95
|
|
|
Service Code
|
NDC 00591564201
|
| Hospital Charge Code |
5115
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$291.66 |
| Max. Negotiated Rate |
$416.65 |
| Rate for Payer: Aetna Commercial |
$393.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.92
|
| Rate for Payer: Cash Price |
$370.36
|
| Rate for Payer: Cofinity Advantage |
$324.06
|
| Rate for Payer: Cofinity Commercial |
$398.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.36
|
| Rate for Payer: Healthscope Commercial |
$416.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$347.21
|
| Rate for Payer: PHP Commercial |
$393.51
|
| Rate for Payer: Priority Health SBD |
$291.66
|
|
|
MINOXIDIL 2.5 MG TABLET
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 68084020401
|
| Hospital Charge Code |
5115
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.26 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna Medicare |
$133.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: BCBS Complete |
$107.14
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Advantage |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.10
|
| Rate for Payer: UHC Core |
$139.54
|
| Rate for Payer: UHC Exchange |
$105.26
|
|
|
MINOXIDIL 2.5 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 68084020411
|
| Hospital Charge Code |
5115
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Advantage |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health SBD |
$1.69
|
|
